NC0047279_Fact Sheet_20210621

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
Fact Sheet
NPDES Permit No. NC0047279
Permit Writer/Email Contact Emily Phillips
Date: February 9, 2021
Division/Branch: NC Division of Water Resources/NPDES Complex Permitting
Fact Sheet Template: Version 09Jan2017
Permitting Action:
© Renewal
❑ Renewal with Expansion
❑ New Discharge
❑ Modification (Fact Sheet should be tailored to mod request)
Note: A complete application should include the following:
• For New Dischargers, EPA Form 2A or 2D requirements, Engineering Alternatives Analysis, Fee
• For Existing Dischargers (POTW), EPA Form 2A, 3 effluent pollutant scans, 4 2nd species WET
tests.
• For Existing Dischargers (Non-POTW), EPA Form 2C with correct analytical requirements based
on industry category.
Complete applicable sections below. If not applicable, enter NA.
1. Basic Facility Information
Facility Information
Applicant/Facility Name:
RNH Investments, LLC/Heritage Meadows WWTP
Applicant Address:
6659 Private School Road, Oxford, NC 27565
Facility Address:
6659 Private School Road, Oxford, NC 27565
Permitted Flow:
0.01 MGD [capacity of 86 people]
Facility Type/Waste:
Minor Municipal; 100% domestic
Facility Class:
Class II
Treatment Units:
• Influent tank with bar screen
• Two influent pumps
• Two aeration blowers
• Two aeration basins
• Two digesters, 800 gallons each
• Two clarifiers
• Effluent tank with chlorine dispenser
• Dechlorination
Pretreatment Program (Y/N)
N
Page 1 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
County:
Granville
Region
Raleigh
Briefly describe the proposed permitting action and facility background: Heritage Meadows WWTP has
applied for an NPDES permit renewal at 0.01 MGD. This facility serves a population of —86 people. The
facility has a single Outfall 001.
2. Receiving Waterbodv Information:
Outfalls/Receiving Stream(s):
Outfall 001— UT to N Fork
Tar River
Stream Segment:
28-5
Stream Classification:
WS-IV; NSW
303(d) listed/parameter:
N/A
Basin/Sub-basin:
Tar-Pamlico/03-03-01
3. Effluent Data Summary
Table. Effluent Data Summary Outfall 001
PARAMETER
(Parameter Code)
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location2
Flow
(50050)
0.01 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5-day (20°C) (00310)
(April 1— October 31)
5.0 mg/L
7.5 mg/L
Weekly
Grab
Effluent
BOD, 5-day (20°C) (00310)
(November 1 — March 31)
10.0 mg/L
15.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids (00530)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
NH3 as N (00610)
(April 1— October 31)
2.0 mg/L
10.0 mg/L
Weekly
Grab
Effluent
NH3 as N (00610)
(November 1 — March 31)
4.0 mg/L
20.0 mg/L
Weekly
Grab
Effluent
Dissolved Oxygen (00300)
Daily average > 6.0 mg/L
Weekly
Grab
Effluent
Page 2 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
Dissolved Oxygen (00300)
Weekly
Grab
U & D
Fecal Coliform (31616)
(geometric mean)
200 / 100 ml
400 / 100 ml
2/Month
Grab
Effluent
Total Residual Chlorine3 (50060)
17 pg/L
2/Week
Grab
Effluent
Temperature (°C) (000/0)
Daily
Grab
Effluent
Temperature (°C) (00010)
Weekly
Grab
U & D
Total Kjeldahl Nitrogen (TKN) (00625)
Monthly
Grab
Effluent
Nitrate / Nitrite Nitrogen (00630)
(NO2-N + NO3-N)
Monthly
Grab
Effluent
Total Nitrogen (00600)
(NO2-N+NO3-N+TKN)
Monthly
Calculated
Effluent
Total Phosphorus (00665)
Monthly
Grab
Effluent
pH (00400)
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
4. Instream Data Summary
Instream monitoring may be required in certain situations, for example: 1) to verify model predictions
when model results for instream DO are within 1 mg/1 of instream standard at full permitted flow; 2) to
verify model predictions for outfall diffuser; 3) to provide data for future TMDL; 4) based on other
instream concerns. Instream monitoring may be conducted by the Permittee, and there are also
Monitoring Coalitions established in several basins that conduct instream sampling for the Permittee (in
which case instream monitoring is waived in the permit as long as coalition membership is maintained).
