WQ0029653_Monitoring - 10-2016_20161202

f ORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Facility Name:
SCOTCH HALL PRESERVE WWTP
County: Bertie
Month:
October
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r "PORM: NDAR-1 10-13 NOWDISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
❑ Compiiaht ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or..runoff from the 81tes? ❑ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑ Corri'pliaht ❑ Non -Compliant
Were all setbacks listed in your• permit maintained for every application to each permitted site? ❑ Com`piiaht ❑ Non -Compliant
Were all freeboards maintained in accordance With the specified -freeboard heights in your permit? ❑ Com'phaht ❑Non -Compliant
If the facility is non-compliant, please explain in the space below the �eason(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) Cgrtifidation
Permittee Certification
ORC: RICK HARRELL
Permittee: S`GOTCH HALL PRESERVE WWTP
Certification No., S1986118
Signing Official: DANIEL SUMEREL
Grade: Phone Number: 252-724-1663
Signing Official's;iitlb: GENERAL M/aNAGER
Has the ORC cheriged since the previous NDAR-1? El Yes [I No
Phone Number:919-300-9316 Permit Exp.:
Signature Date
Signature Date
By'tnis Signature, I certify that this report is. accurrate and complete to the best of my knowledge.
I certify, under penalty of ]a.W, that this document and all attachments were prepared under my dl&ection or supervision in accordance
with a system designed to 2ssure that all qualified personnel property gathered and evaluated the information submitted. Base,dnrl 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 bglipf; true, accurate, and complete. I am aware that there are significant
penalties for sub miffing false information, including the possibility of fines and impilsonment for knowing violations. .
Mail Original.and Two Copies tib:
Division of Water Resources
Information Processing Unit
1617 --;Mail Service Center
Raleigh, North Carolina 27699-16:17