WQ0022785_Monitoring - 09-2020_20201021

NON -DISCHARGE APPLICATION REPORT Pageof
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0022785
MONTH: September YEAR: 2020
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Formulas:
Daily Loading (inches) = [Vciume Applied (gallons) x 0.1336 (mbicfeeugallon) x 12 (inches/foonj / (Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallonsiacre-inch)I
Maximum Hourly Loading (inches) = Daily Loading (inches) I [Time Irrigated (minutes) / 60 (minutes/hour)I Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this months Monthly Loading (inches) and precious 11 month's Monthly Loadings (inches)
Ave.a,.e week! l oadin., /i-heci - rne..,,thi� I -di- (. M ,/months ( Number of days in the month (days/month)l x 7 (dayslweek)
,....,... ., .. __...7 __.._... ,..._.. _.. ,..._......I ----
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
A
T
WEATHER CONDITIONS
Storage
Lagoon
Freeboard
PERMITTED YEARLY RATE (inches):
23.75
PERMITTED YEARLY RATE (inches):
Weather
Code'
Temper -acre
at application
Precipita-tion
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
E
(oF)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
NA
261
10
0.01
0.06
2
PC
78
0.67
NA
261
10
0.01
0.06
3
NA
0
0
0.00
#DIV/01
4
NA
0
0
0.00
#DIV/01
5
NA
0
0
0.00
#DIV/0!
6
NA
0
0
0.00
#DIV/0!
7
NA
0
0
0.00
#DIV/O!
8
PC
82
0.102
NA
0
0
0.00
#DIV/01
9
NA
0
0
0.00
#DIV/O!
101
NA
0
0
0.00
#DIV/0!
ill
NA
0
0
0.00
#DIV/O!
121
NA
0
0
0.00
#DIV/0!
13
NA
0
0
0.00
#DIV/0!
14
NA
0
0
0.00
#DIV/01
15
NA
0
0
0.00
#DIV/01
16
NA
0
0
0.00
#DIV/O!
17
R
70
0.46
NA
0
0
0.00
#DIV/0!
18
NA
0
0
0.00
#DIV/0!
191
1
NA
0
0
0.00
#DIV/O!
20
NA
0
0
0.00
#DIV/0!
21
NA
0
0
0.00
#DIV/O!
22
NA
0
0
1 0.00
#DIV/O!
23
NA
0
0
0.00
#DIV/01%
24
NA
0
0
0.00
#DIV/01.
25
R
60
4.1
NA
0
0
0.00
#DIV/0'.
261
1
NA
0
0
0.00
#DIV/O!
27
NA
0
0
0.00
#DIV/0!
28
NA
0
0
0.00
#DIV/01
29
PC
75
0.47
NA
0
0
0.00
#DIV/0!
30
NA
281
10
0.01
0.06
31
NA
Total Gallons/Monthly Loading
(inches)
803
0.03
0
0.00
12 Month Floating Total (inches)
3.53
Average Weekly Loading (inches)
:
0.0066307
0
Weather Codes: C-clear, PC -partly cloudy, CI -cloudy, R-rain, Sn-snow, 51-sleet
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number:
Chad Leinbach
23928 Check Box if ORC Has Changed
Phone: [phone]
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR �' S
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center n� ` BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 L.�s z`J d TO THE BEST OF MY KNOWLEDGE.
C'
G�
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.
Com liant 9N
F� YY
0
0
NA
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."
//Y--D
V Chad Leinbach
(Signature of Permittee)* Da (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
(Perm ittee Address)
(Position or Title)
[phone]
(Phone Number)
ORC
* 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).
10/31 /23
(Permit Exp. Date)
DENR FORM NDAR-1 (52003)

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: W00022785 MONTH: September YEAR: 2020
FACILITY NAME: Lattisville Grove Baptist Church 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 Facilit : Yes: No:
50050
00400 1
50060
00310 1
00610
00530
31616 1
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 (G.
metric Mean)
TKN
Nitrate +
Nitrite
Total
Phosph
ores
Total
Nitrate
as N
Total
Nitrogen
as N
HRS
YIN
GALLONS
UNITS
UGIL
MG/L
MGIL
MG/L
1100ML
MG/L
MG/L
MG/L
MG/L
MG/L
1 1
57
2
13:20
0.25
Y
57
7.2
0.11
3
67
4
67
5
67
6
67
7
67
8
1325
1 0.25
N
67
7.31
0.19
9
67
10
67
11
67
12
67
13
67
141
67
15
67
16
67
17
11110
0.25
N
67
7.27
0.24
18
63
19
63
20
63
21
63
22
63
23
63
24
63
251
11:00
0.5
Y
63
7.28
1 0.33
26
125
27
125
28
125
29
10:45
0.33
N
125
7.34
0.38
30
129
311
1
129
Average
76.806452
::
0.25
#DIV/01
#DIV/0!
#DIV/0!
#NUMi!
#DIV/0.'
#DIV/0!
#DIV/0!
#DIV/01:
#DIV/0!
Daily Maximum
129
7.34
0.38
0
0
0
0
0
0
0
0
0
Daily Minimum
57
7.2
0.11
0
0
0
0
0
0
0
0
0
Monthly Limit(s)
956 GPD
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
Composite (C) / Grab (G)
G
G
G
G
G
G
IG
G
G
IG
IG
Operator in Responsible Charge (ORC): _
Check Box if ORC Has Changed:
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 1
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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? L
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, jiincluding the possibility of fines and imprisonment for knowing violations."
/ii b () Chad Leinbach
(Signature of Permittee)* D to (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)
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
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 Ma nesium
32730 Phenols
00680 TOC
71900 Mercur
00665 Phosphorus, Total
00530 TSS7TSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbitli
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)