WQ0004972_Monitoring - 09-2020_20201030

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0004972
Name of Facility:*
Month:* September
Report Information
Forest Lakes Preserve ELS
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
Forest Lakes 1.49MB
Preserve_September. pdf
FDF a,ly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Jessica Mize
Reviewer: Williams, Kendall
10/30/2020
This will be filled in automatically

Is the project number correct?* WQ0004972
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Winston-Salem
Accepted Date: 10/30/2020

Page
1 of 2
NON -DISCHARGE WASTE
WATER MONITORING
REPORT
MONTH: September
YEAR:
2020
PERMIT NUMBER: \1' 0004972
COUNTY: Davie
FACILITY NAME: Forest Lakes Preserve ELS
Flow Monitoring Point: Effluent: Influent:
Li
❑
Parameter Monitoring Point: Effluent: Ej
Influent: LJJ
Surface Water (SW): I SW CodelName:
Was There Effluent Flow for this Month Generated At This Facility:
Yes: LNd
No:
70300 00940
50060 00400
60060
00310
00610
00530 mm
00665
00625
00630
00600
00620
Operator
Fecal
D A rival OaiN Rate
C'.[IhlUfln
Total
Tosat
A Time Operator ORG (Flow) into
S13 n mic
Total
Hjcldhat
Total
Ni:ralc 6issolvcd
'[- 240D Time on on Treatment
kcsiduxl
nn1)-5
NIi 3-N
'r55 Mcan•1
rho,
Nitrogen
NO2.tiU3
1nn�gen
KC)3 N Solids Chloride
E Clue .Sit, Site? Syst111 pit
Chlorin,
20'C'
MGf1,
MGl1.
Mf7fL linoMh
M(Vl.
MGlL
MULL
31G'L
0.lIi�L MGIL h1G:L
H EiS YIN (i ID llNl'fti
lJ[i1L
Mnolhk
Monthly
Moodily Ill A'ly
Monitly
Monthly
M11nn[hiy
.Lfonllly
NuNhly 3lycar Sfyoor
C'onlinunil+ SrlvccA
5;lVeck
1 1508 0.15 I1 9,131 5.87
<10
1 1458 0.15 B 8,888 5.91
<10
3 1322 0.15:. E 8,142 5.89
<10
4 1533 0.15 IS 8,243 5.86
<10
s 17,3 89
n 17,389
7 1101ida
8 0752 0,25 1 Y 17,389 5.81
<10
9 1310 0.25 1 Y 10,077 5,99
<10.
In 1411 0.25 Y 10,004 5.90
<10
it 0900 0.50 y 9,262 5.96
<10
12 13,217
1313.217
..:,.
.:
14 0910 0.75 Y 13,217 6,04
<10
is 1413 0.15 It 12,044 5.99
<10
16 1633 0.15 0 11,063 5.98
<10
17 1629 0.15 11 8,218 6.02
<10.
Ia 1447 0.15 n 7979 6.I16
<10
t9
9,486
2u
9,486
21
1212
14011
1353
Oa0
0.25
0.50
Y
Y
y
9,486
10,345
10,294
6.11
6.09
6.11
<10
110
<11)
:2
23
24
1502
0.23
Y
9.101
6.08
<10
25
1355
0.25
y
8,776
6.08
<10
26
10,888
xv
10,888
2x
0918
0.50
Y
1 f1,888
6.02
<1 O
29
1700
0.25
It
9.397
6.00
<10
i❑
0815
11.25
1 13
8,028
6.01
<10
11.3
39.9
6.60
>242U
5.15
50,0
<(1.05
M).0
<II.O5
31
Average ]0,756
q0
11.3
39.9
6.60 �2420
S.15
5(LO
<0.05
50.0
<U.115
Daily Alaxinrurrl 17,389 6AI
<10
11.3
39.9
6.60 >2420
5,15
541.0
<0.05
50,0
<0,05
Daily %llnimane 1 7,979 5.81
<10
11.3
39.9
6.60 >2420
5.15
50.0
<0.05
50.0
<0.05
Monthly I.Imlts (s) 1 24400
Cmnposiw U Grall (G)
Operator In Responsible Charge (ORC): Glenn Price
Grade:
It Phone: [phone]
Cluck Box if ORC Has Changed: ❑
ORC Certification Number: 987931/20771
Certified Laboratories (1): R & A Laboratories Inc.
(2):
Person(s) Collecting Samples: Glenn Price
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X _A'1
DENR (s]GNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality Ely this signature, I certify that this report is accurate and
1617 Mail Service Center complete t0 the best of my knowledge.
RALEIGII,NC 27699-1617
DENR Form NDAR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
FACILITY STATUS:
Please answer the following question: Compliant ,N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
If the facility is non-comnlinnt, 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 a qualified personnel properly gather and evaluate 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."
(Signature of Permt ee)* Date
Baron Neal McDuffie (Authorized Agent)
(Permittee-Please print or type)
2N Riverside Plant Suite 800
Chicago, Il 60606
(Permittee Address)
01002 Arsenic
01022 Boron
00310 BOD5
01027 Cadmium
00916 Calcium
00940 Chloride
50060 Chlorine, Total
Residual
01034 Chromium
00340 COD
31504
Coliform, Total
00094
Conductivity
01042
Copper
00300
Dissolved Oxygen
31616
Fecal Coliform
01051
Lead
00927
Magnesium
71900
Mercury
00610
NH3 as N
01067
Nickel
Baron Neal McDuffie
(Name of Signing Official -Please print or type)
Field Services Director (R & A Laboratories. Inc-)
(Position or Title)
3/31/21
(Permit Exp. Date)
00600 Nitrogen, Total
00630 NO2 & NO3
00620 NO3
00556 Oil & Grease
W 09 PAN Plant Available
00400 pH
32730 Phenols
00665 Phosphorus, Total
00937 Potassium
00545 Settleable Matter
00929
Sodium
00931
SAR
00745
Sulfide
00515
TDS
00010
Temperature
00625
TKN
00680
TOC
00530
TSS/TSR
00076
Turbidity
01092
Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone], extension 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the renortina_
faciliVs permit for reporting_ data.
If signed by other than the Petmittee, delegation of signatory authority must be on file with the state per I SA NCAC 213.0506 (b) (2) (D).

