WQ0022785_Monitoring - 11-2016_20170105

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: W00022785 MONTH: November YEAR: 2016
FACILITY NAME: Lattisville Grove Baptist Church COUNTY: Orange
Flow Monitoring Point:
Effluent:
n' IRM,
►���.
Parameter Point:
Effluent:
-Monitoring
:.,Nitrate
+
Nitrite -RON
mEMIMM
Composite (C) I Grab (G)
Operator in Responsible Charge (ORC): Chad Leinbach Grade: SI Phone: [phone]
Check Box if ORC Has Changed: ORC Certification Number: 23928
Certified Laboratories (1): Conner Consulting, LLC (Field) I
Person(s) Collecting Samples:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compllce Un
DENR
Division of Wafg4Quality
1617 Mail ServicgCenter 15;
RALEIGH, NC 2-iQ L4617s°'r.
(2): ENCO, Inc. (Lab)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDMR-1 (512003)

NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Page of
Please answer the following question:
Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements? 0
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.
No inflow from well water reported due to usage at softball field during summer. Chad-ORC
"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."
6f e_� /-'z, Chad Leinbach
(Signature of Permittee)* Date (Name of Signing Official -Please print or type)
Lattisville Grove Baptist Church
(Permittee -Please print or type)
1701 Jimmv Ed Road
Hurdle Mills, NC 27541
(Permittee Address)
Parameter Codes:
(Position or Title)
[phone]
(Phone Number)
ORC
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 BAR
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 Ma nesium
71E00 Me rcu
32730 Phenols
00665 Phosphorus, Total
00680 TOC
00530 TSs/rSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidi
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
4/30/18
(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 16A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00022785
MONTH: November
Page _ of
YEAR: 2016
FACILITY NAME: Lattisville Grove Baptist Church COUNTY- Orange
Formulas:
Dally Loading (Inches) _ [Volume Applied (gal ons) x 0.1336 (cubic feetigallon) x 12 (nchesffoot)] / [Area Sprayed (acres) x43,560 (square feetlacre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallonslacre•inch)]
Maximum Hourly Loading (inches) =Daily Loading (inches)/ [Time Irrigated.(minutes) /60 (minutesrnouf)] I Monthly Loading (Inches) =Sum of Dairy Loadings (inches)
12 Month Floating Total (Inches) = Sum ofthis month's Monthly Loading (riches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (nchestmonth) / Number of days in the month (days/month)] x 7 (days/Week)
Did Irrigation Occur At This Facility:id
Yes: No:
Irrigation Occur On This Field:
Yes:
No:
Did Irrigation Occur On This Field:
Yes: M
No:
FIELD NUMBER:j
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
PERMITTED YEARLY RATE (inches):
23.75
PERMITTED YEARLY RATE (inches):
A
T
E
Storage
Weather Temperature Lagoon
Code' atapplication Precipitation Free -board
Volume Time
Applied Irrigated
Daily
LoadingLoadingApplied
Maximum
Hourly
Volume Time
Irrigated
Daily
LoadingLoading
Maximum
Hourly
(°F) - inches feet
gallons - minutes
inches
inches
gallons - minutes
Inches -
Inches
l
NA
91 3
0.00
0.06
2
C 75 0 NA
91 3
0.00
0.06
3
NA
111 1 4
0.00
0.06
4
NA
111 4
0.00
0.06
s
NA
111 4
0.00
0.06
s
NA
111 4
0.00
0.06
7
NA
111 4
0.00
0.06
s
NA
'111 4
0.00
0.06
9
NA
111 4
0.00
0.06
10
C 70 0 NA
111 4
0.00
0.06
11
NA
114 4
0.00
0.06
12
NA
114 4
0.00
0.06
13
NA
114 4
0.00
0.06
14
NA
114 4
0.00
0.06
is
NA
114 4
0.00
0.06
161
1 NA
114 4
0.00
0.06
17
C 70 0.3 NA
114 4
0.00
0.06
18
NA
133 5
0.00
0.06
19
NA
133 5
0.00
0.06
20
NA
133 5
0.00
0.06
21
NA
133 5
0.00
0.06
22
NA
133 5
0.00
0.06
231
C 65 0 NA
133 5
0.00
0.06
24
NA
111 4
0.00
0.06
25
NA
111 4
0.00
0.06
26
NA
111 4
0.00
0.06
27
NA
111 4
0.00
0.06
28
NA
111 4
0.00
0.06
29
NA
111 4
0.00
0.06
30
CI 1 72 1 0.25 NA
111 4
0.00
0.06
311
1 1 1 NA
Total Gallons/Monthly Loading (inches)
3443
0.12
0
0.00
12 Month Floating Total (inches)
4.61
Average Weekly Loading (inches)
: 0.0284302
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:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
Chad Leinbach
Phone: [phone]
23928 Check Box if ORC Has C anged:
(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
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. )
limit(s) in
Compliant N
Y
1. The application rate(s) did not exceed the specified 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
YO
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)
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 imprisonment for kn ng violations.
P�' ,./ "
1 Chad Lan bach
(S)Tature of Permittee)" Date (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 2B.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)