WQ0002096_Monitoring - 12-2021_20220214

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of
Permit No.: WQ0002096 Facility Name: Ahoskie Assisted Living county: Hertford Month: December Year: 2021
PPI: 001 Flow Measuring Point: ❑Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑tnfluent 2 Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code --► 50050 00400 00310 31616 00530 00610 00625 00630 00665 50060 00940 70300 00620 00600 00615
C E U)
> d !Q -0 C �. Y 8 f6 a) a) C
r. 0 E :; 3 p Tao a- ca o a) a) g' m '° -c m2c d @ > 2 C ) '3
N U p fn 0
G m )a) •O FO- a- O E Y 2 'Y .`_, O C2 F N 7.O O , N T, y o O .`.
0' ~ 0 LL U j � E � Z Z Z ~ O QU U NfA Z Z Z
o m to a o a o
0 I-
24-hr hrs GPD su mg/L #/100 mL mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L mg/L
1 10:00 0.5 1,553 6.9 <0.1
2 10:00 0.5 1,553
3 10:00 0.5 1,553
4 1,553
5 1,553
6 1,553
7 1,553
8 1,553
9 1,553
10 10:00 0.5 1,553
11 1,553
12 1,553
13 1,553
14 10:00 0.5 1,553
15 10:00 0.5 1,553 6.9 <0.1
16 10:00 0.5 1,553
17 10:00 0.5 1,553
18 10:00 0.5 1,553
19 15:00 0.5 1,553
20 10:00 0.5 1,553
21 1,553
22 1,553
23 1,553
24 1,553 fG
25 1,553
26 10:00 0.5 1.553
27 1,553
28 1,553
29 1,553
30 1,553
31 1,553
Average: 1,553 0.00
Daily Maximum: 1,553 6.90 0.10
Daily Minimum: 1,553 6.90 0.10
Sampling Type: Estimate Grab Grab Grab Grab Grab Grab Calculated Grab Grab Grab Grab Grab Calculated Grab
Monthly Avg. Limit: 7,500
Daily Limit:
Sample Frequency: Continuous Weekly 3/year 3/year 3/year 3/year 3/year 3/year 3/year Weekly 3/year 3/year 3/year 3/year 3/year

1
FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of •
Sampling Person(s) Certified Laboratories
Name: Randy Parker Name: Environment 1, Inc.
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E 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: Randall Parker Permittee: Ahoskie Assisted Living
Certification No.: 996843 Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153 Signing Official's Title: Administrator
Has the ORC changed since the previous NDMR? ❑Yes 2 No Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
..••••••"/ "*.7::024 CP
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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. NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096 I Facility Name: Ahoskie Assisted Living I County: Hertford Month: December Year: 2021
Field Name: Site1 Field Name: Site 2 Field Name: Site 3 Field Name: Site 4
Did irrigation occur
Area(acres): 1.75 Area(acres): 1.33 Area(acres): 1.35 Area(acres): 1.5
at this facility? Cover Crop: Trees Cover Crop: Trees Cover Crop: Trees/Bermuda Cover Crop: Bermuda
El
YES No Hourly Rate(in): 0.25 Hourly Rate(in): 0.25 Hourly Rate(in): 0.25 Hourly Rate(in): 0.25
Annual Rate(in): 18 Annual Rate(in): 18 Annual Rate(in): 31.5 Annual Rate(in): 31.5
Weather Freeboard Field Irrigated? It YES 7 NO Field Irrigated? 0 YES ❑NO Field Irrigated? [YEs 7 NO Field Irrigated? E YES ❑NO
r. `J
m co c
0 .° m a 4 E ,cu m m >, c) c E m m 2 a c `E E m m 2 >, c 3 ` c m m m >, c � c
O a ii 2 3 . E a� Ti m E 5 a B. E a '@ 5 E m = . E a� •� m E m = a E rn •� w E 3
t a .2 ° > C O a 1- C 0 o •m = p O a R a p 'R = p O a H 0 p � = p O a H •- ° p m = @p
� F 2 CI. N O f0 1 Q J J > Q = J J > Q u- J J > Q .- J E J
N
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 C 51
2 C 49 60,000 600 1.47 0.15
3 C 47 2 42.000 420 1.15 0.16
4
5
i 6
7
8 0.3
9
10 C 48 0.1 1.83
11 0.1
12 0.1
13
14 C 55
15 C 61
16 C 64 30.000 300 0.74 0.15
17 C 69 1.83 24,000 240 0.51 0.13
18 C 67 18,000 180 0.38 0.13
19 CL 61 0.6 30,000 300 0.83 0.17
20 C 46 2
21 0.2
22 0.1
1 23
24
25
26 C 63 2
27
28
29 0.1
30 0.1
31 0.2
Monthly Loading: 42,000 0.88 , j 30,000 u 0.83 42,000 ': 1.15 aim 90,000 ;; 2 21 Wigfai
12 Month Floating Total(in): � ...... 10.85 �,, .. 11.73 11.63 Firz ai77 11.93y .

FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT(NDAR-1) Page of •
Did the application rates exceed the limits in Attachment B of your permit? 0 Compliant ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 0 Compliant ❑Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓ Compliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? 2 Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 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: Randall Parker Permittee:
Ahoskie Assisted Living
Certification No.: 996843 Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153 Signing Official's Title: Administrator
Has the ORC changed sin the previous NDAR-1? ❑Yes No Phone N ber: 252-513-8591 Permit Exp.: 4/30/25
1f3l20ZZ
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

+ORM NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096 I Facility Name: Ahoskie Assisted Living County: Hertford Month: December Year: 2021
Field Name: Site 5 Field Name: Field Name: Field Name:
Did irrigation occur
Area(acres): 1.94 Area(acres): Area(acres): Area(acres):
at this facility? Cover Crop: Bermuda Cover Crop: Cover Crop: Cover Crop:
0 YES ❑NO Hourly Rate(in): 0.25 Hourly Rate(in): Hourly Rate(in): Hourly Rate(in):
Annual Rate(in): 31.5 Annual Rate(in): Annual Rate(in): Annual Rate(in):
Weather Freeboard Field Irrigated? ❑YES ❑NO Field Irrigated? ❑YES ❑NO Field Irrigated? i= YES 7 NO Field Irrigated? _]YES 7 No
,� v m _ m a� Em m � > c g � c � m m )
2 > c E c Em m � >, °c' � ` c Em mm >. E E � E
m - •E E � a E E m - n E � � E
a> a , U o a E ' O m •x O o a i- .� 0 m x O ca O a F •� o m 'X p a E •
01 0 'K o., >. Q C O �p = O C O i3 . 3 O �p = O O R = O
d co f0 a > Q J 2 J > Q J > < _ J J > Q = J J
m F C- o cc
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 60.000 600 1.14 0.11
2
3
4
5
6
7
8
9
10
11
12
13
14
15 60,000 600 1.14 0.11
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading: 120,000 2.28 0 i 0.00 0 ° 0.00 nAkr 0 0.00
12 Month Floating Total(in): ,' 12 08 o�•!a �!s

FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of •
Did the application rates exceed the limits in Attachment B of your permit? Q Compliant E Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 2 Compliant ❑Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Compliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 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: Randall Parker Permittee:
Ahoskie Assisted Living
Certification No.: 996843 Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153 Signing Official's Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑Yes Li No Phone Number: 252-513-8591 Permit Exp.: 4/30/25
"‹,411:0 * (�� �' 113/1202t
Signature Date S 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

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.govlagronomi/ Report No. FY22-SL006709
Z
ti Client: Randy Parker Advisor: Hertford CES-HOUSE
:`;.t Predictive 240 S.Early Station Rd. 301 W Tryon St
/17 .& , 41)! Ahoskie,NC 27910 Winton,NC 27986
t•:
:-1. : Soil Report Mehlich-3 Extraction
Sampled County:Hertford
_
Links to Helpful Information
Client ID: 514301 Advisor ID: 449531
sampt.d:09/27/2021 Received: 10/04/2021 completed: 10/14/2021 Fun:Ahookie Assisted Living
Sample ID: 00001 Recommendations: Lime Nutrients(lb/acre) More
Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information
Lime History: 1-Pine,M 0.0 100-150 30 0 0 0 0 0 Note.11
2- 0.0
Test Results[units-WN in g/cn13;CEC and Na in meq/100 cm3;NO3-N in mg/dm;]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-I NO3-N
0.66 0.93 6.7 69 2.1 5.2 24 72 44 19 54 138 116 116 38 0.3 4
Sample ID: 00002 Recommendations: Lime Nutrients(Ib/acre) More
Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information
Lime History: 1-Pine,M 0.0 100-150 30 0 0 0 $ 0 Note:11
2- 0.0
Test Results[units-WN in g/crtt;;CEC and Na in meq/100 cm3;NO3-N in mg/dm;]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-I NO3-N
0.60 0.94 5.7 70 1.7 5.4 21 73 47 16 42 87 101 101 25 0.4 7
North Carolina4,,,,,
Reprogramming of the laboratory-information-management system that makes this report possible is being funded
•
through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
Steve Troxler. Commissioner of Agriculture
l„tmen.Trust I ud Gurnn ism n

