WQ0002005_Monitoring - 06-2023_20230726

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month:* June
WQ0002005
House of Raeford Rosehill
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Reviewer:
Year:* 2023
Upload Document*
NDMR, NDAR-1, NDMLR June 2023.pdf 1.24MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Mason. [e-mail]
Mason Drew
44,460dP)LOW
Wanda.Gerald
7/26/2023
This will be filled in automatically

Is the project number correct?* W00002005
Is the monitoring report accepted?* Yes NO
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 7/26/2023

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _L_ of
Permit No.: W00002005
Fac04 Name: }louse of Raeford Farms, Inc.
County: Duplin
Month: June
Year: 2023
Field Name:
L1
Field Now
L2
Field Nance:
L3
Field Name:
L4
Field Name:
L5
Area (acres):
12.04
Area (acres):
1204
Area (acres):
12.04
Area (acres}:
12.04
Area (acres):
10.52
Cover Crop:
Cover Crop:
Cover Crop:
Corer Crop:
Cower Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Tree:
PAN
Load Type:
PAN
Field Loaded?
p YES ❑ NO
Field Loaded?
O YE5 ❑ No
Field Loaded?
YEs ❑ NO
FkM Loaded?
[) YES No
Field Loaded?
❑ YES mo
�y
p
ILLO.
t
4
a
R
_j
m y
z
tQ
t
1!.
t
<
d
I5F�a
ti
a
z
4
t
z
rl
m
Z
U
<
d
z
=
z
�
m
d
O
y^'aa
o
a
a
m
tt
Month
gal
mglL
ibs/ac
Ibslac
Rtfac
lbafae
gal
mqtL
lbs/ac
lbslac
gW
mpt
lbetac
(bs/ac
gal
L
lbslac
1bslac
January
487,800
39.6
13.4
13.4
944,100
39.6
25.9
25.9
479,700
39.6
13.2
13.2
719,100
39.6
19.7
19.7
477,000
39.6
15.0
15.0
February
648,000
29.35
13.2
26.6
350,100
29,35
7.1
33.0
352,800
29.35
7.2
20.3
171,000
29.35
3.5
23.2
688,700
29.35
16.0
31.0
March
438.500
30.35
9.2
35.7
073,200
30.35
14.2
47.2
630,000
30.35
13.2
33.6
546,3W
30.35
11.5
34.7
472,500
30.35
11.4
42.4
April
544,500
34.45
13.0
48.7
929,700
34.45
22.2
69.4
369,000
34.45
8.8
42.4
531,000
34.45
12.7
47.4
578,700
34.45
15.8
58.2
May
747,000
29.6
15.3
64.0
W3,100
29.6
14.0
83.4
469,800
29.6
9.6
52.0
468,000
29.6
10.0
57.3
477,000
29.6
11.2
69.4
June
521,100
26.8
9.7
73.7
486,100
26.8
9.0
92.4
639,006
26.8
11.9
63.9
414,9W
26.8
7.7
65.0
512,100
26.8
10.9
80.2
July
554,400
16.25
6.2
80.0
706,500
16.25
8.0
100.3
675,900
16.25
7.6
71.5
849,6W
16.25
9.6
74.8
939,600
16.25
12.1
92.4
A ust
630,000
36.65
16.0
95.9
577,800
36.65
14.7
115.0
432,000
36.65
11.0
62.5
517,560
36.65
13.1
87.7
270,000
36.65
7.8
100.2
Sapkrnber
546,300
18.45
7.0
102.9
522,900
18.45
6.7
121.7
539,100
18.45
6.9
89.3
539,100
18,45
6.9
94.6
492,300
18.45
7.2
107.4
October
594,900
23.5
9.7
112.6
63Q9W
23.5
10.3
131.9
513,000
23.5
8.4
97.7
516,400
23.5
8.4
103.1
489,600
23.5
9.1
116.5
November
674,100
26.5
12.4
125.0
707,400
26.5
13.0 1
144.9
626,400
26.5
11.5
109.2
441,000
26.5
8.1
111.1
154,800
26.5
3.3
119.8
December 571,500 33.15
12 Month Floating PAN Load
RW r):
Annual PAN Load Limit
L__ lbs! r '
13.1
138.1
300M
138.1 228,000 33A5 5.2 1
150.2
300.00
15021 266,400
33.15
6.1
115.3
300.00
115.3
453800 1
33.15
10:4 1
121.E
300.00
121.61
411,3000
33.15
10.8
130.6
300.00
130.E

