NC0055255_Permit (Issuance)_20060717

NPDES DOCUMENT SCANNINL COVER SNEErr
NPDES Permit: NC0055255
Crown MHP WWTP
Document Type: A.Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Headworks Analysis
201 Facilities Plan
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: July 17, 2006
Thies document is printed on reuse paper- igiaore any
content on the reverse side

�OF W A rF9 Michael F.Easley,Governor
�O G William G.Ross,Jr.,Secretary
�2 r North Carolina Department of Environment and Natural Resources
� y
.� Alan W.Klimek,P.E.,Director
Division of Water Quality
July 17, 2006
Mr. Lee Simaan
Crown Mobile Home Park
6205 Wescott Drive
Summerfield, North Carolina 27358-9072
Subject: Issuance of NPDES Permit NC0055255 . .
Crown Mobile Home Park WWTP
Guilford County
Dear Mr. Simaan:
The Division received your application for a wastewater discharge permit on February 27, 2006. Division
personnel have reviewed and approved your application. Accordingly, we are forwarding the attached NPDES
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
May 9, 2004, (or as subsequently amended).
A Total Residual Chlorine (TRC) limit has been added to this permit. Because you may need time to make
modifications to your plant in order to comply with this new condition, the TRC limit will not take effect until
February 1, 2008.
This final permit includes no major changes from the draft permit sent to you on May 24, 2006.
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 other permits which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, the Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Vanessa Manuel at telephone number (919)
733-5083, extension 532.
Sincerely,
/PZv- ,
Alan W. 10imek, P.E.
Attachment
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection Section
TEDFS File) Nrnc
"o�1tCarolina
watura!!y
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] 1-877-623-6748
An Equal OpportuniYAffirmahve Action Employer-50%Recyded/t 0%Post Consumer Paper

Permit NCO055255
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 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,
LEE SIMAAN
is hereby authorized to discharge wastewater from a facility located at the
Crown Mobile Home Park.WWTP
Jonquil Drive
Guilford County
to receiving waters designated as an unnamed tributary to Hickory Creek in the
Cape Fear River Basin
in.accordance with effluent limits, monitoring requirements, and other conditions
set forth in Parts I, II, III and IV hereof.
This permit shall become effective September 1, 2006.
This permit and authorization to discharge shall expire at midnight on August 31, 2011.
Signed this day July 17, 2006.
Alan W. Klimek, P.E., Vrector
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0055255
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.
LEE SIMAAN
is hereby authorized to:
1. Continue to operate an existing 0.042 MGD wastewater treatment facility with
the following components:
♦ Bar screen
♦ Aerated equalization basin
♦ Aeration tanks in series
♦ Clarifiers in parallel
♦ Tablet chlorination with chlorine contact tank
♦ Tablet dechlorination
♦ Reaeration tank with diffused air
♦ Aerated sludge digester
♦ Flow recording device
This facility is located south of Groometown at the Crown Mobile Home Park
WWTP off Jonquil Drive in Guilford County.
2. Discharge from said treatment works at the location specified on the attached
map into an unnamed tributary to Hickory Creek, classified WS-IV:*waters in
the Cape Fear River Basin.
Waterbody Special Designation: `*° This symbol identifies waters that are within a designated
Critical Supply Watershed and are subject to a special management strategy specified in
15A NCAC 2B .0245.

