WQ0029653_Monitoring - 12-2022_20230124

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * December
Report Information
WQ0029653
Scotch Hall Preserve WWTP
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
[e-mail]
Brian Jernigan
Year:* 2022
Upload Document*
n d a r005757202301201139... 2.49 M B
PDF Only
n d m r005756202 301201136 ... 1.09 M B
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-7, NDAR-2, NDMLR, GW-59).
1 /24/2023
This will be filled in automatically

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0029653
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 2/14/2023

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: 1111 •.
•
:-
December
1
• irrigation occur
at this facility?
■ YES NO
Field
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.Annual
Rate (in):
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page
Permit No.: 1111 •.53
Facility Name: Scotch Hall PreserveBertie
.
December1

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: 1111 •.53
Facility Name: Scotch Hall Preserve.
. December
Did irrigation occur
at this facility?
F-1 YES 71 NO
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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?
❑� 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?
2 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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: 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 F�] No
Phone Number: 336-410-4761 Permit Exp.: 2/28/26
-- - 9
Signature Date
ature Date
Byzssign!a2ure, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, 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 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