NC0051489_Regional Office Historical File Pre 2016

F�t=�RfYf��
N.C. 6e®t. of ENQ
=�- V NOV 3 2000
NCDENR'winston•Salem
Rnional office
North Carolina Department of Environment and Natural Reso
Division of Water Quality
Michael F. Easley, Governor
Mrs. Barbara Boles
5240 S Main St
Winston-Salem, N.C.
Dear Mrs. Boles:
27107
William G. Ross, Jr., Secretary
Coleen H. Sullins, Director
November 5, 2008
Rescission of NPDES Permit NCO051
Three Ws Mobile Home Park WWTP
Forsyth County
Division staff has confirmed that the subject permi�is no longer required. Therefore, in
accordance with.your request, NPDES Permit NC005k489 is rescinded, effective ' , ately.
If in the future your mobile home park wishes to discharge wastewater to the State's .surface
waters, they must first apply for and receive a new NPDES permit. Discharge of wastewater
without a valid NPDES permit will subject the responsible party to a civil penalty of up to
$25,000 per day.
If you have questions about this matter, please contact Charles Weaver of my staff at the
telephone number or address listed below.
Sincerely,
1tv
Coleen H. Sullins
cc: Central Files
�U,'inston;Salem 3•ruitt`
NPDES'Pe iYe
Fran McPherson, DWQ Budget Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Internet: www.ncwaterquality.org
Phone: [phone] / FAX [phone]
charles.weaver@ ncmail. net
Nne
orthCarohna
Naturally
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Re: NCO051489 - rescission & remission request
Subject: Re: NCO051489 - rescission & remission request
From: Steve Tedder <[e-mail]>
Date: Fri, 31 Oct 2008 05:31:06 -0400
To: Charles Weaver <[e-mail]>
CC: Rose Pruitt <[e-mail]>, Tom Belnick <[e-mail]>
Yes you can rescind the permit.
Since the assessment has been made I guess it needs to be remitted in full, including costs, by the
Director so that needs to be done down there. I will send form and recommendation to remit.
Tedder
Steve Tedder
[e-mail]
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336)-771-4950
Fax [phone]
On 10/30/2008 6:07 PM, Charles Weaver wrote:
Steve - the Division received a handwritten letter from Mrs. Boles requesting rescission of the
permit and remission of a penalty, though she didn't say for what case.
The letter got to me last week; I was working half -days and have just now gotten to it. Mrs. Boles
also called me today to confirm that I received the letter, to stress that her WWTP had been drained
and that all wastewater has been connected "to the City."
The only open case in our files is LV-2008-0349 (with a penalty amount of $902.49). I assume
that's the case she mentions in her letter. Naturally, BIMS isn't working, so I can't see if she has
multiple cases pending.
1. Can I rescind the permit?
2. If the discharge is gone, can the WSRO rescind / delete the assessment? I think it's worth the
$902.49 to have this discharge eliminated.
Let me know,
CHW
Steve Tedder <Steve.Tedder(a,NCmail.net>
WSRO
NC DENR
1 of 1 11/12/2008 1:42 PM

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
August 26, 2008
CERTIFIED MAIL 7008 0150 0002 8342 1542
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
Coleen H. Sullins Director
Division of Water. Quality.
A review of Three R's Mobile Home Park's monitoring report for May 2008 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
05/21/08
45 mg/1
47 mg/l
Daily Maximum
Exceeded
Coliform, Fecal MF, M-FC
05/21/08
400 #/100m1
600 #/100ml
Daily Maximum
Broth,44.5C
Exceeded
BOD, 5-Day (20 Deg. C)
05/31/08
30 mg/1
30.5 mg/1
Monthly Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
I=''_®,
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility:
S
Pertnit/Pipe No.: NC.0051 LI R9 Month/Year 01
Monthly Averagge Violations
Parameter
Permit Limit D\ZR Value
% Over Limit
_ ��•ys
Weekly �ail�' tions
Date
Parameter
Perrhit Limit/Tti,oe DNIR Value
% Over Limit
21
80 D
q5 INJfIp Ll I
1V a
5.2�•off
"�
2�S'/ �P Ss'
S� Q•oS
��C
2is .,0 3 j
° d � �.
5.21. 06
T &G14L COW
y00 f /00'r-I • 00
Week] /Dail Violations
Date
'•
Parameter
�lA-2,as/V0
Permit Limit/T«e �2 Value
% Over Limit
Z915-
09
- I-�-� us N
5
3- •o8
_ti
2.'5.s_
Uther violations
Completed by:
Date:
Regional Water Quality
Supervisor Signoff:
Date: jf 0

✓, RECEIVED � �$
N.C. Deot. of ENR /V
NPDES PERMIT NO.: NCO051489 DISCHARGE NO.: _ MONTH: MAY YEAR: 2008
,. JUL e
FACILITY NAME: 3 R'S MHP CLASS: II COU UL 2 4 2' �� ® Z�(78
OPERATOR IN RESPONSIBLE CHARGE: RANDY t GRADE: 3 PHONE: [phone] Winston-Salem
CERTIFIED LABORATORIES: (1) TOest (2) ETS Regional Office
Check box if orc has changed [ ] PERSON(S) COLLECTI G SAMPLES: RANDY BELL �[
Mail ORIGINAL and ONE COPY to: I % / � NW
ATTN: CENTRAL FILES X & [
DIVISION OF WATER QUALITY (SIGNATURE OF ORC) DATE jU-Iq 2��? jyj
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
ARive
Time
2400
clock
Opr.
Time
on
Site
Orc
on
Site
Flow
[ ] Inf
Eff
Temp.
pH
Res
Cl2
BOD5
@
20C
NH3-N
T
S
S
Fecal
Colifonn
Geometric
Mean
Dissolvd
Oxygen
(DO)
Total
Khejdahl
Nitrogen
Nitrates
Nitrites
Total
Nitrogen
Total
Po4
D
A
T
E
#
HRS
HRS
Y/N
MGD
C
UNITS
u /L
m /L
m /L
m /L
#/100ml
mg/L
m /L
m /L
m /L
m L
#
1
17:00
0.5
RB
0.0050
20
1
2
13:00
0.5
RB
0.0040
19
2
3
0.0070
3
4
0.0060
4
5
19:00
0.5
RB
0.0050
18
5
6
19:00
0.5
RB
0.0050
18
6
7
10:00
0.5
RB
0.0050
19
19.6
25.50
24.0
300
7
8
11:00
1
RB
0.0050
18
7.3
12
6.6
8
9
19:00
0.5
RB
0.0060
18
15
9
10
0.0050
10
11
0.0050
11
12
11:00
0.5
RB
0.0050
16
7.5
11
40.0
13.80
27.0
60
7.1
12
13
8:00
1
RB
0.0050
18
14
13
14
16:00
0.5
RB
0.0050
19
14
15
15:00
0.5
RB
0.0060
19"
16
16
12:00
0.5
RB
0.0050
20
16
17
0.0060
17
18
0.0050
18
19
20:00
0.5
RB
0.0060
21
<10
19
20
16:00
0.5
RB
0.0070
20
20
21
11:00
0.5
RB
0.0080
19
24.50
29.0
0
21
22
14:00
1
RB
0.0080
19
7.4
<10
�-
6.2
22
23
18:00
0.5
RB
0.0060
21
23
24
1
1 0.0050
24
25
0.0050
25
26
10:00
0.5
RB
0.00501
HOLIDAY
26
27
9:00
1
RB
0.0050
23
7.1
16.0
2.00
15.0
<1
6.3
27
28
19:00
1
RB
0.0140
22
28
29
17:00
0.5
RB
0.0050
22
29
30
12:00
1
RB
0.0050
23
3" /
30
31
0.0050
NW
31'
AVERAGE
0.0058
20
23.0
NrMft
16.45
23.8
134
6.6
#DIV/01
#DIV/0!
#DIV/0!
#DIV/01
#
MAXIMUM
0.0140
23
7.5
55.0
47.0
25.50
29.0
300
7.1
0.0
b.00
0.00
0.00
#
MINIMUM
0.0040
16
7.1
11.0
16.0
2.00
15.0
60
6.2
0.0
0.00
0.00
0.00
#
COMP/GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
#
DAILY LIMIT
0.012
NA
NA
28
45.0
1019 -"
45
2001400
N/A
NA
NA
NA
NA
#
QUARTERLY LIMIT
NA
NA
NA
NA
NA
I NA
NA
I NA
I NA
I NA
I NA
I NA
2.0
#
MONTHLY LIMIT
0.012
NA
>6,<9
NA
35.0
30
200/400
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont.
Daily
Wkly
'2/Wk
Wkly'
Wkly
Wkly
Wkiy
�Wkly
Wkly
Wkly
Wkly
Wkly
#
FREQUENCY MET
YES
YES
YES
Y S
YES
YES
YES
YES
YES
YES
YES
YES
YES
#
COMPLIANT
YES
I YES
YES
ES
YES
YES
YES
YES
YES
YES
YES
#
Total Monthly Flow 0.1790 MG Sd TN Monthly Loading (Ibs.) #DIV/0!
DEM Form MR-1 (12/03) r j ] Annual TN Mass Loading (Ibs./yr)
DEM Form MR-1 (12/03) Annual TN Mass Loading (lbs./yr)

M
3R'S MHP Status: (Please check one 'of the following)
All monitoring data and sampling frequencies meet permit requirements [ ]
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements [
Nonc pliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADM])
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00645 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
��hRj% &a6
l
Signature of Permittee** Date
Ph-�o �a Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal 34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

NPDES PERMIT NO:NC0051489 DISCHARGE NO.: 001 MONTH: MAY YEAR: 2008
FACILITY NAME: 3 R MHP
STREAM: LOCATION:
UPSTREAM
COUNTY:Forsyth
100ft Above Discharge Point
STREAM: LOCATION: NCSR 2932
DOWNSTREAM
00010
00300
31616
00010
00300
31616
D
Fecal
D
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Coliform
T I
Temp
Oxygen
T
Temp
Oxygen
E
2400 1
1
Geometri I
I
E 12400
1
1
Geometric
Clock
DO
Mean
Clock
DO
Mean
#
HRS
C
m /L
#/100ml
#
HRS
C
m /L
#/loom[
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
11:00
15.0
7.7
8
11:15
16.0
8.1
9
9
10
10
11
11
12
12
13
8:10
14.0
7.8
13
8:30
15.0
8.3
14
14
15
15
16
1
116
17
17
18
18
19
19
20
20
21
21
22
14:40
16.0
7.5
22
14:55
17.0
7.9
23
23
24
24
25
25
26
26
27
9:20
18.01
7.6
27
1 9:30
18.0
8.2
28
28
29
29
30
30
31
31
AVERAGE
1 15.8
7.7
1
1
1
1
1 16.5
8.1
MAXIMUM
18.0
7.8
MAXIMUM
18.0
8.3
MINIMUM
14.0
7.5
MINIMUM 1
15.0
7.9
COMP/GRAB
GRAB
GRAB
I COMP/GRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12193)

nfor UBOG

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 08/12/08 Page: 1 of 3
Permit `y _c&5'1489 MksBetween 5 2067 "and `
'.R gion %
Violation Category: q/Q
Progham Category °lo
, ,: ,4=2008
-
Facility`Name: % Para'm Name:-% �
=County: °
�, Subbasin: °l°`,Violation
Action:- OX
_
MajorMmor°lo'
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL/
VIOLATION
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
09 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
09/04/07
Weekly
03 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
03/12/08
Weekly
03 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
03/31/08
Weekly
09 -2007
001
Effluent
Coliform, Fecal MF, M-FC
09/04/07
Weekly
Broth,44.5C
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/12/08
Weekly
Broth,44.5C
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/26/08
Weekly
Broth,44.5C
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/31/08
Weekly
Broth,44.5C
04 -2008
001
Effluent
Coliform, Fecal MF, M-FC
04/14/08
Weekly
Broth,44.5C
05 -2007
001
Effluent
Nitrogen, Ammonia Total (as
05/29/07
Weekly
09 -2007
001
Effluent
Nitrogen, Ammonia Total (as
09/17/07
Weekly
09 -2007
001
Effluent
Nitrogen, Ammonia Total (as
09/30/07
Weekly
03 -2008
001
Effluent
Nitrogen, Ammonia Total (as
03/12/08
Weekly
03 -2008
001
Effluent
Nitrogen, Ammonia Total (as
03/17/08
Weekly
03 -2008
001
Effluent
Nitrogen, Ammonia Total (as
03/26/08
Weekly
UNIT OF
MEASURE LIMIT
mg/I 45
mg/I 45
CALCULATED
VALUE
49
61
mg/I
30
33.25
#/100ml
400
1,100
#/100ml
400
6,000
#/100ml
400
6,000
#/100ml
200
713.52
#/100ml 400
mg/I 8.7
mg/I 8.7
mg/I 2.9
mg/I 28.2
mg/I 28.2
mg/I 28.2
700
9.8
11
3.18
33
37
35
VIOLATION TYPE
VIOLATION ACTION
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
Proceed to
Enforcement Case
Monthly Average Exceeded
No Action, BPJ
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Proceed to
Enforcement Case
Monthly Geometric Mean
Proceed to
Exceeded
Enforcement Case
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
Monthly Average Exceeded
No Action, BIMS
Calculation Error
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
Daily Maximum Exceeded
No Action, BIMS
Calculation Error

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 08/12/08
Page: 2 of 3
q4-2008
°%K
Permd: hc0051489
MRs Between 5-2007
and
Region:%
Violation•Category:•
Progiam Cotegory,
%T
I Facility Name "/o, ;,, Param Naive %
Courity°:%
Subbasin'%
Violation.Action 0%� -
MojorMinor:=,%
PERMIT: NCO051489
FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
03 -2008 001 Effluent
Nitrogen, Ammonia Total (as.
03/31/08
Weekly.
mg/I
9.4
26.3
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/09/08
Weekly
mg/I
8.7
12.6
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/14/08
Weekly
mg/I
8.7
49
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/23/08
Weekly
mg/I
8.7
10.2
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/30/08
Weekly
mg/I
2.9
20.05
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
Monitoring Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
04 -2008 001 Effluent
BOD, 5-Day (20 Deg. C)
04/05/08
Weekly
mg/I
Frequency Violation
Proceed to NOV
11 -2007 001 Effluent
Chlorine, Total Residual
11/03/07
2 X week
ug/I
Frequency Violation
None
04 -2008 001 Effluent
Coliform, Fecal MF, M-FC
04/05/08
Weekly
#/100ml
Frequency Violation
Proceed to NOV
Broth,44.5C
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/05/08
Weekly
mg/I
Frequency Violation
No Action, BIMS
N)
Calculation Error
04 -2008 001 Effluent
Nitrogen, Ammonia Total (as
04/05/08
Weekly
mg/I
Frequency Violation
Proceed to NOV
04 -2008 001 Effluent
Solids, Total Suspended
04/05/08
Weekly
mg/I
Frequency Violation
Proceed to NOV
Reporting Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 08/12/08 Page: 3 of 3
77
Permit:.nc0051489` fMRs Between: + 5-2007 and: 42008 �� Region: oQ
_�. — _.
Violdtion.Category:
:- _._ {a
Program Category. °!a
Facitity NarOe °lo ~�r , �', Param Name °Vc
County:'°/n
Subbasin: owViolation"Actiori
°14'
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Reporting Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI LOCATION PARAMETER
DATE FREQUENCY
MEASURE LIMIT VALUE
VIOLATION TYPE VIOLATION ACTION
08 -2007 001 Effluent Nitrogen, Total (as N)
08/31/07 Quarterly
mg/I
Parameter Missing None
08 -2007 001 Effluent Phosphorus, Total (as P)
08/31/07 Quarterly
mg/I
Parameter Missing None

t 'J
September 2, 2008
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown Street
Winston Salem, NC 27107
RKBell
Bell Enterprise
PO Box 1291
Clemmons, NC 27012
RE: Notice of Violation
3 R MHP
H80 (Vl;=ti
u.o. os,
i bi t'vR
SEP 0 5 4108
win'"
Regicna;
To Whom It May Concern;
Concerning exceeding maximum limits for dates 5/21/2008 and 5/31/2008. Plant going through
transformation due to fixed media being removed, thus stirring up plant and causing BOD and Fecal to
exceed limit. Plant now operating properly after removal of fixed media.
If you have any questions please call me 336-766-9626, Thanking you in advance,
Sincerely,
Randy Bell/ORC

Michael F. Easley, Governor
William G. Ross. Jr., Secretary
North Carolina Department of Environment and Natural Resources
August 26, 2008
CERTIFIED MAIL 7008 0150 0002 8342 1542
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile home Park
5240 S Main St
Winston Salem NC 27107
Coleen H. Sullins Director
Division of water Quality
Subject: NOTICE OF VIOLATION
_ ...... __-._ fermi __70: TC00 1-4.8g-___._.---_-_.__.._________.- _._..__
Three Rs Mobile dome Park
Forsyth County
Dear Mrs Boles:
A review of Three R's Mobile Home Park's monitoring report for May 2008 showed the
following violations:
Parameter
Date
, Limit 'value
Reported Value
Limit 'Type
BOD, 5-Day (20 Deg. C)
05/21108
45 mg/1
47 mgtl
� Daily Maximum
�
Exceeded
i
Coliforn-4 Fecal iv1F, -M-FC
j 05,121/08
400 #1100rn1
600 #/100m1
Daily Maximum
Broth,44.5C
Exceeded
B©D, 5-Day (20 Deg. C)
1051311018
-1 mgN1
30.5 mg/l
Monthly Average
i
II
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt. at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
WSRO
585 Waughtown Street Winston-Salem„ NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

Facility: 3 CS 'MW
Parameter
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Pem- it/Pipe No.: NC OOS l Li Sri Month/Year CP V L �f
Monthly Average Violations
Permit Limit DMR Value
Weekly/Daily Violations
Over Limit
Date Parameter Permit Limitgype DMR Value % Over Limit
IN'log `r OZIL 'O AA 3
Z ofS N1-}3�+sN �•�
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date: LI5
Regional Water Quality j
i (J Supervisor SiQnoff: Date: CQ

Facility
Parameter
3As /hNP
Cover Sheet from
Staff Member to
Regional Supervisor
DMR. Review Record
Permit/Pipe No.: �� ��51 y8� Month/Year
zoos'
Monthly Average Violations
Permit Limit
DMR Value
Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit,,7vl2e DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date:
Regional Water Quality
Supervisor Signoff: Date:

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility:. J 5 f2l Permit/Pipe No.: NG 0051 ygg Month/Year
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
D� q5 m.51 /o
9-Z-09 ✓V 4-o, 0 A16
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date: A?
Regional Water Quality !� �� _�_
Supervisor Signoff: "� Date:

NODES PERMIT NO.: NCO051489
DISCHARGE NO.: 1 MONTH: Sept YEAR: 2008
FACILITY NAME: 3 R'S MHP
CLASS: II COU[, i ft}f,
OPERATOR IN RESPONSIBLE CHARGE: RANDY L GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES:
(1) Tn T t (2) ETS
Check box if ore has changed [ ]
PERSON(S) COLLECTING SAMPLES: RANDY BELL
Mail ORGINAL and ONE COPY to:
10 0-2
ATTN: CIENTRAL FILES
X
DIVISION OF WATER QUALITY
(SI NATURE OF O DATE
DENR
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
NA) s°,'1
'LRECEIVEQ , i
N.C. Dept. of ENR
NOY 2008
Winston-Salem
Regional Office
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Lon
Flow
['] Inf
[XI Eff
Temp.
wkly
pH
2x wk
Res
Cl2
1 x wk
BOD5
@
20C
wkly
NH3-N
wkly
T
S
S
wkly
Fecal
Coliform
Geometric
Mean
wldy
Dissolvd
Oxygen
(DO)
Total
Khejdahl
Nitrogen
Nitrates
Nitrites
Total
Nitrogen
Total
Po4
D
A
T
E
# JHRS
JHRS
YIN I
MGD I
C
UNITS
u /L
m /L
m /L
m /L
# / 100 ml
mg/L
m /L
m /L
m /L
m /L
#
1
Holiday
0.0060
1
2
12:00
0.5
RB
0.0060
26
< 2
11.03Y
n 0 -
2.0
30
2
3..,
.. 6:00
0.5
RB
0,0050
24
3
4
14:00
0.5
RB
0.0050
27
4
5 ,
10:06
1
RB,-
0.0060
25
6.2 '
12.
7.0
5
6
0.0060
6
7
`. 0.0060
7 „
8
7:00
0.5
RB
0.0060
24
8
9
17:00
. 0.5
RB
0.0060
26
9
10
12:00
0.5
RB
0.0070
24
7.3
< 114
i
" 0.20
9.0
< 1 1
7.5
1
1
10
11
17:30
0.5
RB
0.0080
24
14.
12
-6:00
0.5
RB
0.0070
23
)
12
13
0;0040,
13
14
0.0040
14
15
10:00
0.5
RB
0'.0020
23
4.0
0.30
T.0 :
180
15
16
7:00
1
RB
0.0030
22
7.5
17
7.7
1
1
16
17
17:00
0.5
RB
0.0030
24
17
18
20:00
0.5
RB
0.0040
23
18
19
6:00
0.5
RB
0.0030
23
22
19 .
20
0.0070
20
21
0.0070'
21
22
16;00
1
RB
0,0070
22
7.5
16
7.5
22
23
21:00
0.5
RB '
0.0050
21
23
24
10:00
0.5
RB
0.0050
22
8.0
0.10
7.0
< 1
24
25
12:00
0.5
RB
0r0090
''20
12,
'25
26
6:00
0.5
RB
0.0050
19
26
27.
-
0.0076,
27
28
0.0070
28
29
10:00
0.5
RB
0.0070
20
< 4
< .1
60
< 1.
29
30
11:00
1
RB
0.0100
21
7.4
14
7.6
30
31
31
AVERAGE
0,0057
23
15.3
17.3
3.40
5.0
73
7.5
#DIV10I
#DIV/01
#DIV/01
#DIV/01
#
MAXIMUM
0,0100
27.
7.5-
22.0
46.0
13.00
9.0
180
7.7
0.0
. 0.00
0.00
0.00•
#
MINIMUM
0.0020
19
6.2
12.0
4.0
0.10
1.0
30
7.0
0.0
0.00
0.00
0.00
#
COMP/GRAB .
CONT.
GRAB
GRAB
GRAB
GRAB.
GRAB
GRAB,
GRAB,
GRAB
GRAB A.
GRAB .=
GRAB
GRAB
#
DAILY LIMIT
NA
NA
NA
NA
45.0
45
400
WA
NA
NA
NA
NA
#
QUARTERLY LIMIT
NA.
NA,
NA
NA,
NA
-NA
NA,
NA
NA
NA
sNA
NA
2.0
#
MONTHLY LIMIT
0.012
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont.
Daily
Wkly
2/Wk
Wkly -
Wily'
WMy
Wkly
Wkly,
Wkly
'Wily
Wkly
Wkly
#
FREQUENCY MET
YES
YES
I YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
#
COMPLIANT
YES
YES
, YES
I YES
I NO
1. YES
YES
YES
YES
YES
YES
YES
Total Monthly Flow 0.1720 MG I TN Monthly Loading (Ibs.)
DEM Fond MR-1 (12103) 00 5 0 teted 62i4 Annual TN Mass Loading (lbs./yr)
DEM Form MR-1 (12/03) Annual TN Mass Loading (lbs./yr)

3R'S MHP Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements [ �]
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements [ ]
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Ces
Permittee (Please print or type)
Permittee Address:
5240 SOUTH MAIN STREET WINSTON SALEM, NC 27107
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADM[)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
lo%!-7
Signature of Permittee** Date
Phone Number: Permit Exp. Date
336-788-8347
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual,
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

,14,
NI?DES PERMIT NO:NC0051489 DISCHARGE NO.: 001 MONTH: SEPT YEAR: 2008
FACILITY NAME: 3 R MHP COUNTY:Forsyth
STREAM: LOCATION: @ 10011 Above Discharge Point STREAM: LOCATION: NCSR 2932
I IPSTRFAM
DnWNSTREAM
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
2
Facility:. 3 ^ s ✓Y1'H-i� Permit/Pipe No.: Month/Year 21
Zug
Parameter
NH3,&_�oN
Date Parameter
/o •13` og Al N3" Al
1 QL? orK ALA2.6o /U
Date Parameter
Other Vinlatinnc
Completed by:
Regional Water Quality
Supervisor Signoff:
Monthly Average Violations
DMR Value
(e •-7
Weekly/Daily Violations
Permit Lin-lit/Type
rn �P
% Over Limit
DMR Value % Over Limit
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations
Date: / � 9
Date: �— 7— ef 7
G
1�
"Jo

Ms. Barbara Bolas
-- ----_._._ --.
J_-- 0
5ek/Ac

v'
e, WA Michael F. Easley, Governor
�� 7p William G. Ross Jr., Secretary
\Q G North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director,
=1 Division of Water Quality
July 7, 2008
CERTIFIED MAIL 7008 0150 0002 8342 1474
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
A review of Three R's Mobile Home Park's monitoring report for April 2008 showed the
following violations:
Parameter •
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
04/14/08
400 #/100ml
700 #/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Parameter
Date
Measuring
Frequency
Violation
Solids, Total Suspended
04/05/08
Weekly
Frequency
BOD,.5-Day (20 Deg. C)
04/05/08
Weekly
Frequency
Coliform, Fecal MF, M-FC
Broth,44.5 C
04/05/08
Weekly
Frequency
Nitrogen, Ammonia Total (as N)
04/05/08
Weekly
Frequency
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
MMS_l�O)

Cover Sheet from
Staff Member to.
Regional Supervisor
DMR Review Record
Facility: 'S Permit/Pipe No.: NG 00 `� �� Month/Year %I L
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly0allolations
Date Parameter Permit Lin-lit/Type DMR Value % Over Limit
-08 re-ctx CQP,4,4 yv0 Ago .M.P - :zoo 25 a
J-iq-08 0As co N
Monitoring Frequency Violations
Date Paramet Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Al Date:•
Regional Water Quality
Supervisor Signoff: A Date:
IV 1v

NPDES PERMIT NO.: NCO051489 DISCHARGE NO.: 001 MONTH: April YEAR: 2008
FACILITY NAME: 3 R MHP CLASS: II -C-OU Pik t. Frssyth-
OPERATOR IN RESPONSIBLE CHARGE: Randy II GRADE: III PHONE: [phone]
CERTIFIED LABORATORIES: (1 ) Tri st (2) ETS
Check box if orc has changed[ ] PIERS (S) COL9'.
LLEECTING SAMPLES: Randy Bell
Mail ATTN: CIGINAL and ONE ENTRAL FILES COPY to: X_ X/
DIVISION OF WATER QUALITY (SIGNATURE OF C) DATE
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RECEIVED
N.C. Dept of ENR
UN 111008
Winston-Salem
A
v 2 200R
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617 �j
aw
2046
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Lon
Flow
[ ] Inf
Eff
Temp.
pH
Res
Cl2
BOD5
@
20C
NH3-N
T
S
S
Fecal
Conform
Geometric
Mean
Dissolvd
Oxygen
(DO)
Total
Mejdahl
Nitrogen
TGP3B
Total
Nitrogen
Total
Po4
D
A
T
E
# JHRS
JHRS
Y/N I
MGD
I C
UNITS I
u /L
mall-
I m /L
m /L 1
#/100ml
mg/L
m /L I
m /L
m /L
m /L
#
1
10:00
1
RB
0.0060
14
.7.1
, 15
7.4
PASS
1
1
2
17:00
0.5
RB
0.0060
13
2
3
17:00
0.5
RB
0.0060
13
3
4
12:00
0.5
RB
0.0050
12
13
4
5
0.0060
5
6
0.0100
6
7
21:00
0.5
RB
0.0050
13
7.4
12
7.0
7
8
9:00
0.5
RB
0.0040
14
B
9
900
0.5
RB
0.0080
16
12.0
12.60
1.0
1
15.3
15.32
0.63
9
10
1800
1
RB
0.0040
17
11
10
11
1100
0.5
RB
0.0080
17
11
12
0.0090
12
13
0.0090
13
14
11:00
0.5
RB
0.0080
15
7.0
49.00 %
20.0
00'
14
.15
12:00
1
RB
0.00B0
15
7.5
14
7,5
15
16
19:00
0.5
RB
0.0070
17
16
17
20:00
0.5
RB
0.0050
17
17
18
10:00
1
RB
0.0050
19
8
18
19
0.0650
19
20
0.0050
20
21
17:00
0.5
RB
0.0050
18
21
22
16:00
1
RB
1 0.0030
19
1
22
23
1 10:001
1
RB
0.0040
19
'7.5
14
<4
10.201
16.0
30
7.4
23
24
1 14:001
0.5
RB
0.0050
19
24
25
18:00
0.5
RB
0.0050
19
12
25
26
0.0060
26
27
0.0060
27
28
11:00
0.5
RB
0.0080
16
38.0
8.40
15.0
<1
28
29
12:00
1
RB
0.0080
17
7.4
16
7.6
29
30
17:001
0.5
RB
0.0050
18
30
31
1
1
a
31
AVERAGE
0.0061
16
12.8
19.0
20.05 4
13.0
28
7.4
15.3
0.00
15.32
0.63
#
MAXIMUM
0.0100,
19
7.5
16.0
38.0
49.00
20.0
700
7.6
15.3
0.00
15.32
0.63
#
MINIMUM
0.0030
12
7.1
8.0
7.0
8.40
1.0
1
7.0
15.3
0.00
15.32
0.63
#
COMP/GRAB
CONT.
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
#
DAILY LIMIT
NA
NA
NA
NA
16.5
45
400
N/A
NA
NA
NA
NA
#
QUARTERLY LIMIT
NA
NA
NA
NA
NA
'NA
NA
NA
NA
NA
NA.
NA
2.0
#
MONTHLY LIMIT
EiE
NA
>6,<9
j2r _UG
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont.
Daily
Wily
2M/k
Wkly
Wldy
Wkly
wily
vWy
WHY
Wkly
Wkly
wkly
#
FREQUENCY MET
0
YES
YES
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
#
COMPLIANT
YES
I YES
I YES
YES
I YES
YES
NO
YES
I YES
YES
YES
YES
#
Total Monthly Flow 0.1830 MG TN Monthly Loading (Ibs.) 23
DEM Form MR-1 (12103) Annual TN Mass Loading (lbs./yr)
DEM Form MR-1 (12103) Annual TN Mass Loading (lbs./yr)

3R'S MHP Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements [ ]
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements [
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
A( l r 3 I'll 4� � L' !,-_ T D 1a � � `z � 0 , ► -.t 1C b -) P R o
I -If 514 r,-,.e i� � 13 � ti Ts 5)-,%-.11 � inw �� �3��
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
PARAMETER CODES
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400.pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
RLZ 5011/u D
z.213IZP i3-aC,--s
Permittee. (Please print or type)
93,E clBo4, �;/i,) /D
Signature of Permittee** Date
Phone Number: Permit Exp. Date
_2 2 5 z-P 7------------------
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

NPDES PERMIT NO:NC0051489 DISCHARGE NO.: 001 MONTH: April YEAR: 2008
FACILITY NAME: 3 R MHP COUNTY:Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: NCSR 2932
UPSTREAM
DOWNSTREAM
DEM Form MR-3 (12193) DEM Forrn MR-3 (12t93)

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 07/07/08 Page: 1 of 2
'Mks
e
r
'Permit: nc0051189 Betweeri: 4-2007 and
°
3-2008 Regiori. /o
°
ry Violation Category: /o
,o
Program Category: /o
Facility Name: % Param Name: % ...
County; %
Subbasin: %
Violation Action:
Major.Minor. %
PERMIT: NCO051489
FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
09 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
09/04/07
Weekly
mg/I
45
49
Daily Maximum Exceeded
Proceed to NOV
03 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
03/12/08
Weekly
mg/I
45
61
Daily Maximum Exceeded
Proceed to
Enforcement Case
03 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
03/31/08
Weekly
mg/I
30
33.25
Monthly Average Exceeded
No Action, BPJ
09 -2007
001
Effluent
Coliform, Fecal MF, M-FC
09/04/07
Weekly
#/loom[
400
1,100
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/12/08
Weekly
#/loom[
400
6,000
Daily Maximum Exceeded
Proceed to
Broth,44.5C
Enforcement Case
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/26/08
Weekly
#/loom[
400
6,000
Daily Maximum Exceeded
Proceed to
Broth,44.5C
Enforcement Case
03 -2008
001
Effluent
Coliform, Fecal MF, M-FC
03/31/08
Weekly
#/100ml
200
713.52
Monthly Geometric Mean
Proceed to
Broth,44.5C
Exceeded
Enforcement Case
04 -2007
001
Effluent
Nitrogen, Ammonia Total (as
04/11/07
Weekly
mg/I
8.7
9.7
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2007
001
Effluent
Nitrogen, Ammonia Total (as
04/30/07
Weekly
mg/I
2.9
3.44
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
05 -2007
001
Effluent
Nitrogen, Ammonia Total (as
05/29/07
Weekly
mg/I
8.7
9.8
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
09 -2007
001
Effluent
Nitrogen, Ammonia Total (as
09/17/07
Weekly
mg/I
8.7
11
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
09 -2007
001
Effluent
Nitrogen, Ammonia Total (as
09/30/07
Weekly
mg/I
2.9
3.18
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
03 -2008
001
Effluent
Nitrogen, Ammonia Total (as
03/12/08
Weekly
mg/I
28.2
33
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
03 -2008
001
Effluent
Nitrogen, Ammonia Total (as
03/17/08
Weekly
mg/I
28.2
37
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 07/07/08 Page: 2 of 2
— ' ( --. — �zr'�";°-: `' "r '.� —: L .:w ,�;,:�-"'� _ c� +r^^
Permit nc0059489 MF?s:Between; 4-2{107 and 3`-2008 Re ion:=°la Fr°, Violation Cate o' >°°lo Pfo 'ram Cateto . Ufa':,
9 g F1'g g rY
�FBCIIIt :Name " ° Param N "me: 4fo. o- Sub6asin: o.
y fo a S5 Gaunty s fo Violation Aofi6h fa
�G Major Minor"
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park -Three R's Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
REPORT PPI LOCATION
PARAMETER
DATE
FREQUENCY
03 -2008 001 Effluent
Nitrogen, Ammonia Total (as
03/26/08
Weekly
03 -2008 001 Effluent
Nitrogen, Ammonia Total (as
03/31/08
Weekly
Monitoring Violation
UNIT OF
CALCULATED
MEASURE
LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
mg/I
28.2 35
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/I
9.4 26.3
Monthly Average Exceeded
No Action, BIMS
Calculation Error
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
11 -2007 001
Effluent
Chlorine, Total Residual
11/03/07
2 X week
ug/I
Frequency Violation
None
Reporting Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
08 -2007 001
Effluent
Nitrogen, Total (as N)
08/31/07
Quarterly
mg/I
Parameter Missing
None
08 -2007 001
Effluent
Phosphorus, Total (as P)
08/31/07
Quarterly
mg/I
Parameter Missing
None

ft
zs��.
This letter I am forwarding to you sir, is in regards to the sewage
plant located at Three R's Mobile Home Park, 170 Jones Road,
Winston-Salem, NC 27107. Several years ago, R & A out of
Kernersville were operating the plant. Mr. Sam Kondo inserted the
fixed media. My husband was not aware about the permit. He was
told that it would be taken care of. At that time Mr. Randy Bell, was
not involved with this matter. The fixed media has been no problem
according to my knowledge, in the past. Mrs. Pruitt, from 2006 until
March of 2008 was not inspecting the sewage plant, if so there were
no complaints, until March 2008. All the requests she then made on
my part of the sewage plant has been taken care of. The streams
have been cleaned out, media removed and placed--j J,
Mr. Tedder, since my husband, Norman Boles, expired of Sarcoma
Cancer on August 19, 2006, he was either taking chemo or in the
hospital most of the time, I personally left it all up to Mr. Bell to infor
me, of all issues concerning the plant. Norman took care of all
requirements that was needed when he was alive. After his death, I
was left with a great deal of responsibty, but I have followed to the
best of my abiliti on my part to keep the plant in complete
fty
compliance.
At present, all easements from the city has been done. Mr. Mike
Hall, gave me a map for City Sewage showing where the City will
connect sewage. From Rink Road in Winston-Salem, to my area it is
only a short distance. I really feel myself, they will begin the project
with in a month to six weeks, I pray!
I do so much apology for an inconvaince this h2s caused -
Thank you and may you -have a blessed day.
Barbara Boles
Owner
9-hree R's Mobile Home Park

North Carolina
i r) � Ct County
I, Xdriml7e �% L',-/,illS , allotary Public of 0,
Cnty, �iZ "wee- n/R certify that /
Afd L/ EGG personally appeared before me this day, and duly
sworn, stated that he knows the handwriting of �3l2�.e/a _ o Ye,,--S and
�th t the signature of the foregoing instrument is the signature of
i�IlL8.9.�A
Witness my hand and official seal, this the r-20 day of 140 Y , 20 OS�
�...,
w CHAVIS
Notary Public
EADRIENNE
yIIt¢�d C unty
btl�Ga4U." ]2011
Uon Expires NAY
Notary Public
My commission expires X��/ 2% 3 20_4L

May 20, 2008
RKBell
Bell Enterprise
PO Box 1291
Clemmons, NC 27012
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown Street
Winston Salem NC 27107
RE: Compliance Issues
311 MH Park
To Whom It May Concern:
On compliance issues:
1. Fix Media:
a. Fix media is being removed. We are expected to be completed within the next two
weeks. Will notify upon completion for reinspection.
2. Requested copies of Calibration, Maintance Log and Bench Sheet:
a. As requested copies of above papers will bed delivered to the office on Waughtown
Street, May 22, 2008. j
b. Maintance Log: Although we have a check off sheet; we have now implemented a
notebook with a detail description of Maintance.
3. Debris in Creek:
a. Debris has been removed from creek on 3R's and adjoining land.
Thanking you in advance,
Sincerely,
v
Randy Bell/Bell Enterprise

0
4 ,--
April 27, 2008
RKBell
Bell Enterprise
PO Box 1291
Clemmons, NC 27012
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown Street
Winston Salem NC 27107
RE: Compliance Issues
311 MH Park
To Whom It May Concern:
RECEIVED
N.C. Deot. of ENR
APR 2 9 2008
Winston-Salem
Regional Office
On compliance issues:
1) Failure to comply with the permit
a. Facility not permitted for dechlor systems see attached documents.
b. In response to fixed media with no ATC: Fixed media will be removed.
c. Complete copy of permit now on sight
2) Operations and Maintenance
a. _Have maintenance check list, have started new log
3) Record Keeping
a. Process control data and equipment calibration sheets are with DMR's
b. No ORC Maintenance Log: Now have Maintenance Log
4) Effluent Pipe
a. Solids in stream: on day of inspection there: were no solids in the stream and there are
still no solids in the stream
b. Effluent Pipe submerged: Due to excessive rain pipe was practically submerged; this had
not been a problem in the past. However for future excessive rain, pipe has been raised.
5) Effluent Sampling
a. Laboratory: No equipment calibration records for field perimeter testing. Have
documentation of these records with DMR's.
b. Due to resent rain event, for that week of sampling, stuck bottle into pipe to collect
samples. For future sampling on excessive rain events, pipe was raised.
Thanking you in advance;
Randy Bell/Bell Enterprise

