WQ0002015_Monitoring - 07-2020_20201005 (2)

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0002015
Name of Facility:*
Month:* August
Report Information
Oak Hill Fellowship Center
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
COH .pdf 1.86MB
FDF only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
[e-mail]
Dale Mathews
Reviewer: Williams, Kendall
10/5/2020
This will be filled in automatically

Is the project number correct? * WQ0002015
Is the monitoring report r Yes r No
accepted?*
Regional Office * Raleigh
Accepted Date: 10/5/2020

FORM: t -1 10-13 NON -DISCHARGE APPL PION REPORT (NDAR-1) Page_

FORM:-110-13
NON -DISCHARGE APPt TION REPORT (NDAR-1)
Page _
Did the application rates exceed the limits in Attachment B of your permit?
ID Compliant
D Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
�i 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?
❑� 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
Permittee Certification
ORC: Dale Lee Mathews
Permittee:
Oak Hill Fellowship Center
Certification No.: 22794
Signing Official: Alan Glover
Grade: Spray Irrigation Phone Number: [phone]
Signing Official's Title: Facility Manager
Has the ORC changed since the previous NDAR-1? Dyes No
Phone Number: [phone] Permit Exp.: 7/31/19
A c31 _?WA�l
I Za
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certity, 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: 03-12 NON -DISCHARGE MO )RING REPORT (NDMR) Page _

FORM:! ; 03-12 NON -DISCHARGE MO `RING REPORT (NDMR) Page _
Sampling Person(s) Certified Laboratories
Name: Dale Lee Mathews Name: Meritech
Name: Andy L. Mathews Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of 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: Dale Lee Mathews
Permittee: Oak Hill Fellowship Center
Certification No.: 22794
Signing Official: Alan Glover
Grade: Spray Irrigation Phone Number: [phone]
Signing Official's Tide: Facility Manager
Has the ORC changed since the previous NDMR? Elves MNo
Phone Number: [phone] Permit Expiration: 7/31/19
m `� I� I za2�
Signature Date
a
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 accodan ce 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 these are significant penalfies 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