NC0065358_Renewal (Application)_20210831

ROY COOPER = '
Governor `K +
ELIZABETH S.BISER ��`" *•
•Usr „or'
Secretary ° Esc``
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
August 31, 2021
SIP Hidden Forest, LLC
Attn: Sean Dyer, Manager
665 Hancock St Ste 3
Quincy, MA 02170-2868
Subject: Permit Renewal
Application No. NC0065358
Hidden Forest Estates WWTP
Randolph County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 31, 2021 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.
Sincerely,
ilt-Un4q6
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Paul Smith, ORC
ec: WQPS Laserfiche File w/application
DE Qw North Carolina Department of Environmental Quality Div ion of Water Resources
`7vJq/ Winston-Salem Regional Office 450 West Hanes Mill Road.Suite 300 Winston-Salem,North Carolina 27105
33b.776,9800

NPDES Permit Number Facility Name Modified Application Form 2A
AI C--00 6 5 33 8 N: (, 1�, -s Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
NPDES MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
the instructions may result in denial of the application.)
SECTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
H ; cIA .--0 (-e-5 -A' E54-c -c .
Mailing address(street or P.O. box)
Ci y or town State ZIP code
w pc):AC r I N1 f} 02_ 17 0
gContact name first and last) Title Phone number Email address
5e0,A. Ooirve. r 617 46 9 00 v�nc.k. rna,Aay o,4--C
Location/ ( address(sltr t,route number,or other specific ide ifie) 0 ame as mailing address 30"a `( , cu,-
ci v v° /lJ l d e fie. �)ct ►\- f d E K 1. O c.ti A .)Vv-cam tom,
City or town State ZIP code
. c \e_ w, G.r /VC- a) 3/7
1.2 Is this application for a facility that has yet to commence discharge? RECEIVE
❑ Yes 4 See instructions on data submission ❑ No 4
requirements for new dischargers. N U6 31 2021
1.3 Is applicant different from entity listed under Item 1.1 above?
pal Yes 0 No 4 SKIP to Item ACDEQ/Dw/NpDE
Applicant name J\----
= Applicant address(street or P.O. box)
-90 60h 2be
E Citytown n
o or State ZIP code
03 Contact name(first a d last) Title Phone number Email ad ress I 1
Pd0t3c,.t a) C. + 36932�3Y7 s�►'f�;nC1�SrI The_
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.) U2 I SUv f� '�� -f"-
0 Owner )a Operator 0 Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
Facilit ❑ Facility and applicant
y ❑ Applicant (they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
LInumber for each.
ZS Existing Environmental Permits
n.
�v 0 NPDES(discharges to surface-. 0 RCRA(hazardous waste) ❑ UIC(underground injection
c water) control)
C. °<-76-5 5 8
2 ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
C
w
c El Ocean Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section ❑ Other(specify)
w 404)
-_
Page 1

1 NPDES Permit Number Facility Name i I Modified Application Form 2A
/C_ ti Q 00 65,33 /J, g8ev. FJreS Modified March 2021
1.7 Provide the collection system information requestedbelow for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
joO %separate sanitary sewer RI Own ❑ Maintain
agOav le r ) 3 v %combined storm and sanitary sewer 0 Own 0 Maintain I
d 0 Unknown 0 Own 0 Maintain
c %separate sanitary sewer ❑ Own 0 Maintain
o
%combined storm and sanitary sewer 0 Own 0 Maintain
ro
0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
-a %combined storm and sanitary sewer 0 Own 0 Maintain
m 0 Unknown 0 Own 0 Maintain
g __ %separate sanitary sewer 0 Own 0 Maintain
›, %combined storm and sanitary sewer 0 Own 0 Maintain
c _ 0 Unknown 0 Own 0 Maintain
o
Total
°' Population 15 0
o Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of vv %
sewer line(in miles) /
ok
z' 1.8 Is the treatment works located in Indian Country?
c
0
0 ❑ Yes No
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
R
c ❑ Yes ts1No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0, 0 Z-7 mgd
aw Annual Average Flow Rates(Actual)
v Two Years Ago Last Year This Year __
c o ON 6) //C) mgd o, 0/0 mgd 0. 0") mgd
iiiLL Maximum Daily Flow Rates(Actual)
cu
a Two Years Ago Last Year This Year
v , 0 2,'1...0 mgd 0, 02.. q mgd 0, 0 2 7 mgd i
1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type. _
.Q _ Total Number of Effluent Discharge Points by Type
Combined Sewer 0.1Constructed
Treated Effluent I Untreated Effluent Bypasses Emergency
ccs.0 Overflows Overflows
co
Page 2

