NC0080195_Regional Office Historical File Pre 2018

1
RECEIVED/NCOENRIDWR
EFFLUENT J S E P 18 2017
w--
AIL WQRGS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH 3enc' YEAR 2017
FACILITY NAME Forest Hill Mobile Home Estates CLASS:ww-1 COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: 1 /,-' C
_
- -
ATTN:CENTRAL FILES x '' 8.28.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 ' 31616 00300 00600 00665 00070 101045 I 010551
F g * FLOW w Q= p co ENTER PARAMETER CODE ABOVE
> I— e.2 EFF III0 co pre Q W J 0 J re W Z J W NAME AND UNITS BELOW
W INF ❑ i� IV� LLI F< . W= Oo DOFIL p0O
d
I.
c ° �v mN 2 ON in co O gA . J1- v I 0 I2
O o UV aZ V Z
dgpion �O G
Turbidity Iron Managnese
HRS HRS Y/B/N MGD o C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L ntu mg/L ug/I
1
2
3
4 10:54 0.5 Y .003E 6.97 23 <2.5 1 0.322 0.001
5
6
7
8
9
10
II
12
13
14
15
16
17 10:43 0.5 Y 0.003E 7.14 29 <2.5 1.4
18
19 MES
20,
QA SEP 12 2t17
22
23
24 szt 12ZI
25
26
27
28
29
30
31
AVERAGE 0.003E 7.055 26 <2.5 1.2 0.322 0.001
MAXIMUM 0.003E 7.14 29 <2.5 1.4 0.322 0.001
MINIMUM 0.003 E 6.97 23 <2.5 1 0.322 0.001
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L NIL N/L
• RF FI\/FD
SEP 12 2017
DWQ Form MR-1(11/04)
O`t,"; ';CION
n irnr, ^"',• PROCESSING UN.

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
jewiJ , Ana. 8.29.2017
FOREST HILLS MOBILE HOME ESTATES gnature of P itt *** Date
C/O AC INVESTMENT PROPERTIES Required unl s su miffed electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2)'"'KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) • Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 RECEIVED COUNTY:Gaston
Vi ,
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner J U N 13 2018 ORC CERT NUMBER:28220
• RECEIVED/NCDENRIDWR
GRADE:PC-2 ORC HAS CHANGED:No CENTRAL FILES eDMR PERIOD:04-2018(April 2018) VERSION: 1.0 DWR SECTION STATUS:Processed .i I I Ni 8 2(118
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARSagg‘igt REGIONAL OFFIC
MOM 60400 58060 C0531 01•15 01055 WOWA
1 f 1 2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
u S Instantaneous PH
Grab Grab Grab Gab Grab
' 8
S F O off an oRev►s Tss-C•.e IRONMANt?1� TUaa/D71'
2400.loch nn 2606 dock Hn WINN me su uel mg/I me/1 ugh mu
i
2
3 1100 0.3 N 0.003 7.1 39 <2.5 0.18 0.006 0.75
3
6
7 1300 .25 Y NOFLOW
e
9
N
11
12
13 1130 0.25 Y NOFLOW
14
1s
16
17
IS
19
20
21
22
23
24
25
26
27
2e
29
s
Merl*Annie L.! 36
MaatYy Merat 0.003 39 0 0.18 0.006 0.75
Day Man non 0.003 7.1 39 0 0.18 0.006 0.75
Doily 61161 0.003 7.1 39 0 0.18 0.006 0.75
•'s No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation-Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-I COUNTY:Gaston
V1 fi'P
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:04-2018(April 2018) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:05/21/2018
05/21/2018
ORC/Certifier Signature: Rac ael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of co : tive actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES pe it.
' 1 05/21/2018
Permittee/ ubmitter Signat •*** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dall C 2:034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(bX2)(D).

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
Va TP
OWNER NAME:Randy Fem1l ORC:Leonard Earl Stopper ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:04-2018(April2018) VERSION:1.0 STATUS:Processed
Outfall 001-Effluent Comments:
After April 6,2018 there was no flow at the facility due to the discharge being eliminated by a septic tank.

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active 3
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-I RECEIVED COUNTY:Gaston
` 1P JUN132018
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No CENTRALFILES RECEIVEDMCDENRIDWR
— DWR SECTION
eDMR PERIOD:03-2018(March 2018) VERSION:2.0 STATUS:Processed )1 ;,\ 6 ?ON
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCH��(� *. ROS
--MOOI�ESVIL��REGIONALOFFICE
56050 00400 50060 C0530 01045 01055 00070
I
I
S 2 X month 2 X month 2 X month 2 X month Quuurly Quarterly 2 X month
A
S Ins Instantaneous Grab Grab Grab Grab Grab Grab
YyI
8 I pi 5 o PH auosuva Tse-Co.. IRON MANraress 7vssmrr
2400 doh tin 240stock Has v/DIN med su ue/1 mel me/1 ugn ntu
2
3
4
5
6 1032 0.5 N 0.003 7.07 47 <2.5 0.55
7
8 1030 0.25 Y
9
I.
II
12
13 1000 0.25 Y
14
15
16
17
L
19
20 1107 0.4 N 0.003 6.97 47 10.7 8
21 1500 0.25 Y
22
u
24
25
26
27
26
39 1000 0.25 Y
36
31
OraoHly Amerap Loin 30
11140101yA.or 0.003 47 5.35 4.275
Dolly Marra.. 0.003 7.07 47 10.7 8
Daly 111/Mana` 0.003 6.97 47 0 0.55
6s06 No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PE1tMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferri11 ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:03-2018(March 2018) VERSION:2.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:05/21/2018
_ 05/21/2018 1;::::: .-10%.0„.2
C/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a F. of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the ES pe it.
Gh.„,i0 ' , e 05/21/2018
Per ittee/Submitt1 Sign.ture:*** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rh Rd a alias NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental!,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/fonns.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(bX2XD).

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-I COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:03-2018(March 2018) VERSION:2.0 STATUS:Processed
Report Comments:
In the data entry process,the numbers for the Chlorine Residual on Tuesday,March 20,2018 were transposed.This report is amended to correct that error.

PDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP RECEIVED
- ------.3
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner MAY 02 2018 ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:03-2018(March 2018) VERSION: 1.0 BEN I r AL FILES STATUS:ProcessedDWR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
50050 00400 50060 C0530 01045 01055 00070
IA 2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
a
0 to`t A Instantaneous Gab Grab Crib GrabGrabGab
Io o PHctH CHLORINE ,ss_Coen IRON MANGNESE TUI/®TY
2410 deck Hr. 24110 dock Hr. YJIR4 mgd su ug/l me/l mg/1 ugfl ntu
2
3
4 s RECEIVED/NCDENPJDwF
6 1032 0.5 N 0.003 7.07 47 <2.5 . 0.55
7 h 1;
1030 0.25 Y WQROa
9 MOORFSVLLE RC©IONAL Orr-ICE
1.
II
12
13 1000 0.25 Y
14
15
lb
17
le
19
20 1107 0.4 N 0.003 6.97 74 10.7 8
21 1500 0.25 Y
22
23
24
25
26
27
2.
29 1000 0.25 Y
30
3,
Mealy Avenge limit 30
Moodily Average: 0.003 60.5 5.35 4.275
Daily Mmdmare 0.003 7.07 74 10.7 8
Daly 11111iraane0.003 6.97 47 0 0.55
****No Reporting Reason:ENFRUSE=No Flow-ReuselRecycle; ENV WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

PDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-I COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:03-2018(March 2018) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:04/20/2018
isci ""---,.-------.
04/20/2018
C/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
Cali/L12 04/20/2018
Permittee/Sub itter Signature R hael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas N 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmenatl,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
CILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
Ri• r'C!VED
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner APR 02 2 ARC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No ARC
RECEIVED/NCDENR/DWR
eDMR PERIOD:02-2018(February 2018) VERSION: 1.0 C[�11t/�!_ F)ON
°WR SECri
ri ATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NOaRos
MOORESVILLE RFCIONAL OFFICE
32050 00400 50060 C0530 01045 01055 00070
f
I 8 g j
2 X month 2 X moth 2 X month 2 X month Quarterly Quarterly 2 X month
u G 1 8 , Instantaneous Grab Grab Grab Grab Grab Grab
li
a itS I, �' o oI
I FLOW PH CHLORINE 758-cwe IEON nuwravrae 77RalD7 Y
2400 dock Hr. 2400 clock Hee r/uN mgd so ug/I mg/I mg/I ug/1 ntu
1
3
4
5
6 0956 0.5 N 0.003 7.03 49 32.7 30
7
a
9 0900 0.25 Y
10
II
12
13
14 1000 0.25 Y
15
16
17
1a
19
20 1113 0.3 Y 0.003 7.08 19 3.4 1.1
21
22
23
24
23 1000 0.25 Y
26
27
20
86a1Y2 Avenge rldlt 30
Meatbly Average: 0.003 34 18.05 15.55
payne 0.003 7.08 49 32.7 30
Daly Miming=
0.003 7.03 19 3.4 1.1
•ee•No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
CILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:02-2018(February 2018) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:03/20/2018
(1/4 (''..v-1.4‘)4' iltl .". .. ---"-...-) 03/20/2018
ORC/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrmtive actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the ' i ' permit.
•/ 1 /1 03/20/2018
P. mittee/Sub ifr S g ture:*** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: ' yne d . las NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2XD).
A

NPD1ES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 C( PERMIT STATUS:Active
-
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 RE(.',`�' \/ COUNTY:Gaston3
W ' MAR 09 Z018
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:REC 28220
NR
GRADE:PC-2 ORC HAS CHANGED:No C�(V 1 I f" L
OWR S SECTIONN.EEIVEDMCDENR/D
eDMR PERIOD:01-2018(January 2018) VERSION: 1.0 STATUS:Processed
�y�C�1N 1 :) ;`!In
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
WQROS
MOORESVII l F gJsC10NAl OFt-ICE
t 50050 00400 50060 C0530 01045 01065 00070
I I 8 I
2 X month 2 X month 2 X month 2 X monthQuarterly Quarterly Quarterly 2 X month
I I. o' ei
i Instantaneous Grab Grab Grab Grab Grab Grab
I
u
a t 0 0 o Z FLOW pH CMH.ORJNE TSS-Cow IRON MAN048$& TURRHITY
2400 dock Hn 2400 desk Ors Y/LN mgd su ug/1 mg/I mg/I ug/1 au
1
2
3 1032 0.5 N 0.003 6.96 46 <25 0.179 0.185 0.8
4 1100 0.25 Y
5
6
7
s
9 1500 0.25 Y
I.
II
12
13
14
15 1530 0.25 Y
16 1123 0.5 N 0.003 7.01 39 <2.5 0.6
17
10
19
20
21
22
23
24
25
26 1030 0.25 Y
27
2s
2!
3a
31 1400 0.25 Y
Moa0Yy Aver..13.6k 30
Mo40 lr Average: 0.003 42.5 0 0.179 0.185 0.7
Dar Maximum 0.003 7.01 46 0 0.179 0.185 0.8
Daly 1111misimu 0.003 6.96 39 0 0.179 0.185 0.6
eee}No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDS PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferri11 ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:01-2018(January 2018) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:02/26/2018
02/26/2018
ORC/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDE 1
,„
02/26/2018
Permi ee/Submitter nat e:*** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Perm' ee Address:Rhyne D NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2XD).

NPDDS PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTR
OWNER NAME:Randy Ferri11 ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:01-2018(January 2018) VERSION:1.0 STATUS:Processed
Report Comments:
Flow is estimated.

ES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
-TP - RECEIVED
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner FEB 0 8 2018 ORC CERT NUMBF EDINCDENRIDWR
GRADE:PC-2 ORC HAS CHANGED:No FEB
eDMR PERIOD: 12-2017(December 2017) VERSION: 1.0 CENTRAL FILES STATUS:Processed ?
OWR SECTION
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISMA i4: ONAL OFFICE
50050 00400 5040 COAX/ 01045 01055 00070
I Y 11
F 12 X month 2 X mash 2 x month 2 X month Quarterly Quarterly 2 x month
S n Gr
ab Grab G Gr
ab ab GrabGrab ab
Y
a o o r row r+► CHLORINE INS-Cam non MANQYLSB TUMMY
2440 deck line 2400 dock line WW14 mgd su ug/1 mg/I m8/1 ugh Mu
3
4
8 1115 0.5 N 0.003 6.98 47 <2.5 0.5
e
7
8 0930 0.25 Y
9
I0
II
02
13 1103 0.25 Y
14
Is
14
17
1a
19 1120 0.5 N 0.003 7.03 39 4 0.9
20
21 1100 0.25 Y
22
23
24
25
24
27
v
29 1400 0.25 Y
30
31
MoutNy Average WIG 39
Mare7 Average: 0.003 43 2 0.7
DaFj Maalaar 0.003 7.03 47 4 0.9
abMWaac 0.003 6.98 39 0 0.5
i4•0 No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

DES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferri11 ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD: 12-2017(December 2017) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:01/24/2018
r - CRC 01/24/2018
ORC/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permi
/ 01/24/2018
Permittee/S .mitter Si tur :*** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2XD).

ES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER 28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:12-2017(December 2017) VERSION: 1.0 STATUS:Processed
Report Comments:
Flow is estimated

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FAAILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP R l P I\/P V RECEIVEDINCDENRIDWR
OWNER NAME:Randy Ferri11 ORC:Leonard Earl Stogner JA N 0 0 Z 01 QRC CERT NUMBER:28220 ,A N I 6 L r
GRADE:PC-2 ORC HAS CHANGED:No jf
eDMR PERIOD: 11-2017(November 2017) VERSION: 1.0 DWF SECTION STATUS:Processed WQROS
I""ORhtATION PROCESSING UNIT MOORESVILLE REGIONAL.OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
50150 MIN 51161 C0530 01045 01655 60010
A i
2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
10 Instantaneous Grab Grab Gab Grab Grab Grab
y 7 g O I M CHLORINE FROM 7V1i6•TY
�i 2416aw r>r. IANdock rro WINN mgd su ug/l mg/I me ag/I ntu
1 1400 0.3 Y
2
3
5
6
7 1150 0.5 N 0.003 6.99 44 <2.5 0.4
a 1330 0.3 Y
9
1
II
12
13
14
15 1100 0.3 Y
16
17
10
19
20
21 1058 0.5 N 0.003 7.11 39 <2.5 0.5
22 1300 0.3 Y
23
24
25
26
27
20
D 0730 0.3 Y
30
MoMYy Averap rink 30
Mom!'Aversac 0.003 41.5 0 0.45
Day Masiasaa 0.003 7.11 44 0 0.5
Daly MIS 0.003 6.99 39 0 0.4
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD: 11-2017(November 2017) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE: 12/12/2017
,71" ‹ Leorvixd N P_r 12/12/2017
ORC/Certifier Signature: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES pe
•/ 1 / / • J( 12/12/2017
Permittee/'ubmitter Sign e:** Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee • dress:Rhyne Rd Da_ NC 8034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(bX2)(D).

