NC0061204_Permit (Issuance)_20140521

UP®ES 9OCUWEMT SCAMMIMC COVER SHEET
NPDES Permit: NC0061204
Scarlett Acres MHP WWTP
Document Type: Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Staff Report
201 Facilities Plan
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: May 21, 2014
This docaimeat is prlated oa reuse paper-ignore aay
ooateat oa the reverse side

A
Ayr
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla III
Governor Secretary
May 21, 2014
Mr. Thomas M. Alphin, Jr.
P.O. Box 5
Walkertown, NC 27051-0005
Subject: Issuance of NPDES Permit NC0061204
Scarlett Acres Mobile Home Park WWTP
Forsyth County
Class WW-2
Dear Mr. Alphin:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
This final permit includes no major changes from the draft permit sent to you on April 23,
2014.
➢ NOTE: Proposed Federal regulations require electronic submittal of all discharge monitoring
reports (DMRs). Accordingly, NC DENR has established an electronic data-submission system.
Permittees must begin using the system no later than 270 days following the effective date of
permit renewals. In your case, that deadline is April 1, 2015.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles Weaver at telephone number (919) 807-
6391.
Sincer ly,
L
Thomas A. Reeder, Director
Division of Water Resources
cc: Central Files _
Winston-Salem Regional Office
NPDES Unit
1617 Mail Service Center,Raleigh, North Carolina 27699-1617 512 North Salisbury Street,Raleigh, North Carolina 27604
Phone: [phone]/FAX [phone] http://podal.ncdenr.org/web/wq
An Equal Opportunity/Affirmative Action Employer-50'/n Recycled/10°/o Post Consumer Paper

Permit NCO061204
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions 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,
Thomas M. Alphin
is hereby authorized to discharge wastewater from a facility located at
Scarlett Acres Mobile Home Park
5528 Sherene Lane
Walkertown
Forsyth County
to receiving waters designated as an unnamed tributary to Mill Creek in subbasin 03-07-04 of the
Yadkin-Pee Dee River Basin in accordance with effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, I1I, and IV hereof.
The permit shall become effective July 1, 2014.
This permit and the authorization to discharge shall expire at midnight on June 30, 2019.
Signed this day June 13, 2014
TIC Vas A. Reeder, Director
tston of Water Resources
By Authority of the Environmental Management Commission
1 of

Permit NCO061204
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility,whether for operation or discharge are hereby revoked, and as of this
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.
Thomas M. Alphin is hereby authorized to:
1. Continue to operate an existing 0.024 MGD wastewater treatment facility that includes
the following components:
➢ Bar screen
➢ Flow equalization with influent pumps
➢ Two 12,000-gallon package plants with aeration, clarifiers, chlorine disinfection,
fixed media and post aeration
➢ Dechlorination equipment
➢ Sludge digester
This facility is located at the Scarlett Acres Mobile Home Park (5528 Sherene Lane,
Walkertown) in Forsyth County.
2. Discharge treated wastewater (via Outfall 001) from said facility into an unnamed
tributary to Mill Creek, currently classified C waters in the Yadkin-Pee Dee River
Basin, at the location specified on the attached map.
2of6

Permit NCO061204
Part
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized to
discharge from Outfall 001. Such discharges shall be limited and monitored' by the Permittee as specified below:
PARAMETER EFFLUENT LIMITATIONS MONITORING REQUIREMENTS
[PCS CODE] Monthly Average Daily Maximum Measurement Sample Sample
Frequency T pe Location
Flow [50050] 0.02 MGD Continuous Recording Influent or
Effluent
BODS [003101 16.0 mg/L 24.0 mg1L Weekly Grab Effluent
(April 1 —October 31)
BOD5 [00310] 30.0 mg/L 45.0 mg/L Weekly Grab Effluent
(November 1 —March 31)
Total Suspended Solids
30.0 mglL 45.0 mglL Weekly Grab Effluent
[00530]
NH3-N [006101 12.0 mg/L 35.0 mg/L Weekly Grab Effluent
(April 1 —October 31)
NH3-N [00610]
(November 1 —March 31) Weekly Grab Effluent
Dissolved Oxygen [003001 Daily average>6.0 mg/L Weekly Grab Effluent
Dissolved Oxygen [00300] Weekly Grab U & D
Fecal Coliform [316161 200/100 ml 400/100 at Weekly Grab Effluent
(geometric mean
Total Residual Chlorine(TRC)3
17 µg/L 2/Week Grab Effluent
[50060]
Temperature [000101 Daily Grab Effluent
Temperature [00010] Weekly Grab U, D
Chronic Toxicity4 [TGP3B] Quarterly Grab Effluent
Total Nitrogen [00600]
(TKN + NO2+NO3) Quarterly Grab Effluent
Total Phosphorus [00665 Quarterly Grab Effluent
pH 100400] >6.0 and<9.0 Standard Units Weekly Grab Effluent
Notes:
1. No later than April 1, 2015, the permitter shall begin submitting discharge monitoring reports electronically
using the Division's eDMR application system [see A. (4)].
2. U: approximately 100 feet upstream from the outfall. D: Downstream from the outfall at NCSR 2219.
3. The Division shall consider all effluent TRC values reported< 50 µg/L to be in compliance with the pent it.
However, the Permittee shall continue to record and submit all values reported by a North Carolina certified
laboratory(including field certified), even if these values fall below 50 µg/L.
4. Chronic Toxicity(Ceriodaphnia P/F at 90%, February, May, August, and November) [see A. (2.)].
There shall be no discharge of floating solids or visible foam in other than trace amounts.
3 of 6

