WQ0007026_Monitoring - 11-2016_20170104

NON DISCHARGE WASTEWATER MONITORING REPORT Paged—of 5 -
PERMIT NUMBER: WQ0007026
FACILITY NAME: Sanford Health & Rehabilitation
MONTH: November
COUNTY:
YEAR: 2016
Lee
Flow Monitoring Point:
Effluent:
(]
Influent:
❑Ix
Parameter Monitoring Point:
Effluent:
El
Influent:
❑
Isurface Water (SW): ❑ SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility:
Yes: Lj
No: Lj
D
A
T
E
Operator
Arrival
Time operator ORC
2400 Time on on
Clock site Site?
50050
Daily Rate
(Flow) into
Treatment
System
00400
pH
50060
Residual
Chlorine
00310
BOD -5
20°C
00610
NH3-N
00530 31616
Fecal
coliform
(Geo -metric
TSS Mean*)
00625 00620 665
Total
Total NO3 Phosph
TKN as N orous
HRS Y/N
GALLONS
UNITS
UG/L
MGIL
MG/L
MG/L /100ML
MG/L MG/L
MG/L
1
10809
2
10809
3
10809
4
10809
5
10809
6
10809
7
8:15 0.42 Y
10809
6.81
0.4
8
6392
9
6392
10
6392
Ili
6392
12
6392
13
6392
_
14
8:00 0.42 Y
6392
6.86
0.66
�)1
15
5977
O
16
5977
7P '
171
1
5977
18
5977
v r
19
5977
20
5977
C__3
�_ n
21
7:40 0.42 Y
5977
6.84
0.32
c,
22
9374
G
231
9374
24
9374
'6
25
9374
26
9374
27
9374
28
7:40 0.33 Y
9374
1 6.86
0.38
291
1
670
301
1
670
311
1
NA
Average
7640.133
0.44
#####
#####
##### #NUM!
##### #DIV/0!
#####
Daily Maximum
10809
6.86
0.66
0
0
0 0
0 0
0
Daily Minimum
670
6.81
0.32
0
0
0 0
0 0
0
Monthly Limit(s)
1 d
NA
NA
NA
NA
NA NA
NA NA
NA
Composite (C) / Grab (G)
G
G
G
G
G G
G G
G
Operator in Responsible Charge (ORC): _
Check Box if ORC Has Changed: ❑
Randall Jarrell
Grade: IV/ SI Phone: [phone]
ORC Certification Number: 7937/23925
Certified Laboratories (1): Wastewater Management, L.L.C. (2): ENCO
Person(s) Collecting Samples: Randall Jarrell
Mail ORIGINAL and TWO COPIES to: a`�.L�;
ATTN: Non -Discharge Compliance Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
Division of Water Quality AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
DENR FORM NDMR-1 (5/2003)

P.age 2 of
NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
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 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, incl.iding the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)* Date
Sanford Health & Rehabilitation
(Permittee -Please print or type)
2702 Farrell Road
Sanford, N.C. 27330
(Permittee Address)
Parameter Codes:
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500
(Phone Number)
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 SAR
00310 BOD5
01042 Copper
00620 NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00556 Oil -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
WQ09 PAN (Plant Available)
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
Residual
00927 Magnesium
71900 Mercury
32730 Phenols
00665 Phosphorus, Total
00680 TOC
00530 TSS(rSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
5/31/2015
(Permit Exp. Date)
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units designated in the reporting
facility's permit for reporting data.
* 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).
DENR FORM NDMR-1 (5/2003)

M
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00007026
MONTH: November
Page 3 of
YEAR: 2016
FACILITY NAME: Sanford Health & Rehabilitation COUNTY: Lee
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (Inches) = Daily Loading (inches) / [Time Irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Tota[ (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Avoranp Wopkly f nadinn finrhpsl = rMnnihly I nadinn finrhes/mnnthl / Numhar of days in the mnnth /days/mnnthll x 7 fdays/weekl
Did Irrigation Occur At This Facility:
Yes: [] No:
❑
Did Irrigation Occur On This Field:
Yes: 221 No: ❑
Did Irrigation Occur On This Field:
Yes: ❑ No:
FIELD NUMBER: 1
AREA SPRAYED (acres): 8
COVER CROP: Fescue
PERMITTED HOURLY RATE (inches): 0.25
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):
30.11
PERMITTED YEARLY RATE (inches):
D
A
T
E
Temper-
weather ature at Precipita-
Code* application tion
Storage
Lagoon
Free-
board
Volume Time
Applied Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume Time Daily
Applied Irrigated Loading
Maximum
Hourly
Loading
(°F) Inches
feet
gallons minutes
inches
inches
gallons minutes inches
inches
1
NA
2
NA
3
NA
4
NA
5
NA
6
NA
_
7
C 39 0.24
27'
37500 300
0.17
0.03
8
NA
s
NA
10
NA
11
NA
12
NA
13
NA
14
R 45 0.22
2'5"
15
NA
16
NA
17
NA
18
NA
19
NA
20
NA
21
C 26 0.04
3'4"
37500 300
0.17
0.03
zz
NA
23
NA
24
NA
25
NA
26
NA
27
NA
28
CL 27 0
3'1"
37500 300
0.17
0.03
29
NA
30
NA
31
Tota[ Gallons/Monthly Loading (inches)
112500
0.52
0 0.00
12 Month Floating Total (inches)
14.52
Average Weekly Loading (inches)
10.12076451
0
weatner woes: t. clear, r -L. -parry cluuuy, L1l-c1UUVy, r[-rdlll, Oil-WIVW, 01-JIVUL
Spray Irrigation Operator in Responsible Charge (ORC)
ORC Certification Number: 7937 / 23925
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Randall Jarrell Phone: [phone]
Check Box if ORC Has Changed: El
(SIGNATURE OF 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)

NON -DISCHARGE APPLICATION REPORT Page { of S
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. )
The did the limit(s) in the
Compliant (Y,N)
ly
1. application rate(s) not exceed specified 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.
Y�
4. All buffer zones as specified in the permit were maintained during each application.
I�
5. The freeboard in the treatment andlcr 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."
t-/z�,llt.
(Signature of P rmittee)* Date
Sanford Health & Rehabilitation
(Permittee -Please print or type)
2702 Farrell Road
Sanford, N.C. 27330
(Permittee Address)
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500 5/31/2015
(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).
DENR FORM NDAR-1 (5/2003)

Sanford Health And Rehabilitation
12 Month Rolling Total Application In Inches
2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2015 2016
Field Jan Feb March April May June July August Sept Oct Nov Dec Total
1 1.21 1.38 1.04 1.55 1.21 1.04 1.55 1.21 1.04 1.73 0.52 1.04 14.52