FOW NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page Z of
Permd No.: W00002005
Facility Name: House of Raeford Farms, Inc.
County: Duphn
Month: June
Year: 2023
Field Name:
L6
FIeM Na"W.
L7
Field Name:
L8
FiWd irons:
L9
Field Name:
L10
Area (acres):
8.66
Anal (acres):
12.04
Area (acres):
12.04
Area lumen}:
12.04
Ara* (acres):
10.62
Cover Crop:
Cow Crop:
Cover Crop:
Cevw Crop:
Cover Crop:
Load Type:
PAN
load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑ YES 0 No
FlMd Loffided?l
❑ YES No
Field Loaded?
0 YES ❑ No
FhM Lorded?
[] YES ❑ do
Field Loaded?
❑ YES 0 No
E'z
a
9
1
a
a
f
f
;Q
�°
a
o.
s
�m
as
a
a
'z
8a
�rz
Month
gal
m L
lbalac
ibsisc
9W
mgk
ibelaC
wwac
gal
moll.
Ibelac
tbslac
am
mgfL
Iba/ac
Ibdac
gW
rnWL
lbs/ac
lbslsc
January
287,100
39.6
10.9
10.9
866,T00
39.6
23.8
23.8
984,600
39.6
27.0
27.0
M,500
39.6
21.4
21.4
419,790
39.6
15.1
15.1
February
671,400
29.35
19.0
29.9
W6,100
29.35
11.5
35.3
509,400
29.35
10.4
37.4
667,80Q
29.35
13.6
34.9
356,400
29.35
8.3
23.4
March
306,100
30.35
8.9
38.8
U4,0W
30.35
10.6
45.9
741,600
30.35
15.6
53.0
634,500
30.35
13.3
48.3
604,800
30.35
14.6
37.9
April
308,700
34.45
13.2
52.1
822,6W
34.45
19.8
65.5
565,200
34.45
13.5
66.4
356,5Q0
34.45
8.5
58.8
742,500
34.45
20.3
56.2
May
314,100
1 31.4
9-5
61.6
7W,2W
31.4
17.2
82.7
U 768,600
31.4
1 16.7
83.2
698,500
31.4
13.0
69.8
319,500
31.4
8.0
66.1
June
345,600
26.8
8.9
70.5
591,300
26.8
11.0
93.7
493,200
26.8
9.2
92.3
266,40Q
26.8
4.9
74.7
880,200
26.8
18.7
84.8
July
780,300
16.25
12.2
82.7
W1,100
16.25
10.7
104.4
664,200
16-25
7.5
99.8
524,700
16,25
5.9
80,6
0
16.25
0.0
84.8
August
479,800
36.65
16.9
99.6
6%,400
36.65
14.1
118.5
501,300
36.65
12.7
112.5
691,200
36.65
17.5
982
459,900
36.66
13.4
98.2
September
525,600
18.45
9.3
109.0
500,400 1
18.45
6.4
124.9
348,300
18.45
4.5
117.0
351,000
18.46
4.5
102.7
254,700
18.45
3.7
101.9
October
309,600
23.5
7.0
116.0
S53,50o
1 23.5
9.0
133.9
229,500
23.5
3.7
120.7
$39,900
23.5
VA
113.1
622,800
23.5
11.6
113.5
November
653,400
26.5
16.7
132.7
eW,800
26.5
12.1
146.0
534,600
26.5
9.8
130.5
655,200
26.5
12.0
125.1
423,k1i
December 0 33.15
Month Floating PAN Load...1t34.8 (lbslaclyr):Annual PAN Load Urnit
Ibat r):
0.0
132.7 Q 33A5 0.0
f46.0
287,100
33.15
6.6
300.00
137.1
415,800
33.15
9.6
300.00
134.6
242,12

