WQ0002096_Monitoring - 03-2021_20210506

FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of Or
Permit No.: WQ0002096 Facility Name: Pinewood Manor Rest Home County: Hertford Month: March Year: 2021
PPI: 001 Flow Measuring Point: ❑Influent ❑Effluent ❑No flow generated Parameter Monitoring Point: ❑Influent E Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code -► 50050 00400 00310 31616 00530 00610 00625 00630 00665
C t N
cO 0 lc
y E to a a C }
`- E tea„ ; = 0 V O Ta C mi o a ca a) a $ s
m Q E 1- (n o
o. o G) o Q O E Y° b O O-
M O F Li m LL O ~ co fn E Z H N
0 V = Q Z Z t
0.
0 1-
24-hr hrs GPD su mg/L #/100 mL mg/L mg/L mg/L mg/L mg/L
1 10:00 0.5 1,264
2 1,264
3 1,264
4 10:00 0.5 1,264
5 14:00 0.5 1,264
6 1,264
7 1,264
8 1,264
9 1,264
10 13:00 0.5 1,264
11 15:00 0.5 1,264
12 1,264
13 1.264
14 1,264
15 1,264
16 10:00 0.5 1,264
17 1.264
18 1,264
19 1.264 t‘II
20 10:00 0.5 1,264 tom% '
21 15:00 0.5 1,264 t�,��.. cV°6 T
22 1,264
24 1,264
U
25 1,264 t Q, ,NI\ ?
26 10:00 0.5 1,264
27 10:00 0.5 1,264
28 1,264
29 1,264
30 1,264
31 10:00 0.5 1,264
Average: 1,264
Daily Maximum: 1,264
Daily Minimum: 1,264
Sampling Type: Estimate Grab Grab Grab Grab Grab Grab Grab Grab
Monthly Avg. Limit: 7,500
Daily Limit:
Sample Frequency: Continuous 3/year 3/year 3/year 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? ❑' 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: Pinewood Manor Rest Home
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 ❑No Phone N ber: 252-513-8591 Permit Expiration: 4/30/2020
/x720zi
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 D
Permit No.: WQ0002096 I Facility Name: Pinewood Manor Rest Home I County: Hertford Month: March Year: 2021
J 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
Li]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): 31.5 Annual Rate(in): 31.5 Annual Rate(in): 18 Annual Rate(in): 18
Weather Freeboard Field Irrigated? L YES L NO Field Irrigated? 0 YES ❑NO Field Irrigated? [I YES L NO Field Irrigated? L YES L NO
-4-
(1) E c
> U , c 0 to w E m m m >, c E i c E m an d > c 7 0) E 0 m 2 >, c' ' c E e m 8 >, c) c
% @ 1 E i o E �a a E ' �a E >3 PE
a ° >,'a o a F E o o g = o o a F E o o g = o o a i= E o o.- f6 p_ Q J J Q = J J Q _ J Q = J J
1-- a. O
°F in ft ft gal min in in gal min in in gal min in in gal min in in
1 R 64 0.3
2
3
4 C 58 1.83
5 C 48 24,000 240 0.59 0.15
6
7
8
9 _
10 C 68 12,000 120 0.33 0.16
11 C 64 2 12,000 120 0.33 0.16
12
13
14 _ _ .
15
16 R 41 1.2 1.83
17
18
19
20 C 42 30,000 300 0.83 0.17
21 C 60 2 30,000 300 0.63 0.13
22
23
24 -- - - -
25
26 R 70 0.2
27 R 68 0.4 1.75
28
29
30
31 R 78 1.6 1.63
Monthly Loading: 30,000 " ' 0.63 ,n 30,000 0.83 rig , 24,000 ,yy 0 65 r271% 24,000 ' % 0.59
11.45 '', 13.44 ' .. v 13.04 .ii,D ,1 8.23 �H�
12 Month Floating Total(in): ���� y���ya ti� ,

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 ❑Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Q Compliant ❑Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 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:
Pinewood Manor Rest Home
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 0 No Phone Number: 252-513-8591 Permit Exp.: 4/30/20
1 0?/L4-
lov 2//2 22/
J
Signature Date ature 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

,FARM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of 0
Permit No.: WQ0002096 I Facility Name: Pinewood Manor Rest Home I County: Hertford Month: March 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:
YES _ N > Hourly Rate(in): 0.25 Hourly Rate(in): Hourly Rate(in): Hourly Rate(in):
Annual Rate(in): 18 Annual Rate(in): Annual Rate(in): Annual Rate(in):
Weather Freeboard Field Irrigated? `YES ^NO Field Irrigated? 71 YES No Field Irrigated? _ YES ,NO Field Irrigated? Li YES [ NO
c, c
°
ud
° Z pa) -o a a E —' a> Ea a a; o>. a> E a> Fa' .a . 18 > a a a Ea> va> n; >, a a '
a
U 2 a . E . E a a . E a a E a o as o 50 4-, 2. a a f0 .x2 o i— .2) a 2 a .,7Oo6a i= .°> aR , a °E Na J J > < > < J J
d coA
3 ~ "'
°F in ft ft gal min in in gal min in in gal min in in gal min in in
2 -3
4 24,000 240 0.46 0.11
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: 24,000 46Z5 0.46 is%' 0 Ng& 0.00 � 0 ;� � 0.00 � �� 0 0 00
12 Month Floating Total (in) n.r n 10.55 ;, r ''�' z; ;!' y '�i f y

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 E Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� 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? ❑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:
Pinewood Manor Rest Home
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? C Yes 7 No Phone Number: 252-513-8591 Permit Exp.: 4/30/20
)71 /262/
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,tha is 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