NC0034452_Regional Office Historical File Pre 2016

AL 4 VX-KAWWA
A4
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 14, 2015
Thomas J. Roberts, President
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: NOTICE OF VIOLATION
NOV-2015-LV-0516
Permit No. NCO034452
Willow Creek WWTP
Davidson County
Dear Mr Roberts:
Donald R. van der Vaart
Secretary
A review of Willow Creek WWTP's monitoring report for May 2015 showed the following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
5/27/2015
13.500 mg/I
21.800 mg/I
Daily Maximum Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please be aware that violations of your NPDES permit could result in enforcement action by the
Division of Water Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W. Hanes Mill Rd, Suite 300; Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

41
w�
NCDER
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July12, 2015
Mr. Thomas Roberts
Aqua North Carolina, Inc.
202 Mackenan Avenue
Cary, NC 27511
SUBJECT: Compliance Evaluation Inspection
Willow Creek WWTP
NPDES Permit # NCO034452
Davidson County
Dear Mr. Roberts:
Donald R. van der Vaart
Secretary
On June 18, 2015, Ms. Jenifer Carter of the Winston-Salem Regional Office conducted a Compliance
Evaluation Inspection at Willow Creek Subdivision's wastewater treatment plant. Charles Pearson, ORC,
and Sam Pegram, back-up ORC, were present during the inspection. The inspection consisted of an on -
site inspection of the treatment facilities and a review of facility files and self -monitoring data. The following
is a summary of findings during the inspection:
A. Facility records (daily logs and maintenance records) are well organized and current. A review of
self -monitoring data showed that laboratory data correctly correlates with data submitted on the
monthly Discharge Monitoring Reports.
B. The gravity sand filter is being pypassed. Mr. Pearson said that Total Suspended Solids is higher
when it is in use, and wondered if the underdrain needs to be repaired. He also theorized that it
may be the cause of repeated build-up of solids in the dechlorination chamber. The filter may
need to be drained to assess its overall condition.
C. Mr. Pearson seems to have a good grasp on how to run the plant as efficiently as possible. The
problem with solids has been ongoing issue at the plant for prior operators as well. Mr. Pearson's
efforts to troubleshoot the causes is very much appreciated.
Please refer to the attached report for more inspection details. Should you have any questions please
contact Jenifer Carter in our Winston-Salem Regional Office at [phone].
Enclosure
cc: DWR central files
WSRO files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W Hanes Mill Rd., Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncdenr.gov
An Equal Opportunity \ Afrmative Action Employer — Made in part by recycled paper

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN 1 2 15 I 3 I NCO034452 I11 12 15/06/18 17 18 Li 19 1 � j 201
21I11111IIIIIII1IIIIII IIIIIIIlIIIIIIIIlllllf6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 61 CA ----------- —------ Reserved-----------
67 701, I 71 JIN I 72 N 731 I 174 75I III I I' I80
LJ I I
Section B: FacilityDataIJ
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
02 OOPM 15/06/18
14/05/01
Willow Creek WWTP
Exit Time/Date
Permit Expiration Date
Dorado Dr
03:OOPM 15/06/18
19/04/30
High Point NC 27262
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Charles Alton Pearson/ORC//
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Harold White,1730 N Main St High Point NC 27262//336-881-1422/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement N Operations & Maintenance Records/Reports
Self -Monitoring Program 0 Sludge Handling Disposal 0 Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
pi, Carter WSRO WQ//336-776-9691/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
r,
^ J �X ,, —
�. J�
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type (Cont.)
31 NC0034452 �11 12 15/06/18 17 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Mr. Pearson seems to have a good grasp on the complexities of this system. He acknowledges the
continual difficulty in keeping sludge under control, as has been a continual problem for prior operators.
Sludge storage capacity is less than ideal, contributing to the problem.
The filter is being bypassed, as the Mr. Pearson believes its use only contributes to increased Total
Suspended Solids in the effluent, as well as sludge in the dechlorination chamber. It may need to be
drained to see if repairs are needed.
Page#

Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 06/18/2015 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
0
❑
❑
❑
application?
Is the facility as described in the permit?
0
❑
❑
❑
# Are there any special conditions for the permit?
❑
0
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment:
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
M
❑
❑
❑
Is all required information readily available, complete and current?
M
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
M
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
M
❑
❑
❑
Is the chain -of -custody complete?
M
❑
❑
❑
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
0
❑
on each shift?
Is the ORC visitation log available and current?
0
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
0
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
M
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
Comment:
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? M ❑ ❑ ❑
Is sample collected below all treatment units? ❑ ❑ ❑
Page# 3

Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 06/18/2015 Inspection Type: Compliance Evaluation
Effluent Sampling
Yes No NA NE
Is proper volume collected?
0
❑
❑
❑
Is the tubing clean?
0
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
❑
❑
❑
representative)?
Comment:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and 0 ❑ ❑ ❑
sampling location)?
Comment:
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
❑
❑
❑
Is flow meter calibrated annually?
❑
❑
❑
Is the flow meter operational?
M
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
0
❑
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable 0 ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Bar Screens
Yes No NA NE
Type of bar screen
a.Manual
b.Mechanical
❑
Are the bars adequately screening debris?
0
❑
❑
❑
Is the screen free of excessive debris?
0
❑
❑
❑
Is disposal of screening in compliance?
0
❑
❑
❑
Is the unit in good condition?
0
❑
❑
❑
Page# 4

14
Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 06/18/2015 Inspection Type: Compliance Evaluation
Bar Screens Yes No NA NE
Comment:
Equalization Basins
Yes No NA NE
Is the basin aerated?
E
❑
❑
❑
Is the basin free of bypass lines or structures to the natural environment?
0
❑
❑
❑
Is the basin free of excessive grease?
N
❑
❑
❑
Are all pumps present?
N
❑
❑
❑
Are all pumps operable?
0
❑
❑
❑
Are float controls operable?
S
❑
❑
❑
Are audible and visual alarms operable?
❑
❑
Cl
# Is basin size/volume adequate?
E
❑
❑
❑
Comment:
Aeration Basins
Yes No NA NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
0 ❑
❑
❑
Are surface aerators and mixers operational?
❑ ❑
0
❑
Are the diffusers operational?
E ❑
❑
❑
Is the foam the proper color for the treatment process?
0 ❑
❑
❑
Does the foam cover less than 25% of the basin's surface?
0 ❑
❑
❑
Is the DO level acceptable?
❑ ❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
❑ ❑
❑
Comment:
Secondary Clarifier
Yes No NA NE
Is the clarifier free of black and odorous wastewater?
N
❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
0
❑
Are weirs level?
N
❑
❑
❑
Is the site free of weir blockage?
E
❑
❑
❑
Is the site free of evidence of short-circuiting?
0
❑
❑
❑
Is scum removal adequate?
S
❑
❑
❑
Is the site free of excessive floating sludge?
0
❑
❑
❑
Page# 5