NPDES Permit Number I Facility Name Modified Application Form 2A
N` 0 06S3 H �C�`�v C Modified March 2021
l� 1 C J
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes IN No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
O Continuous
gpd 0 Intermittent
O Continuous
gpd 0 Intermittent
❑ Continuous
13
gpd 0 Intermittent
13
2 1.14 Is wastewater applied to land?
❑ Yes in No 4 SKIP to Item 1.16.
N 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Average Daily Volume Continuous or
Location Size Applied Intermittent
(check one)
acres gp 0 Continuous
d 0 Intermittent
"' 0 Continuous
acres gpd 0 Intermittent
0
acres gp 0 Continuous
d ❑ Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
o I ❑ Yes gr' No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes El No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O. box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
Page 3

NPDES Permit Number �Faccility Name Modified Application Form 2A
N C.- o 06 53,5 3 1i• 8%UL,•^- I re54— Modified March 2021
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name Mailing address(street or P.O. box)
d
City or town State ZIP code
c
o,
w Contact name(first and last) Title
-a
0
a Phone number Email address
M
To
in NPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
0
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
8 not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
CD
1 ❑ Yes LJ No 4 SKIP to Item 1.23.
n1.22 Provide information in the table below on these other disposal methods. 1
01 Information on Other Disposal Methods
t Annual Average Continuous or Intermittent
Disposal
o Location of Size of-0 Method Daily Discharge
Volume
co Description Disposal Site Disposal Site (check one)
0 Continuous
Tit acres gpd 0 Intermittent
o_ 0 Continuous
acres gpd ❑ Intermittent
0 Continuous
acres gpd ❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
,) cn Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
R Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
❑co 4.2 Section 301(h)) 302(b)(2))
0 Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
Yes 0 No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 _ Contractor 2 Contractor 3
o Contractor name J N.'.t-\1... a�S lea 5
`~ (company name)
'6a Mailing address P'Bo 26't i
c (street or P.O.box)
o City,state,and ZIP Q , NS•,' l ie NL
code Z 323
c Contact name(first and
last) .PcaJ� 5.+,
Phone number 3.36 9 3 2 w 3 9
so,:ti-44%cl JT'i} C_
Email address � C..a.l t,oJ� . A.
—
Operational and eRC%(KeK;r jIrau_
maintenance tra+'f5 (J
responsibilities of �j e w 1-,4_,.. it.)f-.5
q —
contractor -��t S � ,�
Page 4