Horizon Engineering & Consulting, Inc.
Utlalk0 ROa
W. Pleasant. N.C. 28124
704-78B-4465
FaX� 704-788-4455
FebTuaryy 16, 2007
Ms. Barbara Boles
Three Ks Mobile Home Park
5240 South Nlain Street
Winston-Salem, N.C, 27107
Project: Engineering Services
Certification, of Final Construction
Dechlorination System
Three Rs Mobile Home Park
NCO051489
Dear 1TVIs. Boles
Enclosed herewith are copies of the final plans and specifications to serve as your record copy (as required
by NC DENR), and a copy of the signed engineer's certification. I mailed the original certification to the
slate.)
I appreciate, the opportunity -to provide ffiese services.
If you have any questions, etc. please call me (704-798-4455..)
C: Randy Bel!
4 x
I ax wg� X16-11
tucu
4<
'4se5ed
�Lg.L' e11ON XVJ A-4sOd
2UTJeeUT2U3 UOZIJOH wy+'E :8 800E sa JJU
SSPIt- 88—) tL71-1

Three R's Nfobhe Rome Park
Three R's Mobile Home Parls. WAITP
A to C No- 051489AGI
Januaxy 22, 200 7
Engineer's Cerfiflidation
1f14F,, as a' duly registered Professional Engineer in
the State of'North Carolina, having beers authorized to 6 : bserve (periodically/weekly/full tim- e)
the construction of the modifications and iniprovernents' to the Three R's MHPVV-"VN-TP located
on Jones Road in Forsyth County for "Three R's Mobile'Rome Park, hereby state that, to the best
of ray abilities, due care and diligence was used 1D the observation of the following construction:
Instaltation of dechlorination system utilizing godium suffite pursuant to the test
track application received on January 17, 2007, and in conformity with the
Minimum Design Criteria for Dechlorimation Fa6ilides.
I certify that the, construction of the above referenced project was observed to be built
Nwithin substantial compliance and intent of the approved plans and specifications.
Signatur ";Mo Registration No.
e,
E.
X
Date (�eC,-O
Send to: Constmetion. Grants & Loons DENTRiDWQ z-_-,
1633 Mail Service Center
Raleigh. NC 27699-1633
kiRM
a-d sGiliv-86L-i7OL 2UTJqaUI2U3 UOZTJOH Ww+'6:8 800a Ga idu

WAr, Michael F. Easley, Governor
\O�OF FRQG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
O �
April 22, 2008
CERTIFIED MAIL 7007 3020 0000 6279 6870
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION/RECOMMENDATION FOR ENFORCEMENT
NOV-2008-PC-0277
Compliance Evaluation Inspection
Three R's Mobile Home Park
Permit No. NCO051489
Forsyth County
Dear Ms. Boles:
Enclosed please find a copy of the Inspection Report from the inspection conducted March 1,
2008 at Three R's Mobile Home Park. The Compliance Evaluation Inspection was conducted
by Rose Pruitt of the Winston-Salem Regional Office. Randy Bell, ORC was present for the
inspection. The inspection consisted of two parts: an on -site inspection of the treatment facility
and a file review. The following are the findings from the subject inspection.
The treatment facility was found to be in violation of permit NCO051489 for the following:
Compliance issues found during the inspection are:
Inspection Area
Compliance Issue
Permit
Failure to comply with the permit.
Permit
o Facility not as permitted. Dechlor system installed without following fast
track authorization to construct (ATC) notification and approval process.
See enclosed fast track application package with minimum design criteria.)
Repeat Violation
o Previous addition of Fixed Media Conversion System still not permitted,
no ATC submitted. (As noted in 2002 inspection) Repeat Violation
• Complete copy of the permit not on site.
Operations and Maintenance
Failure to provide operation and maintenance resources necessary to operate the
existing facilities at optimum efficiency.
Record Keeping
Process control data including field parameters tested and equipment calibrations
not available at inspection.- Repeat Violation
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-7714630 (Fax)

Three R's
Page 2
April 22, 2008
Inspection Area
Compliance Issue
Effluent Pipe
Solids in stream.
Effluent pipe submerged.
Debris/trash in stream.
Record Keeping
No ORC maintenance log- Repeat Violation
Operations & Maintenance
• Fixed media detached from blowers and floating in aeration basin.
• Sludge worms growing on solids in aeration basin.
• Solids in chlorine contact chamber.
Laboratory
No equipment calibration records for field parameter testing. Repeat Violation
Effluent Sampling
Effluent pipe submerged. Explain sampling results.
Please refer to the enclosed Inspection Report for any additional observation and comments:
I. Permit
The NPDES permit for the Three R's Mobile Home Park WWTP became effective June 1, 2004
and expires on May 31, 2009. The permitted components of the 0.012 MGD wastewater
treatment plant include: an influent bar screen, aeration basin, clarifier, aerated sludge holding
tank, chlorination, contact chamber, post aeration, and flow monitoring device.
Violations of permit NCO051489 have occurred. Failure to comply with the permit.
Section B General Conditions (1) Duty to comply. The permittee must comply with all
conditions of this permit. Any permit noncompliance constitutes a violation of the Clean
Water Act and is grounds for enforcement action; for permit termination, revocation and
reissuance, or modification; or denial of a permit renewal application [40CFR 122.41].
Facility not as permitted.
Section E Reporting Requirements: 2. Planned Changes- The permittee shall give notice to
the Director as soon as possible of any planned physical alterations or additions to the
permitted facility [40 CFR 122.41 (1)].
You are reauired by vour hermit to seek Division atinroval for anv chances made
to treatment processes. A Dechlorination system was installed without following
fast track authorization to construct (ATC) notification and approval process.
Attached please find an Application package that includes: Application Form,
Certification Form and System Minimum Design Criteria for Dechlorination
Facilities Authorization to Construct. Please complete and submit this fast track
application immediately,
On reviewing the file for this permit it was noted that during the 2002 inspection
that this facility was required to immediately submit a request for Authorization to
Construct (ATC) because of the addition of a Fixed Media Conversion System
II

Three R's
Page 3
April 22, 2008
the
ATC was
find
Apply for retroactive ATC's immediately. These 'are repeat violations.
The Clean Water Act provides that any person who violates sections of the Act or any permit
condition or limitation is subject to a civil penalty of up t'o $25, 000 per day for each violation.
II. Records/Reports
A review of the laboratory reports and Discharge Monit
Mobile Home Park WWTP for the period January 2007
the facility had a total of three limit violations. The da
September for BOD 5 day and Fecal Coliform, an addit
Coliform in January. A Notice of Violation was issued
violations.
Violations were found in the following records:
(1) No ORC Maintenance Log. Repeat Violation
(2)
ng Reports (DMRs) for the Three R's
sough December 2007 revealed that
maximum was exceeded once each in
violation was noted for Fecal
the Division for each of these
Part II Standard Conditions for NPDES Permits, Section C. Operation and
Maintenance of Pollution Controls (1) Certifie'd Operator... The ORC of each Class
U, III and IV facility must: Visit the facility at least daily, excluding weekends and
holidays, Properly manage and document daily operation and maintenance of the
facility.
i
field parameters tested and ec
calibrations). Repeat Violation
Part II Standard Conditions for NPDES Permits, Section C. Operation and
Maintenance of Pollution Controls (2) Proper Operation and Management: The
permittee shall at all times provide the operation and maintenance resources necessary to
operate the existing facilities at optimum efficiency... Proper operation and
maintenance also includes adequate laboratory controls and appropriate quality
assurance procedures.
III. Facility Site Review
The facility site review indicated that the 0.012 MGD treatment works is not consistent with the
permitted components. The permitted treatment system consists of an influent bar screen,
aeration basin, clarifier, aerated sludge holding tank, chlorination, contact chamber, post aeration,
and flow monitoring device.
Violations were found
• Additions noted but not permitted; dechlorination unit, addition of fixed media
conversion, system (see section I. Permit above)
• Operations and maintenance at the time of the subject inspection were deemed

Three R's
Page 4
April 22, 2008
unsatisfactory.
o At the time of the inspection the inspector noted that fixed media was no longer
attached to the aeration pipes and was floating free in the aeration basin. Solids and
sludge worms were present in the aeration basin.
o The effluent pipe was submerged in the stream.
IV. Effluent / Receiving Stream
The WWTP discharges to Leak Creek a class C water in the Yadkin -Pee Deer River Basin.
Violations were found
The effluent pipe was submerged at the time of the inspection and later when the
inspector returned to check during low flow.
There were solids in the stream.
• There was debris, trash and mattresses in the stream.
V. Flow Measurement
Effluent flow is measured with an ISCO 4210 flow meter. Meter calibration records indicate it
was last calibrated 11/24/2007 by Horizon Engineering & Consulting.
VI. Self -Monitoring Program
A review of the Discharge Monitoring Reports (DMRs) for the Three R's Mobile Home Park
WWTP for the January 2007 through December 2007 revealed that the facility had a total of
three limit violations. The daily maximum was exceeded once each in September for BOD 5
day and Fecal Coliform, an addition violation was noted for Fecal Coliform in January. A Notice
of Violation was issued by the Division for each of these violations.
The effluent pipe is submerged even during low flows. The ORC reports that
he is reaching into effluent pipe to recover samples. Samples are diluted by
the stream.
Samples collected by the inspector on 03/11/2008 are not consistent with
samples reported by the ORC on submitted DMR's. See attached sampling
results. Please justify your sampling methods and results in your response to
this NOV.
VII. Compliance Schedules
No compliance schedules to evaluate.
�v

Three R's
Page 5
April 22, 2008
VIII. Laboratory
I
All of the contract lab sample analyses are conducted by Tritest Labs. The laboratory was not
reviewed at the time of the subject inspection.
Violations were found in the following records:
• No process control data including field parameters tested and equipment.calibrations.
IX. Operation and Maintenance
i
Operation and maintenance at the time of the subject inspection was deemed unsatisfactory.
Violations were found in the following areas:
• At the time of the inspection the inspector noted that fixed media was no longer
attached to the aeration pipes and was floating free in the aeration basin. Solids and
sludge worms were present in the aeration basin.
• The effluent pipe was submerged in the stream
• Solids in the contact chamber
• Solids and trash in the stream
Section C. Operation and Maintenance of Pollution Controls (2) Proper Operation and
Management: "The permittee shall at all times'provide the operation and maintenance
resources necessary to operate the existing facilities at optimum efficiency. The Permittee
shall at all times properly operate and maintain all facilities and systems of treatment and
control (and related appurtenances) which are installed or used by the Permittee to achieve
compliance with the conditions of this permit."
I
X. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of
properly. Forsyth Rooter last hauled sludge for this facility on 03/05/2008.
i
XI. Pretreatment
Not evaluated during this inspection. No pretreatment program required.
XII. Stormwater
Not evaluated during this inspection.
XIV. Sewer Overflow
None to report. .
XV. Pollution Prevention
Not evaluated during this inspection.

Three R's
Page 6
April 22, 2008
XVI. Multimedia
Not evaluated during this inspection.
Please refer to the enclosed Inspection Report for any additional observations and comments.
Technical assistance is available to you. Please contact Marc Stokes the Wastewater Treatment
Plant Consultant, in the Winston Salem Regional Office at 336-771-4952.
As a condition of your permit, you are required to comply with all conditions of this
permit. Any permit noncompliance constitutes a violation of the.Clean Water Act and is
grounds for enforcement action; for permit termination, revocation and reissuance, or
modification; or denial of a permit renewal application [40CFR 122.41]. Under state law, a
civil penalty of not more than $25,000 per violation may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of a
permit. [North Carolina General Statutes § 143-215.6A].
The Winston-Salem Regional Office is considering preparation of an enforcement action for the
violation of permit conditions. To prevent further action, carefully review these violations and
deficiencies and respond in writing to this office within fifteen (15) working day of receipt of
this letter. You should address the causes of noncompliance and all actions taken to prevent the
recurrence of similar situations. If you should have any questions, please do not hesitate to contact
Rose Pruitt at 336-771-5000.
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments
Cc: Randall Bell, PO Box 1291 Clemmons NC 27012
Central Files
IWVJOW
Tonja Springer, DWQ Lab Certification, Chemistry Lab
Marc Stokes, Technical Assistance
NPDES Unit
Charles Weaver, NPDES Unit
Attorney General

I�ESEARCM ANA[j/TICA1 .......Y (,ems
t LAbORAT fll' S� INC.
4
RECEIVED
a -V ~ N.C. Dept. of ENR � cc • � Z: U) �
1 :`� PVC #34
Analytical/Process Consultations ! hi. 2- "t 8
Re�,iona! Office �� � ° •••••••• y �o
NCDENR Pate Sample Collected 03/11/08
583 WAUGHTOWN STREET Date Sample Received 03/11/08
WINSTON-SALEM, NC 27107 Date Sample Analyzed 03/11/08
Attn: ROSE PRUITT Date of Report 03/19/08
Analyses Performed by KLK-L
Lab Sample Number
-----------------
611880
Parameter Storet # Results
i
Fec Coli-MF (31616) 860 col/100 ml
---------------------
Clients Sample Source 3REFFLUENT
,\Tumber
Time Collected (Hrs) 1110
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 ° 336-996-2841 • Fax [phone]
www.randalabs.com

WSROSPNLC
THREE R'S
-(ID
CAS # Analyte Name
Sample temperature at retell
Method Reference
JV(,' (DIWQ Laboratory �'ectzon'Aesucts
PQL Result Qualifier Units
0.4
Collect Date: 03/11/2008
Collect Time:: 11:10
Analyst/Date Approved By bate
C DSAUNDERS JGOODWIN
3112108 3/12108
MIC
BOD, 5-Day In liquid 2.0 12
mg/L
ADEXTER
MOVERMAN
Method Reference APHA52108
3/13108
3/20108
WARO
Residue —Suspended in liquid 6.2 118
mg/L
LBUCK
ESTAFFORD
Method Reference APHA2540D-20th
3113108
3/24/08
NUT_
NH3 as N In liquid 0.02 31
mg/L as N
MOVERMAN
CGREEN
Method Reference Lac10-107-06-1-J
3112/08
3/19108
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Page 2 of 2

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
I
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
a
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NC0051489 111 121 08/03/07 { 117 181 cl 191SI 20III
Remarks
211 1I6
I
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ----------------------
67 I 169 701 I 71 I I 72 I N I t� 73 I I 174 751 l I I I l l 180
Section B: Facility 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)
11:30 AM 08/03/07
05/05/01
Three R's Mobile Home Park
Exit Time/Date
Permit Expiration Date
170 ,Tones Rd i
Winston Salem NC 27107
12:15 PM 08/03/07
09/05/31
Name(s) of Onsite Rep resentative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
I
Randall Keith Bell/ORC/336-373-7740/
I
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Randall Keith Bell,5240 S Main St Winston Salem NC 27107//336-766-96t6o/
I
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ® Flow Measurement ® Operations & Maintenance Records/Reports
Self -Monitoring Program ® Sludge Handling Disposal ® Facility Site Review ® Effluent/Receiving Waters
Laboratory
Section D: Summary of Find in /Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
I
i
i
I.
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
I
Rose Pruitt WSRO WQ//336-7j71-5000/
i
Signature of agement er Agency/Office/Phone and Fax Numbers Date
2ARev
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

. V
NPDES yr/mo/day Inspection Type
3I NC0051489 I11 12I 08/03/07 I17 181CI
(cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
At the time of the inspection the facility showed signs of gross neglect. the fixed media had broken loose
and was floating in the aeration basin, solids had built up there and sludge worms covered the surface. The
ORC, Randy Bell, said that he was not being paid to clean it up. There was no maintenance log for this
facility. there was no process control data or equipment calibrations for field parameters. There was no
copy of the permit available. At the time of the inspection the effluent pipe was submerged and there was
sludge, trash, mattresses in the creek. The stream was full of trash and debris including mattresses.
This facility has failed to apply for an AtC for 1)the fixed media 2)dechlorination unit as mentioned in
previous inspection reports.
Page # 2

,j ,
Permit: NCO051489 Owner -'Facility: Three R's Mobile Home Park
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
i
Is the plant generally clean with acceptable housekeeping? n ■ n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ® n n f_1
Judge, and other that are applicable?
Comment: Fixed media has broken loose in aeration basin and sludge worms are
growing on solids
No equipment calibrations
Yas Nn NA NF
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
®
n
Is the facility as described in the permit?
n
®n
n
# Are there any special conditions for the permit?
n
n
®
n
Is access to the plant site restricted to the general public?
®n
n
n
Is the inspector granted access to all areas for inspection?
®
n
n
n
Comment: previous violations for change to fixed media and addition of dechlorination
unit without submitting AtC
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
❑
®
n
n
Is all required information readily available, complete and current?
n
n
n
Are all records maintained for 3 years (lab. peg. required 5 years)?
n
n
Are analytical results consistent with data reported on DMRs?
®n
❑
❑
Is the chain -of -custody complete?
®
n
n
n
Dates, times and location of sampling
n
Name of individual performing the sampling
n
Results of analysis and calibration
n
Dates of analysis
n
Name of person performing analyses
n
Transported COCs
n
Are DMRs complete: do they include all permit parameters?
®❑
Has the facility submitted its annual compliance report to users and DWQ?
®n
n
n
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
n
n
n
Is the ORC visitation log available and current?
®
n
n
n
Is the ORC certified at grade equal to or higher than the facility classification?
®
n
n
n
Page # 3

Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Is the backup operator certified at one grade less or greater than the facility classification?
■
n
n
n
Is a copy of the current NPDES permit available on site?
n
®n
n
Facility has copy of previous year's Annual Report on file for review?
n
n
n
Comment: permit not on site, no maintenance log, no process control data
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
n
■
Are the receiving water free of foam other than trace amounts and other debris?
®
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
n
❑
■
❑
Comment: effluent pipe submerged, sludge in stream, trash and debris in stream
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
Is flow meter calibrated annually?
®
❑
❑
❑
Is the flow meter operational?
®n
n
n
(If units are separated) Does the chart recorder match the flow meter?
❑
n
n
■
Comment: ISCO 4210 calibrated 11/24/2007 by Thurman Horne
Yac
Nn
NA
NF
Type of bar screen
a.Manual
b.Mechanical
n
Are the bars adequately screening debris?
n
n
n
Is the screen free of excessive debris?
n
n
n
Is disposal of screening in compliance?
n
n
F1
Is the unit in good condition?
n
n
n
Comment:
Aeration Basins Yes No NA NE
Mode of operation Ext. Air
Type of aeration system Fixed
Is the basin free of dead spots? n IN n n
Are surface aerators and mixers operational? ❑ in 0
Are the diffusers operational? n Im 0
Page # 4

br ,
Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Aeration Basins
Yes
No
NA
NE
Is the foam the proper color for the treatment process?
❑
®
❑
fl
Does the foam cover less than 25% of the basin's surface?
n
®
n
[I
Is the DO level acceptable?
n
n
fl
Is the DO level acceptable?(1.0 to 3.0 mg/I)
n
I1
n
Comment: fixed media had broken loose and was floating in aeration basin with solids
buildup and sludge worms. ORC. said he wasn't paid to remove it
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
®n
n
n
Is the site free of excessive buildup of solids in center well of circular clarifier? ,
n
n
®
n
Are weirs level?
®n
n
n
Is the site free of weir blockage?
®
n
n
n
Is the site free of evidence of short-circuiting?
®
fl
n
n
Is scum removal adequate?
n
®
n
Is the site free of excessive floating sludge?
rl
®
0
n
Is the drive unit operational?
n
n
Is the return rate acceptable (low turbulence)?
n
rl
n
Is the overflow clear of excessive solids/pin floc?
rl
rl
n
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
n
n
n
Comment: solids
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
®
❑
fl
n
Are the tablets the proper size and type? i
®
n
fl
rl
Number of tubes in use?
4
Is the level of chlorine residual acceptable? ,
nnn®
Is the contact chamber free of growth, or sludge buildup?
❑
®❑
n
Is there chlorine residual prior to de -chlorination?
❑
n
❑
Comment: solids in contact chamber
Laboratory
Yes
No
NA
NE
Are field parameters performed by certified personnel or laboratory?
n
Q
n
Are all other parameters (excluding field parameters) performed by a certified lab?
n
n
n
Page # 5

Permit: NC0051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Laboratory
Yes
No
NA
NE
# Is the facility using a contract lab?
■
n
n
n
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑
❑
■
n
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
■
n
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
❑
❑
®
Q
Comment: No calibration records for field parameter testing
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
❑
n
®
n
Is sample collected below all treatment units?
n
■
n
❑
❑
❑
n
E
Is proper volume collected?
Is the tubing clean?
n
n
■
n
-
n
n
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)? n - ■ -
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? n n ® n
Comment: effluent pipe submerged
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? n n n
Comment:
De -chlorination Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
n
n
n
®n
n n
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
■
n
n n
Comment. -
Are the tablets the proper size and type?
n
n n
®
n
❑ n
Are tablet de -chlorinators operational?
2
Number of tubes in use?
Comment:
Page # 6

Compliance Inspection Report
Permit: WQCSD0256 Effective: 03/01/00 Expiration: Owner: Barbara Boles
SOC: Effective: Expiration: Facility: Three R's Mobile Home Park Collection
System
County: Forsyth
Region: Winston-Salem
Contact Person: Barbara Boles Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/07/2008 Entry Time: 11:30 AM Exit Time: 12:15 PM
Primary Inspector: Rose Pruitt Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Deemed permitted collection system management and
operation
Facility Status: ❑ Compliant 4 Not Compliant
Question Areas:
Miscellaneous Questions ® Performance Standards S Operation & Maint Reqmts ® Records
® Monitoring & Rpting ® Inspections ® Pump Station
Reqmts
(See attachment summary)
Page: 1

IN
I
Permit: WQCSD0256 Owner - Facility: Barbara Boles
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation I Reason for Visit: Routine
Inspection Summary:
i
I
I
I '
I
Page: 2
I — �

Permit: WQCSD0256 Owner - Facility: Barbara Boles
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Performance Standards Yes No NA NE
Is Public Education Program for grease established and documented? j ❑ ■ ❑ rl
What educational tools are used?
Is Sewer Use Ordinance/Legal Authority available? ❑ ❑ ■
Does it appear that the Sewer Use Ordinance is enforced? fl ❑ ■ ❑
Is Grease Trap Ordinance available? Ej
fl n
Is Septic Tank Ordinance available (as applicable, i.e. annexation) ❑ 0 ■ f=1
List enforcement actions by permittee, if any, in the last 12 months
Has an acceptable Capital Improvement Plan (CIP) been implemented?
n
n
■ ❑
Does CIP address short term needs and long term \"master plant/ concepts?
❑
1)
■ El
Does CIP cover three to five year period?
n
n
® n
Does CIP include Goal Statement?
rl
fl
■ n
Does CIP include description of project area?
❑
D
Does CIP include description of existing facilities?
n
n
® n
Does CIP include known deficiencies?
Does CIP include forecasted future needs?
❑
❑
■
Is CIP designated only for wastewater collection and treatment?
n
n
Approximate capital improvement budget for collection system?
Total annual revenue for wastewater collection and treatment?
CIP Comments
Is system free of known points of bypass?
❑
❑
❑ ■
If no, describe type of bypass and location
Is a 24-hour notification sign posted at ALL pump stations?
n
n
n ■
# Does the sign include:
Instructions for notification?
fl
fl
❑ ■
Pump station identifier?
n
n
n ■
24-hour contact numbers
❑
❑
❑ ■
If no, list deficient pump stations
Page: 3

t
t
• I
Permit: WQCSD0256 Owner - Facility: Barbara Boles
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
# Do ALL pump stations have an "auto polling" feature/SCADA? fl ❑ ❑ ■
i
Number of pump stations
i
Number of pump stations that have SCADA
Number of pump stations that have simple telemetry
Number of pump stations that have only audible and visual alarms
Number of pump stations that do not meet permit requirements
# Does the permittee have a root control program? ❑ fl ❑ ■
# If yes, date implemented?
Describe:
Comment:
Inspections
Yes
No
NA
NE
Are maintenance records for sewer lines available?
❑
■
n
n .
Are records available that document pump station inspections?
0
■
0
Are SCADA or telemetry equipped pump stations inspected at least once a week?
❑
❑
❑
■
Are non-SCADA/telemetry equipped pump stations inspected every day?
n
n
n
■
Are records available that document citizen complaints?
❑
■
❑
❑ .
# Do you have a system to conduct an annual observation of entire system?
n
®n
n
# Has there been an observation of remote areas in the last year?
❑
■
fl
rl
Are records available that document inspections of high -priority lines?
Has there been visual inspections of high -priority lines in last six months?
Comment:
Operation & Maintenance Requirements
Yes
No
NA
NE -
Are all log books available?
n
®
n
n
Does supervisor review all log books on a regular basis?
n
®
00
Does the supervisor have plans to address documented short-term problem, areas?
Do
00
What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas?
,Are maintenance records for equipment available? ❑ ® 0 ❑
Is a schedule maintained for testing emergency/standby equipment? ❑ ®❑
What is the schedule for testing emergency/standby equipment?
Page: 4

Permit: WQCSD0256 Owner - Facility: Barbara Boles
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Do pump station logs include:
Inside and outside cleaning and debris removal?
Inspecting and exercising all valves?
Inspecting and lubricating pumps and other equipment?
Inspecting alarms, telemetry and auxiliary equipment?
Is there at least one spare pump for each pump station w/o pump reliability!,
i
i
Are maintenance records for right-of-ways available?
Are right-of-ways currently accessible in the event of an emergency?
Are system cleaning records available?
Has at least 10% of system been cleaned annually?
What areas are scheduled for cleaning in the next 12 months?
Is a Spill Response Action Plan available?
Does the plan include:
24-hour contact numbers
Response time
Equipment list and spare parts inventory
Access to cleaning equipment
Access to construction crews, contractors, and/or engineers
Source of emergency funds
Site sanitation and cleanup materials
Post-overflow/spill assessment
Is a Spill Response Action Plan available for all personnel?
' I
Is the spare parts inventory adequate?
Comment:
I
Records
Are adequate records of all SSOs, spills and complaints available?
Are records of SSOs that are under the reportable threshold available?
I
Do spill records indicate repeated overflows (2 or more in 12 months) at same location?
If yes, is there a corrective action plan?
Is a map of the system available?
I
Reason for Visit: Routine
nnn■
..nnn■
nnn■
nnn■
nnn■
n■nn
nnn■
0N0­0
n'■0D
Page: 5

e
o ,
Permit: WQCSD0256 Owner -Facility: Barbara Boles
Inspection Date: 03/07/2008 Inspection Type: Compliance Evaluation
Does the map include:
Pipe sizes
Pipe materials
Pipe location
Flow direction
Approximate pipe age
Number of service taps
I
Pump stations and capacity
I
If no, what percent is complete?
List any modifications and extensions that need to be added to the map
• i
# Does the permittee have a copy of their permit? j
Comment:
Monitoring and Reporting Requirements
Are copies of required press releases and distribution lists available?
Are public notices and proof of publication available?
I
# Is an annual report being prepared in accordance with G.S. 143-215.1 C?
# Is permittee compliant with all compliance schedules in the permits?
If no, which one(s)?
i
Comment: No records provided by Randy Bell ORC
I
I
I
I
I
Reason for Visit: Routine
Yes No NA NE
n■00
n®nn
n■nn
nn■n
Page: 6

Faxed To: Randy Bell
Fax #: 2 �4 b _ /� Phone [phone]
I
WWTP Annual Inspection Checklist
This information should be available to the inspector, at inspection time. /
Facility: Three R's NPDES: NC0051489
0 Permit Effective Dates: June 1, 2004 to May31, 2009 v
Inspection Date: -7 Inspection Time:
IN-
DMRs (Dates: January 2007 to December 2007 ) �`
­12) Lab Data (per DMR dates)
Laboratories used for analysis & certification #'s
f4) Chain of Custody forms (per DMR dates)
5) y, Complete copy of current.NPDES permit
Status of SOC or Moratorium issuance (if applicable)
r7) ORC and Back-up ORC current certification , r 6AAe
giLl
, -8) Wastewater Annual Report (fiscal or calendar year>icable)
--9) Daily Operator's log / ORC visitation log
10) -)k Maintenance log
( 11) Process control data (which includes field parameters tested and equipment
calibrations)
g� 12) --- Field Parameter certification (if applicable)
,� �3) Flow meter calibration records (if applicable)— `4,- O y2162 /j 100107
y1 1A4-�t and/or effluent samplers
k,A5) Flow charts (if applicable)'
reset -Inspection /under load checks
L,-,l7) Spill Response Plan (with current emergency contact numbers)
permit (if applicable) `/19) Sludge / Residuals hauling records (if applicable) 3ly�f .3150
sW4nnual Report (if applicable)
Jr21) Plant visual inspection of treatment units OVA(:�;j 2
­22) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
M Division of Water Quality
�) Winston-Salem Regional Office
[phone]
Fax: [phone]
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der

MONITORING REPORT(MR) VIOLATIONS for:
Permit: nc0051489 MRs Between: 1 2007 and 12-2007 Region: °%
Facility Name: % Param Name: County:"
Major Minor: %
Violation Category:
Subbasin:
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park COUNTY: Forsyth
Report Date 04/08/08 Page 1 of 1
Program Category: "rb
Violation Action:
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
09 -2007 001
Effluent
BOD, 5-Day (20 Deg. C)
09/04/07
Weekly
mg/I
45
49
Daily Maximum Exceeded
Proceed to NOV
01 -2007 001
Effluent
Coliform, Fecal MF, M-FC
01/30/07
Weekly
#/100ml
400
500
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
09 -2007 001
Effluent
Coliform, Fecal MF, M-FC
09/04/07
Weekly
#/100ml
400
1,100
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
04 -2007 001
Effluent
Nitrogen, Ammonia Total (as
04/11/07
Weekly
mg/I
8.7
9.7
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2007 001
Effluent
Nitrogen, Ammonia Total (as
04/30/07
Weekly
mg/I
2.9
3.44
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
05 -2007 001
Effluent
Nitrogen, Ammonia Total (as
05/29/07
Weekly
mg/I
8.7
9.8
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
09 -2007 001
Effluent
Nitrogen, Ammonia Total (as
09/17/07
Weekly
mg/I
8.7
11
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
09 -2007 001
Effluent
Nitrogen, Ammonia Total (as
09/30/07
Weekly
mg/I
2.9
3.18
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
Monitoring Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
11 -2007 001
Effluent
Chlorine, Total Residual
11/03/07
2 X week
ug/I
Frequency Violation
None
Reporting Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
08 -2007 001
Effluent
Nitrogen, Total (as N)
08/31/07
Quarterly
mg/I
Parameter Missing
None
08 -2007 001
Effluent
Phosphorus, Total (as P)
08/31/07
Quarterly
mg/I
Parameter Missing
None

COLLECTION SYSTEM INSPECTION CHECKLIST
To: AND _ Facility: 3 ?--:�, S Fax #:
Inspection Date: �- l% � 6 Inspection Time: l0 3 CD ate_
Please have the following information available for the inspector:
1. Sanitary Sewer Overflows (SSOs)
- Number of SSOs in the past 12 months and copies of reports
- Copies of public notice for all spills over 15,000 gallons
- Copies of press release for all SSOs reaching surface water & over 1,000 gallons
2. Current Collection System Map with the following information:
- Approximate age of sewer lines - Line size
- Pipe material - Flow direction
- Pump stations - Major tap locations of satellite systems
- Annual updates - Construction drawings if available
- Length of sewers
3. Grease Control Program
- Copies of the educational materials that have been distributed
4. High Priority Sewer Lines (i.e. suspended, in channel, or under body of water)
- Inspection log that includes: date, inspection method and corrective actions
5. Operation & Maintenance Plan with the following information:
- Pump station inspection frequency - Preventative maintenance sched.
- Spare parts inventory - Overflow response plan
- Schedule to test emergency equip.
6. Pump. Station Inspections & Maintenance — show evidence of the following tasks:
- Removal of interior and exterior debris as needed
- Exercising of all valves
- Lubrication of pumps & mechanical equipment
- Operation of alarms, telemetry, and generator
- Pump / power failure contingency plan posted at pump station
Have this information available for inspector:
Total # Pump Stations:
# Pump Stations with telemetry:
# Pump Stations w/out telemetry:
# Pump Stations with emergency contact information posted:
7. Right-of-ways and easements maintenance
Provide any maintenance logs or maps to show progress
8. Sewer line cleaning (should be performed on 10% of lines per year if any overflows)
Provide any maintenance logs or maps to show progress
9. General observation of entire system (should be performed on an annual basis)
Provide any maintenance logs or maps to show progress
10. All records should be maintained for 3 years

I'
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
June 2, 2008
CERTIFIED MAIL 7007 0220 0004 0732 7223
RETURN RECEIPT REQUESTED
'Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: CONTINUING NOTICE OF VIOLATION/RECOMMENDATION FOR
ENFORCEMENT
NOV-2008-PC-0277
Compliance Evaluation Inspection
Three R's Mobile Home Park
Permit No. NCO051489
Forsyth County
Dear Ms. Boles:
The Winston Salem Regional Office of the Division of Water Quality is in receipt of a response
to our Notice of Violation (NOV) dated April 22, 2008 and submitted on your behalf by Randy
Bell, ORC.on April 29, 2008. This response only partially addressed the original NOV and as a
result the Division requires additional action.
• Your response indicates that unpermitted fixed media additions will be removed. What is
the timeline for this removal? It will be necessary to schedule a reinspection immediately
thereafter. Time is of the essence.
• Provide'this office a copy of the ORC maintenance log.
• Provide this office with copies of field parameters tested and equipment calibrations.
• -Trash and household debris from your site must be removed from the stream
immediately. This will require that you gain access to the down stream area from an
adjoining property owner. You should contact this owner for permission to access the
stream from their property before cleanup begins. You are currently in violation of water
quality stream standards for this violation, which can carry penalties of $25,000.00 per
day per violation. Schedule a followup inspection as soon as this has been completed.
You remain in violation of your permit. As a condition of your permit, you are required to
comply with, all conditions of this permit. Any permit noncompliance constitutes a violation
of the Clean Water Act and is grounds for enforcement action; for permit termination,
revocation and Ireissuance, or modification; or denial of a permit renewal application
[40CFR 122.411Under state law, a civil penalty of not more than $25,000 per violation
may be assessed against any person who violates or fails to act in accordance with the
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)
t

Michael F. Easley, Governor '
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality *„
May 12, 2008
CERTIFIED MAIL 7007 3020 0000 6279 6917
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: CONTINUING NOTICE OF VIOLATION/RECOMMENDATION FOR
ENFORCEMENT
NOV-2008-PC-0277
Compliance Evaluation Inspection
Three R's Mobile Home Park
Permit No. NCO051489
Forsyth Courity
Dear Ms. Boles:
The Winston Salem Regional Office of the Division of Water Quality is in receipt of a response
to our Notice of Violation (NOV) dated April 22, 2008 and submitted on your behalf by Randy
Bell, ORC on April 29, 2008. This response only partially addressed.the original NOV and as a
result the Division requires additional action.
• Your response indicates that unpermitted fixed media additions will be removed. What is
the timeline for this removal? It will be necessary to schedule a reinspection immediately
thereafter'. Time is of the essence.
• Provide this office a copy of the ORC maintenance log.
• Provide this office with copies of field parameters tested and equipment calibrations.
i Trash and household debris from your site must be removed from the stream
immediately. This will require that you gain access to the down stream area from an
adjoining property owner. You should contact this owner for permission to access the
stream from their property before cleanup begins. You are currently in violation of water
quality stream standards for this violation, which can carry penalties of $25,000.00 per
day per violation. Schedule a followup inspection as soon as this has been completed.
You remain in violation of your permit. As a condition of your permit, you are required to
comply with all conditions of this permit. Any permit noncompliance constitutes a violation
of the Clean Water Act and is grounds for enforcement action; for permit termination,
revocation and reissuance, or modification; or denial of a permit renewal application
[40CFR 122.411. Under state law, a civil penalty of not more than $25,000 per violation
may be assessed against any person who violates or fails to act in accordance with the
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

L
Three R's -
Page 2
May 12, 2008
terms, conditions, or requirements of a permit. [North Carolina General Statutes § 143-
215.6A]
The Winston-Salem Regional Office is still considering preparation of an enforcement action for
the violation of permit conditions. To prevent further action, carefully review these violations and
deficiencies and respond in writing to this office within ten (10) working days of receipt of this
letter. You should address the causes of noncompliance and all actions taken to prevent the
recurrence of similar situations. If you should have any questions, please do not hesitate to contact
Rose Pruitt at 336-771-5000.
Sincerely,
( ��c4�6'
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments
Cc: Randall Bell, PO Box 1291 Clemmons NC 27012
Central Files
VU-SR,O
Tonja Springer, DWQ Lab Certification, Chemistry Lab
Marc Stokes, Technical Assistance
NPDES Unit
Charles Weaver, NPDES Unit
Attorney General

United States Environmental Protection Agency
Form Approved.
E P ^ 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 I NI 2 15I 3I NCO051489 111 121 08/06/10 ' 117 18I CI 19I SI 201
Remarks
2111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIll
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ----------------------
67I 169 701 I 711 I 721 NJ 73 I I 174 751 I I I I I I 180
�u L
Section B: Facility 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)
09:00 AM 08/06/10
05/05/01
Three R's Mobile Home Park
Exit Time/Date
Permit Expiration Date
170 Joiies- Rd
Winston Salem NC 27107
09:30 AM 08/06/10
09/05/31
Name(s) of Onsite Rep resentative(s)lfitles(s)/Phone and Fax Number(s)
Other Facility Data
Randall Keith Bell/ORC/336-373-7740/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Randall Keith Bell,5240 S Main St Winston Salem NC 27107//336-766-96N6o/
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Operations & Maintenance 0 Records/Reports, 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
Marc Stokes WSRO WQ//336-771-5000/
Rose Pruitt WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I. NCO051489 I11 12I 08/06/10 1
17 18ICI
(cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
reinspection 6/10/2008 with Rose Pruitt and Marc Stokes from WSRO. Also present Randy Bell ORC and
his attorney Thomas Hilliard.
Randy Bell stated that the park maintenance man, Mickey, had removed all of the fixed media and disposed
of approx 100+ bags into the dumpster. Requested something in writing to verify this info.
Requested copy of AtC app instead of just engineers certification for dechlorination unit.
Mr Bell showed the inspector a notebook he had recently begun to keep with maintenance info.
Effluent pipe had been raised above stream -level.
Stream debris had been removed and stream channel had been recently excavated, apparently by shovel.
sand from streambed piled on banks.
Requested sludge hauling manifests from 2008.
Unevaluated records submitted by Mr Bell since last inspection include some sludge hauling records,
maintenance log, field bench sheets and calibration records.
Page # 2

