WQ0004502_Monitoring - 09-2016_20161024

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0004502
Page of
MONTH: September YEAR: 2016
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Formulas:
Daily Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feettgallon) x 12 (nch..1oot)l I [Area Sprayed (acres) x43,560 (square feetlacre)) OR
= Volume Applied (gallons) I [Area Sprayed (acres) x27,152 (gallons/acre-inch))
Maximum Hourly Loading (inches) = Daily Loading (inches) I [Tune Irrigated (minutes)160 (minuteslhour)) 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)
Averaee Weekiv Loadino (inches) = IMomhiv Loadino finches/month)! Number of days in the month (days/month)) x 7 (daystweek)
Did Irrigation Occur At This Facility: Did irrigation Occur On This Field:
Yes: ❑Q No: ❑ Yes: Q No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No: ❑
FIELD NUMBER: 1
AREA SPRAYED acres : 2.6
COVER CROP: Deciduous -Conifer
PERMI "TED HOURLY RATE (inches):
FIELD NUMBER:
AREA SPRAYED acres
COVER CROP:
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
storage
Weather Temper- lagoon
atureat Pmcipita- Free -
code• application tion board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
26
Maximum
Hourly
Loading
PERMITTED YEARLY RATE finches
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
t°F) inches feet
gallons
minutes
inches
inches
gallons minutes inches
inches
1
2
31
1
4
5
C 64 0 2.75
0
0
0.00
#DIV/0!
6
7
8
9
10
11
12
13
C 78 0 2.5
8520
240
0.12
0.03
14
15
16
17
18
19
R 76 0.5 2.75
0
0
0.00
#DIV/O!
20
21
22
23
24
25
26
CL 66 0 2.5
0
0
0-00
#DIV/01
27
28
29
30
31
Total Gallons/Monthly Loading (inches)
8520
0.12
0 0.00
12 Month Floating Total (inches)
2.06
Average Weekly Loading (inches)
0.028141
_ 0
Weather Codes: C -clear, PC -partly cloudy, C1 -cloudy, R -rain, Sn-snow,
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number: SI 987567
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH. NC 27699-1617
James W Gooch
Check Box if ORC Has Changed:
Phone: [phone]
"URE OF OPERAT0171N RRONSIBLE CHARGE)
,SIGNATURE, 1 CERTIFY HAT THIS REPORT IS ACCURATE AND COMPLETE
BEST OF MY KNOWLEDGE.
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 your facility put (NA) in the
compliant box. )
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
0
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.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
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
and imprisonment for knowing violations."
Sig a ref erm' ittee)' ate
Hillsborough United Church of CV
(Permittee-Please print or type)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
Russell Knop
(Name of Signing Official -Please print or type)
Chair of Trustees
(Position or Title)
919-732-9183 9/30/2018
(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 213.0506 (b)(2)(D).
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DENR FORM NDAR-1 (5/2003)