Permit NCO061204
A. (2) CHRONIC TOXICITY PERMIT LIMIT (Quarterly)
The permittee shall conduct acute toxicity tests on a quarterly basis using protocols defined in the North Carolina
Procedure Document entitled"Pass/Fail Methodology For Determining Acute Toxicity In A Single Effluent
Concentration" (Revised December 2010 or subsequent versions). The monitoring shall be performed as a
Ceriodaphnia dubia 24-hour static test. The effluent concentration at which there may be at no time significant
acute mortality is 90% (defined as treatment two in the procedure document). The tests will be performed during
the months of February,May, August, and November. These months signify the first month of each three-
month testing quarter assigned to the facility. Effluent sampling for this testing must be obtained during
representative effluent discharge and shall be performed at the NPDES permitted final effluent discharge below all
treatment processes.
Should any single quarterly monitoring indicate a failure to meet specified limits, then monthly monitoring will
begin immediately until such time that a single test is passed. Upon passing, this monthly test requirement will
revert to quarterly in the months specified above.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge
Monitoring Form(MR-1) for the month in which it was performed, using the parameter code TGE313.
Additionally, DWQ Form AT-2 (original) is to be sent to the following address:
Attention: NC DENR / DWR / Water Sciences Section / Aquatic Toxicity Branch
1621 Mail Service Center
Raleigh,NC 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later than 30
days after the end of the reporting period for which the report is made.
Test data shall be complete and accurate and include all supporting chemical/physical measurements performed in
association with the toxicity tests, as well as all dose/response data. 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, pernit 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 Section at the
address cited above.
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 will revert to quarterly in the months specified above. Assessment of toxicity compliance is based on
the toxicity testing quarter, which is the three month time interval that begins on the first day of the month in which
toxicity testing is required by this permit and continues until the final day of the third month.
Should any test data from either these monitoring requirements 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 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.
4of6

Permit NCO061204
A. (3) NUTRIENT REOPENER FOR HIGH ROCK LAKE
This permit may be reopened and modified to implement nutrient requirements in accordance with any future
TMDL and/or nutrient management strategy for High Rock Lake.
A. (4) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Proposed federal regulations require electronic submittal of all discharge monitoring reports (DMRs)and specify
that, if a state does not establish a system to receive such submittals, then permittees must submit DMRs
electronically to the Environmental Protection Agency(EPA). The Division anticipates that these regulations will
be adopted and is beginning implementation.
NOTE: This special condition supplements or supersedes the following sections within Part II of this permit
(Standard Conditions fa-NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning no later April 1, 2015, the pennittee shall begin reporting discharge monitoring data electronically
using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and submitted
electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring data and submit
DMRs electronically using the internet. Until such time that the state's eDMR application is compliant with
EPA's Cross-Media Electronic Reporting Regulation (CROMERR), pernittees will be required to submit all
discharge monitoring data to the state electronically using eDMR and will be required to complete the eDMR
submission by printing, signing, and submitting one signed original and a copy of the computer-printed eDMR
to the following address:
NC DENR/Division of Water Resources/Information Processing Unit
ATTENTION: Central Files/eDMR
1617 Mail Service Center
Raleigh,NC 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility being
physically located in an area where less than 10 percent of the households have broadband access, then a
temporary waiver from the NPDES electronic reporting requirements may be granted and discharge monitoring
data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by the Director.
Duplicate signed copies shall be submitted to the mailing address above.
Requests for temporary waivers from the NPDES electronic reporting requirements must be subtrritted in
writing to the Division for written approval at least sixty (60)days prior to the date the facility would be
required under this permit to begin using eDMR. Temporary waivers shall be valid for twelve(12)months and
shall thereupon expire. At such time, DMRs shall be submitted electronically to the Division unless the
permittee re-applies for and is granted a new temporary waiver by the Division.
5of6

