WQ0004230_Monitoring - 11-2022_20221227

Monitoring Report Submittal
Permit Number #* WQ0004230
Name of Facility:* A Place at the Beach III Homeowners Association Inc.
Month: * November Year: * 2022
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
November 2022 NDAR 2.08MB
NDMR report
WQ0004230.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Victor Perez
12/27/2022
This will be filled in automatically

Reviewer:
Gerald, Wanda
Is the project number correct?*
WQ0004230
Is the monitoring report accepted?*
Yes NO
Regional Office*
Wilmington
Reviewer: _anonymous
Review Date: 1/17/2023

Did the application rates exceed the limits in Attachment B of your permit?
c;rpi" E] n-cc�mc
If not a basin, were the sites kept free of vegetation and raked? EK-=*,-t El Non -compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites?
E] tdan-rcxrtplla#rt
If a basin, were there any instances of breakout from the berms?
Was the onsite automatically activated standby power source tested and operational?DRavianit
ElN
If the facility is non -compliant, ease 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 toRc) certification
Certffication No.: / 0b Li 1q
Grade: 3 Phone Number
Has the ORC changed since the previous NDAR 2? ❑ Yes
aQ-;t3-:2
Signature bate
By ttds signature, t =*#Wffft report is accurtate andwmplettth, best ar mw knowledge.
Fermi tee Cerocattion
Pennifte` u . c _ -
Signing official:
Signing Officlal s Trge: t i"
Phone Number:
Permit Exp. r :4 i�
Signature — I r
Date
i cae". under penalty of law, itrat this document and aft attachments were prepared under my drection or supervision in accordance
with a system designed to assure chat act quaned personnel properly gattwed and evacuated the irdbrMation submitted. Based on
in ry of ft per or perms who manage my
syshsnr, or those persons �' 195POW1113te for gatering the information, the
infturnaWn submitted is, to the best of my knowledge and beitef, trite, accurate, and complete. t am aware that two are significant
penalties for subm i fatse infOrmatiorl, MudirIg the prss"Ity Of MM and Imprisonment for krim
Mail Original and Two Copies to:
Division of Water Resources
irefomnation Processing Unit
1617 Mail Service Center
Raleeigh, North Carolina 27699-1617

ii _.� st!. a __

Sampling Person($)
Name: k 'Mer-
Nam:
[r E
Certified Laboratories
Does all monitoring data and sampling frequencies rust the requirements in Attachment A of your permit? t nit 0 6dlt-Comoant
If the facility is Kant, 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) Cantification Permittee Certification
Certification No.: tj-7ujje P WIZ,
Signing Official:
Grade- Phone Number. Q 9 va ;3 LI a 1 Signing Official's Title: b'
Has the ORC changed sincethe previous N3At7 Y.
EAw
� .
Phone Number: @ 7 . ''` -- Permit Upiratiion:
E� �r
r
Signature date i
Styn re Date .
ByMISsignature, I raythat tli'B report Is acmr af° and GOMPlate to the best of my knaiviedge. I certify, under penalty of taw, tills document and all attachments were prepared under my direction or Supervisjori in
accordance with a system designed to assure do all qualified personnel property gathered and evaluated the inforrrradcrr
submitted. Based an my inquiry of the person or persons why manage the system, or those persolis directly, responsible for
gattwing the inforrmedcxa, the info nation submitted is, to lim bast of my knowledge and belief, tore, accurate, and cwVlota. I am
aware Mat these are significant penahm for submit" tam Information, kuaxfrng tha possibihity of fines and irroso rment for
knuMng vktafirms.
Mail Original and Two Copies to
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994617