WQ0019782_Monitoring - 09-2016_20170123

6amplin9 Person(s)
11
Certified Laboratories
Name: Chip White
Name: Environment 1
Name: Anthony Branch
Name'
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ocomolant ❑ Non -Compliant
If the facility is non-compllant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets M necessary.
I
Operator in Responsible Charge (ORC) Certification
Permitteelcertifieaticn
ORC: Chip White I
Permittee: YMCA of Greensboro
Certification No.:
Signing Official: Greg Jones
Grade: Phone Number. 252-235-4900
Signing Officlars Title: President/CEO
Has the ORO changed since the previous NOMR? Oyes ❑ No
Phone Number. 3368548410 Permit Expiration: 9/30/2020
L 321
.A X;ft tR. d 1LC( `-z x(.07-U'L4 v to
Signature Date
Signature U)
By We ser lue, I ceniry Mat this report isaCwimla anti Complete to the trod of my iaioebdge.
Icash, under penafty d law. Ong this docunient and all Beach meiits were pmpered undamy d'aectim oraupeMsionN
accoiderrta wsh a system designed toassum that all quaffpemonno] pmpeM gathered end evaluated the iniornabor
subMsed. based an my inqulryafare peninar pemans wtro age tlat sYslom, ortlxee persons dueosyropondbhk
gathehg ine inionwasam Means hewn submiaed is. to the best of my anadedge and belts. Cue. aavrete, and eomplek
am aware that them are dgngkaid penalses for submitting false 6dariimdcn. Including the posdballoflines and linpdsonm
for lawnina violations.
Mail Original and Two Copies to: '
Division of Water Resources
Information Processing Unit
' 1617 Mail Service Center

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
I
Sampling Person(s) Certified Laboratories
Name: Chip White Name: Environment 1
Name: Anthony Branch Name:
Does all monitoring data and sampling frequencies meet the requirements In Attachment w or your permit Or — - If the facility Is non-compliant, please explain in the space below the reason(s) the facility was not In compliance. Provide in your explanation the date(s) of the non-oompliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Chip White
Permittee: YMCA of Greensboro
Certification No.:
Signing Official: Greg Jones
Grade: Phone Number: 252-235-4900
Signing Official's Title: PresidentICEO it
Has the ORC changed since the previous NDMR? 0 ye; D No
Phone Number: 3368548410 Permit Expiration: 9/30/2020
/74 /-0(
Signature Date
Signature Date
By Iris algnaturo. I eartay that on report Is amwrate and compete b the beat of my xnowbdge.
1 o mfy, undw pmaky of low, that the documert arld cog W.CIM1e112 wars preparOd uxler my dbectbn a aupervabn b
accordance with a system designed to an" net eti qualified persomN properly gathered and mabated the INormaaon
submitted. Based on my Inquiry of the parson or persona who mamas the system, or these persoes directly responaWe for
galherYq the Wometbn, the INwmallon submitted 1% to the heal of my ImoMedge and boost. We. accuale, and complete. I am
aware that there are sgnrlcara penalties forsubmtitelp false Womediom i cNMing the posaiWly, of Pros and bnpdsoroeN for
Ivawelg wdelbna.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
i 1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 1 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
0
Permit No.: WQ0019782
Facility Name:
YMCA -CAMP WEAVER
County: Guilford
1�, onth:
September
Year:
2016
Field.N6me:
1
Field Name:
2
Field Name:
3
Field Name:
4
Did irrigation occur
Area (aces):
0 3719
Area (acres):
0.3719
Area (acres):
:0.4477
Area (acres):
0.4477
at this facility?
Cover Crop:
Natural"Forest
Cover Crop:
Natural Forest
Cover Crop:
Natural Forest
Cover Crop:
Natural Forest
Hourly Ratel(in):
'.'.0.4
Hourly Rate (in):
0.4
Hourly'Rate (in):
0.4
Hourly Rate (in):
0.4
%Annuall.Ratom):
'x38.3
Annual Rate (in):
38.3
Annual Rate (in):
: 38.3 :
Annual Rate (in):
38.3
Weather Freeboard
=Fieldlrrigated?
Field Irrigated?
Field:lrrigated?.
Field Irrigated?
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% a =
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d O N
t,i:jr.L'
N N
3 °F in ft ft
.-::gal min„
.in -
in.
gal min
in
in
gal,.,, min
in in
gal min
in
in
1
1,808 ,60'
0A8
0.18 -',
2,225 90
0.22
0.15
2
CL 88 2.3'.,3,254
90
0.32¢'.
'0.21.'':
3,465 90
0.34
0.23
3
CL 78 0.35 2.4
_
4
5
CL 81 1.66 2.3
6
;810. ',30
0'08 ,
0.08 l�'
813 30
0.08
0.08
'
7
8
CL 82 0.76 2.7
1.
9
10
C 84 2.9
11
12
C 86 3.1
13
14
15
C 93 1 0.07 3.6
16
17
C 92 3.8
18
19
CL 83 3.1
20
21
22
C 81 0.15 3.1-
23
24
CL 84 3.6
_
25
26C
74 4.3
27
28
29
CL 83 0.62 4.6
30
0

