WQ0022785_Monitoring - 10-2016_20161207

a
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: October YEAR: 2016
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Formulas:
Dally Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (mcheslfbot)] / [Area Sprayed (acres) x43,560. (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallonslacre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) /[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 (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = tMnnthly Loadin lnnhealmonth) / Number of days in the month (days/month)l x 7 (days/week)
Old Irrigation OccurAt This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: Z
No:
Did Irrigation Occur On This Field:
Yes: F1
No:
FIELD NUMBER: 1
AREA SPRAYED (acres): : 1.04
COVER CROP:1 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• at application Preci ita-ion Free -board
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
23.75
Maximum
Hourly
Loading
PERMITTED -YEARLY RATE (inches):
Maximum
Volume Time Daily Hourly
Applied Irri ated Loading Loading
("F) inches feet
gallons minutes
inches
Inches
gallons minutes
Inches inches
1
NA
1010 38
0.04
0.06
2
NA
1010 38
0.04
0.06
3
NA
1010 38
0.04
0.06
4
NA
1010 38
0.04
0.06
5
CI 70 0.5 NA
1010 38
0.04
0.06
6
NA
870 33
0.03
0.06
7
NA
870 33
0.03
0.06
a
NA
870 33
0.03
0.06
s
NA
870 33
0.03
0.06
10
NA
870 33
0.03
0.06
11
NA
870 33
0.03
0.06
12
C 68 4.5 NA
870 33
0.03
0.06
13
NA
800 30
0.03
0.06
14
NA
800 30
0.03
0.06
1s
NA
800 30
0.03
0.06
16
NA
800 30
0.03
0.06
17
NA
800 30
0.03
0.06
18
NA
800 30
0.03
0.06
1s
C 80 0 NA
800 30
0.03
0.06
20
NA
149 5
0.01
0.06
21
NA
149 5
0.01
0.06
22
NA
149 5
0.01
0.06
23
NA
149 5
0.01
0.06
24
NA
149 5
0.01
0.06
25
NA
149 5
0.01
0.06
26
C 67 0 NA
149 5
0.01
0.06
27
NA
91 3
0.00
0.06
28
NA
91 3
0.00
0.06
2s
NA
91 3
0.00
0.06
30
NA
91 3
0.00
0.06
31
NA
91 3
0.00
1 0.06
Total Gallons/Monthly Loading (inches)
18238
0.650
0.00
12 Month Floating Total (inches)
l:
5.22
Average Weekly Loading (inches)
. 0.1457404
0
Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
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 (SI TUR OF OPERATOR IN RES SIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27 699-1 61 7 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)
i

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 facilityput (NA) in the
compliant box. )
Com liant 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). YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit. YO
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) NA
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 impris
onment for knowing violations."
ZA! ( Z3 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)
[phone] 4/30/18
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 213.0606 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)
_.