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronoml/ Report No. FY22-SL006709
R&ndy Parker Page 2 of 3
Sample ID: 00003 Recommendations: Lime Nutrients(Ib/acre) More
Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information
Lime History: 1-Bermuda hay/past.,M 0.8 180-220 90 160 0 0 0 0 0 0 Note-12
2- 0.0
Test Results[units-WN In g/cm3;CEC and Na in meq/100 cm3;NO3-N in mg/dm']: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-I K4 Ca% Mg% S-I Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-I NO3-N
0.60 1.05 6.0 74 1.6 5.4 22 32 53 19 41 66 57 133 133 49 0.2 3
Sample ID: 00004 Recommendations: Lime Nutrients(lb/acre) More
Crop (tons/acre) N P2Os K20 Mg S Mn Zn Cu B Information
Lime History: 1-Bermuda hay/past.,M 1.2 180-220 50 80 0 0 0 0 0 0 Note:12
2- 0.0
Test Results[units-WN In g/cm3;CEC and Na in meq/100 cm';NO3-N in mg/dm']: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn-I Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-I NO3-N
0.81 0.97 6.6 70 2.0 5.1 36 64 45 20 56 115 86 98 98 42 0.3 5
Sample ID: 00005 Recommendations: Lime Nutrients(Ib/acre) More
Crop (tons/acre) N P205 K20 Mg S Mn Zn Cu B Information
Lime History: 1-Bermuda hay/past.,M 1.3 180-220 90 140 0 0 0 0 0 0 Note: 12
2- 0.0
Test Results[units-WN in g/crrr3;CEC and Na In meq/100 cm3;NO3-N in mg/dm;]: Soil Class: Mineral
HM% WN CEC BS% Ac pH P-I K-I Ca% Mg% S-I Mn4 Mn-All Mn-Al2 Zn-I Zn-Al Cu-I Na ESP SS-I NO3-N
0.71 0.90 5.6 62 2.1 5.0 22 37 40 19 48 185 128 70 70 97 0.2 4

NCDA&CS Agronomic Division Phone: [phone] Website: www.ncagr.gov/agronomil Report No. FY22-SL006709 ,
RLndy Parker Page 3 of 3
Understanding the Soil Report:explanation of measurements,abbreviations and units
Recommendations Report Abbreviations
Lime Ac exchangeable acidity
If testing finds that soil pH is too low for the crop(s)indicated.a lime recommendation will be given in units of either B boron
ton/acre or lb/1000 sq ft.For best results,mix the lime into the top 6 to 8 inches of soil several months before planting. BS% %CEC occupied by basic cations
For no-till or established plantings where this is not possible.apply no more than 1 to 1.5 ton/acre(50 lb/1000 sq ft)at onO Ca% %CEC occupied by calcium
time.even if the report recommends more.You can apply the rest in similar increments every six months until the full rate CEC cation exchange capacity
is applied.If MG is recommended and lime is needed,use dolomitric lime. Cu-1 copper index
ESP exchangeable sodium percent
Fertilizer HM/ percent humic matter
Recommendations for field crops or other large areas are listed separately for each nutrient to be added(in units of K-i potassium index
lb/acre unless otherwise specified).Recommendations for N(and sometimes for B)are based on research/field studies K20 potash
for the crop being grown,not on soil test results.K-I and P-I values are based on test results and should be>50.If they Mg% %CEC occupied by magnesium
are not,follow the fertilizer recommendations given.If Mg is needed and no lime is recommended.0-0-22(11.5%Mg)is MIN mineral soil class
an excellent source:175 to 250 lb per acre alone or in a fertilizer blend will usually satisfy crop needs,SS-I levels appear Mn manganese
only on reports for greenhouse soil or problem samples. Mn-All Mn-availability index for crop 1
Mn-Ai2 Mn-availability index for crop 2
Mn-I manganese index
Farmers and other commercial producers should pay special attention to micronutrient levels.If S.pHS.SpH, C or Z M-0 mineral-organic soil class
notations appear on the soil report.refer to SNote Secondary Nutnents and Micronutnents In general,homeowners do not N nitrogen
need to be concerned about micronutrients.Various crop notes also address lime fertilizer needs:visit Na sodium
ncagr.gov/agronomi/pubs.htm
NO3-N nitrate nitrogen
ORG organic soil class
Recommendations for small areas,such as home lawns/gardens,are listed in units of lb/1000 sq ft.If you cannot find pH current soil pH
the exact fertilizer grade recommended on the report.visit vww.ncagcgov/aaronomi/obaarta.ht nd information that P-I phosphorus index
may help you choose a comparable alternate.For more information,read A Homeown is uide to Fertilizer P20s phosphate
S-I sulfur index
Test Results SS-I soluble salt index
W/V weight per volume
Zn-AI zinc availabilityindex
The first seven values[soil class,HM%.W/V.CEC.BS%,Ac and pH]describe the soil and its degree of acidity.The Zn-i zinc index
remaining 16(P-I,K-I,Ca%,Mg%,Mn-I,Mn-All.Mn-Al2,Zn-I.Zn-Al,Cu-I,S-I,SS-I,Na,ESP,SS-I,NO3-N(not routinetj
www.ncagr.gov/agronom✓uvrsf.htm
available)]indicate levels of plant nutrients or other fertility measurement.Visit