i
Permit: NC0034452 Owner -Facility: Willow Creek WWTP
Inspection Date: 06/18/2015 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes No NA NE
Is the drive unit operational?
❑
❑
0
❑
Is the return rate acceptable (low turbulence)?
0
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
0
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately '/. of the sidewall depth)
M
❑
❑
❑
Comment:
Filtration (High Rate Tertiary)
Yes No NA NE
Type of operation:
Is the filter media present?
❑
❑
M❑
Is the filter surface free of clogging?
❑
❑
❑
Is the filter free of growth?
❑
❑M
❑
Is the air scour operational?
❑
❑
M
❑
Is the scouring acceptable?
❑
❑
0
❑
Is the clear well free of excessive solids and filter media?
❑
❑
M
❑
Comment: Filter being massed. Mr. Pearson said that TSS is higher when it is in use, and wonders if
the underdrain needs repairs. Also wonders if the filter A need of repair) is cause of
repeated build-up of sludge in the dechlorination chamber.
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
M
❑
❑
❑
Are the tablets the proper size and type?
M
❑
❑
❑
Number of tubes in use?
8
Is the level of chlorine residual acceptable?
0
❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
M
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
0
❑
❑
❑
Comment:
De -chlorination
Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
M ❑
❑
❑
Is storage appropriate for cylinders?
❑ ❑
0
❑
# Is de -chlorination substance stored away from chlorine containers?
0 ❑
❑
❑
Comment:
Are the tablets the proper size and type? M ❑ ❑ ❑
Page# 6

Permit: NC0034452 Owner -Facility: Willow Creek WWTP
Inspection Date: 06/18/2015 Inspection Type: Compliance Evaluation
De -chlorination Yes No NA NE
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
❑ ❑ ❑
0
Yes No NA NE
■ ❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ■ ❑
Page# 7

WKWA
A
RECEIVED
N.C. Dept of ENR
MAR
AK
17 2015
,A�FFENCDENR REGONOCr
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
March 13, 2015
CERTIFIED MAIL ITEM 7010 2780 0003 4825 6632 - RETURN RECEIPT REQUESTED
Mr. Thomas J. Roberts
Aqua North Carolina Inc
202 MacKenan Ct
Cary, NC 27511
Subject: Notice of Deficiency
Failure to Submit Electronic Discharge Monitoring Reports (eDMRs)
[see attached list of facilities]
Dear Permittee:
Per the terms of your NPDES permit, you were required to register for and begin using the Division of
Water Resources' electronic Discharge Monitoring Report (eDMR) system by 1/26/2015. Our records indicate
that as of the date of this letter, the subject facility has not submitted any data using the eDMR system.
Failure to register and begin submitting reports electronically is a violation of the terms of your permit,
subjecting you to a possible Notice of Violation and/or the assessment of civil penalties. In order to reduce
the risk of receiving additional enforcement action, you must complete your registration within 30 days of
receipt of this notice.
The Division has prepared a website devoted to all aspects of eDMR, including registration for its use,
obtaining an eDMR user account, and answers to frequently asked questions. You are encouraged to visit
the website at: http://portal.ncdenr.org/web/wa/adminibog/ipu/edmr. Should you have further questions
regarding eDMR after reviewing the website's content, or have need of further assistance, you should contact
the appropriate Division staff member as listed under the "Contact Us" section of the website.
Thank you for your cooperation in this matter.
Since ly, '
S. Jay Zimmerman, Dir
Division of Water Resources
cc: NPDES File
Central Files
Winston-Salem Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] Vntemet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmatnre Action Employer— Made in part by recycled paper

March 13, 2Q1'S
Failure to submit eDMR data
List of affected facilities:
PERMIT FACILITY NAME County Name
Number
NCO034452
Willow Creek WWTP
Davidson
NCO063720
Forest Ridge WWTP
Forsyth
NC0083925
Salem Glen Subdivision WWTP
Davidson
NC0084409
Wellesley Place WWTP
Forsyth
NC008 4498
Mitchell Bluff Subdivision Well #1
Surry
NCO088528
Hillcrest Subdivision- Well #3
Surry
NCO088536
Bannertown Hills Subdivision - Well #2
Surry
NCO088552
Colonial Woods Subdivision - Wells #1 & #2
Surry
NCO088609
Windgate Subdivision - #1
Surry
NCO088625
The Hollows Subdivision
Surry
NC0088633
Reeves Woods Subdivision Well #2
Surry
NCO088854
Pine Lakes Subdivision - Well # 2
Surry

4
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 12, 2014
Thomas J. Roberts, President
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0388
Permit No. NCO034452
Willow Creek WWTP
Davidson County
Dear Mr. Roberts:
John E. Skvarla, III
Secretary
A review of Willow Creek WWTP's monitoring report for April 2014 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
04/23/14
13.5 mg/1
19.6 mg/1
Daily Maximum Exceeded
BOD, 5-Day (20 Deg. C)
04/30/14
9 mg/1
10.34 mg/1
Monthly Average Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that violations of your NPDES permit could result in enforcement action by the Division of
Water Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity1 Affirmative Action Employer— Made in part by recycled paper

s*
2
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
June 4, 2014
Thomas J. Roberts, President
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0249
Permit No. NCO034452
Willow Creek WWTP
Davidson County
Dear Mr Roberts:
John E. Skvarla, III
Secretary
A review of Willow Creek WWTP's monitoring report for February 2014 showed the following violation:
Parameter
Date
Limit Value
Reported Value
Type
tMaximum
BOD, 5-Day (20 Deg. C)
02/05/14
22.5 mg/l
25.1 mg/l
Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that violations of your NPDES permit could result in enforcement action by the Division of
Water Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

