WQ0007026_Monitoring - 06-2021_20210817 (5)

DWR - NonDischarge Monitoring Report Submittal
NORTH CAROLINA
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Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0007026
Name of Facility:* Sanford Health&Rehabilitation
Month:* June Year:* 2021
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR SHR NDMR 6-21.pdf 2.77MB
FDF Only
GW-59 SHR MW's#1,#2,#3 6-24- 2.69MB
21.pdf
FDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Randall Jarrell
Signature:
r c &07at-tee
Date of submittal: 8/17/2021
This will be filled in automatically

Initial Review
Reviewer: Mokashi, Poorva
Is the project number correct?* WQ0007026
Is the monitoring report r Yes r No
accepted?*
Regional Office* Raleigh
Accepted Date: 9/11/2021

NON DISCHARGE WASTEWATER MONITORING REPORT Page \ of S._
PERMIT NUMBER: WQ0007026 MONTH: June YEAR: 2021
FACILITY NAME: Sanford Health & Rehabilitation COUNTY: Lee
Flow Monitoring Point: Effluent: 0 Influent: ❑
Parameter Monitoring Point: Effluent: 0 Influent: ❑ Surface Water(SW): ❑ SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: ❑ No: ❑
50050 00400 50060 00310 00610 00530 31616 00625 00620 665 180C 940
Operator
D Arrival Daily Rate Fecal
A Time operator ORC (Flow)into Total
Coliform
T 2400
Time on on Treatment Residual BOD-5 (Geo-metric Total NO3 Phosph Chlorid
E Clock Site Site? System pH Chlorine 20°C NH3-N TSS Mean*) TKN as N orous TDS 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 10:30 0.5 Y 8933 6.76 0.14 _
2 8571 _
3 8571
4 8571
5 8571
6 16:00 0.42 Y 8571 6.41 0.12
7 7401
8 7401
9 7401
10 7401
11 7401
12 7401
13 7:40 0.42 Y 7401 6.87 0.12
14 8072
15 8072
16 8072
17 8072
18 8072 -
19 8072
20 8072
21 11:35 1 Y 8072 6.7 0.1
22 9282
23 9282
24 9282
25 9282
26 9282
27 9282
28 11:15 0.42 Y 9282 6.76 0.16
29 8896
30 8896
31
Average 8364.567 0.128 ##### ##### ##### #NUM! ##### #DIV/0! ##### ##### #####
Daily Maximum 9282 6.87 0.16 0 0 0 0 0 0 0 0 0
Daily Minimum 7401 6.41 0.1 0 0 0 0 0 0 0 0 0
Monthly Limit(s) 15720 gpd NA NA NA NA NA NA NA NA NA
Composite(C)/Grab(G) G G G G G G G G G
Operator in Responsible Charge(ORC): Randall Jarrell Grade: IV/SI Phone: [phone]
Check Box if ORC Has Changed: ❑ ORC Certification Number: 7937/23925
Certified Laboratories(1): Wastewater Management, L.L.C. (2): ENCO
Person(s)Collecting Samples: Randall Jarrell
/%
Mail ORIGINAL and TWO COPIES to: �.,q./1"4
ATTN: Non-Discharge Compliance Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
DENR 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 Center
RALEIGH, NC 27699-1617
DENR FORM NDMR-1 (5/2003)

Page 2 of .S.--
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? Y
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."
72,14,/tA l.. \z1 Randall Jarrell
(Signature of Pe ittee)* Date (Name of Signing Official-Please print or type)
Sanford Health & Rehabilitation ORC
(Permittee-Please print or type) (Position or Title)
2702 Farrell Road 919-210-2500 5/31/2015
(Phone Number) (Permit Exp. Date)
Sanford, N.C. 27330
(Permittee Address)
Parameter Codes:
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 00927 Magnesium 32730 Phenols 00680 TOC
Residual 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
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at(919)733-5083 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 2B.0506(b)(2)(D).
DENR FORM NDMR-1 (5/2003)

NON-DISCHARGE APPLICATION REPORT Page 3 of S.
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE.USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0007026 MONTH: June YEAR: 2021
FACILITY NAME: Sanford Health&Rehabilitation COUNTY: Lee
Formulas:
Daily Loading(inches) =[Volume Applied(gallons)x 0.1336(cubic feet/gallon)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)
Average Weekly Loading(inches) =[Monthly Loading(inches/month)/Number of days in the month(days/month)]x 7(days/week)
Did Irrigation Occur At This Facility: Did Irrigation Occur On This Field: Did Irrigation Occur On This Field:
Yes: ❑ No: LI Yes: 0 No: ❑ 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 WEATHER CONDITIONS PERMITTED YEARLY RATE(inches): 30.11 PERMITTED YEARLY RATE(inches):
Storage
A Temper- Lagoon Maximum Maximum
T Weather atureat Precipita- Free- Volume Time Daily Hourly Volume Time Daily Hourly
E code^ application tion board Applied Irrigated Loading Loading Applied Irrigated Loading Loading
(°F) inches feet gallons minutes inches inches gallons minutes inches inches
1 PC 77 0.28 2.8 62850 498 0.29 0.03
2
3
4
5
6 CL 84 2.68 4
7
8
9
10
11
12
13 PC 71 1.78 3 62850 498 0.29 0.03
14
15
16
17
18
19
20
21 CL 87 1.53 3.6 62850 498 0.29 0.03
22
23
24
25
26
27
28 PC 87 0.4 3.1 62850 498 0.29 0.03
29
30
31
Total Gallons/Monthly Loading(inches) 251400 1.16 0 0.00
12 Month Floating Total(inches) 16.35
Average Weekly Loading(inches) 0.2698683 0
*Weather Codes: C-clear,PC-partly cloudy,Cl-cloudy,R-rain,Sn-snow,SI-sleet
Spray Irrigation Operator in Responsible Charge(ORC): Randall Jarrell Phone: [phone]
ORC Certification Number: 7937/23925 Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: Non-Discharge Compliance Unit
DENR
/4/
Division of Water Quality (SIGNATURE OF OPERATOR IN R PONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH,NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON-DISCHARGE APPLICATION REPORT Page `l of C
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. )
Com.liant Y,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). Y
3.A suitable vegetative cover was maintained on the site(s)in accordance with the permit. Y
4.All buffer zones as specified in the permit were maintained during each application. Y
5.The freeboard in the treatment and/or storage lagoon(s)was not less than the limit(s) Y
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."
/Z-1iY/(1
-6, l 21 Randall Jarrell
(Signature of Pe Mee)" Date (Name of Signing Official-Please print or type)
Sanford Health&Rehabilitation ORC
(Permittee-Please print or type) (Position or Title)
919-210-2500 5/31/2015
2702 Farrell Road (Phone Number) (Permit Exp.Date)
Sanford, N.C.27330
(Permittee Address)
"If signed by other than the permittee,delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506(b)(2)(D).
DENR FORM NDAR-1 (5/2003)

Sanford Health And Rehabilitation
12 Month Rolling Total Application In Inches
2021 2121 2021 2021 2021 2021 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 1.21 0.46 1.16 1.84 2.19 1.38 1.55 1.38 1.38 16.35