WQ0007026_Monitoring - 10-2021_20211207

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * October
Report Information
WQ0007026
Sanford Health & Rehabilitation
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
SHR NDMR 10-21.pdf
PDF Only
2.76M B
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Randall C Jarrell
rzrrz// re'7"itl
Reviewer: Plummer, Lauren
12/7/2021
This will be filled in automatically

Is the project number correct?* WQ0007026
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Accepted Date:
12/17/2021

PERMIT NUMBER:
FACILITY NAME:
NON DISCHARGE WASTEWATER MONITORING REPORT
W00007026
Sanford Health & Rehabilitation
MONTH: October
COUNTY
Page 1 of 5
YEAR: 2021
Lee
Flow Monitoring Point: Effluent: 0 Influent: ❑
Parameter Monitoring Point: Effluent: M 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
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
20oC
NH3-N
TSS
Fecal
Coliform
(Geo-metric
Mean*)
TKN
Total NO3
as N
Total
Phosph
orous
TDS
Chlorid
e
HRS
YIN
GALLONS
UNITS
UG/L
MG/L
MG/L
MG/L
/100ML
MG/L
MG/L
MG/L
Mg/I
Mg/I
1
7523
2
7523
3
7523
4
10:30
0.42
Y
7523
6.46
1 0.19
5
2797
6
2797
7
2797
8
2797
9
2797
10
2797
11
10:25
0.42
Y
2797
6.39
1 0.22
12
7844
13
7844
141
7844
15
7844
16
7844
17
7844
18
10:35
0.42
Y
7844
6.62
0.2
19
6461
201
1
6461
21
6461
22
6461
23
6461
24
6461
25
10:15
0.42
Y
6461
6.69
0.26
26
7429
271
1
7429
28
7429
29
7429
30
7429
31
7429
Average
6270.323
0.218
#####
#####
#####
#NUM!
#####
#DIV/0!
#####
#####
#####
Daily Maximum
1 78441
6.691
0.26
01
0
0
0
01
0
0
0
0
Daily Minimum
2797
6.391
0.19
0
0
0
0
0
0
0
0
0
Monthly Limit(s) 115720
gpd
NA
NA
NA
NA
NA
NA
NA
NAI
NA
Composite (C) / Grab (G)
G
G
G
G
G
G
G
G
IG
Operator in Responsible Charge (ORC): Randall Jarrell Grade: IV / SI
Check Box if ORC Has Changed: ❑ ORC Certification Number:
Certified Laboratories (1): Wastewater Management, L.L.C. (2):
Person(s) Collecting Samples: Randall Jarrell
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Phone: [phone]
7937 /23925
ENCO
I
(SIGNATURE OF OPERATOR IN RE PONSIBLE 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 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?
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."
ZLI I (( Z,Izt
(Signature of Permi tee)* 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)
ORC
(Position or Title)
919-210-2500
(Phone Number)
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 TSSfTSR
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 Page 3 of S
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0007026 MONTH: October YEAR:
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)
Averaae Weekly Loadina f inchesl - tMonthly I. oadino (inches/month) / Number of dnvs in the month ma ­/month)) v 7 fdays/—PI,l
2021
Did Irrigation Occur At This Facility:
Yes: P1 No: ❑
Did Irrigation Occur On This Field:
Yes: I] 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):
weatner
Code'
Temper-
ature at
application
Precipita-
tion
Volume
Applied
Time
Irrigated
Dail y
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
ff)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
2
3
4
C
80
0
2'8"
37500
300
0.17
0.03
5
6
7
8
9
10
11
CL
67
2.06
2'6"
62850
498
0.29
0.03
12
13
14
15
16
17
18
C
48
0
2'9"
62850
498
0.29
0.03
19
20
21
22
23
24
25
CL
65
0
2'3"
62850
498
0.29
0.03
26
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
226050
1.04
0
0.00
12 Month Floating Total (inches)
14.93
Average Weekly Loading (inches)
0.2348284
0
VV-1 c1 ..uuca. �.-ucat, 11-Hatay uuuuy, a.rcruuuy, mraur, an -snow, al -stem
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 VL Ne//i DENR
Division of Water Quality (SIGNATURE OF OPERATOR 114 RESPONSIBLE 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 PageL-1 of 5-
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or I 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 did the limit(s) in the
Com III ant Y,N)
ly
rate(s) not exceed specified permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
YO
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."
(Signature of Perm' ee)* Date
Sanford Health & Rehabilitation
(Perm ittee-Please print or type)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500
2702 Farrell Road (Phone Number)
Sanford, N.C. 27330
(Permittee Address)
5/31 /2015
(Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (1
DENR FORM NDAR-1 (5/2003)

Sanford Health And Rehabilitation
12 Month Rolling Total Application In Inches
2021 2121 2021 2021 2021 2021 2020 2021 2021 2021 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 1.21 1.45 1.04 1.38 1.38 14.93