WQ0029653_Monitoring - 05-2023_20230628

Monitoring Report Submittal
Permit Number#* WQ0029653
Name of Facility:* SCOTCH HALL PRESERVE WWTP
Month: * May Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR doc00786120230628124646.pdf 1.93MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Brian Jernigan
Signature:
ff a r ostw4P"
Date of submittal: 6/28/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00029653
Is the monitoring report accepted?* Yes NO
Regional Office* Washington
Reviewer: _anonymous
Review Date: 7/14/2023

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

FORM:
O .*. R 1 r.REPORT
Page - of
Certified Laboratories
Name: !! name:
Name: Nam®:
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. _
Operator In Responsible Charge (ORC) Certification
ORC: SRIAN JERNIGAN
Certification No.: SI 1006435
Grade: phone Number: 262-325-0771
Has the ORC changed since the previous NDMR7 ❑ Yes Q No
permittee: SCOTCH HALL PRESERVE WWTP
Signing Official: MIKE PARAH
Signing Official's Title: GE_NE?PT-MAlVK6'ER
Phone Number: 0,'.Expiration:
Igna gate Ignature Date
By thl gnature, 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: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page - of

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

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

NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Did the application rates exceed the limits in Attachment B of your permit?
E compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent poning in or runoff from the sites?
0 compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
2 Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
P1 Compliant
® Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
El 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: SRIAN 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 jahanged since the previous NDAR-1? ❑ Yes 0 No Phone Number: 336-410-4761 N �d• �t'er xp.: 2/28126
Si Date Signature Date
PBY7thstgn�ature, 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. 1 am aware that there are significant
penalties for submitting false information, Including the possibility of tines 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