WQ0002015_Monitoring - 04-2021_20210514

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0002015
Name of Facility:*
Month:* April
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:* 2021
Upload Document*
Oak Hill Fellowship.pdf 1.93MB
FflF 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/ a4fiWItt
Reviewer: Williams, Kendall N
5/14/2021
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: 5/14/2021

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
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?
❑i Compliant
Non -Compliant
11 Compliant
Non -Compliant
RCompliant
Non -Compliant
0 Compliant
Non -Compliant
❑� Compliant 0 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 noncompliance 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 the changed since the previous NDAR-1? Yes Q No
Phone Number: [phone] Permit Exp.: 7/31/24
Signature Date
e
Signature Date
By this signature, I certify that this report is accurrate and complete to the best army 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
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? �i compliant nNarcomp(iant
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.
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 thqQkC changed since the previous NDMR? Yes M NoPhone
N [phone] Permit Expiration: 7/31 /24
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 tttose 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 knrnaing vitiations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617