HomeMy WebLinkAboutWQ0024577_Monitoring - 12-2021_20220131Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * December
Report Information
WQ0024577
Sutton's Retirement Center
Year:* 2021
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR WQ0024577 NDAR & NDMR 575.69KB
dec 2021.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * suttonsresthome@bellsouth.net
Name of Submitter: * Kristen Tingen
Signature:
Date of submittal: 1/31/2022
This will be filled in automatically
Initial Review
Reviewer: EADS\wgerald 1
Is the project number correct?* WQ0024577
Is the monitoring report accepted?* YeS No
Regional Office* Washington
Accepted Date: 3/28/2022
FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑✓ Compliant [ Non -Compliant
❑✓ Compliant ❑ Non -Compliant
❑✓ Compliant ❑ Non -Compliant
❑✓ Compliant ❑ Non -Compliant
[I Compliant Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Gary C Sutton
Permittee:
Sutton's Rest Home
Certification No.: 989283
Signing Official: Gary C Sutton
Grade: SI Phone Number: 919-738-2236
Signing Official's Title: Owner
Has the ORC changed since the previous NDAR-1? Yes 1, 1 No
Phone Number: 919-738-2236 Permit Exp.: 1/1/24
V s� (/
1 /30/22
1 /30/22
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Sampling Person(s) Certified Laboratories
Name: Gary C Sutton Name: Environment One
Name: Name.
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? F compliant F_ Non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Gary C Sutton
Permittee: Sutton's Rest Home
Certification No.: 989283
Signing Official: Gary C Sutton
Grade: SI Phone Number: 919-738-2236
Signing Official's Title: Owner
Has the ORC changed since the previous NDMR? J Yes No
Phone Number: 919-738-22336 Permit Expiration: 1/1/2024
ov, ( P
ov, ( P
1 /30/2022
1 /30/2022
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
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