WQ0022785_Monitoring - 09-2016_20161104 (2)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S) .
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0022785
MONTH: September
Page _ of
YEAR: 2016
FACILITY NAME: Lattisyille Grove Baptist Church COUNTY: Orange
Formulas:
Dally Loading (inches) -[Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 Cinches/foot)] / [Area Sprayed (acres) x 43,560 (square feettacre)] OR
= Volume Applied (gallons) I [Area Sprayed (acres) x 27,152 (gallonslacre-Inch)]
Maximum Hourly Loading (inches) = Daily Loading Cinches) I [rime Irrigated (minutes)! 60 (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 Cinches)
1— 61 1 -.ii.... /inwhes - nth\ I h,L.Mhar of do S 1n Ina month Mav1mnn1h11 v 7ldav_cAucakt
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes:
No: F1
Did Irrigation Occur On This Field:
Yes: F I
No:
FIELD NUMBER:1 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 WEATHER CONDITIONS
A storage
T weather Temperature Lagoon
coda• at application Precipita-tion Free -board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
23.75
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
E
(°F) Inches feet
gallons minutes
Inches
inches
gallons minutes
Inches
inches
1 NA
34 1
0.00
0.07
2 NA
34 1
0.00
0.07
3 NA
34 1
0.00
0.07
4 NA
34 1
0.00
0.07
5 NA
34 1
0.00
0.07
6 NA
34 1
0.00
0.07
7 C 90 0 NA
34 1
0.00
0.07
a NA
1106 42
0.04
0.06
9 NA
1106 42.
0.04
0.06
101 NA
1106 42
0.04
0.06
11 NA
1106 42
0.04
0.06
12 NA
1106 42
0.04
0.06
13 NA
1106 42
0.04
0.06
14 C 88 0.2 NA
1106 42
0.04
0.06
15 NA
486 18
0.02
0.06
16 NA
486 18
0.02
0.06
17 NA
486 18
0.02
0.06
181 NA
486 18
0.02
0.06
19 NA
486 18
0.02
0.06
20 NA
486 18
0.02
0.06
21 CL 76 1.1 NA
486 18
0.02
0.06
22 NA
479 18
0.02
0.06
23 NA
479 18
0.02
0.06
24 NA
479 18
0.02
0.06
25 NA
479 18
0.02
0.06
26 NA
479 18
0.02
0.06
27 NA
479 18
0.02
0.06
28 PC 75 1.5 NA
479 18
0.02
0.06
29 NA
834 31
0.03
0.06
30 NA
834 31
0.03
0.06
311 1 1 NA
Total Gallons/Monthly Loading (inches)
16403
0.58
0
0.00
12 Month Floating Total (inches)
5.92
Average Weekly Loading (inches)
0.1354461
0
• Weather Codes: Cclear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC):
ORC Certification Number:
Chad Leinbach
23928 Check Box if ORC Has Changed:
Phone: [phone]
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 �.fi BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
v �o
� , vF-
�tP
DENR FORM NDAR-1 (5/2003)

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 facilityput (NA) in the
compliant box. )
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).
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.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limits)
specified in the permit.
Page
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."
1c&j ,-- o -30A4
(Signature of Permittee)' D to
Lattisviile Grove Baptist Church
(Permittee -Please print or type)
1701 Jimmy Ed Road
Hurdle Mills, NC 27541
(Permittee Address)
Chad Leinbach
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
[phone]
(Phone Number)
' If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).
4/30/18
(Permit Exp. Date)
DENR FORM NDAR-1 (5/2003)