Permit NC0061204
Information on eDMR and application for a temporary waiver from the NPDES electronic reporting
requirements is found on the following web page:
ham://porta I.ncdenr.orghveb/wq/admin/bog/ipu/edmr
Regardless of the submission method, the first DMR is due on the last day of the month following the issuance
of the permit or in the case of a new facility, on the last day of the month following the commencement of
discharge.
2. Signatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B. (11.) (d)l
All eDMRs submitted to the permit issuing.authority shall be signed by a person described in Part II, Section
B. (I 1.)(a)or by a duly authorized representative of that person as described in Part II, Section B. (I 1.)(b). A
person, and not a position, must be delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user account and
login credentials to access the eDMR system. For more information on North Carolina's eDMR system,
registering for eDMR and obtaining an eDMR user account, please visit the following web page:
http://port a 1.ticdenr.or,,/web/wq/achnin/bog/inu/cctnii-
Certification. Any person submitting an electronic DMR using the state's eDMR system shall make the
following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL BE
ACCEPTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or
supervision its 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 offnnes and innp-isonment for knowing violations."
3. Records Retention [Supplements Section D. (6.)l
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions. These
records or copies shall be maintained for a period of at least 3 years from the date of the report. This period
may be extended by request of the Director at any time [40 CFR 122.41].
6of6

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NCO061204 - Scarlett Acres MHP Facility
Location
Latitude:36°10'03" Longitude:80'11'06"
Stream Class:C - USGS Quad:Walkertown,N.C.
Subbasin:03-07-04 Receiving Stream:UT Mill Creek Forsyth County
Map not to scale

NORTH CAROLINA
FORSYTH COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned; qualified, and authorized by law to administer oaths; personally
appeared D.H. Stanfield, who being duly sworn, deposes and says: that he is
Controller of the Winston-Salem Journal, engaged in the publishing of a
newspaper known as the Winston-Salem Journal, published, issued and
entered as second class mail in the City of Winston-Salem, in said County and
State: that he is authorized to make this affidavit and sworn statement: that the
notice or other legal advertisement, a true copy of which is attached hereto,
was published in the Winston-Salem Journal on the following dates:
April 25, 2014
and that the said newspaper in which such notice, paper document, or legal
advertisement was published was, at the time of each and every such
publication, a newspaper meeting all the requirements and qualifications of
Section 1-597 of the General Statutes of North Carolina and was a qualified
newspaper within the meaning of Section 1-597 of the General Statutes of
North Carolina. nn
This 25th day of April, 2014 lAlt�C
(signature of ers n n aking affidavit)
Sworn to and subscribed before me, this 25th day of April, 2014
Notar Yublic
My Commission expires: September 28, 2015
PUBLIC NOTICE
North Carolina Environmental I
Management Commission/NPDES Unit
1617 Mail Service Center
Raleigh,NC 27699.1617
1 Notice of Intent to Issue a
NPDES Wastewater Permit
at I7he North Carolina Environmental Management
MALEY JC31� NSON Commission proposes to issue a NPDES wastewa-
ter discharge permit to the person(s) listed below.
NOTARY PUBLIC Written comments regarding the proposed permit
FORSYTH COUNTY will be accepted until 30 days after the publish
STATE OF fJOflTN CAP Q date of this notice.The Director of the NC Division
of Water Resources (DWR) may hold apublic hear-
1rTi - ' 1SSION EXPiF1ES-
b1 - > ing should there be a significant de of public
�, yFa-aK^==fE interest. Please mail comments and/or informa-
tion requests to DWR at'the above address. Inter-I
ested persons may visit the DWR at 512 N. Salis-
bury Street, Raleigh, NC to review information on'
(file. Additional information on NPDES permits and
this notice may be found on our website: http://po
rtal.ncd6nr.org/web/wq/swp/ps/6pdes/calendar,
or by calling [phone].'7In as M. Alphin,Jr.'
?requested renewal of permit NC0061204/Scarlett�
?Acres MHP WWTP/Forsyth County. FacIII dis-
charges to an unnamed tributary to Mill Creek/
lYadkin-Pee Dee River Basin. Currently, BOD, Am-�
Ton la Nitrogen, Dissolved Oxygen, Fecal Collformi
and Total Residual Chlorine are water quality lim
-I
�ited. -
W�5l:Apri125,2014

