WQ0013808_Monitoring - 10-2016_20161207

NON -DISCHARGE APPLICATION REPORT .
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00013808
MONTH: October -
FACILITY NAME: Summerfield Constructed Wetlands COUNTY:
Formulas:
Daily Loading (inches) = [Volume Applied (gallons) x 0.1336 (orbic feet/galim) x 12 (inchesffoot)] /[Area Sprayed (acres) x 43,560 (square feeffacre)] OR
= Volume Applied (gallons) / (Area Sprayed (acres) x 27,152 (gallonsfacrevinrh)]
Maximum Hourly Loading (inches) = Daily Loading (inches) f [Time Irrigated (minutes)160 (minutes/hour)] - Monthly Loading (inches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings ('orches)
Averane Weekly Loading tinnh-I = WrinthN Laadina rinchesfmonth) / Number of days in the month (dayslmonth)1 x 7 (days/week)
Page _ of
YEAR: 2016
Guilford
= Sum of Daily Loadings (inches)
Did Irrigation Occur At This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes:
No:
Did Irrigation Occur On This Field:
Yes:
No:
FIELD NUMBER:j
AREA SPRAYED (acres): 0.7.1
COVER CROP: Grass/Forest
PERMITTED HOURLY RATE (inches): 0.3
FIELD NUMBER: 2
AREA SPRAYED (acres): 0.52
COVER CROP: Grass/Forest
PERMITTED HOURLY RATE (inches): 0.3
D WEATHER CONDITIONS
A storage
T Weather 7emperaWre Lagoon
E Code• atapptication Precipiladion Fm-boafd
PERMITTED YEARLY RATE (inches):
Volume Time Daily
Applied Irrigated LoadingLoadingApplied
34.75
Maximum
Hourly
PERMITTED YEARLY RATE (Inches):
Volume Time Daily
Irrigated LoadingLoading
34.75
Maximum
Hourly
(°F) inches feet
.gallons
minutes
inches
inches
gallons
minutes
inches
Inches
1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
2
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/0!
3 1
0
0
0.00
#DIV/01
0
0 1
0.00
#DIV/01
4 C 78 1.5 4.6
500
17.857143
0.03
0.09
0
0
0.00
#DIV/01
5
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
6
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/0!
7
0
0
0.00
#DIV/0!
0
0
0.00
#DIWO!
a
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/Ol
9
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
10
0
0 -
0.00
#DIV/0!
0
0
0.00
#DIV/0!
III C 68 4.7 3.1
1000
35.714286
0.05
0.09
1000
38.4615385
0.07
0.11
12
3000
107.14286
0.16
0.09
507
19.5 1
0.04
0.11
13
3500
125
0.18
0.09
0
0
0.00
#DIV/0!
14
5000
178.57143
0.26
0.09
0
0
0.00
#DIV/01
15
7000
250
0.36
0.09
0
0
0.00
#DIV/0!
15
7500
267.85714
0.39
0.09
0
0
0.00
#DIV/01
17
7000
250
0.36
0.09
0
0
0.00
#DIV/01
181 C 80 5 4.8
5000
178.57143
0.26
0.09
1000
38.4615385
0.07
0.11
1s
1000
35.714286
0.05
0.09
1000
38.4615385
0.07
0.11
20
1000
35.714286
0.05
0.09
1500
57.6923077
0.11
0.11
21
1500
53.571429
0.08
0.09
1000
38.4615385
0.07
0.11
22
1000
35.714286
0.05
0.09
1500
57.6923077
0.11
0.11
23
1500
53.571429
0.08
0.09
1000
38.4615385
0.07
0.11
24
1000
35.714286
0.05
0.09
1001
38.5
0.07
0.11
251 C 72 0 3.6
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
26
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
27
0
0
0.00
#DIV/0!
0
0
0.00
#DIV/01
28
0
0
0.00
#DIV/Ol
0
0
0.00
#DIV/01
29
0
0
0.00
#DIV/0!
1 0
0
0.00
#DIV/O!
30
0
0 1
0.00
#DIV/0!
0
0
0.00
#DIV/01
31 1 1 1
0
0
0.00
#DIV/01
0
0
0.00
#DIV/0!
Total Gallons/Monthly Loading (inches)
46500
2.41
9508
0.67
12 Month Floating Total (inches)
33.77
24.59
Average Weekly Loading (inches)
0.5442905
0.1519575
Weather Codes: Cclear, PC-par8y cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC):
Chad Leinbach
Phone: [phone]
ORC Certification Number: _23928 Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SI TURF OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mai) 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)
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. )
Page
1. The did limit(s) in
Compliant(YN
application rate(s) not exceed the specified the permit.
Y
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
0
4. All buffer zones as specified in the permit were maintained during each application.
YO
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
YO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that 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." ,
(Signa ure 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
(Phone Number)
" If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 28.0506 (b)(2)(D).
