WQ0002096_Monitoring - 12-2023_20240123

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * December
WQ0002096
Ahoskie Assisted Living
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2023
Upload Document*
NDMR Dec 2023.PDF 172.53KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Paula G Armstrong
Reviewer: Wanda.Gerald
1 /23/2024
This will be filled in automatically

Is the project number correct?* WQ0002096
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 2/7/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: December
Year: 2023
PPI: 7TOT777TFlow
Measuring Point: ❑� Influent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: ❑ Influent 0 Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code - 0
50050
00400
00310
31616
00530
00610
00625
00630
00665
50060
00940
70300
00620
00600
00615
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24-hr
hrs
GPD
su
mg1L
#1100 mL
mg/L
mg1L
mg/L
mg/L
mg/L
mg/L
mg1L
mg1L
mg1L
mg/L
mg1L
1
1 10:00
0.5
1,909
21
1,909
3
1,909
4
1,909
5
1 1,909
6
1,909
7
1,909
8
10:00
0.5
1,909
9
1,909
10
1,909
11
1,909
12
1,909
13
1,909
14
1,909
15
10:00
0.5
1,909
16
1,909
17
1,909
18
10:00
0.5
1,909
7.2
1.97
19
10:00
0.5
1,909
20
10:00
0.5
1,909
21
10:00
0,5
1,909
22
10:00
0.5
1,909
23
1,909
241
1,909
25
1,909
26
1,909
27
1,909
28
1,909
29
10:00
0.5
1,909
301
1,909
311
10:00
0.5
1,909
Average:
1,909
1.97
Daily Maximum:
1,909
7.20
1.97
Daily Minimum:
1,909
7.20
1.97
Sampling Type:
Estimate
Grab
Grab
Grab
Grab
Grab
Grab
Calculated
Grab
Grab
Grab
Grab
Grab
Calculated
Grab
Monthly Avg. Limit:
7,500
Daily Limit:
Sample Frequency:
Continuous
Weekly
31year
3/year
31year
3/year
3/year
T 3/year
3/year
Weekly
31year
31year
3/year
31year
3/year

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Randy Parker Name: Waypoint Analytical
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? [D 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: Randall Parker
Permittee: Ahoskie Assisted Living
Certification No.: 996843
Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the evious NDMR? ❑ Yes 0 No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
6 o,
-7
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 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: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: December
Year: 2023
irrigation occur
lity?
at this Did iris facility?
Field Name:
Sitell
Field Name:
Site 2
Field Name:
Site 3
Field Name:
Site 4
Area (acres):
1.75
Area (acres):
1.33
Area (acres):
1.35
Area (acres):
1.5
P/1 YES ❑ NO
Cover Crop:
Trees
Cover Crop:
Trees
Cover Crop:
Trees/Bermuda
Cover Crop:
Bermuda
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Annual Rate (in):
18
Annual Rate (in):
18
Annual Rate (in):
31.5
Annual Rate (in):
31.5
Weather
Freeboard
Field Irrigated?
❑� YES ❑ NO
Field Irrigated?
E YES ❑ NO
Field Irrigated?
YES ❑ NO
Field Irrigated?
❑ YES ED NO
❑
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in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
C
64
2
2
3
4
5
6
7
8
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54
1.91
9
10
11
12
13
14
151
C
1 56
1.83
16
17
1.5
18
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57
55,200
480
1.16
0.15
19
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46
41,400
360
1.15
0.19
20
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44
27,600
240
0.75
0.19
211
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1 50
27,600
240
0.58
0.15
22
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2.16
27,600
240
0.76
0.19
23
24
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271
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28
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1.91
Monthly Loading:
82,800
1.74
69,000
1.91
27,600
0.75
0
0.00
12 Month Floating Total (in):
4.36
7.07
5.83
8.66

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
Q Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
0 Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Q Compliant
❑ Non-Compllant
Were all setbacks listed in your permit maintained for every application to each permitted site?
❑, Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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: Randall Parker
Permittee:
Ahoskie Assisted Living
Certification No.: 996843
Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since t e previous NDAR-1? ❑ yes 0 No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
1
/9
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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: December
Year: 2023
Did irrigation occur
Field Name:
Site 5
Field Name:
Field Name:
Field Name:
Area (acres):
1.94
Area (acres):
Area (acres):
Area (acres):
at this facility?
Cover Crop:Bermuda
Cover Crop:
P'
Cover Crop:
P�
Cover Crop:
P:
Hourly Rate (in):
0.25
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):
Q YES ❑ NO
Annual Rate (in):
31.5
Annual Rate (in):
Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field Irrigated?
❑ YES 7 No
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ NO
Field Irrigated?
❑ YES ❑ No
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? 0 Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? 21 Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? D 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? 21 Compliant ❑ Non -Compliant
It 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: Randall Parker
Permittee:
Ahoskie Assisted Living
Certification No.: 996843
Signing Official: Paula Armstrong
Grade: SI Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑ yes Q No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Signature Date
Signature Date
6'
By this signature, l 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