WQ0002096_Monitoring - 05-2024_20240619

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * May
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:* 2024
Upload Document*
May 2024 NDMR.pdf 267.57KB
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
6/19/2024
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: 7/18/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: May
Year: 2024
PPI: 001
Flow Measuring Point: Q Influent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: ❑ Influent El Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code 01
50050
00400
00310
31616
00530
00610
00625
00630
00666
50060
00940
70300
00620
00600
00615
}
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01
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Z
y
ZZ-2C
24-hr
hrs
GPD
su
mglL
#/100 mL
mg/L
mg/L
mg/L
mg/L
mg1L
mg/L
mg1L
mg/L
mg/L
mg1L
mg/L
1
2,249
2
2,249
3
2,249
4
10:00
0.5
2,249
5
10:00
0.5
2,249
6
2,249
7
2,249
8
2,249
9
2,249
10
2,249
11
2,249
12
10:00
0.5
2,249
7.3
1,5
13
10:00
0.5
2,249
14
2,249
15
2,249
16
2,249
171
2,249
181
2,249
19
2,249
20
10:00
0.5
2,249
7.1
0.6
21
10:00
0.5
2,249
22
2,249
23
2,249
24
2,249
25
10:00
0.5
2,249
26
2,249
27
2,249
28
2,249
29
2,249
30
2,249
31
2,249
Average:
2,249
0.70
Daily Maximum:
2,249
7.30
1.50
Daily Minimum:
2,249
7.10
0.60
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
3/year
3/year
31year
3/year
3/year
3/year
Weekly
31year
3/year
31year
3/year
31year

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? 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
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 MR? ❑ 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 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: May
Year: 2024
Did irrigation occur
Field Name.
Site1
Field Name:
Site 2 ''Field Name:
Site 3
Field Name:
Site 4
this faClIy�
Area (acres)
1.75
Area (acres):
1.33 i Area (acres):
1.35
Area (acres):
1.5
at
Cover Crop
Trees
Cover Crop:
Trees
Cover Crop:
Trees/Bermuda
Cover Crop:
Bermuda
YES ❑ rto
Hourly Rate (in):
0,25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
Hourly Rate (in):
0.25
A_nual:Rate (in):
18
Annual Rate (in):
18
Annual Rate (in):
31.5
Annual Rate (in):
31.5
Weather
Freeboard
"Field Irrigated?
C YES ❑ NO
Field Irrigated?
YES ❑ NO
Field Irrigated?
g
YES
n � NO
Field irrigated?
YES NO C
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in
ft
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gal
min
in
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in
gal
min
in
in
gal
min
in
in
1
2
3
4
R
73
0.3
1.83
5
CL
76
0.1
1.83
6
{
7
8
9
10
0.1
11
12
C
71
1.91
41,400
360
0.87
0.15
13
C
72
2.08
48,300
420
1.34
0.19
14
1.1
15
16
17
18
0.1
1
19
20
C
76
11.83'.;480
1.51
0.19
21
C
77
2
41,400
360
1.02
0,17
22
23
24
0.6
25
C
79
2.16
26
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28
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Monthly 31 so
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FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-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?
Page of
IA Compliant ❑ Non -Compliant
E Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
[] Compliant ❑ Non -Compliant
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 the previous NDAR-1? ❑ Yes Q No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Signature Date
Signat re Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penatty 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

Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
GountyHertford
Month: May
f • irrigation occur
at this facility'?
o YES■
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Hourly Rate
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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?
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?
❑� Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
Q 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 I Permittee Certification
ORC: Randall Parker Permittee: Ahoskie Assisted Living
Certification No.: 996843 Signing Official: Paula Armstrong
Grade: SI Phone Number. 252-287-4153 Signing Officials Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑ Yes F�j 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 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