Y
r.
Permit: NCO051489
Inspection Date: 06/10/2008
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Operations &o Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
n
n
■
n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■
n
n
n
Judge, and other that are applicable?
Comment: Plant appeared in better condition than at previous inspection
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
n
n
n
■
Is all required information'readily available, complete and current?
D
❑
n
■
Are all records maintained for 3'years (lab. reg. required 5 years)?
❑
n
.n
■
Are analytical results consistent with data reported on DMRs?
❑
❑
n
■
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: ORC has submitted some missing data Maintenance log (& notebook/log
inspected today), bench sheet & calibration records.
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?
Page # 3

Y
Permit: NCO051489
Inspection Date: 06/10/2008
Owner,- Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Effluent Pipe
Comment: effluent pipe has been raised above stream level
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for'the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg%1)
Comment: ORC said that maintenance man Mickey had removed all fixed media in
100+ plastic trash bags that had been disposed of in trash
De -chlorination
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?
Are the tablets the proper size and type?
Comment: requested AtC for this as only engineering certification recieved, permit not
yet modified
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Yes No NA NE
Yes No NA NE
■nOn
■nnn
DOn�
■nnn
■nnn
nnn■
OnD■
Yes No NA NE
D ❑ ❑ ■
Page # 4

11I1J.T-�i fi ��IIiY;iI�� 1
June 11, 2008 006
June 11, 2008 002
June 11, 2008 007
rnl%�ir �irs� r
+r/IIt>11fI``jl l / N �r'5+t1111�1�1
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f%%00,11, gulp 11 1�111{IlililIIAllll
June 11, 2008 003
June 11, 2008 008
i a
June 11, 2008 004
June 11, 2008 009
June 11, 2008 005

County:
FORSYTH
River Basin
Report To
WSROSP
Collector:
R PRUITT
Region:
WSRO
Sample Matrix:
Surfacewater
Loc. Type:
Effluent
Emergency Yes/No
COC Yes/No
I Location ID: WSROSPNLC
RECEIVED
MAR
o' ��'p
MAR 2 b 2008
Winston-Salem
Regional Office
`JJ VV J-1a ut allur-y JL'1.1.6V16 Au,)a6GJ
Sample ID: AB27712
•tir,1,5, ! f:
PO Number# 18W1801
�- Date Received: 03/12/2008
Time Received: 09:60
+^rim'. �y':—,•,:`;�s:?r.:s:>
Labworks LoginlD DSAUNDERS
Date Reported: 3/24/08
Report Generated: 03/24/2008
VisitlD
Loc. Descr.: THREE R'S
Collect Date: 03/1112008 Collect Time:: 11:10
Sample Qualifiers and Comments
Sample Depth
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A -Value reported is the average of two or more determinations
61-Countable membranes with <20 colonies; Estimated N3-Estimated concentration is < PQL and >MDL
62-Counts from all filters were zero. NE -No established PQL
83-Countable membranes with more than 60 or 80 colonies; Estimated P-Elevated PQL due to matrix interference and/or sample dilution
134-Filters have counts of both >60 or 80 and < 20; Estimated Q1-Holding time exceeded prior to receipt at lab.
85-Too many colonies were present; too numerous to count (TNTC) 02- Holding time exceeded following receipt by lab
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated PQL- Practical Quantitation Limit -subject to change due to instrument sensitivity
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated U- Samples analyzed for this compound but not detected
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated X1- Sample not analyzed for this compound
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Page 1 of 2

XC DWQQ Laboratory Section 1(esurts oample lu H614/ I I L
Location ID: WSROSPNLC Collect Date: 03/11/2008
L 1
Loc. Descr.: THREE R'S Collect Time:: 11:10
Visit ID
CAS # Analyte Name
PQL Result Qualifier Units
Analyst/Date
Approved By /Date
Sample temperature at receipt by lab
0.4 °C
DSAUNDERS
JGOODWIN
Method Reference
3/12/08
3/12/08
MIC
BOD, 5-Day In liquid
2.0 12 mg/L
ADEXTER
MOVERMAN
Method Reference APHA52106
3/13108
3/20108
WARO
Residue —Suspended in liquid
6.2 1i� mg/L
LBUCK
ESTAFFORD
Method Reference APHA2540D-20th
3/13/08
3/24108
NUT
NH3 as N In liquid 0.02 31 mg/L as N MOVERMAN CGREEN
Method Reference LaclO-107-06-1-J 3/12/08 3/19/08
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

COUNTY %-D A--; 1% I t /
RIVER BASIN: yADR 1 /,v
REPORTTO I/L�J /1 U Regional Office
Other :
COLLECTOR(S)
Estimated BOD Range
DIVISION OF WATER QUALITY
Chemistry Laboratory Report / Water Quality Lab Nul'.Ie
SAMPLE TYP Date Received D �j
PRIORITY Time Received: w<
AMBIENT QA El STREAM EFFLUENT Received By
COMPLIANCE CHAIN OF CUSTODY LAKE INFLUENT
EMERGENCY VISIT ID El ESTUARY ❑ Data Released
(1 Date Reported :
Station Location:
Seed: Chlorinated: BOG l < G Remarks:
Station H/Location Code Dale Begin (yy/mm/dd) Date End (y /mm/d0) Time Begin Time End I Depth - DM, DB, DBM Value Type - A, H, L Composite-T, S, B I Sample Type
COMMENTS:

a
03/19/2008 10:03. 336-9960326
R & A LABORATORIES PAGE 02/03
RESEARCh & ANAI.yTICA1
LAb0RAT0RIES, INC.
Analytical/Process Consultations
NCDENR Date Sample Collected 03/11/08
585 WAUGHTOWN STREET Date Sample Recej.ved 03/11/08
WINSTON-SALEM, NC 27107 Date Sample Analyzed 03/l1/08
Attn: ROSE PRUITT Date of Report 03/19/08
Analyses Performed by KLK-L
Lab Sample Number
--------------------
611seo
Parameter Storet # Results
Fec Coli-MF (31616) 860 col/1.00 ml
-------------
Clients Sample Source 3REFFLUENT
Number
Time Collected (Hrs) 1110
P.O. Box 473. 106 Short Street • Kernersville, North Carolina 27284.336.096.2841 • Pax 336-996-0326
www.randalabs.com

RESEARCh & ANA[yTICA1
Ubo ATORIES, INC.
Anaiytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
WATER ! WASTEWATER I FASC.
i
•
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■ • . •
OA
REQUESTED ANALYSIS
CITY. STATE, ZIP
CONTACTr
�yr rT3/
MON■■■■■■
■■■■■■■■■■■■
■■■
MMI-■■■■■■
■■■■■■■■■■■■
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RECEIVED BY
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'REMARKS:
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03/19/2008 10:03 336-9960326
R & A LABORATORIES
PAGE 01/03
RESEARch & ANA1VTICAI
UbORATORIES, INC.
a,00yticauProcew; Censultauni
Date:
From:
Comments:
FACSIMILE MESSAGE
64'1
� W2�
Research & Analydcal Laboratories, Inc.
Telephone [phone]
Fax [phone]
Gar
Pages to Follow:
Mailing Address: Shipping Address:
PO Box 473 106 Shout Street
Kernersville, NC 27285 Kernersville, NC 27284

Report to: liJS }j (7 WATER QUALITY SECTION
CHAIN OF CUSTODY (COC) RECORD
NC DENR/DWQ LABORATORY (check one): [srCENTRAL [ ] ARO [ ] WaRO
Page i of
For Investigation of: 2
J 9
/V)
Sample collector (print name)
and DM -I forms completed by: � 05X �i� t
Sample collector's signature:
Field storage conditions and location (when applicable):
Lab Use Only `
LAB NO.
STATION NO.
STATION LOCATION
DATE
SAMPLED
TIME
SAMPLED
NUMBER
OF
CONTAINERS
Relinquishe y(sign�atu�rej �:
D to
Time
Received by (signature):
Date
Time
Relinquished by (signature):
Date
Time
Received by (signature):
Date
Time
Relinquished by (signature):
Date
Time
Received by (signature):
Date
Time
Method of Shipment (circle one):
Gat,Courier Hand -delivered Federal Express UPS
Other:
Security Type and Conditions:
Seale by:
Broken by:.
-
1INIKALAtSV1tA1VKY I:HAliN VN l;UJ1VllY - Lab Use Onl
LAB NUMBERS I I I NUMBER ANALYSES' RELINQUISHED RECEIVED DATE TIME
FROM THROUGH BOTTLES REQUESTED BY: BY:
QA\Forms\Sample Receiving\COC form WQ 4/10/Oldbs

,✓ty3 .Saa � � s n
z •t, 30 7

DIVISION OF WATER QUALITY
Chemistry Laboratory Report / Water Quality
'
COUNTY
c 1 j %
3 1) / /
PRIORITY
� SAMPLE TYPE
RIVER BASIN :
/
,D ' /V
AMBIENT QA
STREAM 171 EFFLUENT
REPORT TO
VV S Q Regional Office
` COMPLIANCE CHAIN OF CUSTODY
LAKE ❑ INFLUENT
Other :
EMERGENCY VISIT ID
ESTUARY
COLLECTOR(S)
Lab Number
Date Received:
Time Received
Received By
Estimated BOD Range: Station Location: 3 %)
Seed: Chlorinated: Remarks:
Station #/Location Code Date B gin (yy/mm/dd) Date End (yr/mm/d) Time Begin Time End I Depth - DM, DB, DBM Value Type- A, H, L Composite-T, S, B I Sample Type
BOD 310 mg/L
COD High 340 mg/L
COD Low 335 1119/1-
Coliform: MF Fecal 31616 /1001111
Coliform: MF Total 31504 /1001n1
Coliform: tube Fecal 31615 /100m1
Coliform: Fecal Strep 31673 /100ml
Residue: Total 500 mg/L
Volatile 505 mg/L
Fixed 510 mWL
Residue: Suspended 530 mg/L
Volatile 535 mg/L
Fixed 540 mg/L
pH403 units
Acidity to pH 4.5 436 mg/L
Acidity to pH 8.3 435 mg/L
Alkalinity to pH 8.3 415 mglL
Alkalinity to pH 4.5 410 mg/L
TOC 680 mg/L
Turbidity 76 NTU
Coliform Total Tube /100 ml
COMMENTS:
Chloride 940 mg/L
Chlorophyll a EPA 445.0 modified option ug/L
Color: True 80 c U.
Color: (pH) 83 pH= c U.
Color: pH 7.6 82 c u.
Cyanide 720 mg/L
Fluoride 951 mg/L
Formaldehyde 71880 mg/L
Grease and Oils 556 mg/L
Hardness Total 900 mg/L
Specific Cond. 95 umhos/cm
MBAS 38260 mg/L
Phenols 32730 ug/L
Sulfate 945 malL
Sulfide 745 mg/L
Boron
Tannin & Lignin ug/L
Hexavalent Chromium ug/L
Bicarbonate mg/L
Carbonate mg/L
Total Dissolved Solids mg/L
NH3 as N 610 mg/L
TKN an N 625 mg/L
NO2 plus NO3 as N 630 mg/L
P: Total as P 665 mg/L
PO4 as P 70507 mg/L
P: Dissolved as P 666 mg/L
K-Potassium mg/L
Cd- Cadmium 1027 ug/L
Cr-Chromium:Total 1034 ug/L
Cu- Copper 1042 ug/L
Ni-Nickel 1067 ig/L
Pb- Lead 1051 ug/L
Zii- Zinc 1092 ug/L
V-Vanadium ug/L
Ag- Silver 1077 ug/L
Al- Aluminum 1105 ug/L
Be- Beryllium 1012 ug/L
Ca- Calcium 916 mg/L
Co- Cobalt 1037 ugfl.
Fe- Iron 1045 ug/L
Mo-Molybdenum ug/L
Sb-Antimony ug/L
Sn-Tin ug/L
TI-Thallium ug/L
TrTitanium ug/L
Hg-1631 ng/L
Li -Lithium 1132 ug/L
Mg- Magnesium 927 mg/L
Mn-Manganese 1055 ug/L
Na- Sodium 929 mg/L
Arsenic.Total 1002 ug/L
Se- Selenium 1147 ugfL
Hg- Mercury 71900 ug/L
Ba-Banunl ug/L
Organochlorine Pesticides
Organophosphorus Pesticides
Organonitrogen Pesticides
Acid Herbicides
Base/Neutra]&Acid Extractable Organics
TPH Diesel Range
Forgeable Organics (VOA bottle req'd)
TPH Gasoline Range
TPH/BTEX Gasoline Range
Phytoplankton
Temperature on arrival (°C):

N
W
W
A
N
F
Certificate No. 5495
a
STATE OF NORTH CAROL_INA DEPARTMENT OF THE
ENWRONMENT AND NATURAL RESOURCES
®QVISION OF WATER QUALITY
LABORATORY CERTIFICATION PROGRAM
bra ac=dlance with Me pravi&ws of N.C,C_S. 143-215 3 (a) (1). 143.255.3 (a)(IO) and NCAC 2H-GM-
FiMd Parameter Only
•
r -
r���'• r d�
SELL ENTERPRISES
Is hweby certified 8o perform environ-ental anaWis as fisted cn Attachment t and report rr mrT mV data to DWQ for
coa**ance widz NPDES effluent, surface water grmvxAaate-r, and prebeatrrremt regrdatkm&
By reference 15A NCAC 2H .0800 is made a part of d7is certificate.
Ttris cerbfmate does not guarantee vabelity of data generated, but vxDcates the roethodalogy equprment, 4uaMy control procedures,
retard% and profwjemty of the faboratwy trace been exanuned and found to be aaceptaNe.
This aertif cafe sfmg be uetid urW December 31, 2008
Pat DorxaeAy

Print Preview http://maps2.co.forsyth.nc.us/geodata/printPreview.aspx?PrintOptDa...
Forsyth County, NC
4212 5292 T z 2
41155199
4419 5699
PIN
6832-81-3240
Property Address
170 Jones Rd
Block Lot
2712 009C
Additional Lots
011, 013C
Tax Jurisdiction
Winston-Salem
Anx
Y
Taxable Owner Name I
BOLES, BARBARA M
Taxable Owner Name2
Taxable Owner Address
5240 Main St
Taxable Owner City St Zip
Winston Salem, NC 27107-7434
Taxable Deed Bk-Pg
1482-519
Taxable Deed Date
4/17/1985
Taxable Deed Stamps
$21.50
New Owner Name 1
New Owner Name2
New Owner Address
New Owner City St Zip
New Deed Bk-Pg
New Deed Date
New Deed Stamps
Map Number 636818
W/P Work In Process
Land Value $1
Dwelling Value $1
Commercial Value
Industrial Value
Misc Imp Value
Total Value
Acreage
Sq Ft Living Area (Res)
Gross Sq Ft (Com)
Year Built (Res)
Year Built (Com)
Census Tract
Zoning
Last Qualified Sale Price
36.00
MH
1 of 2 4/30/2008 8:51 AM

Print Preview http://maps2.co.forsyth.nc.us/geodateprintPreview.aspx?PrintOptDa...
Forsyth County, NC
76H' ro l _
4764 8 i 4 U t i 5950 . :.
w �
$74436 r 4U r y 9823 0893 3851
66;i; 1 T
6694 864t {�-
fi622ONES RD
-
5461. '� y, ` ~ r 478 9498
5394
529�1s�"��
�y
�5081Y
p } P —^
0 i669 '. LI 7630
'5662
5565
5459 •`
15452
5366 a TM {
5268 203
r r:
_ 6 7816
PIN 6832-71-9685 New Deed Date
Property Address 160 Jones Rd New Deed Stamps
Block Lot 2712 010 Map Number 636818
Additional Lots WIP
Tax Jurisdiction Winston-Salem Land Value $76,361
Anx Y Dwelling Value $76,482
Taxable Owner Name
BECKERDITE, NANCY ANN
Commercial Value
Industrial Value
Misc Imp Value $200
Taxable Owner Name2
Taxable Owner Address
160 Jones Rd
Taxable Owner City St Zip
Winston-Salem, NC 27107-9418
Total Value
$153,043
Taxable Deed Bk-Pg
1560-1311
Acreage
9.95
Taxable Deed Date
Taxable Deed Stamps
New Owner Name
10/10/1986 Sq Ft Living Area (Res)
Gross Sq Ft (Com)
Year Built (Res)
Year Built (Com)
1428
1951
New Owner Name2
36.00
New Owner Address
Census Tract
New Owner City St Zip
Zoning
RS9
New Deed Bk-Pg
Last Qualified Sale Price
1 of 2 4/30/2008 8:52 AM

11/09/2006 23:38
4
TZ OSBORNE WWTF 3 97714631
Steve W. Tedder
Water Quality Regional Supervisor
Winston Salem Region
Division of Water Quality
Subject: N.O,W, Response
Compliance Evaluation Inspection.
Three R's MHP
Permit A NCO051489
Forsyth County -
NO.310
clofy
Post-;RO Fax Note 7671
Date !
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Phone #
-1 ,Permit to construct dechlor system wasn't obtained because system was installed when
-the plant was constructed under the advice of Steve Mauney and Mike Mickey.
The fixed media conversion system was installed while R&A was operating this
facility. Since I have taken over the operations I have been removing -the media over
time as the anchor netting has been deteriorating and letting the media float to the surface
where it is removed.
00=4 2 I will be implementing a new sign in sheet and daily log that will include maintenance
and process control parameters along with instrument calibration.
3 Flow charts are now stored on site in a weather resistant container.
4 Rose Pruitt sent a sample of an Annual Report so I will know how to write it up and
submit it. I am currently gathering the information together for the report and should
have it completed soon. Future reports should be on time.
5 Record keeping: There was and is a visitation log on site, It may not be up to
standards but it was on site at the time of inspection. As mentioned before I will be
implementing a new sign in sheet and daily log book.
6 The leak that caused the dead spot had just occurred and, is not ao ongoing -
problem. The Maintenance supervisor was notified and the problem was repaired
on 5/5/06.
x'jWe are currently in the process of getting our field parameter certifications.
If you have any further questions feel free to contact me. Thanks for your continuing
help and patience.
Randall Ee11
Fr,

11/09/2006 23:38 TZ OSBORNE WWTF 4 97714631 NO.310 P02
Performance Annual Report
General Information
Facility/System, Name: Three R's MID
Responsible Entity: Norman Boles
Verson in Charge/Contact: Randall Bell
Applicable Permit: NCO051489
copy
DESCRIPTION OF COLLECTION SYSTEM OR TREATMENT PROCESS:
This .012 MGD wastewater treatment facility consists of an influent bar screen, aeration
basin, clarifier, Three aerated sludge holding tanks, chlorination, contact chamber, post
aeration, declor and contact tank, and flow monitoring device.
TEXT SUMMARY OF SYSTEM PERFORMANCE FOR CALENDAR YEAR 2005
This facility had a total of thirteen limit violations and three monitoring violations.
LIST BY MONTH VIOLATIONS OF PERMIT CONDITIONS OP OTHER
ENVIROMENTAL REGULATIONS. MONTHLY LIST SHOULD INCLUDE
DISCUSSIONS OF ANY ENVIROMENTAL IMPACTS AND CORRECTIVE;
MEASURES TAKEN TO ADDRESS VIOLATIONS,
January: 1 daily maximum exceeded for fecal colifon-n.
February: Compliant
March: 1 Daily maxirntun exceeded for fecal colifoxm.
April: Compliant
May: Compliant
June: Flow, quarterly nitrogen and quarterly phosphorous were inadvertently missed.
July: Monthly average for flow was exceeded,
August: 1 Daily maximum was exceeded for fecal colifoxm,
September: Compliant
October: Compliant

11/09/2006
23:3e TZ OSBORNE WWTF 4 97714631
NO.310 P03
November: Compliant
December: 8 daily maximums were exceeded ;for chlorine. ORC in,is-read the new
chlorine meter for ultra low chlorine recording and also marked the D.1vl.R.7s wrong by
checking the mg/1 box instead of the ug/l box.
3: NOTIFICATION
This report has been trade available to the owner of the facility for distribution.
4: CERTIFICATION
I certify under penalty of law that this report is complete and accurate to the best of
my knowledge. I further certify that this report has been made available to the users or
customers of the nailed system and that those users have been notified of its availability.
Randall Bell
Responsible Fefson
Title: ORC/Owner
Entity: Bell Enterprises

..� � W,gTF Michael F. Easley, Governor
�• �O �Q William G. Ross Jr., Secretary
O G North Carolina Department of Environment and Natural Resources
Uj
Alan W. Klimek, P.E. Director
Division of Water Quality
'C L
July 11, 2006
CERTIFIED MAIL 7006 0100 0001 8758 6047
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION/RECOMMENDATION FOR ENFORCEMENT
Compliance Evaluation Inspection
Three R's Mobile Home Park
Permit No. NCO051489
Forsyth County
Dear Mr. Boles:
Enclosed please find a copy of the Inspection Report from the inspection conducted May 2, 2006
at Three R's Mobile Home Park. The Compliance Evaluation Inspection was conducted by
Rose Pruitt of. the Winston-Salem Regional Office. Randy Bell, ORC and Bradley Flynt, Backup
ORC were present for the inspection. Also present was Marc Stokes, Technical Assistance,
Winston Salem Regional Office. The inspection consisted of two parts: an on -site inspection of
the treatment facility and a file review. The following are the findings from the subject
inspection.
The treatment facility was found to be in violation of permit NCO051489 for the following:
Compliance issues found during the inspection are:
Inspectionn Area
Compliance Issue
Permit
Facility not as permitted. Dechlor system installed without following
fast track authorization to construct (ATC) notification and approval
process. ( See enclosed fast track application package with minimum
design criteria.)
Previous addition of Fixed Media Conversion System still not
permitted, no ATC submitted. (As noted in 2002 inspection)
Flow Measurement
Flow charts not available at inspection
Record Keeping
Process control data including field parameters tested and equipment
calibrations not available at inspection.
Record Keeping
No annual report for this or previous years- Repeat Violation.
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

a
Three R's
Page 2
July 11, 2006
r
Inspection Area
Compliance Issue
Record Keeping
No ORC visitation log
Operations &
Leak at the pump keeps air from blowing through the last diffuser if
Maintenance
all others are open creating dead spot per ORC. Same dead spot was
noted at last years inspection.
Laboratory
The ORC and backup ORC do not have appropriate field parameter
certification for this facility.
Please refer to the enclosed Inspection Report for any additional observation and comments.
I. Permit
The NPDES permit for the Three R's Mobile Home Park WWTP became effective June 1, 2004
and expires on May 31, 2009. The permitted components of the 0.012 MGD wastewater
treatment plant include: an influent bar screen, aeration basin, clarifier, aerated sludge holding
tank, chlorination, contact chamber, post aeration, and flow monitoring device.
A violation of permit NC0051489 has occurred. Facility not as permitted.
Section E Reporting Requirements: 2. Planned Changes- The permittee shall give notice to
the Director as soon as possible of any planned physical alterations or additions to the
permitted facility [40 CFR 122.41 (1)]. .
You are required by your permit to seek Division approval for any changes made to
treatment processes -A Dechlorination system was installed without following fast track
authorization to construct (ATC) notification and approval process. Attached please find
an Application package that includes: Application Form, Certification Form and System
Minimum Design Criteria for Dechlorination Facilities Authorization to Construct.
Please complete and submit this fast track application immediately.
On reviewing the file for this permit it was noted that during the 2002 inspection that this
facilitywas required to immediately submit a request for Authorization to Construct
(ATC) because of the addition of a Fixed Media Conversion System installed without
approval from this Agency. This ATC was not submitted. Contact the Construction
Grants and Loans Section immediately. Attached find ATC application form and
guidance documents
Apply for retroactive ATC's immediately.

Three R's
Page 3
July 11, 2006
II. Records/Reports
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Three R's
Mobile Home Park WWTP for the period January 2005 through December 2005 revealed that
the facility had a total of thirteen limit violations and three monitoring violations. The daily
maximum was exceeded eight times in December 2005 for Total Residual Chlorine and once for
Fecal Coliform. An enforcement case was issued for these violations. Daily maximums were
exceeded for Fecal Coliform in January, March and August 2005. The monthly average was
exceeded for Flow in July 2005. A Notice of Violation was issued by the Division for these
violations. Monitoring frequency violations were noted for Flow, Quarterly Nitrogen and
Quarterly Phosphorus in June 2005.
Lab data and chain of custody, forms were available.
Violations were found in the following records:
(1) No annual report for this or previous year. Repeat Violation
Part II Standard Conditions for NPDES Permits, Section E. Reporting.
Requirements (12) Annual Performance Reports:
Permittees who own or operate facilities that collect or treat municipal or domestic waste
shall provide an annual report to the Permit Issuing Authority and to the
users/customers served by the Permittee (NCGS 143-215.1C). The report shall
summarize the performance of the collection or treatment system, as well as the extent to
which the facility was compliant with applicable Federal or State laws, regulations and
rules pertaining to water quality. The report shall be provided no later than sixty days
after the end of the calendar or fiscal year, depending upon which annual period is used
for evaluation.
To help you in preparing this report I have enclosed a blank Performance Annual Report
guidance document for your use. Also a copy of the letter from the Director of the Division of
Water Quality pertaining to this matter is enclosed.
(2) No Daily Operators Log/ ORC Visitation Log.
Part II Standard Conditions for NPDES Permits, Section C. Operation and
Maintenance of Pollution Controls (1) Certified Operator... The ORC of each Class
U, HI and IV facility must: Visit'the facility at least daily, excluding weekends and
holidays, Properly manage and document daily operation and maintenance of the
facility.

Three R's
Page 4
July 11, 2006
(3) No process control data (including field parameters tested and equipment
calibrations).
Part II Standard Conditions for NPDES Permits, Section C. Operation and
Maintenance of Pollution Controls (2) Proper Operation and Management: The
permittee shall at all times provide the operation and maintenance resources necessary to
operate the existing facilities at optimum efficiency... Proper operation and
maintenance also includes adequate laboratory controls and appropriate quality
assurance procedures.
III. Facility Site Review
The facility site review indicated that the 0.012 MGD treatment works is not consistent with the
permitted components. The permitted treatment system consists of an influent bar screen,
aeration basin, clarifier, aerated sludge holding tank, chlorination, contact chamber, post aeration,
and flow monitoring device.
Additions noted but not permitted; dechlorination unit, addition of fixed media conversion
system (see section I. Permit.above).
IV. Effluent / Receiving Stream
The WWTP discharges to Leak Creek a class C water in the Yadkin -Pee Deer River Basin. The
effluent was clear and free of visible solids on the date of inspection. The receiving stream was
free of solids, foam and debris.
V. Flow Measurement
Effluent flow is measured with a Stevens model 61R flow meter._ Meter calibration records
indicate it was last calibrated June 3, 2005 by Horizon Engineering & Consulting.
Deficiencies were found in the following records:
Flow charts were not available as requested for the inspection.

Three R's
Page 5
July 11, 2006
VI. Self -Monitoring Program
A review of the Discharge Monitoring Reports (DMRs) for the Three R's Mobile Home Park
WWTP for the period January 2005 through December 2005 revealed that the facility had a total
of thirteen limit violations and three monitoring violations. The daily maximum was
exceeded eight times in December 2005 for Total Residual Chlorine and once for Fecal
Coliform. An enforcement case was issued for these violations. Daily maximums were
exceeded for Fecal Coliform in January, March and August 2005. The monthly average was
exceeded for Flow in July 2005. A Notice of Violation was issued by the Division for these
violations. Monitoring frequency violations were noted for Flow, Quarterly Nitrogen and
Quarterly Phosphorus in June 2005.
VII. Compliance Schedules
No compliance schedules to evaluate.
VIII. Laboratory .
All of the contract lab sample analyses are conducted by Tritest Labs. The laboratory was not
reviewed at the time of the subject inspection.
Violations were found in the following records:
The ORC and backup ORC do not have appropriate field parameter certification for this
facility.
Please contact DWQLab Certification at the Chemistry Lab immediately. Tonja Springer
maybe contacted at 919-733-3908 ext 254.
IX. Operation and Maintenance
Operation and maintenance at the time of the subject inspection was deemed unsatisfactory.
Deficiencies were found in the following areas:
(1) A dead spot noted in the aeration basin at last years inspection was still there.
According to the ORC a leak at the pump keeps air from blowing through the last diffuser if
all others are open creating a dead spot. The same dead spot was noted at last years
inspection.
(2) Dechlorination feed ratio was not proportional to the chlorine amount.
(3) Weirs were blocked by algae.
(4) The chlorine contact chamber contained solids.
(5) The bar screen was submerged.

Three R's
Page 6
July 11, 2006
Section C. Operation and Maintenance of Pollution Controls (2) Proper Operation and
Management: "The permittee shall at all times provide the operation and maintenance
resources necessary to operate the existing facilities at optimum efficiency. The Permittee
shall at all times properly operate and maintain all facilities and systems of treatment and
control (and related appurtenances) which are installed or used by the Permittee to achieve
compliance with the conditions of this permit."
X. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of
properly. Forsyth Rooter last hauled sludge for this facility on May 1, 2006.
XI. Pretreatment
Not evaluated during this inspection. No pretreatment program required.
XII. Stormwater
Not evaluated during this inspection.
XIV. Sewer Overflow
None to report.
XV. Pollution Prevention
Not evaluated during this inspection.
XVI. Multimedia
Not evaluated during this inspection.
Please refer to the enclosed Inspection Report for any additional observations and comments.
Technical assistance is available to you. Please contact Marc Stokes the Wastewater Treatment
Plant Consultant, in the Winston Salem Regional Office at 336-771-4952.

Three R's
: Page 7
July 11, 2006
As a condition of your permit, you are required to comply with all conditions of this
permit. Any permit noncompliance constitutes a violation of the Clean Water Act and is
grounds for enforcement action; for permit termination, revocation and reissuance, or
modification; or denial of a permit renewal application [40CFR 122.411. Under state law, a
civil penalty of not more than $25,000 per violation may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of a
permit. [North Carolina General Statutes § 143-215.6A]
The Winston-Salem Regional Office is considering preparation of an enforcement action for the
violation of permit conditions. To prevent further action, carefully review these violations and
deficiencies and respond in writing to this office within fifteen (15) working day of receipt of
this letter. You should address the causes of noncompliance and all actions taken to prevent the
recurrence of similar situations. If you should have any questions, please do not hesitate to contact
Rose Pruitt at 336-771-5000.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments
Cc: Randall Bell, PO Box 1291 Clemmons NC 27012
Central Files w/ attachments
'7S'RC3 / a � -km. . t
70
Forsyth County HeaM Dept w/attachments
Tonja Springer, DWQ Lab Certification, Chemistry Lab.
Marc Stokes, Technical Assistance
Construction Grants and Loans

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 INI 2 I5I 31 NCO051489 Ill 121 06/05/02 117 181CI 191SI 20I II
Remarks
2111111111 1111 1111 I III 1 1 1 1 1 1 1 1 1 1 1 1 1 LI I I III III 11116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA -------------------- ------ Reserved --- ------------------
671 169 701 21 711 1 721 N 1 73 L_L_J 74 751 1 1 1 1 1 1 1 80
Section B: Facility 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)
11:45 AM 06/05/02 05/05/01
Three R's Mobile Home Park
Exit Time/Date Permit Expiration Date
170 Jones Rd
Winston Salem NC 27107 12:50 PM 06/05/02 09/05/31
Name(s) of Onsite Representative (s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
Bradley Todd Flynt/ORC/336-373-7740/
Randall Keith Bell/ORC/336-373-7740/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Randall Keith Bell,5240 S Main St Winston Salem NC 27107//336-766-962r6/
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ■ Flow Measurement E Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal 0 Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summaryof Find in/Comments Attach additional sheets of narrative and checklists as necessa
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Rose Pruitt WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

r
NPDES yr/mo/day Inspection Type (cont.) 1
NC0051489 I11 12I 06/05/02 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The inspector was met at the facility by the ORC Randy Bell and backup ORC Bradley Flynt. At the time of
the inspection the effluent was clear and free of solids. Repeat violations and serious compliance issues .
were noted during the inspection.
The facility is not as permitted.
No Authorization to Construct (ATC) has been submitted for the addition of a dechlor unit.
Attached find a fast track application for Dechlorination Facilities and related documents.
Review of past Compliance Evaluations has revealed that this facility was advised in 2002 to
immediately submit an ATC for the Fixed Media Conversion System that had been added. This does
not appear to have been done.
No annual report has been issued for this or the previous 2 years despite this facility recievi ng. notice of
violation during 2 previous inspections.
Field parameter certification has not been obtained for this facility by the ORC or Backup ORC.
Process control data including field parameters tested and equipment calibrations was not available at the
inspection.
The .ORC visitation/ daily operators log was not available at the inspection.
Effluent flow charts were not available at the inspection.
The chlorine contact chamber was cloudy, there was algae growth on the clarifier weirs, and the bar screen
was submerged. The dead spot noted in last years inspection was -still there and was attributed by the ORC
to a leaky air pump that would not allow air to reach that diffuser if the other diffusers were in use.
Page # 2

r
Permit: NCO051489
Inspection Date: 05/02/2006
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping? ■
D
D
D
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■
D
D
D
Judge, and other that are applicable?
Comment:
Permit Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? D
D
■
D
Is the facility as described in the permit? D
■
D
D
# Are there any special conditions for the permit? D D ■ D
Is access to the plant site restricted to the general public? ■ ❑ ❑ D
Is the inspector granted access to all areas for inspection? ■ D D D
Comment: Facility not as permitted. Dechlor system installed without following fast
track authorization to construct notification and approval process. Enclosed fast track
app package with minimum design criteria.
Previous addition of Fixed Media Conversion System still not permitted.
Record Keeping
Yes
No
NA
NE
A'e records kept and maintained as required by the permit?
D
■
D
D
Is all required information readily available, complete and current?
D
■
D
D
Are all records maintained for 3 years (lab. reg. required 5 years)?
D
■
D
D
Are analytical results consistent with data reported on DMRs?
■
D
D
D
Is the chain -of -custody complete?
■
D
D
D
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?
D
D
D
■
Has the facility submitted its annual compliance report to users and DWQ?
❑
MOD
(if the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
D
D
■
D
Is the ORC visitation log available and current?
fl
■
❑
D
Is the ORC certified at grade equal to or higher than the facility classification?
■
❑
D
D
Page # 3

Permit: NCO051489
Inspection Date: 05/02/2006
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Record Keeping
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: No annual report for this or previous years- repeat violation.
No ORC visitation log.
Process control data including field parameters tested and equipment calibrations not
available at inspection.
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:
Flow Measurement - Effluent
# 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: Flow charts not available at inspection.
Aerobic Digester
Is the capacity adequate?
Is the mixing adequate?
Is the site free of excessive foaming in the tank?
# Is the odor acceptable?
# Is tankage available for properly waste sludge?
Comment:
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Yes No NA NE
■nnn
■nnn
■nnn
nnn■
Page # 4

}
r
Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 05/02/2006 Inspection Type: Compliance Evaluation
Bar Screens
Yes No
NA
NE
Is disposal of screening in compliance?
■
❑
Is the unit in good condition?
❑
❑
❑
m
e
Comment: Bar screen was submerged.
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
n
n
O
Is the site free of excessive buildup of solids in center well of circular clarifier?
n
n
■
Are weirs level?
■
❑
Is the site free of weir blockage?
❑
■
n
n
Is the site free of evidence of short-circuiting?
■
n
n
n
Is scum removal adequate?
■
❑
n
❑
Is the site free of excessive floating sludge?
■
❑
❑
0
Is the drive unit operational?
n
❑
■
Is the return rate acceptable (low turbulence)?
n
n
n
■
Is the overflow clear of excessive solids/pin floc?
■
n
n
n
Is the sludge blanket level acceptable? (Approximately %< of the sidewall depth)
❑
n
❑
Comment: Excessive algae growth on weirs
Aeration Basins
Yes
No
NA NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
❑
■
❑
❑
Are surface aerators and mixers operational?
❑
■
n
n
Are the diffusers operational?
❑
■
n
n
Is the foam the proper color for the treatment process?
■
n
n
n L
Does the foam cover less than 25% of the basin's surface?
■
❑
❑
fl
Is the DO level acceptable?
n
n
n
■
Is the DO level acceptable?(1.0 to 3.0 mg/1)
❑
❑
❑
■
Comment: ORC says air leak at the pump keeps air from blowing through the last
diffuser if all others are open creating dead spot. Same dead spot was noted at last
years inspection.
De -chlorination
Yes
No
NA NE
Page # 5

e
l
Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 05/02/2006 Inspection Type: Compliance Evaluation
De -chlorination
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
n
n
o
Is storage appropriate for cylinders?
■
# Is de -chlorination substance stored away from chlorine containers?
❑
■
❑
n
Comment: 4:1 ratio. .
Dechlor bucket stored in open next to bucket of chlorine. This may present a safety
problem.
Are the tablets4he proper size and type? ::.
■
n
n
Are tablet de -chlorinators operational?
■
Cl
❑
❑
Number of tubes in use?
1
Comment: Dechlor unit not authorized in permit, no ATC submitted.
Laboratory
Yes
No
NA
NE
Are field parameters performed by certified personnel or laboratory?
❑
■
n
0
Are all other parameters(excluding field parameters) performed by a certified lab?
■
n
# Is the facility using a contract lab?
■
n
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
n
n
n
■
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
fl
❑
❑
■
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
n
n
■
Comment: The ORC and backup ORC do not have appropriate field parameter
certification for this facility.
Tritest Lab used for other testing.
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
n
Are the tablets the proper size and type?
■
❑
❑
n
Number of tubes in use?
4
Is the level of chlorine residual acceptable?
n
n
n
■
Is the contact chamber free of growth, or sludge buildup?
n
■
❑
n
Is there chlorine residual prior to de -chlorination?
n
n
n
■
Comment: The contact chamber was cloudy.
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
n
n
■
Page # 6

Permit: NCO051489
Inspection Date: 05/02/2006
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Effluent Sampling
Yes
No
NA
NE
Is sample collected below all treatment units?
❑
Is proper volume collected?
fl
❑
M
Is the tubing clean?
❑
❑
❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑
❑
❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
n
■
n
n
Comment: Freqency violations in June 2005 for flow (6/5), Quarterly Nitrogen total,
Quarterly Phosphorus total.
Upstream / Downstream Sampling
Yes
No
NA
NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■
n
n
n
Comment:
Page # 7

i
State of North Carolina .
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for DECHLORINATION FACILITIES A UTHORIZATION TO
CONSTRUCT
THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL
INSTRUCTIONS: Indicate that you have included the following list of required application package items by
signing your initials in the space provided next to each item. Failure to submit all required items will lead to return
of the permit application.
A. Application Form - Submit one original and one copy of the completed and appropriately
executed application form. -Any changes to this form will result in the application being returned.
The Division of Water Quality (the Division) will only accept application packages that have been
fully completed with all applicable items addressed. You DO NOT need to submit detailed plans
and specifications at this time Plans and specifications shall be maintained on -site.
B. Certification Form - Submit the completed engineers certification form signed and sealed by a
professional engineer registered in the state of North Carolina.
C. Designated Representative - If the application is being filed by a party other than the owner, a
letter from the owner designating the applicant as his/her authorized representative must be
included.
D. Read, understood, and followed the Dechlorination System Minimum Design Criteria
(adopted 4/18/03 and as subsequently amended).
THE COMPLETED APPLICATION PACKAGE SHOULD BE SENT TO THE FOLLOWING
ADDRESS:,
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
CONSTRUCTION GRANTS & LOANS SECTION
By U.S. Postal Service: By Courier/Special Delivery:
1633 Mail Service Center 2728 Capital Blvd., Rm. 1F-140
Raleigh, North Carolina 27699-1633 Raleigh, North Carolina 27604
Telephone Number: [phone]
For more information, visit our web site at hitp✓/www.nccgLnetl
FORM: DCL 4/2003

Certification
Fast -Track Authorization to Construct for Dechlorination Facilities
Professional Engineer's Certification:
attest that this application for
has been reviewed by me and is accurate,
complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation. I further attest that the proposed design has been prepared in accordance with all applicable
regulations and Minimum Design Criteria for Dechlorination Facilities, adopted April 18, 2003. Although certain
portions of this submittal package may have been prepared by other professionals, inclusion of these materials under
my signature and seal signifies that I have reviewed this material and have judged it to be consistent with the
proposed design.
NOTE: In accordance with NC General Statutes 143-215.6A and 143-215.613, any person who knowingly makes
any false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor
which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. Furthermore,
failure to design the above referenced facilities in accordance with Minimum Design Criteria for Dechlorination
Facilities and good engineering practice could subject you to disciplinary action by the North Carolina Board for
Professional Engineers and Land Surveyors.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification:
I , attest that this application for
has been reviewed by me and is accurate
and complete to.the best of my knowledge. By signing this certification I, certify that facilities have been designed
in accordance with the Division's Dechlorination System Minimum Design Criteria, and commit to insure
construction proceeds in accordance with said criteria. NOTE: In accordance with NC General Statutes 143-215.6A
and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000 as well as civil
penalties up to $25,000 per violation.
Signature: Date:
FORM: DCLC 4/2003

. e
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION FORM
for DE CHL ORINA TION FACILITIES A UTHORIZATION TO
CONSTRUCT
THIS FORMMAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL
1. Facility Name:
2. Facility Permit Number:
3. Facility Address:
4. Contact Person:
5. Contact Telephone:
6. Project Description:
FORM: DCLb 4/2003

Dechlorination System Minimum Design Criteria
Adopted April 18, 2003
Introduction
The Triennial Review Committee's move to adopt a fresh water standard for total residual
chlorine (TRC) is driving the implementation of TRC. effluent limitations for facilities that use
chlorine or a chlorine derivative for disinfection. Such a limit may necessitate the use of a
dechlorinating agent such as sulfur dioxide or a sulfite derivative. The relatively simple nature
of dechlorination affords the Division the opportunity to develop a fast -track permitting
strategy for approval of such systems. The minimum design criteria outlined herein are meant
to provide the regulated community and their engineers the information necessary to ensure
proper system design and rapid project turn -around.
Applicability
This criteria document applies to the design of sulfur dioxide and sulfite derivative systems.
Facilities proposing to employ an alternate means for dechlorination, such as activated carbon,
are required to follow the standard authorization to construct (ATC) permitting process.
Design Criteria
1.0 Dosage Rates
The following dosage rates are to be used for the design of dechlorination systems. These
dosage rates constitute the stoichiometric requirement plus a 10% margin of safety'.
R
ti.
i�
..r wxa .., n; x.• v w.
Llosri Rafe . a
"POW U; •�, r'
g -
Sulfur Dioxide 'm 10 /L SOzp-- -g - er m /L Ch removed
----- -- ----------------- ---
Sodium Bisulfite 1.6 mg/L NaHSO3 per mg/L C12 removed
-------- - - ---------------------------------------------
Sodium Metabisulfite 1.5 mg/L Na2S2O5 per mg/L C12 removed
2.0 Duality Requirements
Designs shall include dual feed systems to insure compliance with residual chlorination
limitations in the event the primary (if one is designated) system fails.
1 Recommended Standards for Wastewater Facilities; Great Lakes -Upper Mississippi River Board of State
and Provincial Public Health and Environmental Managers; page 100-7, 1997 Edition.

