WQ0002015_Monitoring - 09-2020_20201028

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0002015
Name of Facility:*
Month:* September
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 1.94MB
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
6W� 6/ a4fiW1V1
Reviewer: Williams, Kendall
10/27/2020
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: 10/28/2020

FORM R-1 10-13 NON -DISCHARGE APP TION REPORT (NDAR-1) Page _ -)f

FORM:' -1 10-13 NON -DISCHARGE APPI rION REPORT (NDAR-1) Page _ !
Did the application rates exceed the limits in Attachment B of your permit?
�i Compliant
0 Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
IDCompliant
D Not -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
F±1 Compliant
0NorrCompliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
ElCompliant
Not -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
ED 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)
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)W101C changed since the previous NDAR-1? Yes❑, No
Phone Number: [phone] Permit Exp.: 7/31/19
zo
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 person
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 violation.
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►
Panes

FORM: 1 03-12
Name: Dale Lee Mathews
Name: Andy L. Mathews
Sampling Person(s)
NON -DISCHARGE ll
RING REPORT (NDMR)
Name: Meritech
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
Page _
❑� Compliant NorrCo pliant
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 dates) 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 NDMR? Yes R No
Phone N er: [phone] Permit Expiration: 7/31/19
t offal Izo
101�--t iza
Signature Date
Signature Date
By ties signature, I certify that this report is accurrate and compete 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 propoly gathered and evaluated the information submitted. Based on my inquiry of the parson 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 fires 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