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page .3- of
Permit No.: W00002005
Faculty Name: House of Raeford Farms, Inc.
County: Duplin
Month: June
Year. 2023
Field Name:
CP4
Field Name:
5A
Field Name:
5AA
Fold Nam:
5B
Field Name:
6A
Area {scree):
23
At" (acres):
6.9
Area (acres):
5,5
Area (scree):
8.9
Area (acres):
16.02
Corer Crop:
Covet Crop:
Cover Crop:
C~ Croix
Cover Crop.
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
E YES ❑ No
Field Loaded?
❑ ve5 p No
Field Loaded?
❑ YES ❑ No
I'lleld Loaded?
❑ YES ❑ No
FleM Loaded?
0 YES ❑ No
o.
G
O
1
C
0
a
n�
j
<
a
a
,-j
J
7<
<
6
=
E
Z
<
U
Month
1
L
Ibslac
anift
go
fnu&
#Woe
Ibalac
pal
m
Ibslac
Ibs/ac
go
moti.
f wiac
"I"
nt
Ibslac
IbW&c
January
1,117,800
39.6
16.1
16.1
8�,714
39.6
30.1
30.1
0
39.6
0.0
0.0
889,053
39.6
42.6
42.6 11
582,483
39.6
12.0
12.0
February
2,103,300
29.35
22.4
38.4
697,783
29,35
24.8
54.9
0
29,35
0.0
0.0
548,911
29.35
19.4
82.0
358,321
29.35
5.5
17.5
March
1,511,100
30.35
16.6
55.1
618,714
30.35
22.7
77.5
0
30.35
0.0
0.0
484,938
30.35
17.8
79.7
317,718
30.35
5.0
22.5
April
2,682,900
34.45
33.5
88.8
761,913
34.45
31.7
109.3
0
34.45
0.0
0.0
404,515
34.45
16.8
96.6
370,671
34.45
6.6
29.2
Wy
1,748,700
29.6
18.8
107.3
711,610
29.6
25.5
134.7
0
29.6
0.0
0.0
557,070
29.6
20.0
116,5
360,370
29.6
5.6
34.7
June
3,208,500
26.8
31.2
138.5
596,366
26.8
19.3
154.0
0
26.8
0.0
0.0
499,757
26.8
10.2
132.7
306,242
26.8
4.3
39.0
July
2,340,900
16.25
13.8
152.3
874,754
16.25
17.2
171.2
0
16.25
0.0
0.0
685,6/8
16.25
13.5
146.2
449,198
16.25
3.8
42.8
August
21136,600
36.65
28.4
180.7
481,222
36.65
21.3
192.6
0
38.65
0.0
0.0
377,174
36.65
18.7
162.9
247,114
36.65
4.7
47.5
September
21130,300
18.45
14.3
195.0
W2,707
18.45
14.8
2071
0
18.45
0.0
0.0
519,419
118.45
1 11.6
1 174.5
340,309
1 18.45
3.3
50.8
OCtober
2,907,900
23.5
24,8
219.7
710,474
23.5
20.2
227.5
0
23.5
0.0
0.0
556,8W
23.5
15.8
190.3
364,838
23.5
4.5
55.2
November
2,097,000
26.5
20.2
239.9
0
28.5
0.0
227.5
0
26.5
0.0
0.0
727,407
28.5
23.3
213.8
476,577
26.5
6.6
81.8
December 2,226,600 33.15
26.8
266.7 0 33.15 0.0 1
227.51 0
1 33.15
0.0
0.0
727407 33.15
29.1 1
242.71 476577
33,15 8.2
70.0
12 Month Floating PAN Load
(Ibsfa r
266.7
227.5
0 0
2427
70.0
Annual PAN Load Limit
(lbs/a r
300
300.00
300.Q0
300.00
300.00

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page 1 _ of
Permit No.: W00002005
Facility Name: House of Raeford Farms, Inc.
County: Duplin
Month: June
Year: 2023
Field Name:
6B
FieM Name:
Field Name:
Field Name:
Field Name:
Area (acres):
6.7
Area (sans):
Area lease):
Area (acresp
Area (acres):
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crap:
Cover Crop:
Load Type:
PAN
Load Type:
Load Type:
Load Type:
Load Type:
Field Loaded?
Q YEs ❑ No
Fls&f Loaded?
❑ YES ❑ No
Field Loaded?
❑ YEs ❑ NO
Flom Loaded?
Q YEs ❑ No
Field loaded?
❑ YES ❑ NO
>
0
A
y► 9
J
CL
>
<
CL
a
c
>
U
>
J
a
>
4
�
ci
Month
gal
F"91L
IlWac
tbslac
m
HxL%c
lbelac
gal
mgtL
lbalac
lbslac
gal
mak
UWac
UWac
gal
IbWac
January
613,140
39.6
30.2
30.2
_TOILIbslac
Februa
377,180
29.35
13.8
44.0
March
334,440
30.35
12.6
56.6
Aprii
390,180
34.45
16.7
73.4
May
384,600
29.6
14.2
87,5
June
322,360
26.8
10.8
98.3
July
472,840
16.25
9.6
107.9
August
260,120
36.65
11.9
119.7
September
358,220
18.45
8.2
128.0
October
384,040
23.5
11.2
139.2
November
501,660
26.5
16.5
155.7
December 501,660 33,15
12 Month Floating PAN Load
(It)ala r):
Annual PAN Load Limit
(lbalaclyr):
20.7 1
176.4
300
176.4
0.0
0.0
0.0
0.0
i

