WQ0013808_Monitoring - 02-2023_20230327

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0013808
Name of Facility:* Summerfield Constructed Wetlands WWTF
Month: * February Year: * 2023
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
SUM —ND— 2302.pdf 396.55KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Chad Leinbach
6�Aw'a
Reviewer: Wanda.Gerald
3/27/2023
This will be filled in automatically

Is the project number correct?* WQ0013808
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 5/22/2023

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
Page of
PERMIT NUMBER: WQ0013808
FACILITY NAME: Summerfield Constructed Wetlands
MONTH: Febru
COUNTY:
YEAR:
Guilford
Formulas:
Daily Loading (inches) _ [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) 160 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No: F
Did Irrigation Occur On This Field:
Yes: M No:
- - - - - - - - - - - - - -
FIELD NUMBER:1
1
FIELD NUMBER:
2
AREA SPRAYED (acres):
1 0.71
AREA SPRAYED (acres):
0.52
COVER CROP:
Grass/Forest
COVER CROP:
Grass/Forest
PERMITTED HOURLY RATE (inches):
0.3
PERMITTED HOURLY RATE (inches):
0.3
D
A
T
ECotle'at
WEATHER CONDITIONS
storage
Lagoon
Free -board
PERMITTED YEARLY RATE (inches):
34.75
PERMITTED YEARLY RATE (inches):
34.75
Weather
Temper-ature
application
Precipita-tion
Volume
A lied
Time
Irri ated
Daily
Loadin
Maximum
Hourly
Loadin
Volume
A lied
TimegDailyHourly
Irri atedLoadininches
Maximum
feet
gallons
minutes
inches
inches
gallons
minutes
inches
1
CL
50
1400
28
0.07
0.16
1400
28
0.21
2
CL
43
1400
28
0.07
0.16
1400
28
0.21
3
CL
44
966
19.32
0.05
0.16
1613
32.26
0.21
a
C
40
1400
28
1 0.07
0.16
1400
28
0.10
0.21
5
CL
54
1 1400
28
0.07
0.16
1400
28
0.10
0.21
6
C
61
1400
28
0.07
0.16
1400
28
0.10
0.21
7
PC
59
0.65
1.8
1400
28
0.07
0.16
1400
28
0.10
0.21
6
CL
69
700
14
0.04
0.16
1400
28
0.10
0.21
9
CL
68
700
14
0.04
0.16
700
14
0.05
0.21
10
CL
1 67
1400
28
0.07
0.16
2100
42
0.15
0.21
11
CL
54
1400
28
1 0.07
0.16
1400
28
0.10
0.21
12
CL
42
1 1400
28
0.07
0.16
1400
28
0.10
0.21
13
CL
61
700
14
0.04
1 0.16
1400
28
0.10
0.21
14
C
52
1.4
1.6
1700
34
0.09
0.16
2904
58.08
0.21
0.21
15
CL
66
2000
40
0.10
0.16
4000
80
0.28
0.21
16
CL
72
1
2000
40
0.10
0.16
3999
79.98
0.28
0.21
17
CL
63
5274
105.48
0.27
0.16
3000
60
0.21
0.21
16
C
51
3000
60
0.16
0.16
3000
60
0.21
0.21
19
CL
57
3000
60
0.16
0.16
3000
60
0.21
0.21
20
CL
60
1 2000
40
0.10
0.16
4000
80
0.28
0.21
21
C
68
0.87
1.9
2000
40
0.10
0.16
4248
84.96
0.30
0.21
22
CL
72
2000
40
0.10
1 0.16
4000
80
0.28
0.21
23
CL
80
1
2000
40
0.10
0.16
4000
80
0.28
0.21
24
CL
67
2000
40
0.10
0.16
4000
80
0.28
0.21
25
CL
53
3000
60
0.16
0.16
3000
60
0.21
0.21
26
CL
59
3000
60
0.16
0.16
3000
60
0.21
0.21
27
CL
64
2305
46.1
0.12
0.16
4000
80
0.28
0.21
26
C
75
0.28
2.2
3000
60
0.16
0.16
3000
60
0.21
0.21
29
0
0
30
0
0
31
1
0
0
Total Gallons/Monthly Loading (inches)l
53945
1
2.80
71564
5.07
12 Month Floating Total (inches)
23.91
29.70
Average Weekly Loading (inches)l
0.6314355
1.1437403
- weatner �oaes: t,-clear, ril-partly ciouay, w-clouay, K-ram, an -snow, arsleet
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach
ORC Certification Number: 23928 Check Box if ORC Has Changed
Mail ORIGINAL and TWO COPIES to:
ATTN N D• h C I• U •t
7
Phone: [phone]
on- Isc arge omp lance nl
DENR (3lli�," z,,4azZ
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, INC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Page of
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
1. The did the limit(s) in
Com Iiant Y,N
Y
application rate(s) not exceed specified the permit.