Dechlorination System Minimum Design Criteria
3.0 Feed Systems
3.1 Sulfur Dioxide
Gaseous sulfur dioxide feed systems shall employ vacuum pumps and carbon steel or stainless
steel piping. For aqueous solutions, PVC, PE, CPVC, or rubber tubing are acceptable piping
alternatives.
3.2 Sulfite Derivatives
Feed systems for both sodium bisulfite and sodium metabisulfite solutions shall employ
positive displacement pumps and stainless steel piping.
4.0 Mixing
Proper turbulent mixing should be provided such that the dechlorinating agent is completely
mixed within 20 seconds of application. Designs shall provide no less than 30 seconds detention
time for mixing?
5.0 . 'Chemical Storage
The dechlorinating agent storage area must route solution spills or leakage to a containment
area. Chlorine and sulfur dioxide are to be stored separately in well -ventilated areas.,
6.0 Effluent Quality
Dechlorination consumes alkalinity and exerts an oxygen demand. As such, proper
consideration must be given to effluent pH and dissolved oxygen to ensure that both
parameters are within acceptable ranges at the point of discharge.
2 Recommended Standards for Wastewater Facilities; Great Lakes -Upper Mississippi River Board of State
and Provincial Public Health and Environmental Managers; page 100-8, 1997 Edition.
Version 4.18.2003
Page 2 of 2

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
1 • •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
October 19, 1999
Dear Wastewater System Owner or Operator,
House Bill 1160, the Clean Water Act of 1999, was ratified by the North Carolina General
Assembly on July 20 and signed into law by the Governor on July 21, 1999. This legislation has placed
significant, new reporting requirements on those entities that own or operate wastewater treatment and
collection systems. This letter is provided as guidance to assist you in meeting this aspect of the new .
reporting requirements.
Spill Notification
One of the new requirements that became effective October 1, 1999 for all wastewater facilities
that collect or treat wastewater is that they must notify the public of wastewater spills. Wastewater facility
owners or operators must issue a press release after a discharge to surface waters of 1,000 gallons within
48 hours of first knowledge of the spill by the owner/operator. The law requires that the press release must
be issued to "all electronic and print news media outlets that provide general coverage in the county where
the discharge occurred." A copy of the press release must be maintained for one year by the
owner/operator. This press release is required in addition to the permit requirement of contacting the
North Carolina Division of Water Quality (DWQ). A list of media outlets, sorted by County, and a sample
press release are attached for your reference.
If a discharge of 15,000 gallons or more reaches surface water, a public notice is required in addition
to the press release. The public notice must be placed in a newspaper having general circulation in the County
in which the discharge occurred and the county immediately downstream. A sample public notice format is
also enclosed for your reference. If a discharge of 1,000,000 gallons of wastewater or more reaches surface
waters, the DWQ regional office must be contacted to determine in what additional counties, if any, a public
notice must be published. A copy of all public notices and proof of publication must be sent to the DWQ to
the attention of "NDCEU" at the letterhead address within 30 days of publication. A sample public notice is
attached for your reference. The minimum content of the notice is the location of the discharge, estimated
volume, water body affected, steps taken to prevent future discharges and a phone number and contact name.
Annual Report
Another new requirement is that the owner or operator of any wastewater treatment works or
wastewater collection systems that treats or collects primarily domestic or municipal waste must provide an
annual report to its users or customers and to the Department of Environment and Natural Resources that
summarizes the treatment works' or collection system's performance over a 12 month period. The
following is provided as guidance to assist you in meeting this aspect of the new reporting requirements.
The new law states the above mentioned report shall summarize the performance of the treatment
works or collection system and state the extent to which any terms of its permit, federal laws, or any State
laws, regulations or rules related to the protection of water quality have been violated. In order to meet the
spirit of this law, it is strongly suggested that, at a minimum, the report contain the following information:
I. General Information
Name of regulated entity
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
ployer 50% recycled/10% post -consumer paper
An Equal Opportunity Affirmative Action Em

• Responsible entity, person or contact with phone number or address
• Listing of applicable permit(s)
• Description of collection or treatment system or process
H. Performance
Description of overall 12 month performance, noting highlights and deficiencies.
By month, list of the number and type of any violations of permit conditions, environmental
regulations or environmental laws, including (but not limited to):
Pen -nit Limit Violations
Monitoring and Reporting Violations
(Illegal) Bypass .of treatment facilities*
Sanitary Sewer Overflows*
*Note estimated total monthly volumes and locations of events in which more than1,000 gallons
of waste reached surface waters.
Description of any known environmental impact of violations
Description of corrective measures taken to address violations or deficiencies
III. Notification
• Statement as to how users or customers have been provided access to the report.
IV. Certification
• Statement by a responsible official certifying the report is accurate and complete .
It shall be left to the individual applicable entities to decide both how much detail above minimum
they wish to provide in the report and how they will provide the report to their users or customers. This law
was established to provide a mechanism for public oversight (and hopefully, to instill public confidence).
Those entities that fall under the scope of this part of the law are encouraged to be forthcoming in their
report and they should provide its readers a contact where they may view more detailed information. To
satisfy the Departmental -reporting requirement, three copies of the report should be submitted to the
following address:
System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Annual reports must be submitted within 60 days of the end of the applicable 12-month review period.
You may base your report on either a calendar year or a fiscal year (July 1— June 30) time frame. Initial
reports must be prepared and submitted for either the 1999 calendar year or the 2000 (beginning July 1,
1999) fiscal year. A sample format has been provided to you as an attachment to this letter.
As was noted at the beginning of this letter, there are several new reporting requirements as a
result of the Clean Water Act of 1999. As a stakeholder in environmental regulation, you are encouraged
to review the entire scope of the Act to see if other part apply to your operations. A copy of the Act can be
can be viewed on the North Carolina General Assembly's web site at
htti)•//www ncga state nc us/htmll999/bills/ratified/house/hbil1160.full.html.
If you have any questions, please contact your DWQ Regional Office or [phone] ask for
the Non -Discharge Compliance and Enforcement Unit for the spill notice requirements or the Point Source
Compliance and Enforcement Unit for the Annual Report requirement.
Sincerely,
Kerr T. Stevens

performance Annual Report
I. General Information
Facility/System Name:
Responsible Entity:
Person in Charge/Contact:
Applicable Permit(s):
Description of Collection System or Treatment Process:
II. Performance
Text Summary of S}Tstem Performance for Calendar Year.--------,
List (by month) any violations of permit conditions or other environmental regulations. Monthly
lists should include discussion of any environmental impacts and corrective measures taken to
address violations.

. a
` February
Etc.
Ill. Notification
of the system and how those
Statc how this report has been made available to users or customers
users have been notified of its availability.
I-/_ certification
I certifyunder penalty of law that this report is complete and accurateable to the
users or customers of
est Of MY
that this report has been made available knowledge. I further certify P
the named system and that those users have been notified of its availability_
Date
ResponsiUle Person
Title
Entity

Faxed To: Randall Bell
Fax #: -Malr- ` eAJY Phone [phone]
WWTP Annual Inspection Checklist
This information should be available to the inspector at inspection time.
Facility: Three Rs MHP WWTP NPDES: NCO051489
Permit Effective Dates: June 1, 2004 to May 31, 2009 f / ' _(�
Inspection Date: / ZO0 ca Inspection Time:
l DMRs (Dates: January 2005 to December 2005 )
✓2) Lab Data (per DMR dates)
t,�3_) Laboratories used for analysis & certification #'s
: < Chain of Custody forms (per DMR dates)
5) Complete co y of current NPDES permit
atus of SOC or Moratorium issuance (if appli9ble) 'n-C�lb�
ORC and Back-up ORC current certification
.:+)vz� Wastewater Anindal Report (fiscal or calendar year - if applicable) y\,D
Daily Operator's log / ORC visitation log
Maintenance log
11 - Process control data (which includes field parameter tested and equipment
calibrations) I\j C_- ZPpb
Field Parameter certification (if applicable)
13) Flow meter calibration records (if applicable)
144___k44Fe A a-nefer effluent samplers
? r�� Flow charts (if applicable)
s-peetion / under load checks
-,-V) Spill Response Plan (with current emergency contact numbers)
C / Residuals permit (if applicable)
✓l9) Sludge/ Residuals hauling records (if applicable) -
Annual Report (if applicable) -
d41) Plant visual inspection of treatment units
L�-Z2) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office
[phone]
Fax: [phone]
U0,

Horizon Engineering & Consulting, Inc.
2510 Walker Road
Mt. Pleasant, N.C. 28124
Ph.: 704-788-4455
Fax: [phone]
To: Rose Pruitt
From: J. Thurman Horne, P.E.
Date: May 2, 2006
Fax No.: 336-771-4630
Subject: Three R MW
Meter calibration record sheet
Message:
Ms. Pruitt,
No. of pages: 2
(includu1g cover)
NO.719 D01
Attached is a copy of the report.
Please call me if you have any questions or need my additional information (704-788-4455.)
Thanks!

05/02/06 12:40 HORIZON ENGINEERING & CONSULTING 3367714630 NO.719 902
Horizon Engyneer ng & Consu tinq, Inc.
2510 Wa or Road
Mt, Pleasant, KC, 28124
704.70E-4455
Fax [phone]
Flow Meter Calibration Data .Sheet
Facility Name:
ZJM A
R City: &h;4&6- g!QAdk2State: N.C.
Of
Utility Name:
/��
. c
Primary Device we' etc.): ?� - Ll-'Vt al
Flow Meter Manf.: yei+s
Model: !2?I Serial No. /o7ZZJ- 82
Type:
Bubbler:
Ultrasonic: Other: A16011-
1. Primary Device:
Comments_
A.
Level
_ yes no
B.
Free Flow
✓ yes no
C.
Turbulence
yes ✓ no
D,
Blockage
yes ----no
E.
Surface
Buildup
yes no
F.
Properly
Mounted
ryes no
Il. Meter:
A.
Programmed correct yes no WMP't �O.9&2L1er
B.
Calibration:
1. Calibrated with flow cut off yes t' no
If yes,
Level Before
Level After
Resume flow, compare measured level to meter reading.
Verify that readings agree yes. no
2. If no,
Flow Level Before _3 �_ /g.0 o a
Flow Level After 3 t / i o00 ea.a
C.
Check if level
to flow conversion for primary device is correct: c/yes no
D.
Chec e
w is totalized correctly: ryes no
Calibrated b -
Date: a " �
rm hlorne, P.E. Time: AM oeNM

Permit: NCO051489
Inspection Date: 07/04/1976
Aeration Basins
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment:
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
��.. Yes No NA NE
Ir
a�
nnn�'
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)? `'� L� ❑ Gin ❑
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away frorfi chlorine containers? n n n n
Comment:`�'�
Are the tablets the proper size and type? 'n n n n
Are tablet de -chlorinators operational? n n n n
Number of tubes in use?
Z-
Comment:
Standby Power
Yes
No
NA
NE
Is automatically activated standby power available?
n
n
n
n
g pri ry power source?
Is the generator teZea
n
n
n
n
Is the generator teload?
❑
❑
❑
❑
Was generator tesduring the inspection?
n
n
n
n
Do the generatorcapacity to operate the entire wastewater site?
n
n
n
n
Is there a emergency agreement with a fuel vendor for extended run on back-up power?
n
n
n
n
h Ahe generator fuel level monitored?
n
n
n
n
Comment:
Laboratory
Yes
No
NA
NE
Are field parameters performed by certified personnel or laboratory?
n
n
n
n
Are all other parameters(excluding field parameters) performed by a certified lab?
n
n
n
n
# Is the facility using a contract lab?
n
n
n
n
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
n
n
n
n
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑
❑
❑
❑
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
n
n
n
n
Page # 4

i
Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park
Inspection Date: 07/04/1976 Inspection Type: Compliance Evaluation
Laboratory
Yes No NA
NE
Comment:
Flow Measurement - Effluent
Yes No NA
NE
n
n
# Is flow meter used for reporting?n
Is flow meter calibrated annually?
fl' n n
n
Is the flow meter operational?
n n
n
(If units are separated) Does the chart recorder match the flow meter?
Comment: ;
Record Keeping
Yes No NA
NE
Are records kept and maintained as required by the permit?
❑ n
Is all required information readily available, complete and current?
n n
n
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?
n n n
n
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
P
Dates of analysis
Name of person performing analyses
ML
a
Transported COCs
T-
Are DMRs complete: do they include all permit parameters?
n n n
rr
Has the facility submitted its annual compliance report to users and DWQ?
n
(If the facility is = or > 5 MGD permitted flow) Do they operate 2417 with a certified operator on each shift?
n n
n
Is the ORC visitation log available and current?
n 0 n
n
Is the ORC certified at grade equal to or higher than the facility classification?
n n
n
Is the backup operator certified at one grade less or greater than the facility classification?
L n n
n
Is a copy of the current NPDES permit available on site?I
a
n n
n
Facility has copy of previous year's Annual Report on file for review?
n n
n
Comment:
Effluent Sampling Yes No NA NE
Is co osite sampling flow proportional? n- n n
Page # 5

Permit: NC0051489
Inspection Date: 07/04/1976
Effluent Sampling
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
Comment:
14n n n
n.nnl'
n n n1'
n n n
Vnnn
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? f n n n
Comment:
Aerobic Digester Yes No NA NE
Is the capacity adequate? ❑ n
ri
Is the mixing adequate? ❑ ❑ ❑
Is the site free of excessive foaming in the tank? n n n
# Is the odor acceptable? n n n
# Is tankage available for properly waste sludge? zi n n
Comment:
Compliance Schedules
Yes No
NA NE
Is there a com ' nce schedule for this facility?
n ❑
❑ ❑
Is t cility compliant with the permit and conditions for the review period?
n n
n n
Comment:
Effluent Pipe
Yes No
NA NE
Is right of way to the outfall properly maintained?
rfi' n
n n
Are the receiving water free of foam other than trace amounts and other debris?
n
n n
If effluent (diffuser pipes are required) are they operating properly?
° n
n
Comment:
S_ econdary Clarifier
Yes No
NA NE
Is the clarifier free of black and odorous wastewater?l
n
n n
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
fn n
n n
Is the site free of weir blockage?
n n
n n
Page # 6

i
Permit: NC0051489
Inspection Date: 07/04/1976
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes No
NA NE
Is the site free of evidence of short-circuiting?
/n n
n n
Is scum removal adequate?
❑ 0
❑ ❑
Is the site free of excessive floating sludge?
n n
n n .
Is the drive unit operational?
nnn'
Is the return rate acceptable (low turbulence)?
n n
n
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately %< of the sidewall depth)
n n
nip
Comment:
Disinfection -Tablet
Yes No
NA NE
Are tablet chlorinators operational?
rain
n n
Are the tablets the proper size and type?i
n
n n
Number of tubes in use?
Is the level of chlorine residual acceptable?
n n
n
Is the contact chamber free of growth, or sludge buildup?
n n
n n
Is there chlorine residual prior to de -chlorination?
n
n n
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
n
n
Is the facility as described in the permit?
n
n
n
n
# Are there any special conditions for the permit?
n
n
n
n
Is access to the plant site restricted to the general public?
n
n
n
n
Is the inspector granted access to all areas for inspection?
n
n
n
n
Comment:
Flow Measurement - Inflot
Yes
No
NA
NE
f. porting?
# I/meter
n
n
n n
Is ted annually?
n
n
n n
Is trational?
n
n
n n(If•d)
Does the chart recorder match the flow meter?
n
n
n n
Comment:
Page # 7

Permit: NCO051489
Inspection Date: 07/04/1976
Owner - Facility: Three R's Mobile Home Park
Inspection Type: Compliance Evaluation
vvJ
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? n n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n n n n
Judge, and other that are applicable?
Comment:
Bar Screens Yes No NA NE
Type of bar screen
a.Manual
n
1 b.Mechanical Z,� � f
Are the bars adequately screening debris? 7 "�wvl'&) n n nf
Y
Is the screen free of excessive debris? ❑ n n
Is disposal of screening in compliance? I n n n
Is the unit in good condition? n n n
Comment:
Equalization Basins Yes No NA NE
Is the basin aerated? 7—f ❑ n ❑
Is the basin free of bypass lines or structures to the natural environment? n n n
Is the basin free of excessive grease? n n n n
Are all pumps present? 2 n n n n
Are all pumps operable? n n n
Are float controls operable?
Are audible and visual alarms operable? n ❑ n
# Is basin size/volume adequate?' n n n
Comment:
i
Aeration Basins % Yes No NA NE
M de of operation
T pe of aeration system
Is the basin free of dead spots? f n n n
Are surface aerators and mixers operational? n n n n
Are the diffusers operational? n n n n
Is the foam the proper color for the treatment process? / n ❑ n
Page # 3

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
To: From:
Fax: Pages:
Phone: G �P CO �p z- Date:
CC:
❑ Urgent ❑ For. Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
• Comments:
thCarolina
North Carolina Division of Water Quality 585 Wan Internet:
n Street; Winston-Salem, NC 27107 PhFax(336 771-46 0 No l thrall f
Customer Service: . 1-877-623-6748
Internet: www.ncwaterquality.org )
An Equal Opportunity/Affirmative Action Employer— 50%Recycled/10%Post Consumer Paper

Permit Inspection History
Permit:
NCO061489
Owner:
Three R's Mobile Home Park
Facility:
Three R's Mobile Home Park
Primary Inspector
Inspection Type
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion .
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
Max S Mauney
Compliance Evaluation
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
William C Basinger
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Page 1
Report Date: 04/18/06
County:
Forsyth
Region:
Winston-Salem
Permit Type:
Discharging 100% Domestic
< 1MGD
Inspection Reason Inspection Date
Facility Status
Routine
09/20/85
Not Compliant
Routine
08/14/86
Compliant
Routine
02/03/87
Neither
Routine
12/13/88
Neither
Routine
06/07/89.
Compliant
Routine
08/08/90
Compliant
Routine
09/11/91
Compliant
Routine
05/19/93
Not Compliant
Routine
04/14/94
Compliant
Routine
03/28/96
Compliant
Routine
05/07/97
Compliant
Routine
05/13/98
Not Compliant
Routine
03/24/99
Compliant
Routine
03/01/00
Not Compliant
Routine
03/20/01
Not Compliant
Routine
02/25/02
Compliant
Routine
05/01/03
Compliant
Routine
04/20/04
Not Compliant
Routine
05/12/05
Not Compliant
Routine
Neither

PERMIT NUMBER: NCO051489
FACILITY NAME: Three R's Mobile Home Park - Three R's Mobile Home Park
PERIOD ENDING MONTH: 12 - 2005 DMR 12 Month Calculated
PAGE 4 OF 5
CITY: Winston Salem COUNTY: Forsyth REGION: Winston-Salem
OUTFALL:001 EFFLUENT
00010
00300
00310
00400
00530
00600
00610
00665
deg c
mg/1
mg/l
su
mg/1
mg/l
mg/l
mg/1
Temperature,
DO, Oxygen,
BOD, 5-Day (20
pH
Solids, Total
Nitrogen, Total
Nitrogen,
Phosphorus,
Water Deg.
Centigrade
Dissolved
Deg. C)
Suspended
(as N)
Ammonia Total
N)
Total (as)
(as
30
30
1 - 05
9.2
7.5
14.8
6.2-6.9
16.3
21.1
10.4
3.45
30
30
2-05
10.7
7.5
14.75
6.7-7.2
17.75
10.9
30
30
3-05
10.5
7.2
28
6.9-7.4
11.5
13.4
30
30
4-05
13
6.9
4.75
6.9 - 7.3
8.75
1.412
3.9
3.19
30
30
2.9
5-05
12.666667
7
3.6
6.9 - 7.3
12
2.46
30
30
2.9
6-05
16.727273
7.02
10.5
6.9 - 7.4
13
7.25 Violation
30
30
2.9
7-05
20.15
6.75
5
6.9 - 7.3
4.5
11.42
6.225 Violation
2.83
30
30
2.9
8-05
22.043478
6.88
10.8
6.7 - 7.2
4.4
5.08 Violation
30
30
2.9
9-05
19,380952
7.275
8.25
6.7 - 7.4
4
2.225
30
30
2.9
10-05
14.380952
7.375
8.2
6.7 - 7.2
5.4
15.2
5.48 Violation
1.24
30
30
9.4
11 - 05
11.85
6.66
13.5
6.8 - 7.1
8.25
4.275
30
30
9.4
12-05
11
1 6.9
1 8.75
6.6 - 7
11.5
8.95

PERMIT NUMBER: NCO051489
FACILITY NAME: Three R's Mobile Home Park - Three R's Mobile Home Park
PERIOD ENDING MONTH: 12 - 2005 DMR 12 Month Calculated
PAGE 5 OF 5
CITY: Winston Salem COUNTY: Forsyth REGION: Winston-Salem
31616
50050
50060
TGP3B
V100ml
mgd
ug/1
pass/fail
Coliform, Fecal
Flow, in
Chlorine, Total
P/F STATRE 7Day
MF, M-FC
conduit or thru
Residual
Chr Ceriodaphnia
Broth,44.5C
treatment plant
0.012
1 - 05
89
0.006
0.2
1
0.012
2-05
125
0.004
0.012
3-05
41
0.005
0.012
4-05
22.8
0.005
1
0.012
5-05
5.596066
0.005516
0.012
6-05
88.994382
0.006379
0.012
7-05
14.007647
0.014355 Vi0—Iqt
1
0.012
8-05
78.856443
0.006613
0.012
9-05
46.149634
0.005167
0.012
10-05
58.223834
0.004226
0.012
11 - 05
9.005824
0.004467
0.012
12-05
54.074378
1 0.006
0

MONITORING REPORT(MR)VIOLATIONS for
Report Date: 04m9/06
Page: cmo
051489
PERM|T:NCOV514O9
FACILITY: Three R's Mobile Home Park ' Three R'oMobile Home Park COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
Mow/Ton/waourpALL
wowTInw
UNIT OF
oALouuTso
nsponr /pp/ Looxrmw
pARAmsrcn
u*Ts pnsuuEwu'
mcA«»ns
uw/T
«»mc
VIOLATION TYPE
vmLATmwAorow
07'e005 001 Effluent
Flow, mconduit »'thmtreatment
07/31m5 Continuous
mgd
0u12
0.0144
Monthly Average Exceeded
kPff6W6:mjmov:—~
p|um
Oo eUoo oo1 Effluent
' `
Nitrogen, Ammonia
'
8o��Km ��oNy
mU0
�
u7
mn
�
ou|��a�mumsxm�dod
N»Action,e|M8
Calculation Error
ms'u000 001 Effluent
Nitrogen, Ammonia Total (as w)
06/27/05 Weekly
mOx
8.7
15.8
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
06uomo no� ��uom
`
w�mgem�mmvniuTvm|��N)
'
oa8omo vvuemy
mo0
uV
�
7�ua
momh�/�omgoexm�dou
NoAction, o|M8
Calculation Error
07 uomo 001 ��uon�
'
Nitrogen, Ammonia
o7�70o vvoemy
mg8
oJ
���s
Daily
N»��»n'oa�sn*Y
.
Error
07000n oO1 ��mvm
'
m�mgvn Ammv�oTo�|kmm)
'
o7�10w VV*eNy
mo8
�
en
n�zo
Monthly
N»Am�»'o»�snuy
Error
oo 2uOo no� ��mon�
'
N�mQenmnmn�aTo�|$��@
'
ou0o0o Vv�omy
mO8
oJ
x�n
o��ma�mum�x���vd
mo��»n'mMG
Calculation Error
08'2005 001 e0mant
Nitrogen, Ammonia Total (as N)
08/3105 vvoomy
mg0
8.7
11.8
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
Ou coO5 oo1 ��uon�
'
Nitrogen, Ammonia
'
om31/uo w�omy
mu/|
xa
000
monm|y/w�nogosxoeed�d
w»Action,a|mG
Calculation Error
10'2005 001 Effluent
Nitrogen, Ammonia Total (as w)
103105 vvonmy
mu8
2.9
5.48
Monthly Average Exceeded
NuAction, Bpu
Monitoring Violation
Mow/TommoouTpxu
VIOLATION
UNIT OF
CALCULATED
nsponr /pp/ Loo*Tmw
pxnAMsrsR
DATE Fnsuuswo,
ws««»Rs
uwn
VALUE
VIOLATION TYPE
VIOLATION ACTION
os-c000 001 Effluent
Fkmv inconduit »rtxmtreatment
oomnmo Continuous
mod
Frequency Violation
None
plant
os-oOOo 001 Effluent
Nitrogen, Total (as N)
06/30m5 Cmanony
mg8
Frequency Violation
None
nO'uouo 001 Effluent
Phosphorus, Total (as P)
06/30/05 Quarterly
mD/|
Frequency Violation
None

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 04/19/06 Page: 1 of 3
r . _w ,
- ,:P :• 4 s B x _ :y.,x. - ;. " =' o ; Volation,Cate o "` ' ''
ermlt nc0051 89, MR etween 1 2005, 12 2005, Region.., /o /at f
:' X
Program Category. /o
F, ,
.and .
v.
�Subbasin;,
FaclUt ame. Q. F�...Param
/- ,....., . ,F,:,,,,•,• ,•.,;., ,.,, .. Name.a,
� �'. �.;
Caun /o.
lo:
V` Ii' i
s< roatonActon;',Ip;
/a. w
J� 4;
u_b;;
R
,rv. :x+rs..n ., <r„-„-.,,..,A..�•x,.,.,.,,.,..wt,...<,,,,,.<w..-t,.,.c.-..a,r., x.,....,.--✓..,aGo.x
f.- .wm^ �.,......,...,,«,.w.«-.5�'siw...w..:�...w.L«z.�.»-.t..vv,,.
�, .i .•" _N a.. ..., . ,
= - � ;:v ::a:.,2w.,.__ , .:
,. .. .,. , .. ..,,
��iS',A.., , ; :'..u-X "x'•4 ...,+.ra,.r� /...<... ve .<r..
,,,. .. ✓, ... ,. _.. rs. r ..a
;, <,. < ,.b, u ..». ,«,<.,w ..e «-L...«_<.,,-_ •6<„ ,_, . e ,e <::,£
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
REPORT
/PPI
LOCATION
PARAMETER
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, Total Residual
12 - 2005
001
Effluent
Chlorine, -Total Residual
01 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
03 -2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
03 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
08 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
10 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
12 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
VIOLATION
DATE
FREQUENCY
12/05/05
2 X week
12/07/05
2 X week
12/12/05
2 X week
12/14/05
2 X week
12/19/05
2 X week
12/21/05
2 X week
12/27/05
2 X week
12/29/05
2 X week
01/31/05
Weekly
03/14/05
Weekly
03/31/05
Weekly
08/08/05
Weekly
10/12/05
Weekly
12/12/05
Weekly
UNIT OF
MEASURE
ug/I
ug/I
ug/1
ug/I
ug/I
ug/l
ug/I
ug/I
#/100ml
#/100ml
#/100ml
#/100ml
#/100ml
#/100ml
LIMIT
28
28
28
28
28
28
28
28
400
400
400
400
400
400
CALCULATED
VALUE
100
300
200
100
100
300
200
300
490
490
490
700
410
1,900
VIOLATION TYPE
VIOLATION ACTION
Daily Maximum Exceeded
Q. roceed fd�
En`fo�cement Case
Daily Maximum Exceeded
Proceed►toil'
nE ocement Case
Daily Maximum Exceeded
¢Proceed
En of r ement-Case
d -_-0
Daily Maximum Exceeded
4Pr'5
Enforcement Case
Daily Maximum Exceeded
?'Lroceed�to
Enforcement Case
Daily Maximum Exceeded
Rroceeeed'_to�
Enforcement Case
tI-
Daily Maximum Exceeded
�Proceeci
EnforceNff-Case
Daily Maximum Exceeded
Rrro eeed`to
xEnforcement Case
Daily Maximum Exceeded
Rroeeed=toiNOd
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
No Action, Data Entry
Error
Daily Maximum Exceeded
F_r_oceed to_NOV
Daily Maximum Exceeded
No Action, BPJ
Daily Maximum Exceeded
Proceed to
ff_9-nforceinent_QAaej

Page 1 of 2
North Carolina Division Of Water Quality
Construction Grants & Loans Section
Authorization To Construct (ATC) Application Form
To Be Used On and After Jul 1, 2004
Date:
Permittee/Owner Name:
Address:
Contact Person:
Telephone Number:
Engineer Of Record:
Address:
Telephone Number:
Check Each
Please Note: The Following Box For
Items/Information Must be Submitted Which
To Be Considered a Complete Information Remarks/Explanation
Package. If Any Applicable Item Is
Missing The Package Will Be Returned Is Provided
As Incomplete. N
VRequest for ATC from Permittee
rized Agent.
2 escription Of the Proposed
Project.
A Complete Copy Of the NPDES Permit
3 or Public Notice of A Draft NPDES
Permit.
4 Design Capacity (in Million Gallons per MGD
Day - MGD).
r9include
w or Expanding Design Capacity is
5 er than or equal to 0.500 MGD
a copy of Finding Of No
Significant Impact (FNSI).
Three Sets Of Plans Signed and Sealed
6 By A NC Professional Engineer and
Stamped With "Final Drawing - Not
Released For Construction"
]7Three Sets of Technical Specifications.
NCDWQ ATC Application July 2004

Page 2 of 2
Three Sets each of Process, Design, and
$
Hydraulic Profile Calculations.
A Hydraulic Profile; and A Flow
9 Schematic With Sizes Of Major
Components On 81/2" X 11" Paper.
Documentation that a Soil & Erosion
10 Control Permit Application Has Been
Submitted to Division of Land Resources.
Management Plan (for all
JResiduals
cilities producing residuals).
Construction Sequence Plan (for
12
Modifications).
110 Volt table Water
13 Included =Plans.
Hydrogeologic Information Must Be
14 Provided If A Potential For Groundwater
Contravention Exists.
For Abandonment of WWTPs, a
15
Statement That the Facility Will Be
Properly Disconnected.
For Municipal/Public Facilities, A
Signed/Sealed Certification From the
16
Engineer Of Record That the Project
Complies With G.S. 133-3.
NCDWQ ATC Application July 2004

Authorization to Construct Guidance Document
NC DENR — DWQ — Construction Grants, And Loans Section
The Authorization to Construct Process
"After an NPDES permit has been issued [by DWQ] ..., construction of wastewater treatment facilities or
additions thereto shall not begin until final plans and specifications have been submitted to and an
Authorization to Construct has been issued to the permittee..."1
Activities Requiring An ATC
The construction of permitted treatment facilities. .
Any addition, deletion or modification of equipment, components or processes at an existing facility
which has the potential to affect the treatment process.
• Upgrade or Replacement of older equipment with equipment of a different capacity (other than
what was originally permitted).
• Installation of piping which may by-pass equipment, components or processes.
When to Submit
• Not before the establishment. of effluent limits or not before a draft permit has been sent to public
notice.
• At least 90 days prior to the start of construction or the awarding of any bids2.
• For Publicly Owned Treatment Works (POTW), prior to exceeding 90% of the system
's permitted
hydraulic capacity.3
What to Submit
In addition to a properly completed application and all applicable information; for any system or
component that does not have well -established treatment capabilities: assurance that the facility can
comply with permit requirements. Supply performance data or pilot test data if available.
Where to Submit
Submit complete application package to:
NC Division of Water Quality
Construction Grants & Loans Section
1633 Mail Service Center
Raleigh, N.0 27699-1633
Attention: Daniel M. Blaisdell, P.E.
Questions regarding ATCs can be directed to Mr. Daniel M. Blaisdell, P.E., Assistant Chief, Engineering
Branch, Construction Grants & Loans Section [phone].
lsee 15 NCAC 2H .0138 (a).
2General Statutes 143-215.1.a.8
3see 2H .0223
ATC Requirements
July 1, 2004
Iof3

Authorization to Construct Guidance Document
NC DENR — DWQ — Construction Grants And Loans Section
Design Requirements
For Treatment Works and Disposal Systemsl_
• No bypass lines.
• Multiple pumps and blowers.
• capable of handling flow with largest component out of service.
• Standby Power. At least one of the following:
• dual source/dual feed or automatically activated stand-by power supply on -site for essential
components.
• history of power reliability (applies only to facilities discharging to Class C waters).
• Protection -from 100-year flood.
• Meet all minimum buffer requirements listed in 2H.0219.
• Flow equalization of at least 25% of the permitted hydraulic capacity.
• Preparation of an operational management plan for complex components or unique processes.
• A 110-volt power source and potable water source (with back -flow prevention).
• Provide a minimum of 30 days on -site storage of residuals.
Reliability:
To ensure treatment reliability and flexibility for operational and maintenance activities, all new or
hydraulically expanding facilities must meet duality/multiple component requirements for all major
treatment components2. In addition, the DWQ encourages designing for dual -train treatments of
approximately equal flow capability. As an example, the following processes require multiple
components:
For primary treatment:
• bar screens for facilities with design flows > 1.0 MGD.
• primary clarifiers.
For biological treatment:
• aeration basins, nitrification basins, SBRs, RBCs, etc.
• extended aeration package plants with design flows >- 0.02 MGD.
• some Oxidation ditches.
For additional treatment:
• final clarifiers and tertiary filters.
• feed equipment for chlorine disinfection and dechlorination.
• contact basins for design flows > 0.1 MGD.
• UV lamp banks.
1 see 2H .0219 0) and 2H .0138 (b)
2see 2H.0124
ATC Requirements
July 1, 2004
2of 3

s
a
Authorization to Construct Guidance Document
NC DENR — DWQ - Construction Grants And Loans Section
Engineer's Certification
• The engineer must oversee construction.
• The engineer must certify that the facilities were constructed as approved by DWQ.
• The certification must be sent to DWQ prior to operation of the new or expanded facilities.
• The region must be notified 48 hours prior to operation, of installed facilities.
Major Modifications Require:
• Full re -submittal of Plans and Specifications for review.
• Issuance of a modification of the previously issued ATC.
ATC Requirements
July 1, 2004
3of 3

00. --r
June 30, 2005
Randy Bell ORC
3 R's Mobile Home Park
P.O. Box 1291
Clemmons, NC 27012
Re: Response to Evaluation Inspection
3 R's MHP WWTP
Permit No. NC0051489
Forsyth County
Mr. Tedder:
The flow meter has been calibrated and a copy of the calibration data sheet is
enclosed. Proper chlorine tablets are being used and have always been used. (Water
Guard Norweco Bio Sanitizer tablets.) Diffusers are not clogged. The fixed media has
floated to surface blocking, the view of aeration turbulence. The fixed media was only
there for a couple of days. We are continuing to remove the floating media and piling it
up 'for disposal after it has been washed down. The annual report will be taken care of
now that we know what to do and have a template to go by.
For any further assistance please feel free to contact me at 336.766.9626.
Thank you,
Randy Bell
Cc: Norman Boles
3 R's MHP owner

Horizon Engineering & Consulting, Inc.
2510 Walker Road
Mt. Pleasant, N.C. 28124
704-788-4455
Fax: [phone]
Flow !Meter Calibration Data Sheet
%�,✓
City: tts^ State:
Facility Name:"
Utility Name:
F �
Primary Device weir etc.): i
Flow Meter Manf.: :-1515''ez-v
s
Model: 6/ Serial No. />7�� —9�
Type:
Bubbler:
Ultrasonic:
other: a':?O� ;7
1. Primary Device:
Comments.
A.
Level
yes
-no
B.
Free Flow
eyes
,
no,n�
C.
Turbulence
yes
�o
D.
Blockage
Y- s/yes
no
E.
Surface
Buildup
yes
i>' no
F.
Properly
ye
Mounted
no
Il. Meter:
C.
Al
Calibrated by:
Programmed correct yes no ,`t✓�.f,��/r� a��%
Calibration:
1. Calibrated with flow cut off yes —,---no
If yes, Level Before
Level After
Resume flow, compare measured level to meter reading.
Verify that readings agree yes no
2. If no, Flow Level Before , _
Flow Level After 7 e 1
Check if level to flow conversion for primary device is correct: yes no
Check ' see f f+-i totalized correctly: es no
n Hofne, P.E.
Date: e2 -d / 03 / 5
Time: 1-Z fM r PM

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek,. P.E. Director
Division of Water Quality
June 2, 2005
CERTIFIED MAIL 7002 0860 0000 7978 3805
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Compliance Evaluation Inspection
Three R's Mobile Home Park
Permit No. NCO051489
Forsyth County
Dear Mr. Boles:
Enclosed please find a copy of the Inspection Report from the inspection conducted May 12,
2005 on the Three R's Mobile Home Park. The Compliance Evaluation Inspection was
conducted by Rose Pruitt of the Winston-Salem Regional Office. Randy Bell, ORC and Bradley
Flynt, Backup ORC were present for the inspection. The inspection consisted of two parts: an
on -site inspection of the treatment facility and a file review. The following are the findings from
the subject inspection.
The treatment facility was found to be in violation of permit NCO051489 for the following:
Compliance issues found during the inspection are:
Inspection Area
Compliance Issue
Flow Measurement
Flow meter not calibrated. No calibration records for flow meter.
Operations &
Maintenance
Improper chlorine tablets being used.
Operations &
Maintenance
Clogged diffusers creating dead spots
Operations &
Maintenance
Used fixed media piled on ground and not disposed of properly.
Records/Reports
No annual report for this or previous year.
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

Three R's
Page 2
June 2, 2�05
I. Permit
The NPDES permit for the Three R's Mobile Home Park WWTP became effective June 1, 2004
and expires on May 31, 2009. The permitted components of the 0.012 MGD wastewater
treatment plant include: an influent bar screen, aeration basin, clarifier, aerated sludge holding
tank, chlorination, contact chamber, post aeration, and flow monitoring device.
II. Records/Reports
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Three R's
Mobile Home Park WWTP for the period December 2003 through December 2004 revealed that
the facility had one violation. The October 2004 DMR was late or missing. A Notice of
Violation was issued by the Division for this violation. Operations records include all sample
analyses and process control tests that are performed.
There was no record of the electronic flow meter being calibrated.
There was no annual report issued.
Deficiencies were found in the following records:
(1) No annual report for this or previous year.
North Carolina State Statute § 143-215.1C requires permit holders to: Report to
wastewater system customers on system performance; publication of notice of discharge
of untreated wastewater and waste.
(a) Report to Wastewater System Customers. - The owner or
operator of any wastewater collection or treatment works, the
operation of which is primarily to collect or treat municipal or
domestic wastewater and for which a permit is issued under this
Part, shall provide to the users or customers of the collection
system or treatment works and to the Department an annual report
that summarizes the performance of the collection system or
treatment works and the extent to which the collection system or
treatment works has violated the permit or federal or State
laws, regulations, or rules related to the protection of water
quality. The report shall be prepared on either a calendar or
fiscal year basis and shall be provided no later than 60 days
after the end of the calendar or fiscal year.
To help you in preparing this report I have enclosed a blank Performance annual Report
guidance document for your use. Also a copy of the letter from the Director of the Division
of Water Quality pertaining to this matter is enclosed.

