NC0057720_Renewal (Application)_20220613

STATE 4
ROY COOPER •
Governor
ELIZABETH S.BISER
Secretory
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
June 13, 2022
Jones Estate Hidden Lake, LLC
Attn: Ashleigh A. Davis
2310 S Miami Blvd Ste 238
Durham, NC 27703
Subject: Permit Renewal
Application No. NC0057720
Hidden Lakes Village Mobile Home Park WWTP
Stokes County
Dear Applicant:
The Water Quality Permitting Section acknowledges the June 13, 2022 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. 150B-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,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
DE Q North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 450 West Hanes Mill Road,Suite 300 Winston-Salem,North Carolina 27105
nw..�e�E «*.•+wr� /'� 336.776.9800

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0. 1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
132022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP 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
JONES ESTATES HIDDEN LAKES LLC
Mailing address(street or P.O.box)
2310 S MIAMI BLVD#238
City or town State ZIP code
DURHAM NC 27703
Contact name(first and last) Title Phone number Email address
KELLEN BUSS DIRECTOR [phone] [e-mail]
Location address(street,route number,or other specific identifier) El Same as mailing address
1020 Twin Lakes B Drive
U-
City or town State ZIP code
KING NC 27021
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
El Yes ❑✓ No 4 SKIP to Item 1.4.
Applicant name
= Applicant address(street or P.O. box)
0
io
o City or town State ZIP code
Q
Contact name(first and last) Title Phone number Email address
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑� Owner ❑ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility ❑ Applicant 0 Facility and 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
number for each.)
Existing Environmental Permits
✓❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
NC0057720
2 ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
w
rn
N ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
100 %separate sanitary sewer El Own El Maintain
40 %combined storm and sanitary sewer ❑ Own 0 Maintain
d El Unknown ❑ Own 0 Maintain
c %separate sanitary sewer ❑ Own El Maintain
O %combined storm and sanitary sewer 0 Own ❑ Maintain
c 0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
-C %combined storm and sanitary sewer 0 Own 0 Maintain
os ❑ Unknown ❑ Own ❑ Maintain
d %separate sanitary sewer 0 Own ❑ Maintain
combined storm and sanitary sewer 0 Own ❑ Maintain
co
o` 0 Unknown ❑ Own 0 Maintain
Total
d Population 40
co Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of ° °
sewer line(in miles) ioo /° o /°
?' 1.8 Is the treatment works located in Indian Country?
•
o El Yes El No
0
c1.9 Does the facility discharge to a receiving water that flows through Indian Country?
0 ❑ Yes El No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
.04 mgd
„`°= Annual Average Flow Rates(Actual)
ato
Two Years Ago Last Year This Year
C• O mgd .02 mgd .02 mgd
• `L Maximum Daily Flow Rates(Actual)
6 Two Years Ago Last Year This Year
mgd mgd mgd
y 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
O Total Number of Effluent Discharge Points by Type
a Q. Constructed
w > Combined Sewer
Es' Treated Effluent Untreated Effluent Bypasses Emergency
k
Overflows
. Overflows
U
G
Page 2

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
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 ❑✓ 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
0 Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
_2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
H Land Application Site and Discharge Data
o Continuous or
Location Size Average Daily Volume Intermittent
Applied (check one)
acresgpd ❑ Continuous
H ❑ Intermittent
6
d acres d ❑ Continuous
gp ❑ Intermittent
0
0 Continuous
acres gpd ❑ Intermittent
6 1.16 Is effluent transported to another facility for treatment prior to discharge?
o El Yes ❑✓ 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?
El Yes El No 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 Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP 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
2 City or town State ' ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
QNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
U)
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
not have outlets to waters of the State of North Carolina(e.g., underground percolation, underground injection)?
El Yes ❑✓ No- SKIP to Item 1.23.
