WQ0002096_Monitoring - 11-2023_20240426

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * November
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
Reviewer:
Year:* 2023
Upload Document*
NDMR Nov 2023.pdf 181.62KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Paula Armstrong
Wanda.Gerald
4/26/2024
This will be filled in automatically

Is the project number correct?* W00002096
Is the monitoring report accepted?* Yes NO
Regional Office* Washington
Reviewer: _anonymous
Review Date: 5/21/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0002096 Facility Name: Ahoskie Assisted Living
County: Hertford
Month: November
Year: 2023
PPI: 001
Flow Measuring Point: Influent ❑ Effluent ❑ No now generated
Parameter Monitoring Point: ❑ Influent Q 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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0
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Z
24-hr
hrs
GPD
su
mg1L
#1100 mL
mg1L
mglL
mg/L
mg1L
mg1L
mg1L
mg1L
mg1L
mg1L
mglL
mg1L
1
10:00
0.5
1,169
2
1,169
3
1,169
4
1,169
5
1,169
6
1,169
7
10:00
0.5
1,169
7
12
8
10:00
0.5
1,169
9
1,169
10
1,169
11
1,169
12
1,169
13
10:00
0.5
1,169
141
1,169
15
1,169
16
1,169
17
1,169
18
1,169
19
1,169
201
10,00
0.5
1,169
21
1,169
22
1,169
23
1,169
24
1,169
251
1,169
261
1,169
27
10:00
0.5
1,169
7.3
1.5
28
1,169
29
30
10:00
0.5
1,169
1,169
31
Average:
1,169
1,35
Daily Maximum:
1,169
7.30
1.50
Daily Minimum:
11169
7.00
1.20
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
3/year
31year
31year
3/year
3/year
3lyear
31year
Weekly
3lyear
3lyear
3lyear
3lyear
3lyear

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
aCllOnt5) LaKen. mi[acn aUUIUUMM 5rIeULZi II IIUUUbtictly.
requirements were not met; Total Dissolved Residue- Laboratory control sample exceeded control limits. Blank result exceeded method co
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 previou NDMR? ❑ Yes El No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
Signature
Date
Signature Date
By this signature, I certify that this report is accurrate and eompiote to the best of my knowledge.
I certify, under penalt�-fw, 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: November
Year: 2023
Did irrigation occur
Field Name:
Sites
Field Name:
Site 2
Field Name:
Site 3
Field Name:
Site 4
at this facility?
Area (acres):
1.75
Area (acres):
1.33
Area (acres):
1.35
Area (acres):
1,5
Q YES ❑ NO
Cover Crop:Trees
Cover Crop:
p:
Trees
p•
Cover Crop:
Trees/Bermuda
p•
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?
0 YES ❑ NO
Field Irrigated?
❑ YES [ No
Field Irrigated?
❑ YES ❑ 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
48
2
2
3
4
5
6
7
C 1
73
1.83
34,500
300
0.85
0.17
8
C
70
9
10
11
12
131
C
60
2.08
14
15
16
17
18
19
20
C
1 60
1.91
21
0.4
22
0.5
23
0.1
24
25
26
271
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1 53
1.66
1 48,300
420
1.02
0.15
28
29
30
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54
1.83
48,300
420
1.34
0.19
31
111111RUMMM-1, isle

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?
El 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? 2 Compliant ❑ Non -Compliant
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? Q 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: S[ Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the previous NDA 1? ❑ Yes E] No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Signature Date
Signature Date
By this signature, I certify that this report Is accurrale 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.
Mall 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.: errr r•.
- Assisted
Hertford
November
Did irrigation occur
Field Name:
Field Name:
at this facilit Y
Area (acres):
Cover Crop:
F±1 YES F� tio
Hourly Rate (in):
rgm VA -.f IC41 Ing
Hourly Rate (in):
-�
Annual Rate (in)::
t
�
�
NMI
m
==-_-----

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?
❑� Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
❑r 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?
0 Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
E] 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 1I Permittee Certification I
ORC: Randall Parker
Certification No.: 996843
Grade: SE Phone Number: 252-287-4153
Has the ORC changed sirlice the previpus NDAR-17 [i Yes 0 No
Perm ittee:
Ahoskie Assisted Living
Signing official: Paula Armstrong
Signing Official's Title: Administrator
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Signature 11 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