Fleetwood
.
F
,J
,
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE; MONITORING REPORT (DMR)
Form Approved
OM B No. 2040-0004
PERMITTEE NAME/ADDRESS (Include Facility NameA-ocation if Different)
12590
WAPPINGER IT)
20 MIDDLE BUSH RD
WAPPINGERS FALLS, NY 12590
FLEETWOOD MANOR SO WWTP
FLEETWOOD DRIVE
WAPPINGERS FALLS, NY 12590
NAME:
ADDRESS:
FACILITY:
LOCA TION:
A TTN: DAWN
PARAMETER
Temperature, water deg. fahrenheit
00011 1 0
Effluent Gross
Temperature, water deg. fahrenheit
00011 GO
Raw Sewage Influent
BOD, 5-day, 20 deg. C
00310 1 0
Effluent Gross
BOD, 5-day, 20 deg. C
00310 G 0
Raw Sewage Influent
pH
00400 1 0
Effluent Gross
pH
00400 G 0
Raw Sewage Influent
Solids, total suspended
00530 1 0
Effluent Gross
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
NY0021601
PERMIT NUMBER
001-X
DISCHARGE NUMBER
DMR Mailing ZIP CODE:
MINOR
(SUBR 03)
FROM
MONITORING PERIOD
MMIDDNYYY MMIDDNYYY
03/01/2010 03/31/2010
No DischargeD
External Outfall
QUANTITY OR LOADING
QUALITY OR CONCENTRATION
NO. FREQUENCY SAMPLE
EX OF ANALYSIS TYPE
VALUE
VALUE
UNITS
VALUE
VALUE
VALUE
UNITS
,/I
NAME/llTLE PRINCIPAL EXECUTIVE OFFICER I crrtify under penak~f law lb.1ll this documelll BRd all al:tachmenls were prepared under my direction or 0! 1 /!/ TELEPHONE DATE 1
:;.:::: i~~=elio::ut:'it~j,~c=t~c:~~~d~o;;;r:/~~ :::::~:~=c~C::~e~:rand . ~/l;(,t~JlfII.{i(.ULI.~ 04/20/2010
Michael P. Tremper I)'Slem, or IhOSt persons di~ctly responsible for SlIIha-inS lhc infonnatim. Ibe inConnation liubmined is, 845-463-7310
~~~~it~:=~~ti:~~:e ~~;'::~~l~C':dinr;'~~~:bW~~~/~ ~~~~~~~~:r;t~~=~
Chief Onerator violmions. SIGNA TURE OF PRINCIPAL EXECUTIVE OFFICER OR AREA cOdel
TYPED OR PRINTED AUTHORIZED AGENT NUMBER MIWOD/YVYY
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
EPA Form 3320-1 (Rev.OlI06) Previous editions may be used.
Page 1
~
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
Form Approved
OMS No. 2040-0004
PERMITTEE NAME/ADDRESS (Include Facility NameA-ocation if Different)
WAPPINGER (T)
20 MIDDLEBUSH RD
WAPPINGERS FALLS, NY 12590
FLEETWOOD MANOR SD WWTP
FLEETWOOD DRIVE
WAPPINGERS FALLS, NY 12590
NAME:
ADDRESS:
FACILITY:
LOCA TION:
ATTN: DAWN
PARAMETER
Solids, total suspended
00530 G 0
Raw Sewage Influent
Solids, settleable
00545 1 0
Effluent Gross
Solids, settleable
00545 G 0
Raw Sewage Influent
Flow, in conduit or thru treatment plant
50050 G 0
Raw Sewage Influent
Chlorine, total residual
50060 1 0
Effluent Gross
Coliform, fecal general
740551 0
Effluent Gross
BOD. 5-day, percent removal
81010 K 0
Percent Removal
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
NAME/TlTLE PRINCIPAL EXECUTIVE OFFICER
Mi~hael P. Tremper
12590
NY0021601
PERMIT NUMBER
001-X
DISCHARGE NUMBER
DMR Mailing ZIP CODE:
MINOR
(SU BR 03)
FROM
MONITORING PERIOD
MM/DDIYYYY MMIDDIYYYY
03/01/2010 03/31/2010
No DischargeD
Exte mal Outfall
QUANTITY OR LOADING
QUALITY OR CONCENTRATION
NO. FREQUENCY SAMPLE
EX OF ANALYSIS TYPE
VALUE
VALUE
UNITS
VALUE
VALUE
VALUE
UNITS
I urtify underpenaJIy oflawthallhis document and 1111 attllChments were p-cpard undtrmy direction or
supcrviaioft in accordll1ce with . system dHligned 10 IISsure lh. (JIalitifli personnel properly gothn and
evalual:e the infonnRlion submitted. Bued on my inquiry oflbc ptrSQII or persoDSwbo RlIIRBgC the
s)'1ltem, or those ptlWDS direc::lly r~5ible for !ltha-ing the infonnalion. the infonnalioo submitted is,
~oe~~tt~~:;:::~~:~1.t:e ~~~:{~~~ci.:d:~~~~Wi~~~lf: ~~~~~~~f:r1~~=:
violwt<18li.
