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Home My WebLink AboutWQ0002096_Monitoring - 09-2022_20221024 (3)Monitoring Report Submittal Permit Number #* Name of Facility:* Month: * September Report Information WQ0002096 Ahoskie Assisted Living Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address:* Name of Submitter: * Signature: Date of submittal: Initial Review Year:* 2022 Upload Document* AAL_Sept22_NDMR_NDM... 1.01 MB PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). armstrongmgt2@gmail.com Paula G Armstrong Pc fiI,g q AUSPOog 9,VV Reviewer: Gerald, Wanda 10/24/2022 This will be filled in automatically Is the project number correct?* WQ0002096 Is the monitoring report accepted?* Yes No Regional Office* Washington Reviewer: _anonymous Review Date: 11/1/2022 FORM: NDMR 03-12 NOWIDISCHARGE MONITORING REPORT (NDMR) Page _ of Permit No.: WQ0002096 —'—I Facility Name: Ahoskie Assisted Living County: Hertford Month- September Year: 2022 P PI: 001 Flow Measuring Point: El Influent E-] Effluent ❑ No flow generated Parameter Monitoring Point: ❑ Influent E] Effluent El Groundwater Lowering El Surface Water Parameter Code 0, 0000 00310 ':: 31616 0— 00610 00625 00630 ;:'00668,', 1111"",; 50060 :�.7,00046,- 70300 .00fi2D 00600 00615,0 Z E E Esc 0 + CD 4) > 'n (3) M <- F- 4) E .2 0 6 0 LL < F- z 0 N 24-h r hrs su M 61L9 #11oO mL mg1L IL mg/L gC. m IL g mg/L mg/L 1 09:00 05 2 1 Q44 7777 3 . .... . 4 10:00 0.5 61 7 9 10:00 0.5 W 10 11 ,G44 121 10:00 0.5 7.1 <0.1 13 14 16 17 18 19 06:30 2 7 5600 13,2 0.1 3 <0.1 3 80 "'0 23.65 20 21 22 23 -4 24 09:00 0.5 25 26 271 A4 281 29 30 09:00 0.5 31 Average: 5,600.00 �4 0 ".9 13.20 2:15 1 0, 3 ,,,3 0.00 380.00 23 .65 Daily Maximum 7.10 5,600.00 13.20 0,13 1'32(, 0.10 380 .00 Q 23.65 Daily Minimum: 44M 7.00 5,600.00 13.20 0.13 0.10 4.: 380.00 6 23. 5 p 0 Sampling Type : s!Ta e Grab ',Qr0iA1` Grab G ra"b "I", Grab Calculated Grab G b"' Grab alcul Calculated Gra Monthly Avg. Limit: Daily Limit, Sample Frequency: "Tc 3/year 3/year —Weekly f W�, 31year 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? 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 Officials Title: Administrator Has the ORC changed since the previous NDMR? ❑ Yes [f No Phone Number: 252-513-8591 Permit Expiration: 4/30/2025 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-'I) Page of 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? ❑✓ Compliant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? [J 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? El Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Q 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 NDARA? ❑ Yes 0 No Phone Number: 252-513-8591 Permit Exp.: 4/30/25 ibjzqjz� Signature Date Signature Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge. l 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. t 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 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? I] Compliant ❑ Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? 21 Compliant ❑ Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? 21 Compliant ❑ Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 21 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: Ahaskie 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 0 No Phone Number: 252-513-8591 Permit Exp.: 4/30/25 ( V 21YI&O&Z _0 Signature Date Sign Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge. € 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 fries 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 Drinking Water ID; 37715, Z11 0141�'U'111 M( )a111 fDF11111\/E pFic"F11E (2,1,,421f rbb- �62'08 �14,i C, 2785/,,3',' FAX (252j, 7E,,'6-11D(333 THIS IS A CORRECTED COPY OF PREVIOUSLY REPORTED DATA,*** ID#: 377 AHOSKME ASSISTED LIVING 240 SOUTH EARLY STATION RD. AHOSKIE, NC 27910 DATE COLLECTED: 09/19/22 DATE REPORTED 10/3.2/22 REVI EWED, 13"n Effluent Well #4 Well #5 Well #7 Analysis Method PARAMETERS Date Analyst Code BOD, ing/l 33 09/20/22 JMS 521OB-16 Fecal Coliform (TVIF), /100 NUS 5600 <1 > 600 < 1 09119/22 JD,J 9222D-15 Total' Suspended Residue, wng/l 64 09/20/22 BLV 25401145 Ammonia Nitrogen as N, rngJ1 13.20 0.49 0.29 0.05 09121/22 KES 350.1 R2-93 'Total Kjeldahl Nitrogen as N,mg/l 23.52 09/22/22 BMD 351.2 112-93 Nltrate+Nitrite as N, mg/I (ca1c) 0.13 353.2 R2-93 Nitrate Nitrogen as