WQ0002096_Monitoring - 08-2024_20240905

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * August
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*
NDMR Aug 2024.PDF 275.8KB
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
��nula ��arf!-�tswy
Reviewer: Wanda.Gerald
9/5/2024
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: 9/16/2024

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0002096
Facility Name: Ahoskie Assisted Living
County: Hertford
Month: August
Year: 2024
PPI: 001 7FIow
Measuring Point: ❑✓ Influent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: ❑ Influent Q Effluent ❑ Groundwater lowering ❑ Surface Water
Parameter Code --►
50050
00400
00310
31616
00530
00610
00625
00630
00665
50060
00940
70300
00620
00600
00615
_
o
a
0
v
E�
.
0
E
"i~
a
OL]
�
0
oCD
o;m
N
0.
Ua)
c
O O
�o
O
U
oc v
ON O
Qm
,„
O z°c >
MW
..
xz
24-hr
hrs
GPD
su
mg1L
#1100 mL
mg1L '`
mg1L
mg1L
mg1L
mg1L `
mg1L
mg/L
mglL
mg1L
mg1L
mg/L
1
2,662
2
2,662
3
2,662
4
2,662
5
10:00
0.5
2,662
7.2
1.9
6
10:00
0.5
2,662
7
2,662
8
2,662
9
2,662
10
2,662
11
2,662
12
2,662
13
10:00
0.5
2,662 "
14
10:00
0.5
2,662
6.8
0.2
15
10:00
0.5
2,662
16
10:00
0.5
2,662
17
10:00
0.5
2,662
18
2,662
19
2,662
20
2,662
21
2,662
22
2,662
23
2,662
24
10:00
0.5
2,662
25
2,662
26
2,662
27
2,662
28
2,662
29
2,662
30
2,662
311
10:00
1 0.5
2,662
Average:
2,662
1.05
Daily Maximum:
2,662
7,20
1.90
Daily Minimum:
2,662
6.80
0.20
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
3/year
31year
3/year
3/year
3/year
3/year
Weekly
31year
3/year
3/year
3/year
3/year

FORM: NDMR 03A2 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? 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 evious NDMR? ❑ Yes No
Phone Number: 252-513-8591 Permit Expiration: 4/30/2025
rjULc�
Signature
Date
Signature Date
ay 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 atl 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: August
Year: 2024
Did irrigation occur
Field N 6in"e"'i
Sit1
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
Cover Crop:
Trees
Cover Crop;
Trees i
Cover Crop:
Trees/Bermuda
Cover Crop:
Bermuda
Q YES ❑ No
Hourly Rate (in):
0,25
Hourly Rate (in):
0.25
Hourly Rate (m}:
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 J No :;
Field irrigated?
[ YES ❑ No
Field Irrigated?
E YES NO
Field Irrigated?
, J YES ❑ X0
°
o
y
m
CL
EL
°. o
�ft
m is
a
>° Q
o
E M
m o
°
E T rn
E rl
cxC
m y
S!
CL
¢
d
•�
a�
�. C
o
°
J
E T rn
7 C
E
z° 0O
J
a�
G7
c
O C7.
Q
N y
E `°
i- >O'
i
6
T
o
O o
E
C
E 3
ro z
�r ...I ::
2
z
O CL
> Q
y N
E
_
a C
II C
J
7
E 4s
•� 2 O
J
°F
in
ft
g al
min
in
in
gal
min
in
in
gal-
min
in
in
gal
min
in
in
1
2
3
4
5
CL
83
55,200
480
1.36
0.17
6
CL
81
2
7
0.2
8
0.4
9
0.2
10
0.2
11
12
13
C
76
1.75
141
C
79
41,400
360
1,13
0.19 :
1
15
C
81
27,600
240
0.76
0.19
16
C
82
20,700
180
0,44
0.15
17
C
82
2
13,800
120
0.29
0,15
18
0.2
19
0.2
20
I
21
22
23
24
C
79
1.83
25
26
27
28
29
30
[]L84
31
1.75
Monthly
Loading:,,:,,
.34 500 "°
0.73
27,600
=
0 76
;_
41;400. ,
' , 4=
1,13
__
55,200
1.36
12 Month Floating Total (in):
l
'10.75
11 45s
12.04
10.52

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?
Q Compliant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Q Compliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
El Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
0 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 NDAR-1? ❑ yes 0 No
Phone Number: 252-513-8591 Permit Exp.: 4/30/25
4� ` � �
L" - 61 , a 6 1 5.
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
PermitNo.: WQ0002096
Facil4 Name: Ahoskie Assisted Living 11
County: Hertford
Month: August
Did irrigation
Field Name:
at this facility.?
Cover Crop:
oYES .
-.
-.
-_Hourly
-_
-
Annual Rate (in),
Field Irrigated?
Mmmmmm
mm
MOM
Monthly • . • •
.
'e''"'
�.,'.✓`�-G� `h
�
^.ski` �'
MER
.
. 1

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?
Page of
❑� Compliant ❑ Non -Compliant
❑r 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? [D 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
ORC: Randall Parker
Certification No.: 996843
Grade: SI Phone Number: 252-287-4153
Has the ORC changed since the-pf1evious NDAR-1? ❑ Yes 0 No
Permittee Certification
Permittee:
Ahoskie Assisted living
Signing Official: Paula Armstrong
Signing Official's Title: Administrator
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