WQ0029653_Monitoring - 07-2022_20220907 (2)

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0029653
Facility Name: Scotch Hall Preserve WWTP
County: Berfie
Month: July
Flow Measuring Point: 71 influent Effluent D No flow generated
Parameter Monitoring Point: E] influent Effluent [] Groundwater Lowering Surface Water
Parameter Code __P
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: TOM BEASLEY Name: ENVIRONMENTAL CHEMISTS, 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.
BOD is h
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: BRIAN JERNIGAN
Permittee: SCOTCH HALL PRESERVE WWTP
Certification No.: SI 1006435
Signing Official: MIKE PARAH
Grade: Phone Number: 252-325-0771
Signing Official's Title: GENERAL MANAGER
Has the ORC changed since the previous NDMR? Yes No
Phone Number: 336-410-4761 Permit Expiration: 2/28/2026
ature 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

FOW. NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: WQ0029653 'Facility
Name: Scotch Hall Preserve WWTP
County:Bertie
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FOW NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
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FONM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0029653
Facility Name: Scotch Hall Preserve WWTP
County: Bertie
Month: July
Did irrigation
occur
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at this facility?
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0 FORM: NDAR-1 05-16 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? ❑� Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q 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: BRIAN JERNIGAN Permittee:
SCOTCH HALL PRESERVE WWTP
Certification No.: SI 1006435 Signing Official: MIKE PARAH
Grade: Phone Number: 252-325-0771 Signing Official's Title: GENERAL MANAGER
Has the ORC changed since the previous NDAR-1? ❑ Yes 2] No Phone Number: 336-410-4761 erm' Exp.: 2/28/26
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