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _� of 3
Did the mass loading rates exceed the limits in Attachment B of your permit? L_,] compliant L� 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
actionlsl taken Attach additional sheets if nerpssary
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Joseph Teachey Permittee:
House of Raeford
Certification Number: 14930 Signing Official:
Nicole Reynolds
Grade: SI Phone Number: [phone] Signing Official's Title: Plant Manager
Has the ORC changed since the previous NDMLR? F -] yes [i No Phone No.: [phone] Permit Exp.: 10/31/23
i�
Signature r
By this signature. I certify that this repon is accurrate and complete to the best of my knowledge.
.� Yz3 r u 4 4?_3
-
Date I
Signature Date
under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance wlth a system designed to assure that all qualified personnel property 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: HOAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page i of
Permit No.: VVQ0002006
Facility Name: House of Raeford Farms, Inc
County: Duplin
Month: June
Year. 2023
Did Irrigation occur
at this faculty?
YES ❑ NO
Fidd Nsmv
5-A
Field Name:
5-AA
FWNome:
s-s
Field Name:
6-A
Area (acres).
8.9
Area (acres):
5.5
Am (scm):
6.9
Area (acres):
16.2
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Hourly Rate (in):
Hourly Rate (In):
Hourly Ras (in):
Hourly Rate (in):
Annual Wts (in):
s0
Annual Rate (in):
60
Annual Rate (in):
60
Annual Rate (in):
50
Weather
Freeboard
Field irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YEs ❑ NO
FWd Inrlptsd?
❑ YES ❑ No
Field irrigated?
❑ YES ❑ NO
I°
a
01
� Q
1 j
...
O
F��
o
r
GCL
E_.yc
w
X= O
J
In
ft
it
min
In
in
gal
min
In
InV
min
it
In
min
In
in
1
C
61
0
4.25
2
C
70
0.1
4.12
3
CL
71
0
4.16
103,119
300
0.55
0.11
80,823
300
0.43
0.09
52,953
300
0.12
0.02
4
C
67
0
4.33
103,119
300
0,55
0.11
80,823
$00
0.43
0.09
52,953
300
0.12
0.02
5
C
49
0
4.5
103,119
300
0,55
0.11
80,823
300
0.43
0109
52,953
300
OA2
0.02
6
C
58
0
4.71
7
C
60
0
4.58
8
C
61
0.4
4.86
9
C
52
0
4.5
103,119
300
0.55
0.11
80823
300
0.43
0.09
52,953
300
0.12
0.02
10
C
85
0
4.66
11
C
81
0
4.75
92,796
270
0.50
0.11
72,732
270
0,39
0.09
47,652
270
0.11
0,02
12
C
69
1 0
14.91
13
PC
65
1 0.1 14.87
C
64
0
4.87
114
1 s
C
88
0
4.79
18
C
68
0 1
4.79
17
C
72
0
4.83
18
C
72
0
4.75
19
CL
69
0
4.75
32,335
120
0.17
0.09
20
R
72
0
4.96
21
R
69
0.8
4.71
22
CL
71
0.7
4.41
23
C
73
1.3
4.08
24
CL
73 1
07
3.83
25
C
68
0
3.75
26
C
73
0
3.66
27
CL
70
0.65
3.58
28
C
68
0
3.16
29
C
65
0
3.5
30f
G
68
0
3.66
91,094 1
265 1
0.49 1
0.11
71,398
265 1
0.38 1
0.09
46,778
265
0.11
1 0.02
31
Monthly Loading:
696,388
3.18 1
0.00
7.06
499,757
2.67
28,05
306,242
0.70
25.55
12 Month Floating Total (In):
28.79