If applicable, summarize any instream data and what instream monitoring will be proposed for this
permit action: N/A
Is this facility a member of a Monitoring Coalition with waived instream monitoring (Y/N): NO
Name of Monitoring Coalition: N/A
5. Compliance Summary
Summarize the compliance record with permit effluent limits (past 5 years): No limit violations, but
BPJed NOVs for daily max exceeded for chlorine in 2015.
No major activities or problems with this facility.
Summarize the compliance record with aquatic toxicity test limits and any second species test results
(past 5 years): N/A
Summarize the results from the most recent compliance inspection: No record of recent inspection.
Page 3 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
6. Water Quality -Based Effluent Limitations (WQBELs)
Dilution and Mixing Zones
In accordance with 15A NCAC 2B.0206, the following stream flows are used for dilution considerations
for development of WQBELs: 1 Q 10 streamflow (acute Aquatic Life); 7Q10 streamflow (chronic Aquatic
Life; non -carcinogen HH); 30Q2 streamflow (aesthetics); annual average flow (carcinogen, HH).
If applicable, describe any other dilution factors considered (e.g., based on CORMIX model results): Not
evaluated for this renewal.
If applicable, describe any mixing zones established in accordance with 15A NCAC 2B.0204(b): NA
Oxygen -Consuming Waste Limitations
Limitations for oxygen -consuming waste (e.g., BOD) are generally based on water quality modeling to
ensure protection of the instream dissolved oxygen (DO) water quality standard. Secondary TBEL limits
(e.g., BOD= 30 mg/1 for Municipals) may be appropriate if deemed more stringent based on dilution and
model results.
If permit limits are more stringent than TBELs, describe how limits were developed: NA
Ammonia and Total Residual Chlorine Limitations
Limitations for ammonia are based on protection of aquatic life utilizing an ammonia chronic criterion of
1.0 mg/1 (summer) and 1.8 mg/1 (winter). Acute ammonia limits are derived from chronic criteria,
utilizing a multiplication factor of 3 for Municipals and a multiplication factor of 5 for Non -Municipals.
Limitations for Total Residual Chlorine (TRC) are based on the NC water quality standard for protection
of aquatic life (17 ug/l) and capped at 28 ug/1 (acute impacts). Due to analytical issues, all TRC values
reported below 50 ug/1 are considered compliant with their permit limit.
Describe any proposed changes to ammonia and/or TRC limits for this permit renewal: There are no
proposed changes.
Reasonable Potential Analysis (RPA) for Toxicants NA
If applicable, conduct RPA analysis and complete information below.
The need for toxicant limits is based upon a demonstration of reasonable potential to exceed water quality
standards, a statistical evaluation that is conducted during every permit renewal utilizing the most recent
effluent data for each outfall. The RPA is conducted in accordance with 40 CFR 122.44 (d) (i). The NC
RPA procedure utilizes the following: 1) 95% Confidence Level/95% Probability; 2) assumption of zero
background; 3) use of Y2 detection limit for "less than" values; and 4) stream flows used for dilution
consideration based on 15A NCAC 2B.0206. Effective April 6, 2016, NC began implementation of
dissolved metals criteria in the RPA process in accordance with guidance titled NPDES Implementation of
Instream Dissolved Metals Standards, dated June 10, 2016.
A reasonable potential analysis was conducted on effluent toxicant data collected between NA. Pollutants
of concern included toxicants with positive detections and associated water quality standards/criteria.