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
YY
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
YY
4. All buffer zones as specified in the permit were maintained during each application.
YY
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
N�
specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
The freeboard was in compliance at the end of the month. Chad - ORC
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Z_ge;f�a,4 3/27/2023
(Signature of Permittee)* Date
Kotis Properties, Inc.
(Permittee-Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
Chad Leinbach
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919 260-7301 7/31/23
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
Page of
PERMIT NUMBER: WQ0013808
FACILITY NAME: Summerfield Constructed Wetlands
MONTH: Febru
COUNTY:
YEAR:
Guilford
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
- Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) 160 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No: 7
Did Irrigation Occur On This Field:
Yes: 7 No:
FIELD NUMBER:1
3
FIELD NUMBER:
AREA SPRAYED (acres):
1 0.17
AREA SPRAYED (acres):
COVER CROP:
1 Grass/Forest
COVER CROP:
PERMITTED HOURLY RATE (inches):
0.3
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
storage
Lagoon
Free -board
PERMITTED YEARLY RATE (inches):
34.75
PERMITTED YEARLY RATE (inches):
weather
Code*
Temper-ature
at application
Precipita-lion
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
ff)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
CL
50
600
30
0.13
0.26
2
CL
43
600
30
0.13
0.26
3
CL
44
1
600
30
0.13
0.26
a
C
40
600
30
0.13
0.26
5
CL
54
1 794
39.7
0.17
0.26
6
C
61
600
30
0.13
0.26
7
PC
59
0.65
1.8
600
30
0.13
0.26
6
CL
69
600
30
0.13
0.26
9
CL
68
900
45
0.19
0.26
10
CL
1 67
600
30
0.13
0.26
11
CL
54
600
30
0.13
0.26
12
CL
42
1 600
30
0.13
0.26
13
CL
61
900
45
0.19
0.26
14
C
52
1.4
1.6
300
15
1 0.06
0.26
15
CL
66
0
0
0.00
#DIV/0!
16
CL
72
1
0
0
0.00
#DIV/0!
17
CL
63
0
0
0.00
#DIV/0!
16
C
51
0
0
0.00
#DIV/0!
19
CL
57
0
0
0.00
#DIV/0!
20
CL
60
1 0
0
0.00
#DIV/0!
21
C
68
0.87
1.9
0
0
0.00
#DIV/0!
22
CL
72
0
0
0.00
#DIV/0!
23
CL
80
1
0
0
0.00
#DIV/0!
24
CL
67
0
0
0.00
1 #DIV/0!
25
CL
53
0
0
0.00
#DIV/0!
26
CL
59
0
0
0.00
#DIV/0!
27
CL
64
0
0
0.00
#DIV/0!
26
C
75
0.28
2.2
0
0
0.00
#DIV/0!
