WQ0004502_Monitoring - 05-2020_20200624

Page _ of
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WO0004502
MONTH:
YEAR: 2020
FACILITY NAME: Hillsborough United Church Of Christ COUNTY: Orange
Formulas:
Daily Loading (inches) _ [Volume Applied (gallons) x 0.1336 (cubic feeVgallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feetiacre)] OR
= Volume Applied (gallons) I [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes)160 (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)
Average Weekly Loading inches = [Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (days/week)
Did Irrigation occur At This Facility:
Yes: 2 No: ❑
Did Irrigation Occur On This Field:
Yes: ❑Q No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
FIELD NUMBER:
1
FIELD NUMBER:
AREA SPRAYED (acres):
2.6
AREA SPRAYED (acres):
COVER CROP:
Deciduous -Conifer
COVER CROP:
PERMITTED HOURLY RATE (inches):
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
Storage
Lagoon
Free -Volume
board
PERMITTED YEARLY RATE (inches):
26
PERMITTED YEARLY RATE (inches):
Weather
code
Tamper-
atum at
application
Pnecipita-
tion
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
lied
Time
Irrigate
Daily
Loading
Maximum
Hourly
Loading
(°F)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
2
3
4
5
6
7
8
CL
64
0
2.75
8520
240
0.12
0.03
9
10
11
12
13
14
15
C
84
0
2.5
6690
180
0.09
0.03
16
17
16
19
20
21
CL
62
0
3
22
23
24
25
26
PC
78
0
2.25
8520
240
0.12
0.03
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
23730
0.34
0
0.00
12 Month Floating Total (inches)
3.01
Average Weekly Loading (inches)
1 0.075851
1
0
Weather Codes: C-clear, PC -partly cloudy, Cl-cloudy, R-rain, Sn-snow, SI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): James W Gooch
ORC Certification Number: SI 987567
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Check Box if ORC Has Changefl:
Phone: [phone]
(9119NATURE OF QPERAflbR 1N RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.
,p� 4 2020
DENR FORM NDAR-1 (5/2003)

Page
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. )
Compliant ,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4. Ail buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
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.
"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
an imprisonment for knowing violations."
(Signature of ermi ee)* Date
Hillsborough United Church of Christ
(Permittee-Please print or type)
Davis Rd.
Hillsborough NC 27278
(Permittee Address)
Russell Knop
(Name of Signing Official -Please print or type)
Chair of Trustees
(Position or Title)
919-732-9183 4/30/2021
(Phone Number) (Permit Exp. Date)
* ff 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).
DENR FORM NDAR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: WQ0004502 MONTH: May YEAR: 2020
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
MonitoringFlow P. El.
Parameter ■
® ..-
.. ..
.•(Flow)
Daily
into
Treatment
System
sailymaximum
Operator in Responsible Charge (ORC): .lames W Gooch Grade: IV Phone: [phone]
Check Box if ORC Has Changed: ORC Certification Number: 988035
Certified Laboratories (1):
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
(2):
(SIGNATURE O P RESPONSIBLE CHARGE)
BY THIS SIGNATU CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDMR-1 (5/2003)

Page of
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? �Y
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."
Zc�r2( / 7- r• Russell Knop
(Signature of Permittee)* V Date (Name of Signing Official -Please print or type)
Hillsborough United Church of Christ
(Permittee-Please print or type)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
Parameter Codes:
Chair of Trustees
(Position or Title)
919-732-9183 4/30/2021
(Phone Number) (Permit Exp. Date)
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
TSSITSR
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 26.0506 (b)(2)(D).
DENR FORM NDMR-1 (512003)