WQ0019782_Monitoring - 08-2020_20201006

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of
Permit No.: WQ0019782
FacilityName: YMCA -CAMP WEAVER
County: Guilford
Month: August
Year: 2020
PPI: 001
Flow Measuring Point: - e Influent ❑ Effluent n No Flow generated
parameter Monitoring Point: a Influent 0 Effluent 0 Groundwater Lowering ❑ Surface Water
Parameter Code -►
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SamplingT eCOt(9
Type:
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�� Gkati�
Grab
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Sample Frequency
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3x Year
N4Year
3x Year
3x Year

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of
Sampling Person(s)
Name: Chip White
Name:
Name: Statesville Analytical
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? u i-ampltam u non-t.ompuanc
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_
due to the deduct values being higher than
occurred due to people were using more water at the areas where the deducts are
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Chip White
Permittee: YMCA of Greensboro
Certification No.:
Signing Official: Rhonda Anderson
Grade: Phone Number: 252-235-4900
Signing Official's Title: President/CEO
Has the ORC changed since the previous NDMR? Yes o No
Phone Number: Permit Expiration: 9/30/2020
20
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 better, We, accurate, and complete. 1 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: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 of 2
PermitNo.: WQ0019782
Facility Name: YMCA -CAMP WEAVER
County: Guilford
Month: August
Year: 2020
Did irrigation occur
at this facility?
a YES 0 NO
Field Name;
2
0-01
B '11 t
Field Name:
4
1 910111
MIN SL37
Area (acres):
0.3719
OUR
acres
Area (ac
0.4477
;Jri Cover
op
a nm
Cover Crop:
Natural Forest
WINE
Cover Crop:
Natural Forest
M
Hourly Rate (in):
0.4
Hourly Rate (in):
0.4
f:eft
0
Annual Rate (in):
38.3
;g quil"'t Jv
Annual Rate (in
38.3
Weather
Freeboard
0 NO
ry
fl
07
0
U
0)
2
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Monthly Loading:
REMNEWUMMI-7-3-17MM-75-3
48,842
4-02
12 Month Fk " T
25.05
881

FORM: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Page 2 of 2
C3 Compliant
❑ Non -Compliant
O Compliant
0 Non -Compliant
• Compliant
❑ Non -Compliant
o Compliant
❑ Non -Compliant
to 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: Chip White
Permittee: YMCA of Greensboro
Certification No.:
Signing Official: Rhonda Anderson
Grade: Phone Number- 252-235-4900
Signing Official's Title: President/CEO
Has the ORC changed since the previous NDAR-1? ❑ Yes o No
Phone Number: Permit Exp.: 9/30/20
Signature Daie
Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penally 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