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NON-DISCHARGE �VASTE �'VATER n70NITORItiG REPOR'C
PERMIT NUMBER: �i'00002857 MONTH: Novembcr V'H.4R: 2016
P:�CILITY NA!V11?: Picdmont Cus[om Mcats WW'i� COUNTIl Caswcll
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Operalnrin Rrspunsiblr CLivgcll)kC): tileven 1'arbrnu�h (:rnJe: til PLune: 336-99fi ?8J1
Check Bnx if ORC Has Changed: � ORC CerH�ication Number: 98G612
Ccrli�icd Labm�alorics (1): R S,� Laboratnrics. Inc (2):
Pcrson(s) Cullecling Samplcs: Stcvcn Yarbrou�lh
�AI:�il ORIGI.AAl, and 7Avn COYIES to:
17"1 \: \on-0ischarge Compliancr Gnit X
UH,AR �.4T1, PhRd70Nl.A�RNSYONSI6LF,CH,ARGN.)
Dirision uf N aler Quuli�y I;r this tiignalure, I cerlifc that Ihis repurt is necurete anA
Ifi17 Mnil tien'ice Center cnmplete tu Ihe best of my knonledge.
RALEIGII. NC 27699-1617
DENR Form NDAR-1 (5/2003)
NON DISCHARGE WASTEWATER MONITORING REPORT
FACILITY STATUS:
Please answer the following question:
1. Does all monitoring data and sampling frequencies meet permit requirements?
If the facility is non-comnliant, 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.
C�
Com liant Y,N)
"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 a qualified personnel properly gather and evaluate 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
infonnatio ubmitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
penalt' s for s bmitting fa�nf�ination, including the possibility of fines and imprisonment for knowing violations."
�
(Permittee-Please print or type)
9683 Ken-'s Chapel Road
Gibsonville, NC
(Permittee Address)
01002 Arsenic
01022 Boron
00310 BODS
01027 Cadmium
00916 Calcium
00940 Chloride
50060 Chlorine, Total
Residual
01034 Chromium
00340 COD
PARAMETER CODES
31504 Coliform, Total
00094 Conductivi
01042 Co er
00300 Dissolved Ox gen
31616 Fecal Coliform
01051 Lead
00927 Magnesium
71900 Mercu
00610 NH3 as N
01067 Nickel
James M. Cheshire
(Name of Signing Official-Please print or type)
President R & A Laboratories
(Position or Title)
336-582-8247
(Phone Number)
00600 Nitro en, Total
00630 NO2 & NO3
00620 NO3
00556 Oil & Grease
WQ09 PAN Plant Available
00400 H
32730 Phenols
00665 Phos horus, Total
00937 Potassium
00545 Settleable Matter
03/31/21
(Permit Exp. Date)
00929 Sodium
00931 SAR
00745 Sulfide
00515 TDS
00010 Tem erature
00625 TKN
00680 TOC
00530 TSS/TSR
00076 Turbidi
01092 Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at (919) 733-5083, extension 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use onlv units designated in the reportin�
facilitv's permit for reportine data•
* 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).
r
NON-DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
Page 2 of 3
PERMIT NUMBER: W00002857 MONTH: November YEAR: 2016
FACILITY NAME: Piedmont Custom Meats WWTF COUNTY: Caswell
Formulas:
Daily Loading (inches) _�Volume Applied (gallons) x 0.1336 (cubic feeUgallon) x 12 (incheslfoot)] ![Area Sprayed (acres) x 43,560 (square feeUacre) or
_ [Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch).
