WQ0004502_Monitoring - 08-2020_20210201

NON DISCHARGE WASTEWATER MONITORING REPORT Page _ of
PERMIT NUMBER: W00004502 MONTH: August YEAR: 2020
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Flow Monitoring Point: Effluent: 0 Influent -
Parameter Monitoring Point: ___ _ ____ Effluent: LJ Influent: --'Surface Water (SW):_
Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: ■ ■
loDaily
.. -.
.
.-(Flow)
into
System
:..
•
•
Addendum for Lab Report
9 @
_0M�
mmpzns
®�p
i�ifGrufa�i
-IDaily
Minimum
Operator in Responsible Charge (ORC): _
Check Box if ORC Has Changed: LJ
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
MATURE OF OPERATFI RESPONSIBLE CHARGE)
HIS SIGNATURE, I 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? C�
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
fals information, including the possibility of fines and imprisonment for knowing violations."
Russell Knop
(Signet re o rmitt)` 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:
Chair of Trustees
(Position or Title)
919-732-9183 4/30/2021
(Phone Number) (Permit Exp. Date)
01002 Arsenic
31504 Corrform, 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 Colitorm
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 TSS/TSR
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 28.0506 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)