-VA
NCU R
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Aqua North Carolina, Inc.
Attn: Mr. Thomas J. Roberts, President & COO
202 Mackenan Court
Cary, NC 27511
SUBJECT: Compliance Evaluation Inspection
Willow Creek WWTP
NPDES Permit No. NCO034452
Davidson County
Dear Mr. Roberts:
April 15, 2014
John E. Skvarla, III
Secretary
A compliance Evaluation Inspection was performed at Willow Creek's WWTP on March 27, 2014 by Jenifer Carter
of the Winston-Salem Regional Office. Samual Pegram, ORC, and Darrell Horner, ORC in training, were present for
the inspection. This type of inspection consists of two basic parts: a review of facility files and self -monitoring data,
and an on -site inspection of the facility. The following was noted during the inspection.
A) The permit was renewed as required and becomes effective on May 1, 2014.
B) Facility records (daily logs and maintenance records) are well organized and current. A review of self -
monitoring data showed that laboratory data correctly correlates with data submitted on the monthly
Discharge Monitoring Reports.
C) Sludge depth in the secondary clarifiers was greater than 75% of the total depth during the inspection, with
a small amount of pin floe observed in the older clarifier. Flow from the clarifiers was clear during the
inspection. Please make sure proper sludge depth is maintained in order to prevent solids from
leaving the plant, especially during high flow events.
D) Many improvements and repairs have been made to the collections system to cut down on problems with
inflow and infiltration. Further repairs are planned.
No violations were noted during the inspection. Please review the enclosed inspection form for more detailed
information. If you have any questions, please call Jenifer Carter at [phone].
attachment
cc: DWR-Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 1 5 I 31 NCO034452 111 12I 14/03/27 117 181 C I 19101 201
LuJ LJ U IJ
Remarks
211 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Jill Jill J_ I I 1 1 16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA -------- —----------------- Reserved ------------ —--- -----
67 I 169 70 U 3 71 72 I N 73' —�—+ I 174 751 I I I I I I 180
�—�
Section B: Facilliit--yet Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:00 AM 14/03/27
09/07/01
Willow Creek WWTP
Exit Time/Date
Permit Expiration Date
Dorado Dr
High Point NC 27262
10:40 AM 14/03/27
14/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Samuel E. Pegram//704-525-7990 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Harold White,1730 N Main St High Point NC 27262//336-881-1422/ No
Section C: Areas Evaluated During Inspection Check only those areas evaluated)
Permit E Flow Measurement 0 Operations & Maintenance Records/Reports
Self -Monitoring Program 0 Sludge Handling Disposal 0 Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Jenif rter WSRO WQH336-771-5000/ _
ignature of Management Q A�Reviewer Agency/Office/Phone and Fax Numbers Date
Sdrt.�7�``r'
NWo
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NC0034452 111 12,
14/03/27 117 18' _
(cont.) 1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Darell Horner was being trained to eventually take over as ORC at this facility. Make sure that ORC
visitation requirements are met during the transition, and that a change of ORC form is submitted to DWR
when necessary. Mr. Horner seemed to have a good basic grasp of the plant's operating requirements.
Sludge depth on both the new and old sections of the plant was >75 % of the sidewall depths during the
inspection. Excessive sludge depth was noted during the previous inspection as well. Although the
discharge from the clarifiers was clear during the inspection, this may not be the case during high flow/
heavy I&I situations. While it was noted that improvements/ repairs have been made to the collection
system to help alleviate problems with I&I, sludge build-up within the plant should not be considered normal
practice.
Page # 2

Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 03/27/2014 Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? ■ ❑ ❑ ❑
Is the facility as described in the permit? ■ ❑ ❑ ❑
# Are there any special conditions for the permit? ❑ ■ ❑ ❑
Is access to the plant site restricted to the general public? ■ ❑ ❑ ❑
Is the inspector granted access to all areas for inspection? ■ ❑ ❑ ❑
Comment:
Record Keeping
Yes
No NA NE
Are records kept and maintained as required by the permit?
■
❑ ❑ ❑
Is all required information readily available, complete and current?
■
❑ ❑ ❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
❑ ❑ ❑
Are analytical results consistent with data reported on DMRs?
■
❑ ❑ ❑
Is the chain -of -custody complete?
■
❑ ❑ ❑
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
❑ ❑ ❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑ ❑ ■
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
❑ ■ ❑
Is the ORC visitation log available and current?
■
❑ ❑ ❑
Is the ORC certified at grade equal to or higher than the facility classification?
■
❑ ❑ ❑
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑ ❑ ❑
Is a copy of the current NPDES permit available on site?
■
❑ ❑ ❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑ ❑ ■
Comment:
Effluent Sampling
Yes
No NA NE
Is composite sampling flow proportional?
■
❑ ❑ ❑
Page # 3

I
Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 03/27/2014 Inspection Type: Compliance Evaluation
Effluent Sampling Yes No NA NE
Is sample collected below all treatment units? ■ ❑ ❑ ❑
Is proper volume collected? ■ ❑ ❑ ❑
Is the tubing clean? ■ ❑ ❑ ❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? ■ ❑ ❑ ❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ ❑ ❑ ❑
Comment:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ ❑ ❑ ❑
Comment:
Flow Measurement - Effluent Yes No NA NE
# Is flow meter used for reporting? ■ ❑ ❑ ❑
Is flow meter calibrated annually? ■ ❑ ❑ ❑
Is the flow meter operational? ■ ❑ ❑ ❑
(If units are separated) Does the chart recorder match the flow meter? ❑ ❑ ■ ❑
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑
Judge, and other that are applicable?
Comment:
Standby Power Yes No NA NE
Is automatically activated standby power available? ❑ ■ ❑ ❑
Is the generator tested by interrupting primary power source? ■ ❑ ❑ ❑
Is the generator tested under load? ■ ❑ ❑ ❑
Was generator tested & operational during the inspection? ■ ❑ ❑ ❑
Do the generator(s) have adequate capacity to operate the entire wastewater site? ■ ❑ ❑ ❑
Is there an emergency agreement with a fuel vendor for extended run on back-up power? ❑ ❑ ❑ ■
Is the generator fuel level monitored? ❑ ❑ ❑ ■
Comment:
0w 0— ---- Vn AI.. AIA KIM
Page # 4

E
Permit: NCO034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 03/27/2014 Inspection Type: Compliance Evaluation
Bar Screens
Yes No NA NE
Type of bar screen
a.Manual
■
b.Mechanical
Q
Are the bars adequately screening debris?
■
0 Q 0
Is the screen free of excessive debris?
■
0 I]
Is disposal of screening in compliance?
■
❑ ❑ Q
Is the unit in good condition?
■
❑ I]
Comment:
Equalization Basins
Yes
No NA NE
Is the basin aerated?
■
O ❑
Is the basin free of bypass lines or structures to the natural environment?
■0
0 O
Is the basin free of excessive grease?
■
❑ 0 0
Are all pumps present?
■
Q Q Q
Are all pumps operable?
■
0 O
Are float controls operable?
■
Q D
Are audible and visual alarms operable?
O
0 0 ■
# Is basin size/volume adequate?
■
Cl
Comment:
Aeration Basins
Yes
No NA NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
Q 0 0
Are surface aerators and mixers operational?
Q
❑ ■ Q
Are the diffusers operational?
■
0 ❑ 0
Is the foam the proper color for the treatment process?
■
Q Q 0
Does the foam cover less than 25% of the basin's surface?
■
0 O 0
Is the DO level acceptable?
I]
❑ O ■
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Q
0 0 ■
Comment: Wasterwater appeared on the young side in both the old and newer ABs
Secondary Clarifier
Yes
No NA NE
Page # 5

