WQ0029653_Monitoring - 02-2023_20230330

Monitoring Report Submittal
...................................................
Permit Number#* WQ0029653
Name of Facility:* SCOTCH HALL PRESERVE WWTP
Month: * February Year: * 2023
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
doc00663020230330094557.pdf 1.43MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Brian Jernigan
cL'J t-44W C,01by-9RN
Reviewer: Wanda.Gerald
3/30/2023
This will be filled in automatically

Is the project number correct?* WQ0029653
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 5/30/2023

FORM: NQAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -of_______

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR.1) Page _ of

FORM: NDAR-1 06-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of

FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment D of your permit?
0 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?
E,]/ Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
Cf Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
n 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 c nged since the previous NDAR-1? ❑ Yes 0 No Phone Number: 336-410-4761 xp.: 2/28/26
Si re Date Signature Date
By t4 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

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of _

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: 11 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 chanW since the previous NDMR? ❑ Yes P1 No Phone Number: 336-410-4761 Permit Expiration: 2/28/2026
Ignatu Date Signature Date
By t s 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