WQ0004502_Monitoring - 12-2021_20220404

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: W00004502 MONTH: December YEAR: 2021
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Flow Monitoring Point: Effluent: Ii Influent: 0
Parameter Monitoring Point: Effluent: i ! Influent: ❑ Surface Water(SW): Li SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: n No: ❑
50050 00400 50060 00310 00610 00530 31616 665 625 630 600
Operator
0 Arrival Daily Rate
Fecal
A Time Operator ORC (Flow)into Coliform
T 2400 Time On on Treatment Residual BOD-5 (Geo-metric TOT NO2- TOT N
E Clock Site Site? System pH Chlorine 20°C NH3-N TSS Mean') Phos TKN No3 C Calc
HRS Y/N GALLONS UNITS UG/L MG/L MG/L MG/L /100ML MG/L MG/L MG/L MG/L
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6 14:40 0.3 N 6.4 0 229 23.6 14.9 866 9.5 28.3 55.6 83.9
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Average #DIV/0! 0 229 23.6 14.9 866 9.5 28.3 55.6 83.9
Daily Maximum 0 6.4 0 229 23.6 14.9 866 9.5 28.3 55.6 83.9
Daily Minimum 0 6.4 0 229 23.6 14.9 866 9.5 28.3 55.6 83.9
Monthly Limit(s) 0.00156
Composite(C)/Grab(G)
Operator in Responsible Charge(ORC): James W Gooch Grade: IV Phone: [phone]
Check Box if ORC Has Changed: ORC Certification Number: 988035
Certified Laboratories(1): (2):
Person(s)Collecting Samples:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non-Discharge Compliance Unit - 00 (S NATURE OF PERATOR IN RESPONSIBL HARGE)
DENR O • IS SIGNATURE,I CERTIFY THAT THIS REPORT IS ACCURATE
Division of Water Quality D COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH,NC 27699-1617 C�a
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? 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."
‘7 0 7/�� � Russell Knop
(S gnature of Permittee) /// ate (Name of Signing Oficial-Please print or type)
Hillsborough United Church of Christ Chair of Trustees
(Permittee-Please print or type) (Position or Title)
200 Davis Rd. 919-732-9183 4/30/2021
(Phone Number) (Permit Exp. Date)
Hillsborough NC 27278
(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 W009 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 permiftee,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)