1 _ i
NPDES Permit Number Facility Name Modified Application Form 2A
NL O( 5 3 - I� Fe)reS I Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
a ❑ Yes 1 No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflowand Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
r..
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
R Q. specific requirements.)
co
0
0 ❑ Yes CINo
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
0
`6 (See instructions for specific requirements.)
_ a,
o ❑ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1.
E
Q 2.
E
0
3.
C)
d
4.
-a
R 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
o Improvement Construction Construction Discharge Level
(list outfall
(from above) (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)
number) (MM/DD/YYYYd
5 1.
2.
3
4.
2.7 Have appropriate permits/clearances concerning other federalistate requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No El None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
/ C 006,533 0 ! , Modified March 2021
SECTION 3. INFORMATION ONEFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number Oc) I Outfall Number Outfall Number
State /V
In
To
County 1 c.` e..co ip /.
oCity or town t vv%,
0 Distance from shore / ft. ft. ft.
to Depth below surface / ft. ft. ft.
Average daily flow rate b.0/ v mgd mgd mgd
Latitude " N or ° " N or ° " N of
Longitude " N or " N or ° "
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
as
n :• ;` ❑ Yes R No 4 SKIP to Item 3.4.
a)
`'r°' 3.3 If so,provide the following information for each applicable outfall.
i
tn Outfall Number Outfall Number Outfalf Number I
0
Number of times per year
o discharge occurs _
a Average duration of each
o discharge(specify units)
c Average flow of each
R discharge mgd mgd mgd
CD co
Months in which discharge
occurs _
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
NO Yes Nt No 4 SKIP to Item 3.6.
aT 3.5 Briefly describe the diffuser t)pe at each applicable outfall.
Outfall Number Outfall Number Outfall Number
d
en
a
v_ 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
m one or more discharge points.
ea
IQ Yes 0 No 3SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
/r c Ov 6� 3,5B 1� `-%C f', PD i''t5i- Modified March 2021
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number Outfall Number Outfall'Number
Receiving water name
7-r, 6 Jkc--c .
Name of watershed,river, tun c A t.444 v
o or stream system 1,u k,�...
U.S. Soil Conservation
0 Service 14-digit watershed
cs code
:i Name of state C cil t- few ,
3 management/river basin C 45 a r/1.
U.S. Geological Survey
8-digit hydrologic
ce cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 00 I Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary ❑ Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
g. Secondary 0 Secondary 0 Secondary
Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0
Design Removal Rates by
0.
� Outfall
U)
N
BOD5 or CBODs
c
d
d TSS
❑ Not applicable 0 Not applicable 0 Not applicable
Phosphorus % %
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen %
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
% % %
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A 1
V G 006�35 F� Modified March 2021
I �S
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below. v V ! k._
0
Outfall`Number06( Outfall Number Outfall Number
CL Disinfection type w f;
5 frI
= Seasons used A l
Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
❑ Yes ❑ Yes ❑ Yes
El No ❑ No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
14 Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes K.] No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
rts
Number of tests of discharge
water
a Number of tests of receiving
water
z
Lu
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine. No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
El Yes 9q No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
N C ao17,53 L I ' 62 , .J Ted-
"& Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years? IQ No Complete tests and Table E and SKIP to
❑ Yes Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES
permitting
No Provideittinresults inTable E and SKIP to
❑ Yes ❑ Item 3.26.
3.21 Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of,Results
(MMIDD/rerr)
= 3.22Regardless Re ardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
a> ❑ Yes ❑ No 4 SKIP to Item 3.26.
d 3.23 Describe the cause(s)of the toxicity:
_
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the Not results
Io able becthe ause packag1 submitted
pp previously
❑ Yes information to the NPDES ermittin authorit .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
l C� ov 6,S 3 5 Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and (d))
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application. For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
Section 1: Basic Application ❑ w/variance request(s) ❑ wl additional attachments
Information for All Applicants
46 Section 2:Additional ❑ wl topographic map ❑ w/process flow diagram
Information ❑ w/additional attachments
' w/Table A ❑ w/Table D
zf' Section 3: Information on Er w/Table B ❑ w/additional attachments
Effluent Discharges ElE wl Table C
Section 4:Not Applicable
47-
Section 5: Not Applicable
a)
a)
�a Section 6: Checklist and ❑ w/attachments
Certification Statement
6.2 Certification Statement
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 fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Signature
Date signed
6 , 23 , a/
Page 10

