WQ0002015_Monitoring - 09-2021_20211101 (2)

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DWR - NonDischarge Monitoring Report Submittal •4 ..
NORTH CAROLINA
Emlranmenlcl QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0002015
Name of Facility:* Oak Hill Fellowship Center
Month:* September Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR Oak Hill Fellowship Center 1.91MB
.pdf
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Dale Mathews
Signature:
Date of submittal: 11/1/2021
This will be filled in automatically
Initial Review
...................
Reviewer: Mokashi, Poorva

Is the project number correct?* WQ0002015
Is the monitoring report accepted?* Yes No
Regional Office* Raleigh
Accepted Date: 12/2/2021

FORM:NDMR 03-12 NON-DISCHARGE MONITORING REPORT(NDMR) Page of
Permit No.: WQ0002015 I Facility Name: Oak Hill Fellowship Center I County: Granville I Month: September I Year: 2021
PPI: Flow Measuring Point: D Influent Effluent El No flaw generated I Parameter Monitoring Point: El Influent El Effluent ID Groundwater Lowering El surface water
Parameter Code --1, 50050 00400 ,50060� 00310 ,'3l0610 00530 r 1616 00615 -0i06 0"'. 00665 -0 ' 00010 0295 , 00940
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Average: 1j7j 23.07
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Sampling Type: *t9k 0 ' rt $ t ro ; g c t a +s'
Monthly Avg.Limit: O ���� ,
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Daily Limit: �r.yy 0w > S r,3 Y7+7 V 1 't Y t 1 @, t 'btK ? 3 t ,:j ; "v.
Sample Frequency: g , 11 ,?

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? ci 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 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: Bart Streb
Grade: Spray Irrigation Phone Number: [phone] Signing Official's Title: Facility Manager
Has •.•- `;changed since the previous NDMR?7 , Ejves El No Phone Number: [phone] Permit Expiration: 7/31/24
t�13►�Z, tol3►IzI
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 irptsry 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 vidations.
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 of
Permit No.: WO0002015 Facility Name: Oak Hill Fellowship Center County: Granville I Month: September Year: 2021
Field iia ': i Field Name: mid ire Field Name:
Did irrigation occur at >
Area t s t 1i Area(acres): A i iiiii Area(acres):
this facility?
ver t '- escde Cover Crop: O IL Cover Crop:
❑NO � 1ttt ,11 r Hourly Rate(in): our i 1a in)3 b Hourly Rate(in):
DYES
kttt'tita1 plate(ttijt:' Annual Rate(in): AnnttalRatelia) Annual Rate(in):
Weather Freeboard Fit`el+ itt ted? 10 NO Field Irrigated? 0 YES Ei No P0:i:1 dt : ,, Field Irrigated? 0 YES 0 NO
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a � En E rn i 4) E � a E rn
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�� Total 1W�,��`'...f`..1�'.I'. '.>.s}'`. '.,../`�'.. ,,, 'Iii ff"`,X.t''. '., './w'�.:; ''''"'". , .�''{,� " '.+'''r''./.f :f�'1''.r'./, '.',',:..v�°'`''..'' ,+;+'..+','". ,,.r°�". `�`. _ �.�` J".. .'`°',.,,ff.';". ` .f�'..4?'" .niiMir '/'. ../.,4

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? 0Compliant Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? El compliant ❑Ncn-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Licompliant Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? �i compliant ElNcn-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? []compliant El 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: Bart Streb
Grade: Spray Irrigation Phone Number: [phone] Signing Official's Title: Facility Manager
Has 7 at,6. .
tr= •+- changed since the previous NDAR-1? „Yes „No Phone Nu r: [phone] Permit Exp.: 7/31/24
�13►1z� 10\3)12.1
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 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