29
0
30
0
31
0
Total Gallons/Monthly Loading (inches)
8894
1.93
0
0.00
12 Month Floating Total (inches)
29.07
Average Weekly Loading (inches)
0.4347948
0
- weatner �oaes: t,-clear, ril-partly ciouay, w-clouay, K-ram, an -snow, arsleet
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach
ORC Certification Number: 23928 Check Box if ORC Has Changed
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
7
Phone: [phone]
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, NC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Page of
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Com Iiant Y,N
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
YY
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
YY
4. All buffer zones as specified in the permit were maintained during each application.
YY
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
N�
specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
The freeboard was in compliance at the end of the month. Chad - ORC
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
(Signature of Permittee)*
Kotis Properties, Inc.
(Permittee-Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
Chad Leinbach
Date (Name of Signing Official -Please print or type)
ORC
(Position or Title)
919 260-7301
(Phone Number)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
7/31 /23
(Permit Exp. Date)
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
Page of
PERMIT NUMBER: WQ0013808
FACILITY NAME: Summerfield Constructed Wetlands
MONTH: Febru
COUNTY:
YEAR:
Guilford
Formulas:
Daily Loading (inches) _ [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 (inches/foot)] / [Area Sprayed (acres) x 43,560 (square feet/acre)] OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallons/acre-inch)]
Maximum Hourly Loading (inches) = Daily Loading (inches) / [Time Irrigated (minutes) 160 (minutes/hour)] Monthly Loading (inches) = Sum of Daily Loadings (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes: No: F
Did Irrigation Occur On This Field:
Yes: R No:
FIELD NUMBER:1
3
FIELD NUMBER:
AREA SPRAYED (acres):
1 0.17
AREA SPRAYED (acres):
COVER CROP:
1 Grass/Forest
COVER CROP:
PERMITTED HOURLY RATE (inches):
0.3
PERMITTED HOURLY RATE (inches):
D
A
T
E
WEATHER CONDITIONS
storage
Lagoon
Free -board
PERMITTED YEARLY RATE (inches):
34.75
PERMITTED YEARLY RATE (inches):
weather
Code*
Temper-ature
at application
Precipita-tion
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume
Applied
Time
Irrigated
Daily
Loading
Maximum
Hourly
Loading
ff)
inches
feet
gallons
minutes
inches
inches
gallons
minutes
inches
inches
1
600
30
0.13
0.26
2
600
30
0.13
0.26
3
1
600
30
0.13
0.26
4
600
30
0.13
0.26
5
1 794
39.7
0.17
0.26
6
600
30
0.13
0.26
7
PC
59
0.65
1.8
600
30
0.13
0.26
6
600
30
0.13
0.26
9
900
45
0.19
0.26
10
600
30
0.13
0.26
11
600
30
0.13
0.26
12
600
30
0.13
0.26
13
900
45
0.19
0.26
14
C
52
1.4
1.6
300
15
0.06
0.26
15
0
0
0.00
#DIV/0!
16
0
0
1 0.00
#DIV/0!
17
0
0
0.00
#DIV/0!
16
0
0
0.00
#DIV/0!
19
0
0
0.00
#DIV/0!
20
0
0
0.00
#DIV/0!
21
C
68
0.87
1.9
0
0
0.00
#DIV/0!
22
0
0
0.00
#DIV/0!
23
0
0
0.00
#DIV/0!
24
0
0
0.00
#DIV/0!
251
0
0
0.00
#DIV/0!
26
0
0
0.00
#DIV/0!
27
0
0
0.00
#DIV/0!
26
C
75
0.28
2.2
0
0
0.00
#DIV/0!
29
0
30
0
31
0
Total Gallons/Monthly Loading (inches)
8894
1.93
0
0.00
12 Month Floating Total (inches)
29.07
Average Weekly Loading (inches)
0.4347948
0
- weatner il.,oaes: t,-ctear, ril-panty ciouay, mot-ciouay, K-ram, an -snow, arsteet
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach
ORC Certification Number: 23928 Check Box if ORC Has Changed
Mail ORIGINAL and TWO COPIES to:
7
Phone: [phone]
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail Service Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND COMPLETE
RALEIGH, INC 27699-1617 TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
Page of
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box ) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
Compliant Y,N
1. The application rate(s) did not exceed the limit(s) specified in the permit.
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
YY
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
YY
4. All buffer zones as specified in the permit were maintained during each application.
YY
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
N�
specified in the permit.
