WQ0007026_Monitoring - 09-2020_20201110 (2)

NON DISCHARGE WASTEWATER MONITORING REPORT
Page I of _
PERMIT NUMBER:
FACILITY NAME:
W00007026
Sanford Health & Rehabilitation
MONTH: September YEAR:
COUNTY:
9n9n
Lee
Flow Monitoring Point: Effluent: �2j Influent: n
Parameter Monitoring Point: Effluent: ❑ Influent: ❑ ISurface Water (SW): ❑
SW Code/Name:
Was There
Effluent
Flow
For This Month
Generated At This Facility: Yes:
No:
50050
00400 1
50060
00310
00610
00530
31616
00625
00620
665
180C 1
940
D
A
T
E
Operator
Arrival
Time
2400
Clock I
Operator
Time On
Site
ORC
on
Site?
Daily Rate
(Flow) into
Treatment
System
I
pH j
Residual
Chlorine
BOD-5
20°C
NH3-N
I
TSS I
Fecal
Coliform
(Geo-metric
Mean*)
TKN
Total NO3
as N
Total
Phosph
orous
TDS
Chlorid
e
HRS
Y/N
GALLONS
UNITS
UG/L
MG/L
MG/L
MG/L
/100ML
MG/L
MG/L
MG/L
Mg/I
Mg/I
1
15919
2
15919
3
15919
4
15919
5
15919
6
15919
7
15919
8
10:55
0.42
Y
15919
6.31 I
0.26
9
15946
10
15946
ill
15946
12
15946
13
15946
14
15946
15
9:00
1
Y
15946
6.48
0.31
9
3.4
47
2000
8.3
<0.041
2.3
160
37
16
16184
171
16184
18
16184
19
16184
20
14:40
0.42
Y
16184
6.46
0.28
21
1707
22
8:35
1.58
Y
1707
I
231
1707
241
1707
25
1707
26
1707
27
1707
28
10:40
0.5
Y
1707
6.25
0.21
29
13510
301
1
13510
31
0
Average
11631.291
0.265
9
3.4
47
2000
8.3
#DIV/O!
2.3
160
37
Daily Maximum
16184
6-481
0.311
9
3.4
47
2000
8.3
01
2.3
160
37
Daily Minimum
01
6.251
0.211
9
3.4
47
2000
8.3
01
2.3
160
37
Monthly Limit(s)
15720 gpdl
NAI
NAI
NA
NA
NA
NA
NA
NAI
NA
Composite (C) / Grab (G)
IG
IG
IG
G
G
G
G
IG
IG
Operator in Responsible Charge (ORC):
Check Box if ORC Has Changed: ❑
Randall Jarrell
Grade: IV / SI Phone: [phone]
ORC Certification Number: 7937 /23925
Certified Laboratories (1): Wastf/ater Management, L.L.C. (2): ENCO
Person(s) Collecting Samples: '(% Randall Jarrell
Mail ORIGINAL and TWO COPIES to: ©Vol
ATTN: Non -Discharge Compliance_ Unit -© (SIGNATURE OF OPERAT R IN RESPONSIBLE CHARGE)
DENR 0 ra BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
Division of Water Quality,. �� AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Centery 7�
RALEIGH, NC 27699-1617
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?
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."
(Signature of Permitt e)* Date
Sanford Health & Rehabilitation
(Permittee-Please print or type)
2702 Farrell Road
Sanford, N.C. 27330
(Permittee Address)
Parameter Codes:
Randall Jarrell
(Name of Signing Official -Please print or type)
(Position or Title)
919-210-2500
(Phone Number)
NO
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 TSSlTSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
5/31 /2015
(Permit Exp. Date)
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 213.0506 (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.
PERMIT NUMBER: WQ0007026 MONTH: September
Page 3 of -;-
YEAR: 2020
FACILITY NAME: Sanford Health & Rehabilitation COUNTY: Lee
Formulas:
Daily Loading (inches) = (Volume Applied (gallons) x 0.'• 336 (cubic feet/gallon) x 12 (inches/foot)] i [Area Sprayed (acres) x 43, 560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (galionslacre-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)
11.... \I1I....LI.. 1 .... ;I /:ne kI 1 ..../ ­.V'inn I f A , in }he mn nfh r 71n�e M1.roo41
Did Irrigation Occur At This Facility:
Yes: El 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):
8
AREA SPRAYED (acres):
COVER CROP:
Fescue
COVER CROP:
PERMITTED HOURLY RATE (inches):
0.25
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
Storage
Lagoon
Free-
board
PERMITTED YEARLY RATE (inches):
30.11
PERMITTED YEARLY RATE (inches):
Weather
Code'
Temper-
ature at
application
Precipita-
tion
Volume
Applied
Time
Irrigated
Dail Y
Loading
Maximum
Hourly
Y
Loading
Volume
Applied
Time
Irrigated
Dail Y
Loading
Maximum
Hourly
y
Loading
(°F)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
2
3
4
5
6
7
8 1
PC
78
0.14
4'4"
49875
399
0.23
0.03
9
10
11
12
13
14
15
C
67
1.74
32"
49875
399
0.23
0.03
16
17
18
19
20
PC
67
2.23
3'0"
49875
1 399
0.23
0.03
21
22
23
24
PC
72
2'10"
49875
399
0.23
1
25
26
C
63
1
11111,
49875
1 399
0.23
0.03
27
28
PC
70
2.26
2'6"
49875
399
0.23
0.03
29
30
31
Total Gallons/Monthly Loading (inches)
299250
1.38
0
0.00
12 Month Floating Total (inches)
22.93
Average Weekly Loading (inches)
0.3212335
0
- Weather Goaes: ).-Clear, t't.-partly ciouay, i.l-ciouuy, M-rdm, an -snow, N-blUet
Spray Irrigation Operator in Responsible Charge (ORC)
ORC Certification Number: 7937 / 23925
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Randall Jarrell Phone: [phone]
Check Box if ORC Has Changed: ❑
/L /t
(SIGNATURE OF OPERATOR INAESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.
DENR FORM 1 (5/2003)

NON -DISCHARGE APPLICATION REPORT Page �j of
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 did the limit(s) in the
Compliant Y,N)
YL�
application rate(s) not exceed specified 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 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."
/Z1
(Signature of Permittee)"�JJ Date
Sanford Health & Rehabilitation
(Permittee-Please print or type)
2702 Farrell Road
N.C.27330
(Permittee Address)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500 5/31 /2015
(Phone Number)
(Permit Exp. Date)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)

Sanford Health And Rehabilitation
12 Month Rollinq Total Application In Inches
2020 2020 2020 2020 2020 2020 2020 2020 2020 2019 2019 2019 2020
Field Jan Feb March April May June JuIv Auclust Sept Oct Nov Dec Total
1 1.74 2.52 1.83 1.28 2.31 2.02 1.84 2.19 1.38 2.02 1.65 2.15 22.93