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Permit NCO055255
A. (1.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS.— FINAL
During the period beginning on September 1, 2006, and lasting until August 31, 2011, the permittee is
authorized to discharge treated wastewater from outfall 001. Such discharges shall be limited and monitored
by the permittee as specified below: -
EFFLUARACTERISTICS$ e'1 ' ^EFFLUENT LIMITS'ENT CH - MONITORING REQUIREMENTSn
r a p �h•,?, *hv f' -» " ah a. t-. 5 ar' : t
AY.x
Yky� ry .p; 4 ..r. S h .b J sL 5 Ghf.
f' y„ �r21 p
�_ Monthly +D iily Uni oN Measrrement Sample ,{� 5ampnee
Lp ra" teuDescriptwn_.PCS.Code $", .Averages, Maximum Measure *'Frequency,, -<sTLocetion� 1
Influent or
Flow,in conduit or thru treatment plant - 50050 0.042' MGD Continuous Recorder Effluent
BOD,5-Da 20 Deg.C - 00310 16.0 24.0 m /L Weekly Composite Effluent
Solids,Total Suspended - 00530 30.0 45.0 m /L Weekly Composite Effluent
Nitrogen,Ammonia Total as N - 00610 - Summer 2.0 10.0 m /L Weekly Composite Effluent
Nitrogen,Ammonia Total as N - 00610 - Winter 4.0 20.0 m /L Weekly Composite Effluent
Coliform, Fecal MF,M-FC Broth,44.5C - 31616
eom.mean 200 400 #/100ml Weekly Grab Effluent
Chlorine,TotalResidual2 - 50060 /L 2/week Grab Effluent
Chlorine, Total Residual2 - 50060 17 /L 2l week Grab Effluent
Daily--
Temperature,Water Deg.Centigrade - 00010 deg. C weekdays Grab Effluent
DO,Oxygen,Dissolved3 - 00300 m /L Weekly Grab Effluent
pH4-00400 S.U. Weekly Grab Effluent
Upstream&
Temperature,Water Deg. Centigrade - 00010 deg.C Weekl Grab Downstream
Upstream&
D0,0 en, Dissolved - 00300 mg/L Weekl Grab Downstream
Summer: April 1 -October 31
Winter: November 1 -March 31
Footnotes:
1. Upstream: at least 100 feet upstream from the outfall; Downstream: at NCSR 1132.
2. Total Residual Chlorine (TRC) limit takes effect February 1, 2008. Until the limit becomes effective, the
permittee shall monitor and report TRC (with no effluent limit).
. 3. The daily average Dissolved Oxygen effluent concentration shall not be less than 6.0 mg/L.
4. ' The pH shall not be lessthan 6.0 standard units (s.u.) nor greater than 9.0 s.u.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

News&Record
Published by
News&Record, Inc.
Greensboro,North Carolina
North Carolina,Guilford County Affidavit of Publication 5/26/2006
Before the undersigned,a Notary Public of said County and State,duly commissioned, qualified and authorized by law to
administer oaths, personally appeared the Publisher's Representative who being first duly sworn,deposed and says:
1. That he/she is the Publisher's Representative of the Greensboro News &Record, Inc.a corporation,engaged in the
publication of newspapers known as "News&Record",published,issued and entered as second class mail in the City of
Greensboro in said County and State.
2. That he/she is authorized to make this affidavit and sworn statement; that the notice or other legal advertisement,
a copy of which is attached hereto,was published in the News&Record on the dates listed below.
3. That the said newspaper(or newspapers) 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 of the requirements and qualifications of
Section 1-S97 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.
Publisher's Representative_ (J/�-�`�.�• �v l�L.,
"d$
Sworn to and subscribed before me,this day of 2006.
Notary Public 4 r t e ��� C CC!vun. =XP c_13-201 0
My commission expires: August 23, 2010
Name Ad# Date Edition Class PO Ad Coot/
NCDENR DWO NPDES 8352777 05/26/06 News&Record 400 PERMITS PUBLIC NOTICESTATE O