s
Permit: NC0034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 03/27/2014 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No NA NE
Is the clarifier free of black and odorous wastewater?
■
❑ ❑ ❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑ ■ ❑
Are weirs level?
■
❑ ❑ ❑
Is the site free of weir blockage?
■
❑ ❑ ❑
Is the site free of evidence of short-circuiting?
■
❑ ❑ ❑
Is scum removal adequate?
■
❑ ❑ ❑
Is the site free of excessive floating sludge?
■
0 I] ❑
Is the drive unit operational?
❑
❑ ■ ❑
Is the return rate acceptable (low turbulence)?
■
❑ ❑ ❑
Is the overflow clear of excessive solids/pin floc?
■
❑ Cl ❑
Is the sludge blanket level acceptable? (Approximately''% of the sidewall depth)
❑
■ ❑ ❑
Comment: Sludge depth on both sides of the plant was >75 % of the sidewall depths
during the inspection. Excessive sludge depth was noted during the previous inspection
as well. Although the discharge from the clarifiers was clear during the inspection, this
may not be the case during high flow/ heavy I&I situations.
Filtration (High Rate Tertiary)
Yes No
NA
NE
Type of operation:
Down flow
Is the filter media present?
0110
❑
Is the filter surface free of clogging?
■ ❑
❑
❑
Is the filter free of growth?
■ ❑
❑
❑
Is the air scour operational?
❑ ❑
■
❑
Is the scouring acceptable?
❑ ❑
■
❑
Is the clear well free of excessive solids and filter media?
■ ❑
❑
❑
Comment:
Disinfection -Tablet Yes No NA NE
Are tablet chlorinators operational? ■ ❑ ❑ ❑
Are the tablets the proper size and type? ■ ❑ ❑ ❑
Number of tubes in use? 8
Is the level of chlorine residual acceptable? ■ ❑ ❑ ❑
Is the contact chamber free of growth, or sludge buildup? ■ ❑ ❑ ❑
Page # 6

Permit: NC0034452 Owner - Facility: Willow Creek WWTP
Inspection Date: 03/27/2014 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Is there chlorine residual prior to de -chlorination?
Comment:
n-M —a.,.,a:,..,
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
Comment:
Are the tablets the proper size and type?
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
■ ❑ ❑ ❑
Yes No NA NE
Tablet
❑ ❑ ■ ❑
❑ ❑ ■ ❑
■ ❑ ❑ ❑
■❑❑❑
■ ❑ ❑ ❑
8
Yes No NA NE
■ ❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ■ ❑
Page # 7

T�,v i (� 55A
Water Pollution Control System Operator Designation Form
WPCSOCC
NCAC 15A 8G .0201.
Permittee Owner/Officer Name: ii Vad NC 7-CM RO &C -5
Mailing Address: 20 2 /IMAC (c'FNAN Co,c R T"
City: C0V State: _ C Zip: AU-11 - Phone #: (R l i) ` 6 ,7 - 87(.2
Email address: /�djfMCd4 4 i 4e u C" q9q gIV&,,AlC�' • ea�"t
Signature: 40.-e M OIL' Date: 3,22-1-/el
Facility Name: W /16 ow COQF'c& Permit #: 746
SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM! tj C 60
Facility Type/Grade:
Biological WWTP_ Surface Irrigation
Physical/Chemical Land Application
Collection System
Operator in Responsible Charge (ORC)
Print Full Name: VARAE e- C /-%QN£e
Certificate Ty ade / Number: Gy w . LEV- q 9 90Z % Work Phone #: (33 {o) .36.7, - / 0 Yg
Signature: T J 6:NNo&e_� �1.C��__ Date:
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
.................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: IQo6CAT 499AKfAC
Certificate Type / Grade / Number; l v.
9'i Work Phone #:
03(o)
39.7- - 3178
Signature:tr_tX--r )-I" .
Date:
-?,-
X 0 1 '
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in ISA NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
.................................................................................................................................................. ,
Mall, fax or entail the WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 Fax; 919.807.6492
original to. Email; certadatin a ucdenr.eoy
Mail or fax a copy to the Asheville
appropriate Regional Office: 2090 US Hwy 70
Swannanoa 28778
Fax: 828,299.7043
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: 910.486,0707
Phone: [phone]
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: 910.350,2018
Phone: [phone]
A400resville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: 704.663,1699
Winston-Salem
585 Waughtown St
Winston-Salem 27107
Fax: [phone]
Phone: 336,771.5000
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]
Revised 02-2013

Facility Name: t: it-CQc-i e"exer, Pernilt#: NC 00.1y�,/S.Z
.................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: 6AM U A (_ C P-E-G,PRn
Certificate Type / Grade / Number: Lt>.A��
Gy � / / o O H Work Phone #: (3y3(a) fA
Signature: �t�f`� Low Date: 3-�� f _/) 1
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC asset forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: 8E`TE- 09,4e, /.y6
Certificate Type / Grade / Number: �&JW -17 7?7 511 , Work Phone #: (.334) 3G.? - 2008
Signature: � ��.�i �/_/ >_-- _ Date: o3 - 2-8 -it/
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: /Y! / ChWXt_ 5nelc&G4ko
Certificate Type / Grade / timber: eq &J. ' 6 D M Work Phone #: (396 ) 3V -- 4 // g
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Com, ission."
.................................................................................................................................................
Back -Up Operator In Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number: Work Phone #:
Signature:
Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and Mill abide by the
rules and regulations pertaining to the responsibilities of the BU ORC asset forth in 15A NCAC 080.0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
..........................................................................................................................................................................
Revised 02-2013

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory
Governor
Attn: Thomas Roberts
Aqua North America
4163 Sinclair Street
Denver, NC 28037
Dear Mr. Roberts:
Thomas A. Reeder
Director
December 5, 2013
N.C.Dept. of ENR
DEC 10 2on
Winston-S ;;;,'n
Re Tonal
John E, Skvarla, III
Secretary
1AA&kO CilU9
Subject: Receipt of permit renewal
Permit NCO034452
Davidson County
The NPDES Unit received your permit renewal application on November 20, 2013. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the. subject permit, please contact Maureen
Kinney [phone].
Sincerely,
I
Wren Thedford
Point Source Branch
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]Customer Service:1-877-623-6748
Internet:: www.ncwater.org
An Equal OpportunitylAffirmative Action Employer

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCO034452
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
AQUA NORTH CAROLINA, INC.
Facility Name
WILLOW CREEK WWTP
Mailing Address
202 MACKENAN COURT
City
CARY
State / Zip Code
NC 27511
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road SW of WILLOW CREEK COUNTRY CLUB
City HIGH POINT
State / Zip Code NORTH CAROLINA
County DAVIDSON
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name AQUA NORTH CAROLINA, INC
Mailing Address 202 MACKENAN COURT
City CARY
State / Zip Code NORTH CAROLINA 27511
Telephone Number [phone]
Fax Number [phone]
1 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
®
Number of Homes 154
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
This system serves residential customers only.
Population served: 392
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
Abbotts Creek in the Yadkin -Pee Dee River Basin
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration: _
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
The 0.080 MGD package plant consist of the following:
•
Influent pump station
•
Bar Screens
•
Flow equalization tank
•
Two aeration basins
•
Two secondary clarifiers
•
Gravity sand filters
•
Chlorine contact chamber
•
Dechlorination
•
Effluent flow measurement
2 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.080 MGD
Annual Average daily flow 0.051 MGD (for the previous 3 years)
Maximum daily flow 0.237 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum
and monthly average. If only one analysis is reported, report as daily maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
7.4
2.0
MG/L
Fecal Coliform
300
8.6
#/ 100ML
Total Suspended Solids
12.3
4.4
MG/ L
Temperature (Summer)
25.9
21
'Celsius
Temperature (Winter)
14.8
10.4
° Celsius
pH
8.1
N/A
UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO034452
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3of3
Form-D 05/08

