WQ0019782_Monitoring - 10-2016_20170123

• F()RM- NnKAR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 2
Permit No.:
PPI:
W00019782Facility Name: YMCA -CAMP WEAVER
001 Plow Measuring Point Influent Effluent ❑No flow generated
County: Guilford
Parameter Monitoring Point: �mfluent
Month:
OEfFluent
October Year: 2016
OGmundwater Lowering 0surface water
Parameter Code --►
'-50050":`
00400 50000 <1
00310
i6061.0 00530
` 31616`--
00630
00625 '
00665
00010
00620
00615`
w
tm8
m
O
E. o po
m�0
.-.
®
z
'
®0
fp
aU.
uCo
°
Z Z
Me
ta
E
-
®--
.•.
m�0
24•hr
hrs
GPD
su "m"gLL :.
mglL
mglL - mglL
;:#1100.mL;
mglL
,nig/L !
mglL
°C'
mglL
mglL `
®
e °
-
®--
m�0
®
e e
®0
Me
ee
.•.
®--
.•.
m�0
®
°
m
--
m
m--
®
e °
-
®--
�®
®--
®`--
m�0
°
-®
ED
M
° e
�®
®--
M--

FnRM• NDMR 10.13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Name: Chip White
Name: Anthony Branch
Sampling Person(s)
I
Certified Laboratories
Name: Environment 1
Name:
• rnrnmdiam ONnn-Compliant
Does all monitoring data and sampling frequencies meet the requirements in gttasinnrcusn yr y....r r�.•••••i
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-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
Permittee: YMCA of Greensboro
ORC: Chip White
Signing Official: Greg Jones
Certification No.:
Phone umber: 252-235-4900
Signing Official's Title: President/CEO
Grade:
MR7 Ove; ONO
Phone Number: 3368548410 Permit Expiration: 9/30/2020
Has the ORC changed since the previous
Dale
Signature ,I Date
Signature
By this signature. I carthat this report is eccurtsle and complete to the beat of my knowledge.
I certify, ander penally or law, that We dowment and of altaChmenfs were prepared under my direction o aapervMon in
a000manoe with a system designed to asswe that at qualified personnel preperN gathered and evaluated the Information
submitted Based on my kputy of to person Or pemos who manage the system, or those persons drectfy reaponsibla for
est of my knowledge and bellef. true,
g lhedpg Wormation, the submifted Is, to the
Land mpdsonmcommeenl
aware that Were are significant pansies for submitting false Information, nformation, Including the possibility of fines form
knavi 'vlolatlos.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699.1617
I .

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) I I Page 1 of 2
••1
. •
• .•
_
Did irrigation occur
Area (acres):
Area (acres):
atthisfacility?
Natural For
�_®_
■ •
■
■ e
■ O
am
m
am
m
o©m
�m
----.
m��®�_
----
-ME
M
----
----
®�m_�_
-_--
-_---_
m�m_®_
-__-_-_
----
m___--
----
mom�®�
----ME
�ME
0=
M
ME
®��_
®_
----
-_--
m�m_®_
lot
M___
VIMV/////.0

• , 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?
Were all setbacks listed in your permit maintained for every application to each permitted site?
OCompliant ❑Non -Compliant
00ornplWm ONon-Compliant
R+Cmnpliam ❑Nan-Complbm
OCompliant DNon-Camplydnt
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? I ocompgant CNon•Cmnpliant
If the facility is non-comoliant. 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
taxen. Auacn 8aanximu sneers
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 NDAR-1? Ayes Ona
Phone Number: 3368548410 permit Ftp.: 9/30/20
Signature I Date
Signature ✓rylA .wr;tq, - t.E.)t.Q-Q� to
By this signature, i tangy that this report is accunate and complete to the best of my knowledge.
I Certify, under penalty of low, that this dmment and am attachments were prepared under my direction or supervision In accordanee
with a system designed to assure that all qualified personal propedy gathered and evaluated the Information submitted. Based on my
Inquiry of the person or persons who manage the system, or those pereons directly responsible for gathering the Information, the
Information submitted Is, to the best of my knowledge and belief, we, accurate, and complete. I am aware that mere are significant
penalties for submitting false Information. bldudirg the posslbpty of lines and Imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617