WQ0002015_Monitoring - 01-2022_20220301

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * January
Report Information
WQ0002015
Oak Hill Fellowship Center
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
Oak Hill Fellowship Center 1.96MB
pdf
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: Gerald, Wanda
3/1 /2022
This will be filled in automatically

Is the project number correct?* WQ0002015
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Accepted Date: 4/11/2022

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? r-41Compliant F]Nont-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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Dale Lee Mathews
Permittee: Oak Hill Fellowship Center
Certification No.: 22794
Signing Official: Liza Farrar
Grade: Spray Irrigation Phone Number: [phone]
Signing Official's Title: Facility Manager
Has the ORC changed since the previous NDMR? ye two
Phone Niumber 919-782-2888 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 certfy, 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 qudiified 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
Permit No.: W00002015
Facility Name: Oak Hill Fellowship Center
Did irrigation occur at
this facility?
YES NO
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County: Granville I Month:
January
Year:
2022
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Annual Rate (in):
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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? PiCompliant 0 Non -compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? RCompliant El Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? �i compliant Non -Compliant
Were'all setbacks listed in your permit maintained for every application to each permitted site? P]Compliant Non -compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? PiCompliant nNon-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.
SPRAY FIELD PUMPS ARE DRAINED AND WINTERIZED DURING MONTHS OF FREEZING TEMPERATURES. FLOWS ARE LIMITED AND SPRAYING NOT REQUIRED.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Dale Lee Mathews
Permittee:
Oak Hill Fellowship Center
Certification No.: 22794
Signing Official: Liza Farrar
Grade: Spray Irrigation Phone Number: [phone]
Signing Official's Title: Facility Manager
Has the ORC changed since the previous NDAR-1? E]Yes�i No
Phone Number: 919-782-2888 Permit Exp.: 7/31/24
`
aA
0
i�iI
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