WQ0022785_Monitoring - 08-2020_20201021

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
Page _ of
PERMIT NUMBER: WQ0022785
MONTH: August
YEAR: 2020
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0,1336 (cubic feeUgallon)x 12 (inches/f-01 / [Area Sprayed (acres) x 43,560 (square feetlacre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) /[rime Irrigated (minutes)/ 60 (minuteS4)our)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) =Sum of this month's Monthly Loading (inches) and previous 11 monlh's Monthly Loadings(inches)
Average Weekly Loading (inches! = [Monthly Loading (incheshnonth) / Number of days in the month (days/monlh)] x 7 (days/week)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No:
Did Irrigation Occur On This Field:
Yes: n 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-arure
at application
Frecipda4ion
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
E
ff)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
i
NA
0
0
0.00
#DIV/01
2
NA
0
0
0.00
#DIV/O!
3
NA
0
0
0.00
#DIV/01
4
PC
88
2.78
NA
0
0
0.00
#DIV/O!
5
NA
0
0
0.00
#DIV/O!
6
NA
0
0
0.00
#DIV/0!
7
NA
0
0
0.00
#DIV/0!
8
NA
0
0
0.00
#DIV/01
9
NA
0
0
0.00
#DIV/O!
10
NA
0
0
0.00
#DIV/O!
11
NA
0
0
0.00
#DIV/0!
12
PC
88
0.75
NA
0
0
0.00
#DIV/O!
13
NA
0
0
1 0.00
#DIV/O!
14
NA
0
0
0.00
#DIV/O!
15
NA
0
0
0.00
#DIV/O!
161
NA
0
0
0.00
#DIV/0!
17
NA
0
0
0.00
#DIV/O!
18
NA
0
0
0.00
#DIV/O!
19
C
87
1.8
NA
0
0
0.00
#DIV/01
20
NA
457
17
0.02
0.06
21
NA
457
17
0.02
0.06
22
NA
457
17
1 0.02
0.06
231
NA
457
17
0.02
0.06
24
NA
457
17
0.02
0.06
25
NA
457
17
0.02
0.06
26
PC
92
1.55
NA
457
17
0.02
0.06
27
NA
261
10
1 0.01
0.06
28
NA
261
10
0.01
0.06
29
NA
261
10
0.01
0.06
30
NA
261
10
0.01
0.06
311
NA
261
10
0.01
0.06
Total Gallons/Monthly Loading (inches)
4504
0.16
0
0.00
12 Month Floating Total (inches)
• :
3.57
Average Weekly Loading (inches)
:
0.0359916
0
' Weather Codes: C-clear, PC -partly cloudy, Cl-cloudy, R-rain, Sn-snow, SI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach Phone: [phone]
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
rW�y
FDA 0
C�s
23928 Check Box if ORC Has Changed: El
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (52003)

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.
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 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)* lbate (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church
(Perm ittee-P lease 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 file with the state per 15A NCAC 2B.0506 (b)(2)(D).
10/31/23
(Permit Exp. Date)
DENR FORM NDAR-1 (5/2003)

J NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: WQ0022785 MONTH: August YEAR: 2020
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Flow Monitoring - ■��/���
Parameter Monitoring Point: Effluent: go
mllmn�
:..
N,
Nitrite
.. -
MENI
Operator in Responsible Charge (ORC):
Check Box if ORC Has Changed:
Certified Laboratories (1): Conner Consulti
Chad Leinbach Grade:
ORC Certification Number:
SI Phone: [phone]
23928
LLC (Field) (2): ENCO, Inc. (Lab)
Person(s) Collecting Samples: Chad Leinbach
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, INC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I 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? 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, i duding the possibility of fines and imprisonment for knowing violations."
Chad Leinbach
(Signature of Permittee)* Date (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
00921 Ma nesium
32730 Phenols
00680 TOC
71900 Mercur
00665 Phosphorus, Total
00530 TSSlrSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidi
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).
DENR FORM NDMR-1 (5/2003)