WQ0002015_Monitoring - 10-2021_20211214

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * October
Report Information
WQ0002015
Oka 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*
SMMWATERSER21121407... 1.93MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Dale Mathews
Reviewer: Zhong, Vivien
12/14/2021
This will be filled in automatically

Is the project number correct?* WQ0002015
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Accepted Date:
12/20/2021

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)
Name: Dale Lee Mathews
Name: Andy L. Mathews
Name: Meritech
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
�i 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 necessarv.
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 the ORC changed since the previous NDMR? Yes No Phone Number: [phone] Permit Expiration: 7/31/24
t1i3-p�21
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 su
pervision 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: 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
Nan -Compliant
❑i Compliant
Non -Compliant
�i Compliant
Nan -Compliant
R Compliant
❑ Non -Compliant
M Compliant nNon-Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not incompliance. 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: Bart Streb
Grade: Spray Irrigation Phone Number: [phone]
Signing Official's Title: Facility Manager
Has the-CLRC changed since the previous NDAR-1? Yes [D No
Phone Number: [phone] Permit Exp.: 7/31/24
A
t ! 1360)
Signature Date
Signature Date
By this signalise, I cerfify 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