WQ0004502_Monitoring - 08-2016_20160919 (2)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00004502
Page _ of
MONTH: August YEAR: 2016
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Formulas:
Daily Load -mg (inches) =[Volume Applied (gallons)x0.1336(orbic SeeVgallon)x12(imhestfoot)]I[Area Sprayed (acres) x43,560 (square f-Vacro)] OR
= Volume Applied (gallons) I [Area Sprayed (acres) x27.152 (gallonslacre-inch)]
Maximum Hourly Loading (inches) = Daily Loading finches)! [Time Irrigated (minutes)! 60 (minuleslhour)] 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)
Aver-ne Weekly 1 nadinn lfnchas)=nAnnWy I n-dinn rineh-srmenthl I Nnmher of days in the month (days/mongt)1 x 7 (daysAveek)
Did Irrigation Occur At This Facility:
Yes: El No:
❑
Did Irrigation Occur On This Field:
Yes: El No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
FIELD NUMBER: 1
AREA SPRAYED (acres): 2.6
COVER CROP: Deciduous -Conifer
PERMITTED HOURLY RATE (inches):
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
D
A
1.
WEATHER CONDITIONS
Ter-
emp
Weather ature at Precip(ta-
Code* application tion
Lagoon
Free-
board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied irrigated Loading
26
Maximum
Hourly
Loading
1 PERMITTED YEARLY RATE inches):
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
E
°F inches
feet
gallons minutes
inches
inches
galore minutes inches
inches
1
2
3
4
PC76 0
2.25
8520 240
0.12
0.03
5
11
6
7
8
9
10
11
C 78 0
2.75
0 0
0.00
#DIV/0!
12
13
14
15
16
C 90 0
2.75
0 0
0.00
#DIV/01
17
18
19
20
21
22
C 76 0
2.5
4260 120
0.06
0.03
23
24
25
26
27
28
29
30
C 76 0
2.75
0 0
0.00
#DIV/0!
31
Tota[ GallonslMonthly Loading (inches)
12780
0.18
0 0.00
12 Month Floating Total (inches)
.;.:,;,;,;,;,;,;,;,;,;,;,,;-:-;-:-;-;-:-:-:-
2.58
Average Weekly Loading (inches)
;-:::::::::•:•: :•
0.04085
0
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, sn-snow,
Spray Irrigation Operator in Responsible Charge (ORC):
James W Gooch
Phone: [phone]
ORC Certification Number. SI 987567 Check Box if ORC Has Changed: ❑
Mall ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Coglpliance Unit
DENR !*1 O ®
Division of Water Quality (SIG TORE OF OP O PONSIBLE CH
1617 Mai! Service Center (� 13Y HIS SIGNATURE, I C RTIFY THAT THIS REPORT
RALEIGH, NC 27699-1617 �o THE BEST OF MY KNOWLEDGE.
-o C,
AND COMPLETE
DENR FORM NDAR-1 (512003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to yourfacility put (NA) in the
compliant box. )
"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
annm'sonment for knowing violations."
Russell Knop
Sign a of ermittee)*Date (Name of Signing Official -Please print or type)
Hillsborough United C ch of Christ Chair of Trustees
(Permittee -Please print or type) (Position or Title)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
919-732-9183 9/3012018
(Phone Number) (Permit Exp. Date)
* if signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
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DENR FORM NDAR-1 (5/2003)
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
0
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
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
annm'sonment for knowing violations."
Russell Knop
Sign a of ermittee)*Date (Name of Signing Official -Please print or type)
Hillsborough United C ch of Christ Chair of Trustees
(Permittee -Please print or type) (Position or Title)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
919-732-9183 9/3012018
(Phone Number) (Permit Exp. Date)
* if signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
Page of
DENR FORM NDAR-1 (5/2003)