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FAFILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferri!! ORC:Leonard Ferri Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:11-2017(November 2017) VERSION:1.0 STATUS:Processed
Report Commeab:
Flow is estimated

NPISES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 RECEIVE DCOUNTY:Gaston
tWTP OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner U E C 00 2 U I? ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No CENTRAL FILES
eDMR PERIOD:10-2017(October 2017) VERSION:1.0 DWR SECTION STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
116199 31981 Cosa 81045 01055 11171
IpA1 I. 2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
u y a
bI k Instantaneous Grab Grab Grab Grab Grab Grab
a
d 8 r- a x' FLOW PR CHLORINE TES-C.a IRON MANGNESR TORRR)TY
?AN dads an 14W dock Um Y/WN me su ugh mg/I mg/I VA nth
t
2
3 1047 0.5 N _ 0.003 6.87 _17 <2.5 1.33 47
4
5
6
7
a
9
I.
it 37
IT
13
14
15
16
17 1056 0.4 N 0.003 6.93 45 18 7.2
II
19
20
21
22
23
24
25
26
n
2.
29
36
31
Muddy Average ILdtr 30
MseftlyAvagc 0.003 31 9 1.33 47 22.1
Daly Maras 0.003 6.93 45 18 1.33 47 37
Dray Ml.rarm. 0.003 6.87 17 0 1.33 47 72
••••No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:10-2017(October 2017) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:11/27/2017
Z)/ e* 11/27/2017
ORC/Certifier Signature: R chael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
,,,the NPDES permit.
a� .0 V11/27/2017
Permittee/Su' itter Sign : * Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas N 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;RACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2XD).

•
NPDFS PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Fer i11 ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:10-2017(October 2017) VERSION:1.0 STATUS:Processed
Report Comments:
The flow is estimated.

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active 3
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stegner RECEIV'�1l '�n
CERT NUMBER•2E2s2O' '' - • -
GRADE:PC-2 ORC HAS CHANGED:No N O V X 0 0 0 1/ N O V 2 0 2 017
eDMR PERIOD:09-2017(September 2017) VERSION:2.0 CENTRAL FILEsiATUS:Processed
DWR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
1 I 1 I
MtM
P 5N5a N NWC0531 61115 01655 aNON
i2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
u b aE. i- Instantaneous Grab Grab Grab Grab Grab Grab
a
a F C z pH CHLORINS TSS_C e IRON MA VGN�SC 7UY.mTY
2466 deck 9n 2496 dirk an Y/NN mgdat ug/1 mg/1 mg/1 WO Mu
1
2
3
1
5
6 1101 0.5 N 0.003 6.87 47 5.2 17
7
a
9
N
II
12
13
14
15
la
17
Is
19 1036 1.0 N 0.003 6.78 31 <2.5 12
2a
21
22
23
24
25
24
27
21
29
36
MeeM17 Avenge lilt 36
Avenge: 0.003 39 2.6 14.5
My aaiwar. 0.003 6.87 47 5.2 17
DailyMilne= 0.003 6.78 31 0 12
eefe No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-I COUNTY:Gaston
WTP I OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:09-2017(September 2017) VERSION:2.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:828657_0 SUB ON DATE:10/27/2017
C 'e^' 'e el41k - *, ' / / / ` iX 10/27/2017
ORC/Certifier Signature: Rachael G Kramer E-Mail:r•chael@kacei .co Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit 0,
g 1 / 10/27/2017
Permittee/Submitter ignature:*** ach 1 G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
1
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:09-2017(September 2017) VERSION:2.0 STATUS:Processed
Report Comments:
Flow is an estimate

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 RECEIVED COUNTY:Gaston
W_rP OCT 02 2017 �EIVFf
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:2
CENTRAL FILES
GRADE:PC-2 ORC HAS CHANGED:No pW R SECTION
eDMR PERIOD:08-2017(August 2017) VERSION:1.0 STATUS:Processed
OR
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGMOESE*V:�!NO MAL OFFICE,
9050 1MIM 5000 C05311 01M5 •1055 11170
8 2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
7J Uv 8 Instantaneous GrabGrabGrab (hab Grab Grab
re CHLORINE 7ss-ck IRON a1ANcNBSe TOFsmrr
2aN dad Hn 2400 cheek Hn Y/INV ntgd au ug/1 mg/I ntu
2
3
5
7
$ 1122 0.5 Y 0.003 6.96 41 5.2 2.9
5
IS
1
12
13
14
15
16
17
IS
15
29
21
1107 0.5 Y 0.003 6.89 32 5.7 11
23
24
25
24
27
2s
25
30
31
Ma61615 Average lint 30
Meanly Asap 0.003 36.5 5.45 6.95
Daily Mmalnan' 0.003 6.96 41 5.7 11
Daly 0.003 6.89 32 5.2 2.9
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDEVERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PC-1 COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Leonard Earl Stogner ORC CERT NUMBER:28220
GRADE:PC-2 ORC HAS CHANGED:No
eDMR PERIOD:08-2017(August 2017) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compli• t CONTACT PHONE#:[phone] SUBMISSION DATE:09/12/2017
/
41001 -iI- 09/12/2017
RC/Certifier Signatu e: Rachael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
09/12/2017
Permittee/Submi er Signature * * achael G Kramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 2803 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Water Tech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(bX2XD).

RECEIVED/NCDENR/DWR
EFFLUENT G ,�L�
WOROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH June YEAR 2017
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED u NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x 7.19.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 own 101045 I 010551
*
F * FLOW w Q Z CI N ENTER PARAMETER CODE ABOVE
=a$ I- EFF IIF coG R n Q W J G J d. If) J W K NAME AND UNITS BELOW
A R 2 O IN›-La w. o. ZV ON zw Oa W olCZ O N5, Ow Oa
o V -1� Lio m 21= FN aO rnp I-- �2
g• UV 0pa
O disinfection z C.) Z Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3
4
5 10:59 0.5 Y .003E 7.71 28 29 22
6
7
8
9
10 OP
12
13 \UG G 4 lL 1 t
14
15
16
17
18
19 10:40 0.8 Y .003E 6.91 21 5.5 0.85
20
21
22
23tiD24 J.,+A
25
26 JUL t4 ?D17
27
28 I1-„3„rie;i:,;' I-MC=11 g Lrl;t
29 _ LAVi Section
30
31
AVERAGE 0.003E 7.31 24.5 17.25 11.425
MAXIMUM 0.003E 7.71 28 29 22
MINIMUM 0.003 E 6.91 21 5.5 0.85
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 ,/\/G N/L N/L N/L
AUG 0 2 201?
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
7.19.2017
FOREST HILLS MOBILE HOME ESTATES gnature of Pe ee ** Date
C/O AC INVESTMENT PROPERTIES Required unles ub itted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT t
RECEIVEDINCDENR/DWR
f`I; c� ./
V
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH May YEAR 2017
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I WOR@' Gaston
CERTIFIED LABORATORY Water Tech Labs CERN/MO f> '►I EGI(3NAL OFFICE
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED II NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: 1 u�-' _/__ _,__
ATTN:CENTRAL FILES x 6.26.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 00070 I 01045 I 010551
i= E * FLOW w Q z 0 o y ENTER PARAMETER CODE ABOVE
>8 I- ;; EFF ■ H y pit n Z W J W J re u W J W NAME AND UNITS BELOW
W u o U5 INFO iii9 a0 O <Z <O J <O 4o
G mg mQ. O �W yI!w a KV mN ace On.. WJ „, ow OH
A.
0 IYi <� w UV <Z ~D IL V (:I ~Z
C a
O G aiefatioo Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/IOOML MG/L, MG/L MG/L ntu mg/L mg/L
1 11:31 0.5 Y .003 E 6.98 20 <2.5 0.8
2
3
4
5 6 QA
7
8 9 JUL 1 2 zo>T
10
11 '
12
13
14
15 10:53 0.5 Y .003 E 7.48 44 4.1 1.6
16
17
18
19 20 Rl ,F'ifFD
21 JUL
22 _
24 INFO ° SECTaN JUL ] 2017
25 tAT "SING UNIT VME
26
27
28
29
30
31
AVERAGE 0.003E 7.23 32 4.1 1.2
MAXIMUM 0.003E 7.48 44 4.1 1.6
MINIMUM 0.003 E 6.98 20 4.1 0.8
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
DWQ Form MR-1(11/04)

