WQ0004502_Monitoring - 12-2020_20210201

NON DISCHARGE WASTEWATER MONITORING REPORT Page ___ of
PERMIT NUMBER: WQ0004502
FACILITY NAME: Hillsborough United Church of Christ
MONTH: December YEAR: 2020
COUNTY: Orange
Monitoring Point__ Effluent: El Influent:
Point:!Flow
Parameter Monitoring
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..(Flow)
Daily
into
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: - System
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DEi•�i•iGl6
Operator in Responsible Charge (ORC)
Check Box if ORC Has Changed
Certified laboratories (1):
Person(s) Collecting Samples:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
James W Gooch Grade:
ORC Certification Number:
(2):
IV Phone: [phone]
988035
;ATURE OF OP'EgATORIN RESPONSIBLE CHARGE)
HIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS ACCURATE
COMPLETE TO THE BEST OF MY KNOWLEDGE.
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."
S' _ 2 / Russell Knop
(Si of Pe ittee Date (Name of Signing Official -Please print or type)
Hillsborough United Church of Christ
(Permittee-Please print or type)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
Parameter Codes:
(Position or Title)
919-732-9183
(Phone Number)
Chair of Trustees
01002 Arsenic
31504 Coli(orm, 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 Col form
W009 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 TSS/TSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
4/30/2021
(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 perrnittee, 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)

Page ____ of
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00004502
MONTH: December YEAR: 2020
FACILITY NAME: Hillsborough United Church Of Christ COUNTY: Orange
Formulas:
Daily Loading (inches) _ [Votume Applied (gallonsi x 0.1336 (cubic feetgalloni x 12 (inchesrtoot)) / [Area Sprayed (acres) x 43560 (square feebacre)) OR
= volume Applied (gallons) / [Area sprayed (ec;res) x 27,152 (gallons/acte inch))
Maximum Hourly Loading (inches) - Daily Loading (inches) I jTime hrgated (minutes) I60 (minutes/hour)] Monthly Loading (inches) = Sum of Dady Loadings (inches)
12 Month Floating Total (inches) - sum of thm month's Monthly Loading (inches) and premus 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) - [Monthly Loading (nchestmooth) I Number of days in the month (days/month)] x 7 (days/week)
Did Irrigation Of — At This Facility:
Yes: P1 No: 1
Did Irrigation Occur On This Field:
Yes: [j No: ❑
Did Irrigation Occur On This Field:
Yes: L J No: ❑
FIELD NUMBER:
1
FIELD NUMBER:
AREA SPRAYED (acres);
2.6
AREA SPRAYED (acres):
COVER CROP:
Deciduous -Conifer
COVER CROP:
PERMITTED HOURLY RATE (inches):
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
Stwaga
Lagoon
Fraa-
b—rd
PERMITTED
YEARLY RATE (inches):
26
PERMITTED YEARLY RATE (inches):
Go�de�'
Temps-
alum at
application
Precipita-
lion
Volume
I Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
lied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
("F)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
PC
44
0
2.75
0
0
0.00
#DIV/0!
2
3
4
5
6
7
8
9
10
PC
56
0
2.5
0
0
0.00
#DIV/0!
11
12
13
14
1s
16
17
16
C
42
0
2.25
8520
240
0.12
0.03
19
20
21
22
C
48
0
2.5
8520
240
0.12
0.03
23
24
25
26
27
28
29
30
31
CL
50
0
2.75
0
0
0.00
#DIV/0!
Total Gallons/Morlthly Loading (inches)
17040
0.24
0
0.00
12 Month Floating Total (inches)
3.13
Average Weekly Loading (inches)
0.054467
0
Weather Codes: Cclear, PC-parby cloudy, Clcloudy, Rain, Snsnow, SI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): James W Gooch
ORC Certification Number: SI 987567 Check Box if ORC Has Changed:
Phone: [phone]
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (S N URE OF OPERATOR IN ESPONSIBLE CHARGE)
1617 Mail Service Center OY THIS SIGNATURE, I CERTI THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (512003)

Page _ of
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITES)
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. )
commiam N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. Y
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. T­71
4. All buffer zones as specified in the permit were maintained during each application. Y�
& The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s) �I
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
aprekimprisonment for knowing violations."
Russeti KnoQ
Sign t r of Permittee)" Date (Name of Signing Official -Please print or type)
_ Hillsborough United Church of Christ
(Permittee-Please print or type)
200 Davis
Hillsborough NC 27278
(Permittee Address)
Chair of -Trustees
(Position or Title)
919-732-9183 4/30/2021
(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 28.0506 (b)(2)(D).
DENR FORM NDAR-1 (5r2003)