8/31/17
(Permit Exp. Date)
DENR FORM NDAR-1 (5/2003)

NON -DISCHARGE APPLICATION REPORT Pageof_
SPRAY IRRIGATION SITE(S) i -
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W00013808
FACILITY NAME: Summerfield Constructed Wetlands
MONTH: October YEAR: 2016
COUNTY- Guilford
Formulas:
Daily Loading (Inches) = [Volume Applied (gallons) x 0.1336 (cubic feet/gallon) x 12 Cinches/foot)] f [Area Sprayed (acres) x 43,560 (square feetfacre)] OR
- Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (gallonsfarrewinch)]
Maximum Hourly Loading (inches) - Daily Loading (inches)/ [Time Irrigated (minutes) 160 (minutes/hour)] Monthly Loading (inches) =Sum of Daily Loadings Cinches)
12 Month Floating Total (inches) = Sum of this month's Monthly Loading (inches) and previous 11 montWk Monthly Loadings Cinches)
Did Irrigation OccurAt This Facility:
Yes: No:
Did Irrigation Occur On This Field:
Yes:
No:
Did Irrigation Occur On This Field:
Yes:
No:
FIELD NUMBER:1 3
AREA SPRAYED (acres): 0.17
COVER CROP:j Grass/Forest
PERMITTED HOURLY RATE (inches): 0.3
FIELD NUMBER:
AREA SPRAYED (acres):
COVER CROP:
PERMITTED HOURLY RATE (inches):
D WEATHER CONDITIONS
PERMITTED YEARLY RATE (inches):
34.75
PERMITTED YEARLY RATE (inches):
7 Weather Temper-ature tag0000n
E Code• atapplicad n Precipita-tion Free -board
Volume Time
Applied Irrigated
Daily
Loading
Maximum
Hourly
Loading
Volume Time
Applied Irrigated
Maximum
Daily. Hourly
Loading Loading
("F) inches feet
gallons minutes
Inches
inches
gallons minutes
inches inches
1
0 0
0.00
#DIV/01
2
0 0
0.00
#DIV/0!
3 1
0 0 1
0.00
#DIV/01
4 1 C 1 78 1.5 4.6
0 0
0.00
#DIV/01
6
0 0
0.00
#DIV/01
6
0 0
0.00
#DIV/01
7
0' 0
0.00
#DIV/01
8
0 0
0.00 `
#DIV/01
9
0 0
0.00
#DIV/01
10
0 0
0.00
#DIV/0!
11 C 68 4.7 3.1
824 68.666667
0.18
'0.16
12
800 66.666667
0.17
0.16
13
0 0
0.00
#DIV/0!
14
0 0
0.00
#DIV/01
15
0 0
0.00
#DIV/0!
16
0 0
0.00
#DIV/0!
17
1 0 0
0.00
#DIV101
18 C 80 5 4.8
493 41.083333
0.11
0.16
19
300 25
0.06
0.16
20
0 0
0.00
#DIV/01
21
0 0
0.00
#DIV/0!
22
0 0
0.00
#DIV/Ol
23
0 0
0.00
#DIV/Ol
24
0 0
0.00
#DIV/0!
25 C 72 0 3.6
1 0 0
0.00
#DIV/0!
26
0 0
0.00
#DIV/0!
27
0 0
0.00
#DIV/0!
28
0 0
0.00
#DIV/01
29
0 0
0.00
#DIV/01
30
0 0
0.00
#DIV/0!
31
0 0
0.00
#DIV/0!
Total GallonstMonthly Loading (inches)
2417
0.52
0
0.00
12 Month Floating Total (inches)
20.00
Average Weekly Loading (inches)
0.11815820
VWdUlCr l U=b: by V4r, rV Pd111y GI000y, { G1000y, R-14111, On -now, JI-SI..l
Spray Irrigation Operator in Responsible Charge (ORC): Chad Leinbach
Phone: [phone]
ORC Certification Number: 23928 Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality (SINATURE 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 Page
SPRAY IRRIGATION SITE(S)
Facility Status:
Please indicate ( by inserting Y(es) or N(o) in the appropriate box) whether the facility has been compliant
with the following permit requirements: (Note: if a requirement does not apply to your facility put (NA) in the
compliant box. )
"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 knoyring violations."
' I l / /"�/ L (® Chad Leinbach
(Signature of Permittee)` ate 66 (Name of Signing Official -Please print or type)
Kotis Properties, Inc.
(Permittee -Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
ORC
(Position or Title)
919 260-7301 8131/17
(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 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (512003)
Com liant 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).
YO
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4. All buffer zones as specified in the permit were maintained during each application.
0
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the limit(s)
YO
specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach
additional sheets if necessary.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that 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 knoyring violations."
' I l / /"�/ L (® Chad Leinbach
(Signature of Permittee)` ate 66 (Name of Signing Official -Please print or type)
Kotis Properties, Inc.
(Permittee -Please print or type)
Post Office Box 9296
Greensboro, NC 27429
(Permittee Address)
ORC
(Position or Title)
919 260-7301 8131/17
(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 26.0506 (b)(2)(D).
DENR FORM NDAR-1 (512003)