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100%domestics (e.g., schools, mobile
home parks, etc)that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d)listed water,toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date Charles H. Weaver 4/21/2014
Permit Number NCO061204
Facility Name Scarlett Acres MHP WWTP
Basin Name/Sub-basin number 03-07-04
Receiving Stream UT to Mill Creek
Stream Classification in Permit C
Does permit need Daily Max NH3 limits? No—already resent
Does permit need TRC limits/language? No—already resent
Does permit have toxicity testing? No
Does permit have Special Conditions? No
Does permit have instream monitoring? Temperature and Dissolved Oxygen
Is the stream impaired (on 303(d) list)? No
For whatparameter?
Any obvious compliance concerns? No enforcements in 2012 or 2013. Sporadic
flow and fecal coliform violations over the past
two years.
Any permit modifications since lastpermit? None.
New expiration date 6/30/2019
Comments on Draft Permit ➢ Updated component list.
➢ Added High Rock Lake reopener.
➢ Added eDMR requirements.
Most Commonly Used Expedited Language:
• 303(d) lanauaee for Draft/Final Cover Letters: "Please note that the receiving stream
is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with permitted effluent limits and
stream impairment can be attributed to your facility,then mitigative measures may be
required".
• TRC laneuaae for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"I'he facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values < 50 µg/L will be treated as zero for
compliance purposes."
This page has been printed on scrap paper to save money and reduce our program's environmental
Impact. Disregard any content on the back of this page.

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCOO 6
If you are completing this form in computer use the TAB key or the up — down arrows to moue from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
/yp n mos dnI_• 1fI 1�2 Yc
Facility Name
I
�jritrP."�"T ACrPS
Mailing Address Q (,� Roo 6-
City
State / Zip Code N C 70 5-/
Telephone Number ( 3b ) 6 S>j- X,�X 7
Fax Number ( ) RECEtVEDMEMRtnWR
e-mail Address
2. Location of facility producing discharge:
Water Resources
Check here if same address as above ❑ Permitting Section
Street Address or State Road 1� 4 3
lJ� N 9
city ( .fir: l l:ertt;,,.) ✓1
State / Zip Code l� 70�
County
r
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC,r
Name hJ(-I i Lnforpr' PG
Mailing Address C) X C/�
City
lP n9 r,'7!":n 5
State / Zip Code N 9 70 1
Telephone Number
Fax Number
e-mail Address
1 of 3 Form-D 9/2013

NPDES APPLICATION - FORM D
For privately-owned treatment.systems treating 100% domestic.wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial Number of Einpldyees - - -
Commercial ❑ Number of.Employees,,,, .. .,
Residential [ Number of Homes R ,,
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): (1)0 h, I(� 4Ome �C-(' (Jl
Number of persons served:
S. Type of collection system
6 Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge. points
Outfall Identification number(s) C
Is the outfall equipped with a diffuser? ❑ Yes 21No
7. Name of receiving stream(s) (NEW applicants:Provide a map show ing the exact location of each
outfall):
'FnI/�"1
8. Frequency of Discharge: Ely,,—Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities,provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
Q
1 - Ua,- .�(rec'i i
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3 -
,A �6C. ?(C", iw;�td�
j� a�r�a�',.o✓i. Io1� Qc¢.� ©)l C'_c2G)'1 )
3QU Sop? /L or- 707-r�ei+�ctln�
1 S 5 3Onw/L or 707c, l�en,GJr
2 of 3 — Il,(; f ro7 ej) - Nu L i,v, Form-D 912013

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design now , 0A MGD
Annual Average daily flow " 00`7 MGD (for..the previous 3 years)
Maximum daily flow a yJ / _MGD (for the previous 3 years)
11. Is this facility located on IInddian country?
❑ Yes E No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed. Fecal Colifonn, Temperature and pH shall be grab
samples,for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximurn and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading(Daily Maximum)and Monthly Average over
the past 36 months for parameters curTe thi in your pernmmnit. Mark other parameters 'N/A
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODs) ry'c /L
Fecal Coliform -7 (o000 lY1L
Total Suspended Solids
Temperature (Summer) a (� a , (,.u .
Temperature (Winter) ( y -
pH J�Q IY •r Ui1ir'
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES �(( oZC�� Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and beli f such information is true, complete, and accurate.
Prin ed name of Person Signing Title
SignP'ture of Applicant ( Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be
guilty of a misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (18 U.S.C.Section 1001
provides a punishment by a fine of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)
3 of 3 Form-D 9/2013

Weaver, Charles
From: Boone, Ron
Sent: Wednesday, October 16, 2013 2:49 PM
To: Weaver, Charles
Cc: Boone, Ron; Basinger, Corey
Subject: NPDES Permit Renewals
Charles,
I have no questions,comments,or concerns about the renewal of the following three NPDES permits:
NC0061204 Scarlett Acres Mobile Home Park Scarlett Acres MHP WWTP
NC0051713 Lakeview MHP, LLC Lakeview Mobile Home Park
NC0088242 Taylor and McChesney LLC Conrad Farm WWTP
Please go ahead and reissue these NPDES permits. Let me know if you have any questions or concerns.
Thanks,
Ron
Ron Boone
NC DENR Winston-Salem Regional Office
Division of Water Resources,Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Email:[e-mail]
Voice: [phone]
FAX:[phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
t