Three R's
Page 3
June 2, 2005
III. Facility Site Review
The facility site review indicated that the 0.012 MGD treatment works is consistent with the
permitted components. The actual treatment system consists of an influent bar screen, aeration
basin, clarifier, aerated sludge holding tank, chlorination, contact chamber, post aeration, and
flow monitoring device.
IV. Effluent / Receiving Stream
The WWTP discharges to Leak Creek a class C water in the Yadkin -Pee Deer River Basin. The
effluent was clear and free of visible solids on the date of inspection. The receiving stream was
free of solids, foam and debris.
V. Flow Measurement
Effluent flow is measured with a flow meter. There were no meter calibration records available
for this year. Documentation on file with the Division indicates the meter was last calibrated
May 31, 2002. The permit calls for proper operation and maintenance of the facility at all times.
Proper maintenance and operation also includes appropriate quality assurance procedures.
Deficiencies were found in the following records:
(1) The flow meter had not been calibrated this year. Last known calibration was May 31,
2002. The permit states: "Appropriate flow measurement devices and methods consistent
with accepted scientific practices shall be selected and used to ensure the accuracy and
reliability of measurements of the volume of monitored discharges. The devices shall be
installed, calibrated and maintained to ensure that the accuracy of the measurements is
consistent with the accepted capability of that type of device ... Flow measurement devices
shall be accurately calibrated at a minimum of once per year".
VI. Self -Monitoring Program
A review of the discharge monitoring reports (DMRs) for the time period of December 2003
through December 2004 demonstrated that the Three R's Mobile Home Park WWTP had one
violation. The October 2004 DMR was late or missing. A Notice of Violation was issued by the
Division for this violation.
VII. Compliance Schedules
No compliance schedules to evaluate.
VIII. Laboratory
All of the sample analyses are conducted by Tritest Labs. The laboratory was not reviewed at the
time of the subject inspection.

Three R's
Page 4
June 2, 2005
IX. Operation and Maintenance
Operation and maintenance at the time of the subject inspection was deemed unsatisfactory.
Deficiencies were found in the following areas:
(1) Fixed media had been removed from the aeration basin and was left lying on the
ground. The permit requires that any "solids, sludge, filter backwash, or other pollutants
removed in the course of treatment or control of wastewaters shall be utilized/disposed of 'in
accordance with state and federal regulations.
(2) The aeration basin contained dead spots as a result of clogged media / diffusers, foam
covered significantly more than 25% of the basin's surface. "The permittee shall at all
times provide the operation and maintenance resources necessary to operate the existing
facilities at optimum efficiency. The Permittee shall at all times properly operate and
maintain all facilities and systems of treatment and control (and related appurtenances) which
are installed or used by the Permittee to achieve compliance with the conditions of this
permit."
(3) Chlorine tablets for swimming pools were being used for waste water disinfection. Only
chlorine tablets approved for waste water disinfection should be used. Chlorine tablets
(chlorinated isocyanurates) for swimming pools have a different chemical composition than
waste water tablets (Calcium hypochlorite) and present hazards to both humans and aquatic
life. When used in a flow -through wastewater tablet feeder, swimming pool tablets will not
thoroughly disinfect the effluent and the chlorine residual remains for long periods of time.
Use of the incorrect type of chlorine tablets in a wastewater treatment system violates the
EPA's control system and subjects the user to civil, as well as, criminal prosecution under the
Federal Insecticide and Rodenticide Act.
The effluent was clear and free of visible solids.
X. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of
properly. Forsyth Rooter last hauled sludge for this facility on May 3, 2005.
XI. Pretreatment
Not evaluated during this inspection. No pretreatment program required.
X1I. Stormwater
Not evaluated during this inspection.
XIV. Sewer Overflow
None to report.

Three R's
Page 5
June 2, 2005
XV. Pollution Prevention
Not evaluated during this inspection.
XVI. Multimedia
Not evaluated during this inspection.
The Division of Water Quality greatly appreciates your prompt attention to the non-compliance
issues noted in this inspection. Your continued oversight at this facility is very important. The
Division also encourages you to continue to be proactive in your efforts to maintain compliance.
Please refer to the enclosed Inspection Report for any additional observations and comments.
As a condition of your permit, you are required to comply with all conditions of this permit. Any permit
noncompliance constitutes a violation of the Clean Water Act and is grounds for enforcement action; for
permit termination, revocation and reissuance, or modification; or denial of a permit renewal application
[40CFR 122.41]. Under state law, a civil penalty of not more than $25,000 per violation may be assessed
against any person who violates or fails to act in accordance with the terms, conditions, or requirements of
a permit. [North Carolina General Statutes § 143-215.6A]
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within thirty (30) working day of receipt of this letter. You should address
the causes of noncompliance and all actions taken to prevent the recurrence of similar situations.
If you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachment
Cc: Randall Bell, PO Box 1291 Clemmons NC 27012
Central Files w/ attachment
"SRO �w/ attachment-`3
Forsyth County Health Dept w/attachment

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance InspeQtion 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 U 2 U 31 NCO051489 1 11 121 05/05/12 1 17 18 U 19 U 20 U
Remarks
211111111111111111111111111111111111111111111111166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved -----------------------
671 1 69 70 U 71 U 72 U 73 W 74 751 1 1 1 1 1 1 1 80
Section B: Facility 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)
10:30 AM 05/05/12
04/06/01
Three R's Mobile Home Park
Exit Time/Date
Permit Expiration Date
170 Jones Rd
Winston Salem NC 27107
11:30 AM 05/05/12
09/05/31
Name(s) of Onsite Rep resentative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Randall Keith Bell/ORC/336-373-7740/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Randall Keith Bell,5240 S Main St Winston Salem NC 27107//336-766-962r6/
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal ■ Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Find in /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
Rose Pruitt WSRO WQ///
_
Signature of Management Q�A Reviewer Agency/Office/Phone and Fax Numbers Date
j-` —
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

NPDES yr/mo/day Inspection Type (cont. ) 1
3 I NC0051L 111 121 05/05/12 117 18 m
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
This inspection was performed on May 12, 2005 with ORC Randy Bell and backup ORC Bradley Flynt present. Used
fixed media was observed lying in a pile on the ground. Please dispose of this sludge properly and in a timely
manner.
Clogged diffusers were impairing function in the aeration basin, foam covered significantly more than 25% of
the basin's surface.
Improper chlorine tablets are being used. You must use chlorine for wastewater treatment only, pool
chlorine tablets are toxic to aquatic life and may result in further violations of water quality standards.
Flow meter calibration could not be documented.
No annual report for this or any other year was available.
Sludge hauled by Forsyth Rooter 5-3-2005

PPS
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Yes No
❑ ❑
NA
■
NE
❑
Is the facility as described in the permit?
® ❑
❑
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:
Yes No
NA
NE
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
❑ E ❑
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge Judge,
❑
❑
❑
and other that are applicable?
Comment: Fixed media discarded on the ground and piled up in corner.
Yes No
NA
NE
Bar_ runs
Type of bar screen
a.Manual
b.Mechanical
❑
Are the bars adequately screening debris?
E ❑
❑
❑
Is the screen free of excessive debris?
❑ ❑
❑
0
Is disposal of screening in compliance?
E 1311
❑
Is the unit in good condition?
❑ ❑
❑
E
Comment:
Yes No
NA
NE
FduallZatlpn Basins
Is the basin aerated?
■ ❑
❑
❑
Is the basin free of bypass lines or structures to the natural environment?
0 ❑
❑
❑
Is the basin free of excessive grease?
0 ❑
❑
❑
Are all pumps present?
0 ❑
❑
❑
Are all pumps operable?
E ❑
❑
❑
Are float controls operable?
❑ ❑
❑
E
Are audible and visual alarms operable?
❑ ❑
❑
■
Is basin size/volume adequate?
❑ ❑
❑
Comment: Fixed media clogged diffusers
Yes No
NA
NE
Primary Clarifier
Is the clarifier free of black and odorous wastewater?
0 ❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑ ❑
0
❑
Are weirs level?
0 ❑
❑
❑
Is the site free of weir blockage?
0 ❑
❑
❑
Is the site free of evidence of short-circuiting?
E ❑
❑
❑
Is scum removal adequate?
E ❑
❑
❑
Is the site free of excessive floating sludge?
❑ ❑
❑
N
Is the drive unit operational?
❑ ❑
❑
■
Is the sludge blanket level acceptable?
❑ ❑
❑
E
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
❑ ❑
❑
0
Comment:
Yes No
NA
NE
Aeration Basins
Mode of operation
Ext. Air
Type of aeration system
Fixed

Aeration Basins
Is the basin free of dead spots?
Yes No NA
❑ M ❑
NE
❑
Are surface aerators and mixers operational?
❑ ❑ ❑
0
Are the diffusers operational?
❑ M ❑
❑
Is the foam the proper color for the treatment process?
0 ❑ ❑
❑
Does the foam cover less than 25% of the basin's surface?
❑ M ❑
❑
Is the DO level acceptable?
❑ ❑ ❑
M
Are settleometer results acceptable?
❑ ❑ ❑
M
Is the DO level acceptable?(1.0 to 3.0 mg/I)
❑ ❑ ❑
.
Are settelometer results acceptable?(400 to 800 ml/I in 30 minutes)
❑ ❑ ❑
Comment: Dead spots, may indicate clogged media. Thick foam covering most of surface.
Disinfection
Yes No NA
NE
-Tablet
Are cylinders secured adequately?
N ❑ ❑
❑
Are cylinders protected from direct sunlight?
M ❑ ❑
❑
Is there adequate reserve supply of disinfectant?
❑ M ❑
❑
Are tablet chlorinators operational?
0 ❑ ❑
❑
Are the tablets the proper size and type?
❑ M ❑
❑
Number of tubes in use?
4
(Sodium Hypochlorite) Is pump feed system operational?
❑
❑
®
❑
Is bulk storage tank containment area adequate? (free of leaks/open drains)
❑
❑
No
Is the level of chlorine residual acceptable?
❑
❑
❑
0
Is the contact chamber free of growth, or sludge buildup?
0
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
❑
❑
❑
0
Comment: Not using proper chlorine tablets (using pool tabs).
Using hose on auto float to clean contact chamber so plant doesn't back up.
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)? ❑ ■ ❑ ❑
Is storage appropriate for cylinders? 0 ❑ ❑ ❑
Is de -chlorination substance stored away from chlorine containers? ❑ ❑ ❑ M
Comment: 4:2 chlorine to dechlor
Are the tablets the proper size and type?
❑ ❑
❑
E
Are tablet de -chlorinators operational?
0 ❑
❑
❑
Number of tubes in use?
2
Is the feed ratio proportional to chlorine appropriate? (Approximately ratio 1:1)
❑ ■
❑
❑
Comment: 4:2 chlorine to dechlor
Yes_ No
NA
NF
Lahoratory
Are field parameters performed by certified personnel or laboratory?
M ❑
❑
❑
Are all other parameters (excluding field parameters) performed by a certified lab?
M ❑
❑
❑
Is the facility using a contract lab?
0 ❑
❑
❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑ ❑
❑
0
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑ ❑
❑
M
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
❑ ❑
❑
Comment: Tritest Labs
Is flow meter used for reporting? 0 ❑ ❑ ❑

Flow Measurement - Efflljpnt
Is flow meter calibrated annually?
Yes No NA
0
NE
Is the flow meter operational?
E
(If units are separated) Does the chart recorder match the flow meter?
0 0
0
N
Comment: No calibration records for flow meter.
Yes No
NA
NE
R - oP�� rd KPPina
Are records kept and maintained as required by the permit?
E
Is all required information readily available, complete and current?
N
Are all records maintained for 3 years (lab. reg. required 5 years)?
0
Are analytical results consistent with data reported on DMRs?
0
Is the chain -of -custody complete?
0
O&M Manual
As built Engineering drawings
Schedules and dates of equipment maintenance and repairs
E
-
Dates, times and location of sampling
0
Name of individual performing the sampling
0
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
0
Transported COCs
E
Are DMRs complete: do they include all permit parameters?
0
Has the facility submitted its annual compliance report to users and DWQ?
0 E
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
0 0
■
Is the ORC visitation log available and current?
E
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?
E
Is a copy of the current NPDES permit available on site?
■
Facility has copy of previous year's Annual Report on file for review?
0 0
Comment: No annual report on file for this or any other year.
Yes No
NA
NE
Effluent Sampling
Is composite sampling flow proportional?
E
Is sample collected below all treatment units?
0
Is proper volume collected?
E
Is the tubing clean?
E
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
0
0
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
Comment:
Yes
No
NA
NE
tlnstr am / Downstream Sam Ijinq
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)?
❑
O
0
Comment:
YPs
No
NA
NE
Solids HandlinEquipment
Is the equipment operational?
❑
❑
E
O
Is the chemical feed equipment operational?
00
0
11
Is storage adequate?
11
O
0
11
Is the site free of high level of solids in filtrate from filter presses or vacuum filters?
C1
0
E
0

6
Solids Handling Fguipment
Is the site free of sludge buildup on belts and/or rollers of filter press?
YPs
❑
No
❑
NA
M
NE
❑
Is the site free of excessive moisture in belt filter press sludge cake?
❑
❑
0
❑
The facility has an approved sludge management plan?
❑
❑
!
❑
Comment:
Yes
No
NA
NE
Effluent Pioe
Is right of way to the outfall properly maintained?
■ ❑
❑
❑
Are the receiving water free of foam other than trace amounts and other debris?
M
❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
❑
0
Comment:

performance Annual Report
I. General Information
Facility/System Name:
Responsible Entity:
Person in Charge/Contact:
Applicable Permit(s):
Description of Collection System or Treatment Process:
H. Performance
Tcxt Summary of System Performance for Calendar Year -
List (by month) any violations of permit conditions or other environmental regulations. Monthly
lists should include discussion of any environmental impacts and corrective measures taken to
address violations.

�L
Permit
(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:
Operations & Maintenance
Does the plant have general safety structures in place such as rails around or covers over tanks, pits, or wells?
Is the plant generally clean with acceptable house eepin ?
Comment:
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris? (�
Is disposal of screening in compliance? /^
Is the unit in good condition?
Comment:
Eq ia� Iizatup Basins
Is aeration adequate?
Is the basin free of bypass lines or structures to the natural environment?
Is the general housekeeping acceptable? '
Is the basin free of excessive grease?
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Are audible and visual alarms operable?
Is basin size/volume adequate?
Comment:
Primary Clarifier
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 biockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive Floating sludge?
Is the drive unit operational?
Is the sludge blanket level acceptable?
Comment:
Aeration Basins
Mode of operation
Type of aeration system awAl
OMOMWO
II ■ ■ ■
❑❑❑
❑' ❑ q_z
2r❑❑❑
❑ ❑ ❑ ❑
Yes No
❑ ❑
NA
❑
NE
❑
A00El
❑❑❑❑
0❑❑❑
❑
❑
❑
�1❑❑❑
❑ ❑
❑
❑
❑❑(A❑
■ ■ ■
Yes No
P 0
N.A NE
0 0
❑ ❑
Z ❑
0❑❑❑
0 ❑
❑ ❑
❑
❑ ❑
❑
❑ ❑
❑
❑ ❑
Q cl
y, -
❑ ❑
❑ ;Z,-

Aeration Basins_
Is the basin free of dead spots?
Yes No NA NE
❑ 0 ❑ ❑
Are surface aerators and mixers operational? ��aap���,�� f ' .
ma%V�G (�,p ///
El El El'®
Are the diffusers operational?
❑ 0 ❑
❑
Is the foam the proper color for the treatment process?
P1 ❑ ❑
❑
Does the foam cover less than 25% of the basin's surface?
❑ ❑
❑
Is the DO level acceptable?
❑ ❑ ❑
Are settleometer results acceptable?
❑ ❑ ❑
Comment:
Yes No NA
NE
Disinfectim
? Type of system ''�.2G��y "" �
Are cylinders secured adequately?
y� ❑ ❑
❑
Are cylinders protected from direct sunlight?
VJ ❑ ❑
❑
Is there adequate reserve supply of disinfectant?
Z ❑ ❑
❑
Is ventilation equipment operational?
❑ ❑
❑
Is ventilation equipment properly located?
❑ ❑
❑
Is SCBA equipment available on site?
❑ ❑
❑
Is SCBA equipment operational?
❑ ❑
❑
Is staff trained in operating SCBA equipment?
❑ ❑
❑
Is staff trained in emergency procedures?
❑ ❑
❑
Is an evacuation plan in place?
❑ ❑
❑ ❑
❑
❑
Are tablet chlorinators operational?
Are the tablets the proper size and type? "a T
'i J
+` ❑
❑
Number of tubes in use? q
(Sodium Hypochlorite) Is pump feed system operational?
❑ ❑
❑
Is bulk storage tank containment area adequate? (free of leaks/open drains)
❑ ❑
❑
Is the level of chlorine residual acceptable?
❑ ❑
N
Is there adequate detention time
❑ ❑ ❑
Is the contact chamber free of growth, or sludge buildup?
❑ ❑
❑
Comment:
— O '
Yes No NA
NE
�grhior__ in�ion
Type of system?
LJI�
Is the feed ratio proportional to chlorine amount (1 to 1)? Z
❑
Is storage appropriate for cylinders?
❑ ❑ ❑
Is de -chlorination substance stored away from chlorine containers?
.0 ❑ ❑
❑
Is ventilation operational?
❑ ❑ V
❑
Comment:
Are the tablets the proper size and type?
❑ ❑ 13
11
Are tablet de -chlorinators operational?
❑ ❑
❑
Number of tubes in use?
Comment:
Standby Power
Is automatically activated standby power available?
Yes No NA
❑ 0 ❑
NE
❑
Is generator tested weekly by interrupting primary power source?
❑ ❑
0
Is generator tested under load at least quarterly?
❑ ❑
❑

Standby Power
Was generator tested & operational during the inspection?
Do the generator(s) have adequate capacity to operate the entire wastewater site?
Does generator have adequate fuel?
Is there an emergency agreement with a fuel vendor for extended run on back-up power?
Comment:
t_aboratory /B
Are field parameters performed by certified personnel or laboratory?
Are all other parameters(excluding field parameters) performed by a certified lab?
Is the facility using a contract lab?
Are analytical results consistent with data reported on DMRs?
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
Comment:
Flo�sur m nt - lnf]UVnt
s
flowmrused for reporting?
Iw meter calibrated annually?
Is flow meter operating properly?
(If units are separated) Does the chart recorder match the flow meter?
Comment:
v M .ns ur .m .nt - Effluent
Is flow meter used for reporting?
Is flow meter calibrated annually?
Is flow meter operating properly?
(If units are separated) Does the chart recorder match the flow meter?
Comment:
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?
Are sampling and analysis data adequate and include:
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
Plant records are adequate, available and include
O&M Manual
As built Engineering drawings
Schedules and dates of equipment maintenance and repairs
Are DMRs complete: do they include all permit parameters?
Has the facility submitted its annual compliance report to users?
Yes No
❑
NA
❑
NE
❑
❑
❑
❑
❑
❑
❑
p❑❑❑
P
V1 ❑
❑
❑
El
El
lQ
❑
❑
❑ I
❑
❑

Rp,cQrd K spina
Yes No NA NE
(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? Z ❑ ❑ ❑
Is a copy of the current NPDES permit available on site? ❑ ❑ ❑
Is the facility description verified as contained in the NPDES permit? ❑ ❑ ❑
Does the facility analyze process control parameters, for example: MLSS, MCRT, Settleable Solids, DO, Sludge ❑ ❑ ❑
Judge, pH, and others that are applicable?
Facility has copy of previous year's Annual Report on file for review? ❑ e)❑ ❑
Comment:
Yes
No
NA NE
Effluent Sampling
Is composite sampling flow proportional?
❑
❑
❑
Is sample collected below all treatment units?
❑
❑
❑
Is proper volume collected?
❑
❑
❑
Is the tubing clean?
❑
❑
❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑
❑
❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
❑
❑ ❑
Comment:
Yes
No
NA NE
Upstream / Downstream Sam Ip ina
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)?
r— El
El ❑
Comment: 7 ?�� r,
�/
Aerobic Di e� styr
the capacity adequate?
Yes
El
No
El
NA �N(E
El J1
Is the mixing adequate?
❑
❑
❑ Ed
Is the site free of excessive foaming in the tank?
❑
❑
❑ VT
Is the odor acceptable?
❑
❑
❑ T
Comment:
Compliance Schiadulezi
Is there a compliance schedule for this facility?
Yes No
❑ T
NA NE
❑ ❑
Is the facility compliant with the permit and conditions for the review period?
❑
❑ ❑
Comment:
Yes No
NA NE
Effluent Pipe
Is right of way to the outfall properly maintained?
A ❑
❑ ❑
Are receiving water free of solids and floatable wastewater materials?
Pn ❑
❑ ❑
Are the receiving waters free of solids / debris?
JZ ❑
❑ ❑
Are the receiving waters free of foam other than a trace?
❑
❑ ❑
Are the receiving waters free of sludge worms?
❑
❑ ❑
If effluent (diffuser pipes are required) are they operating properly?
0 0
❑
3
?/ / q NCAI�

PERMIT NUMBER: NCO051489 PERIOD ENDING MONTH: 12 - 2004 DMR 12 Month Calculated
FACILITY NAME: Three R's Mobile Home Park - Three Rs Mobile Home Park
CITY: Winston Salem COUNTY: Forsyth
OUTFALL:001 EFFLUENT
REGION: Winston-Salem
PAGE 1 OF 3
00010
00300
00310
00340
00400
00500
00530
00545
deg c
mg/1
mg/l
mg/l
su
mg/1
mg/1
ml/1
Temperature,
DO, Oxygen,
BOD, 5-Day (20
COD, Oxygen
pH
Solids, Total
Solids, Total
Solids,
Water Deg.
Dissolved
Deg. C)
Demand, Chem.
Suspended
Settleable
Centigrade
(High Level)
30
30
1 - 04
8.9
7.6
3.75
6.7 - 7.2
7.66
30
30
2 - 04
11
7.3
5.25
6.8-7.2
5.75
30
30
3 - 04
11.2
6.9
8
6.7 - 7.1
5
30
30
4 - 04
11.5
6.6
7.75
6.9-7.1
2.6
30
30
5 - 04
16.1
6.47
1.5
7.2 - 7.4
3.5
30
30
6 - 04
19.6
6.64
5.4
6.9-7.3
2.8
30
30
7 - 04
23
6.6
15.2
6.9-7.2
5.3
30
30
8 - 04
22.2
7.1
7
6.9-7.5
2.2
30
30
9 - 04
19
7.3
4.4
6.7 - 7.1
4
30
30
10 - 04
17
7.27
8.3
6.7-7.1
10.8
30
30
11 - 04
15
7.4
8.6
6.8 - 7.2
19
30
30
12 - 04
12
7.38
9.75
6.5 - 6.9
8.5

PERMIT NUMBER: NC0051489 PERIOD ENDING MONTH: 12 - 2004 DMR 12 Month Calculated
FACILITY NAME: Three R's Mobile Home Park - Three R's Mobile Home Park
CITY: Winston Salem
COUNTY: Forsyth
REGION: Winston-Salem
PAGE 2 OF 3
00600
00610
00665
31616
31616
31616
50050
50060
mg/l
mg/1
mg/1
V100ml
mg/1
mpn/100ml
mgd
ug/1
Nitrogen,
Nitrogen,
Phosphorus,
Coliform,
Coliform,
Coliform,
Flow, in conduit
Chlorine,
Total (as N)
Ammonia Total
Total (as P)
Fecal MF, M-FC
Fecal MF, M-FC
Fecal MF, M-FC
or thru
Total Residual
(as N)
Broth,44.5C
Broth,44.5C
Broth,44.5C
treatment plant
0.012
1 - 04
5.12
0.22
0.95
22
0.005
2.8
0.012
2 - 04
7.65
17
0.007
0.36
0.012
3 - 04
0.8
1
0.005
0.3
0.O12
4-04
5
1.6
2.38
30
0.006
0.2
0.012
5 - 04
4.4
12.8
0.008
0.012
6 - 04
1.94
23.3
0.006
0.012
7 - 04
3.36
9.7
3.45
78.8
0.007
0.012
8 - 04
0.28
23.8
0.007
0.18
0.012
9 - 04
0.48
36.5
0.008
0.21
0.012
10 - 04
12.7
5.85
1.22
64
0.008
0.012
11 - 04
1.8
130
0.006
0.012
12 - 04
0.5
30
0.009

PERMIT NUMBER: NC0051489
FACILITY NAME: Three R's Mobile Home Park - Three R's Mobile Home Park
CITY: Winston Salem COUNTY: Forsyth
TGP3B
pass/fail
P/F STATRE
7Day Chr
Ceriodaphnia
1 - 04
1
2-04
3-04
4-04
1
5-04
6-04
7-04
8-04
9-04
10-04
1
11 - 04
12-04
PERIOD ENDING MONTH: 12 - 2004
REGION: Winston-Salem
DMR 12 Month Calculated
PAGE 3 OF 3

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 04/27/05 Page: 1 of 1
m..
Between-2003 ane Ion..,°°12R,::•:.. .a-F..:• ..,
V I ate a u
laton,C004
P rgg ra ;m.
,Cate9o!....MRs
x
, -_.- ... • . s
Name. !°
, .
..r
Param.Na o ...._ _.... Coun tY '
�>'o' ,
- Sutiba.
Violation:Action:' °fo. • '
_,
PERMIT: NCO051489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT /PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE
07 - 2004 001 Effluent
Coliform, Fecal MF, M-FC
07/31/04
Weekly
#/100ml
400 1,200
Broth,44.5C
Reporting Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE
01 - 2004
03/02/04
02 - 2004
03 - 2004
05 - 2004
04 - 2004
06 - 2004
07 - 2004
10 - 2004
03/31 /04
05/01 /04
05/31 /04
05/31 /04
07/31 /04
08/31 /04
12/01 /04
VIOLATION TYPE
Daily Maximum Exceeded
VIOLATION TYPE
Late/Missing DMR
Late/Missing DMR
Late/Missing DMR
Compliance Status Missing
Late/Missing DMR
Late/Missing DMR
Late/Missing DMR
Late/Missing DMR
VIOLATION ACTION
No Action, BPJ
VIOLATION ACTION
None
None
None
None
None
No Action, BPJ
No Action, BPJ
Proceed to NOV

Permit Inspection History
Permit:
NCO051489
Owner:
Three R's Mobile Home Park
Facility:
Three R's Mobile Home Park
Primary Inspector
Inspection Type
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
Max S Mauney
Compliance Evaluation
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
William C Basinger
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Page 1
Report Date: 12/13/04
County:
Forsyth
Region:
Winston-Salem
Permit Type:
Discharging 100% Domestic
< 1MGD
Inspection Reason Inspection Date
Facility Status
Routine
09/20/85
Not Compliant
Routine
08/14/86
Compliant
Routine
02/03/87
Neither
Routine
12/13/88
Neither
Routine
06/07/89
Compliant
Routine
08/08/90
Compliant
Routine
09/11/91
Compliant
Routine
05/19/93
Not Compliant
Routine
04/14/94
Compliant
Routine
03/28/96
Compliant
Routine
05/07/97
Compliant
Routine
05/13/98
Not Compliant
Routine
03/24/99
Compliant
Routine
03/01/00
Not Compliant
Routine
03/20/01
Not Compliant
Routine
02/25/02
Compliant
Routine
05/01/03
Compliant
Routine
04/20/04
Not Compliant

Faxed To:
,_�0-,Y\dOL_L2 6C-0-0
Fax #:
)AA Phone #: 7 CP `e - 47 (p Z (.'
WWTP Annual Inspection Checklist
Facility: /`� p� �Z 5 NPDES:
Permit Effective Dates: / r to 5
o�
Inspection Date: 2� 3 T�`�Inspection Time: am/ m
1) DMRs (Dates: � Z - O to 1 Z '�' )
2) Lab Data (per DMR dates)
3) Laboratories used for analysis & certification #'s r
�4) Chain of Custody forms (per DMR dates)
Complete copy of current NPDES permit
6) Status of SOC or Moratorium issuance (if applicable
7p ORC and Back-up ORC current certification
Wastewater Annual Report (fiscal or calendar year - if applicable)
9) Daily Operator's log / ORC visitation log 2
10) Maintenance log
�11) Process control data (which includes field parameters tested and equipment
calibrations)
12) Field Parameter certification (if applicable) 3 /7
--• 13) Flow meter calibration records (if applicable) � l
/1'4) Influent and/or effluent samplers
,15) Flow charts (if applicable)
16) Generator Inspection / under load checks
Spill Response Plan (with current emergency contact numbers)
18) Current Sludge / Residuals permit (if applicable)
19) Sludge / Residuals hauling records (if applicable)
20) Sludge / Residuals Annual Report (if applicable)
— 21) Plant visual inspection of treatment units
__22) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office
[phone]
0-a /
weld�

RECEIVED
N.C. Dept. of ENR
June 7, 2004 JUN 0 8 2004
Winston-Salem
Regional Office
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
585 Waughtown Street
Winston Salem NC 27107
RE: Norman E. Boles
Three R's Mobile Home Park
Violation Notice
Dear Mr Tedder:
The following are corrections made to the above violations at Three R Mobile
Home Park.
Compliance Issue
1. Record Keeping: No spill response plan: .Spill Plan Response now on
sight at Three R Mobile Home Park Facility and in record keeping, in new
filing system.
2. Record Keeping: No annual report: In process of fulfilling annual
reports as requested.
3. Record Keeping: No complete copy of NPDES permit: NPDES Permit
now on sight at Three R Mobile Home Park and in new filing system
I hope these corrections are to the states satisfaction. If there are any problems to these
corrections please contact the ORC, Randy Bell, 336-766-9626.
Thanking you advance, I am,
Randy Bell/ORC
CC: Norman Boles

f
r
ATF9
Michael F. Easley, Governor
JW
William G. Ross Jr., Secretary
QG
North Carolina Department of Environment and Natural Resources
\Ot
r
Alan W. Klimek, P.E. Director
Division of Water Quality
o �
May 21, 2004
CERTIFIED MAIL 7003 0500 0000 2522 4260
RETURN RECEIPT REQUESTED
Norman E Boles -
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Compliance Evaluation Inspection
-Three R's Mobile Home Park
Permit No. NCO051489
Forsyth County
Dear Mr. Boles:
Enclosed please find a copy of the Inspection Report from the inspection conducted 2004-04-20.
The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem
Regional Office. The treatment facility was found to be in violation of permit NCO051489 for the
following:
Compliance issues found during the inspection are:
Inspection Area
Compliance Issue
Record Keeping
No spill response plan
Record Keeping
No annual report
Record Keeping
No complete copy of NPDES permit
Please refer to the enclosed Inspection Report for any additional observation and comments.
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)
IN,

NPDES yr/mo/day Inspection Type
NCO051489 I11 12 I 04/04/20 I17 18 i Cl
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)

Three R's
Page2
May21, 2004
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within thirty (30) working day of receipt of this letter. You should address
the causes of noncompliance and all actions taken to prevent the recurrence of similar situations.
If you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
W, tV, (e
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachment
Cc:
WQ Central Files w/ attachment
WSRzO-w/_rattachment-v,

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 INI 2 51 31 NCO051489 I11 121 04/04/20 117 18 U 19 U 20 U
u IJ
Remarks
211111Jill Jill Jill IIIIIIIIIIII1111IIIIIIII IIII111"
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA -------------Reserved-----------
67 I 169 70 U 71 U 72 L`J 73 W 74 751 I I I I I I 180
Section B: Facility 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)
01:00 PM 04/04/20
99/08/01
Three R's Mobile Home Park
Exit Time/Date
Permit Expiration Date
170 Jones Rd
Winston Salem NC 27107
02:00 PM 04/04/20
04/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Norman E Boles,5240 S Main St Winston Salem NC 27107//336-788-8347FontaCted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal 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
Rose Pruitt WSRO WQ//336-771-4608/336-771-4630
Signature of Management Q A Review r Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park - Three R's Mobile Home Park
Inspection Date: 04/20/04 Inspection Type: Compliance Evaluation
Yes No
NA
NE
Record rd Keeping
Are all records maintained for 3 years (lab. reg. required 5 years)?
0 ❑
❑
❑
Are analytical results consistent with data reported on DMRs?
N ❑
❑
Cl
Are sampling and analysis data adequate and include:
❑
❑
❑
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
Plant records are adequate, available and include
❑ ❑
❑
E
O&M Manual
❑
As built Engineering drawings
❑
Schedules and dates of equipment maintenance and repairs
❑
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
Has the facility submitted its annual compliance report to users?
❑ 0
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑ ❑
E
❑
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?
❑ E
❑
❑
Is the facility description verified as contained in the NPDES permit?
0 ❑
❑
❑
Does the facility analyze process control parameters, for example: MLSS, MCRT, Settleable Solids, DO, Sludge
❑ ❑
❑
E
Judge, pH, and others that are applicable?
Facility has copy of previous year's Annual Report on file for review?
❑ N
❑
❑
Comment:No annual report.
No spill response plan.
No complete copy of NPDES permit.
Yes No
NA
NE
Fffluent Pine
Is right of way to the outfall properly maintained?
E ❑
Cl
❑
Are receiving water free of solids and floatable wastewater materials?
0 ❑
❑
❑
Are the receiving waters free of solids / debris?
0 ❑
❑
❑
Are the receiving waters free of foam other than a trace?
N ❑
❑
❑
Are the receiving waters free of sludge worms?
■ ❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑ ❑
❑
Comment:

t
Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park - Three R's Mobile Home Park
Inspection Date: 04/20/04 Inspection Type: Compliance Evaluation
Yes No
NA
NE_
Permit
(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:
Yes No
NA
NE
On rations & Maintenance
Does the plant have general safety structures in place such as rails around or covers over tanks, pits, or wells?
■ ❑
❑
❑
Is the plant generally clean with acceptable housekeeping?
❑ ■
❑
❑
Comment:Grass not cut.
Rar Scream
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment:
EdMZQL,larifier
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?
Is the drive unit operational?
Is the sludge blanket level acceptable?
Comment:
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Are settleometer results acceptable?
Comment:
Disinfection
Type of system ?
Are cylinders secured adequately?
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ ■ ❑
■ ❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ❑ ■
■ O ❑ O
■ ❑ ❑ ❑
❑ ❑ ❑ ■
❑❑❑■
Tablet
■ ❑ ❑ ❑

Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park - Three R's Mobile Home Park
Inspection Date: 04/20/04 Inspection Type: Compliance Evaluation
Yes No
NA
NE
Disinfection
Are cylinders protected from direct sunlight?
0 ❑
❑
❑
Is there adequate reserve supply of disinfectant?
0 ❑
❑
❑
Is ventilation equipment operational?
❑ ❑
E
❑
Is ventilation equipment properly located?
❑ ❑
0
❑
Is SCBA equipment available on site?
❑ ❑
E
❑
Is SCBA equipment operational?
❑ ❑
E
❑
Is staff trained is operating SCBA equipment?
❑ ❑
M
❑
Is staff trained in emergency procedures?
❑ ❑
E
❑
Is an evacuation plan in place?
❑ ❑
❑
0
Are tablet chlorinators operational?
❑
❑
❑
Are the tablets the proper size and type?
❑
Cl
❑
Number of tubes in use?
(Sodium Hypochlorite) Is pump feed system operational?
Is bulk storage tank containment area adequate? (free of leaks/open drains)
Is the level of chlorine residual acceptable?
Is there adequate detention time
Is the contact chamber free of growth, or sludge buildup?
Comment:
De -chlorination
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?
Is ventilation operational?
Comment:
Are the tablets the proper size and type?
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Flow Measurement - Influent
Is flow meter used for reporting?
Is flow meter calibrated annually?
Is flow meter operating properly?
(If units are separated) Does the chart recorder match the flow meter?
Comment:
Flow Measurement - EfflUent
Is flow meter used for reporting?
Is flow meter calibrated annually?
Is flow meter operating properly?
(If units are separated) Does the chart recorder match the flow meter?
Comment:
Record Keeping
Are records kept and maintained as required by the permit?
Is all required information readily available, complete and current?
❑ ❑ ❑
❑ ❑ ❑ E
❑ ❑ ❑
❑ ❑ ❑ ■
❑ ❑ ❑
❑ ❑ ❑ E
Yes No NA NF
❑ O ■ ❑
00011
❑ ❑ ■ O
❑ ❑ ■ ❑
■ ■ ■
M►. ► ►r
■ ■ ■

