WQ0022785_Monitoring - 08-2016_20161007 (2)

NON -DISCHARGE APPLICATION REPORT: Page „of_
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0022785 MONTH: August ' YEAR: 2016
FACILITY NAME: Lattisyille Grove Baptist Church COUNTY- Orange ,
Formulas:
Dally Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feelfgallon) x 12 Qncheslrooq]! [Area Sprayed (acres) x43,560 (square feetfacre)]' OR
= Volume Applied (gallons)! [Area Sprayed (acres) x 27,152 (gallonslacre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches)1 [Time Irrigated (minutes)160 (minutes/hour)]' , . Monthly Loading (inches) =.Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading Cinches) and previous 11 month's Monthly Loadings (inches)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes:
No:
Did Irrigation Occur On This Field:
Yes:
No:
FIELD NUMBER:1
AREA SPRAYED acres): 1.04
COVER CROP: Fescue, Rye
PERMITTED HOURLY RATE (inches): 0.2
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
Storage
Weather Temperature Lagoon
code• atap lication Precipita-tion Free -board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
A lied Irri ated Loading
' " 23.75
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
Maximum
Volume Time 'Daily Hourly
Applied Irrigated Loading Loadin
("F) inches feet
gallons` minutes
Inches -
Inches
gallons - minutes
Inches Inches
1
NA
80 3
0.00
0.06
2
NA
80 3
0.00
0.06
3
NA
80 3
0.00
0.06
4
C 75 0.6 NA
80 3
0.00
0.06
5
NA
54 2
0.00
0.06
6
NA
54 2
0.00
0.06
7
'NA
54 2
0.00
0.06
8
NA
54 2
0.00
0.06
s
NA
54 2
0.00
0.06
10
NA
54 2
0.00
0.06
11
NA
54 2
0.00
0:06
12
C g0 0.6 NA
54 2
0.00
0.06
O
13
NA
2 0
0.00
#DIV/0!
'
14
NA
2 0
0.00
#DIV/0!
i
1s
NA
2 0
0.00
#DIV/0!
16
NA`
2 0
0.00
#DIV/01
1.
17
NA
2 0
0.00
#DIV/0!
18
CI 84 0.2 NA
2 0
0.00
#DIV/01
-IV/01
19
NA
0 . 0
0.00
-75
20
NA
0 0
0.00
#DIV/0!
21
NA
0 0
0.00
#DIV/0!
221
NA
0 0
0.00
#DIV/0!
231
NA
0 0
0.00
#DIV/01
24
NA
0 0
0.00
#DIV/01
25
C 80 0.15 NA
0 0
0.00
#DIV/0!
26
NA,
83 3.
0.00
0.06
27
NA
83 3
0.00
0.06
28
NA
83 3
0.00
0.06
29
NA
83 3
0.00
0.06
30
NA
83 3
0.00
0.06
31
PC 87 0 NA
83 3
0.00
0.06
Total Gallons/Monthly Loading (inches)
1262
0.04.
00.00
12 Month Floating Total (inches)
5.58
Average Weekly Loading (inches)
0.0100847
0
- weamer roues: t.ciear, r•t.-parny ciouuy, t.rciouuy, rc-ram, an-snoW, ar•esrcec
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach Phone: [phone]
ORC Certification Number: 23928 Check Box if ORC Has Changed:
Mail ORIGINAL and TWO COPIES to: ^�
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (512003)

t- ws
NON -DISCHARGE APPLICATION REPORT Page _of
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 your facility put (NA) in the
compliant box.) .
1. The did limit(s) in
Com liantY N
F Y
application rate(s) not exceed the specified the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
Y�
3. A suitable vegetative cover was maintained on the site(s) in accordance with the,permit
0
4. All buffer zones as specified in the permit were maintained during each application..
Y�
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
NA
specified in the permit:'
If the facility is non-compliant, please explain in the space below.the reasons) 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.
The irrigation system was out -of operation for a short period in August. The pump was replaced. The supply line was repaired.
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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonmenffor knowing violations."
K� Chad Leinbach
(Signature of Permittee)* Dat (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church ORC
(Permittee -Please print or type) (Position or Title)
[phone] 4/30/16
1701 Jimmy Ed Road (Phone Number) (Permit Exp. Date)
Hurdle Mills, NC 27541
(Permittee Address)
• If signed by other than the permittee, delegation of signatory authority must be on file with the state per 16A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)