WQ0007026_Monitoring - 03-2021_20210501 (2)

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0007026
Name of Facility:*
Month:* March
Report Information
Sanford Health & Rehabilitation
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
[e-mail]
Randall C Jarrell
Reviewer: Williams, Kendall N
Year:* 2021
Upload Document*
SHR NDMR 3-21.pdf
FDF only
2.99MB
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
5/1 /2021
This will be filled in &Aormticaly

Is the project number correct? * WQ0007026
Is the monitoring report r Yes r No
accepted?*
Regional Office * Raleigh
Accepted Date: 5/4/2021

NON DISCHARGE WASTEWATER MONITORING REPORT Page 1 of �_
PERMIT NUMBER:
FACILITY NAME:
WQ0007026
Sanford Health & Rehabilitation
MONTH: March YEAR: 2021
COUNTY:
Lee
Flow Monitoring Point: Effluent: LZ Influent: ❑
Parameter Monitoring Point: Effluent: 121 Influent: ❑ Surface Water (SW): ❑
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: 0 No: ❑
60050
00400
60060
00310
00610
00530
31616 1
00625
00620
665
180C
940
D
A
T
E
Operator
Arrival
Time
2400
Clock
operator
Time on
Site
ORC
on
Site?
Daily Rate
(Flow) into
Treatment
System
pH
Residual
Chlorine
BOD-5
20°C
NH3-N
TSS
Fecal
Coliform
(Geo-metric
Mean*)
TKN
Total NO3
as N
Total
Phosph
orous
TDS
Chlorid
e
HRS
Y/N
GALLONS
UNITS
UGIL
MG/L
MG/L
MGIL
1100ML
MG/L
MG/L
MG/L
Mg/I
Mg/I
1
10:30
0.42
Y
6625
6.64
0.15
2
6195
3
6195
4
6195
5
1
6195
6
6195
7
6195
8
9:35
0.42
Y
6195
6.67
0.16
9
7429
10
8:00
1.58
Y
7429
23
2.4
29
440
7.7
0.85
2.2
200
1 34
ill
1
7429
12
7429
13
7429
14
7429
15
12:35
0.42
Y
7429
6.56
0.2
16
8387
171
8387
18
8387
19
8387
20
8387
21
8387
22
10:35
0.42
Y
8387
6.62
0.19
231
8483
24
8483
25
8483
26
8483
27
8483
28
8483
291
10:251
0.42
1 Y
8483
6.67
0.16
301
8288
311
1
8288
Average
7634.161
0.172
23
2.4
29
440
7.7
0.85
2.2
200
34
Daily Maximum
8483
6.67
0.2
23
2.4
29
440
7.7
0.85
2.2
200
34
Daily Minimum
6195
6.56
0.15
23
2.4
29
440
7.7
0.85
2.2
200
34
Monthly Limit(s)
15720 gpd
NA
IG
NAI
NAI
NAI
NAI
NAI
NAI
NAI
NA
Composite (C) / Grab (G)
G
IG
IG
IG
IG
IG
IG
IG
Operator in Responsible Charge (ORC): Randall Jarrell Grade:
Check Box if ORC Has Changed: ❑ ORC Certification Number:
Certified Laboratories (1): Wastewater Management, L.L.C. (2):
Person(s) Collectinq Samples: Randall Jarrell
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, INC 27699-1617
IV / SI Phone: [phone]
7937 /23925
ENCO
�Jv
(SIGNATURE OF`OPERA OR 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)

Page z of 5'
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."
y �,., � 2t
(Signature of P rmittee)* 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)
ORC
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.
Page _3_ of �
PERMIT NUMBER: WQ0007026
MONTH: March YEAR: 2021
FACILITY NAME: Sanford Health & Rehabilitation COUNTY: Lee
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (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)
Averaoe Weekly Loading (inches) = rMonthly I nadino (inches/month) / Number of days in the month fdays/month)l x 7 fdays/week)
Did Irrigation Occur At This Facility:
Yes: B No: ❑
Did Irrigation Occur On This Field:
Yes: F11 No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
FIELD NUMBER:
1 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
ff)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
R
60
1.18
2' 10"
2
3
4
C
64
2'6"
37500
300
0.17
0.03
5
6
7
8
C
43
0.04
3'6"
37500
300
0.17
0.03
9
10
11
C
75
3'6"
37500
300
0.17
0.03
12
13
14
15
CL
50
0
3'5"
16
17
18
CL
72
3'0"
37500
300
0.17
0.03
19
20
21
22
C
61
1.21
2-11"
37500
300
0.17
0.03
23
24
25
PC
73
32"
37500
300
0.17
0.03
26
27
28
29
C
54
1.04
32"
37500
300
0.17
1 0.03
30
31
Total Gallons/Monthly Loading (inches)
262500
1.21
0
0.00
12 Month Floating Total (inches)
19.13
11
Average Weekly Loading (inches)l
10.2726939
0
weatner t;oaes: u-clear, rc-paruy cloudy, w-cloudy, K-rain, sn-snow, JI-sleet
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: ❑
(SIGNATURE OF OPERATOPAN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Page q of 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.
Com III Y,N)
Y
0
0
0
0
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."
,/221L6A
(Signature of Permittee)* Date
Sanford Health & Rehabil
(Perm ittee-P lease print or type)
2702 Farrell Road
Sanford, 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 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)

Sanford Health And Rehabilitation
12 Month Rolling Total Application In Inches
2021 2121 2021 2020 2020 2020 2020 2020 2020 2020 2020 2020 2021
Field Jan Feb March April May June July August Sept Oct Nov Dec Total
1 1.38 2.21 1.21 1.28 2.31 2.02 1.84 2.19 1.38 1.55 1.38 1.38 19.13