WQ0002096_Monitoring - 07-2024_20240822

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month:* July
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:* 2024
Upload Document*
July 2024 NDMR.PDF 466.23KB
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
8/22/2024
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: 8/22/2024

FORM: NDMR 03.12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.:'` 0c)(A
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: July
Year: 2024
PPI: 001
Flow Measuring Point: ❑� Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent ❑ Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code 0
50050
00400
00310
31616
00530
00610
00625
00630
00665
50060
009440
70300
00620
00600
00615
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Q
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F- '
yN
N
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Q
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pt
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24-hr
hrs
GPD
su
mg/L
#1100 mL
mg1L
mg/L
mg/L
mg1L
mg/L
mg/L
mg/L
mg/L
mg/L
mg1L
mg/L
1
2,373
2
14:00
0.5
2,373
7
0.61
3
14:00
0.5
2,373
4
14:00
0.5
2,373
5
2,373
6
2,373
7
2,373
8
2,373
9
2,373
10
2,373
11
10:00
0.5
2,373
12
2,373
13
2,373
14
2,373
15
2,373
16
2,373
17
2,373
18
10:00
0.5
2,373
19
2,373
20
2,373
21
2,373
22
14:00
0,5
2,373
7
0.1
23
14:00
0.5
2,373
24
14:00
0.5
2,373
25
2,373
26
2,373
27
2,373
28
2,373
29
2,373
30
2,373
31
10:00
0.5
2,373
Average:
2,373
0,36
Daily Maximum:
2,373
7.00
0.61
Daily Minimum:
2,373
7.00
0.10
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
3lyear
3lyear
3/year
3/year
3/year
3/year
3/year
Weekly
31year
3/year
3lyear
3lyear
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? El 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 Officials Title: Administrator
Has the ORC changed since the previous NDMR? ❑ Yes ❑Q No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2026
[�Z_4zvf
404 //f
as a�
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

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Permit No.: W00002096
Facility Name:
Ahoskie Assisted
Living
County:
Did irrigation occur
Field Name
SIte1
Field Name:
Site 2
Field;
Area (acres)
1 75
Area (acres):
1.33
Area (i
at tI11S facility?
Cover Crop
Trees
Cover Crop:
Trees
Govei
0 YES ❑ NO
Hourly Rate (in)
0 25
Hourly Rate (in):
0.25
HourSy Ra
Annual Rate'(In'):
1,8
Annual Rate (in):
18
Annual Ra
Weather
Freeboard
Field irrigated?
Q YES Q No
Field Irrigated?
Q YES [] No
Field Irri
o
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m°i
ors
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is
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ate+
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oa
�¢
-�
g
_
in
in
gal
min
in
in
al=
Hertford I Month:
J
Page of
July
Year:
2024
Field Name:
Site 4
Area (acres):
1.5
Cover Crop:
Bermuda
Hourly Rate (in):
0.25
Annual Rate (in):
31.5
Field Irrigated?
[J YES
Q No
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Monthly Loading
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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?
❑r Compliant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
E1 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 every application to each permitted site?
Q 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: SI Phone Number: 252-287-4153
Signing Officials Title: Administrator
Has the ORC changed since the p ious NDAR-17 ❑ Yes (] No
Phone Number: 252-513-8591 Permit Up.: 4/30125
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

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?
❑✓ Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑� Compliant
El 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?
it 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 Officials Title: Administrator
Has the ORC changed since the previous NDAR-1? ❑ Yes jQ 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 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