Ad # 18352777 Date 05/25/2006 Time 10:04 AM
PUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT
COMMISSIONI t1POE5 UNIT
1617 MALL SERVICE CENTER
RALEIGH, NC 27699.1617
NOTIFICATION OF INTENT TO ISSUE A
Hli WASTEWATER PERMIT
On the basis of thorough staff review and appli-
cation of NC General Statute 143.21,Public law
92-500 and other lawful standards and regula-
tions,the North Carolina Environmental Man-
agement Commission proposes to issue a Na-
tional Pollutant Discharge Elimination System
(NPDES)wastewater discharge permit to the
person(s)listed below effective 45 daysfrom
thepublish dateofthisnotice -
Written comments regarding the proposed per-
mit will be accepted until 30 days after the
publish date of this notice.All comments re-
ceived prior to that date are considered in the
final determinations regarding the proposed
permit.The Director of the NC Division of Wa-
ter Quality may decide to hold a public meet-
ing for the proposed permit should the Division
receive a significant degree of public interest.
Copies of the draft permit and other supporting
information on file used to determine condi-
tions present in the draft permit are available
upon request and payment of the costs of re-
production.Mail comments ari requestsfor
information to the NC Division of Water Qual-
ity at the above address or call the Ms.Carolyn
Bryant [phone], extension 363 or
Ms. Frances Candelana(919)733-5033,exten-
sion 520 at the Point Source Branch. Please in-
clude the NPDES permit number(attached)in
any communication. Interested persons may
also vi sit the Division of Water Quality at 512 N.
Salisbury Street,Raleigh,NC 27604-1148 be-
tween the hours of 8:00 a.m.and 5:00 p.m.to
review information on file.
Sunrise&Sun,LLC(5625 Newman Davis Rd.,
Greensboro,INC 27406)has applied for renewal
of NPDES permit NCO041483 for the Sunrise 1►
Park WWTP in Guilford County.This permitted V
facility discharges treated wastewater to
Hickory Creek in the Cape Fear River Basin.
Some parameters maybe water quality limited,
which may affect future allocations in this por-
tion of the Cape Fear River Basin.
Crown Mobile Home Park(6205 Wescott Drive,
Sum m erfield,North Carolina 2735&9072)has
applied for renewal of NPDES permit
N C0055255 for the Crown Mobile Home Park
WWTP in Guilford County.This permitted facil-
ity currently discharges 42,000 gallonsper day
treated wastewater into an unnamed tributary
to Hickory Creek in-the Cape Fear River Basin.
Currently,BOD,ammonia nitrogen,and total
residual chlorine arewater quality limited.This
discharge may affect future allocations in this
portion of the Cape Fear River Basin.
Apex Oil Corn pany(NCO071463)has appli el to
renew its perm it dischargi ng to an unnam ed, J 1• _
tributary of Horsepen Creek located within the
Cape Fear River Basin.The param eters benzene,
toluene,and lead are water-quality limited.This _
discharge m ay affect future wasteload alloca-
tionsto the receiving stream. ((��
[Magellan Terminals Holdings,LP(NCOO 74578) V
has applied to renew its permit discharging to
unnamed tributary of Long Branch within the
Cape Fear River Basin.No parameters are water
quality limited.This discharge may affect fu-
ture wasteload allocations to the receiving
stream.
Ad shown is not actual print size

imap:Hvanes sa.manuel%40dwq.denr.ncma [e-mail] ma il.net:143/...
Subject: Re: [Fwd: DEH Comments - Crown MHP]
From: Corey Basinger<[e-mail]>
Date: Thu, 06 Apr 2006 08:05:52 -0400
To: [e-mail], Vanessa Manuel <[e-mail]>
Steve and Vanessa,
I spoke to Lee Spencer with DEH regarding Crown MHP. I informed him of the compliance (or
non-compliance) history at Crown. I also informed him that pursuant to my last compliance inspection
there were 14 items to completed by April 30th. Four had been completed and the remaining 10 were
pending. Those "10" items are what he's referring to. No need to put a special condition in the permit.
I'm following Crown's progress closely and will respond with the appropriate actions should the
remaining items not be completed. Proceed with issuance as advised.
Corey
Corey Basinger
[e-mail]
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
Fax (336) 771-4630 ��c(iSS1S�
On 4/6/2006 6:58 AM, Steve Tedder wrote:
-------- Original Message --------
Subject:DEH Comments - Crown MHP
Date:Wed, 05 Apr 2006 09:13:23 -0400
From:Vanessa Manuel <vancssa.manuel((Dncmai].net>
To:steve tedder<[e-mail]>
Steve,
I have received comments from Lee. Spencer with DEH regarding the permit
renewal for Crown MHP. He indicated they will concur with issuing the
permit provided the "permittee complies with the remaining 110' items
which the regional DWQ office has stipulated must be done. " what are
these items and do you feel they should be incorporated as a special
condition in the permit?
-Vanessa
Steve Tedder
Steve.Tedder@ncmail .net
NC DENR Division of Water Quality
1 of 2 4/6/2006 1:03 PM