.�
i y.� •,
'�

AQUA
l`'" North Carolina.
SLUDGE MANAGEMENT PLAN
For
Aqua North Carolina, Inc.
No sludge will be treated on any wastewater treatment plant site operated
by Aqua N.C., Western Division
Where practical, sludge removed from a Aqua N.C., Western Division
facility will be transported via a contract hauler to another Aqua N.C.,
Western Division facility for the purpose of "seeding" a new or under
loaded plant.
Unusable (or "dead") sludge will be removed by a contract hauler and
properly disposed of in accordance with NCGS 143-215.1. Contract
haulers used by Aqua N.C., Western Division will be required to report the
quantity of sludge transported and identify the location of the proposed
disposal site if the sludge is not taken to an existing plant operated by Aqua
N.C., Western Division. Aqua N.C., Western Division has not entered into
any agreement to accept sludge into its facilities from plants not owned by
them.
Aqua N.C., Western Division will keep records on the quantity of sludge
removed from each facility, the name of the contract hauler, and the
destination of the sludge (whether used in another plant or disposed of).
The information will be kept on file and will be made available to any
regulatory agency having jurisdiction over sludge treatment or disposal.
Aqua N.C., Western Division includes all of the facilities under the
jurisdiction of the Winston-Salem Regional Office.

AQUA_
North Carolina
September 29, 2008
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: NPDES Renewal Application
Will Creek WWTP
NPDES Permit No.: NCO034452
Davidson County, North Carolina
Dear Mrs. Sprinkle,
RECEIVED
OCT - 8 2008
DENR - WATER QUALITY
POINT SOURCE BRANCH
Transmitted herewith are the completed/signed originals and two
copies each of:
1. The subject NPDES permit renewal application and
2. The facility's sludge management plan
Also attached are two copies of this cover letter. Dechlorination
facilities (sodium sulfite) were added to the WWTP in 2007 in
accordance with an ATC issued by DWQ on 09/07/2007 (Engineer's
Certification dated 12/27/2007).
It is my understanding that no filing fee is required for this renewal.
If you have any questions regarding this application, please do not
hesitate to contact me.
Sinc eIy,
Thomas J
President
Roberts
202 MacKenan Court, Cary, North Carolina 27511 • 919-467-8712

NPDES APPLICATION - FORM D
` For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit 000034452
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Aqua North Carolina, Inc.
Facility Name
Willow Creek WWTP
Mailing Address
202 Mackenan Court
City
Cary
State / Zip Code
North Carolina/27511
Telephone Number
[phone] (Ext. 30)
Fax Number
[phone]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road Southwest of Willow Creek Golf Club
City High Point
State / Zip Code North Carolina
County Davidson
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Aqua North Carolina, Inc.
Mailing Address 4163 Sinclair Street
City Denver
State / Zip Code NC/28037
Telephone Number [phone]
Fax Number [phone]
1 of A Fnrm-n i /nr,

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that applyj:
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
®
Number of Homes 141
School
®
Number of Students/Staff 417
Other
®
Explain: Golf Club
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Residential, private school, and golf club (400 members with restaurant)
Population served: 1175 (estimated --see above)
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points One
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall�.
Abbots Creek, WS-III, Yadkin Pee -Dee River Basin
S. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Continuous
9. Describe the treatment system
List all installed components, including capacity, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
0.080 MGD WWTP consising of influent pump station, bar screens, aerated equalization
basin, three aeration basins, three secondary clarifiers, gravity sand filters, chlorine
contact basin, tablet dechlorination, effluent flow measurement, and two small sludge
holding basins. Facilities are designed to meet the following Monthly Average/ Daily
Maximum permit effluent limitations (mg/1): BOD 9.0/ 13.5 (summer), BOD 15.0/22.5
(winter), TSS 30/45, NH3 as N 5.5/27.5 (summer), NH3 as N 11.0/35.0 (winter). No
Phosphorus limit speed in current MPDES permit.
of d Fnrm_n 1 MA

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.080 MGD
Annual Average daily flow 0.020337, 0.030518, 0.022518 MGD (for the previous 3 years)
Maximum daily flow 0.058, 0.203, 0.098 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
Provide data for the parameters listed Fecal Colifbrm, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. Effluent testing data must be based on at least three samples
and must be no more than four and one half years old
Parameter
Daily
Monthly
Units of
Number of
Maximum
Average
Measurement
Samples
Biochemical Oxygen Demand
<2.1
<2.0
mg/1
3 (from 4/08-
(BODs)
6/08 DMRs)
130.0
15.0
#/ 100m1
3 (from 4/08-
Fecal Coliform
6/08 DMRs)
7.0
<3.0
mg/1
3 (from 4 / 08-
Total Suspended Solids
6/08 DMRs)
21.2
18.9
Centigrade
3 (from 4/08-
Temperature (Summer)
6/08 DMRs)
Temperature (Winter)
---
---
Centigrade
0
7.15
3 (from 4/08-
pH
6/08 DMRs)
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NCO034452
14. APPLICANT CERTIFICATION
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Special Order of Consent (SOC)
Other
Permit Number
3nfA
Fnrm-n 1 K1F

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 1000/6 domestic wastewaters <1.0 MGD
I certify that I am familiar with the information contained in the application and that to the '
best of my knowledge and belief such information is true, complete, and accurate.
Printed name of Person Signing Title
of
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement
representation, or certification in any application, record, report, plan, or other document files or required to be
maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,
or who falsifies, tampers with, or knowly renders inaccurate any recording or monitoring device or method required to
be operated or maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by
imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not
more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
d of d Fnrm_n 1=

,anrudt. "5E'N`
Longitude S 06'0 "
U SVS C?uac D?.2,NF
Pjvtr Fusin =: C,30 Ci
Rtc,6vinb Sirr-arr. '.bb= ree'r:
.rear„ �,�__ 'd:'_•-1':)
NC0O34452 - i
i
Facility,
4 `ita ��t 't' yr. •�.�{�.
4
T. Y 1T ' � ! .'F' ii �
'�.tt*J
Location
i� h '4'r.,i�1
I
_'�TortCr
c'_� OX