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
W C 6o6 5 3 l y // 4 d o , 3( !` ` ( Modified March 2021
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical ML or MDL
Value Units Value Units Method (include units)
Sam ales
Biochemical oxygen demand
III
or❑CBOD5 / f 5 2 O�' Ni.ML
2v / `- 3! ��'e'� ZJI1 _rn,,A ❑MDL
resort one
Fecal coliform 2J0J !NM ii3
3/V)LQ,k Ca): ri-I U 2 �/10 0 ML
Pill'� ❑MDL
Design flow rate O 27,44 MIMI 0. 0 1 v /V 2 D e vH,T invert),
,67
pH(minimum) 50
pH(maximum) M111111 5v
Temperature(winter) 1111 aMill ,, 3 v•Je,e,
Temperature(summer) 2-8
Total suspended solids(TSS) Mil ')/v)t-Q,V �v\ Z.5 d f}. ao/( 3�O inAL
❑MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 1,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC- `t ' .53 L' - 1 A. 0_r \ D (
Modified March 2021
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDi.
Pollutant Value Units Value Units Number of Method, (include units)
1 Samples
Ammonia(as N) X 0, J ►n y /1-- / ° eN,Ni/r' 3�v-�C 2 K �¢f 2 Z•0 G. o MDL
Chlorine
❑ML
(total residual,TRC)2 / ❑MDL
Dissolved oxygen 9 w`9 /L 7 J Aid /L, 3/w e L k 6 3 I o 6.v`"F MDL
Nitrateinitrite [ ° J 7/-- ✓�.3/L �,,.,n+L IS EPA 363. Z ❑ML
to- v' Z, U ❑MDL
t ❑ML
Kjeldahl nitrogen Z0 nny/� /p Chi /(_ �jr.o, 1- � ¢ z 5� 2 �' ❑MDL
Oil and grease ❑ML
0 MDL
Phosphorus 6 rs.1 I(` / e 3 A 5,T ZM /c ❑ML o 4"of,
✓t3 /L /�V`'ee�� ate J 2. ❑MDL ✓`q
Total dissolved solids J ❑ML
❑MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e..methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
t
EPA Form 3510-2A(Revised 3-19) Page 12

Facility Name: Hidden Forest WWTP Month/Year Ap r ' 2 2- I
Permit#: NC0065358
County : Randolph
Temperature SM 2550 B 2010 Dissolved Oxygen SM 4500 0 G-2011
Effluent Effluent I Temp Temp DO DO DO DO Signature
Meter Flow Collected/ Celsius Adjusted Calibration Reading Sample
Reading MGD Analyzed I Air Time mg/L I Analysis
Date Calibration I Time
1 3561f06Oo ) / 10 I, I9.3g 1116 7, 3 weQ - S
2 b,oIZy �
3 6►0l2q
4 J
p.o! Z3
5 33008o,olz.S ! - ;
6 35-)00C(,0078; 12 O 5 -ZY- 6. 31-/ 1 2 10 G -9 1 Z/ 2 I_ _f
357(/9 b-O(O$j 113 L 2-7- j 4FC, 3c ' if 3 a 7, 2 tl t/o
8 1'7z 6,oI ov li 3b 12- 26 I / )(
9 573(Zo.cx,' S
i ! 10 O,b/oV ' I __
i
11 o.c.11O�/
12 377l9b,ol09 j
1
13 D 0 ? 7
I 3.5�72r~ ,v0 � 1 2�U 2 Z b 12y � 7. ! z Y� �.��
14 .57832,6,opo& / s l /v ' 9, 0D I 258 3 11 J 6
zs y ! i
357,3010-00( ( 120 / Z �, 70 I2 L tS -? ,1 Z 1 7-
L'6 33803214,0 /024 -
18 p, oflo !
19 30362. 6, o /101 i I j i ---r ----
20 3.3gy6•66,010ill Ja 'A j 2 3 Z5U ! I2_5o 7, 0 I ) 259, e
21 3.5$-58�o, o 1)M7 i/ 36 2 Z I Fr• e _i Iv-0. 4 8 I Nil -P
� 3
23 3506700, bIoPi / /`f0 l B 9, 5�/ 1/'-i3 i 7, ) 4-
3.582 go,0l0L. iI
24 0; 01 2(3.
' 25 I 0, 0 / 2I:: I +
--_J
26 cl /V10.o/2_4 I
27 353E70,0/031 PO 8 2_ L 8-, V0 ; Intl 16, S I 6 Ie-----e--C---C
28 5 3 31°,0106 _1362. `_ Z.. I �, 0 I jv3 ! 7, 2 ?/ lv 3
,
- 29 ,5 30 Uo1 o4oto8! Il5 I Z5 F, 2 f 126 ! 7 0 I 1ZZ ---
I t 614c o,o t l y I —21 -- ' 1 1 --
i 31 ;
I I .