Based on this analysis, the following permitting actions are proposed for this permit:
Page 4 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
• Effluent Limit with Monitoring. The following parameters will receive a water quality -based
effluent limit (WQBEL) since they demonstrated a reasonable potential to exceed applicable
water quality standards/criteria: NA
• Monitoring Only. The following parameters will receive a monitor -only requirement since they
did not demonstrate reasonable potential to exceed applicable water quality standards/criteria,
but the maximum predicted concentration was >50% of the allowable concentration: NA
• No Limit or Monitoring: The following parameters will not receive a limit or monitoring, since
they did not demonstrate reasonable potential to exceed applicable water quality
standards/criteria and the maximum predicted concentration was <50% of the allowable
concentration: NA
• POTW Effluent Pollutant Scan Review: Three effluent pollutant scans were evaluated for
additional pollutants of concern.
o The following parameter(s) will receive a water quality -based effluent limit (WQBEL)
with monitoring, since as part of a limited data set, two samples exceeded the allowable
discharge concentration: NA
o The following parameter(s) will receive a monitor -only requirement, since as part of a
limited data set, one sample exceeded the allowable discharge concentration: NA
If applicable, attach a spreadsheet of the RPA results as well as a copy of the Dissolved Metals
Implementation Fact Sheet for freshwater/saltwater to this Fact Sheet. Include a printout of the RPA
Dissolved to Total Metal Calculator sheet if this is a Municipality with a Pretreatment Program.
Toxicity Testing Limitations
Permit limits and monitoring requirements for Whole Effluent Toxicity (WET) have been established in
accordance with Division guidance (per WET Memo, 8/2/1999). Per WET guidance, all NPDES permits
issued to Major facilities or any facility discharging "complex" wastewater (contains anything other than
domestic waste) will contain appropriate WET limits and monitoring requirements, with several
exceptions. The State has received prior EPA approval to use an Alternative WET Test Procedure in
NPDES permits, using single concentration screening tests, with multiple dilution follow-up upon a test
failure.
Describe proposed toxicity test requirement: NA
Mercury Statewide TMDL Evaluation
There is a statewide TMDL for mercury approved by EPA in 2012. The TMDL target was to comply
with EPA's mercury fish tissue criteria (0.3 mg/kg) for human health protection. The TMDL established a
wasteload allocation for point sources of 37 kg/year (81 lb/year), and is applicable to municipals and
industrial facilities with known mercury discharges. Given the small contribution of mercury from point
sources (-2% of total load), the TMDL emphasizes mercury minimization plans (MMPs) for point source
control. Municipal facilities > 2 MGD and discharging quantifiable levels of mercury (>1 ng/l) will
receive an MMP requirement. Industrials are evaluated on a case -by -case basis, depending if mercury is a
pollutant of concern. Effluent limits may also be added if annual average effluent concentrations exceed
the WQBEL value (based on the NC WQS of 12 ng/l) and/or if any individual value exceeds a TBEL
value of 47 ng/1
NA Table. Mercury Effluent Data Summary
Page 5 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
# of Samples
Annual Average Conc. ng/L
Maximum Conc., ng/L
TBEL, ng/L
WQBEL, ng/L
Describe proposed permit actions based on mercury evaluation: NA
Other TMDL/Nutrient Management Strategy Considerations
If applicable, describe any other TMDLs/Nutrient Management Strategies and their implementation
within this permit: NA
Other WQBEL Considerations
If applicable, describe any other parameters of concern evaluated for WQBELs: NA
If applicable, describe any special actions (HQW or ORW) this receiving stream and classification shall
comply with in order to protect the designated waterbody: NA
If applicable, describe any compliance schedules proposed for this permit renewal in accordance with
15A NCAC 2H.0107(c)(2)(B), 40CFR 122.47, and EPA May 2007Memo: NA
