WQ0004972_Monitoring - 12-2016_20170203

Page 1 of 2
NON -DISCHARGE WASTE WATER MONITORING REPORT
PERMIT NUMBER: W00004972 MONTH: December YEAR: 2016
FACILITY NAME: Forest Lakes Preserve ELS COUNTY: Davie
x Sample had to be recollected due to lab error. Sample was recollected December 4th & will be included on Decembe
Operator in Responsible Charge (ORC): Glenn Price Grade: II Phone: [phone]
Check Box if ORC Has Changed: 1-1
ORC Certification Number: 987931/20771
Certified Laboratories (1): R & A Laboratories, Inc. (2):
Person(s) Collecting Samples: Glenn Price
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
By this signature, I certify that this report is accurate and
complete to the best of my knowledge.
FES o S 21,7
DENR Form NDAR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
FACILITY STATUS:
Please answer the following question: Compliant (YN)
1. Does all monitoring data and sampling frequencies meet permit requirements?
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that a qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
pen ties r submitting e ' formation, including the possibility of fines and imprisonment for knowing violations."
- James M. Cheshire
( igna e of pe tee) ate (Name of Signing Official -Please print or type)
ames M. Cheshire (Authorized Agent) President R & A Laboratories
(Permittee -Please print or type) (Position or Title)
2N Riverside Plaza , Suite 800
Chicago, Il 60606
(Permittee Address)
01002 Arsenic
01022 Boron
00310 BOD5
01027 Cadmium
00916 Calcium
00940 Chloride
50060 Chlorine, Total
Residual
01034 Chromium
00340 COD
31504
Coliform, Total
00094
Conductivity
01042
Copper
00300
Dissolved Ox en
31616
Fecal Coliform
01051
Lead
00927
Magnesium
71900
Mercury
00610
NH3 as N
01067
Nickel
00600 Nitrogen, Total
00630 NO2 & NO3
00620 NO3
00556 Oil & Grease
WQ09 PAN Plant Available
00400 H
32730 Phenols
00665 Phosphorus, Total
00937 Potassium
00545 Settleable Matter
00929
Sodium
00931
SAR
00745
Sulfide
00515
TDS
00010
Temperature
00625
TKN
00680
TOC
00530
TSS/TSR
00076
Turbidity
01092
Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone], extension 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only units designated in the 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 2B.0506 (b) (2) (D).

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NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDIDTIONAL PAGES AS NEEDED
PERMIT NUMBER: W0004972 MONTH: December YEAR: 2016
FACILITY NAME: Forest Lakes Preserve ELS. COUNTY: Davie
Formulas:
Dally 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) / [rime irrigated (minutes) / 60 (minutes/hour)] Monthly Loading (inches) =Sum of Dally Loading (inches)
12 Month Floating Total (Inches) = Sum of this month's Monthly Loading (inches) and previous 11 month's Monthly Loadings (inches)
Average Weekly Loading (inches) = [Monthly Loading (inches/month) / Number of days in the month (days/month )] x 7 (days/week)
*Weather Codes: C -clear, PC -partly cloudy, CI -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): Glenn Price Phone:
ORC Certification Number: 987931/20771
Mail ORIGINAL and Two COPIES to:
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHI
Division of Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center complete to the best of my knowledge.
RALEIGH, NC 27699-1617
Check Box if ORC Has Change ❑
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.)
Compliant (Y,N)
1. The application rate(s) did not exceed the limit(s) specified in the permit. 4
2. Adequate measures were taken to prevent wastewater runoff from the site(s).
4
3. A suitable vegetative cover was maintained on the site(s) in accordance with the permit.
4
4. All buffer zones as specified in the permit were maintained during each application.
5. The freeboard in the treatment and/or storage lagoon(s) was not less than the
limit(s) specified in the permit.
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance with its
permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s) taken. Attach
additional sheets if necessary.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that a qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
informat' n submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
pena ies folI submitting f es ormation, including the possibility of fines and imprisonment for knowing violations."
of P
(Permittee -Please print or type)
2N. Riverside Plaza, Suite 800
Chicago, I1 60606
(Permittee Address)
James M. Cheshire
(Name of Signing Official -Please print or type)
President R & A Laboratories
(Position or Title)
(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).