State of North Carolina
Department of Environment ` •
and Natural Resources
Division of Water Quality
Michael F. Easley Governor NCDENR
William G. Ross, Jr., Secretary
NORTH CAROLINA DEPARTMENT OF
Alan W. Klimek, P.E., Director ENVIRONMENT AND NATURAL RESOURCES
March 22, 2006
MEMORANDUM
RECEIVED
TO: Lee Spencer N.C.Dept.of ENR
NC DENR / DEH / Regional Engineer MAR 2 3 20U6
Winston-Salem Regional Efice
I Winston-S21etq: - `
From: Vanessa E. Manuc J' Regiony.ON¢e
{�
l \�Eastern NPDFS Program
Subject: Review of Draft NPDES Permit NCO055255
Lee Simaan —Crown Mobile Home Park WWTP
Guilford County
please indicate below your agency's position or viewpoint on the draft permit and i[tiro t0s rrm by April 24, 20066
t -
if you have any questions on the draft permit, please contact me at the telephone mt\i•ber or e-mail address listed at
the bottom of this page.
RESPONSE: (Check one)
❑ Concur with the issuance of this permit provided the facility is operated and maintained properly,the stated effluent limits
/are met prior to discharge,and the discharge does not contravene the designated water quality standards.
X Concurs with issuance of the above permit,provided the following conditions are met*
n „
PJI THE /�c�.r, r.-�� Cr.r,�< �E-.t t> r_�T�/c ��E 'Yd..✓".JG /t`7
TLHS W/N/Cd 'HL ��G11/o-tAL /JC.1a DFF/Ce Hot
❑ Opposes the issuance of the above permit,based on reasons stated below,or attached:
Signed Date: -5 za5 0 �O
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 919 733-5083,extension 532 (fax)919 733-0719
VISIT US ON THE INTERNET @ www.navateinualitV.ore [e-mail]

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Permit NCOOSS255
A. (1.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS — DRAFT
During the period beginning on the effective date of the permit and lasting until 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 EFFLUENT LIMITS MONITORING REQUIREMENTS
Monthly Daily Unit of Measurement Sample Sample
Parameter Description-PCS Code Average Maximum Measure Frequency Type Locations
Influent or
Flow,in conduit or thru treatment plant - 50050 0.042 MGD Continuous Recorder Effluent
BOD, 5-Da 20 Deg.C - 00310 16.0 24.0 m /L Weekly Composite Effluent
Solids,Total Suspended - 00530 30.0 45.0 m /L Weekly Composite Effluent
Nitrogen,Ammonia Total as N - 00610 - Summer 2.0 10.0 m /L Weekly Composite Effluent
Nitrogen,Ammonia Total as N - 00610 - Winter 4.0 20.0 m /L Weekly Composite . Effluent
Coliform, Fecal MF, M-FC Broth,44.5C - 31616
eom.mean 200 400 #/100ml Weekly Grab Effluent
Chlorine,Total Residual2 - 50060 /L 2/week Grab Effluent
Chlorine,Total Residua12 - 50060 17 /L 2/week Grab Effluent
Daily--
Temperature,Water Deg. Centigrade - 00010 de .C weekdays Grab Effluent
DO, Oxygen, Dissolved3 - 00300 m /L Weekly Grab Effluent
pH4-00400 S.U. Weekly Grab Effluent
Upstream&
Temperature,Water Deg. Centigrade - 00010 de . C Weekly Grab Downstream
Upstream&
DO, Oxygen, Dissolved - 00300 mg/L Weekly Grab Downstream
Summer: April 1 -October 31
Winter: November 1 -March 31 oS&) U)0�
2 �Jea.� Pb`r C­'
Footnotes: 6���
1. Upstream: at least 100 feet upstream from the outfall; Downstream: at NCSR 1132.
2. Total Residual Chlorine (TRC) limit takes effect 18 months from the effective date of the permit. Until the
limit becomes effective, the permittee shall monitor TRC (with no effluent limit).
3. The daily average Dissolved Oxygen effluent concentration shall not be less than 6.0 mg/L.
4. The pH shall not be less than 6.0 standard units (s.u.) nor greater than 9.0 s.u.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