Facility Status:(Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 certity,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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
i 6.26.2017
FOREST HILLS MOBILE HOME ESTATES gnature of P i e*** Date
C/O AC INVESTMENT PROPERTIES Required unl ss .miffed electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental, Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No. •
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT RECEIV:_D;'NCDENR/DWR
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH Apr p}���Y)A `±0f7
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-COUP�'YLE 6akiiif'!AL OFFICE
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED NO FLOW/DISCHARGE FROM SITE* El
Mail ORIGINAL and ONE COPY to: 1 __
ATTN:CENTRAL FILES x - '' 5.23.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS ACCURATE NC 27699-1617 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E on * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 100070 101045 I 010551
P Y FLOW w a Z 0 G N ENTER PARAMETER CODE ABOVE
W • � G 44 EFF ■ F? p C Z W J G J g I W J W NAME AND UNITS BELOW
E,.., as INFO < Mg CV 8 4Z 4O 417 4O
C m� O Y•W Ili Zu mN EZ O1 .d WJ wk 0� Da
g 0 p ~ disinfection tion a Z 0 C Z a.
Turbidity Iron Managnese
HRS FIRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3 10:50 0.5 Y .003E 6.94 38 36 17 5.22 0.367
4
5 A 6
7 RCnf"I‘ s_—ram.
9 30 1 ., zati�1
to
iUq 5 ?pi?
II
12
13rrrn..+"
.mow
14
15
16
17 10:45 0.4 Y 7.16 27 4.3 1.4
18
19
20
21
22
_
23
24
25
26 -
JUN 142017
27
28 _
29 VIVI
_30
31
AVERAGE 0.003E 7.05 32.5 20.15 9.2 5.22 0.367
MAXIMUM 0.003E 7.16 38 36 17 5.22
MINIMUM 0.003 E 6.94 27 4.3 1.4 5.22 0.367
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print I r type)
Ojr
Au 11 al Li, '_L 5.23.2017
FOREST HILLS MOBILE HOME ESTATES •ignature of:111 i --e*** Date
C/O AC INVESTMENT PROPERTIES (Required Tss Ibmitted electronically)
PO BOX 19288 .
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

RECEIVEDiNCDENR/DWR
EFFLUENT
,/
WQROS
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH MMarcti�R1-SV) FA E IiiPyAL OFFICE
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED II NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: 1 „
Y-. _;- - • (,
ATTN:CENTRAL FILES x 4.24.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
€ 150050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 00070 I mass I 01o55]
F Y E 4. FLOW m Q Z p 0 to ENTER PARAMETER CODE ABOVE
°>i; F EFF ■ M y p n a W J G J g w z J W NAME AND UNITS BELOW
E,• ao « o INFO m x WO 630 00 HW U2 JO HO �x
A• IN o cj JI- 1 ui, �v mN 2t Oa iun I-u) LLO mx0 OF-F o;
UV Q
O d fation Z to C.) G Z a.
Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L N/100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3 11:15 0.5 Y .003E 6.96 20 <2.5 1.2
4
5
6
7
8
9s
i*f,F1\1F .
10
1
1
2 AY 12151. ' Mty 1 2017 .
13
14l�'. ";
15 .np °aJ
16 R��T`
17
18
19
20 10:46 0.8 Y .0003E 7.14 20 7.7 1.3
21
22
23
24
25
26
27
28
29
30
31
AVERAGE 0.003E 7.05 20 3.85 1.25
MAXIMUM 0.003E 7.14 20 7.7 1.3
MINIMUM 0.003 E 6.96 20 <2.5 1.2
Comp.(C)/Grab(G) 11 G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
ki/c9 ,6,
FOREST HILLS MOBILE HOME ESTATES Si attire' tte ** Date /
C/O AC INVESTMENT PROPERTIES ( equireddunle su itted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

3
RECEIVED/NCDENR/DWR
EFFLUENT APR R i 7 2 u 17
WQROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH February YEAR 2017
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Ste hen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED LI NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x 3.30.2017-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
150050 00010 00400 50060 00310 00610 00530 ' 31616 00300 00600 00665 00070 I 01045 J 010551
F Y E *. FLOW W a Z 0 C h ENTER PARAMETER CODE ABOVE
1$ ` EFF I m m p K a la J 0 J Z W Z J la
D NAME AND UNITS BELOW
Fw., Et
w a INFO �m x ui= 0P 00 HW <0 JO I-0 0x
Q Oy ' 0 }W W W 6 ret,) OG 2re Oa W J 0} 0re Otl
A l a ; U J�- 1 v m N 2 I- I-co U.0 CO OO I-F- F"O
O uv Q 0 x'
0 disinfection Z Cl) V Z Turbidity Iron Managnese
HRS HRS Y/B/N , MGD ° C UNITS UG/L MG/L MG/L MG/L #/IOOML MG/L ' MG/L MG/L ntu mg/L mg/L
1
2
3
4
5
6 10:59 0.5 Y .0003E 6.98 <17 4 0.85
7
8
9 .- .
10 '-'
11
12
13 APR 112017
14
16 16 VME
17
18
19
20 11:09 0.8 Y .0003E 7.01 20 4.1 1.4
21
22
23
24 .I
25
26 APR5 20/1
27 ,:,,.n,,� C,; :
329 0 .:nTtO, ROcE,�SiN�L,N
IT
31
AVERAGE 0.003E 6.995 20 4.05 1.125
MAXIMUM 0.003E 7.01 20 4.1 1.4
MINIMUM 0.003 E 6.98 20 4 0.85
Comp (C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
OA
DWQ Form MR-1(11/04) APR 11 2017

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
4340'
FOREST HILLS MOBILE HOME ESTATES gnature of . ee*** Date
C/O AC INVESTMENT PROPERTIES (Required ss submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC C E IV/�".�r®UNTY:Gaston
WTP
MAR 0 6 2017
OWNER NAME:Randy Ferri!! ORC:Not Required ORC CERT NUMIIE$1 JNCDENR/DWR
GRADE:PCNC ORC HAS CHANGED:No CENTRAL FILES
eDMR PERIOD:01-2017(January 2017) VERSION:1.0 DWR SECTIONTATUS:Processed
��QQCC�qq WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO Ll�l.;liAK1L OFFICE
MN004N MN C0530 40070 01045 011155
I
H I C i ' I X month 2 X month 2 X month 2 X month 2 X month
Id o i Instantaneous Grab Grab Grab Grab Calculated Calculated
C d ) 1 g O z FLOW PH CHLORINE 771s Caste TURBIDTY IRON MANCNGSE
2400 dusk m. 2400 dads firs Y/I/N me sn ug/l ,mg/I nlu mg/i mg/I
1
2
3 11:08 0.3 Y 0.0003 7.13 10 33 1.1 038 0.02
4
s
6
7
0
9
10
II
12
13
14
IS
10 10:43 0.3 Y 0.0003 6.97 16 <2.5 3.2
17
18
19
20
21
22
23
24
25
26
27
20
29
30
31
Moodily Average Limit m
Moodily Average: 0.0003 13 1.65 2.15 0.38 0.02
Ddly M"omum' 0.0003 7.13 16 33 3.2 038 0.02
Daily Mialo_' 0.0003 6.97 10 0 1.1 0.38 0.02
'•f'No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather;NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:01-2017(January 2017) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:02/28/2017
02/28/2017
ORC/Certifier Signature: achael G K der -Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
02/28/2017
Permittee/Submitter Signatu e:*** Rachael Kra er E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