N, rng/I 0.04 < 0.04 <004 < 0.04 09/20/22 BMD 353.2 1t2-93 Nitrite Nitrogen as N, rng/l 0.09 09/20/22 TRJ 353.2 112-93 Total Phosphorus as R, mg(l 3.33 09122122 TRJ 365.4-74 Total Phosphorus as R, ing/l O.69 0.41 09/28/22 BMD 365.4-74 ,rotat Phospliorus as P, mg1l 7.3,8 10/11122 BMD 365,4-74 Total Or Carbon, ing/l TESTED 'TESTED TESTED Cliloride, mg/1 64 33 7 93 09/26/22 BLV 4500CLB-11 Total Dissolved Residue, mg/I 380 270 290 26'O 09/20/22 HMV 115907-13 Total Nitrogen, mg/l (cale) 23.65 N("aTE: Any result hsted above as "'I'l-Siv)-was sub -contracted tar another laboratory, The correspond4ig resu Its ai°c attached, Element One !pc. 6319-0 Carolina Beach Rd. Wilmington, NC 28412 Phone: 910 793-0128 Fax: 910 792-6863 ellab@ellab.com a FINAL, REPORT OF ANALYSES Ann Baynor October 6, 2022 Environment 1, Inc. Element One Project: 39425 PO Box 7085 Client: Ahoslcde Assisted Living Greenville, NC 27858 Project: 377 Sample Matrix DWR/GW Date Analyzed 10/06/22 Date Received 10/05/22 Sample Type Grab Method SM5310B Time Received 1246 Sampled By R. Parker DL, mg/L 1.0 Received by LLB eOne ID Sample ID TOC Rgesult in Dilution Date Sampled Time Sampled 39425-9 Well #4 193 B 09/19/22 0715 39425-10 Well #5 38,0 1 09119/22 0640 39425-11 Well 97 10.5 1 09/19/22 0655 Ken Smith, Laboratory Director 39425 Environment 1 Report Compiled by__.,) NC Certifications: DW 37788 and DWO DENR 604 Page 3 of 7 11 11,� Cj CIV-5,!,lik (-'10V1P1JANCF', REPORTFORAI oa, hSubngil one caleh itllornforin,g period Nvirh (M51V lorws,) Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A) YES - CN be submitted after the established due date? 2 Was any required information missing on the f.�W-59 report forms? YES IF the answer to question I or 2 is "YES", list in the space provided below the well identification number(s) and explain the problems encountered in obtaining the required information. 3 r missing cap, missing Are my of the monitor wells in need of repair or maintenance ('damaged casing, unlocked or/ YES - " ional Office ft)r guidance. identification plate, area overgrown, etc.)? ff 1he ansiver is conlacl Me Reg 4 Are any monitored constituents, equal to or above the established standards? lithe answer to question 4 is "NO", skip to section 8. If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s) exceeding standards in the space provided below: — 11 In VV --ii I -tx> q 3, Vyl 117 7h, For the constituents identified in question 4 above, have standards been exceeded previously for the YES NO same constituent(s) in the same well(s) in the last two years? If the answer to question 5 is "NO', skip to section 8. If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding standa s, concentration(s) reported, and sample collection date for each, occurrence (for the last two years) 19 - 17, ji 1147114 1j)kV--6-T, n TOL, jtll�L�, il � I— , , c, In, - tfi J/L, (Tj W -'-,5 To Co, elzi ry)w-y-7nc14,,,6Fj1, 1#1 U ,J & 6 Are the monitoring wells listed in section 5 located at or beyond the review boundary? VITs— to ........ . ...... If the answer is "YES'", a groundwater quality problem may be occurring. CONTACT THE REGIONAL OFFICE IMMEDIA, TEL Y FOR GUIDANCE, If the answer is "NO", monitoring wells may be improperly located; contact, the Regional Office. 7 Is the permittee implementing previously approved actions required by the Division involving this YES (No/ groundwater quality problem? ...... . . . ......... If the answer to question 7 is "YES" describe those actions in the space provided below. If the answer to question 7 is v6-1 contact the Regional Office within 90 days; an evaluation may be required to determine the impact the, waste disposal sntem is having at the review and compliance boundaries surrounding this tacill Failure to do so may subject the permittee to a Notice of Violation, fines, and/or penalties. 8 The person completing this portion (GW-59A) of the monitoring report should sign below and submit this form with GW-59 forms for required wells to the address provided at the top of the current Glib'-59 form. I hereby acknow,ledgle that the above information was evaluated and the information submitted in this report (Co�l �Ice Report GW-59A) is true and complete to the blest of my knowledge. 0/ 2Y�ZZ SiginatureoNkPer tte4e (6or Aulho,riized _Age Dafe— thorized . .. . ...... . (111,VV-59ik, 12/8/2003