TRC Limit Calculation
NCO055255 <------
Total Residual Chlorine
s7Q10 CFS 0 <------
DESIGN FLOW MGD 0.042 <------
DESIGN FLOW CFS 0.0651
STREAM STD UG/L 17.0
UPS BACKGROUND LEVEL /L 0
IWC % 100.00
Allowable Concentration (Ng/L) 17.00
TRC standard requires limits of
17-28 Ng/L
3/17/2006

MERI TECH, INC.
rkw
ENVIRONMENTAL LABORATORIES
A Division of Water Technology and Controls, Inc.
�i
March 16, 2006 MAR 2 0 2006 t�
To: Carolyn Bryant ` _ k. I'ly
Point Source Branch L_Por.:Y sou;;cF BMANI N
NCDWQ
1617 Mail Service Center r
Raleigh, NC 27699-1 6 1 7
Re: Crown Mobile Home Park WWTP NCO055255
Permit Renewal
Solids from this facility are removed by licensed contract hauler and disposed of
properly. Contractors used are, Van Boys Septic, Neal's Septic Service, and Jenkins
Septic. If you have any questions or need additional information, please do not hesitate to
call.
David Merritt
Meritech, Inc.
Operators Crown MHP
642 Tamco Road < P.O. Box 27 a Reidsville, NC 27320
[phone] ^ [phone] Fax

NPDES APPLICATION FOR PERMIT RENEWAL -.FORM D
For privately owned treatment stems tree 100% domestic wastewaters- _....,,....: .. .
p y systems treating <0.1 MGD
Mail the complete application to: l
N. C. Department of Environment and Natural Resources ' + ;
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617 /
NPDES Permit CO055255
If you are completing this form in computer use the TAB key or the up -down arrows to_move from;one:;,
field to the neat To check the bones click our mouse on to o the box. Otherwise lease-not ar e.
y P f P P hJP - --
1. Contact Information: c• :-,rrlc :.. .,..
Owner Name Lee Simaan
Facility Name Crown Mobile Home Park
Mailing Address 6205 Wescott Dr.
City Summerfield
State / Zip Code NC 27353
Telephone Number [phone]
Fax Number [phone]
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road Jonquil Drive
City Greensboro
State / Zip Code NC 27401
County Guilford
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Meritech Inc
Mailing Address PO Box 27
City Reidsville
State / Zip Code NC 27320
Telephone Number [phone]
Fax Number [phone]
1 of 4 Form-D 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 1000/6 domestic wastewaters <0.1 MGD
4. Description of wastewater.
Facility Generating Wastewater(check all that apply}
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential ® Number of Homes 147 /
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater(example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile home park
Population served: A 7
S. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfaB equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map shounng the exact location of each outfalir
unnamed tributary to Hickory Creek in the Cape Fear River Basin
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: cunt.
9. Describe the treatment system
List all installed components, including capacity,provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient; attach the description of the treatment system in a
separate sheet of paper.
.042 mgd. wastewater treatment facility:
Bar screen, equalization basin, Aeration tanks in series, dual clarifiers, tablet
chlorination with contact tank, reaeration tank with diffused air, aerated sludge
digester, continuous flow recording
2 of 4 Fom-D 1106