3
NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC COUNTY:Gaston
WTP RECEIVED
OWNER NAME:Randy Ferrill ORC:Not Required 7 ORC CERT NUM
� NCDENR/DWR
GRADE:PCNC ORC HAS CHANGED:No r r O O 1 r
eDMR PERIOD:12-2016(December 2016) VERSION:1.0 CENTRAL FILES STATUS:Processed
1WP SECTION WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISMakal
erkiTINU AL OFFICE
50050 MOO 50060 C0530 01045 01055 00070
Y 8 I
C y 1' 2 X month 2 X month 2 X month 2 X month Quarterly Quarterly 2 X month
I < s
I. $ _ u Instantaneous Grab Grab Grab Grab Grab Grab
a g d
B d I! O Z FLOW PH CHLORINE TSS-Cow IRON MANGNESE TURa1D7Y
7w0 dock Hn 2400 els& Hn Y/NN mgd su ugh ms/I mg/I us/I mu
2
3
a
5 1030 0.4 Y 0.003 7.13 20 52 5.3
6
7
0
9
10
1
12
13
14
15
16
17
10
19 1033 0.25 Y 0.003 7.03 40 6.2 5.5
20
21
22
23
24
25
26
27
28
29
30
31
r Meanly Average Lisle 34
M.eMy Avenge: 0.003 30 5.7 5.4
aW'Mauer' 0.003 7.13 40 6.2 5.5
Daly Mialar. 0.003 7.03 20 5.2 5.3
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD: 12-2016(December 2016) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:01/26/2017
61Z/7
aIIe 01/26/2017
ORC/Certifier Signature: I)fachael G Kr r -Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
01/26/2017
Permittee/Submitter Signature:** Rachael G 1a r E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 R EC E i V E DPERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC COUNTY:Gaston
WTP JAN 0 3 2017
OWNER NAME:Randy Ferrill ORC:Not Required ORC CERT NUMBER, 995491
CENTRAL FILES
GRADE:PCNC ORC HAS CHANGED:No DWR SECTION
eDMR PERIOD: 11-2016(November 2016) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO •
50054 M45S 50060 C0531 /4071
A
8
2 X mash 2 X month 2 X month 2 X month 2 X month
g
a ! I 6 {` Cr Cr Instantaneous Grab Crab ab Gab
a e 8 6i
G Ud F O O O 7S !LOW !H CHLORINE T36-Clod TURB[DTY
2411 eki Hu 2400 dock Hcd Y/B/N slEdSu nel ntu
3
7 1105 0.4 Y 0.0003 7.01 20 8.5 7.9
9
10
1
12
13
14
15
16
17
10
1,
20
21 1035 0.4 Y 0.0003 7.12 40 4 8.7
22
23
24
25
26
27
2a
20
30
Moab'Avenge Limlb
M.alky A.ery= 0.0003 30 6.25 8.3
ab Ma'imic 0.0003 7.12 40 8.5 8.7
Dalybous' 0.0003 7.01 20 4 7.9
***I'No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0080195 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Forest Hills Mobile Home Estates CLASS:PCNC COUNTY:Gaston
WTP
OWNER NAME:Randy Ferrill ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:11-2016(November 2016) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHO #:8286571810 SUBMISSION DATE: 12/27/2016
12/27/2016
ORC/Certifier Signature: Rachael G Kr m r E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
4.}..ct a 12/27/2016
Permittee/Submitter Signature:*** Rachael •ramer E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Rhyne Rd Dallas NC 28034 Permit Expiration Date:07/31/2020
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 qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who managed 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.
CERTIFIED LABORATORIES
LAB NAME:Watertech Labs;KACE Environmental,Inc.
CERTIFIED LAB#:50;5424
PERSON(s)COLLECTING SAMPLES:Stephen Preul
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

EFFLUENT ;_.; ;
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH October. YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLAN 'WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50 "�'t,ti
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Stephen Preul GRADE I CERTIFICATION NO. 1002116
PERSON(S)COLLECTING SAMPLES Stephen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: C
ATTN:CENTRAL FILES x 11.28.2016-Flow is an estimate.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E # 50050 00010 . 00400 50060 00310 00610 00530 31616 00300 00600 ' 00665 soon 01045 I 010551
F Y FLOW Wa' Q Z Z O O to ENTER PARAMETER CODE ABOVE
>8 t' ;: EFF ■ Fen p 2 .4 Z W J G J W z J W NAME AND UNITS BELOW
i.a E. Er, $ INF ❑ N° O V O 4 Z 4 0 .-I 4 0 4 O
A I/ i O �1t1 tw n Zv OP -ere Oa w� uu, Om oa
Fi U �1- 20 3I- Hu) LLO wp t-H ~g
A. 0 q W 4 O a
O G¢ F eor«ate Z to U Z Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3 10:38 0.5 Y .0003E 6.9 10 4.1 3.9
4
5 0 to wit
6 1.1.1 o —10
7 > N U- F-
9 W e ' ce�
10 U v �re
11 W c Si
12 ft
13
14
15
16
17 10:50 0.5 Y .0003E 7.01 20 17 11 6.7 0.174
18
19
20
21 W G
22
23
24 I
DC C X S 2016
AVERAGE 0.003E 6.955 15 10.55 7.45 6.7 0.174
MAXIMUM 0.003E 7.01 20 17 11 6.7 0.174
MINIMUM 0.003 E 6.9 10 4.1 3.9 6.7 0.174
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
OA -�
DEC 0 6 2C16
DWQ Form MR-1(11/04) !i „f-j

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
. jhrii4L.,/
02f//
FOREST HILLS MOBILE HOME ESTATES attire of Permittee*** Date
C/O AC INVESTMENT PROPERTIES equired unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT �ttG?;v_ c;,= ,r`' j
vJ i F ,,II
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 4'4 "^September I ` Yg
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver or Stephen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED 11111 NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: S uwerir!I ` 'b "v 1711
ATTN:CENTRAL FILES x rtl,# llaatbDItI... __
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN ESP()\til131.1.(I IARGL) DA I L
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
°E oi * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 00070 I 01045 1 010551
F Y FLOW w a Z 0 o a, ENTER PARAMETER CODE ABOVE
>$ ` y EFF ■ re
p Q W p J W 2 J W = NAME AND UNITS BELOW
E- 4. o �' INFO a� x �g Oo 00 la—W U10i JO HO 02
G m'4 $, 0 -II- it° a �O mN 2I- O-N u-0 In0 Oi- OFO
R °
pG Qg w ❑ UV QZ D U p0 2 a
6 O O F aiaief«tloe _ t/1 Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L k/100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3 RECEIVED
4
5 NOV 02 ?018
6
7 CENTRAL FILES
8 DWR SECTION
9
10
11
12 9:50 0.5 Y .0003E 7.1 20 32 30
13
14
15
16 C a
17 S
18 NOV 1 t 'nil
_19 NOV 0S2O?6
20
21
22
23
24
25
26 11:00 0.5 Y .0003E 6.9 20 3.3 1.3
27
28
29
30
31
AVERAGE 0.003E 7 20 17.65 15.65
MAXIMUM 0.003E 7.1 20 32 30
MINIMUM 0.003 E 6.9 20 3.3 1.3
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
FOREST HILLS MOBILE HOME ESTATES ignature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