Maximum Hourly Loading (inches) = Daily Loading (Inches)/ [fime irrigated (minules) / 60 (minules/hour)] Monthly Loading (inches) =Sum of Daily Loading (inches)
12 Month Floating�Tolal (inches) = Sum of lhis month's Monlhly Loading (inches) and previous 11 month's Monlhly Loadings (inches)
Average Weekly Loading (inches) _[Monlhly Loading (inches/month) / Number of days in the month (days/month )] x 7(days/week)
•N�cathcr Codes: Gcicar, PC-partly cluuJy, CI-cloudy, R-rain, Sn-snow, SI-slect
Spray Irrigation Operator in Responsible Charge (ORC): Steven YarbrouQh Phone: 336-996-2841
ORC Certi�cation Number: 986612 C eck Box ' ORC Has Changed: ❑
Mail ORIGINAL and Two COPIES to:
ATTIV: Non-Discharge Compliance Unit X
DENR
Division of Water Quality
1617 Mail Service Centcr
RALEIGH, NC 27699-1617
(SIGNATU�OPERATOR IN RESPONSIBLE CHARGE)
By this signature, I certify that this report is accurate and
complete to the best of my knowledge.
DENR Form NDAR-1 (5/2003)
FACILITY STATUS:
Please indicate( by inserting Y(es) or N(o) in the appropriate box) whether the facility has been comaliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
Compliant (Y,N)
l. 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.
S. 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-comnliant, 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 a qualified personnel properly gather and evaluate 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
inform ubmitted is, to the best of iny knowledge and belief true, accurate, and complete. I am aware that there are significant
pena ies for ubmitting f� i�formation, including the possibility of fines and imprisonment for knowing violations."
of
(Permittee-Please print or type)
9683 Kerr's Chapel Road
Gibsonville, NC
(Permittee Address)
James M. Cheshire
(Name of Signing Official-Please print or type)
President R & A Laboratories
(Position or Title)
336-582-8247
(Phone Number)
03/31/21
(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).
DENR Form NDAR-1 (5/2003)
,. • .
NON-DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
Page 3 of 3
PERMIT NUMBER: W00002857 MONTH: October YEAR: 2016
FACILITY NAME: Piedmont Custom Meats WWTF COUNTY: Caswell
Formulas:
Daily Loading (inches) _[Volume Applied (gallons) x 0.1336 (cubic feeUgallon) x 12 (inches/foot)] I[Area Sprayed (acres) x 43,560 (square feeUacre) or
_ [Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch).
Maximum Hourly Loading (inches) = Daily Loading (inches) /[Tme irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (Inches) =Sum of Daily Loading (Inches)
12 Monlh Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 monlh's Monthly Loadings (inches)
Average Weekly Loading (inches) _[Monlhly Loading (inches/month) / Number of days in lhe monlh (days/month )] x 7(days/week)
"Neather Cades: Gcicar, PC-ryartly cloudg CI-cloudy, R-rain, Sn-sno�v, SI-sleet
Spray Irrigation Operator in Responsible Charge (ORC): Steven Yarbrou2h Phone: 336-996-2841
ORC Certification Number: 986612 Check Box if RC Has Changed: �
Mail ORIGINAL and Two COPIES to:
ATTN: Non-Discharge Compliance Unit X
DENR (SIGNAT OPERATOR IN RESPONSIBLE CHARGE)
Division af Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Form NDAR-1 (5/2003)
FACILITY STATUS:
Please indicate( by inserting Y(es) or N(o) in the appropriate box) whether the facility has been comaliant
with the following permit requirements: (Note: If a requirement does not apply to your facility put (NA) in the
compliant box.)
1. The application rate(s) did not exceed the limit(s) specified in the pennit.
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.
S. The freeboard in the treatment and/or storage lagoon(s) was not less than the
limit('s) specified in the permit.
Y " ` yr
Compliant (Y,N)
�
�
(
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If the facility is non-comnliant, please explain in the space below the reason(s) the facility was not in compliance with its
pennit. 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 a qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the infonnation, the
info ion ubmitted is, to the best of my lrnowledge and belief true, accurate, and complete. I am aware that there are significant
pen ties for ubinitting �e �ormation, including the possibility of fines and imprisonment for knowing violations."
al
of
(Permittee-Please print or type)
9683 Kerr's Chapel Road
Gibsonville. NC
(Permittee Address)
James M. Cheshire
(Name of Signing Official-Please print or type)
President R & A Laboratories
(Position or Title)
336-582-8247
(Phone Number)
03/31/21
(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).
DENR Form NDAR-1 (5/2003)