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
10. Flow Information: _
Treatment Plant Design flow .042 MGD
Annual Average daily flow .020 MGD (for the previous 3 years)
Maximum daily flow .042 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples,for all other
parameters 24-hour composite sampling shall be used. Effluent testing data must be based on at least three
samples and must be no more than four and one half years old.
Parameter Daily Monthly Units of Number of
Maximum Average Measurement Samples
Biochemical Oxygen Demand 16.8 3.76 mg/l 5
(BODs)
Fecal Coliform 1 <1 200/100 ml 5
Total Suspended Solids 9 3.9 mg/l 5
Temperature (Summer) 26 24.6 C 3
Temperature (Winter) 14 11 C 3
pH 7.4 7.3 5
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 NCO055255 Dredge or fill(Section 404 or CWA)
PSD (CAA) Special Order of Consent(SOC)
Non-attainment program (CAA) Other
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the
bestp�my knowledge and belief such information Is true, complete, and accurate.
Printed name of Person Signing Title
3 of 4 Form-D 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
Signature of App 'cant 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 knowly renders inaccurate any recording or monitoring device or
method required to be operated or maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed
$25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a
punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar
offense.)
4 of 4 Form-D 1/O6

PERMIT OWNER FACILITY COUNTY CASE# Parameter AssessDate PENALTY$ PAID$
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LM-2002-0035 DO 01/06/2003 $ 1,117.32 $316.96
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LM-2002-0036 BOD 02/10/2003 $ 2,050.64 $545.21
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LM-2004-0008 BOD 05/12/2004 $ 251.00
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LM-2004-0021 BOD 06/29/2004 $ 401.00
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2002-0114 FEC COLI 04/26/2002 $ 2,300.50 $810.69
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0023 FEC COLI 02/10/2003 $ 2,075.64 $ 551.15
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0096 FEC COLI 02/10/2003 $ 567.32 $ 186.20
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0097 BOD 02/11/2003 $ 3,504.82 $884.60
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0098 FEC COLI 02/11/2003 $ 1,629.82 $438.81
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0099 02/11/2003 $ 1,317.32 $ 364.51
NG0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0100 DO 02/11/2003 $ 1,629.82 $438.81
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0101 DO 02/11/2003 $ 1,417.32 $388.29
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2003-0148 DO 03/05/2003 $ 1,526.00 $420.76
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2004-0503 NH3-N 10/08/2004 $ 352.00
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford LV-2005-0261 NH3-N 08/02/2005 $ 352.00
NC0055255 Crown Mobile Home Park Crown Mobile Home Park Guilford NOV-2005-LV-0173 NH3-N $ - $ -
The major issues at this facility are 0&M and plant operations and ORC being diligent.
Instream monitoring is once per week. This is one that we would like to see one or more of the instream parameters increased to at least 3/week.
This change would force the ORC to go to the receiving stream to view effluent and stream conditions.

FACT' SHEET' FOR CXPCDI'I'CD RCNCFIAL
Permit Number l/C 00 SS.;>SS
Facility Name Crown Obou a4<
Reviewer M
Basin/Sub-basin CF 03 0&00
Receiving Stream T
Stream Classification in permit tks_/I/
Stream Classification in BIMS
Is the stream impaired (listed on 303(d))? 0
Is stream monitoring required? y/
Does the permit need NIi3 limit(s)? iJ 1"5/1- (S :7O rnr/L (W
Does the permit need TRC limit(s)? ? add- Wm /f!�w S d
Does the permit have toxicity testing? o
Are there special conditions? /)o
Any obvious compliance concerns? _ /.)o
Existing Expiration Date fr13/ P
New Expiration Date
Miscellaneous Comments:
7EN WEE Ei
('17N�S Za�2- Zeros
� 0
If expedited, is this a simpler permit o a more difficult ane?