PECEIVEDINCDENR/DWR
EFFLUENT
+ 1 ?016 3
pOu WQROS
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTI Agus's[VILLE. fXfpNy @FF►CE
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICOUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver or Stephen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED IIIII NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: ,({N fr.0
ATTN:CENTRAL FILES x / ril"iniiidie o1 tno)ignt notflnR=ab ery.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESI'i)NSIBI.I.l I IARGE) DA I I.
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 00070 1 moils I 01o551
FY FLOW w Q Z 0 G w ENTER PARAMETER CODE ABOVE
W F$ ;; EFF ■ m j p e Z W -4
W J j W J W NAME AND UNITS BELOW
a� $ INF ❑ �— 0, GV O QZ QO J QO 4tQO�
A ! . C cd J1- iiV 0. OC(=j mN fF Oyu) LLO u)0 O1—� OS
O a Q UY
d ake6oa Q Z V) C) Z
F. Turbidity Iron Managnese
HRS HRS Y/BM MGD o C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L ntu mg/L mg/L
1 i {�
2 RFCEtVED
3
4 LC.T 0 4 ZOIE
5
6 CENTRAL FILES
7 DWR SECTION
8
9 10:02 0.3 Y .0003E 7.01 35 8.6 8.5
10
Il
12 r Y G
1.3
14 OA
15 , r,,. UL I 0 5 2016
16 L I; i i
17
18
19
20
21
22
23 2:21 0.3 Y .0003E 6.93 30 8.5 8.1
24
25
26
27
28
29
30
31
AVERAGE 0.003E 6.97 32.5 8.55 8.3
MAXIMUM 0.003E 7.01 35 8.6 8.5
MINIMUM 0.001 E 6.93 30 8.5 8.1
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 NIL N/L N/L
DWQ Form MR-I (11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
el)141/4** .gh
FOREST HILLS MOBILE HOME ESTATES gnature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT 3
RECEIVED/NCDENR/DWR
SEP 1 9 2016
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH July YEAR 2O1OS
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-ICQdI]fi1RESVQEGIONAL OFFICE
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver or Stephen Preul ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED IIIIII NO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: S t,Yu t ._ ' ' 1tMirt
ATTN:CENTRAL FILES x n.dl£of die nit ri-',I- " sg 'u�
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN I.S1'(1ti51131 L(I 1 kGE) DA I I
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 ' 00665 00070 101045 I 010551
Y c FLOW to Q Z p G to ENTER PARAMETER CODE ABOVE
�a c r EFF ■ 7 y) M 0.' Q W J G J d. W Z J W NAME AND UNITS BELOW
W ED o va INFO ~P N9 GO ZO Q2 QO JW QO 4O
d `ol e O ,'W .w . tYv OP
2tt OCW. WJ u) ( OCC pa
C A C V JF 10 uv Q~ i-? LLO v10 FH F6
A 1g Qg w i Z W U p Z
0 F disinfection
Turbidity Iron Managnese
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L ///100ML MG/L MG/L MG/L ntu mg/L mg/L
1
2
3 REC E VED
5 SLI' 0 2016
6
7 OA EN FILES
8 DWR $� TIC
9 SEP 14 M16
10 `J�/
11 v V
12
13 Skr 1 2016
14
15
16
17
18 10:52 0.3 Y 0.003E 6.8 46 7.5 7.5 5.07 0.163
19
20
21
22
23
24
25
26
27
28 11:00 0.3 Y 0.003E 6.9 32 17.6 II
29
30
31
AVERAGE 0.003E 6.85 39 12.55 9.25 5.07 0.163
MAXIMUM 0.003E 6.9 46 17.6 11 5.07 0.163
MINIMUM 0.003 E 6.8 32 7.5 7.5 5.07 0.163
Comp.(C)/Grab(G) G G G G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45 N/L N/L N/L
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"I certify,under penalty or law,that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
/L
FOREST HILLS MOBILE HOME ESTATES Si' ature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Perrnittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2020
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental, Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2XD).
Page 2

RECEIVED/NCDENR/DWR
EFFLUENT -.......?
AUG 2 3 2O16
WQROS
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 41199F§SX4E REGIOM,A@FFR)t6
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED lillNO FLOW/DISCHARGE FROM SITE* ❑
Mail ORIGINAL and ONE COPY to: 1 i{,tu ..alteru t,... '
ATTN:CENTRAL FILES x middle of the ig t na flawaar8 :.obseoye��d
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN IAl't)NSII3LI:CI IARGE) DA I E
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
°E * 150050 00010 00400 50060 00310 00610 00530 31616 00300 ' 00600 00665 I 1 1
FY FLOW w Q Z p a m ENTER PARAMETER CODE ABOVE
>$ P EFF ■ =en p LY —W J G J IY w zLLI J W NAME AND UNITS BELOW
IW as « e INFO Fy �, WO sO 00 Fa-W V� Jr�} IQ-O �x
.t «i 0 C �w laW tS �V ON ao Oa LLlJ NSC OOC is-
G e a -I I- n'V m XI- FW LLp co I-H 1
ma c oaa..
A. G o W luvdisinfection z co t� 2
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/I00ML MG/L MG/L MG/L
1 .0003 E
2 R .--- � %`h 1�
3
4 /\, ' Uh
5
6 CE T R, L HI FS
7 DAR SECTION.
8
9
10
11
12
13 WG
1415
16 0003E A L G 15 2016
17
18
19
20
21 Q 22 A
23
24 AUG 7 7 rrir
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
I %},,�/64. 7.26.2016
FOREST HILLS MOBILE HOME ESTATESSignature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

RECEIVED/NCDENR/DWR
EFFLUENT u U G 2 3 i 016 3
WQROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH May YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED 1111111 NO FI,OW/DISCHARGE FROM SITE*
1 S..Amenr10c1 7 hA 701A fir,ogtimata flewe
Mail ORIGINAL and ONE COPY to: 1 41.0) ..., s.g ,f b__ i
ATTN:CENTRAL FILES x ,,;}oui v
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RES1'()\SIIiLI.cI IARGL) llAI L
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT This REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
150050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I I I
F Y FLOW Q Z a G to ENTER PARAMETER CODE ABOVE
10i64 E F EFF ■ EX
F j p O u Z W ,J III J re j W J 11.1 tk NAME AND UNITS BELOW
i.. ao « INF ❑ �v� x wJ Ga 00 I--W VIOi 0O <0O l I
in _ 0 v0
0 , a.
- S. u J� cV WV mN SI- Oa 11.0 too If• o2
R 0
6 0 p disinfectionr Q Z N V C Z a
HRS HRS YB/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/IOOML MG/L MG/L MG/L
1
2
3 :.<hrEIVED
4 .0003 E
5 AUG us U16
6
7 CEN"RAL FILES
8 DV F\ SEC,iON
9
10
11 .
12
13
15 W G
15
16
17 At1G 15 L)
18 .0003 E
19
20
21
22
23
24
25 ^
26 li,J A
27 AUG 1 7 si,C1G
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) -G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
'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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
.� ,
6.13.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per I 5A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