AQUA -
North Carolina
SLUDGE MANAGEMENT PLAN
for
Aqua North Carolina, Inc. (Western Region -High Point)
No sludge will be treated on any wastewater treatment plant site operated by
Aqua North Carolina, Inc.
Where practical, sludge removal from Aqua North Carolina West facilities will be
transported via a contract hauler to another Aqua North Carolina West facility for
the purpose of "seeding" a new or under -loaded plant when there is a need for
such.
Unusable (or "dead") sludge will be removed by a permitted/licensed contract
hauler and properly disposed of in accordance with NCGS 143-215.1. Contract
haulers used by Aqua North Carolina West will be required to report, via a
sludge -hauler ,manifest, the quantity of sludge transported and identify the
location of the proposed disposal site if the sludge is not taken to an existing
plant operated by Aqua North Carolina West. Aqua North Carolina West has not
entered into any agreement to accept sludge into its facilities from plants not
owned by them and have no intentions of doing so.
Aqua North Carolina West will keep records on the quantity of sludge removed
from each facility, the name of the contract hauler, and the destination of the
sludge (whether used in another plant or disposed of). The information will be
kept on file and will be made available to any regulatory agency having
jurisdiction over sludge treatment or disposal.
Aqua North Carolina West includes all of the facilities under the jurisdiction of the
Winston;�alem Regional Office.
i

SECTION
D
� NAME
STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
Winston-Salem Regional Office
FILE ACCESS RECORD
ce,buod!� ATE/TIME
PRESENTING
Guidelines for Access: The staff of the Winston-Salem Regional Office is dedicated to making
public records in our custody readily available to the public for review and copying. We also have the
responsibility to the public to safeguard these records and to carry out our day-to-day program
obligations. Please read carefully the following before signing the form.
1. Due to the large public demand for file access, we request that you call at least a day in
advance to schedule an appointment for file review so you can be accommodated.
Appointments are scheduled between 9-.00 a.m. and 3:00 p.m. Viewing time ends at 445
P.m. Anyone arriving without an appointment may view the files to the extent that time and
staff supervision are available.
2. You must specify files you want to review.
3. There is no charge for 25 copies or less If making more than 25 copies there is a charge of
2.5 cents per page. (A page refers to a "single impression". A cjpuble sided copy is to be
counted as 2 pages.) Costs for electronic copies will vary depending on the media type
(diskette, tape, cd-rom), please see Receptionist for information regarding electronic copy
charges. Payment is to be made by check, money order, or cash (see Receptionist).
4. FILES MUST BE KEPT IN THE ORDER YOU RECEIVED THEM. Files may not be taken
from the office. No briefcases large totes etc are permitted in the file review area To
remove, alter, deface, mutilate, or destroy material in one of these files is a misdemeanor for
which you can be fined up to $500.00.
5. In accordance with General Statute 25-3-512, a $25.00 processing fee will be charged and
collected for checks on which payment has been refused.
6. The customer must present a photo ID, sign -in, and receive a visitor sticker prior to reviewing
files.
FACILITY NAME COUNTY
2.
3.
4.
5.
Y\S ignature and N me Nrm/Business Dad
Please attach a business card to this form if available
lJ�Time In Time Out

ri
�..
State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
William W. Cobey, Jr., Secretary
February 15, 1991
Mr. Jack H. Campell, President
Willow Creek Builders, Incorporated
510 Hayworth Circle
High Point, North Carolina 27262
George T. Everett, Ph.D.
Director
Subject: Permit No. NCO034452
Authorization to Construct
Willow Creek Builders, Inc.
Wastewater Treatment Facility
Davidson County
Dear Mr. Campell:
A letter of request for an Authorization to Construct was received September 17, 1990 by
the Division and final plans and specifications for the subject project have been reviewed and found
to be satisfactory. Authorization is hereby granted for the construction of a wastewater treatment
plant expansion from 0.040 MGD to 0.080 MGD consisting of; the installation of two 140 GPM
replacement pumps in the existing influent pump station; new bar screens for the existing facilities;
the installation of an additional 40,000 GPD package treatment plant having a bar screen, a 20,000
gallon areated influent flow equalization tank with blower, a 40,000 gallon aeration basin, two 110
cfm plant blowers, a 7,000 gallon clarifier tank, a 3,155 gallon areated sludge holding tank, and
associated piping, valves and appurtenances; the relocation of the existing tablet chlorinator to
receive total flow from both the existing plant and the new package plant, and the installation of
baffle walls in the chlorine contact basin; and the installation of an 80,000 GPD rapid gravity
sandfilter with parallel 14 square foot filter beds (total 24 sq. ft.), dual 420 GPM backwash
pumps, dual 28 GPM surge pumps to avoid surges of backwash water into the influent pump
station, and associated valves, piping, and appurtenances; with discharge of treated wastewater
into Abbotts Creek, classified Class WS-III waters.
This Authorization to Construct is issued in accordance with Part III paragraph A of
NPDES Permit No. NCO034452 issued December 19, 1989, and shall be subject to revocation
unless the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No. NC0034452.
The sludge generated from these treatment facilities must be disposed of in accordance with
G.S. 143-215.1 and in a manner approved by the North Carolina Division of Environmental
Management.
In -the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those as may be
required by this Division, such as the construction of additional or replacement wastewater
treatment or disposal facilities.
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone 9,19-733-7015
An Equal Opportunity Affirmative Action Employer

The Winston-Salem Regional Office, phone no. 919/ 761-2351 shall.be notified at4east. �
forty-eight (48) hours in advance of operation of the installed ' facilities so that an in -place
inspection can be made. Such notification to the regional supervisor shall be"made during tlie- 4
normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding`States.
Holidays.
Upon completion of construction and prior to operation of this permitted facility upgrades, #'
a certification must be received from a professional engineer certifying that the permitted facility
has been installed in accordance with the NPDES Permit, this Authorization to Construct and the
approved plans and specifications. Mail the Certification to the Permits and Engineering Unit,
P.O. Box 27687, Raleigh, NC 27611.
The Permittee shall employ a certified wastewater treatment plant operator to be in
responsible charge of the wastewater treatment facilities. The operator must hold a certificate of the
grade at least equivalent to the classification assigned to the wastewater treatment facilities by the
Certification Commission. Within thirty days after the wastewater treatment facilities are 50%
complete, the Permittee must submit a letter to the Certification Commission which designates the
operator in responsible charge.
A copy of the approved plans and specifications shall be maintained on file by the Permttee
for the life of the facility.
The sand media of the rapid gravity sandfilter must comply with the Division's sand
specifications. The engineer's certification will be evidence that this certification has been met.
Relocation of the existing chlorine contact chamber must not result in the discharge of
untreated/unchlorinated wastewater in violation of the NPDES permit limitations.
Failure to abide by the requirements contained in this Authorization to Construct may
subject the Permittee to an enforcement action by the Division of Environmental Management in
accordance with North Carolina General Statute 143-215.6.
The issuance of this Authorization to Construct does not preclude the Permittee from
complying with any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.
One (1) set of approved plans and specifications is being forwarded to you.
any questions or need additional information, please contact Mr. John Seymour,
number 919/733-5083.
inc rely,
George T. Eve
cc: Davidson County Health Departmen
Winston-Salem Regional Office
Training and Certification Unit
If you have
telephone

