WQ0022785_Monitoring - 08-2016_20161007

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: VVQ6022785 MONTH: August` YEAR: 2016
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Operator in Responsible Charge (ORC): Chad.Leinbach. Grade: SI Phone: [phone]
Check Box if ORC Has Changed: ORC Certification Number: 23928'
Certified Laboratories (1): Conner Consulting, LLC'(Field) (2): ENCO Inc. (Lab)
Person(s) Collecting Samples: Chad Leinbach A /f
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDMR-1 (5/2003)
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Parameter Monitoring Point:
Effluent: "�®�J
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Composite (C)/Gr'ab(G)
Operator in Responsible Charge (ORC): Chad.Leinbach. Grade: SI Phone: [phone]
Check Box if ORC Has Changed: ORC Certification Number: 23928'
Certified Laboratories (1): Conner Consulting, LLC'(Field) (2): ENCO Inc. (Lab)
Person(s) Collecting Samples: Chad Leinbach A /f
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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? 0
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.
No inflow from well water reported due to usage at softball field during summer. Chad-ORC
..."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."
Chad Leinbach
(Signature of Permittee)* ate _ (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church ORC
(Permittee' -Please print or type) (Position or Title)
1701 Jimmy Ed Road [phone] 4/30/18
(Phone.Number) . (Permit Exp. Date)
Hurdle Mills, NC 27541
(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 WQ09 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 00685 Pho honis, Total
00530 TSS/rSR
01034 Chromium 00610 NH3asN 00937 Potassium
00076 Turbidity
.00340 COD 01067 Nickel 00545 Settleable Matt
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only
the units designated in the reporting facilily's
permit for reporting data.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(�)(D).
er
01092 Zinc
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 WQ09 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 00685 Pho honis, Total
00530 TSS/rSR
01034 Chromium 00610 NH3asN 00937 Potassium
00076 Turbidity
.00340 COD 01067 Nickel 00545 Settleable Matt
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only
the units designated in the reporting facilily's
permit for reporting data.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(�)(D).
DENR FORM NDMR-1 (5/2003)