WQ0004502_Monitoring - 12-2016_20170117

Page _ of
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ0004502 MONTH: December YEAR: 2016
FACILITY NAME: Hillsborough United Church of Christ COUNTY: Orange
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feeVgallon) x 12 (inches/foot))! Was Sprayed (ewes) x43,660 (square feeveere)) OR
= Volume Applied (gallons) I [Area Sprayed (acres) x 27,152 (gallonsfacre-inch))
Maximum Hourly Loading (inches) = Daily Loading (inches)I [Tine Irrigated (minutes)/60 (minutesfhour)) Monthly Loading (inches) =Sum of Dally Loadings (inchest
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) = [Monthly Loading (inchesimonth) I Number of days in the month (daystmonOt)] x7 (days(veek)
Did Irrigation Occur At This Facility: Did Irrigation Occur On This Field:
Yes: Q No: ❑ Yes: No:
❑
Did Irrigation Occur On This Feld:
Yes: ❑ No: ❑
=
FIELD NUMBER:
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
PERMITTED YEARLY RATE (inches): 26
PERMITTED YEARLY RATE (inches):
A storage
Weather application tion board Temper- Lagoon
T atureat Precfpha- F.0-
Cod e'
E
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
2 PC 38 0 2.25
8520 240
0.12
0.03
31 1
41 1
5
6
7
6 CI 50 0 2.5
0 0
0.00
#DIV/0!
9
16
11
12
13
14
15 PC 36 0 2.5
0 0
0.00
#DIV/0!
16
17
18
19
20
21
22 C 1 66 0 2.25
8520 1 180
0.12
0.04
23
24
25
26
27
28
29
36 C 52 0 2.5
0 0
0.00
#DIV/0!
31
Total Gallons/Monthly Loading (inches)
17040
0.24
0 0.00
12 Month Floating Total (inches)
2.15
,A
Average Weekly Loading (inches)
0.054467
1. „ ; 0
Weather Codes: C -clear, PC -partly cloudy, C[ -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsib a '.-barge (ORC): James W Gooch Phone: [phone]
ORC Certification Nu rr Mgr: SI 987567 L� Check Box if ORC Has Changed: [IMail ORIGINAL and TWO COPIEcS�'� a
ATTN: Non -Discharge Complian Unit
DENR Cs�
Division of Water QualityIGNATU E OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mai! Service Center r B; HIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 Cs TO THE 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_ )
"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
aFW imprisonment for knowing violations."
I�C / -17 Russell Knop
�Skdnafufe of Permittee)' ' 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)
919-732-9183
200 Davis Rd. (Phone Number)
Hillsborough NC 27278
(Permittee Address)
9/30/2018
(Permit Exp. Date)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2�0).
Page of
DENR FORM NDAR-1 (512003)
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.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
0
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
aFW imprisonment for knowing violations."
I�C / -17 Russell Knop
�Skdnafufe of Permittee)' ' 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)
919-732-9183
200 Davis Rd. (Phone Number)
Hillsborough NC 27278
(Permittee Address)
9/30/2018
(Permit Exp. Date)
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2�0).
Page of
DENR FORM NDAR-1 (512003)

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
PERMIT NUMBER: W00004502 MONTH:
FACILITY NAME: Hillsborough United Church of Christ
December YEAR: 2016
COUNTY: Orange
Flow Monitoring Point:
Effluent:
❑ Influent:
❑
Parameter Monitoring Point:
Effluent: ❑
Influent: Q
1 Surface Water (SW): ❑
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility.
Yes: ❑ No ❑
50050
00400 50060
00310 00610
00530 31616 665
625 630
600
D
A
T
E
Operator
Arrival
Time Operator ORC
2400 Time On on
Clock Site Site?
Daily Rate
(Flow) into
Treatment
System
Residual
PH Chlorine
BOD -5
20"C NH3-N
Fecal
Coliform
(Geo -metric TOT
TSS Meare) Phos
NO2-
TKN No3
TOT N
C Calc
HRS Y/N
GALLONS
UNITS UG/L
MG/L MG/L
MG/L /100ML MG/L
MG/L MG/L
MG/L
1
417
2
9:32 0.75 Y
417
3
314
4
314
51
314
6
314
7
314
8
13:58 0.25 Y
314
9
334
10
334
11
334
12
334
13
334
14
334
15
9:09 0.25 Y
334
16
203
171
203
18
203
19
203
20
203
21
203
22
13:05 0.75 Y
203
231
28
241
28
25
28
26
28
27
28
28
28
29
28
30112:401
0.25 1 Y
28
31
1 =
190
Average
222.2903
#NUM! #####
#DIV/0!
Daily Maximum
417
0 0
0
0 0 0 0
0 0
0
Daily Minimum
28
0 0
0
0 0 0 0
0 0
0
Monthly Limit(s)
0.00156
Composite (C) / Grab (G)
Operator in Responsible Charge (ORC):
Check Box if ORC Has Changed:
Certified Laboratories (1):
Person(s) Collecting Samples:
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
1♦❑
James W Gooch Grade: IV
ORC Certification Number.
(2):
Phone: [phone]
988035
SIG 4TURE OF OPER,Q�OR IN RESPONSIBLE CHARG,!
THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDMR-1 (5/2003)

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? �Y
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/Wormation, including the possibility of fines and imprisonment for knowing violations."
az �, ✓ - Russell Knop
( gnature of Permittee)* V Date (Name of Signing Official -Please print or type)
Hillsborough United Church of Christ
(Permittee -Please print or type)
200 Davis Rd.
Hillsborough NC 27278
(Permittee Address)
Parameter Codes:
Chair of Trustees
(Position or Title)
919-732-9183 4/30/2021
(Phone Number) (Permit Exp. Date)
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 SAR
00310 BODS
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 TSSrrSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
Parameter Cade 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)