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Home My WebLink AboutWQ0021289_Monitoring - 11-2016_20161230FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of 8 Permit No.: 1111 '• Facility Name: Town of Hertford Perquimans Month:• - •- 1 Flow Measuring Point: Dnfluent R�ffluent gNo flow generated Parameter Monitoring Point: Dnfluent WEffluent []Groundwater Lowering []Surface Water • • m �� ■II ■■��I�■A��■IIIA■4�� moo .. FORM: NDMR 08.11 NON -DISCHARGE MONITORING REPORT (NDMR) Page 'Z of 8 Sampling Person(s) Name: Operators Name: Certified Laboratories Name: Environment 1, Inc. Name: Town of Hertford WWTP Laboratory Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Qcompliant E]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) unci 1. nuaui ODUMU1 101 ai iccio u Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Charles A. Jones, Jr. Permittee: Town of Hertford Certification No.: 985305 / 993143 Signing Official: Brandon Shoaf Grade: IV / SI Phone Number: 252.333.6948 Signing Official's Title: Town Manager Has the ORC changed since the previous NDMR? ❑Yes Eci Phone Number: 252.426.1969 Permit Expiration: 12/19/2014 lZ • Z 2 • IG -�1 .i� . .� r �. - 2 � : 1 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 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 Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of 0 Permit No.: X11 :• Facility Name: Town of - • • WWTF County:- • •nth: November1 Field Name:' Field Name. Field Name: Field Narne:� D • irrigation occur Are, (acres)-.' Area (acres). Area (acres): Area (acres) -'at this facility? Cover Crop:, Cover Crop: Cover Crop:1 Cover Crop: F1 YES F-1-1 NO Hourly Rate (in):, Hourly Rate (in): Hourly Rate (in): Annual Rate (in): Annual Rate (iny. Annual Rate (in)-! WMIRITIM IRRM •••.. . . •.? Field .. •. 0 • • •. N 0 • • -.. Q • m ■■!■! ��[■■L7I� ■�[�ll�■IIIA ■l�� 12 Month Floatina Total fin)- FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page q of 8 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? 20ompliant ❑Non -Compliant Rompliant QNon-Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓Compliant Don -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? OCompliant ❑Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2compliant [—]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 Attacn aaanional sneers IT necessa Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Charles A. Jones, Jr Permittee: Town of Hertofrd Certification No.: 985305 / 993143 Signing Official: Brandon Shoaf Grade: IV/ SI Phone Number: 252.333.6948 Signing Official's Title: Town Manager Has the ORC changed since the previous NDAR-1? Ely- RINo Phone Number: 252.426.1[969 Permit Exp.: _ 12/19/14 / Z ' ZZ• /(� I•'1 - 22. 2orb tel. J�J J 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 Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page S of a Permit • !11 '• • • • • '- •November1 Field • irrigation occur at this facility? Area (acres). Area (acresy Cover Crop: YES n,1 N 0-. 1Hourly -.te (in): Hourly -. 1 Annual Rate (in): Annual Rate (in). Annual Rate (in): - ••.•. • . .. •.. 0 • • .. •. 0 • • •. •. 0 •Field Irrigated?Q • m!!!!! !\\■EWA ®!!!!! �M �� ,MWZ ��_-- m!!!!! FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 6 of Did the application rates exceed the limits in Attachment B of your permit? RICompliant Don -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? OCompliant Don -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓Compliant Don -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? R�ompliant ❑Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? OCompliant ❑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: Charles A. Jones, Jr - Permittee: Town of Hertofrd Certification No.: 985305 / 993143 Signing Official: Brandon Shoaf Grade: IV / SI Phone Number: 252.333.6948 Signing Official's Title: Town Manager Has the ORC changed since the previous NDAR-1? ❑y- P]No Phone Number: 252.426.1969 Permit Exp.: 12/19/14 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 Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina -27699-1617 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -7 of 6 Permit • 1111 :• • • - • • - • • • - •- lrl 111111111111111111110 RIM, • irrigation occur GEME Area (acresy.' Area (acres):'�� at this facility? Cover Crop:1 Cover Crop: Giver Crop:! Cover Crop: ■YES D NO -. 1 Hourly -. -. -. Annual _ •Annual Rate (my.! Annual Rate (in): Annual Rate (in): ... . .. ■D •Field .. •. ■ ■ • . Irrigated?■ ■ • ■ ■ • loop m!!!!! ■I,■■L7/! EME■A■■/IWM ■�� MonthlV Loading: 12 Month ////////,/////// iii////////%//////�f%//////� ///////// ///%///V/////,�/////////i FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 8 of Did the application rates exceed the limits in Attachment B of your permit? 2ompliant ONon-Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites? QCompliant ❑Non -Compliant Was a suitable vegetative cover maintained on all sites as specified in your permit? QCompliant ❑Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? ✓QCompiiant QNon-Compliant Were all freeboards maintained in accordance With the specified freeboard heights in your permit? OCompliant QNon-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 zaKen. Hzzacn aaamonal sneers it Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Charles A. Jones, Jr Permittee: Town of Hertofrd Certification No.: 985305 / 993143 Signing Official: Brandon Shoaf Grade: IV / SI Phone Number: 252.333.6948 Signing Official's Title: Town Manager Has the ORC changed since the previous NDARA? Elyes-ENO' Phone Number: 252.426.1969 Permit Exp.: 12/19/14 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 Quality Information Processing Unit .1617 Mail Service Center Raleigh, North Carolina 27699-1617