WQ0000948_Monitoring - 07-2022_20220808

QRM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of
Permit No, - WQ0000948
Facility Name: Town of Jackson WWTF
County: Northampton
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JWRM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page / of
r �- Sampling Person(s) Certified Laboratories
Name: JohwgJJ U4Ns Name: &NlllRoh[yr�, gt
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? O comioant compuanc
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.
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Operator In Responsible Charge (ORC) Certification
Permittee Certification
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ORC: do(XNj JOIJ J
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Permittee: lOWK o.� 7 Lt. ,eOA(
Certification No.: 2,3 /0),9
Signing Official: aqeI ' k. �Yux
Grade: I (; o lVt 60A( phone Number: . �3 �' g/
Signing Officiars Title: ka J oR
Has the ORC changed since the previous NDMR? ❑ Yes No
Phone Number: 4 54 - 5,3 4-- 3 8/i Permit Expiration: 4 - o - 4-
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S nature Date
Signature Date
By this signature, Ify that this report Is accurrate and complete to the best of my knowledge.
I certify, under penalty of law, tiet this document and all attachments were prepared under my direction or supervision In
accordance with a system designed to assure that all qualified personnel property gathered and evaluated the information
submitted. Based on my Inquiry of the parson or persons who nonage the system, or those persons dhectly responsible for
gathering the Information, the Warnatlon submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am
aware that there are significant penalties for submitting false information, including the possibfy of fines and Imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699.1617

FORM: NDAR-1 05-lF NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page —J— of Z
Permit No.: VVQ0000948
Facility Name: Town of Jackson WWTF
County: Northampton
Did irrigation occur
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-FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _'), of oZ
Permit No,: WQ0000948
Facility Name: Town ol Jackson WWTF
County: Northampton
Did irrigation
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I-VKlul: NUHK-1 Ud-71 WON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of �
Did the application rates enceed the, l'Imits M 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 sides as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
aCompliant
❑ Non -Compliant
12'6ompfiant
❑ Non -Compliant
LJ Compliant
❑ Non -Compliant
[3-Compllant
❑ Non -Compliant
Were a88 freeboards maintained in accordance with the specified freeboard heights in your permit? Oompliant ❑ Nan-Compgant
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
actions) taken. Attach additional sheets if necessarv.
Operator In Responsible Charge (ORC) Certification II Permittee Certification
ORC: Sp)wN9 yo wq J
Certification No.: a.3/-t9'
Grade: i' (�r011'ecbvN phone Number: J-q,2-534-38)1
Has the ORC changed since the previous NDAR-1? ❑ Yes I No
n
a 6-oz 21i-
ySigniiture — Date
By this signature, I certify that this report Is accurrale and complete to the best of my knowledge.
Permittee: I o1 J q ©•�
Signing Official: Tcihte5 �Yt• ��
Signing Official's Title: 'KeRtsoll
Phone Number: a 5.2- 53 4 - 3,Y11 Permit Exp.:
*-_7_`2 P Z_
Signature Date
I corlify, under penally 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 galhedng 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617