Page 2 of 2
NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
PERMIT NUMBER: W 004972 MONTH: Seate frlber YEAR: 2020
FACILITY NAME: Forest Lakes Preserve ELS. COUNTY: Davie
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feeligallon) x 12 (inchesRoot)l! [Area Sprayed (aces) x 43,560 {square teetlacre) or
[Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (galianslacre4nch),
Inches = Dail Loading (inches) l [Time irrigated (minutes) t 6o (minutes/hour)] Monthly Loading {inches) =Sum of Daily Loading (inches)
Maximum Hourly Loading {' J y 9 C
12 Month Reefing Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 morffs Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Numbar of days in the month (daysrmanth )1 x 7 (days1week)
Did Irrigation Occur At This Facility: Did "galion Occur On This Field: Did Irrigation occur On This Field:
Yes_ No: ❑ Yes: © No: ❑ Yes: ❑ No: ❑
Field Number. I Field Number.
Area Sprayed (acres): 17.0 Area Sprayed (acres):
Cover Crop. Cover Crop:
Permitted Hourly Rale (inches): 0.11 Permitted Hourty Rate (inches):
WEATHER CCNDITIONS Permitted Yearly Rate finches): 46.8 Permitted Yearly Rate (inches):
11 Muimum Lrax+nwm
,.\ W.Aher Temperahue slaoge
Code' at Pre pile, Lepoon t'nl,l,n. 'Time 1)aiiy If-lY V'olumc T:I:tr roily Hourly
[� appL.ao„ Uc lvcok�wJ Arplcd hdgnmd Lessling [..ding AppfiW lin,,md Lwding Grding
rn'mum,
I Cl 76 (I 2.4 33,984 240 0.18 0.03
C 88 a 3.1
a C 89 0 2.9
a C 89 11 2.9
S
G
H C1 72 11 2.3
R 84 0.4 2.2
w PC 88 11 2.1
11 C 71 it 2.0 42,40 300 0.22 0.03
t�
17
14 PC 79 (1 2.1 42AX0 300 0.22 Il.fl3
Is C 71 0 2,1
it, 11C 74 (1 2.0 42 480 300 0 22 0.03
17 R 66 0.7 2 „1
In C 7i 0 2.0 42 4811 3110 0.22 ILll3
�u
21 C 60 1 0 2.3 42,480 300 0.22 0.03
22 ( 60 (I 2.9
21 C1 59 0 2,N
'a R 63 2.2 2.7
2s R 69 0.4 2.5
Is PC' 69 11 2.1 12,480 3110 0.22 0.03
Cl 71 0 2.7
nl CI 62 1) 1.6
it In1.IC•r11nnJ.\fnnlLl�i:,a.11n�l nNnl i• ~.�F� 1.50'"�---
-- 14.73
11 �lonld >'Wtlog7olal (iarhnl -- - -' -
A-21Vl'r[Ylyr. dift(1nr-) 0-10
"Weather Codes: CtIear, PC -partly cloudy, CI -cloudy. R-raln, Sn-snow, 51-sltel
Spray Irrigation Operator in Responsible Charge (ORC): Glenn Price Phone: [phone]
ORC Certification Number: 987931/20771 Check Box if ORC Has Changed: ❑
Nlail ORIGINAL and Two COPIES to:
ATTN-. Nan -Discharge Compliance Unit X
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
DENR Farm 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.)
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in 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. ETI
4. All buffer zones as specified in the permit were maintained during each application. C�
S. The freeboard in the treatment and/or 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 a qualified personnel properly gather and evaluate 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."
d Baron Neal McDuffie
(Signature of Permitee)* Date (Name of Signing Official -Please print or type)
Baron Neal McDuffie (Authorized Agent)
(Permittee-Please print or type)
2N. Riverside Plaza, Suite 800
Chicago, Il 60606
(Permittee Address)
Field Services Director (R & A Laboratories. Inc)
(Position or Title)
3/31 /2021
(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).

