WQ0022785_Monitoring - 07-2020_20200918

NON DISCHARGE WASTEWATER MONITORING REPORT
Page of
PERMIT NUMBER:
FACILITY NAME:
W00022785
Lattisville Grove Baptist Church
MONTH: July YEAR: 2020
COUNTY: Orange
Flow Monitoring Point: Effluent: Influent:
Parameter Monitoring Point: Effluent: Dg Influent: Surface Water (SW):
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: No:
50050
001400
50060
00310
00610
00530
31616
00625
00630
00665
000620
00600
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 )Ge
metric Mean')
TKN
Nitrate +
Nitrite
Total
Phosph
orus
Total
Nitrate
as(N)
Total
Nitrogen
as N
HRS
Y/N
GALLONS
UNITS
UG/L
MG/L
MGIL
MG/L
/100ML
MG/L
MG/L
MG/L
MG/L
MG/L
1
1
57
2
11:35
0.25
N
57
6.78
0.29
3
117
4
117
5
117
6
117
7
117
8
1143
0.33
Y
117
7.05
0.55
9
63
10
63
11
63
121
1
63
131
63
141
63
151
63
16
8:05
0.25
N
63
6.57
0.1
17
60
18
60
19
60
20
60
21
14:35
0.25
N
60
6.62
1 0.15
22
71
23
71
24
71
25
71
261
71
27
71
28
14A0
0.25
N
71
6.63
0.15
29
107
30
107
31
107
Average
78,645161
0.248
#DIV/01
#DIV/0!
#DIV/0!
#NUM!
#DIV/0'
#DIV/01
#DIV/0!
#DIV/01
#DIV/0!
Daily Maximum
117
7.05
0.55
0
0
0
0
0
0
0
0
0
Daily Minimum
1 57
6.57
0.1
0
0
0
0
0
0
0
0
0
Monthly Limit(s)
1 956 GPD
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Composite (C) / Grab (G)
G
G
IG
G
G
G
G
G
G
G
G
Operator in Responsible Charge (ORC):
Check Box if ORC Has Changed:
17
Chad Leinbach Grade: SI
ORC Certification Number:
Phone: [phone]
23928
Certified Laboratories (1): Conner Consulting, LLC (Field) (2): ENCO, Inc. (Lab)
Person(s) Collecting Samples: Chad Leinbach
Mail ORIGINAL and TWO COPIES tdl
ATTN: Non -Discharge Compliance liP6 (SIGNATURE OF OPERATOR IN RE SPONSr8LE CHARGE)
DENR y1 BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE
Division of Water Quality u� AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Centers N
RALEIGH, NC 27699-1617 C p
DENR FORM NDMR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
Page of
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."
( 4/ z , II(21z) Chad Leinbach
(Signature of PeYml ee)* Dfite (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church
(Perm ittee-Please print or type)
1701 Jimmv Ed Road
Hurdle Mills, NC 27541
(Permittee Address)
Parameter Codes:
ORC
(Position or Title)
[phone] 10/31/23
(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
003DO Dissolved Oxygen
00556 Oil -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
W009 PAN Plant Available
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
Residual
00927 Ma nesium
32730 Phenols
00680 TOC
71900 Mercur
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 28.0506 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
Page _ __ of
PERMIT NUMBER: VVQ0022785
[N[orWII
YEAR: 2020
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Formulas:
Dally Loading (inches) =[Volume Applied (gallons) x 0,1336 (cubic feet/gallon) x 12(inchestfooq]/[Area Sprayed (acres) x 43, 560(square feeliacre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acr -inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches)/[Time Irrigated (minutes)/ 60 (minutes/hour)l Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this morth's Monthly Loading (inches) and previous 11 month's Monthly Loadings inches)
Avers a Weekly Loadin inches = (Monthly Loading (inches/month) / Number of days in the month (days/month)] x 7 (dayslweek)
Did Irrigation occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No:
FIELD NUMBER:1
FIELD NUMBER:
AREA SPRAYED (acres):
1.04
AREA SPRAYED (acres):
COVERCROP:1
Fescue, Rye
COVER CROP:
PERMITTED HOURLY RATE (inches):
0.2
PERMITTED HOURLY RATE (inches):
D
TWeather
E
WEATHER CONDITIONS
Storage
Lag-,
Free -board
PERMITTED YEARLY RATE (inches):
23.75
PERMITTED YEARLY RATE (inches):
Code`
Temper-atue
at application
Precipita-tion
Volume
Applied
Time
Irrigate
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
(°F)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
Inches
1
NA
0
0
0.00
#DIV/0!
2
PC
82
1.03
NA
0
0
0.00
#DIV/0!
3
NA
0
0
0.00
#DIV/01
4
NA
0
0
0.00
#DIV/0!
5
NA
0
0
0.00
#DIV/0!
6
NA
0
0
0.00 1
#DIV/01
7
NA
0
0
0.00 1
#DIV/0!
8
Cl
82
0
NA
0
0
0.00
#DIV/0!
9
NA
0
0
0.00
#DIV/0!
10
NA
0
0
0.00
#DIV/0!
11
NA
0
0
0.00
#DIV/0!
12
NA
0
0
0.00
#DIV/O!
13
NA
0
0
0.00
#DIV/0!
14
NA
0
0
1 0.00
#DIV/0!
151
V35
NA
0
0
0.00
#DIV/0!
16
PC
80
NA
0
0
0.00
#DIV/0!
17
NA
0
0
0.00
#DIV/01
18
NA
0
0
0.00
#DIV/0!
19
NA
0
0
0.00
#DIV/01
20
NA
0
0
0.00
#DIV/0!
21
PC
95
0.15
NA
0
0
0.00
#DIV/0!
221
NA
543
20
0.02
0.06
23
NA
543
20
0.02
0.06
24
NA
543
20
0.02
0.06
25
NA
543
20
0.02
0.06
26
NA
543
20
0.02
0.06
27
NA
543
20
0.02
0.06
28
PC
92
0.22
NA
543
20
0.02
0.06
29
NA
0
0
0.00
#DIV/0!
30
NA
0
0
0.00
#DIV/0!
311
NA
0
0
0.00
#DIV/01
Total Galls/Morrthly Loading
on
(inches)
3801
0.13
0
0.00
12 Month Floating Total (inches)
• :
3.45
Average Weekly Loading (inches)
:
0.0303739
0
' Weather Codes: Clear, PC -partly cloudy, CI -cloudy, R-rain, Sn-snow, SI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach
ORC Certification Number:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
23928 Check Box if ORC Has Changed:
Phone: [phone]
(SIGNATURE OF OPERATOR IN RESPOASIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT Pageof
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. )
1. The application rate(s) did not exceed the limit(s) specified in the 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.
4. All 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.
Compliant YN
Y
0
0
0
NA
If the facility is noncompliant, 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 noncompliance 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."
Chad Leinbach
(Signature of Permittee)* Dafe / (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church
(Permittee-Please print or type)
1701 Jimmy Ed Road
Hurdle Mills, NC 27541
(Permittee Address)
(Position or Title)
[phone]
(Phone Number)
ORC
* If signed by other than the permittee, delegation of signatory authority must be on rile with the state per 15A NCAC 2B.0506 (b)(2)(D).
10/31 /23
(Permit Exp. Date)
DENR FORM NDAR-1 (52003)