WQ0029653_Monitoring - 12-2022_20230124 (2)

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: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0029653
Facility Name: Scotch Hall Preserve WWTP
County: Bertie
Month: December
I a rein. a 171
Parameter Monitoring Point: Influent Effluent Groundwater Lowering surface Wdt#r
'Parameter Code
•
•
•
Daily Ma)Cimum:,
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of 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: 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 0 No
Phone Number: 336-410-4761 Permit Expiration: 2/28/2026
0
Si Date
/thisture,
Signature Date
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