RECEIVED/NCDENR/DWR
EFFLUENT A U b 2 3 2016
WQROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH April YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED NO Fl OW/DISCHARGE FROM SITE
. 016-Amended 7 9A 2131E to egtimate flout.111
Mail ORIGINAL and ONE COPY to: ,(/ ,}},�.v
ATTN:CENTRAL FILES x �/ o lserve�ciI�I,Ii�GLll !_n,.
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN ISI'oN 1131.I:CI IA 26E) DMA I I[
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
4. 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665
FYg 4. FLOW w Q z p a m ENTER PARAMETER CODE ABOVE
>8 EFF ■ te
m G d' R W J G J W Z J W NAME AND UNITS BELOW
I 4o « c INFO �M x y�jO �0 00 HW U� JO FO �gx
Ag g O� -4 I— ci IX co 0 e 2II-- Ov°i u- N0 OAF OO
gO
& 0 0 p a�of lion <Z U) V Z a
HRS FIRS YB/N MGD ' ° C UNITS UG/L MG/L MG/L MG/L N/100ML MG/L MG/L MG/L
1
2 +y �y
3 , CE1VED
4
5 AUG 48 2f16
6 .0003 E
7 CFNTRA1 FII FS
8 fiVVR rFCT1Qf\;
9
10
11
12
13
14
15
16 WG17
18
19 AUG 15 Z015
20 .0003 E
21
22
23
24
25
26 OA
27
28 AUG j 7 lia'
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status:(Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
1,111 7,
5.16.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

ELC EFFLUENT
MAY 26 2015 3
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH April YEAR 2015
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) James Bridges GRADE I CERTIFICATION NO. 994648
PERSON(S)COLLECTING SAMPLES James Bridges ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED = NO FLOW/DISCHARGE FROM SITE* El
Mail ORIGINAL and ONE COPY to: 1 ,-- ' �
ATTN:CENTRAL FILES x 5.18.2015
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS ACCURA
TE NC 27699-1617 AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E a * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 1 I I
F g 4, FLOW w Q Z p G y ENTER PARAMETER CODE ABOVE
E>1 F ;; EFF ■ F? p O p Z W J O J �'Z J W q�q[[ NAME AND UNITS BELOW
't q o o INFO U" t W= 00 OO FW WI" p0 FO 4d
d is O W W w CC c) m N 2 IL' OIL W 71 N x O I!' O
Ca P. S. V J 1•- 1 ti 2 I— I—to W O to 0 I—II- ~O
p e�lnfE disinfection Q Z en V G Z o=.
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/IOOML MG/L MG/L MG/L
I NO FLOW REC El)
2
3 OA /" 2 b Z01°
4
5 CENTRAL FILMS
6 MAY 2 S Z[115 DWR SECTION
7
8
9
10
11
12
13
14
15 \9
16
17 RECEIVED/NCDENR/DWR
18
19 �►�' J 1,N 01 «:
20
21 WOPOS
22 MOO ZESVII IF REGIONAL OFFICE
23
24
25
26
27
28
29
30
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)I Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status:(Please check one of the following)
•
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
certity,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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
• FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
Sao-iS
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
}011 Sag 3?51 704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2XD).
Page 2

RECEIV ^,',. ,;E,f\'%!pWR
EFFLUENT 3
MCu�� ,," .. S
_,
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH April '4+6fILICQ016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED I NO FLOW/DISCHARGE FROM SITE* a
Mail ORIGINAL and ONE COPY to: 1 0t, .1 teril 6--
ATTN:CENTRAL FILES x 5.16.2016
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 1 I
F Y FLOW w Q Z p C to ENTER PARAMETER CODE ABOVE
W E ` EFF ■ m to p O N Z W J G J K >W J W NAME AND UNITS BELOW
I.. ao « INFO liar x i. WJ Go X 00 00 FW U'- _on FQ-0 I_
G �14 OU J1 aV re C.) mN aH I—U) LLO N)0 0� OO
0 O O G LL H disinfection uv Q Z U V 0 Z a.
HRS HRS YIB/N MGD ° C UN TS UG/L MG/L MG/L MG/L #/IOOML' MG/L MG/L MG/L
1 NO FLOW
2
3
4
5 6 RECEIV di7
8 MAY ,
za 10
9 E..
to CHAL FILE
11 ' R SECTION
12 \
13 \ O
14 � 1�
15
16 -I.17
18
19
20
21 A C
22
23 1 A'; 2 L)v O
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) 'G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-I(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 certify,under penalty of law,that this document and all attaclunents were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
-2-3-1 1,
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental, Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

nctoCI V tU/A;UtNli/UWII
AUG 232016
EFFLUENT 3
WQROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH March YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED 1111 NO FLOW/DISCHARGE FROM SITE*
WWI -.:hmnn(i/t1'7''n 9n1r 4f,zs tiintsfn(Intni,'FI _
Mail ORIGINAL and ONE COPY to: ru.) il y,Yu t, i
ATTN:CENTRAL FILES x eiveel
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN LSI'i)N5I131I l I IARGG) DA I Li
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
e
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I I
f=Y FLOW Q Z p aI ENTER PARAMETER CODE ABOVE
1$ F y EFF ■ F co O OZ n Q W J G J W Z J W NAME AND UNITS BELOW
W 1:r `O FA INFO QFa Fs GV ZO QZ QO JW QO �0
`0$ a 0 Y'W WW O reO mN �K OIL WJ Wy( Ow /-Ft.
0 m N a U J H IA V 2 F- 1-to LL O co p H l—
g. O
O 0 tL
0 disinfection a Z V Z a.
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/IOOML MG/L MG/L MG/L
1
32 .0003E R E C E D
5 AUG 48 2016
6 CENTRAL FILES
8 8 DWR e EC.TION
9
10
11 G 12
13
is AU 15 Z016
16 .0003 E
17
18
19
20
21
22
23 Q A
24
I
AUG 1 7 2E16
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ,
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
4.18.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT 3
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH March YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED I NO FLOW/DISCHARGE FROM SITE* El
Mail ORIGINAL and ONE COPY to: 1 4/f.su if},s.u .__�
ATTN:CENTRAL FILES x RECEIVgJ�J �NRIDWR
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS ' 2 I :H E
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
�E• # 50050 00010 00400 50060 00310 ' 00610 00530 31616 00300 00600 00665 I IW0,G I
I=Y E c FLOW rc a z c p m ESL R�p64�@�v1le'FFICE
W E EFF ■ F j p C b Z W J D J j W J W K NAME AND UNITS BELOW
E. ao $ 75 INFO �■ :� W= 00 00 I-10 Uel � J}O} FO0 x
`41 E O �W We, a' Ira ON �ce Oa WJ u) OrG Oa
Ca SN O C QA wU Pu m aZ ~'to aU 00 ~Z ~1
0 disinfection fn 0 a.
HRS HRS V/B/N MGD o C UNITS UG/L MG/L MG/L MG/L 10/I00ML MG/L MG/L MG/L
2
1 NO FLOW RECEIVED
a VVG MN? 11 I iib
6 MAY Y $ 2016 GENTRAI- 7IUN
DU`JR, _ ,
7
8
9 '
10 Q A
11
12
13 !JAY 1 92C16
14 4,\O
16
16
1 0
198 t1
19 `--J
20
— - -21
22
23
24
25
26
27
28
29
30
31,7'
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
44,4 ti-_,\414.404tA-/ YAW)/
FOREST HILLS MOBILE HOME ESTATES S. ature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2XD).
Page 2