Permit No. NCO034452
Authorization to Construct
February 15, 1991
Enaineer's Certification
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
project, for the
Project Name Location
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within substantial.
compliance and intent of the approved plans and specifications.
Signature Registration No.
Date

(MISCELLANBOUS UNITS CONTINUED) POINTS
(c) Holding Pond for Effluent Flow Equalization and/or
Stage Discharge . . . . . . . . . . . . . . . . . . 5
d Effluent Pumps . . . . . . . . . . . . . . . . 3
e In -Plant Pumps (including air lifts). . . . . . . . T,
f Stand -By Power Supply . . . . . . . . . . 3
g Thermal Pollution Control Device 3
h Treatment Processes for Removal of Metal or Cyanide and
;other Toxic Materials . . . . . . . . . . . . . . . 30
Total Points )5
CLASSIFICATION
Class I . . . . . . . . . . . . . . 5 - 25 Points
Llas$II . . . . . . . . . . . . . . 26 - 50 Points
Class III . . . . . . . . . . . . . . . 51 - 65 Points
Class IY . . . . . . . . . . . . 66 Up Points
Facilities having a rating of one through four points, inclusive,
do not require a certified operator. Classification of all other
facilities requires a comparable grade operator in responsible charge.
-4-
North Carolina
Division of Environmental Management
Checklist of Facility Components
To be Used In Determing Facility Classification
All information will be printed:
r
Name of Plant l�II/r %l, �g, CC r r /i'rV5
County �� tin tJscra
Owner or Contact Person C ne 4 l C? 2 � IC
_)I e ep one
Mailing Address S%� %v. Iti C'f r h v ! .L2 `a
Street or P.O.ox No. Town & Ci ty p
Permit Number Information Construction Stat
NPDES Permit No. Nc ,,,G' ; rct S 2 Please Check:
Existing Facility
Date Issued /,t—Cc--ike, /9,14 Upgraded Facility 1%
New Facility
State Permit No. If Upgraded or New—ility, Give:
50% Completion Date
Date Issued 100% Completion Date
Rated by St fLl (41— Regional Office �e°l�✓K Date %z//P/
Operator in Responsible Charge Grade
Design Flow of Plant in GPD 0 C CMG Plant Class
ITEM POINTS
�1) PRETREATMENT UNITS (see definition No. 34) . . . . . . . . 2
2) DESIGN FLOW OF PLANT IN GPD (not applicable to non -
contaminated cooling waters and non -discharging systems)
0 20,000 . . . . . . . . . . . . . . . . . . 1
20,001 - 50,000 . . . . . . . . . . . . . . . . .
50,001 -- 100,000 . . . . . . . . . . . . . . . . 3
100,001 -- 250,000 . . . . . . . . . . . . . . . .
250,001 - 500,000 . . . . . . . . . . . . . . . 5
500,001 -- 1,000,000 . . . . . . . . . . . . . . . . . . 8
1,000,001 -- 2,0009000 10
2.000,001 (and up) - rate 1 point additional for each 200.000
GPD capacity up to a maximum of . . . 30
Design Flow (GPD):
(3) PRELIMINARY UNITS (see definition No. . . . . . . . ..
(a) Influent Pumps (including air lift) . . . . . . . . . �1
b Bar Screens
or
(c) Mechanical Screens, Static Screens or Comminuting
Devices. . . . . . . . . . . . . . . . . . . 2
(d) Grit Removal or . . . . . . . . . . . . . 1
(e) Mechanical or Aerated Grit Removal . . . . . . . . . 2
(f) Flow Measuring Device or . 1
(g) Instrumented Flow Measurement . . . . . . . . . . . . 2
Effective
7/1/83 -1-

(4)
(5)
�6)
ITEM
POINTS
(h) Preaeration or Equalization . . . . . . . . . . . , 1 (i) Grease or Oil Separators -- Gravity . . . . . . , 2
Mechanical. . . . . 3
A
erated . . . , . , ,
0) Chemical Conditioning
5
,
PRIMARY TREATMENT UNITS
5
Septic Tank (see definition No. 44) . ..
' b
2
Imhoff Tank .. .. •
ja�
c Primary Clarifiers (including
3
sludge air lifts)
d) Settling Ponds or Settling Tanks for Inorganic Non -
Toxic Materials
5
Involving a Discharge to the Surface
waters (sand, gravel, stone, and other mining operations
except recreational activities such as gem or gold
mining). .
.
SECONDARY TREATMENT UNITS
10
(a) Carbonaceous Stage
(i) Aeration - High Purity Oxygen System
Diffused Air System . ' ' '
Mechanical Air System (fixed, floating or rotor)a
Separate Sludge Reaeration
0 i) Trickling Filter - High Rate . , , , ...
3
7
Standard Rate . . . . . .
5
Packed Tower
(iii Aerated Lagoons . . . ' ' '
5
(iv Rotating Biological Contactors (biodisc).
(v Sand
10 10
Filters (intermittent biological) . . .
(vi
2
Stabilization lagoons with Outlet to Stream ,
(vii Clarifier (including sludge
5
air lifts). .
(b) Nitrogenous Stage
(i) Aeration - High Purity Oxygen System.
20
. , , ,
Diffused Air Systems.
Mechanical Air System (fixed,
10
floating, or rotor)8
Separate Sludge Reaeration
, . . , ,
(ii) Trickling Filter - High Rate . . . . . .
3
7
Standard Rate . . .
5
Packed Tower,
(iii Rotating Biological Contactors (biodIsc) . .
(ivJ
5
10
Sand Filter (intermittent biological). . . .
(v) Clarifier (including sludge
2
air lifts) . . .
TERTIARY OR ADVANCED TREATMENT UNITS
5
(a) Activated Carbon Beds - Without Carbon regeneration
5
(b) Powdered or Granular Actilvatedith aCarrbonon eFeedratuithout
15
Carbon regeneration
5
cAmmonia Stripping With Carbon regeneration.15
) .
. . . . . . . . . ' ' ' '
d) Chemical Additions
18
e) Denitrification Process (separate process). . . .
f) Electrodialysis
S
10
9) Foam Separation . . . . . . . . . ' ' ' ' ' '
(h) . .
5
5
Ion Exchange. . . . ' ' ' ' '
. .
5
2-
ITEM
POINTS
(i) Land Application (see definition No. 23b) . ,
(not applicable for facilities
5
under 10(a) .
Microscreens
�1)
k) Phosphorus Removal . .
. . ' ' ' '
5
.
1) Polishing Ponds- Without aeration
202
. . . ,
With aeration . . .
(m) Post Aeration - Cascade . . . .
5
Diffused or Mechanical
n) Pre -Package Unit for Removal of Oil
O
5
and Grease .
o) Reverse Osmosis
30
(P) Sand or Mixed -Media Filters -- Low Rate
5
High Rate
(7) SLUDGE TREATMENT
2
(a) Sludge Digestion Tank -- Heated . . . . . . . . .
10
Aerobic . . . . , . ,
Unheated
b) Sludge Stabilization (chemical or thermal) .
Sludge
3
13
c) Drying Beds .
d) Sludge Elutriation . . . ' ' ' ' ' ' ' ' '
2
e) Sludge Conditioner (chemical or thermal) ....
5
.
f) Sludge Thickener
(9) Sludge Gas Utilization (including gas storage). . .
h Sludge Holding Tank
2
2
-- Aerated ,
S
Non -aerated
(i) Sludge Incinerator (not includin activated carbon
2
regeneration
(8) SLUDGE Vacuum Filter,
DGEDISPOSAL(Centrifuge
includingincinerated
10
10
a Lagoons ash)
b� Land Application (surface and
2
subsurface ) (see def.
23a)
. . . . ' ' ' ' . • •
(c) Landfilled (burial)
10
(9) DISINFECTION ' ' ' ' ' ' ' . . •
5
a) Pre
b) Intermediate
I
c) Post . . . . . .
i3
® .
. . . . . . . . . . . . . . . .
d) Dechlorination.
(e) Chlorine or Ozone Generation . . . . . . '
5
(f) Radiation ' ' ' ' ' ' ' ' • •
(10) MISCELLANEOUS ' '
5
3
UNITS ' ' ' '
(a) Holding Ponds or Holding Tanks for Inorganic, Non -toxic
Materials with no Discharge to the
Surface Waters
(Sludge handling facilities for
2
water purification
plants, sand, gravel, crushed stone and other similar
operations --see definition No. 10)
(b) Holding Ponds or Holding Tanks for
Organic or Toxic
Materials with no Discharge to the surface Waters
(Any pump, valve, or other mechanical control subject
to failure creating a potential
4
for bypass or discharge
from the holding ponds or tanks will necessitate a
minimum classification of Class I requiring a certified
operator).
-3-
■

