WQ0014785_Monitoring - 12-2022_20230404

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
Permit No.: 1111 :
• Middle School
County:Sampson•
December1
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? ❑Compliant ❑Non -compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑� Compliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑compliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑✓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: Jason Dickinson
Permittee:
Sampson County Schools
Certification No.: 1007291
Signing Official: Jason Dickinson
Grade: S Phone Number: 910-385-4915
Signing Official's Title: ORC
Has the ORC changed since the ious NDAR-1? ❑Yes QNo
Phone Number: 910-385-4915 Permit Exp.: 10/31/28
Signature Date
Signature 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: VVQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: December
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit? ❑� Compliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑� Compliant ❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑� Compliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑' Compliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑� 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: Jason Dickinson
Permittee:
Sampson County Schools
Certification No.: 1007291
Signing Official: Jason Dicvkinson
Grade: S Phone Number: 910-385-4915
Signing Official's Title: ORC
Has the ORC changed since the previous NDAR-1? ❑Yes ❑✓ No
Phone Number: 910-385-4915 Permit Exp.: 10/31/28
3��9-�r3
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Signature Date
Signature Date
By this signature, 1 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page
Permit No.: W00014785
Facility Name: Midway Middle School
County: Sampson
Month: December
Year: 2022
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
Field Name:
5
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑YES ONO
Field Loaded?
❑YES ENO
Field Loaded?
❑YES ONO
Field Loaded?
❑YES ENO
Field Loaded?
❑YES ❑NO
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Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
January
0
9.29
0.0
0.0
0
9.29
0.0
0.0
0
9.29
0.0
0.0
0
9.29
0.0
0.0
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9.29
0.0
0.0
February
March
April
May
June
July
August
September
October
November
December
12 Month Floating PAN Load
0.0
0.0
0.0
0.0
0.0
(Ibs/ac/yr):
Annual PAN Load Limit
5.3
MINA
5.30
5.30
5.30
5.30
(Ibs/ac/yr):

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of
Did the mass loading rates exceed the limits in Attachment B of your permit? ElCompliant ❑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: Jason Dickinson Permittee:
Sampson County Schools
Certification Number: 1007291 Signing Official:
Jason Dickinson
Grade: S Phone Number: 910-385-4915 Signing Official's Title: ORC
Has the ORC changed since the previous NDMLR? [-]Yes ❑� No Phone No.: 910-385-4915 Permit Exp.: 10/31/28
a-Z,3- d - 30-�d 9 3 3
Signature Date Signature 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of
Permit No.: W00014785
Facility Name: Midway Middle School
County: Sampson
Month: December
Year: 2022
Field Name:
6
Field Name:
7
Field Name:
8
Field Name:
Field Name:
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
0.435
Area (acres):
Area (acres):
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
Load Type:
Field Loaded?
[-]YES (]NO
Field Loaded?
❑YES ❑NO
I Field Loaded?
❑YES EINO
Field Loaded?
❑YES ❑NO
Field Loaded?
[]YES ONO
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Month
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
January
0
9.29
0.0
0.0
0
9.29
0.0
0.0
0
9.29
0.0
0.0
February
March
April
May
June
July
August
September
October
November
December
12 Month Floating PAN Load
0.0
0.0
0.0
0.0
0El .0
(Ibs/ac/yr):
Annual PAN Load Limit
5.3
5.30
5.30
(Ibs/ac/yr):

FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of
Did the mass loading rates exceed the limits in Attachment B of your permit?
❑� 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: Jason Dickinson
Permittee:
Sampson County Schools
Certification Number: 1007291
Signing Official:
Jason Dickinson
Grade: S Phone Number: 910-385-4915
Signing Official's Title: ORC
Has the ORC changed since the previous NDMLR? ❑Yes 21No
Phone No.: 910-385-4915 Permit Exp.: 10/31/28
�— "
9
2<
G✓ 3 is 043
G•-J 3-- )—A
Signature Date
Signature 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: VVQ0014785
Facility Name: Midway Middle School
County: Sampson
Month: December
Year: 2022
PPI: 001
Flow Measuring Point: ❑Influent ❑� Effluent ❑No flow generated
Parameter Monitoring Point: ❑Influent ❑Effluent [-]Groundwater Lowering ❑Surface Water
Parameter Code —►
50050
00400
00625
00310
00610
00530
31616
00665
00620
WQ09
00940
00600
70300
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24-hr
hrs
GPD
su
mg/L
mg/L
mg/L
mg/L
#/100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
1
2,400
2
2.400
3
2,400
4
2,400
5
2,400
6
2,400
7
2,400
8
2,400
9
2.400
10
2,400
11
2,400
12
2,400
13
2,400
14
2,400
15
3,229
16
3,229
17
3,229
18
3,229
19
3,229
20
3,229
21
3,229
22
329
23
329
24
329
25
329
26
329
27
329
28
329
29
0
30
0
31
0
Average:
1,887
Daily Maximum:
3,229
Daily Minimum:
0
Sampling Type:
Monthly Limit:
310,000
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? ❑� Compliant [:]Non-com pliant
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: Jason Dickinson Permittee: Sampson County Schools
Certification No.: 1007291 Signing Official: Jason Dickinson
Grade: S Phone Number: 910-385-4915 Signing Official's Title: ORC
Has the ORC changed since the pre 'ous NDMR? ❑Yes ❑� No Phone Number: 910-385-4915 Permit Expiration: 10/31/2028
`✓ .3 ot7-z. " 3.z9--Z3
Signature Date 11 Signature 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617