WQ0002096_Monitoring - 04-2022_20220524

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of
Permit No.: WQ0002096 Facility Name: Ahoskie Assisted Living County: Hertford Month: April Year: 2022
PPI: 001 Flow Measuring Point: ❑Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑Influent ❑Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code —► 50050 00400 00310 31616 00530 00610 00625 00630 00665 50060 00940 70300 00620 00600 00615
C
a+ CWs 0 E G + te
j
+. Cd N a)
3 O N C 73
p p } C 'O O d Cf a) tp � O : '6C C a 'a .- a O
f
._'`RQ Na; O = V _ O 2E 2 , QO
p ~ FUf LL Q 0
d 0 00
LL O I— w o E l Z J Z z H O O N _O1- N N Z 1- 4-, 2
a cc U U o Z
O ec
o
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
1 668
2 668
3 668
4 10:00 0.5 668
5 668
6 668
7 668
8 668
9 668
10 668
11 10:00 0.5 668 7 2
12 668
13 668
14 668
15 668
16 668
17 668
18 10:00 0.5 668 r 4 i.g.,
z1
19 668
20 668 2 12-
21 668
22 10:00 0.5 668
23 668
24 668
25 668
26 668
27 10:00 0.5 668
28 668
29 668
30 10:00 0.5 668
31
Average: 668 2.00
Daily Maximum: 668 7.00 2.00
Daily Minimum: 668 7.00 2.00
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

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? 2 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 E No Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
6.5—>,(4/r_glizb
5/0/2-60Z_
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
—PermitNo.: WQ0002096 Facility Name: Ahoskie Assisted Living I County: Hertford Month: April Year: 2022
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
n YES C 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? ❑' YES ❑NO Field Irrigated? ❑YES 0 NO Field Irrigated? YES C:NO Field Irrigated? ❑YES NO
a, m c
o «° R c CD w Em mm >, c = icy £ m a) 0 >. = 3 ` c £ m a> m > _ mac 0 mm ac 3 c
m g v 3 E@ n E '5 '8 E m =o E 3 E -0 E . a E m ca 2 -o
o L E '3 ° a s o a i= •c o o g = o 0 a i= •a' o o cxa 2 0 o a F •c o o 2 0 ° a H ', o o g 2 0
j� ` fn 0@ Q J r2 J Q J J Q J J Q = J J
~ a b
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1
2
3
4 C 60 1.75
5
6
7 0.5
8
9
10
11 C 72 2.08 48,000 480 1.01 0.13
12
13
14
15
16
17
18 R 50 0.61 2
19
20
21
22 C 72 1.91
23
24
25
26
27 C 64 1.83
28
29
30 CL 67 1.83
31
Monthly Loading: 48,000 ' 1.01 0 7 0.00 a 0r4, 0.00 0 0.00
12 Month Floating Total(in): 7.57 ! ,,; 6.24 " 7.86 11.20 r 7 �!0

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? 2 Compliant ❑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? E Compliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? E Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2 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 Officials Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑Yes 0 No Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Vig/?OZZ.--
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 ` Facility Name: Ahoskie Assisted Living 1 County: Hertford Month: April Year: 2022
Field Name: Site 5 Field Name: Field Name: Field Name:
Did irrigation occur
Area(acres): 1.94 Area(acres): Area(acres): Area(acres):
Ihis facility? Cover Crop: Bermuda Cover Crop: Cover Crop: Cover Crop:
5 ❑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? ❑YES ❑NO Field Irrigated? ❑YES ❑NO
.-
CD c
> ° ccs :° m a0 E . a) w > c sic E . a> m >E a ` c E . m � Tc 3 ` E E . aim Tc c ` c
o a B. o 2 a E c 0 E 0 m a E rn m@ E 0 m a E as .m m >_ 0 5 a E as •� m x a m
-0 E ` U) 10 a > < ~ J 2 = J 1 Q ~ J 2 = J > Q ~ i Co 2 _ J > Q ~ _ J i = J
a) F- a 0 _ __ _
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1
2
3
_4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading: 0 0.00 0 0 00 ' 0 0 00 y 0 / 0A0
12 Month Floating Total(in): , , 12.41 /

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? 2 Compliant ❑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? 2 Compliant ❑Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? E Compliant ❑Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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 NDAR-1? ❑Yes LI No Phone Number: 252-513-8591 Permit Exp.: 4/30/25
EbE/7v2C—
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