RESEARCh & ANALyTiCAI
LA ORATORIES, INC.
For: Smithers Viscient
2900 Quakenbush Road
Snow Camp, NC 27349
Attn: Gus Zieske
Client Sample ID: Fecal
Report of Analysis
9/14/2020
t�itrttrrr��
ON
�co Nc#3a cn
�; • ..
NC #37701
\
.�.,,�'<cRR•' OAR
r�irrtrtrryt�
Lab Sample lD: 87231-01
Site: Springborn Viscient Collection Date: 919I2020 12:00
Parameter Method Result Units Rep Limit Analyst Analysis DatelTi,me
Fecal Coliform QT Colilert 18 >2420 MPN/100ml 1 BJ 9/9/2020 1554
NA = not analyzed
P.O. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone]
Fax [phone]
www.randalabs.com Pag e 1

siiiin�onn
LPG (Cyanide) NaOH
��nnoo�nuI
w

R ESEARck & ANAIyTICAI
LAWRATORIES� INC.
For: Forest Lake Preserve
192 Thousand Trails Drive
Advance, NC 27006
Attn: Tracy Overdurf
Client Sample ID: Effluent
Site: Forest Lakes
Report of Analysis
10/16/2020
+1SaaIlf�+lr
A N ALYTj,+�i�
? co NC #34 Z:
NC #37701
r
?#�EDtA1",
Lab Sample ID: 88277-01
Collection Date: 9/30/2020 17:11
arameter Method Result Units Rep Limit Analyst Analysis Date/Time
Ammonia Nitrogen
SM 4500 NH3 D-2011
39.9
mg/L
0.1
FK
1U11tjl1.ULU
BOD-5
SM 5210 B-2011
11.3
mglL
2
HW
1011J2020 1310
Nitrate + Nitrite
SM 4500 NO3 E-2011
<0.05
mglL
0.05
LP
10/1/2020 1650
Nitrate Nitrogen
(SM 4500 NO3 E-2011)-(SM
<0.05
mglL
0.05
LP
10/1/2020 1650
4500 NO2 B-2011)
Total Kjedjahl Nitrogen
Hach 10242
50.0
mglL
1
FK
10/6/2020
Total Nitrogen
Calc
50.0
mglL
1
Total Phosphorous
SM 4500 P E-2011
5.15
mglL
0.05
LP
10/412020
Total Suspended Solids
SM 2450 D-2011
6.60
mglL
5
AW
101212020
NA = not analyzed
P.O. Sox 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
r�; C2 Iri--k: ;1

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
Water / Wastewater
Misc.
Company Forest Lake
Job No.
d
7>
w
U
N
x
°
N
N
O
U
N
y
V
C.
6
N
V
W
a
A
m
a;
O
:
L
O
A
0U
a
z
e
y
a;
o
C
U
U
a
U_
U
1
�'
Street Address
Project
Monthly Effluent Sampling
City, State, Zip
Sampler Name (Pl9W Print)
Gee
°'
Contact
Phone
Sampler Signature
i
Ux
Simple Number
(Lab Use Only)
Date
Time
Comp
Grab
Temp
o
C
Res.
Cl.
Chlorine
Removed
V or N
Sample
Matrix
S or W
Sample Location ! I.D.
p
4-4
�Jo
Requested Analysis
yo
( f
x
w
Effluent
4
2
1
(BOD,TSS,NWN,
NO3-N, T.Nit, T. Phos)
Re 'nquish d �Byd
ate/Time
ece ed y
Remarks:
Relinquished By
Date/Time
Re c ved By
On Ice
Sample Temperature at receipt Q , U °C