0 A 6;A_1_ Tir v / / /
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
May 5, 2008 Division of Water Quality
Ms. Barbara Boles
5240 S. Main Street
Winston-Salem, North Carolina 27107
SUBJECT: WQCSD0256
Collection System Inspection
Three R's MHP Collection System
Forsyth County
Dear Ms. Boles:
An inspection of your collection system was conducted on'March 7, 2008 by Rose Pruitt of this
office. Randy Bell provided the relevant. compliance information on the facility. An earlier
informational letter was sent to you that detailed the requirements for collection systems that are
deemed to be permitted. I would like to remind you that these requirements for sewer collection
systems were first established in 15 NCAC .02H .0200 in March 2000 and are now found in 15
NCAC 2T .0403.
1. O & M Plan- The operation and maintenance plan must list the preventative maintenance
schedule, spare parts inventory, include an overflow response plan and testing frequency
for emergency equipment.
2. Collection System Map -A map of the collection'system must be available and maintained
with any additions to the system. The map should indicate the line size, pipe material, flow
direction, approximate age of the sewer, any high priority lines and number of active service
taps. A simple map on a 8'/z' x 11" sheet with the requested details would suffice. Please
confirm the compliance status for the map within 30 days.
3. High Priority Lines- These sections of sewer include aerial lines, lines contacting surface
waters, sub -waterway crossings, siphons, and sections of sewer parallel to stream banks
which are subject to erosion.arid the potential for failure of the sewer line. High priority lines
must be inspected every six (6) months and a log maintained with dates, inspection
methods, and corrective actions taken or planned. These should be identified on the
Collection System Map as noted above.
4. Right -of Way- The sewer line right-of-ways should be maintained to allow access to the
sewer lines for inspection and repair. The dates of the work performed can be noted on the
map or a log could be used for documentation. (See example form)
5. Observation-A.generaI observation of the.entire system must be conducted every year and
a log (or map) should be maintained to document these observations. Where there are
areas that are visible to the general public, right of way maintenance has been conducted or
where sewer cleaning has occurred, the "observation" requirement has essentially been met
for that section of line. The lines that are not normally seen by the public or maintenance
crews are of main concern for this "observation " requirement.
6. Grease education- Privately owned collection systems must distribute grease education
materials to the users of the system twice per year. (Attached is an example of the type
bilingual mailer that has been used by others). If sewer overflows are caused by grease,
these documents shall be distributed more often. Please note that this distribution schedule
is more frequent than was listed earlier.
o ehCarolina
NNaturally
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Winston-Salem Regional Office Winston-Salem, NC 27107 Fax [phone]
Internet: www.ncwaterguality.org
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

7. Overflows- Any sewer overflows or bypasses that reach surface waters or exceed 1000
gallons (on the ground) must be reported within 24 hours to the Division. (Reporting after
hours or on weekends and holidays should be to the Division of Emergency Management at
1-800-858-0368 or 1-919-733-3300). A follow-up 5-day report is also required which verifies
the cause of the spill and any actions taken to diminish the impacts and to prevent a
recurrence. A press release to all electronic and print news media outlets that provide
general coverage in the county where the discharge occurred is required within 48-hours of
first knowledge of the spill for all discharges of at least 1000 gallons to surface waters. If
there is a spill of at least 15,000 gallons to surface waters a public notice must also be
issued in a newspaper having general circulation in the County where the spill occurred and
in the County immediately downstream. Contact this office if you need any forms or further
information on this topic. Records of the spills that are less than 1000 gallons and do not
reach surface waters should also be maintained as this information can be utilized to identify
obstructions to the lines or excessive infiltration / inflow (1/1). This requirement must be
complied with immediately for any overflows or bypasses.
8. Documentation- Maintain all documentation for at least 3 years.
9. Prevent Discharges- Maintain and operate the system, "at all times to prevent discharge to
land or surface waters, and to prevent any contravention of groundwater standards or
surface water standards".
It is recommended that older sewer systems and systems that have experienced occasional
overflows have at least 10% of the system cleaned each year. Smaller systems not experiencing
overflows, should clean half of the system every five years or 1/3 every three years and a record of
this information should be maintained for review.
You may wish to check the website on collection systems at:
<hftp://h2o.enr.state.nc.uslperesICollection%20SystemsICollectionSystemsHome.html>
Please respond to this office within 30 days to confirm the status of the map and to provide the
distributon schedule for the grease education materials. Should you have any other questions
concerning this correspondence or the requirements relating to collection systems, please contact
Steve Mauney at 336-771-4969.
Sin rely,
teve W. Tedder
Water Quality Regional.Supervisor
Attachments
cc: SWP-Central Files & WSRO
PERCS

Performance Annual Report
1 General Information
Facility/System Name: Three R's MHP
Responsible Entity: Barbara Boles
Person in Charge/Contact: Randall Bell
Applicable Permit: NC0051489
DESCRIPTION OF COLLECTION SYSTEM OR TREATMENT PROCESS:
This .012 MGD wastewater treatment facility consists of an influent bar screen, aeration
basin, clarifier, Three aerated sludge holding tanks, chlorination, contact chamber, post
aeration, declor and contact tank, and flow monitoring device.
TEXT SUMMARY OF SYSTEM PERFORMANCE FOR CALENDAR YEAR 2007
This facility had a total of 2 limit violations.
LIST BY MONTH VIOLATIONS OF PERMIT CONDITIONS OF OTHER -
ENVIROMENTAL REGULATIONS. MONTHLY LIST SHOULD INCLUDE
DISCUSSIONS OF ANY ENVIROMENTAL IMPACTS AND CORRECTIVE
MEASURES TAKEN TO ADDRESS VIOLATIONS.
January: 1 daily maximum exceeded for fecal coliform. 1/29/2007
February: Compliant
March: Compliant
April: Compliant
May: Compliant
June: Compliant
July: Compliant
August:' Compliant
September: Maximum Daily BOD limit exceeded on 9/4/2008
October: Compliant

November: Compliant
December: Compliant
3: NOTIFICATION
This report has been made available to the owner of the facility for distribution.
4: CERTIFICATION
I certify under penalty of law that this report is complete and accurate to the best of
my knowledge. I further certify that this report has been made available to the users or
customers of the named system and that those users have been notified of its availability.
Randall Bell
Responsible Person
Title: ORC/Owner
Entity: Bell Enterprises

a WA Michael F. Easley, Governor
\O�0 RQG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resn. ur res
rColeen H. Sullins Director
Division of Water Quality
November 28, 2007
CERTIFIED MAIL 7007 0710 0001 5586 9455
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION: NOV-2007-LV-0546
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
A review of Three R's Mobile Home Park's monitoring report for September 2007 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
09/04/07
45 mg/1
49 mg/1
Daily Maximum
Exceeded
Coliform, Fecal MF, M-FC
09/04/07
400 #/100ml
1,100 #/100ml
Daily Maximum
Broth,44.5 C
Exceeded
Compliance Issue
DMR should not be marked compliant.
Remedial actions should be taken to correct this problem. The Division of Water Quality may pursue
enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in writing to this
office within 30 working days of receipt of this letter. You should address the causes of noncompliance
and all actions taken to prevent the recurrence of similar situations. If you should have any questions,
please do not hesitate to contact Rose Pruitt at [phone].
Sincer ly,
Steve W. Tedder
Water Quality Regional Supervisor
Winston Salem Region
Division of Water Quality
Cc: WQ Central Files
WSR I
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

l9
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tiF'DES PERMIT NO. as . �% �� DISCH:\RGE NO. %IONTI I S�t � � Y )OD 7
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\ fT.`: CENT R\L FILES = EIVED x
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Facility Starts: (Please check one of the following)
All monitoring data sampling q and sam ling frequencies meet permit requiremcnts C
Cumphant
All monitoring data and sampling frequencies do NOT meet permit requirements 71
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared tinder my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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 tines and imprisonment for knowing violations."
RA- /3
Permittee (Please print or type)
4, �,f �01
Signature of Permittee*" Date
(Required)
Pemlittee Address 910•tPhone Number
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
01067
Nickel
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
01077
Silver
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
01027
Cadmium
01092
01 105
Zinc
Aluminum
00082
Color (ADMI)
00623
Total Kjeldhal
;
00095
Conductivity
00630
Nitrogen
Nitrates/Nitrites
01032
Hexavalent Chromium
01147
Total Selenium
00300
Dissolved Oxygen
01034
Chromium
31616
Fecal Coliform
00310
BOD5
00665
Total Phosphorous
32730
Total Phenolics
003.10
COD
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00400
pH
00745
Total Sulfide
01042
Copper
34481
Toluene
00530
Total Suspended
00927
Total 'Magnesium
01045
Iron
38260
MBAS
Residue
00929.
Total Sodium
01051
Lead
39516
PCBs
005-15
Settleable 'Matter
00940
Total Chloride
01062
;Molybdenum
50050
Flow
Permit Exp. Date
50060 Total
Residual
Chlorine
71830 Formaldehyde
71900 Mercury
81551 Xylene
Parameter Code assistance may obtained by calling the PointUSou?L�t�1oinplianeciEnforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h10 cnr state.nc us/wgs and linking to the Unit's information pages.
Use Only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
* k If signed by other than the permittec, d4legation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
/IN , n

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Erlar Fhrcmatar Code .tea
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Cover Sheet from
Staff Member to
Regional Supervisor
DAIR Review Record
Facility: ) ")S- S Permit/Pipe No.: 01671 Month/Year
Monthly Average Violations
Parameter Permit Limit DMR Value
N 041`j —
Weekl /Daily iolations
Date Parameter Permit Limligype DMR Value
o7 6�r-4k-Colr r-. -IY00 1100 0,0
Monitorin; Frequency Violations
Over Limit
Over Limit
©o
2S G
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
Date: (I - 27 07
Date:
/Ov, a�, V�

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 11/27/07 Page: 1 of 1
t_ :—... �_. _ _ _ _ _ .
Permit: nc0051489 MRs Between'.. 9=2006and� 8-2007 Region: °lo. ' �Violation.Category: %, `.PrograliS,Category:
,.. e
;Facility Name: °Ia ` . �Param Name-, ,County: % �- .Subbasin: % =Violat on Action. °/4'„;. '
_Major Minor: %
n
9
PERMIT: NCO061489 FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
01 -2007 001
Effluent
Coliform, Fecal MF, M-FC
01/30/07
Weekly
#/100ml
400
500
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
04 -2007 001
Effluent
Nitrogen, Ammonia Total (as
04/11/07
Weekly
mg/I
8.7
9.7
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
04 -2007 001
Effluent
Nitrogen, Ammonia Total (as
04/30/07
Weekly
mg/I
2.9
3.44
Monthly Average Exceeded
No Action, BIMS
N)
Calculation Error
05 -2007 001
Effluent
Nitrogen, Ammonia Total (as
05/29/07
Weekly
mg/I
8.7
9.8
Daily Maximum Exceeded
No Action, BIMS
N)
Calculation Error
Monitoring Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
12 -2006 001
Effluent
Flow, in conduit or thru
12/31/06
Continuous
mgd
Frequency Violation
None
treatment plant
Reporting Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
08 -2007 001
Effluent
Nitrogen, Total (as N)
08/31/07
Quarterly
mg/I
Parameter Missing
None
08 -2007 001
Effluent
Phosphorus, Total (as P)
08/31/07
Quarterly
mg/I
Parameter Missing
None

December 5, 2007
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown Street
Winston Salem, NC 27107
Randy Bell
PO Box 1291
Clemmons, NC 27012
RE: Violation: Nov-2007-1-V-0546
Permit No. NC 0051489
Three R's Mobile Home Park
I RECEIVED
N.C. Dept. of ENR
DEC Q 6 2007
Winston-Salem
Regional Office
To Whom It May Concern;
Concerning compliance issues for 9/4/07; First issue, BOD limit 45 mg/I; reported value 49mg/I;
there was a clogged diffuser, which appears contributed to the compliance issue number two which is
the Second issue, Fecal Coliform limits value 400/100 mi. Reported value 1,100 #/100ml; Action taken,
repaired diffuser.
Thanking you in advance. If you have any questions please call me 336-766-9626,
. Sincerely,
Az
IL"el
Randy Bell/ORC

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of En-4ronment and Natural Resources
l�ovember 28, 2007
CERTIFIED iVEAIL. 7007 0710 0001 5586 9455
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION: NOV-2007-LV-0546
Permit No. NC0051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
Coleen H. Sullins Director
Dixision of Water Quality
A review of Three Xs Mobile Home Parks monitoring report for September 2007 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
09/04a`07
45 mg/1
49 mg/l
Daily Maximum
Exceeded
Coliform, Fecal IMF, M-FC
i 09/04/07
400 #1100ml
1,100 #/100m1
Daily Maximum
Broth,44.5C
Exceeded
Compllanee Issue
DMR should not be marred compliant. )
Remedial actions should be taken to correct this problem. The Division of Water Quality may pursue
enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in Writing to this
office within 30 working days of receipt of this letter. You should address the causes of noncompliance
and all actions taken to prevent the recurrence of similar situations. If you should have any questions,
please do not hesitate to contact Rose Pruitt at [phone].
c
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston Salem Region
Division of Water Quality
Cc: WQ Central Files
WSRO
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
p .� U Alan W. Klimek, P.E. Director
Division of Water Quality
November 23, 2006
-
-- ---- ---- ----------
170 Jones Road
Winston Salem, NC 27107
SUBJECT: Three R's Mobile Home Park
Permit No. NCO051849
Collection System Requirements
Forsyth County
Dear Permitee:
I would like to take this opportunity to discuss the requirements for sewer collection systems that were first established in
15 NCAC .02H .0200 in March 2000 and are now found in 15 NCAC 2T..0403 that became effective September 1, 2006
and are applicable to this facility.
High priority" lines must be inspected every six (6) months and a log maintained with dates, inspection methods, and
corrective actions taken or planned. These sections of sewer include aerial lines, lines contacting surface waters, sub -
waterway crossings, siphons,"and . sections of sewer parallel to stream banks which. are subject to erosion and the
potential for failure of the sewer line.
The sewer line right-of-way should be maintained to allow access to the sewer lines for inspection and repair. A map with
dates noted for the work performed or a log could be used for documentation. (See the attached example logs.)
It is recommended that older sewer systems and systems that have experienced repeated overflows have at least 10% of
the system cleaned each year. Smaller systems not experiencing overflows, should clean half of the system every five
years or 1/3 every three years and a record of this information should be maintained for review.
A general observation of the entire system must be conducted every year and a log (or map) should be maintained to
document these observations. Where there are areas that are visible to the general public, right of way maintenance has
been conducted or where sewer cleaning has occurred, the "observation" requirement has essentially been met for that
section of line. The lines that are not normally seen by the public or maintenance crews are of main concern for this
"observation " requirement.
A map of the collection system must be prepared and maintained with any additions to the system. The map should
indicate the line size, pipe material, flow direction, pump station locations, location of any tributary collection system
connections, approximate age of the sewer, and number of active service taps. All records must be kept for 3 years
while the map is a continuous requirement.
Privately owned collection systems must distribute grease education materials to the users of the system every two
years. Publicly owned systems must also inspect the grease interceptors at existing establishments and enforce against
violators. (Attached is an example of the type document that has been used by others). If sewer overflows are caused by
grease, these documents shall be distributed more often.
An operation and maintenance plan must be developed and implemented which lists the frequency of pump station
inspections (see next page), preventative maintenance schedule, spare parts inventory, and overflow response plan.
Testing frequency for any emergency equipment should also be included in this plan.
e
NCarolina
Noaurally
North Carolina Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107 Phone [phone] Fax [phone]
Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

LFEB
ECE;
Three R's Mobile Home Park N. 0�
Three R's Mobile Home Park WWTP 2
A to C No. 051489AOI s;..January 22, 2007 icr.,
Engineer's Certification
I, ���+al� � /'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 modifications and improvements to the Three R's MHP WWTP located
on Jones Road in Forsyth County for Three R's Mobile Home Park, hereby state that, to the best
of my abilities, due care and diligence was used in the observation of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on January 17, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Si
Date
Registration No. 1O'e. -
Send to: Construction Grants & Loans
DENR/D WQ
1633 Mail Service Center
Raleigh, NC 27699-1633
t ttpptt��`' �'A C A
4 -
MA

%
IAT�t�
1':
h T Kv
Barbara Boles
Three R's Mobile Home Park
5240 South Main Street
Winston-Salem, NC 27107
SUBJECT:
Dear Ms. Boles:
67,#'-- Michael F. Easley. Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 26, 2007
Authorization to Construct
A to C No. 051489AOI
Three R's MHP WWTP
Dechlorination Facilities
Forsyth County
Alan W. Klimek, P.E. Director
Division of Water Quality
N.C. D.
JAM 3 1 2007
Rr� .
A fast track application for Authorization to'Construct dechlorination facilities was
received on January 17, 2007, by the Division. Authorization is hereby granted for the
construction of modifications to the existing Three R's MHP WWTP with discharge of treated
wastewater into Leak Creek in the Yadkin River Basin.
This authorization results in no increase in design or permitted capacity and is awarded
for the construction of the following specific modifications:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on January 17, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
This Authorization to Construct is issued in accordance with Part III, Paragraph A of
NPDES Permit No. NCO051489 issued May 1, 2005, and shall be subject to revocation unless
the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No. NC0051489.
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.
The Winston-Salem Regional Office, telephone number [phone], shall be notified
at least forty-eight (48) hours in advance of operation of the installed facilities so that an on site
NorthCarolina
Naturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Ms. Boles
January 22, 2007
Page 2
inspection can be made. Such notification to the regional supervisor shall be made during the
normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State
Holidays.
Pursuant to 15A NCAC 2H .0140, upon completion of construction and prior to operation of
these permitted facilities, the completed Engineering Certification form attached to this permit shall be
submitted to the address provided on the form.
Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of the
wastewater treatment facilities. The operator must hold a certificate of the type and grade at least
equivalent to or greater than the classification assigned to the wastewater treatment facilities by
the Certification Commission.
The Permittee must also employ a certified back-up operator of the appropriate type and
grade to comply with the conditions of T15A:8G.0202. The ORC of the facility must visit each
Class I facility at least weekly and each Class II, III and IV facility at least daily, excluding
weekends and holidays, must properly manage the facility, must document daily operation and
maintenance of the facility, and must comply with all other conditions of T15A:8G.0202.
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for the life of the facility.
During the construction of the proposed additions/modifications, the permittee shall
continue to properly maintain and operate the existing wastewater treatment facilities at all times,
and in such a manner, as necessary to comply with the effluent limits specified in the NPDES
Permit.
You are reminded that it is mandatory for the project to be constructed in accordance
with the North Carolina Sedimentation Pollution Control Act, and, when applicable, the North
Carolina Dam Safety Act. In addition, the specifications must clearly state what the contractor's
responsibilities shall be in complying with these Acts.
Failure to abide by the requirements contained in this Authorization to Construct may
subject the Permittee to an enforcement action by the Division of Water Quality in accordance
with North Carolina General Statute 143-215.6A to 143-215.6C.
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.

J Ms. Boles
January 22, 2007
Page 3
If you have any questions or need additional information, please do not hesitate to contact
Cecil G. Madden, Jr., P.E. at telephone number [phone].
Sincerely,
P4- A ,
F011—
Alan W. Klimek, P.E.
AR/cgm
cc: J. Thurman Horne, P.E., Horizon Engineering & Consulting, Mt. Pleasant
Forsyth County Health Department �®
Wirtston-a eml Re "�rcal'off:ice``S:urface�V�Iater�Pic��ectio�l�-��ct`on
Technical Assistance and Certification Unit
Daniel Blaisdell, P.E.
Point Source Branch, NPDES Program
Cecil G. Madden, Jr., P.E.
Anita Reed, E.I.
A to C File

Three R's Mobile Home Park
Three R's Mobile Home Park WWTP
A to C No. 051489A01
January 22, 2007
Engineer'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 modifications and improvements to the Three R's MHP WWTP located
on Jones Road in Forsyth County for Three R's Mobile Home Park, hereby state that, to the best
of my abilities, due care and diligence was used in the observation of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on January 17, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Signature Registration N
Date
Send to: Construction Grants & Loans
DENR/DWQ
1633 Mail Service Center
Raleigh, NC 27699-1633

W A f �9QG
Av*® Michael F. Easley, Governor
Barbara Boles
Three Ws Mobile Home Park
5240 South Main St
Winston-Salem, NC 27107
Dear Ms. Boles:
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
October 3, 2006 — — L
ertOFENR
0 5 Zoos
on-salemal OPnce
Subject: NPDES Permit Modification
Permit NCO051489
Three R's Mobile Home Park
former owner. Norman Boles
Forsyth County
Division personnel have reviewed and approved your request to transfer ownership of the subject permit,
received on October 3, 2006- This permit modification documents the change in ownership.
Please find enclosed the revised permit All other terms and conditions contained in the original permit remain
unchanged and in full effect This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
if you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
733-5083 extension 363.
Sincerely,
rV an W. Klimek, P.E.
cc: Central Files
Wrnston-Sal'ern-Reiotial'Offiee SiirfaceWatex Psofectio_u"
NPDES Unit File
NorthCarolina
N rth r�WAMIZ4
o Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us - 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF.ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the, Federal Water Pollution Control Act, as amended,
Barbara Boles
is hereby authorized to discharge wastewater from a facility located at -
Three R's NVIHP
170 Jones Road
Winston Salmi; North Carolina
Forsyth County
to receiving waters designated as Leak Creek in the Yadkin Pee Dee River Basin in accordance with
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, and IV
hereof.
The permit shall become effective October 3, 2006.
This permit and the authorization to discharge shall expire at midnight on June 30, 2009.
Signed this day October 3, 2006.
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

v
NCO051489
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of
this permit issuance, any previously issued permit bearing this number is no longer effective. Therefore, the
exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements,
terms, and provisions included herein.
Barbara Boles is hereby authorized to:
1. Continue to operate an existing 0.012 MGD package wastewater treatment facility
consisting of the following components:
• Influent bar screen
• Aeration basin
• Clarifier
• Aerated sludge holding tank =
• Chlorination -
Contact chamber
• Post aeration
• Flow monitoring device
The facility is located at Three R's Mobile Home Park,170 Jones Road, Winston Salem in
Forsyth County.
2. Operate, after receiving an Authorization to Construct and: axiaking the necessary
modifications, a 0.020 MGD wastewater treatment facility, and;
- 3. Discharge treated wastewaters (via Outfall 001) from said facility at the location specified
on the attached map into the Leak Creek, a Class C water in the Yadkin Pee Dee River
Basin.

NCO051489
SECTION A(1). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS -
Beginning on the effective date of this permit and lasting UNTIL EXPANSION ABOVE 0.012 MGD
OR PERMIT EXPIRATION, the Permittee is authorized to discharge treated wastewater from Outfall
001. Such discharges shall be limited and monitored by the Pewattee as specified below:
EFFLUENT -LIMITS
CHARACTERISTICS':
' MONITORING
REQUIREMENTS
Monthly :
Average
Weekly' `
Average
Daily; ::
Maximum
Measuiemenf>
q cy
Fre uen
Sam le . `
p
Type „`
Sample .-
p i
Location.
Flow
0.012 MGD
Continuous
Recorder
I or E
BOD, 5 day, 200C
30.0 mg/I
45.0 mg/1
Weekly
Grab
E
Total Suspended Residue
30.0 mg/1
45.0 mg/1
Weekly
Grab
E
NH3 as N
Weekly
Grab
E
Total Residual Chlorinez
28 µg/L
2/Week
Grab
E
Dissolved Oxygen3
Weekly
Grab
E,U,D
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U,D
pH4
Weekly
Grab
E
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
E
Total Nitrogen
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
Chronic Toxicity5
Quarterly
Grab
E
Footnotes:
1. Sample locations: E- Effluent, I- Influent, U- Upstream, D- Downstream at NCSR 2932
2. TRC limit will take effect on December 1, 2005. The limit and monitoring requirements only apply if chlorine is used for
disinfection.
3. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/1.
4. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
5. Chronic Toxicity (Ceriodaphnia) P/F at 20%; January, April, July, October; see Special Condition A(3).
There shall be no discharge of floating solids or foam visible in other than trace amounts.

NCO051489
SECTION A(2). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning upon EXPANSION ABOVE 0.012 MGD and lasting until permit expiration, the Permittee is
authorized to discharge treated wastewater from Outfall 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
..' ;
EFFLUENT, ;
CHARACTERISTICS .:.:.: :;
LIMITS , _
MONITORING'REQUIREMENTS-
Monthly , ;
Average'
Weekly".
Average'"
Daily: -.
Maximum
Measurement
.Frequency .' '.
Sample '
. Type : •
Sample .
I ocationl
Flow
0.020 MGD
Continuous
Recorder
I or E
BOD, 5 day, 200C
30.0 mg/1
45.0 mg/1
Weekly
Grab
E
Total Suspended Residue
30.0 mg/1
45.0 mg/I
Weekly
Grab
E
NH3 as N
(April 1- October 31
2.9 mg/1
8.7 m 1
g/
Weekly
Grab
E
NH3 as N
ovember 1- March 31
9.4 mg/1
28.2 mg/I
Weekly
Grab •
E
Total Residual Chlorine
28 ug/I
2/ Week
Grab
E
Dissolved Oxygen
Weekly
Grab
E,U,D
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U,D
PH3
Weekly
Grab
E
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
E
Total Nitrogen
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
Footnotes:
1. Sample locations: E- Effluent, I- Influent, U- Upstream, D- Downstream at NCSR 2932
2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/l.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or foam visible in other than trace amounts.

NCO051489
SUPPLEMENT TO EFFLUENT LIMITATIONS
AND MONITORING REQUIREMENTS
SPECIAL CONDITIONS
A(3). CHRONIC TOXICITY PASS/FAIL PERMIT LIMIT (QRTRLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to Ceriodaphnia
dubia at an effluent concentration of 20.0%.
The permit holder shall perform at a minimum, quarterl monitoring using test procedures outlined in the "North Carolina
Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent versions or "North Carolina Phase
H Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions. The tests will be
performed during the months of January; April, July, and October. Effluent sampling for this testing shall be performed at the
NPDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV below the permit limit, then
multiple -concentration testing shall be performed at a minimum, in each of the two following months as described in "North
Carolina Phase H Chronic Whole Effluent Toxicity Test Procedure"`(Revised-February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the highest concentration
having no detectable impairment of reproduction or survival and the lowest concentration that does have a detectable
impairment of reproduction or survival. The definition of "detectable impairment," collection methods, exposure regimes,
and further statistical methods are specified in the "North Carolina Phase H Chronic Whole Effluent Toxicity Test Procedure"
(Revised -February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge Monitoring
Form (MR-1) for the months in which tests were performed, using the parameter code TGP3B for the pass/fail results and
THP3B for the Chronic Value. Additionally, DWQ Form AT-3 (original) is to be sent to •the following address:
Attention: NC DENR / DWQ / Environmental Sciences Branch
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Branch no later than 30 days after the
end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all concentration/response
data, and be certified by laboratory supervisor and ORC or approved designate signature. Total residual chlorine of the
effluent toxicity sample must be measured and reported if chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required, the permittee
will complete the information located at the top of the aquatic toxicity (AT) test form indicating the facility name, permit -
number, pipe number, county, and the month/year of the report with the notation of "No Flow" in the comment area of the
form. The report shall be submitted to the Environmental Sciences Branch at the address cited above.
Should the permittee fail to monitor during a•month in which toxicity monitoring is required, monitoring will be required
during the following month
Should any test data from this monitoring requitement or tests performed by the North Carolina Division of Water Quality
indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include alternate monitoring
requirements or limits.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism survival,
minimum control organism reproduction, and appropriate environmental controls, shall constitute an invalid test and will
require immediate follow-up testing to be completed no later than the last day of the month following the month of the initial
monitoring.

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: % . S Permit/Pipe No.: W OO5 l 4�5-q Month/Year
Parameter
Monthly Average Violations
Permit Limit DMR Value
Date Parameter
,!5•24-07 �JHS AI6 Q
Date Parameter
Other Violations
% Over Limit
Weekly/Daily Violations
Permit Limit/ Tvl2e DMR Value % Over Limit
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
"gel,
41�
Date: ' �5" `c
Date: �, -�' ,e 7

July 19, 2007
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown Street
Winston Salem, NC 27107
To Whom It May Concern;
JUL 24�s
RPUi„rdr
According to permit, for 3 R's Mobile Home Park, There is not limit on total Nitrogen, Ammonia Total.
Attach is a copy of Three R's MHP Permit. Also, according to NOV, the reported value was stated 3.44,
on 4/30/07. Highlighted on DMR shows on 4/30/07 the recorded value is o.2; Yet again, there is no limit
on Nitrogen Ammonia.
Thanking you in advance,
fl�Vn� d,.e�
Bell Enterprise/Randy Bell
PO Box 1291
Clemmons, NC 27012

Michael F. Easley, Governor
William G. Ross Jr., Semtary
North Carolina Department of Environment and Natural Resources
July 11, 2007
CERTIFIED MAIL 7006 0100 0001 8758
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
NOV-2007-LV-0388
Permit No. ?vTC0051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
Coleen H. Sullins Director
Division of water Quality
A review of Three R's Mobile Home Park's monitoring report for April 2007 showed the
following violations:
Parameter
Date
Limit Value
Deported Value
Limit Type j
Nitrogen, Ammonia Total (as
04/30/07
2.9 mg/1
3.44 mg/l
Monthly
N)
Average
Exceeded
Nitrogen, Ammonia Total (as
04/11/07
8.7 mg/l
9.7 mg/l
Daily Maximum
N-)
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing --
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
�._ _
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files —SWT
WSRO
585.Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

EFFLUENT
-SPERMITNO 1
717--'--li
DISCHARGE NO. N IONT] I YEAR
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CLAss- Co U��-, a
C)PERATOR IN RFSP ON $MLE CENRGi�4 CIRE-0
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CHECK BOX IF ORC HAS CHANGED
HIMONS COL LECTING SA.,,,ml! Es
rt
A CENTR-,kL FILES
Y ISNIN OF WATER Q[ ALITY
S lf;,";A ID F 0."; S: 6 F H R -; �E�
14 17 0- SERVICE CENTER
BY THIS 3lGN-tTl:RE. I C.-.4T'Ff u A -1E
ACCURA ME AND r(l,"U'LETE TO TIHE BESTOF
F?xTdilsD 00530, .11616 00-7,04) -.0-4606
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51
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NiC0051460
I ECTION AM. EFFLUENT LIMITATIONS AND MONrTORING REQUIREMENTS
on the effective date of Chis permit and lasting UNTIL EXPM-1-TSION ABOVE 0-0121,/1G-D
,D-R PERNLITA EXPIRAT-10N, ffie Pen-nittee isa-tiehorized to discharge treated wastewater from Ou kfall
OGI. Such discharges shall be- limited and inonitored by t"he Permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIMITS
MONITORING
REQUIREMENTS
Monthly
Average
k-ly
Average
aiij IMeasurement
axiznum I
Frequency
Sample
Type
Saanple
Locafionl
Row
P1.01 12 IV, G D
Continuous
tt ir E
L�nD' 5
30 0 mg/l
45.0 mg/1
WeLkly
Grab ll
Grab
El
E
total Suspended Residue
AW Mg/l
'-fir_ -. 0 mig�
wf--''klv
N 113 a's N
Weeki-,i
Grab
E
Totat Residual Chlorirw,2
28 pg/L
21Wexk
Grob
E
Dissolved
Grab
E,U,D
'remper"Iture
fxailv
Cr.
# E
Ten peralure
is txkly
Grab
# U'D
Week!",
L
Total NftroWn
-100 rn 1
4 W/ I CO m
Weekiv
Quarterly
Crab
Grab
E
E
Total PhosphurUS
0
Grab
E
5-a-rnpfe lucations, E- Effluent, I- Influe.nk, U- Upstream, D- DoivnQ.rearn. at NCSR 2932
2. TTZ.0 hinit will take effect -IRm.unths after the effective date of the final permit. T, 1-je limit anci monimring requirernerits-
unly apply if chlorin eiSused for disinfL-ction.
I The daily average diss,)hred oxygen effluent corxentration shall not be less than 5.0 mg/l.
4� The pH shall not be less than 6.0 standard units nor greater than 9.0standard, unit-,.
5Chronic Toxidty (Ceriodaphina) P/Fat 20%; January, April, July, October;.,�ee Special Condition A(3).
'Phere shall be no discharge of floating solids or foam -vis-ible in other than trace amounts.

