WQ0036210_Monitoring - 03-2020_20200408

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? UCompliant UNon-t:omplont
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
taKen. Hrtacn auurlrunar antes n 1 1o%,V0aa1y.
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Thomas Lewis
Permittee: Benchmark Ministries Inc.
Certification No.: 1002746
signing Official: Thomas Lewis
Grade: SI Phone Number: 919-815-7603
signing Official's Title: President
Has the ORC changed since the previous NDMR? (DYes [ZNo
Phone Number: 919-815-7603 Permit Expiration: 1/31/2023
V
SI tur Date
g ature 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 property gathered and evaluated the Information
submitted. Based on my Inquiry of the person or persona 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 ,n `, of �,_
SC �_
40,
ParmitNo.: WQDD36210
Facility Name: MOORE'S KEEP CHRISTIAN CAMP
County: Moore
Did irrigati_o_r�Occur
at this facility?
YES NO
oAmas�
Wa
Monthly Loading:
12 Month Floating Total (in)-'

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?
[f-omphant
❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
[2,Comphant
❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
El<ompliant
❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
[]'Compliant
❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
[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
CI UtIV I Iib) IGRCI I. /1RQlAI GIUU I I.IVI IGI AI ICU LJ II
Operator in Responsible Charge (ORC) Certification11 Permittee Certification I
ORC: THOMAS LEWIS
Certification No.: 1002746
Grade: SI Phone Number: 919-815-7603
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
Permittee: BENCHMARK MINISTRIES
Signing Official: THOMAS LEWIS
Signing Official's Title: PRESIDENT
Phone Number: 919-815-7603 Permit Exp.
1 /31 /23
nature Date V 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