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach
additional sheets if necessary.
The freeboard was exceeded and more water will be applied to Zones 1 and 2 to get the freeboard in compliance. Chad - ORC
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
3/27/2023
(Signature of Permittee)* Date
Kotis Properties, Inc.
(Permittee-Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
Chad Leinbach
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919 260-7301 7/31/23
(Phone Number) (Permit Exp. Date)
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
DENR FORM NDAR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT Page of
ORC Certification Number:
(2):
PERMIT NUMBER:
FACILITY NAME:
WQ0013808
Summerfield Constructed Wetlands
MONTH
February YEAR:
COUNTY:
Uuurora
Flow Monitoring Point: Effluent: X Influent: 111
Parameter Monitoring Point: Effluent: IN Influent: Surface Water (SW):
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility: Yes: N No:
50050
00400
50060
00310
00610
00530
31616
00625
00620
00665
00600
D
A
T
E
Operator
Arrival
Time 2400
Clock
Operator
Time On
Site
ORC
on
Site?
Daily Rate (Flow)
into Treatment
System
pH
Residual
Chlorine
BOD-5
20*C
NH3-N
TSS
Fecal
Coliform (Geo
metric Mean*)
TKN
Total
Nitrate
Total
Phosph
orus
Total
Nitrogen
HRS
YIN
GALLONS
UNITS
UG/L
MG/L
MG/L
MG/L
1100ML
MG/L
MG/L
MG/L
MG/L
1
1586
2
1586
3
1586
4
1586
5
1586
6
1586
7
13:00
1
Y
1586
6.89
2.2
8
1557
9
1557
10
1557
ill
1
1557
12
1557
13
1557
14
10:00
2
Y
1557
6.87
2.2
15
1486
16
1486
17
1486
18
1486
191
1486
20
1486
21
13:50
1
Y
1486
7.27
2.2
22
1571
23
1571
24
1571
25
1571
26
1571
271
1571
28
12:30
1
Y
1571
7.21
2.2
29
30
31
Average
1550
2.2
#DIV/0!
#DIV/0!
#DIV/0!
#NUM!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Daily Maximum
1586
7.27
2.2
0
0
0
0
0
0
0
0
Daily Minimum
1486
6.87
2.2
0
0
0
0
0
0
0
0
Monthly Limit(s)
3182
IG NA
NA
NA
NA
NA
NA
NA
NA
NAI
NA
Composite (C) / Grab (G)
IG
G
G
G
G
IG
IG
IS
Operator in Responsible Charge (ORC): Chad Lelnbach Grade:
Check Box if ORC Has Changed: ❑
Certified Laboratories (1): Conner Consulting, LLC
Person(s) Collecting Samples: Chad Leinbach
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
Division of Water Quality AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
11/SI Phone: [phone]
23928
ENCO
DENR FORM NDMR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
Page of
Facility Status:
Please answer the following question:
Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements? �Y
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance
with its permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach additional sheets if necessary.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that all qualified personnel properly gathered and
evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fines and imprisonment for knowing violations."
3/27/2023
(Signature of Permittee)" Date
Kotis Properties, Inc.
(Perm ittee-Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
Parameter Codes:
Chad Leinbach
(Name of Signing Official -Please print or type)
(Position or Title)
[phone]
(Phone Number)
ORC
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 BAR
00310 BOD5
01042 Copper
00620 NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00556 Oil -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
W009 PAN (Plant Available)
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
Residual
00927 Magnesium
32730 Phenols
00680 TOC
71900 Mercury
00665 Phosphorus, Total
00530 TSS/TSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
7/31 /23
(Permit Exp. Date)
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units designated in the reporting facility's
permit for reporting data.
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)