WQ0036210_Monitoring - 11-2021_20211206

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FORM: NDMR 03-12. NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
_ Sampling Person(s) i Certified Laboratories .
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? pcompliant pNon Compliant
If the facility is non-compllent, 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
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 Offlclal's Title: President
Has the ORO changed since the previous NDMR? OYes ( No
Phone Number: 919-815-7603 Permit Expiration: ' 1/31/2023
--�/ 4&zz�
I
-Y
Signature Date
I .
Signature Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
I certify, under penalty of low, that this document and all attachments were prepared under my direction or supervision In
accordance with a system designed to essure that all qualified personnel property gathered and evaluated the Information
submitted. Based on my inquiry of the person or persona who manage the system, or those persons directly responsible for
gathering the Information, the Information submitted Is, to the best of my knowledge and ballet, true, accurate, and complete. I am
aware that there are significant penalties for submitting false Information, including the passiblllty.of fines and Imprisonment for
r' knowing violations.
Mall Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699.1617 "

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FORM: NDAR-1 16-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Permit No.: WQDD36210 - '
= Facility Name: MOORE'S KEEP CHRISTIAN CAMP'
County: -' Moore .
' Month:. /V&e
Did irri atiod occur
g
1t this facility?,
❑YES No
;0
- Fieldm'Name.
�; ZONE 1
Field Name:
ZONE 2 A,B
�1 ;Field Names
'N
,Field Name:
g, Area (acres)
1;34 .':
Area (acres):
1.69
Area (acres)
h ;
Area (acres).
; + ,.CovarCrop
4;FOREST , a"'
CoveaCrop:
1s69•"
% :Cove�.Crop
a
Cover Crop.
„Hourly Rate (m)Y
N3:, ;
Hourly Rate (in):
FOREST/GRASS
`f Hourly Rate (m} y
y ,
Hourly Rate (In):
Annual Rate (m)
v ',
Annual Rate (in):
Annual`Rate (in):
Weather:.. ;`
Freeboard
;!'Field Irrigated?
`_;(] vEs 0 No `;l
Field Irrigated?
". ❑ YES-0 No
h' Field Irrigated?
[] YEs 0 Nos
Field Irrigated?
; QYES ❑ NO •.
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FORM; NDAR-1 10-13 i NON -DISCHARGE APPLICATION REPORT (NDAR7-1) Page of
Did the application rates exceed the. limits, ill Attachment B of your permit? 4 [g'tompllant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff fromthe sites? p'Compiiant . ❑ Non -compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? p'Compliant ❑ Non -Compliant
Were all -setbacks listed -in your permit maintained for every application to each permitted site? ;° prCompliant ❑ Non-Complant
Were all freeboards.•maintained in accordance with the specified freeboard- heights -in your permit?[;Kompllant ❑Non-Compllant
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 (ORO) Certification
Permittee Certification
ORO, THOMAS LEWIS,
Permittee; ., BENCHMARK MINISTRIES
Certification No.: 1002746
Signing Official: THOMAS LEWIS
'Grade: SI Phone Number: 919-815-7603
Signing official's Title: PRESIDENT
Has the ORO changed since the previous NDAR-1? Yes 0 No
Phone Number: 919-815-7603 Permit Exp.: 1/3.1/23
y I,z
Signature Date
Signature Date " '
By this signature, I certify that this report Is aocurrate 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
the information submitted. Based on my
with a system designed to assure that ?II qualified personnel properly gathered and evaluated
Inquiry the manage the or those persons directly responsible for gathering the information, the
of person or persons who system,
Information submitted is, to the bbktof my knowledge and belief, true, accurate; and complete. I am aware that there are significant
-' penaltles 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