If applicable, describe any water quality standards variances proposed in accordance with NCGS 143-
215.3(e) and 15A NCAC 2B. 0226 for this permit renewal: NA
7. Technology -Based Effluent Limitations (TBELs)
Municipals (if not applicable, delete and skip to Industrials)
Are concentration limits in the permit at least as stringent as secondary treatment requirements (30 mg/l
BOD5/TSSfor Monthly Average, and 45 mg/l for BOD5/TSSfor Weekly Average). YES
If NO, provide a justification for alternative limitations (e.g., waste stabilization pond). NA
Are 85% removal requirements for BOD5/TSS included in the permit? NA
If NO, provide a justification (e.g., waste stabilization pond). NA
Industrials (if not applicable, delete and skip to next Section) NA
Describe what this facility produces:
List the federal effluent limitations guideline (ELG) for this facility:
If the ELG is based on production or flow, document how the average production/flow value was
calculated:
For ELG limits, document the calculations used to develop TBEL limits:
Page 6 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
Table. TBEL Development per NA
Pollutant
Daily Maximum
BPT/BAT
(lb/1000 lb)
Daily Maximum
Limit
(lb /d)
Monthly Average
BPT/BAT
(lb/1000 lb)
Monthly Average
Limit
(lb/d)
If any limits are based on best professional judgement (BPJ), describe development: NA
Document any TBELs that are more stringent than WQBELs: NA
Document any TBELs that are less stringent than previous permit: NA
8. Antidegradation Review (New/Expanding Discharge):
The objective of an anti -degradation review is to ensure that a new or increased pollutant loading will not
degrade water quality. Permitting actions for new or expanding discharges require an anti -degradation
review in accordance with 15A NCAC 2B.0201. Each applicant for a new/expanding NPDES permit
must document an effort to consider non -discharge alternatives per 15A NCAC 2H.0105 (c)(2). In all
cases, existing instream water uses and the level of water quality necessary to protect the existing use is
maintained and protected.
If applicable, describe the results of the antidegradation review, including the Engineering Alternatives
Analysis (EAA) and any water quality modeling results: NA
9. Antibacksliding Review:
Sections 402(o)(2) and 303(d)(4) of the CWA and federal regulations at 40 CFR 122.44(1) prohibit
backsliding of effluent limitations in NPDES permits. These provisions require effluent limitations in a
reissued permit to be as stringent as those in the previous permit, with some exceptions where limitations
may be relaxed (e.g., based on new information, increases in production may warrant less stringent TBEL
limits, or WQBELs may be less stringent based on updated RPA or dilution).
Are any effluent limitations less stringent than previous permit (YES/NO): NO
If YES, confirm that antibacksliding provisions are not violated: NA
10. Monitoring Requirements
Monitoring frequencies for NPDES permitting are established in accordance with the following
regulations and guidance: 1) State Regulation for Surface Water Monitoring, 15A NCAC 2B.0500; 2)
NPDES Guidance, Monitoring Frequency for Toxic Substances (7/15/2010 Memo); 3) NPDES Guidance,
Reduced Monitoring Frequencies for Facilities with Superior Compliance (10/22/2012 Memo); 4) Best
Professional Judgement (BPJ). Per US EPA (Interim Guidance, 1996), monitoring requirements are not
Page 7 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
considered effluent limitations under Section 402(o) of the Clean Water Act, and therefore anti -
backsliding prohibitions would not be triggered by reductions in monitoring frequencies.
For instream monitoring, refer to Section 4.
11. Electronic Reporting Requirements
The US EPA NPDES Electronic Reporting Rule was finalized on December 21, 2015. Effective
December 21, 2016, NPDES regulated facilities are required to submit Discharge Monitoring Reports
(DMRs) electronically. Effective December 21, 2020, NPDES regulated facilities will be required to
submit additional NPDES reports electronically. This permit contains the requirements for electronic
reporting, consistent with Federal requirements.