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
July 11, 2007
CERTIFIED MAIL 7006 0100 0001 8758
RETURN RECEIPT REQUESTED
Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
NOV-2007-LV-0388
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
Coleen H. Sullins Director
Division of Water Quality
A review of Three R's Mobile Home Park's monitoring report for April 2007 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as
04/30/07
2.9 mg/1
3.44 mg/1
Monthly
1)
Average
Exceeded
Nitrogen, Ammonia Total (as
04/11/07
8.7 mg/l
9.7 mg/1
Daily Maximum
N)
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files —SWP
1f�M
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

t
_ 1 EFFLUENT T 07
"It'I=S PERMIT N0. A C DISCHARGE N0. NIONTI [ l" yE:kF
"FACILITY N:\�[E u� j CLASS C0U. *v1'�'��'►�!�� s,
OPERA'FOR IN RESPONSIBLE CFI.\!tG ' OiZC) GRADE-3—PHONE 3
CERTIFIED LABORATORIES ( I) (jr% 51 (2)
CHECK BOX W ORC ILLS CHANGED ® PERSO:N(S) C0LL-EC TiNiG SAMPLES A `v;/ � 7 .e
Mail OR[GIN•\L and Otis C
O-I'
I"IV: CER.�L FILES
16I7.%LX1I)IVISIOSE VILER EN I_I'Tti'
1(,17 �L\IL SERVICE CENTER
R.1LE1C;1I. NC: 2'(,9'I-I(l7
I'Y to: RE C A. . f
of Ex
N.C. De NR
4 61SiGS,
JUN 200�R1' TIII
Winst n-Salem ACCCR
Regional Office
TURE OF O RATOR IN RESPONSIBLE CHARGE) D �
SIGt,\TL'RE. [ CERT1F5f TmvrTIIIS REPO RT IS
TEANDCO:MPLETETOTHEBESTOFMYK.NW%LEDGE.
00610 00530 j 31616 00300 00600 0066;
00400 50060
00310
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Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements El
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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 infonmation, including the possibility of tines and imprisonment for knowing violations."
Pen itte'e (Plea e print or type)
Signature of Pertnittee** Date
(Required)
') 7 ) 0-) bl,) )2,2 23 q 7
Permittee Address
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable ivlattcr
Phone Number
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/ Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
OI042
Copper
00927
Total Magnesium
01045
Iron
00929.
Total Sodium
01051
Lead
00940
Total Chloride
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
01147
Total Selenium
31616
Fecal Coliform
32730
Total Phenolics
34235
Benzene
34481
Toluene
38260
MBAS
39516
PCBs
50050
Flow
Permit Exp. Date
50060 Total
Residual
Chlorine
71S30 Formaldehyde
71900 Mercury
81551 Xylene
Parameter Code assistance may obtained by calling the Point SourcT U?o i�-iianedfEhforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o enr state.nc us/wgs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
* If signed by other than the permittce, d4legation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(2) (D)•

t�a�o
--j-11'174M
v
iA9 71
v
Forni MR-3 1. 11:•S4 )
0

NOV- 200"? z-V 036e
Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: -Ti ki C� Permit/Pipe No.: NG00SI4947 Month/Year
Parameter
Date
Monthly Average Violations
Permit Limit DMR Value
% Over Limit
t • (� 0
Weekly ail Violations
Parameter Permit Limit/Type DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
Date: *?-)o-07
Date:
lyv"
—// `U 7

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 07/10/07 Page: 1 of 2
'''MRs'Between
' °
a/o
Permit'-nc0051489.,
5=2006 and'
3-2007 Region:%
Violation Category:
Program Category:°lo l
°
Facility. Name: l4 ��
Param°Name % -
`Conn : °la
ty_
Subbasin:�ay
Violation Action: °IQ I
.. Major Minor %,
PERMIT: NCO051489
FACILITY: Three R's Mobile Home Park - Three R's Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL/
VIOLATION
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
06 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
06/07/06
Weekly
06 -2006
001
Effluent
Coliform, Fecal MF, M-FC
06/21/06
Weekly
Broth,44.5C
01 -2007
001
Effluent
Coliform, Fecal MF, M-FC
01/30/07
Weekly
Broth,44.5C
05 -2006
001
Effluent
Nitrogen, Ammonia Total (as
05/01/06
Weekly
05 -2006
001
Effluent
Nitrogen, Ammonia Total (as
05/10/06
Weekly
05 -2006
001
Effluent
Nitrogen, Ammonia Total (as
05/15/06
Weekly
05 -2006
001
Effluent
Nitrogen, Ammonia Total (as
05/31/06
Weekly
06 -2006
001
Effluent
Nitrogen, Ammonia Total (as
06/07/06
Weekly
06 -2006
001
Effluent
Nitrogen, Ammonia Total (as
06/13/06
Weekly
06 -2006
001
Effluent
Nitrogen, Ammonia Total (as
06/26/06
Weekly
06 -2006
001
Effluent
Nitrogen, Ammonia Total (as
06/30/06
Weekly
07 -2006
001
Effluent
Nitrogen, Ammonia Total (as
07/05/06
Weekly
07 -2006
001
Effluent
Nitrogen, Ammonia Total (as
07/31/06
Weekly
UNIT OF
CALCULATED
MEASURE
LIMIT VALUE
VIOLATION TYPE VIOLATION ACTION
mg/I
45 58
Daily Maximum Exceeded Proceed to NOV
#/100ml
400 600
Daily Maximum Exceeded Proceed to NOV
#/100ml
400
500
Daily Maximum Exceeded
Proceed to NOV
mg/I
8.7
10.8
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/I
8.7
13.6
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/1
8.7
10.4
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/I
2.9
10.14
Monthly Average Exceeded
No Action, BIMS
Calculation Error
mg/l
8.7
10.8
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/l
8.7
8.8
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/I
8.7
9.3
Daily Maximum Exceeded
No Action, BIMS
Calculation Error
mg/I
2.9
7.58
Monthly Average Exceeded
No Action, BIMS
Calculation Error
mg/I
8.7
9.2
Daily Maximum Exceeded
No Action, BPJ
mg/1
2.9
3.9
Monthly Average Exceeded
No Action, BPJ

MONITORING REPORTVMRVVIOLATIONS for:
Report Date: mnmm Page: emz
Permit: ncOO51489
it' ;Nam Pai�m Name 9x
PERM[T:NCVD51488 FACILITY: Three R's Mobile Home Park ' Three R'oMobile Home Park COUNTY: Forsyth
REGION: Winston-Salem
Monitoring Violation
mow/Ton/w000rFALL/
VIOLATION UNIT OF
oALoomrco
nsponr pp/ Loo*rmw PARAMETER
oars Fncuucwn, MEASURE
um/T v*mE
VIOLATION TYPE VIOLATION ACTION
12'2006 001 Effluent Flow, mconduit »rmm
12/31m6 Continuous mou
Frequency Violation mono

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
April 12, 2007
CERTIFIED MAIL 7006 0100 0001 8758 7020
RETURN RECEIPT REQUESTED
Three R's Mobile Home Park
Barbara Boles
5240 S main St
Winston Salem, NC 27107
Re: Permit No. NCO051489
Three R's MHP WWTP
Operator in Responsible Charge
Backup Operator in Responsible Charge
Dear (Sir/Madam):
The Winston-Salem Regional Office, of the Division of Water Quality, has reason to believe
there exists a discrepancy between the current listing of operators at your facility and their
validation status. We are requesting information certifying the current valid operators and
backup operators for you facility. This request is made pursuant to Section C, item 1 of your
permit.
Response is necessary within ten (10) working days to alleviate actions by the Division.
If there are questions, contact Marc Stokes at [phone].
Regards
,LCvAU,_t4q_
Rose Pruitt
Division of Water Quality
Cc: M. Stokes
S. Tedder
-..
oe Carolina NNaturally
North Carolina Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107 Phone [phone] Fax [phone]
Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycledl10% Post Consumer Paper

Im
April 20, 2007
Steve Tedder
585 Waughtown St
Winston Salem, NC 27107
Subject: Violation Three R's Home Park
Dear Mr. Tedder;
RECEIF/ED
N.C. Deot. of c+,q
APR 2 � 2007
Winstonsaler;
Re office
On January 30, 2007 due to moisture in CL2 tubes causes CL2 tablets to swell and not falling into
wastewater effluent. Remedy of problem shaking tube on each visit making sure tablets fall. Thank
you. If you need any more information please call me,
&Vav 11e.Gr
Randy Bell/ORC
766-9626

N14 A Michael F. Easley, Governor
William G. Ross Jr.. secretary
North Carolina Department of Environment and Natural Resources
7
Alan W. Klimek:,P.E. Director> Division of Water Quality
April 16,2007
CERTIFIED INLAIL 7006 0100 00018758 7051
RETURIN RECEIPT REQUESTED
Mrs. Barbara Boles
Three R!s Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION: N017-2007-LV-0204
Permit No. NCO051489
Three R's Mobile Home Park
""-Forsyth County
Dear Afts Boles:
A o4 review Three Xs Mobile Home Park's monitoring g report for January 2007 showed the
I I
following violations:
Parameter Date Limit Value
Reported Value
Limit Type
Coliform, Fecal 1\4F, M-FC 01130/07 400 #/1 00ml
500 1-1/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State la,,v.
To prevent further action, carefully review these violations and deficiencies and respond in
writing, to this office within 30,working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar- situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
46
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Z7
Division of Water Quality
Cc: Central Files -SV'P
WSRO
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

f 0� W A 9 Michael F. Easley, Governor
William G. Ross Jr., Secretary
\o�y PG North Carolina Department of Environment and Natural Resources '
Alan W. Klimek, P.E. Director
Division of Water Quality
April 16, 2007
CERTIFIED MAIL 7006 0100 0001 8758 7051
RETURN RECEIPT REQUESTED
Mrs. Barbara Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION: NOV-2007-LV-0204
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mrs Boles:
A review of Three R's Mobile Home Park's monitoring report for January 2007 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
01/30/07
400 #/100ml
500 4/100m1
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files —SWP
�lidri.•�
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

.Y
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Permit/Pipe No.: WOO 5 � Month/Yearl 1
W Iwo
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl OlDailiolations
Date Parameter Permit Limit/Type DMR Value % Over Limit
3P- 07 QCAL, Co la G 0 0 110 600 7i t
Monitoring, Frequency Violations
Date Parameter Permit Frequency Values Reported . # of Violations
Other Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
Date:
Date:

•
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!'AK'
Environmental Testing Solutions, Inc.
PO Box 7565 Phone: [phone]
Asheville, NC 28802 Fax: [phone]
E-mail: [e-mail]
February 05, 2007
Mr. Randy Bell
Bell Enterprises
6164 Ridge Crest Road
Winston-Salem, NC 27103
RE: ETS PROJECT NUMBER: 3024
Dear Mr. Bell:
Enclosed are toxicity test results for samples from the Three R's MHP received by
Environmental Testing Solutions, Inc. January 24 through January 27, 2007.
Parameter Test Procedure EPA Method Final
Code Number Result
North Carolina Ceriodaphnia Chronic Effluent
TGP3B Toxicity Procedure — December 1985, Revised: EPA-821-R-02-013 PASS
February 1998
(Ceriodaphnia Pass/Fail Toxicity Test)
If this test was performed as an NPDES requirement or by Administrative Letter, please
enter a P on the Effluent Discharge Monitoring Form (MR-1) for the collection date
January 23, 2007 using the parameter code TGP313.
Additionally, please sign and submit the original DWQ Aquatic Toxicity Form (AT-1) by
February 28, 2007.
If you have any questions concerning these results, please feel free to contact me.
Sincerely,
Jim umner
Laboratory Director
This report should not be reproduced, except in its entirety, without the written
consent of Environmental Testing Solutions, Inc.
North Carolina Certificate Numbers: Biological Analyses: 37, Drinking Water: 37786, Wastewater: 600
South Carolina Certificate Number: Clean Water Act: 99053-001

\NR rF9
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Cq 7
> r
Alan W. Klimek, P.E. Director
r Division of Water Quality
September 25, 2006
CERTIFIED MAIL 7006 0100 0001 8758 6498
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr Boles:
A review of Three R's Mobile Horne Park's monitoring report for June 2006 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
06/07/06
45 mg/1
58 mg/1
Daily
Maximum
Exceeded
Coliform, Fecal MF, M-FC
06/21/06
400 #/100ml
600 #/100ml
Daily
Broth,44.5 C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at (336) 771--5000.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

3
Cover Sheet from
Staff Member to
Regional 'Supervisor
DMR Review Record
Facility: 1 I� Ie& 2�s Permit/Pipe No.: V C00S1y 9q Month/Year ju o e
0A++P ZOa
Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
NM rh IT - 7
WeeklVI�ailviolations
Date Parameter
7, o � Pxu�
Permit LimitTvl2e
Lis MO-P
DMR Value
� 8
% Over Limit
� G
1.0 ZI.06 C SAL CouF
_
goo
U
(�- 7 •p (o N }�3
I O
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
jy--Zoo U, -al ,25t
iX'r - 2-nDlV- ®/000 — -r(L-C/4-1rl -- I /®(
Completed by: Date: I'
Regional Water Quality /�� o G
Supervisor SiQnoff: Date: 7
y G�

T F LUENT
DES PER,%IIT N0.
tI' mL o ,3/ D S RGE NO NIONTI I �L � YEAR a 00 �®
rr.\CILITY N:\%,(E CLASS CU NT1'
OPERATOR IN RESPONSIBLE CHARGE (ORC) !VD .e-/ O GRADE� PE(p yE'
CERTIFIED LABORATORIES (() 7Z, '�<eSl (2) 1L U 2�►.e ivr I l' �n/
CIIECK BOX IF ORC HAS CHANGED ® PERSON(S) COLLECTING SA. IPLES ArjD
INIa'I ORIGINAL, and 0,NE COPY to: 1
►T'IY: CE\TR\L FILES �yp�� 0 1 o� xl JUL
DIVISION OF WATER QUA ,I•P} AU (SIGNATL•RE OF lERATOR IN RESPONSIBLE CHARGE) (D(t�TJE
1617.NL\IL SERVICE CENT R Winston -Sal c
RALEVAI. NC 27699-1617 Regional BY THIS S(C\',tTL'RE• [CERTIFY THATTHIS REPORT IS
_
►( CL'R4'CE AND COAIPLETF. TO TUE BEST OF.Nn- KNOWLEDGE.
�rM,
mm���������
Emm
tr79i
ROOM
Ummmmm
ON
Mira
ME
m
____�__
_
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�I�i-=
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D1\'Q Form JIR-I (OV00) �� J L

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements 00,pnt
All monitoring data and sampling frequencies do NOT meet permit requirements ❑
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements,to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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
ru
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Permittee (Please print or type
Signature of Permittee*" Date
(Required)
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
00076
Turbidity
00600
Total Nitrogen -
01002
Total Arsenic
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
00082
Color (ADMI)
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites
01034
Chromium
00300
Dissolved Oxygen
O1034
Chromitiin
ChroHexamium
00310
BOD5
00665
Total Phosphorous
00340
COD
00720
Cyanide
O1037
Total Cobalt
00400
pH
00745
Total Sulfide
01042
Copper
00530
Total Suspended .
00927
Total Magnesium
01045
iron
Residue
00929.
Total Sodium
01051
Lead
00545
Settleable Matter
00940
Total Chloride
01062
Molybdenum
01067
Nickel
50060
Total
01077
Silver
Residual
01092
Zinc
Chlorine
01105
Aluminum
01147
Total Selenium
7,1880
Formaldehyde
31616
Fecal Coliform
71900
Mercury
32730
Total Phenolics
81551
Xylene
34235
Benzene
34481
Toluene
38260
MBAS
39516
PCBs
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Coiiipliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.st tc.nc.us/wqs and linking to the Unit's information pages.
Use only touts designated in the, reporting facility's permit for reporting data.
* ORC must, 'Visit facility and document visitation of facility as required per 15A NCAC 8G .0204. L
* of signatoiy authority must be on file with the. -state per;1,5.� N.CAC 26Y,0506 (b)
If signi d by other than the permittec, d4legation
(2).(lD)•
IL

NPDES NO:
FAiDLITY i JAMIE: .
MEAM :
LOCATION.
DISCHARGE NO C� MONTH: y/V -�- YEAR: -12 V x.
COUNTY: ____F-0
STREAM
Downstream

flpX(i
September 28, 2006
Steve Tedder
Water Quality Regional Supervisor
585 Waughtown St
Winston Salem, NC 27107
Bell Enterprise
Randy Bell, ORC
PO Box 1291
Clemmons, NC 27012
RE: Three R MHP
To Whom It May Concern:
RECEIVED
N.C. Dent, of ENR
P 2 9 20M
Winston-Salem
Regional Office
This letter is response to the daily maximum limit exceeded on 6-7-06 at Three R
Mobile Home Park. The problem occurred due to practically clogged return line. The
return line has been unclogged and the plant is in proper running order.
Also I am responding to, maximum daily limit exceeded in 6-21-06, of fecal
coliform exceeding the limit. Problem higher flow than normal cutting down on
detention time and also chlorine tablets swelling into chlorine tubes, not letting chlorine
not letting tablets fall promptly. Flow back to normal replaced chlorine tablets with new,
plant is now in compliance.
If you have any further questions please feel free to contact me, Randy Bell,
ORC, Three R Mobile Home Park, 336-766-9626. Thanking you in advance,
Sincerely,
Randy Bell

114 A
R\
Michael F. Easley, Go-vemoy
William
G. Ross jr,, Secretary
Carolina Department of En-�j-,onmvMj ad Natural Resources
N
Alan IV. Klimek, P.E. Director
Division %vater
of Quality
CE rIFIED-iMAY-1.7flfl6fi-iiinn..,,,7,,,498 September 25, 2006
RETUR,?NTRECEIPT REQUESTED
"Orman E Boles
Three R's Mobile Home Park
5240 S iviain St
Winston Salem NIC 27107
Subject: NOTICE OF VIOLATiON
Permit NO. -NNC0051489
Forsyth County
Dear Mft- Boles:
A review of Three R's Mobile Home Park -Is monitoring report for June 2006 showed the
following violations:
Parameter Date j Limit
Value
ReportedV7alue ypeBOD, 5-Day(20 Deg. C) I06/07/06 45 11&1 58 ingJ/l
Daily
Maximum
Exceeded
COliform, Fecal MF, M-FC06/21/06 400 19/1 00m]. 600 #/1 00mi I
Broth,44.5C I !Daily
Maximum
Remedial actions shouldExceeded
be taken to correct this problem. The Division of Water Quality may
Pursue enforcement action for Illis and any additional 0
violations f State la v.
TO Prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent
you should have the recurrence of similar situations. If
any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W Tedder
Water Quality Regional Supervisol.
Winston-Salem Region
Division of Water Quality
Cc. 7-VQ Central Files
W- SRO
5-05 'Alaughtov'm St-eet 'Mnston-sainrn Nr, 97in-7

ER,�giCr,
;
Three R's Mobile Home Park .:
Three R's Mobile Home Park WWTP 2 m?
A to C No. 051489AOI
January 22, 2007
Engineer's Certification
a�� %�i,}:l`.e� /�' , as a duly registered Professional Engineer in
1, � T%
the State of North Carolina, having been authorized to observe (periodically/weekly/full time)
the construction of the modifications and improvements to the Three R's MHP WWTP located
on Jones Road in Forsyth County for Three R's .Mobile Home Park, hereby state that,. to the best
of my abilities, due care and diligence was used in the observation of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on January 17, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
S
L
Registration No. % 0�
Send to: Construction Grants & Loans
DENR/DWQ
1633 Mail Service Center
Raleigh, NC 27699-1633

Cover Sheet from
Staff- Member to
Regional Supervisor
DMR Review Record
Facility: -T"Ialrc� KS Permit/Pipe No.: NCroos I ti 2;G Month/Year 3 V Ly
y1h i�-P -zoo
onthly verage Violations
Parameter Permit Limit DMR Value % Over Limit
N Hk 3 Cs NJ N0N E
Weekl aily V' lations
Date Parameter Permit Limit/Tvpe DMR Value % Over Limit
7-6 T(P lit 0I-Z
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
No XIADV�Q k'ff'OcwAsi0N
Completed by:
Regional Water Quality
Supervisor Signoff:
Date: - i0 —( Gf ^ O �P
Date:���G�

c
LICI'FL 'FLUENT r
%�PDrS PER.tifITNO./r (9n �� /1a Dl5 I: �' : •O. NIOtiTE( —U.(E.\R
r'[ :\CILITY N:\E �� �[Ii,e Z, CL:\SS COUNT�—
OPERATOR IN RESPONSIBLE CHARGE (ORC) ' 1�V d // GRADE 3 PHONE
CERTIFIED LABOR.\TORIES (l) (2)C1 [ECK BOX IFORC HAS CE O-N(S) COLLECTING S.AIv[PLES!Zb
R( C' E
N C DeI of ENR
LkIail ORIGINAL and ON7E
Ar'TY: CENTRAL FILES
DIVISIO.NOF WATER QCALC
1617>L\1L SERVICE CENTER
RALEI(�11. `C 27699-1617
to:
OCT 0 x 13 �
(SIGN TL•RE OF O R.ATOR 1N RESPO\BL SIE CHARGE)
Regionnsto -Salem
Office BY TIII SIGH,%TL'RE. I CERTIFY THAT THIS RE• PORT• IS
Region
4TE AND COMPLETE TO THE BEST OF DIY K.NOA'LEDGE.
N/L
1
50050
00010
00.60
50060
00310
ODrilO
00530
131616
0030U
00600
00665
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NAME AND UNITS BELOW
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D W Q Form %IR - I (01/OI))

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ❑
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of ry knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of tines and imprisonment for knowing violations."
_N0P—M) %y I1n1��
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Permmittee Address
Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
OI067
01077
Nickel
Silver
50060
Total
Residual
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
01092
Zinc
Chlorine
00080
Color (Pt -Co)
00610
00625
Ammonia Nitrogen
Total Kjeldhal O1027
Cadmium
Ol l05
Aluminum
00082
Color (ADMI)
00095
Conductivity
00630
Nitrogen
Nitrates/Nitrites
01032
Hexavalent Chromium
Ol l47
Total Selenium71SS0
Coliform
71900
Formaldehyde
'Mercury
00300
Dissolved Oxygen
01034
Chromium
31616
32730
Fecal
Total Phenolics
81551
Xylene
00310
BOD5
00665
Total Phosphorous
Cyanide
01037
Total Cobalt
34235
Benzene
00340
COD
00720
00745
Total Sulfide
01042
Copper
34481
Toluene
00400
00530
pH
Total Suspended
00927
Total Magnesium
01045
Iron
38260
MBAS
Residue
00929.
Total Sodium
01051
Lead
39516
PCBs
00545
Settleable'Matter
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at (919) 733-5OS3 or by visiting
the Water Quality Section's web site at h'o cnr state.nc.us/wqs and linking to the Unit's information pages qlh I
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
** If signed by other than the pernlittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(2) (D).

'NilF = l WQO < P -q 2 9 . DISCHARGE NO' 001 MONTH: � I TV YEAR �
f':FA l6f"_' NAME: r[' `z`i . COUNTY:
STREAM: STREAM'
LOCATION. LOCATION:
Upstream Downstream
Name and Units aelaw
I
M - '
®-®®®®®MM
-----------
a•m /34

t.v• ...ri.a.a,. J......
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 74Qt �� Permit[Pipe No.: t�l�• 001) y Sq Month/Year
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
N Aa MOM -el
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
a G;o
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
v.
aw
Completed by: _1 Date:
Regional Water Quality
Supervisor Signoff: Date:

Staff Member to
Regional Supervisor
DMR Review Record
Facility: Permit[Pipe No.: N(,DO!71 y 9 % Month/Year MM
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl O-V iolations
Date Parameter Permit Urnit/Tvpe DMR Value % Over Limit
VON
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations
Completed b (_ Date: ( J �✓�
:
r Y
Regional Water Quality
Supervisor Signoff: Date:
V

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 u 2 U 31 NCO051489 I11 12 17 18 U 19 U 20 U
Remarks
211111111111111111111111111111111111111111111111166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved --------- ------------
67 I 169 70 U 71 U 72 L`J 73 W 74 751 I I I I I I 180
Section B: Facility 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)
99/OS/O1
Three R's Mobile Home Park
Exit Time/Date
Permit Expiration Date
170 Jones Rd
Winston Salem NC 27107
04/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Norman E Boles,5240 S Main St Winston Salem NC 27107//336-788-8347�ontacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit E Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program N Sludge Handling Disposal 0 Facility Site Review 0 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
Rose Pruitt WSRO WQ//336-771-4608/336-771-4630
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

NPDES yr/mo/day Inspection Type
31 N00051489 I11 12 17 18 U
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)

Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park - Three R's Mobile Home Park
Inspection Date: Inspection Type: Compliance Evaluation
Yes
No
NA
NE
Permit
(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:
Yes
No
NA
NE
Operations & Maintenance
Does the plant have general safety structures in place such as rails around or covers over tanks, pits, or wells?
❑
❑
❑
❑
Is the plant generally clean with acceptable housekeeping?
❑
❑
❑
❑
Comment:
Bares
Type of bar screen
Yes
No
NA
NE
a.Manual
❑
b.Mechanical
❑
Are the bars adequately screening debris?
❑
❑
❑
❑
Is the screen free of excessive debris?
❑
❑
❑
❑
Is disposal of screening in compliance?
❑
❑
❑
❑
Is the unit in good condition?
❑
❑
❑
❑
Comment:
Primary Clarifier
Is the clarifier free of black and odorous wastewater?
Yes
❑
No
❑
NA
❑
NE
❑
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?
❑
❑
❑
❑
Is the drive unit operational?
❑
❑
❑
❑
Is the sludge blanket level acceptable?
❑
❑
❑
❑
Comment:
jtion BaGinc
Mode of operation �t
Type of aeration system
Is the basin free of dead spots?
❑
❑
❑
❑
Are surface aerators and mixers operational?
❑
❑
❑
❑
Are the diffusers operational?
❑
❑
❑
❑
Is the foam the proper color for the treatment process?
❑
❑
❑
❑
Does the foam cover less than 25% of the basin's surface?
❑
❑
❑
❑
Is the DO level acceptable?
❑
❑
❑
❑
Are settleometer results acceptable?
❑
❑
❑
❑
Comment:
Flow Measurement - Influent
Is flow meter used for reporting?
Yes
❑
No
❑
NA
❑
NE
❑
Is flow meter calibrated annually?
❑
❑
❑
❑

Permit: NCO051489 Owner - Facility: Three R's Mobile Home Park - Three R's Mobile Home Park
Inspection Date: Inspection Type: Compliance Evaluation
Flow M .asur m nt - Influent
Is flow meter operating properly?
Yes
❑
No
❑
NA
❑
NE
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
❑
❑
Comment:
Yes
No
NA
NE
Flow MeasuMmgnt - Effluent
Is flow meter used for reporting?
❑
❑
❑
❑
Is flow meter calibrated annually?
❑
❑
❑
❑
Is flow meter operating properly?
❑
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
❑
❑
Comment:
Record Keeping
Are records kept and maintained as required, by the permit?
Yes
❑
No
❑
NA
❑
NE
❑
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?
❑
❑
❑
❑
Are sampling and analysis data adequate and include:
❑
❑
❑
❑
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
❑
Plant records are adequate, available and include
❑
❑
❑
❑
O&M Manual
❑
As built Engineering drawings
❑
Schedules and dates of equipment maintenance and repairs
❑
Are DMRs complete: do they include all permit parameters?
❑
❑
❑
❑
Has the facility submitted its annual compliance report to users?
❑
❑
❑
❑
(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?
❑
❑
❑
❑
Is the facility description verified as contained in the NPDES permit?
❑
❑
❑
❑
Does the facility analyze process control parameters, for example: MLSS, MCRT, Settleable Solids, DO, Sludge
❑
❑
❑
❑
Judge, pH, and others that are applicable?
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
❑
Comment:
Effluent Pine
Is right of way to the ouffall properly maintained?
Yes
❑
No
❑
NA
❑
NE
❑
Are receiving water free of solids and floatable wastewater materials?
❑
❑
❑
❑
Are the receiving waters free of solids / debris?
❑
❑
❑
❑
Are the receiving waters free of foam other than a trace?
❑
❑
❑
❑
Are .the receiving waters free of sludge worms?
❑
❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
❑
❑
Comment:

e
Michael F. Easley, Governor
% 4
W AT �RQG
r,
CERTIFIED MAIL #7005 0390 0004 6307 7551
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Boles:
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
July 8, 2005
Alan W. Klimek, P.E. Director
Division of Water Quality
A review of Three R's Mobile Home Park's monitoring report for March 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
03/14/05
400 #/100ml
490 #/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Surface Water Protection
Winston-Salem Regional Supervisor
Division of Water Quality
Cc: WQ Central Files
OW-1 O Fil'.es '
PS Compliance Enforcement Noe Carolina
turally
N.C. Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107 [phone] Customer Service
I(800)623-7748
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

s ,
4
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: -I0)ee A's Permit/Pipe No.: NC- 0051 H92 Month/Year M 412% 2-005
IM*4P
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl aily iolations
Date Parameter
Permit Limit/Type
DMR Value
% Over Limit
3 -1 H -0S FeCA c- C®I-1r,
qco I ®o I'K Q
Monitoring Frequency Violations
Date Parameter
Permit Frequency
Values Reported
# of Violations
Other Violations
Completed by:
Date:
Regional Water Quality
Supervisor Signoff:
Date:���
`

NPDES F8RMIT NO. N& O `�
FACIL4ITY NAME�_�
OPERATOR IN RESPONSIBLE CH,
t'r-DTIFIED LABORATORIES (1)-4
'I{ BOX IF ORC HAS CHA -
EFFLUENT
DISCHARGE NO.
CLASS COUNTY_
GRADE1 PH
c (2j 1
(S) COLLECTING SAMPLES le Al
N.C. Deot of ENR
Mail ORIGINAL and ONE CO Y.to: C{ � OR
ATTN: ('ENTRAL FILFS MAY 2U �� ��
Ll
DIVISION OF WATER QUALITY (SIGNA' URE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
Win ton -Salem
1617 MAIL SERVICE CENTERBY 'THIS. GNATURE.I CERTIFY THATT111S RFPORT IS
RALN,IGH, NC 27699-1G17 Reg nal Office (-i R�� 1 E AND COMPLETE TO TILE BEtiC OF MY KNOW'LE )GE.
MINN
vu'm
�
�t■ii��r
ice■
MWIAICU
EM
�7diCrd2°.e
/
-`�� J
IMS
DNVQ Form MR-1 (01/00)

Facility Status; (Please check one, of the following)
All monitoring data and sampling frequencies meet permit requirements a
.
' Compliant .
ALI monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.;
and a time -table for improvements to be made.
"I certify, uhdcr penalty of law, that -this document and all attachments were prepared under..triy direction or supervision in.accordance
with a system designed -to assure tharqualified 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 tnere-are significant penalties for -
submitting false information, including the. possibility of fines aj2d Imprisonment for knowing v tions.'
/erm�i�tnlease�prin?o/Ype)
signatuic of Pcrhdttre` Datc
(Required)
Permittee Address
Phone Number
Permit Exp. Date
PARAMETrER: CODES
)0010
Temperature
00556
-Oil & fxrease 00951
Total Fluoride
01067
Nickel
50060 Total
YD076
Turbidity
00600-,
Total Nitrogen 01002
Totar Arsenic
01077
Silver
Residual
)0080
Color (Pt -Co)
00610
Ammonia Nitrogen --
01092
Zinc
Chlorine
'10082
Color.(ADML I)..
00625.
Total I4jeIdhal 01-027
-Cadmium
01105
Aluminum
N•
ttrogen.
)G095 Conductivity 00630 Nitrates/Nitrites 01032 Hexavalent Chromium _ 01147 Total Selenium 71-880 Formaldehyde
)0300 Dissolved Oxygen 01034 Chromium 31616 Fecal Coliform 71900' Mercury
10310 BOD' 00665 Total Phosphorous 32730 Total Phenolics 8155, Xylene
)OW. COD 00720 Cyanide 01037 Total Cobalt 34235 Benzene
)0400 pH 00745 Total Sulfide 61042 Copper 3448.1.- Toluene _....
)0530 Total Suspended 00927 Total Magnesium' 01045' Zion 38260 MBAS
Residue 60929 Total Sodium 01051 Lead 39516 PCBs
)0545 Settleable Matter .. 00940. _.Total. Chloride . 01062 Molybdenum 50050 ' Flow -
'arameter Code assistance may -obtained by calling the Point Source CompliancelEnforce'mentlJnit at [phone]'or by visiting
he Water Quality Section's web site at h2o.ennstate.nc.us/was, and linking to-thetnit's information pages-.
ise only units designated in the -repoftiiag facility's permit for 'reporting data.
ORC must visit facility and document visitation df facility as required per 15A NCAC 8G .0204.
* If signed by other than the permittee, delegation of -signatory authority must be tin fife with tggtak� ci Y A NCAC 2B .0506 (b)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: -MPS � A' 5 Permit/Pipe No.: t4C. OaSOS9 Month/Year M► LI
vh i+P ZO° �
Monthly verage Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl /Daily Vi lations
Date Parameter Permit Limit/Type DMR Value % Over Limit
6 - as
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:
Date:
Regional Water Quality
Supervisor Sianoff: Date:

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 1140-41, 12�5
Permit/Pipe No.: N6 005'14`6I
Month/Year �t»�
Monthly Average Violations
Parameter
Permit Limit DMR Value
% Over Limit
s Af
Iv.ot\s -7.
1T
Wee y/Daily Violations
Date Parameter
Permit LimitfI vie DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter
Permit Frequency Values Reported
# of Violations
Other Violations
Completed by:
Date:
— S
Regional Water Quality
Supervisor Signoff:
Date:

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan3W Klimek, P.E. Director
Division of Water Quality
October 11, 2005
CERTIFIED MAIL 7004 2510 0002 2083 5445
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
A review of Three R's Mobile Home Park's monitoring report for July 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Flow, in conduit or thru
07/31/05
0.012 mgd
0.014 mgd
Monthly
treatment plant
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
;:-W_ SRO
585 Waughtown Street
Winston-Salem, NC 27107
336-771-4600(Telephone)
336-771-4630(Fax)
NO,

4
DNIR Review Record
Facility: 'g s Mfr Permit/Pipe No.: D%(DoS i4?S q
Monthly Average Violations
Cover Sheet from
Staff Member to
Regional Supervisor
MondvYear SL)L4 ZGv
Parameter Permit Limit DMR Value % Over Limit
DLO tAj @ , 9 l 2 a►i� l t (ytC
V
(gALXW L A-rj-i:>
e ,,<a m I-) 9 Z o tv dM2)
'� �"i3 a5 �% tat"U:.�� (.i�• Z �.� �� � �
J
Weekly/Daily Yiolations
Date Parameter Permit LimitlTvDe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Freauencv Values Reported it of Violations
Other Violations
Completed by:��E����"�'
Regional Water Quality
Supervisor Signoff:
Date:
)y8 7

Ie�
i�I Uf S PER,tiIIT `iQ- �V O O `� DISCI- ARG • I O. I IONTI I YE;�R off £) c'� j
FACILITY NAME ` %R �s�-�r.:::1: �'.
�j'TY .
;C)PERATO[L,[ ;RESPONSIBLE CH;�ItGE�(O C) GR,4DL•3 PHON .3
CERTIFIED LABOR.\TORTES (1 ) - (7) l y� r
CI[EC K BOY IF ORC' AS CHANGED Q PERSO:'N(S) COLLECTING SANTIPLES,
iViail ORIGINIAL: and ONE COPY to:
Ar'rN: CL. TR.\I -IliES'
lll�'ISIOti OF �5',1TLR f L':1L1'ft'
(SIGN,;1T,L'P,� O,F., OE ER.�T :1:v RESf'OtiSd'BLE.GHs�P.GE)Ew:; d. ,L) F
1617AIAIL SE'RVNf E CENTE`K'''' BY THIS SIGN;\TCRE.I CERTIFY THATTt1IS REI',OR'I:I:S•` „
R:1LE1l;Il, NC 3ifi99-I(l7 ACCLRVFE AND COMPLETE TO THE BEST OF.IY K.vU15'LEDGC.��
=0l)i0 00910.-.00400. i. 0060....-f)03[0-'- 00610 f -00530 j ?L816 L OH37)D 00600 i)OG6
FL
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HRS HRS Y:1S \ NIG.D , C. ,.
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16
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Cnnip. (C) GIJII ((a i ?" i' +� �di. l T'- k
Nlunlhl}' Lim4 - zo) 7
DVVQ Form 'MI:R-1 :D 1l(+)t))'�
1 l

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compk' nt
All monitoring data and sampling frequencies do NOT meet permit requirements ❑
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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 anj imprisonment for knowing violations."
C)
Permittee (Please print or type)
,02
signature of Permittee** Date
(Required)
r
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00090
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended'
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665
Total Phosphorous
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 ToW Phenolics 81551 Xylene
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00745
Total Sulfide
01042
Copper
34481
Toluene
00927
Total Magnesium
01045
Iron
38260
MBAS
00929
Total Sodium
01051
Lead
39516
PCBs
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
** if signed b other than the crmittee delegation of signatory authority must be on file with the state per 15A NCAC_2B-.0�506 b g Y P � g g Y' Y P ()
(2) (D).

Mcnihly
Maximum
Morohly r�
h\inimum `1
DELI Form LMR-3 (11/84)
MONTH: Jam` YEAR:
COUNTY: v 5
STREAM'
LOCATION:
Downstream
Name and Units Below
MMM
-M®MMOMM
M
MMMEW
ii■�i
MM
�■r
im,
.............
�o����

Environmental Testing Solutions, Inc.
�� - PO Box 7565 Phone: [phone]
Asheville, NC 28802 Fax: [phone]
E-rnail: Jini>[e-mail]
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC51 Date: July 29, 2005
Facility. Bell Enterpr6cs NPDES #: NC:- 0051489 Pipe #: 001 County: Forsyth
Three R's M I I P
Uboratory PerlOrining Test: Environmental Testipg Solutiot s, Inc.
Si,.a)ature of Operator in Itcsponsihle Charge: < k
Signature oC Ltthulatury Supervisor: �y
Mail Original Ton North Carolina Department of Environment and Natural Resources
DWQ/ Environmental Sciences Branch
1621 Mail Service Center
Ralcityli, NC 27699-1621
North Carolitai Ceriadaphuirr Chronic Pass/Fail Reprtiduction'l'oxicity'l'est
( :nutrnl (lrrrsanicntc 1 2 3 4 5 6 7 8 9 10 11 12
Comments.
Project: 1972
Satoh hm 1150713.11 � 050716.01
Number of Young Produced
33
130
127
131131134
129
132
131130
1271271
Adult Survival: (L)ive, (U)uld
L
I L
I L
I L
I L
I L
I L
I L
I L
I L
I L
I L
E'Mueut Perceutage 20%
Treatment 2 Organisms
Number of Young Pi-miuced
Adult Survival: (L)ive, (D)ead
1 2 3 4 5 6 7 8 9 10 11 12
JAI (S.I 1.) I st Sam �Ic I st Sample 2nd Sample
Control 7.55 7.57 7.43 7.53 7.73 7.43
Treatment'-) i 7.73 7S9 7.fi4 7.Ei2 7.72 7.50
:n 14 w Cr w
U.O. (ulg/L) I st Salo le st Sam ae 2nd.Sam.6le
Control 8.1 8.0 8.0 7.7 81
7.9 8.0Tretuncnt 2 8.2 7.9 7.8 7.fi
LCsa/Acute Toxicity 'Test
(Mortality expressed as %, combining replicates.)
Concentration M
Mortality (%)
(:lu'rauc Test Result;
Calculated r: -2.154
Tabular r: 2.508
`%r. Reduction' -6.1
Percent
Average
Morality
Reproduction
C'batrol
Control
0.0
302
Treatment 2
Treawent 2
0.0
32.0
Contra) ('V
7.7
Pass Fail
100
Start Data 07-13-05
►ilection (Start) Date:
Sample 1 07-12-OS Sample 07-15-05
Sample Type/Duration
0-I, r:•w�y Ih�r 4.•n
Sutyrle I X
C y u
Sawple 2 Xc-
Q r a
Alkalinity (nT. C_-.M�,/L)
Hardums (0g C4 C0,1L)
Coraloctivity (pm1rtts/cnQ
Towl Residual Chlorine
SantAc Terip. at Receipt C'('i
32. 33
k
�r :
40.40
u.I
209
225
tot.
2.1
LC50 = Method of Determination
95% Confidence Limits Trii-amed Spearman Karber
v'
to Yrobit w
Other: Control
High Come,
Organism Testcd: Ceriod«phrun dubia Duration: 7-days PIE (5.11.) DO (utg/L)
DWQ form AT•1 (3/87) rev. 11195

AUG-29-2005 03:02 PM MS BEES S367669626 P.02
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e

RE -Qv IS/!=U
N.C. pert r( ENR
2 3 211005
Ylinston-$algrtt
Regional pffc
November 21, 2005
Subject: Violation Response
Permit No. NC0051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Tedder,
A review of the July 2005 DMR, revealed that we made a recording error. On
July 26 and 27, the daily flow was .010 and .012 but was reported as .10 and .12. Which
caused our monthly average to be .014 when it actually should have been .008. Thanks
for bringing this to our attention. We will be more careful in the future. If your have any
questions please contact Randy Bell at 366.766.9626.
Sincerely,
i
Randy Bell
ORC Three R's Mobile Home Park
a- ./li�/Vyl.ti

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
October 11, 2005
CERTIFIED MAIL 7004 2510 0002 2083 5445
RETURN RECEIPT REQUESTED
RECEIVED
;N.C. Deot. of ENR
Norman E BolesThree R's Mobile Home Park NV 2 3 2005
5240 S Main St
Winston Salem NC 27107�.`
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
A review of Three R's Mobile Home Park's monitoring report for July 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Flow, in conduit or thru
07/31/05
0.012 mgd
0.014 mgd
Monthly
treatment plant
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations. of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
v Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
WSRO
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

PERMIT NO- 10l 9_05 � t�`�� L)IS(_ f L\I?GE �t�. MONTH
v� `
I-CI1_ITY :�i.\�(E%� -_`� --� _ YEAR •� � O
CLASS _Ct�(:`:i'Y
t )f'E (L:\T'()l2 Ili RES['C)ti�lt;t_( ['[I.\It( E (OtiC'i/✓✓✓ ✓ / --[� P[Il:l`
r _ r �1„�
CHECK uUt (! c`ttr.. tLAs t.:tl.%�rl:1) Q Pk:I:�i)No C'OLLEC"I'I.,G S_\�I.'LES--
:Mail ORI( INAL ar." ONE COPY t(;: % 2 /�j�
. rr�: r 1:� rR.�L rn_Fs X / C J..." -2l 2 S
Pl�'IJf;;ti OF �l'.tTI:R (1[';\I_l"fl" r iil;`.�','l RE OF OPEPATOR IN RESPONSiHLF CH..kR ) D-\ I
1617 NLUL SERVICE CENTER In, TFII� till:\,\'rCRI{, l CFRTIFY THAT IIIIS Rl:l'OR'r IS
iLii,ra(:Il, NC 27490.1617 U'�'isR.\IE,\\DCO�1PLb:TF.'rOTiiii[Sl{ST(')F�II rt�1)RLFi)(:E.
�ir-----
-quill I pl)q!q
f Ql7Sf)11
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111\I11111
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I
11IVQ Form NrR-1 (U 1:(10)
% ,- l

F W ATF Michael F. Easley, Governor
RQ William G. Ross Jr., Secretary
tr North Carolina Department of Environment and Natural Resources
O ° Alan W. Klimek, P.E. Director
r.Divisior'of Water Quality
December 19, 2005
CERTIFIED MAIL 7004 1160 0004 8303 1044
RETURN RECEIPT REQUESTED .
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
A review of Three R's Mobile Home Park's monitoring report for August 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
08/08/05
400 #/100m1
700 #/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
I VSRO
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

�Amlhh' Lintil I o �� I I I S o I
DWQ Form SIR-1 (01/()0)