EFFLUENT RECEIVED/NCDENR/DWR
AUG232016
NPDES PERMIT NO. NCO080195 DISCHARGE NO. 001 M WQROS
��R�tl}��REGYE1I0t..O016°E
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED MI NO FLOW/DISCHARGE FROM SITE*
1S+ mar ripe'7-IA'3r11F in noirnatn Flnvri:
Mail ORIGINAL and ONE COPY to: 1 �,(% 14iyvt..✓
ATTN:CENTRAL FILES x '/ t,ube ve
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR INRESI'ONSI131.I C H RAT ARGE) D '
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
o 50050 ' 00010 00400 50060 00310 00610 00530 31616 00300 00600 ' 00665 I 1 1
E
Y _ c FLOW w R Z 0 coENTER PARAMETER CODE ABOVE
>8 1 e. EFF ■• 7 en G, a In J C J Ce w Z J ZD
NAME AND UNITS BELOW
Fw- ao « e INF ❑ ~m x wX 0o O0 Fa-W t<jl0t. 00 <0 1-O
MN0 23 —re Oa. wJ 0} ow Od
O Tag a JH IV M. tl:V MN Z:H_ i-co Ito to I-I_ O
0 0 p diissinfectiion <Z U) t, 0 O Z d
HRS HRS Y/B/N MGD O C UNITS UG/L MG/L MG/L' MG/L #/IOOML MG/L MG/L MG/L
1
2
3 .0003E RECEIVED
4
5 AUG 48 1016
6 ,
7
CNl`RAtr FILE
8 DWR E:CT1ON
9
10
11
12
13 G 14 V
15
16 AuG 152013
17 .0003 E
18
19
20
21
23 Q
23 A
24
25 AUG j 7 2Dl6
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1 (11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
ts-+�., p l
3.15.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT 3
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH February YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED Ell
NO FLOW/DISCHARGE FROM SITE* El
Mail ORIGINAL and ONE COPY to: 1 /r(v ..dierv'--- RE ' NCDENR/DW
ATTN:CENTRAL FILES x
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
iCNOS
0
J 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I
J I �A L 01
E e
i=Y FLOW w Q 2_ a a q ENTER G1t A9b
i$ ; EFF ■ yl p a a W J O J rt W Z J W yam. NAME AND UNITS BELOW
W $ 7 INF ❑ <i N� CV ZO <z <0 JW QO s0
d O >-W WW KV OP �rt OIL WJ cOA5( OR Oa
G a V -II- 1V aF- F•0) LLO WO HI_- h O
g 4 ltv < x
6 O C C¢ w disinfection Z Cl) V 0 Z P
HRS FIRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L N/100ML MG/L MRE '\I{.�D
I NO FLOW V tt[�...
2
MAY 11 2G'b
4 WG
5 VV GENTRALFI T
6 MAY 18 Z016 RJR..EC •
7
8
9
10
11
12
13 `C,
14
15
16
17 r O
llA
19 1 V1 A r.16
20 _
21
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp(C)I Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status:(Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
j(itAdtoPtA----- 3-02FOREST HILLS MOBILE HOME ESTATES ature of Permittee*** Date
�
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

RECEIVED/NCDENR/DWR
EFFLUENT H G 2 U 16
WQROS 3
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH January YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED NO FLOW/DISCHARGE FROM SITE*
YlrrIn"eiP,ri �^r`-11)117,, +1
Mail ORIGINAL and ONE COPY to: il/ },Yu 4----
ATTN:CENTRAL FILES x ti.%NW at> ►I a1 +
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RI II31.I.�C I IARGE) DA I I
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
°E * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I
F FLOW w� Q z G O Z coENTER PARAMETER CODE ABOVE
i$ y EFF ■ m p d Z
W Q G W Z J W NAME AND UNITS BELOW
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FIRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L it/100ML MG/L MG/L MG/L
2
3 RC" IVFD
4
5 AUG 08 Z016
6 .0003 E
7 CENTRAL FILES
8 :MR SECTION
9
I0
11
12 W G
13
14
15 AU; 152016
16
17
18
19
20 .0003 E
21
22
23
25 Q 25 A
2 7 AUG 1.7 Z,IJ6
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1 (11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
41,0 .4 11 I
2.15.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental, Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

r `EFFLUENT
MAR 3 - Z016
3
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH January YEAR 2016
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED 111.1 NO FLOW/DISCHARGE FROM SITE* El
Mail ORIGINAL and ONE COPY to: 1 jci.do fe.v I-- `-RECEI 1r-;'CVJR
ATTN:CENTRAL FILES x ��'•
DIVISION OF WATER QUALITY (SIGNAL ORE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS k
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
a P .^,?�
� 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665
FY FLOW w� Q z Z 0 0 Z m EI RPiAIEAMi GODS:1 E F 1 C E
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HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L
1 NO FLOW
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3 ir\Ge E N E
5 MAK 0 6
6
7 I RAI.FILLS
8 DWR SECTION
9
10
11
12
13 \°
14 J�
15 ✓/��
16 _
17 A
18 1./
19
20 r, 1
21 "'',
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp(C)I Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
.2,„2.7A
FOREST HILLS MOBILE HOME ESTATES S' ature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

RECEIVED/NCDENR/DWR
EFFLUENT A U G 2 3 2016 3
WQROS
MOORESVILLE REGIONAL OFFICE
NPDES PERMIT NO. NC0080195 DISCHARGE NO. 001 MONTH December YEAR 2015
FACILITY NAME Forest Hill Mobile Home Estates CLASS WW-I COUNTY Gaston
CERTIFIED LABORATORY Water Tech Labs CERTIFICATION NO. 50
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE(ORC) Ken Deaver GRADE II CERTIFICATION NO. 010475
PERSON(S)COLLECTING SAMPLES Ken Deaver ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED MIN NO FLOW/DISCHARGE FROM SITE*
1 1=�MirivrarO ii 7"? 1 A r1i't�ro Y.^tr Fcr,ricM i.
'fry.
Mail ORIGINAL and ONE COPY to: ,01 J i,,�-v t... f+' a't
ATTN:CENTRAL FILES x
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RLSI(()N 1B1.1 ( I IARGL) DATL
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
E * 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 ' I I I
F g * FLOW w Q Z p to ENTER PARAMETER CODE ABOVE
1 o .d. EFF ■ Din p 0' Q W J G J rt W Z J W NAME AND UNITS BELOW
Q cca co U 4- ri5 C O IN>-W lad o. lux Ce0 Cl
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HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100MI. MG/L MG/L MG/L
1
2 .0003E KEG Ei�'En
4 AUG 68 2016
5
6
CENTRAL FILES
7
7 CWR SECTION
9
10
11
12 WG13
14
15 AtRi 15 2016
16 .0003 E
17
18
19
20
21
22 I
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G) _G G G G G G G G
Monthly Limit 0.01 N/L 6.0-9.0 17 30/45
DWQ Form MR-1(11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements XX
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
'l 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
FOREST HILLS MOBILE HOME ESTATES
Permittee (Please print or type)
1.11.16
FOREST HILLS MOBILE HOME ESTATES Signature of Permittee*** Date
C/O AC INVESTMENT PROPERTIES (Required unless submitted electronically)
PO BOX 19288
CHARLOTTE,NC 28219
Permittee Address Phone Number e-mail address Permit Expiration Date
704-359-0826 7/31/2015
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) KACE Environmental,Inc Certification No. 5424
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per I 5A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2