Did the application rates exceed the limits in Attachment B of your permit? OC«rroam ❑Nontc mi leant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑o Compliant ❑Nor-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your perm it? pp compliant ❑Nontompttard
Were all setbacks listed in your permit maintained for every application to each permitted site? I ©Compliant ❑Nb^{Omamnt
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? oranpllant ❑Non{ompiiant
If the facility Is noncompliant, please explain In the space below the reason(s) the facility was not In compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets If necessary.
1
I I
l
i
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Chip White
P
Permittee:
YMCA of Greensboro ,
Certification No.:
Signing Official: Greg Jones
_ ..__...._..._. �._.....- --..._.._... _ ................ _..............
Grade: Phone Number. 252-235-4900
Signing Official's Title: `President/CEO
i............ ___....................... ......... ..... _............... _._............................... _......
Has the ORC changed since the previous NDAR•1? Oyes ❑ No
Phone Number: 3368548410 Permit Exp.: 9/30/20
..
C
Signature -'rw-iJ •tL /yyLQl,(,tt�r-i . Date
Signature ; Date
By this signakne. I certify timtthls report aalareta aW complete to the bestofmy laaM'ledge.
I ,try, mulwpealty Of law. Undthis dcannerd and all attachments ware prepmed under my d in
will, a system designed to waams mat as Paned perscnnei properly garwo and evaluated the jnfbmadon submitted. Based t
inWity of the person or person; who menage thesyskm, or those penman dirady reaponalblefor gathering Use Inla nation, t
inkmashon wbmWW b, to the best of my I mvisdoe and belief, true. 9opaita, and complete. I am swam Chauhan are slgnra
penaift fbrsomiebg false khm alien, IndWbtg the poasiblity of tines and impri=[Owd(Or Wrowirg vidatiana
Maif Origirial and Two Copies to:
Division of water Resources i
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10.13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2 of 2
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
❑' Compliant ❑ Norrc-mpilent
❑+ Compliant ❑ Non -Compliant
❑+ Comptant ❑ Nm -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? O Comptant ❑ Non-compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ! p compoant ❑ Non{ompaant
If the facility is non-mmpllant please explairiIin the space below the reason(s) the facility was not In compliance. Provide in your explanation the date(s) of th�non-compliance and describe the corrective
actions) taken. Attach additional sheets if necessary. _ _
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Chip White Permittee: YMCA of Greensboro
Certification No.: Signing Official: Greg Jones
Grade: Phone Number: 252-235-4900 Signing Official's Title: President/CEO
Has the ORC changed since the previous NIpAR-1? Yes ❑ No Phone Number: 3368548410 Permit Exp.: 9/30/20
Signature Date Signature Dale
By this agmbae, I certiry met Itis report lel c atm le and complete to the beat of my knoMedge. I ceNry, under pime ty of low, art this dxumeot and as aitachmems "ma mpamo under my dkeclien or sts a islon m •oeardence
wiNr a system deslprrd to assure that W quatlild persomel Property gathered and evaluated the hdormatbn submitted. Based on my
i kinky of IM person or person who marage the system. or those penins dkectiy mspoml6le for gameft the Ydormstrn, the
Mormagon aubmtted Is. to the beat of my krowledge and bellel, true. tmc mde, and compote. I am aware that there sm sigrdaram
parraW for a d mmNp fare WmmaOon. bWudbp the possb0y of ones and knWax omen) for knowap vbtatbra.
i
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
AY E �e