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR.1) Page Z of 5
MM[;=U Fri 7153T,5�, Facft Name: House of Raeford Farms, Inc
Did Irrigation occ_U,7�
at this facillity?
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ 3 of S
Raeford
Did Irrigation occur
at this facift?
El YEs El NO
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FORM: NEAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) page q of -S
Permit No.: WQO()02005 Facility Name: House of Raeford Farms, Inc
a
Did irrigation occur
at this facility?
mp" op
� YES No
-
..
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 5 of_1
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
(] Compliant
❑ Non -Compliant
Q Compliant
❑ Non -Compliant
Q Compliant
❑ Non -Compliant
Compliant
❑ NorrCompliant
(] 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: Joseph Teachey
Permittee:
House of Raeford
Certification No.: 14930
Signing Official: Nicole Reynolds
Grade: SI Phone Number: [phone]
Signing Official's Title: Plant Manager
Has the ORC changed since the previous NDAR-1? —I Yes [] No
Phone Number: [phone] Permit Exp.: 10/31/23
Signature Date
Signature Date
By this signature. 1 certify that this report is accunaie 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

FORM: NOMR 06-16 NON -DISCHARGE MONITORING REPORT (NDMR) Paso _ _ of I -
Permit No.. WQD002005
Facility Name: House of Raeford - Rase Hill WWTF
County: Duplin
Month: June
Year: 2023
PPI: 0Q1
Flow Measuring Point: ❑ lMkwt El Emuent ❑ No now Wner"d
Paramator Monitoring Point: ❑Influent ❑ Effluent ❑ Groundwater tn4 ❑Surface water
Parameter Code
50060
003W
00601
00680
00940
50060
31616
00610
00625
00620
00600
00400
00686
WQ09C
70c900
00630
E
Oc
�Z
a
m ,
tZ
24-hr
hrs
GIRD
MWL
mt
m
mgiL
61400 mL
m
m
mak
su
n4pl.
m L
mg1L
mg1L
111
07:00
8
600,000
58
0.08
921
46.8
57.3
<0.02
57.39
7.85
5.99
26.6
75
21
07:00
8
320,000
0.08
8.16
31
07:00
8.25
0
4
08:00
2
310,000
5
08:00
2
630,000
0.12
8.35
a
07:00
8
650,000
0.24
8.11
7
07:00
8
600,000
0.18
8.21
8
07:00
9
610,000
no sample
no sample
9
07:00
825
330,000
0.18
6.91
!o
08:00
2
0
1!
08:00
2
320,000
12
08:00
8
610,000
46
0.18
85
44.9
65.8
1.21
57.09
7.93
5.83
27
89.9
13
08:00
8
590,000
0.23
7.84
14
07:00
9
610,000
0.2
8.21
is
07:00
9
l310,000
0.15
T68
16
07:00
8.75
320,000
0.33
7.82
47
08:00
2
0
lei
08.00
2
330.000
19
07:00
8.5
600,000
0.3
8.23
20
07:00
8.5
620,000
0.04
7.85
21
07:00
8.75
6001000
0.21
7.92
22
07:00
8 1
550,000
0.21
8.03
23
07:00
8
310.1m
0.17
8.4
24
08:00
2
0
25
08:00
2
320,000
26
07:00
8.5
520,000
0.5
8,3
27
07:00
8.75
570,000
0.23
8.13
28
07:00
6.5
550,000
0.28
7.99
29
07:00
8.5
560,000
0.1
8.24
30
07:00
8.75
310,000
0.16
823
3!
Average:
431867
52.00
0.19
279.79
45,85
56.55
0.61
57,24
5.91
26.80
82.45
Daily Maximum:
650 =
58.00
0.50
921.00
46.80
57.30
1.21
57,39
8.40
5.99
27.00
89.90
Daily Minimum:
0
46.00
0.04
$6.00
44.90
55.80
0.02
57.09
6.91
5.83
26.60
75.00
Sampling Type:
Rewter
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Crab
Grab
Grab
Grab
Grab
Grab
Monthly Limit:
8w,000
Deily Limit:
IContlnuaus
Sample Frequency:
2 X Month
AMualiy
Annually
3 X Year
5 X Week
2 X MorMh
2 X Month 12
X Month
2 X Month
2 X Month
5 X Week
2 X Month
2 X Month
3 X Year
2 X Month

48
19
20'
2i
22!
23
24
26
26
27
28

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of (
Sampling Person(s) Certified Laboratories
Name: Jay Baker Name: Enviromental Chemist
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? C compliant n 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: Joseph Teachey
Permittee: House of Raeford
Certification No.: 14930
Signing Official: Nicole Reynolds
Grade: SI Phone Number: [phone]
Signing Official's Title: Plant Manager
Has the ORC changed since the previous NDMR? ❑ yes E No
Phone Number: [phone] Permit Expiration: 10/31/2023
t
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