WQ0007026_Monitoring - 02-2020_20200406

Page 1 of S
PERMIT NUMBER:
FACILITY NAME:
NON DISCHARGE WASTEWATER MONITORING REPORT
W 00007026
Sanford Health & Rehabilitation
MONTH: February YEAR
COUNTY:
[*Twill
Lee
....................................................................
Flow Monitoring Point: Effluent: O Influent: ❑
Parameter Monitoring Point: Effluent: El Influent: ❑ Surface Water (SW): ❑
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: O No: ❑
50050
00400
50060
00310
00610
00530
31616
00625
00620
665
180C
940
D
A
T
E
Operator
Arrival
Time
2400
Clock
Operator
Time On
Site
ORC
on
Site?
Daily Rate
(Flow) into
Treatment
System
pH
Residual
Chlorine
BOD-5
20°C
NH3-N
TSS
Fecal
Coliform
(Geo-metric
Mean')
TKN
Total NO3
as N
Total
Phosph
orous
TDS
Chlorid
e
HRS
Y/N
GALLONS
UNITS
UG/L
MG/L
MG/L
MG/L
/100ML
MG/L
MG/L
MG/L
Mg/I
Mg/I
1
14199
2
14199
3
10:25
0.5
Y
14199
6.47
0.17
4
18678
5
18678
6
18678
7
18678
8
18678
9
18678
1 o
10:40
0.5
Y
18678
6.49
0.19
111
12543
12
12543
13
12543
14
12543
15
12543
16
12543
171
10:15
1 0.5
Y
1 12543
6.53
1 0.18
18
10878
19
10878
'=
20
10878
77
21
10878
�y
d
22
10878
`-
23
10878
24
10:50
0.42
Y
10878
6.59
1 0.16
c -
25
10337
�.
26
10337
27
10337
28
10337
291
10337
30
31
Average
13412.93
0.175
#####
#####
#####
#NUM!
#####
#DIV/0!
#####
#####
#####
Daily Maximum
18678
6.59
0.19
0
0
0
0
0
0
0
0
0
Daily Minimum
10337
6.47
0.16
0
0
0
0
0
0
0
0
0
Monthly Limit(s)
15720 gpdI
NA
NAI
NA
NA
NA
NA
IG
NAI
NA
NA
Composite (C) / Grab (G) IG
IG
IG
G jG
jG
IG
G
Operator in Responsible Charge (ORC)
Check Box if ORC Has Changed
7
Randall Jarrell Grade: IV / SI Phone: [phone]
ORC Certification Number: 7937 /23925
Certified Laboratories (1): Wastewater Management, L.L.C. (2):
Person(s) Collecting Samples:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Randall Jarrell
C
(SIGNATURE OF OPERATORuIN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Page z of -37
- . I
NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements? OY
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance
with its permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach additional sheets if necessary.
"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."
(Signature of ermittee)' Date
Sanford Health & Rehabilitation
(Permittee-Please print or type)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
2702 Farrell Road 919-210-2500 5/31 /2015
(Phone Number) (Permit Exp. Date)
Sanford, N.C. 27330
(Permittee Address)
Parameter Codes:
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 SAR
00310 BOD5
01042 Copper
00620 NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00556 Oil -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
WQ09 PAN (Plant Available)
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
Residual
00927 Magnesium
32730 Phenols
00680 TOC
71900 Mercury
00665 Phosphorus, Total
00530 TSS/TSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units designated in the reporting
facility's permit for reporting data.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).

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Page _ 3 of _ S
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00007026 MONTH: February YEAR:_
FACILITY NAME: Sanford Health & Rehabilitation COUNTY: Lee
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / (Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / Frime Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
AVp-rip Wpplrly I nnrilinn finch-1 - IMnnthly I narlinn hnnha i-m hl / Ni imhar of nave in Iho month Irlava/mnnthll v 7 Iriava/w kl
Did Irrigation Occur At This Facility:
Yes: ❑ No: ❑
Did Irrigation Occur On This Field:
Yes: 2 No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
FIELD NUMBER:
1
FIELD NUMBER:
AREA SPRAYED (acres),
8
AREA SPRAYED acres
COVER CROP:
Fescue
COVER CROP:
PERMITTED HOURLY RATE (inches):
0.25
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
Storage
Lagoon
Free -board
PERMITTED YEARLY RATE (inches):
30.11
PERMITTED YEARLY RATE (inches):
Weather
Code'
Temper-ature
at
application
Precipita-
tion
Volume
A lied
e
Ired
j
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irri ated
Daily
LoadingLoading
Maximum
Hourly
(°F)
inches
feet
gallons
es
inches
inches
gallons
minutes
inches
inches
1
2
3
PC
65
0.68
2'2"
49800
398
0.23
0.03
a
5
6
63
TO"
49800
398
0.23
0.03
7
50
1'10"
99600
796
0.46
0.03
8
9
101
CL
51
4.16
1'10"
49800
398
0.23
0.03
11
12
13
R
63
22"
49800
398
0.23
0.03
14
15
16
17
PC
49
0.73
2'0"
49800
398
0.23
0.03
18
19
20
SN
32
2'3"
49800
398
0.23
0.03
21
22
23
24
CL
1 50
0.58
1 22"
49800
398
0.23
0.03
25
26
27
PC
52
2'5"
49800
398
0.23
0.03
28
PC
60
0.46
211"
49800
398
0.23
0.03
29
30
31
Total Gallons/Monthly Loading (inches)
547800 1
2.52
0
0.00
12 Month Floating Total (inches)
22.59
Average Weekly Loading (inches)l
0.569073
1
0
vvearner i.00es: � -dear, v, ,-panty ciouoy, t,rcwuay, K-ram, an -snow, JI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): Randall Jarrell
ORC Certification Number: 7937 / 23925 Check Box if ORC Has Changed: ❑
Phone: [phone]
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
D EN R
Division of Water Quality (SIGNATURE OF OPERATOR IN FtESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.

Page =1 of
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
limit(s) in the
Compliant (YN)
ly
1. The application rate(s) did not exceed the specified permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
l
4. All buffer zones as specified in the permit were maintained during each application.
I J
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
L�
specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
The storage lagoon exceeded the 2.0 ft. limit on 2/7/20 and on 2/10/20. Ray Milash with DW R was notified on 2/10/20.
The freeboard was back in compliance on 2/13/20. The site recorded 6.61 inches of rainfall for the month of February.
"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 manaqe 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."
4�� 31s jz-
(Signature'of Perm' tee)' Date
Sanford Health & Rehabilitation
(Permittee-Please print or type)
2702 Farrell
Sanford, N.C. 27330
(Permittee Address)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500 5/31 /2015
(Phone Number) (Permit Exp. Date)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).

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Sanford Health And Rehabilitation
12 Month Rolling Total Application In Inches
2020 2020 2019 2018 2019 2019 2019 2019 2019 2019 2019 2019 2020
Field Jan Feb March April May June July Auclust Sept Oct Nov Dec Total
1 1.74 2.52 1.73 1.9 1.55 2.07 1.38 2.04 1.84 2.02 1.65 2.15 22.59