12.Summary of Proposed Permitting Actions:
A. Table. Current Permit Conditions and Proposed Changes NA
Parameter
Current Permit
Proposed Change
Basis for Condition/Change
NA
MGD — Million gallons per day, MA - Monthly Average, WA — Weekly Average, DM — Daily Max
DM — Daily Max
13. Public Notice Schedule:
Page 8 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
Permit to Public Notice: 3/23/2021
Per 15A NCAC 2H .0109 & .0111, The Division will receive comments for a period of 30 days following
the publication date of the public notice. Any request for a public hearing shall be submitted to the
Director within the 30 days comment period indicating the interest of the party filing such request and the
reasons why a hearing is warranted.
14. Fact Sheet Addendum (if applicable):
Were there any changes made since the Draft Permit was public noticed (Yes/No): NO
If Yes, list changes and their basis below: NA
Page 9 of 9

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
sworn, says that he is
NORTH CARCUHNA,)
GRANVILLE COUNTY)
�� r- .being first duly
�r�n•C �Cn g
of the Ledger Publishing Company, inc., 4 North
Carolina Corporation; publisher of the Oxford
Public Ledger, -a ne-wspaper published Weekly in
Granville County, North Carolina; that said
newspaper has a general circulation to paid
subscribers in Granville County, and has been
admitted to the United States mail as second
class matter in Oxford, Granville County, North
Carolina, that he knows it to be a fact that
tot. re 0+2=rrie rrl- -/a ISS Los° P DES
r T o 4 le r 1 `--1-L . Lf P_,
P.5 was
published in said newspaper once a week for
AprI I 1 A D,2 `f' -&44GG-e&s-t'tte
we�cs- beginning be innin with the issue of
/lpri 1 I Off, I and ending
with the issue of r. 1 4 .2j0A /
Sworn to and subscribed before me this
the i St day of , n
Notary Public LORI GARRETT
Notary Public - North Carolina
GranvlllO County 1C 2024
C•} _ � _. kl , My Commisslnn Explroa Sop
My Commission Expires II 7`

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
SALE
JOE BRYAN
& ASSOCIATES, INC.
693-8931
SERVICES
One Man
and a Tractor
"Helping You Achieve
Your Goals"
* Land Management
Bush Hogg * Back Hoe
* Root Grapple
* Box Blade * Tree &
Debris Removal
Call David Gregory
256-636-1255
It pays to advertise
in the
Oxford Ledger
919-693-2646
NOTICE
List With Us For A Quick Sale
Nan Howells Dudley Barnes
919-691-4273 919-482-5435
Joe Bryan 919-693-8931
HELP WANTED
HELP WANTED
The City of Oxford is currently recruiting
qualified applicants for the following positions:
* Part time Event Programming and Promotions
Coordinator
* Utility Maintenance Crew Leader
* Line Maintenance Technician
* Street Maintenance Worker
* Police Officer
You can view full job decriptions at
www.oxfordnc.org Departments - Human
resources -Employment opportunities
Apply on City application at 300 Williamsboro
St., Oxford Or email to:
humanresources(a3oxfordnc.org
NOTICE
NOTICE
Public Notice
North Carolina Environmental Management Commission/NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES Wastewater Permit NC0047279
Heritage Meadows WWTP
The North Carolina Environmental Management Commission proposes to
issue a NPDES wastewater discharge permit to the person(s) listed below.
Written comments regarding the proposal permit will be accepted until 30
days after the publish date of this notice. The Director of the NC Division of
Water Resources (DWR) may hold a public hearing should there be a
significant degree of public interest. Please mail comments and/or information
requests to DWR at the above address. Interested persons may visit the DWR
at 512 N. Salisbury Street, Raleigh, NC 27604 to review information on file.