Facility Name: Hidden Forest WWTPAMonth/Year �� /. i 2-0 a/
Permit It NC0065358
County : Randolph
pH SM 4500 H+B-2011 Total Residual Chlorine SM 4500 CI E-2011
N__- I pH pH Buffer CI Daily Time CL Chlorine TRC
Sample Result Check I Check daily Sample Signature •
Analysis value Standard Check P Result '
Date in-situ Analysis ug/L
ug/L Standard Time
Time Analyzed
IZ3 1 r MIMI O "ZZ
3
4 ,
1111111111111111111 , iL/ . ' —
'2 '2 ' '6 4 IMINIMEMINEIN 1111111111111111111111Z04) i s/ -7 5- \ i
13 c•7
22'118 - ILi d 'MUM1 v
9 IIIIIIIIIIIIntMmlIllIllnIIIIIMim.
_
10 / . ;, ,5
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Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
ANALYTICAL RESULTS
Project: Hidden Forest Eff 7/1
Pace Project No.: 92547410
Sample: Effluent Lab ID: 92547410001 Collected: 07/01/21 10:00 Received: 07/01/21 13:20 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Pace Analytical Services-Eden
Total Suspended Solids ND mglL 2.5 1 07/07/21 14:07
5210B BOD, 5 day EDN Analytical Method:SM 5210B-2011 Preparation Method: SM 5210B-2011
Pace Analytical Services-Eden
BOD,5 day ND mg/L 2.0 1 07/02/21 10:50 07/07/21 14:39
350.1 Ammonia Analytical Method:EPA 350.1 Rev 2.0 1993
Pace Analytical Services-Asheville
Nitrogen,Ammonia ND mg/L 0.10 1 07/13/21 14:40 7664-41-7
351.2 Total Kjeldahl Nitrogen Analytical Method:EPA 351.2 Rev 2.0 1993 Preparation Method: EPA 351.2 Rev 2.0 1993
Pace Analytical Services-Asheville
Nitrogen, Kjeldahl,Total ND mg/L 0.50 1 07/08/21 16:32 07/09/21 05:42 7727-37-9
353.2 Nitrogen,NO2/NO3 pres. Analytical Method: EPA 353.2 Rev 2.0 1993
Pace Analytical Services-Asheville
Nitrogen, NO2 plus NO3 5.1 mg/L 0.080 2 07/13/21 11:01
365.1 Phosphorus,Total Analytical Method:EPA 365.1 Rev 2.0 1993 Preparation Method: EPA 365.1 Rev 2.0 1993
Pace Analytical Services-Asheville
Phosphorus 0.40 mg/L 0.050 1 07/14/21 08:53 07/14/21 11:53 7723-14-0
Sample: Effluent Lab ID: 92547410002 Collected: 07/01/21 10:05 Received: 07/01/21 13:20 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Colilert-18 Fecal Coliform EDN Analytical Method: Colilert-18 Preparation Method:Colilert-18
Pace Analytical Services-Eden
Fecal Coliforms 9.8 MPN/100mL 1.0 1 07/01/21 14:26 07/02/21 08:47
REPORT OF LABORATORY ANALYSIS
• This report shall not be reproduced,except in full,
Date:07/14/2021 05:31 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 13