TELEPHONE
DATE
845 463 7310
04/20/2010
SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR
AUTHORIZED AGENT
AREA Code
NUMBER
MMlDDNYYY
TYPED OR PRINTED
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
EPA Form 3320-1 (Rev.01/06) Previous editions may be used.
Page 2
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
Form Approved
OMS No. 204(}-0004
PERMITTEE NAME/ADDRESS (lnc/ude Facility NameA.ocation if Different)
FACILITY:
LOCA TION:
WAPPINGER (T)
20 MIDDLEBUSH RD
WAPPINGERS FALLS, NY 12590
FLEETWOOD MANOR SD WJIlfP
FLEETWOOD DRIVE
WAPPINGERS FALLS, NY 12590
NY0021601
PERMIT NUMBER
001-X
DISCHARGE NUMBER
DMR Mailing ZIP CODE:
MINOR
(SU8R 03)
12590
NAME:
ADDRESS:
ATTN: DAWN
MONITORING PERIOD
. MM/DDIYYVY I I MMIDDIVVVV
03/01/2010 1 TO r 03/31/2010
External Outfall
No DischargeD
FROM
PARAMETER
QUANTITY OR LOADING
QUALITY OR CONCENTRATION
NO.
EX
FREQUENCY SAMPLE
OF ANALYSIS TYPE
VALUE
VALUE
UNITS
VALUE
VALUE
VALUE
UNITS
Solids, suspended percent removal
SAMPLE
MEASUREMENT
PERMIT
REQUIREMENT
81011 KO
Percent Removal
{A.(/
SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR
AUTHORIZED AGENT
c.=---
NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
Mi~hael P. Tremper
TYPED OR PRINTED
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
I certif~ undcrpenalty of law thatlhi, documtnl and all attachment! were prepared undermy direaion or
~ai~:i~i~fu:~~::~it~ed:~:~e:~~~d~o;~~~~: .:~:e:r~:::e~~~:~e~:rand
system. or (bore penonl directly responsible for JoI:bcring lhe infonnalim, the informatim submitted is,
::~~t~~:;=l.:i:~~1J:c -:1;:~f:~c~~d~:~:n:;:a:W~~~lf~ ~~:~~~~:r:rl~~=~
violations.
TELEPHONE
DATE
845-463 7310
04/20/2010
AREA Code
NUMBER
MMlDDNYVY
Page 3
EPA Form 3320-1 (Rev.01l061 Previous editions may be used.
SECTION 1
~
.....
~
New York State Department of Environmental Conservation
Division of Water
Report o~f Noncompliance Event
To: DEC Water Contact
..,
DEC Region: -5
Report Type: _ 5 Day
/
Permit Violation tL. Order Violation _ Anticipated Noncompliance _ Bypass/Overflow
SECTION 2
Description of n.oncompliance(s) and cause(s): /u...,:;-
rf,:: C.p<;~({;t/ ,)~i.1w,- (/ ..?,~:-lc;.
,
SPDES #: NY.ft.; :;/ (/ 0 / Facility: /~~. r~j( ~p S'Jf:J-1Cifj.l~'{) N~-{--!.7fl
? ,., ~
Date of noncompliance:..) / '6 /;;Ii; to Location .(/?utfa.!!,;Treatment Unit, or Pump Station):
_1
~ C!- (4/(.,1
1./-.. , c - , ,r)
" ("c.".,,/\", . ",1 c. ~,) L~ ,..-r...o:
I / w'" c5-'tA/~.1-';; {,1 .r
;::],.. .;.:.J
I ,Vv C:CI~.p't<-t.~. (, ~
Has event cease~o) If so, when?
Start date, time of event: / /
Was event due to plant upset? (Yes~~SPDES limits violated~(NO)
(AM) (PM) End date, time of event: / / (AM) (PM)
(AM) (PM) DEC Official contacted:
Date, time oral notification made to DEC?
Immediate corrective actions:
If/'? ." ./-P
_.
Preventive (long term) corrective actions:
-;! i_' /'; i T7) CT-', ;- ./1
,
.-r;O i/
(
/()
((;(r
. /,r:~-,-, I
~ r~ c ,i 't:,,/ .~/
il./X /' /c.
(;./ .
.,.i.'V
'1"",.,~ rY;. -r --' -j
~ I.'~' ..,.. /. ~. ......-..~
(
-
SECTION 3
Complete this section jf event was a bypass:
Bypass amount:
Was prior DEe authorization received for this event? (Yes) (No)
DEC Official contacted:
Date ofDEC approval:
Describe event in "Description of noncompliance and cause" area in Section 2. Detail the start and end dates and times in Section 2 also.
SECTION 4
(1' r\- f
Facility Representative: r It, p \ (~ 11 ~ i}J.;
r J ! i l
'" '.- II -) 7' r
Phone #: (t,'~-<\ ).Q...\I: J ... ,31 j
It I; Ij q<~.. ~~:+r/
Title:\.. l'V,-!, -\ \ ; II,n_'.ok ,~
.......' r r. I \(..., ~ ~ f'- ,/
Fax #: (2, ~.) ) I'-"'D...J... /.5 l.<J
, i
Date:~-
iC'/ re-
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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of Ihe 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 fine and imprisonment for knowing violations.
I
Signature of Principal Executive
Officer or Authorized Agent