All monitoring
and sampg �equencies meet Permitrequ""""_ .Loml�l,'f ►^'''���J.
Z meet permit retlements
arid, sampling "even NOT do NO
Noncompllant
ment, operation
All monito,atntenance, etc"
ring data a�
comment
on corrective actions being taken in resp .
ect to egmp
I noncompliant, please comet
he facility
improvements to be made.
d a time -table for
inquiry
under penalty of law, that this document and all attachments werea evaluate theemformation submittedr my direction T Basedvision lon myaccordance
`I certify, P
with a system designed to as
that qualified personnel properly gather a
of the person or persons who manage the system, or thosaccurate,ersons tandleomplete.iblatnfor
aware thatgathering
there arersignificant penalties for
on
submitted is, to the best of my knowledge and belief, true,
submitting false information, including the possibility of fines and imprisonment for knowing violations."
�a�m n1 /
Permittee (Please print or type)
Signature of Permittee**
Date r/
A)
Permittee Address V, 5, P V _
00010
Temperature
00076
Turbidity
00080
Color (Pt -CO)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BODS
00340
COD
00400
pH
00530
Total Suspended
Residue
36)?79'23
Phone Number
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
00625
Ammonia Nitrogen
Total Kjeldhal 01027
Cadmium
00630
Nitrogen
Nitrates/Nitrites
2
HexavalentChromium
0103
00665
Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
01042
Copper
00927
Total Magnesium
01045
Iron
00929
Total Sodium
O] 051
Lead
940
Total Chloride
01062
Molybdenum
01067 Nickel
01077 Silver
01092 Zinc
01105 Aluminum
Permit Exp. Date
50060 Total
Residual
Chlorine
LI
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
34235 Benzene
34481 Toluene
38260 MBAS
39516 PCBs
50050 Flow
00545 Settleable Matter 00
calling the Point Source compliance/Enforcement Unit at [phone] or by visiting
Parameter Code assistance may obtained by g
the Water Quality Section Sweb.96e at h2o.enr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation oC facility as required per 15A NCAC 8G .0204.
** if si ned by other than the permittee, delegation of signatory authority must be on file th the state per 15A NCAC 2B .0506 (b)
wi
g
(2) (D)-

0
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility —FAVLE17e,7 5 Permit/Pipe No.: ;�fCc�05 i Month/Year 99G Z,00 -
yiek
Monthly Average Violations
Parameter Permit Limit DMR Value
f We ai Violations
Date Parameter Permit Limit/Type DMR Value
Monitoring Frequency Violations
% Over Limit
% Over Limit /
S°o
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:64Date: I S
Regional Water Quality �� G f
Supervisor Sianoff: Date: / 1
xQ✓

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 1 r%lC r5 Permit/Pipe No.: �G 005'1 q8-% Month/Year QCT Z®o
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Urnit/Tvoe DMR Value °Io Over Limit
m
/ �'!2' 0 �;° C.O LS F• 140 0 100 w`P y / 0 Idol - 0
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: kc-J-
Regional Water Quality
Super,,-isor SiQnoff:
i
Date:
1Vd Xd7 ��r
Date: l �7,)z

¢ W A 7'F Michael F. Easley, Governor
9 William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
April 13, 2005
CERTIFIED MAIL 7002 0860 0000 7978 3683 RECEIVED
RETURN RETURN RECEIPT REQUESTED N.C. Dept. of ENR
Norman E Boles APR 2- 8 2005
Three R's Mobile Home Park Winston-Salem
f�:e�iamai dfhce' i
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
NOV-2005-LV-0192
Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
A review of Three R's Mobile Home Park's monitoring report for January 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
01/31/05
400 9/100m1
490 #/100m1
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

Dear Mr. Tedder,
The daily fecal violation that occurred on 1/31/05 is thought to have been caused by swelled
chlorine tablets in the chlorine tubes resulting in improper chlorination of the effluent. As you
know this occasionally happens when tablets are used for disinfection purposes. We have
started shaking the tubes down every day to insure that the tablets are not stuck and are also
seeking a better tablet with a greater stability.
Sincerely,
J
Randy Bell
ORC
3R Mobile Home Park

Michael F. Easley, Governor
William G. Ross Jr., Secretary
`O� QG North Carolina Department of Environment and Natural Resources
F:,A W: Klimek, P.E. Director
Division of Water Quality
April 13, 2005
CERTIFIED MAIL 77002 0860 0000 7978 3683
RETURN RECEIPT REQUESTED
Norman E Boles
Three R's Mobile Home Park
5240 S Main St
Winston Salem NC 27107
Subject: NOTICE OF VIOLATION
NOV-2005-LV-0192
Pen -nit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr: Boles:
A review of Three R's Mobile Home Park's monitoring report for January 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Valve
Limit Type
Coliform, Fecal MF, M-FC
01/31/05
400 #/100ml
490 #/100m1
Daily
Broth,44.5 C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
5RS Wniinhtnwn Street Winston-Salem. NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

0
Qo� 0��2 Cover Sheet from
Q� � Staff Member to
Regional Supervisor
DNiR Review Record
DOS 1I S
Facility: —kAw)0e; (1' S Permit/Pipe No.: N � Month/Year ,SR t's -ZQo
VIA 4-,P
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
p�-,/QftwNIA- ,,[o�j 10, ®.y
Weekly/Daily Violations
Date Parameter Permit Limit/Type DN. /IR Value % Over Limit
I's - 05 fr,F (-L'wPog-41 00 too rho L 90 loom 2J
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
No P-cM ✓n LA M \1� V NTr L. P L"T" L-k 61 r4e\t 1D,s
Completed by: (U�
Regional Water Quality
Supervisor Signoff:
/WP/'
Date: -! — I -i .0 S'
Date: / ��� ®,.f

Ll
NPDES PERMIT NO. co �3
FACILITY NAME
OPERATOR IN RESPONSIBLE_ CHARGE 1
CERTIFIED LABORA1 DRIES (Ic
CHECK BOX IF ORC HAS CHAAifii 't
Mail ORIGINAL and ON! COMMOO 1 ���
ATTN: CENTRAL FILES Y;inston-gat n
DIVISION OF WATER QU ITY Regional O _e
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
EFFLUENT
��) y
DISCHARGE NO. ONTH _C1J• F s
f AhL GRADE PHONELa� 9C=�
COLLECTING SAMPLES
/o5
OF PERATOR IN RESPONSIBLE CHARGE) DATE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DWQ Form MR-1 (01/00) 11

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
X
All monitoring data and sampling frequencies do NOT meet permit requirements F-1
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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 atn aware that there are significant penalties for
submitting false information, including the possibility of -fines and imprisonment for knowing violations."
%1% R rn � �✓ l"� �� I �s
Permittee (Please print or type)
19?9/%/htivv`/ I v Sf
Sig ature of Permittee** Date
(Required)
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
00082
Color (ADMI) ,
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
00300
Dissolved Oxygen
01034
Chromium
00310 BOD5 00665 Total Phosphorous
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
00340 COD
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00400 pH
00745
Total Sulfide
01042
Copper
34481
Toluene
00530 Total Suspended
00927
Total Magnesium
01045
Iron
38260
MBAS .-,
Residue
00929
Total Sodium
01051
Lead
39516
PCBs
00545 Settleable Matter
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
SO 81 81 J
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8Cr 0�204n?;
** 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)•

mm
nmm
mom
LL

IC
Cover Sheet from
�1Staff Member to
Regional Supervisor
DMR Review Record
Facility: -4 Ei- PS M4 Permit/Pipe No.: NL 0�s t��� Month/Year � 2!-C)0V
Parameter
� f� •a s �nnrti�n� A
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Na NVE-- , 7 M
Weekly 0ailiolations
Parameter
� t- c &LI-r' yr
K- A-5 dQ,h C) W%&
N-N-S /kM`MoNIR-
Permit Limit/Type
uOo�oo MO
Iko �1✓ ,nn
sns ✓vv o
D'.�4R Value
1 SO o / o O M-P
(0'Z�^%
Monitoring Frequency Violations
Over Limit
?i®O
Date Parameter Permit Frequency Values Reported # of Violations
''`j� Lt
Other Violations �!
Vs(tyCyj"O JG) L- MkTS �A�i�O(y �(Yv�S - (yO 1�-y�y►�1M
U� CTS U NTt L P L�4� � x �rq-N D S
Completed by: Date: q- l -�
Regional Water Quality ft /l���f
Supervisor Signoff: Date: /

` EFFLUENT j
NPDES PERMIT NO. �� 5 DISCHARGE NO. MONTIi�Ty / Y YEARPoo
FACILITY NAME .v -c, 11 CLASS COUNTY 125v7#
OPERATOR IN RESPONSIBLE CH GE (OR C) GRADE PHONFS
CERTIFIED LABORATORIES (1) %y (2) 02 �Yl
r _u
CHECK BOX IF ORC HAS CHANGED PERSON(S) COLLECTING SAMPLES
dfMI
G:
Mail ORIGINAL and ONE COPY to:r£
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY:, ; ; b 5 (S ATURE OF O RA OR IN RESPONSIBLE CHARGE) DATE
r o
1617 MAIL SERVICE CENTER BY S SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ; AC LATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
- i
50050
FOQ01A
QQ40Q;
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a69310
00610
00530
31616
00300
00600
00665
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WW
ENTER PARAMETER CODE ABOVE
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NAME AND UNITS BELOW
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WQ Form N4R-, „

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements Er
- Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements F-1
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who 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."
Pe�Jrmittee (Please print or type)
�l EjPj,di1L964,1
Signature of Permittee** Date
(Required)
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
00082
Color (ADMI)
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
00300
Dissolved Oxygen
01034
Chromium
00310 BOD5 00665 Total Phosphorous
01067
Nickel
50060
Total
01077
Silver
Residual
01092
Zinc
Chlorine
01105
Aluminum
01147
Total Selenium
11880
Formaldehyde
31616
Fecal Coliform
71900
Mercury
32730
Total Phenolics
81551
Xylene
00340 COD
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00400 pH
00745
Total Sulfide
01042
Copper
34481
Toluene
00530 Total Suspended
00927
Total Magnesium
01045
Iron
38260
MBAS
Residue
00929
Total Sodium
01051
Lead
39516
PCBs
00545 Settleable Matter
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204;) D u
** 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)• ; ;.. _..

Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: 1 oze �5 PermitTipe No.: N _ DOG t 4 81 Month/Year �� t
✓h �
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly jailyViolations
Date Parameter Permit Limit/Type DMR Value % Over Limit
NAA3 as N � , 7���„n � Oct o
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
LL1M�Ts 5® P�T c> V I ® --f 0N1
Completed by:
Regional Water Quality
Supervisor Signoff:
Date: ?i - ( 7
Date: )-V IrW
Af

WAT�RQG
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Norman Boles
Three R's Mobile Home Park
5240 South Main St.
Winston-Salem, North Carolina 27107
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
RECF!`r�D
October 1, 2004 N.C. Ui;r+t. ul
OCT 0 5004
Winston-Salem
Regional Office
Alan W. Klimek, P.E., Director
Division of Water Quality
This is to inform you that the Environmental Sciences Section has received your toxicity self -monitoring report form
for the month of July 2004; however, the report form was received late. This is in violation of Title 15A of the North Carolina
Administrative Code, Chapter 2, Subchapter 213, Section .0506 (a)(1)(A) which states that "monthly monitoring reports shall be
filed no later than 30 days after the end of the reporting period for which the report was made."
Your Discharge Monitoring Reports (DMRs) for June and July 2004 have not been received by the Division's Central
Files. Please note the reporting of toxicity self -monitoring data is a dual requirement. Toxicity test results must be entered on
your DMR and the Aquatic Toxicity Reporting Form (AT-1) must be submitted to: DWQ/ESS, 1621 Mail Service Center,
Raleigh NC 27699-1621 within the required time frame.
We attempted to contact your Operator in Responsible Charge, Mr. Randy Bell, on 9/27/04 and 9/28/04 to discuss the
late reporting incident but were unable to speak directly with Mr. Bell. We were informed that the July 2004 AT report form
would be mailed to our office. Our office was able to obtain a copy of your July AT Report Form from your biological testing
laboratory. The 7/14/04 toxicity test result has been recorded as "pass" in our database.
You will be considered noncompliant with the reporting requirements contained in your NPDES Permit for the month
of July 2004 until you make acceptable demonstration to the Environmental Sciences Section that the report form was submitted
to this office within the required 30 day reporting period. In addition if within the next twelve (12) months, future reports are not
received within the required time frame you may be assessed a civil penalty.
The reverse side of this Notice contains a summary of important toxicity monitoring and reporting requirements.
Please read this one page summary and if you have any questions concerning this Notice, please contact Mr. Kevin Bowden with
the Aquatic Toxicology Unit at [phone].
Sincerely,
tvironmental
erton Sciences Section
cc: S ef: veTeMEN N Wins' to -Salem RegionalOff ec
David Russell- Winston-Salem Regional Office
Aquatic Toxicology Unit Files
Central Files
Nor[hCarolina
Naturally
North Carolina Division of Water Quality 1621 Mail Service Center Raleigh, NC 27699-1621 Phone [phone] Customer Service
Internet: esb.enr.state.nc.us 4401 Reedy Creek Rd. Raleigh, NC 27607 FAX [phone]
An Equal Opportunity/Affirmative Action Employer —50% Recycled/10% Post Consumer Paper

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and
reporting information. Please take time to review this information. The items below do not address or include all the toxicity
testing and reporting requirements contained in your NPDES permit. If you should have any questions about your toxicity -
testing requirement, please contact Mr. Kevin Bowden with the Aquatic Toxicology Unit at [phone] or another Unit
representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report
forms are appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the
appropriate parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting
period (eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon
failure of any single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at
least two multiple concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as
can be completed will be accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure
of any single quarterly test, you may choose to conduct either single concentration toxicity testing or multiple concentration toxicity
testing per the Division's WET enforcement initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will
influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity
testing must be conducted during these months).
➢ Should the pemrittee fail to monitor during a month in which toxicity monitoring is required, then monthly monitoring will begin
immediately until such time that a single test is passed. Upon passing this monthly test requirement, the perrivttee will revert to the
quarterly months specified in the permit. Please note that your permit may or may not contain this language.
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January ]-June 30, then you
must provide written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six
months of the calendar year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental
Sciences Section at [phone] and provide written documentation indicating why the test was invalidated and the date when
follow-up testing will occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the
information block located at the top of the AT form indicating the facility name, permit number, pipe number, county and the
month/year of the subject report. You should also write "No Flow" on the AT form, sign the form and submit following normal
procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which
have not received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT
form must also be signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your
toxicity test results certified mail, return receipt requested to the Environmental Sciences Section.

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Norman Boles
Three R's Mobile Home Park
5240 South Main St.
Winston-Salem, North Carolina 27107
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO051489
Three R's Mobile Home Park
Forsyth County
Dear Mr. Boles:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
pcCEIVED
N.C. Dept. of ENR
October 1, 2004 OCT 0 5 2004
Winston -Sale
Regional Office
This is to inform you that the Environmental Sciences Section has received your toxicity self -monitoring report form
for the month of July 2004; however, the report form was received late. This is in violation of Title 15A of the North Carolina
Administrative Code, Chapter 2, Subchapter 213, Section .0506 (a)(1)(A) which states that "monthly monitoring reports shall be
filed no later than 30 days after the end of the reporting period for which the report was made."
Your Discharge Monitoring Reports (DMRs) for June and July 2004 have not been received by the Division's Central
Files. Please note the reporting of toxicity self -monitoring data is a dual requirement. Toxicity test results must be entered on
your DMR and the Aquatic Toxicity Reporting Form (AT-1) must be submitted to: DWQ/ESS, 1621 Mail Service Center,
Raleigh NC 27699-1621 within the required time frame.
We attempted to contact your Operator in Responsible Charge, Mr. Randy Bell, on 9/27/04 and 9/28/04 to discuss the
late reporting incident but were unable to speak directly with Mr. Bell. We were informed that the July 2004 AT report form .
would be mailed to our office. Our office was able to obtain a copy of your July AT Report Form from your biological testing
laboratory. The 7/14/04 toxicity test result has been recorded as "pass" in our database.
You will be considered noncompliant with the reporting requirements contained in your NPDES Permit for the month
of July 2004 until you make acceptable demonstration to the Environmental Sciences Section that the report form was submitted
to this office within the required 30 day reporting period. In addition if within the next twelve (12) months, future reports are not
received within the required time frame you may be assessed a civil penalty.
The reverse side of this Notice contains a summary of important toxicity monitoring and reporting requirements.
Please read this one page summary and if you have any questions concerning this Notice, please contact Mr. Kevin Bowden with
the Aquatic Toxicology Unit at [phone].
Sincerely,
Jimmie verton
ironmental Sciences Section
cc: Steve Tedd_e,- Winston-Salem Regional Office
ibavio-Russel inston�SalemR�gi'onal Office'
Aquatic Toxicology Unit Files
Central Files
Noe Carolina
Aturally
North Carolina Division of Water Quality 1621 Mail Service Center Raleigh, NC 27699-1621 Phone [phone] Customer Service
Internet: esb.enr.state.nc.us 4401 Reedy Creek Rd. Raleigh, NC 27607 FAX [phone]
An Equal Opportunity/Affirmative Action Employer —50% Recycled/10% Post Consumer Paper

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and
reporting information. Please take time to review this information. The items below do not address or include all the toxicity
testing and reporting requirements contained in your NPDES permit. If you should have any questions about your toxicity -
testing requirement, please contact Mr. Kevin Bowden with the Aquatic Toxicology Unit at [phone] or another Unit
representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report
forms are appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the
appropriate parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting
period (eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon
failure of any single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at
least two multiple concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as
can be completed will be accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure
of any single quarterly test, you may choose to conduct either single concentration toxicity testing or multiple concentration toxicity
testing per the Division's WET enforcement initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will
influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity
testing must be conducted during these months).
➢ Should the permittee fail to monitor during a month in which toxicity monitoring is required, then monthly monitoring will begin
immediately until such time that a single test is passed. Upon passing this monthly test requirement, the permittee will revert to the
quarterly months specified in the permit. Please note that your permit may or may not contain this language.
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you
must provide written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six
months of the calendar year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental
Sciences Section at [phone] and provide written documentation indicating why the test was invalidated and the date when
follow-up testing will occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the
information block located at the top of the AT form indicating the facility name, permit number, pipe number, county and the
month/year of the subject report. You should also write "No Flow" on the AT form, sign the form and submit following normal
procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which
have not received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT
form must also be signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your
toxicity test results certified mail, return receipt requested to the Environmental Sciences Section.

�0 WA1.
_o Q�
co r
7 y
Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
i01 Y Alan W. Klimek, P.E., Director
Division of Water Quality
March 17, 2004 f IRE C E: I E D
f
Norman Boles MAR 3 0 2004
Three R's Mobile Home Park
5240 South Main Street
Winston- Salem, NC 27107
Dear Mr. Boles:
$Ovii jter-,. tnin^i;1i aM
Subject: Draft NPDES Permit
Permit NCO051489
Three Ws Mobile Home Park
Forsyth County
Enclosed with this letter is a copy of the draft permit for your facility. Please review the draft very
carefully to ensure thorough understanding of the conditions and requirements it contains.
The draft permit contains the following significant changes from your current permit:
• A total residual chlorine (TRC) limit has been added for the currently permitted flow of 0.012
MGD. The limit will take effect 18 months after the effective date of the final permit. See the
attached TRC policy memo for details.
• Daily maximum ammonia limits have been added for the phased permitted flow of 0.020 MGD.
See the attached NH3N memo for more information
Submit any comments to me no later than thirty days following your receipt of the draft. Comments
should be sent to the address listed at the bottom of this page. If no adverse comments are received from
the public or from you, this permit will likely be issued in May with an effective date of June 1, 2004.
If you have any questions or comments concerning this draft permit, contact me at the telephone number
or e-mail address listed below.
Sincerely,
LeTo a F lds
NPDES Unit
cc: egional Office, Water Quality Section
7WDES-Unit
Aquatic Toxicology
North Carolina Division of Water Quality toya.fieldsCo)ncmail.net - [phone].x551
1617 Mail Service Center FAX [phone]
Raleigh, North Carolina 27699-1617 On the Internet at http://h2o.enr.state.nc.us/

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Norman Soles
is hereby authorized to discharge wastewater from a facility located at
Three R's MHP
170 Jones Road
Winston Salem, North Carolina
Forsyth County
to receiving waters designated as Leak Creek in the Yadkin Pee Dee River Basin in accordance with
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, and IV
hereof.
The permit shall become effective
This permit and the authorization to discharge shall expire at midnight on June 30, 2009.
Signed this day
DRAFT
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

NCO051489
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of
this permit issuance, any previously issued permit bearing this number is no longer effective. Therefore, the
exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements,
terms, and provisions included herein.
Norman Boles is hereby authorized to:
1. Continue to operate an existing 0.012 MGD package wastewater treatment facility
consisting of the following components:
• Influent bar screen
• Aeration basin
• Clarifier
• Aerated sludge holding tank
• Chlorination
• Contact chamber
• Post aeration
• Flow monitoring device
The facility is located at Three R's Mobile Home Park,170 Jones Road, Winston Salem in
Forsyth County.
2. Operate, after receiving an Authorization to Construct and making the necessary
modifications, a 0.020 MGD wastewater treatment facility, and;
3. Discharge treated wastewaters (via Outfall 001) from said facility at the location specified
on the attached map into the Leak Creek, a Class C water in the Yadkin Pee Dee River
Basin.

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Three R's Mobile Home Park - NCO051489 Facility
Location
USGS Quad Name: Midway Lat.: 35059'55"
Receiving Stream: Leak Creek Long.: 80013'28"
Stream Class: C
Subbasin: Yadkin Pee Dee - 030704 North Not to SCALE

NCO051489
SECTION AM. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting UNTIL EXPANSION ABOVE 0.012 MGD
OR PERMIT EXPIRATION, the Permittee is authorized to discharge treated wastewater from Outfall
001. Such discharges shall be limited and monitored by the Permittee as specified below:
EFFLiJENT
CHARACTERISTICS-..
;
I:;TIVIITS _.'
MONITORING:.
REi7IREWN.TS
Mo11
nthly
Average - .-
;Weekly
Average
Daily =" .
Maximum
Nleasuietnent .
Frequency
Sample"-
Type , :
Sample
Location'.
Flow
0.012 MGD
Continuous
Recorder
I or E
BOD, 5 day, 20°C
30.0 mg/I
45.0 mg/1
Weekly
Grab
E
Total Suspended Residue
30.0 mg/l
45.0 mg/1
Weekly
Grab
E
NH3 as N -
Weekly
Grab
E
Total Residual Chlorinez
28 µg/L
2/Week
Grab
E
Dissolved Oxygen3
Weekly
Grab
E,U,D
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U,D
pH4
Weekly
Grab
E
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
E
Total Nitrogen
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
Chronic Toxicity5
Quarterly
Grab
E
Footnotes:
1. Sample locations: E- Effluent, I- Influent, U- Upstream, D- Downstream at NCSR 2932
2. TRC limit will take effect 18 months after the effective date of the final permit. The limit and monitoring requirements
only apply if chlorine is used fof disinfection.
3. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/l.
4. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
5. Chronic Toxicity (Ceriodaphnia) P/F at 20%; January, April, July, October; see Special Condition A(3).
There shall be no discharge of floating solids or foam visible in other than trace amounts.

NCO051489
SECTION A(2). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning upon EXPANSION ABOVE 0.012 MGD and lasting until permit expiration, the Permittee is
authorized to discharge treated wastewater from Outfall 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
'EFFLUENT
:CHARACTEIZISTICS
LIMITS
=-
N40NITORING REQJIREMEIVTS
Monthly
AVe"rage
Weekly'
Average
Daily
Maximum
1Vleasurement
.Frequency"
Sample
:Type
Sample
Locations
Flow
0.020 MGD
Continuous
Recorder
I or E
BOD, 5 day, 20oC
30.0 mg/1
45.0 mg/1
Weekly
Grab
E
Total Suspended Residue
30.0 mg/l
45.0 mg/1
Weekly
Grab
E
NH3 as N
(April 1- October 31)
2.9 mg/1
8.7 mg/l
Weekly
Grab
E
NH3 as N
(November 1 - March 31)
9.4 mg/1
28.2 mg/1
Weekly
Grab
E
Total Residual Chlorine
28 ug/l
2/Week
Grab
E
Dissolved Oxygenz
Weekly
Grab
E,U,D
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U,D
pH3
Weekly
Grab
E
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
E
Total Nitrogen
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
Footnotes:
1. Sample locations: E- Effluent, I- Influent, U- Upstream, D- Downstream at NCSR 2932
2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/1.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or foam visible in other than trace amounts.

NCO051489
SUPPLEMENT TO EFFLUENT LIMITATIONS
AND MONITORING REQUIREMENTS
SPECIAL CONDITIONS
A(3). CHRONIC TOXICITY PASSNAIL PERMIT LIMIT (QRTRLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to Ceriodaphnia
dubia at an effluent concentration of 20.0%.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the "North Carolina
Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent versions or "North Carolina Phase
II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions. The tests will be
performed during the months of January, April, July, and October. Effluent sampling for this testing shall be performed at the
NPDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV below the permit limit, then
multiple -concentration testing shall be performed at a minimum, in each of the two following months as described in "North
Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the highest concentration
having no detectable impairment of reproduction or survival and the lowest concentration that does have a detectable
impairment of reproduction or survival. The definition of "detectable impairment," collection methods, exposure regimes,
and further statistical methods are specified in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure"
(Revised -February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge Monitoring
Form (MR-1) for the months in which tests were performed, using the parameter code TGP3B for the pass/fail results and
THP3B for the Chronic Value. Additionally, DWQ Form AT-3 (original) is to be sent to the following address:
Attention: NC DENR / DWQ / Environmental Sciences Branch
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Branch no later than 30 days after the
end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all concentration/response
data, and be certified by laboratory supervisor and ORC or approved designate signature. Total residual chlorine of the
effluent toxicity sample must be measured and reported if chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required, the permittee
will complete the information located at the top of the aquatic toxicity (AT) test form indicating the facility name, permit
number, pipe number, county, and the month/year of the report with the notation of "No Flow" in the comment area of the
form. The report shall be submitted to the Environmental Sciences Branch at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required, monitoring will be required
during the following month.
Should any test data from this monitoring requirement or tests performed by the North Carolina Division of Water Quality
indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include alternate monitoring
requirements or limits.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism survival,
minimum control organism reproduction, and appropriate environmental controls, shall constitute an invalid test and will
require immediate follow-up testing to be completed no later than the last day of the month following the month of the initial
monitoring.

1
Division of Water Quality
Winston-Salem Regional Office
April 12, 2004
Memorandum to: LeToya Fields, NPDES Unit
Through: Steve W. Tedder
WSRO Water Quality Supervisor
From: Rose Pruitt
Environmental Tech IV
Subject: Frye Bridge WWTP Draft NPDES Permit,
NCO065587 request for comments, Forsyth County
Archie Elledge WWTP Draft NPDES Permit,
NCO037834 request for comments, Forsyth County
Three R's Mobile Home Park Draft NPDES Permit,
NCO051489 request for comments, Forsyth County
I have no comments on the draft permits at this time.

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Article Addressed to:
Barbara Boles
Three R's-Mobile Home Park
5240 S. Main Street
Winston-Salem, NC 27107
A Slonature
❑ Agent
X 1 � Addresse(
B. Redelved by (Printed Name) C. ddDate of Deliver)
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
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❑ Registered ❑ Return Receipt for Merchandis(
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4. Restricted Delivery? (Extra Fee) ❑ Yes
( I / • D
7007 `0710''0'00`1' `55°86 �9'L4 '5 V V I, I,
PS Form 3811. February 2004 Domestic Return Receipt / 7 - A d — A 9

UNITED STATE
F C
__ em� .4 0 L
.
"Permit
• Sender: Please print your name, address, and ZfP+4 in
NCDENR- Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
if I It III I I if It IIII I I III III If If if III III I 1 11.111 1 1 11111 If III I I ill
Paid

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1. Article Addressed to:
Norman E. Boles
Three R's Mobile Home Park
5240 South Main Street
-Winston-Salem, NC 27107 J
❑ Agent
❑ Addressee
Received by (Printed ame) C./ate f I
r v
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7004 2510 0002 2083 5445 1 /0/ 1 1 NO V
PS Form 3811. February 2004 Domestic Return Receipt r 102595-02-M-154

UNITED STATES POSTAL SERVICE
S1 NC®ENR-WATER QUALITY
Winston-Salem Regional Office
ATTN: P/Laty
585 WAUGHT©WN
WINSTON-SALEM,
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
SREE RE(
NC 27 07 I
OCT I � 5
wing
Reg
j f `7-C- '- -I

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X ❑ Agent
Z24::
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1. Article Addressed to:
'-
If YES, enter,V41ivery address be:��❑ No
NormanE. Boles
a n't
Three R's MHP
5240 South Main Street
s. sery e,�Typea ;
Winston-Salem, NC 27107
LK&rtified Mail ❑ Excess Mail .=y�
❑ Registered z'•' "'-- eturn,Recepffor Merchandisi
❑ Insured
4. Restricted Delivery? (Extri Fee) ❑Yes
., . 7 00 2 0;8 6 0 0 0 0 0, 7978
3683
PG P" :iR11 Fahn iani gnna r)—c-tir Pat„m Po in4 1f 9SOS19_M_1 rL

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
LISPS;
Permit No. G-) 0
• Sender: Please print..your name, address, and ZIP+4 in this box .
1'tl CD E R
� - peudL
Division of Water Qu lity
585 Waughtown StreA
Winston-Salem, NC 27107
RECEIvcp�
rd.C, oeot. or F
U
Winston-SaiE,-r,
Regional Ofi'icE

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1. Article Addressed to:
Mr Norman . Bdles
Thre R's MHI' �
5240 S Main, -Street,
Winston Salem NC 27107
A. Siahature
r\ �/ �j/jL)(1,4
❑ Agent
X I'07 ��J 1. Y 1 ❑ Addressee
B. /Re eived by ( Printed Name J C. Date of Delivery
D. Is elivery a r §sE rff6� from item l? El Yes
If �ES, enter deliveryta�tlreN below: ❑ No
JUN 0 2 2004
Winston-Salem
Regional OffIce
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2. Article Number-- -- nr
7003 0-90,0 a M'aOgQ4; 2Va�6i� Pier 1..a_ aat :ar 1V U V
102595-01-M-25C

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR V A
Water Quality Section —
585 Waughtown Street
Winston-Salem NC 27107-2241

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1. Article Addressed to:
Norman Boles
Three TV
Mobile Rome Park
T I
5240 S. Main -Street J
Winston-Salem, NC 27107
z. Article
❑ Agent
C. Date of Delivery
D. Is 6e ive eddres , i m @em 1? P Yes
ry r�ti�� --- —
If YE 3, enter deliveQWddVew tlelow: P No
DEC 2 Z So -
Winston -Salem
0-1-1 eVr-
3. Service Type
nertified Mail ❑ Express Mail
13 Registered etum Receipt for Merchandise
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hG P l
3$ a rua y 2004 1 i i Domestic Return Receipt 102595-027M-1541

UNITED StATES.PO$TA $�R lcq
59MCOEXR-Water Quya ity
Attn: R-cLN,
585 Waughtown Street
Winston-Salem jcVC 27107
First -Class Mail
Postage & Fees Paid.
!N I IQD(Z
13

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t. Article Addressed to:
Norman E. Boles
Three R's Mobile Home Park
5240 South Main Street
LWinston-Salem, NC 27107
-- - -- - --- - - -- - --,
AL
n� -' ,'`(!(!�'W ❑ Addressee
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3. SServ� ype
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. / ❑ Yes
7d05 0390''50"04 6307 7551

UNITED STATES POSTAL SERV)�
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RECEIVED
NCDENR'�R."P 11001 -,'lip
Division of Water Quality 12 2005
585 Waughtown Street
Winston-Salem, NC 27107 Winstar
Regions.

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1. Article Addressed to: I
Norman Boles
Three R's Mobile Home Park /
5240 S. Main Street
Winston-Salem, NC 27107
06'01
PS Form 3811. February 2004
A.
❑ Agent
X �,�/ 1— ❑ Addresse(
B. "Received by (Printed Namb) C. Date of Deliver)
°I --37
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
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-+ 1t a4 i l l I'll,
5698 �F
imestic Return ReceiDt /% _ ii - A /- /sue 102595-02-M-151

UNITED STATES P066 11L'87E I E` "'­,
s
NC Dept, of Environment and Natural
Resources
Division of Water Quality-SWP
585 Waughtown Street
Winston-Salem, North Carolina 27107
Attn: P-'e- w
1111111111i413t11111111111i111i1111I1111li11111111fi1111ililli

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1. Article Addressed to:
MRS. BARBARA BOLES
THREE R''SMOBILE HOME PARK
5240 S. MAIN STREET
WINSTON-SALEM, NC 27107
I
2_1C_
X
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El Agent
❑ Addressee
.1 v(_I`b
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2O°06�1010 U010T 875817Q5W1l1�1111 111 11111 1 11 1 I t I I� { k l l i
PS Form 3811, February 2004
Domestic Return Receipt �- — -)_0 ^ o
102595-02-M-154

UNITED S.TE{TS,..P.O.S L.SERY.ICE.,.,,.,,;.,._
Sender: Please print your name, address, and ZP+4`in this box •
NC DENR - DIVISION OF WATER QUALITY
ATTN:'-��-
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WINSTON-SALEM, NC 27107
IIIiIIiII!iHJIiI}flIII!ii!iIiIIiIIi!IIIIIIIIiIIIIIII IIIIII

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1. Article Addressed to:
BARBARA BOLES
THREE R'S MOBILE HOME PARK
5240 S. MAIN-ST.
WINSTON-SALEM, NC 27107
A.
X
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r-----
2' E70'061 011do! a060�1 6 81 7411
9 ✓ 11
PS Form 3811. February 2004 Domestic Return Receipt l%_ / P7 — /I 102595-02-M-154

-ir ' "'
UNITED STA�
0 Sender: Please print your name, address, and ZIP+4 in this box 0
NC DENR - DIV. OF WATER QUALITY
ATTN: �
585 WAUGHTOWN STREET
WINSTON-SALEM, NC 27107
?

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1. Article Addressed,to:
Norman E. Boles
Three R's Mobile Home Part,
5240 South Main Street
Winston-Salem, NC 27107
I
2.
_ I ,7002i!0
PS Form 3811 Fahn iary
A. Signature
❑ Agent.
Xc , a `.4rn � . ❑ Addressee
B. Received ty (Printed Name) C._D/`qte of Deliver
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6d.' i66'03 i 7,978 38051 11 it
nnmaetir. Ratiirri Rereint
i tl959S-09-M-1 -ria

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Pemlit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDENR .SUN i 0 200
A�_Lwl Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
r + iltl?1136f II11l11�[!t�!!?�li�3S33lI��i11�9ilISI!!l3illlit hilt

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1. Article Addresse to: Winston -Sal"
-- — -----Reglonal-Ofide — -
Norman Boles
Three R's Mobile Home Park
5240 South Main Street
Winston-Salem, PAC 27107
A.
❑ Agent
❑ AddresseE
Received by (P " to Name) C. 7of P
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if YES, enter delivery address below: ❑ No
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ice Type
ertified Mail ❑ xpress Mail
DILReturn Receipt for Merchandise
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2'' 7O•06 0100 0001 8758 6047 1! /
7 Il,i I ��i ['� d i<<; 1k1 I. �`%,/1 , NQy�2� CEz
PS Form 3811, August 2001 Domestic Return Receipt 2ACPRI.03-Z-OS

UNITED STATES P ail Clash
PS
NC ��`1.P` 110 :�, � ";';" iq :Yd..[i....: Permit 710
• Sender: Please print your name, address, and ZIP+4 in This box •
NCDENR- Water Quality Section
`�U p&Uj�(
585 Waughtown Street
Winston-Salem, NC 27107
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Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Barbara Boles
Three:R's Mobile Home Park
5240 South Main Street
Winstor,Salem, NC 27107
A. :ig�X ElAgent
—Ci— ❑ Addressee
B. Received by (Printed Name) C. Date of_DgliveD
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. S rvice Type
Certified Mail q Express Mail
(((]]] Registered Return Receipt for Merchandise
❑ Insured Mail C.O.D.
4. Restd!rd Delivery? (Extra Fee) ❑ Yes
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18 Form 38,111, February 2004 1 1 f f Domestic Return Receipt d, 4-V2595-02-M-154

UNITED STATESPVtSSh&.SkhV#C0t:?Ma -MA11,
Postage & Fees Pai
?;XV_l n9: P rfriit' : G`-1" ..
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDENR- Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107

■ Complete items 1, 2, and 3, Also complete
item 4 if Restricted Delivery Is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailplece,
or on the front if space permits.
1. Article Addressed to:
Barbara Boles
Three Ws Mobile Home Park
5240 South Main Street
Winston-Salem;`NC 27107
A. Signa
x ❑ Agent
❑ AddresseE
B. Recelved by (Printed Name) C., Date of Deuye(f
Y..G
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. jervice Type
Certified Mail
❑ Expres
Registered
IxReturn
A Insured Mail
❑ C:OA.
4. Restricted Delivery? (Extra Fee
s Mail
Receipt for Merchandis(
2.
i 70:0 7x S020; Op��i 6279 6870 (/1 { . i � i j4-; , C
'S Form 3811, February 2004 Domestic Return Receipt d — -) f - /1 Ci ht-
❑ Yes
102595-02-M 15<

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."^~^�^-..^. ^~. .^~..~.. ..' ''' ' _ __-RECEIVED
~ ! N.C. Dept of ENm
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UN|��T��_��| ��� ��- ��l H�
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'/), hill x'/'/'/'oif! }jv''j}

■ -Oomplete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse,
so that we can return the card to you. —
■ Attach this card to the back of the mailplece, _
or on the front if space permits.
1. Article Addressed to:
Barbara Boles
Three R's Mobile Home Park
5240 South Main Street
Winston-Salem, NC 27107 --
2.
1 7 01n $111Q1151101111AN
A. Signatu "
❑ Agent
X
_ ❑ Addre
B. Received by (Printed Name) C. Dgleof Dpll
D. Is delivery address differept k ri ftern t;;?. ' ❑ Yes
If YES, enter delivery 44-igse below: ❑ No
3. Service Type
Certified Mail
Registered
❑ Insured Mail
4. Restrict Del v
PS Form 3811. February 2004 Domestic Return Receipt
Ayt ,ii
�C tpress Mail
ecefpt for Merchandis
? (Extra F. ❑ Yes
• , , ,mil 1
102595-02-M-15

:!f! ......... ........4111: ,,.,,,.
UNITED STATES ''I.„'tcFd�sas'....,.,...if"' ,.
"F'os age '& Fees Y;,,
..USRs:
11 Sender: Please print your name, address, and ZIP+4 in this box °
NCDENR- Water Quality Section
k PautL
585 Waughtown Street
Winston-Salem, NC 2710
RECEIV_C
N.C. Deot. of ENR
7 JUL 1 1 2008

■ Complete items 1, 2, and 3. Also complete
item'4 if ResWicted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
lill Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Barbara Boles
Three R's Mobile Home Park j
5240 South Main Street j
Winston-Salem, NC 27107
A. Signat i
X ❑Agent
�v� ❑ Addresse(
B. Rece!ved by ( Printed Name) C. Da of Deliver)
v
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. S rvice Type
ertified Mail ❑ Express Mail
FRegistered ❑ Return Receipt for Merchandisf
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
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PS Form 3811, February 2004 Domestic Return Receipt (9_ _ .9 ,n G� 102595-02-M-154

UNITED STATES: ,, 9jT,4 CO j.­.
c E.: r, 1
0 Sender: Please print your name, address, and ZIP+4 in this
NCDENR-Division of Water Quality
A - Aeuai
585 Waughtown Street
Winston-Salem, NC 27107
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