—Ivan% AiLV0wI[Vww 1Xrouyiu
Facility: j I 1 1 etAL- Permit No.:. N c OCR q L Pipe No,. MonthlYear: 1 �j
Monthly Average Violations
Parameter
Permit Limit DMR Value % Over Limit Action
Weekly/Daily Violations
Date Parameter Permit Limit Limit T e DMR Value % Over Limit Action
Monitoring Freauencv Violations
Date Parameter Permit Frequency Values Reported # of Violations Action
Violations/Staff Remarks:
lQ
W-L (OVV w. LK = ,l/1-6 wk l "-f� (C')
Ovj- ' s --fIL4- vjed - op I0 pla.vd— p
Supervisor Remarks:
NFU -ACAS- l.0 --0s[
Completed by: C-� Z tvA-Y—Date: Z I
Assistant Regional
Supervisor Sign Off: Date:
r
Regional Supervisor Sign v
Off: -`
Date:

DV-�O l 41 - L,G' - U 3f �
DMR Review Record
Facility: W i�nG.J (6%� iiJ Permit No.:N(0( 13 Sa Pipe No.: C7 MonthNear: 2Q/L�
Monthly Average Violations J/
Parameter Permit Limit DMR Value % Over Limit Action
Vf
Weekly/Daily Violations
Date
Parameter
Permit Limit
Limit Type
DMR Value
Date Parameter
Monitorinq Frequency Violations
Permit Frequency Values Reported
Other Violations/Staff Remarks:
Zasf 12 /II C /t M 6
11/DV.` Aeh 241,q "030P lwt 1110,45p, A o-1
Supervisor Remarks: . /ov
% Over Limit
0
# of Violations
Completed by: `� (� te/ Date: l� /
Action
Action
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign%`> c �"'7
Off: Date:

DMRR R d �(OV�vI
l eview ecor /�
Facility: li(.%1110LA) rf.& G�J� Permit No.:1 � Pipe No.: �`� � MonthlYear: {� t l
Monthly Average Violations
Parameter
Permit Limit
DMR Value
% Over Limit
Violations
Weekly/Daily
Date
Parameter
Permit Limit Limit Type
DMR Value
% Over Limit
13
Moll PC, 1_1
�S; !
Monitoring Frequency Violations
Date
Parameter
Permit Frequency
Values Reported
# of Violations
her Violations/Staff Remarks:
MOAOS
supervisor Remarks:
d
Action
Action
Action
NO &-6'rcounl3 N'0V/U7" J /v vs a- l?#:)J--s
C. o}�'ck'r fGt4�'J
Completed by: �(� ( 1 �� Date: �'^`3y // 4
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign
Off: Date:4---

6v uQJ96 LV - O0Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record c
Facility: Pere- t/Pipe No.: NCO()PgSd- Mond-i Year l�oX/P
Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Weekly 0allyViolations
Date Parameter Permit Limit/Tv e DMR Value %imit
22 'COE) rn 1,
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations Las f I a www As
Nt' 61) (( rra rMDAC-! 1i-n-ii c2011 t/"90P, ls5 /ii'6)-
Completed by: 1/10 rl ✓ Date:
Regional Water Quality
Supervisor Signoff: Date:
N�

MvV
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: kJ1,11" &A %loPermit/Pipe No.: W /)1) 3442 N4onth[Year dJ a 1 /
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Week] /Daily Violations
Date Parameter Permit Limit/Tvpe/ DMR Value % Over Limit
71
'�S D
f -7-5 S S
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations Pre tmji(s
�rlArr4rr�l
Nov 7unP 20o 0,/J%/u OW blaldl-76,
Completed by: Y- Date: 2'
Regional Water Quality
Supervisor Signoff. Date:
a�

Oq I
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility:�jio W &L/a Permit/Pipe No.: Month/Year ILJ—IW o701/
Monthly Average Violations
Parameter Permit Limit DMR Value
Date Parameter
L` j
Weekl /Daily iolations
Permit LimitlTvpe DMR Value
% Over Limit
Over Limit
Monitoring Frequency Violations
Date Parameter Permit Freauencv Values Reported # of Violations
Other Violations /
- ,-, _ 1 i 7 Al i A,' ")"-1 //-�h i, n rw m k Jy 1 o k' 3 _ _ ✓l
Completed by: Date: a� /
Regional Water Quality Date: c
Supervisor Signoff: -A�o