WQ0004502_Monitoring - 11-2016_20161222 (2)

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: November YEAR: 2016
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x0.1336 (cubic feet(gallon) x12 CinchesBoot)] 1 [Area Sprayed (acres) x43,560 (squarefeet/acre)) OR
= Volume Applied (gallons) / [Area Sprayed (acres) x27,152 (gallonslacre-inch)]
Maximum Hourly Loading (Inches) = Daily Loading (inches) I [rine irrigated (minutes) / 60 (mmutes/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)
Average Weekly Loading (inches) =[Monthly Loading [nches/month)I Number of days in the month (dayslmonth)] x7 (daysli a k)
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 HUMBER: 1
AREA SPRAYED (acres): 2.6
COVER CROP: Deciduous -Conifer
PERMITTED HOURLY RATE (inches):
FIELD NUMBER.
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
D WEATHER CONDITIONS
Storage
A Temper- Lagoon
weather
T Code* afore at Preciplta- Free-
E application tion board
PERMITTED YEARLY RATE (inches):
Volume Time Dail Y
Applied Irrigated Loading
26
Maximum
Hourly
Loading
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
(°F) inches feet
gallons minutes
inches
inches
gallons minutes inches
inches
1 CI 56 0 2.75
0 0
0-00
#DIV/0!
2
3
4
5
6
7 C 54 0 2.75
0 0
0.00
#DIV/0!
8
9
10.
11
12
13
14
15
16
17 C 68 1 0 2.5
0 0
0.00
#DIV/0!
16
%.
19
20
21
22 C 54 0 2.5
0 0
0.00
#DIV/0!
23
25
26
to
27
28 CI 54 0 2.5
0 0
0.00
#DIV/01
29
'
30
31
Total Gallons /Monthly Loading (inches)
0
0.00
z
0 ^ 0.00
12 Month Floating Tota[ (inches)
Average Weekly Loading (inches)
0
x .: 0-4
* Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
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]
,IGNATURE OF OPERAT IPR'IN RESPONSIBLE CHARGE)
ZTHY S SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
E BEST OF MY KNOWLEDGE.
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 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.
0
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.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
I�
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
4mp.rirsonment for knowing violations."Russell Knop
e of ermittee)* ! Date (Name of Signing Official -Please print or type)
Hillsborough United Church of Christ Chair of Trustees
(Permittee -Please print or type) (Position or Title)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
919-732-9183 9/3012018
(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 2B.0506 (b)(2)(D).
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DENR FORM NDAR-1 (512003)