WQ0036210_Monitoring - 07-2022_20220822

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
hermit No.: W00036210
Facility Name: Moore's Keep Christian Camp
County: Moore
Month: �J.i j
Year: ac= L
PPI:
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No now generated
Parameter Monitoring Point: L Influent ❑ Effluent ❑ Groundwater Lowering ❑Surface Water
Parameter Code —►
50050
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9
10
11
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12
1301,
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15
16
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17
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19
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23
24
25
26
27
28
29
30
31
Average:
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of -
Sampling Person(s) Certified Laboratories ~
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? [Z Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Thomas Lewis
Permittee: Benchmark Ministries Inc.
Certification No.: 1002746
Signing Official: Thomas Lewis
Grade: SI Phone Number: 919-815-7603
Signing Officials Title: President
Has the ORC changed since the previous NDMR? ❑ Yes E] No
Phone Number: 919-815-7603 Permit Expiration: 1/31/2023
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O
Signature Date
na ure Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
•.: VVQ0036210
•• -• Christian Camp
County: Moore
• irrigation occur
at this facility?
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Annual Rate (in):
Annual Rate (iiate
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of '
Did the application rates exceed the limits in Attachment B of your permit?
5
[2Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Q Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 2/Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? IB/Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 2/compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessarv.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Thomas Lewis
Permittee:
Benchmark Ministries Inc.
Certification No.: 1002746
Signing Official: Thomas Lewis
Grade: SI Phone Number: 919-815-7603
Signing Official's Title: President
Has the ORC changed since the previous NDARA? ❑ Yes 711 No
Phone Number: 919-815-7603 Permit Exp.: 1/31/23
-
L. _ —
Signature Date
ignature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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 property 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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617