Additional information on NPDES permits and this notice may be found on
our website: http://deq.nc.gov/about/divisions/water-resources/water-
resources-permits/wastewater-branch/npdes-wastewaterlpublic-notices or by
calling [phone]. C&.l Bradshaw, LLC (6659 Private School Road,
Oxford, NC 27565) has applied for renewal of NPDES permit NC0047279 for
the Heritage Meadows WWTP in Granville County. This permitted facility
discharges treated wastewater to an unnamed tributary to the North Fork Tar
River in the Tar -Pamlico River Basin. Currently fecal coliform, dissolved
oxygen, total residual chlorine, ammonia -nitrogen, and BOD are water
quality limited. This discharge may affect future allocations in this portion of
the Tar-Pamilco River Basin.

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1B564CB85AFF
ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
LINDA CULPEPPER
Director
Rajnikant Patel, Managing Partner
C&J Bradshaw LLC
6659 Private School Rd
Oxford, NC 27565
Subject: Permit Renewal
Application No. NC0047279
Heritage Meadows WWTP
Granville County
NORTH CAROLINA
Environmental Quality
June 20, 2019
Dear Applicant:
The Water Quality Permitting Section acknowledges the June 19, 2019 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq. nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
DE
Wase�sreaream .++�q��
ncelyr
�1�
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Di+nspon of Water Resources
Raleigh Regbnal Office I S&OD Barrett DriuW I Raleigh, North Carolina 27609
919791-4200

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit RECEIVED/NODE®/DWR
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit
NC0047279
JUN 0 6 2019
Water Quality
If you are completing this form in computer use the TAB key or the up - down arrows € nl iegreetti ve
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
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
RNH Investments, LLC
Heritage Meadows
6659 Private School Road
Oxford
North Carolina
[phone]
(919) 6901297
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road
City
State / Zip Code
County
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
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
North Carolina Community Homes, LLC (pending)
4610 Fairvista Drive
Charlotte
North Carolina 28269
[phone]
[phone]
[e-mail]
1 of 4 Form-D 11/12

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial ❑ Number of Employees
Commercial ® Number of Employees 3
Residential ❑ Number of Homes 1
School ❑ Number of Students/Staff
Other ❑ Explain: Licensed for 80 beds 80
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Heritage Meadows is an Assisted Living Facility license for 80 beds, currently unoccupied, and enough
staff to meet the needs of the residents.
Number of persons served: 0(Currently in the process of reopening with a capacity of 86 persons)
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Unnamed tributary to the north fork of Tar River
8. Frequency of Discharge: ❑ Continuous ® Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Every two hours
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.
This is an older system with no design criteria available and consists of the following components:
Influent tank with bar screen
Two influent pumps
Two aeration blowers
Two aeration basins
Two 800-gallon digesters
Effluen tank with chlorine dispenser
Dechlorination dispenser
Two clarifiers
2 of 4 Form-D 11/12

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Heritage Meadows Sludge Management Plan
Sludge is diverted from the aeration basin on a regular basis, collected in the digesters, and
aerated until time for disposal. After filling the tank with concentrated sludge, it is transported
via septic tank truck to the Oxford Wastewater Treatment for final disposition.
3 of 4 Form-D 11/12

DocuSign Envelope ID: E7554AA2-AB7B-44D7-8C6D-1 B564CB85AFF
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .01 MGD
Annual Average daily flow .005 MGD (for the previous 3 years)
Maximum daily flow .015 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes g No
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters currently in your permit. Mark other parameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
4.3
3.6
mg/ 1
Fecal Coliform
1.0
1.0
/ 100mg
Total Suspended Solids
4.3
4.2
mg/1
Temperature (Summer)
27.0
24.8
Deg. C
Temperature (Winter)
15.0
10.9
Deg. C
pH
7.2
7.0
units
13. List all permits, construction approvals and/or applications:
Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
Permit Number
NC0047279
14. APPLICANT CERTIFICATION
Type
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Ainni I AnJ , M, pATL
Managing Partner
Printed name of Person Signing Title
7(611
05/31/2019
Signature of Applica Date
North Carolina General tatute 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.)
4 of 4 Form-D 11/12