WQ0002096_Monitoring - 06-2024_20240724

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0002096
Name of Facility:*
Month:* June
Report Information
Ahoskie Assisted Living
Year:* 2024
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR June 2024 NDMR.PDF 277.37KB
PDF Only
GW-59 June 2024 GW-59.PDF 2.63MB
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: * Paula Armstrong
Signature:
Date of submittal: 7/24/2024
This will be filled in automatically
Initial Review

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0002096
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 7/29/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: June TYear:
2024
PPI: 001
Flow Measuring Point: Q Influent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: ❑ Influent E Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code 0
50050
00400
00310
31616
00530
00610
00625
00630
00665
50060
00940
70300
00620
00600
00615
ro
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za
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hrs
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su
mglL
#l100 mL
mglL
mg1L
mglL
mglL
mglL-
mglL
mglL
mglL
mglL
mglL
mg1L
1
10:00
0.5
2,227
21
1
2,227
3
1
2,227
41
2,227
5
2,227
6
2,227
7
2,227
8
10:00
0.5
2,227
9
2,227
101
06:30
1.5
2,227
6.7
31
39
61
<0.02
9.86
0.08
1.58
<0.1
36
280
0.05
9.94
0.03
11
10:00
0.5
2,227
12
10:00
0.5
2,227
13
2,227
14
2,227
15
2,227
161
2,227
171
10:00
0.5
2,227
18
2,227
19
2,227
20
2,227
21
2,227
22
2,227
23
2,227
24
10:00
0.5
2,227
25
2,227
26
2,227
27
2,227
28
2,227_.
29
2,227
30
10:00
0.5
2,227
31
Average:
2,227
31.00
39.00
61.00
0.00
9.86
0.08
1.68
0.00
36.00
280.00
0.05
9.94
0.03
Daily Maximum:
2,227
6.70
31.00
39.00
61.00
0.02
9.86
0.08
1,58
0.10
36.00
280.00
0.05
9.94
0.03
Daily Minimum:
2,227
6.70
31.00
39.00
61.00
0.02
9.86
0.08
1.58
0.10
36.00
280.00
0.05
9.94
0.03
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
3/year
3/year
3/year
3/year
3/year
Weekly
31year
3/year
31year
1-3/year
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? Fj 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: Sl Phone Number: 252-287-4153
Signing Official's Title: Administrator
Has the ORC changed since the previous NDMR? ❑ yes Q No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
0
Signature Date
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
1 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, t 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.: 11000 0•.
Ahoskie Assisted Living
Iy: Hertford .
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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
Q Compliant ❑ Non-Ccmpliant
21 Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
❑� Compliant ❑ Non -Compliant
iP1 Compliant ❑ Non-Complfant
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 ARC changed since the previous NDAR-1? ❑ Yes M No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
Signature Date
Signature Date
By this signature, I certify that this report is accurate 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

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: W00002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: June
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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? ❑✓ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? El Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑' Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for even, application to each permitted site? ❑� Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in 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
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 O handed since the v. us NDAR-1? ❑ Yes 2 No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
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 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