r
Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacatabs.caa [phone]
ANALYTICAL RESULTS
Project: Hidden Forest
Pace Project No.: 92458999
Sample: Effluent Lab ID: 92458999001 Collected: 12/31/19 10:00 Received: 12/31/19 13:25 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids 4.0 mg/L 2.7 1 01/03/20 13:00
5210B BOD,5 day EDN Analytical Method:SM 5210B-2011 Preparation Method:SM 5210B-2011
BOD,5 day 5.6 mg/L 2.0 1 12/31/19 14:59 01/05/20 11:51
350.1 Ammonia Analytical Method:EPA 350.1 Rev 2.0 1993
Nitrogen,Ammonia 4.3 mg/L 0.10 1 01/05/20 15:15 7664-41-7
Sample: Effluent Lab ID: 92458999002 Collected: 12/31/19 09:55 Received: 12/31/19 13:25 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Colilert-18 Fecal Coliform EDN Analytical Method:Colilert-18 Preparation Method:Colilert-18
Fecal Coliforms ND MPN/100mL 1.0 1 12/31/19 13:44 01/01/20 08:57
li
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:01/06/2020 04:54 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 10

aceAnalytrcalPace Analytical Services,LLC
® 205 East Meadow Road-Suite A
Eden,NC 27288
vr+rrr_gcalabs.co n [phone]
ANALYTICAL RESULTS
Project: Hidden Forest WW Testing 1/14
Pace Project No.: 92460678
Sample: EFFLUENT Lab ID: 92460678001 Collected: 01/14/20 10:00 Received: 01/14/20 16:30 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual 1
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Total Suspended Solids 16.2 mg/L 2.5 1 01/17/20 08:36
5210B BOD,5 day EDN Analytical Method:SM 5210B-2011 Preparation Method:SM 5210B-2011
BOD,5 day 3.7 mg/L 2.0 1 01/15/20 15:11 01/20/20 13:10 L1
350.1 Ammonia Analytical Method:EPA 350.1 Rev 2.0 1993
Nitrogen,Ammonia 1.8 mg/L 0.10 1 01/21/20 12:55 7664-41-7
365.1 Phosphorus,Total Analytical Method:EPA 365.1 Rev 2.0 1993 Preparation Method:EPA 365.1 Rev 2.0 1993
Phosphorus 0.42 mg/L 0.050 1 01/19/20 17:49 01/20/20 13:05 7723-14-0
Sample: EFFLUENT Lab ID: 92460678002 Collected: 01/14/20 10:05 Received: 01/14/20 16:30 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Colilert-18 Fecal Coliform EDN Analytical Method:Colilert-18 Preparation Method:Colilert-18
Fecal Coliforms ND MPN/100mL 1.0 1 01/14/20 16:42 01/15/20 10:48
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:01/21/2020 05:00 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 11

Pace Analytical Services,LLC
205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacalabs.cma [phone]
ANALYTICAL RESULTS
Project: Hidden Forest WW Testing
Pace Project No.: 92541026
Sample: EFFLUENT COMP Lab ID: 92541026001 Collected: 05/26/21 13:00 Received: 05/26/21 16:30 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Pace Analytical Services-Eden
Total Suspended Solids ND mg/L 2.5 1 05/27/21 16:26
350.1 Ammonia EDN Analytical Method:EPA 350.1 Rev 2.0 1993
Pace Analytical Services-Eden
Nitrogen,Ammonia 1.3 mg/L 0.10 1 05/27/21 11:31 7664-41-7
5210B BOD,5 day EDN Analytical Method: SM 5210E-2011 Preparation Method:SM 5210E-2011
Pace Analytical Services-Eden
BOD,5 day 3.4 mg/L 2.0 1 05/27/21 20:00 06/01/21 22:10 L2
Sample: EFFLUENT GRAB Lab ID: 92541026002 Collected: 05/26/21 13:05 Received: 05/26/21 16:30 Matrix:Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Colilert-18 Fecal Colifonn EDN Analytical Method:Colilert-18 Preparation Method:Colilert-18
Pace Analytical Services-Eden
Fecal Coliforms 7.4 MPN/100mL 1.0 1 05/26/21 16:44 05/27/21 11:30
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:06/03/2021 04:00 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 10