WQ0036210_Monitoring - 12-2020_20210122

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Na--�NQ0036210
•• • Christian Camp
.Moore
Flow Measuring Point: Influent Effluent No flow generated
Influent Effluent Groundwater Lowering El Surface Water
Parameter Monitoring Point:
•
Daily AnIMUM:

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I] Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Thomas Lewis
Permittee: Benchmark Ministries Inc.
Certification No.: 1002746
Signing Official: Thomas Lewis
Grade: SI Phone Number: 919-815-7603
Signing Official's Title: President
Has the ORC changed since the previous NDMR? ❑ yes 0 No
Phone Number: 919-815-7603 Permit Expiration: 1 /31 /2023
S nature Date
ignature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

•FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQ003621 0
Facility Name: Moore's Keep Christian Camp
County: Moore
Month:
:.
--Field Name:
• irrigation occur
Area (acres):.•Area
(ac
at this facility?
Cover Croly.
Cover Crop:
Forest/Grass
YES NO
Hourly Rate (in):
Hourly Rate (in):�
Annual Rate (in):
W.R.M. IT i F11 R.1
Annual Rate (in):
:-....Field
Irrigated?
•
:.Irrigated?ki
•
..:.
•
:. ..:.
•

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
[]Compliant ❑ Non -Compliant
u(Compliant ❑ Non -Compliant
[5 Compliant ❑ Non -Compliant
❑ Compliant ❑ Non -Compliant
[/Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Thomas Lewis
Permittee:
Benchmark Ministries Inc.
Certification No.: 1002746
Signing Official: Thomas Lewis
Grade: SI Phone Number: 919-815-7603
Signing Officials Title: President
Has the ORC changed since the previous NDAR-17 ❑ Yes [Z No
Phone Number: 919-815-7603 Permit Exp.: 1 /31 /23
`—
- -
gnature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617