U
Cl) 1.22 Provide information in the table below on these other disposal methods.
cL) Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acres d 0 Continuous
gp ❑ Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acres gpd ❑ Continuous
❑ 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.
w Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
RI Discharges into marine waters(CWA Water quality related effluent limitation(CWA Section
❑ Section 301(h)) ❑ 302(b)(2))
❑r 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 ❑r No+SKIP 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
0
Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP 9455 HELSABECK ROAD,
code RURAL HALL,NC 27045
Contact name(first and JON SOUTHERN
last)
Phone number [phone]
Email address [e-mail]
Operational and
maintenance OPERATOR ORC
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
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?
rn
o ❑ Yes 0 No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
a
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
R Q specific requirements.)
rn (.3
o
o ❑ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
3 (See instructions for specific requirements.)
o a,
LL �
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
R 1.
E
Q 2.
w
0
N 3.
d
a)
4.
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
2 Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
C,
1.
d
2.
N
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT 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 an Outfall Number Outfall Number
State NORTH CAROLINA
o County TIMMONS CREEK
m
O City or town STOKES COUNTY
0
o Distance from shore ft. ft. ft.
Q
Depth below surface ft. ft. ft.
cm
Average daily flow rate mgd mgd mgd
Latitude ° ° " °
Longitude " ° " ° "
A
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o ❑ Yes El No 4 SKIP to Item 3.4.
d
3.3 If so, provide the following information for each applicable outfall.
ch Outfall Number Outfall Number Outfall Number
o
Number of times per year
o discharge occurs
a Average duration of each
`o discharge(specify units)
oAverage flow of each mgd mgd mgd
discharge
co
cn Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑r No 4 SKIP to Item 3.6.
a, 3.5 Briefly describe the diffuser type at each applicable outfall.
a.
F Outfall Number Outfall Number Outfall Number
d
Cl)
0
o 6 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
d m•
one or more discharge points?
Irs r ❑ Yes 0 No +SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP 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
Name of watershed,river,
0 or stream system
"EL' U.S.Soil Conservation
0 Service 14-digit watershed
o code
L
R Name of state
management/river basin
c U.S.Geological Survey
w 8-digit hydrologic
W 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 Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary ❑ Primary
Treatment(check all that 0 Equivalent to ❑ Equivalent to ❑ Equivalent to
apply per outfall) secondary secondary secondary
❑ Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
0
Q. Design Removal Rates by
Outfall
cn
0 BOD5 or CBODs % % %
Z
a)
E
w TSS %
it
❑ 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
% %
I Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
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.
a,
d
:r
0
Outfall Number Outfall Number Outfall Number
0
Disinfection type
a)
Seasons used
a>
TO
i Dechlorination used? ❑ Not applicable ❑ Not applicable ❑ Not applicable
El Yes El Yes ❑ Yes
❑ No El No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
El 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 ❑ 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
is
Number of tests of discharge
water
Number of tests of receiving
'— water
a,
W
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 El 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?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP 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?
El Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
CI Yes ❑ No-� Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MMIDDNYYY)
TS
a>
0
CO 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
a) 3.23 Describe the cause(s)of the toxicity:
d
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 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 results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES permittin authorit .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP 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
Information for All Applicants ❑ w/variance request(s) ❑ w/additional attachments
❑ Section 2:Additional ❑ w/topographic map ❑ w/process flow diagram
Information
❑ w/additional attachments
❑ w/Table A ❑ w/Table D
❑ Section 3: Information on ❑ w/Table B ❑ w/additional attachments
Effluent Discharges
£ ❑ w/Table C
cts
Section 4:Not Applicable
0
w Section 5: Not Applicable
C,
U
❑ Section 6:Checklist and ❑ w/attachments
Certification Statement
y
6.2 Certification Statement
U
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
ASHLEIGH A DAVIS MANAGER OF SITE INFRASTRUCTURE
Signature Date signed
'ii < 06/0$/2022
A COO
Page 10
1

NPDES Permit Number Facility Name Duffel'Number I Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Value Units Value Units Methods (include units)
)
Biochemical oxygen demand
o ML
ii BOD5 or❑CBOD5 33.0 mg/L 22.0 mg/L WEEKLY GRAB mg/L ❑MDL
(report one)
Fecal coliform 400/100 ml 200/100 ml WEEKLY GRAB El ML
❑MDL
Design flow rate
pH(minimum) >-6.0
pH (maximum) s 9.0
Temperature(winter) MONITOR&REPOR1
Temperature(summer) MONITOR&REPOR1
0 ML
Total suspended solids(TSS) 45.0 mg/L 30.0 mg/L WEEKLY GRAB mg/L ❑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 I,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
NC0057720 HIDDEN LAKES VILLAGE MHP 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 MDL
Pollutant Number of Method' (include
Value Units Value Units Samples units)
❑ML
Ammonia(as N) see attached parame 0 MDL
Chlorine 28 µg/L 2/week GRAB
µg/L ML
0 MDL
(total residual,TRC)2o ML
Dissolved oxygen daily avg 26.0 mg/L daily avg z6.0 mg/L WEEKLY GRAB mg/L 0 MDL
❑ML
Nitrate/nitrite see attached parame 0 MDL
❑ML
Kjeldahl nitrogen ❑MDL
❑ML
Oil and grease ❑MDL
❑ML
Phosphorus ❑MDL
0 ML
Total dissolved solids
o 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 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.
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Method' (include units)
Samples
Metals,Cyanide,and Total Phenols
0 ML
Hardness(as CaCO3) ❑MDL
❑ML
Antimony,total recoverable ❑MDL
❑ML
Arsenic,total recoverable ❑MDL
❑ML
Beryllium,total recoverable ❑MDL
❑ML
Cadmium,total recoverable ❑MDL
❑ML
Chromium,total recoverable ❑MDL
❑ML
Copper,total recoverable ❑MDL
❑ML
Lead,total recoverable ❑MDL
❑ML
Mercury,total recoverable ❑MDL
❑ML
Nickel,total recoverable
❑MDL
❑ML
Selenium,total recoverable ❑MDL
❑ML
Silver,total recoverable
❑MDL
0 ML
Thallium,total recoverable ❑MDL
❑ML
Zinc,total recoverable
❑MDL
0 ML
Cyanide ❑MDL
❑ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
❑ML
Acrolein ❑MDL
❑ML
Acrylonitrile ❑MDL
❑ML
Benzene ❑MDL
❑ML
Bromoform ❑MDL
EPA Form 3510-2A(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Carbon tetrachloride ❑ML
❑MDL
❑ML
Chlorobenzene
❑MDL
❑ML
Chlorodibromomethane
❑MDL
❑ML
Chloroethane
❑MDL
❑ML
2-chloroethylvinyl ether ❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
❑ML
1,2-dichloroethane
❑MDL
ML
trans-1,2-dichloroethylene ❑MDL
ML
1,1-dichloroethylene ❑MDL
0 ML
1,2-dichloropropane ❑MDL
❑ML
1,3-dichloropropylene ❑MDL
❑ML
Ethylbenzene ❑MDL
0 ML
Methyl bromide ❑MDL
0 ML
Methyl chloride ❑MDL
ML
Methylene chloride ❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
ML
Tetrachloroethylene ❑MDL
Toluene ❑ML
❑MDL
1,1,1-trichloroethane ❑ML
❑MDL
1,1,2-trichloroethane ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Duffel!Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Method1 (include units)
Samples
❑ML
Trichloroethylene ❑MDL
❑ML
Vinyl chloride ❑MDL
Acid-Extractable Compounds
❑ML
p-chloro-m-cresol ❑MDL
0 ML
2-chlorophenol ❑MDL
0 ML
2,4-dichlorophenol ❑MDL
0 ML
2,4-dimethylphenol ❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
❑ML
2,4-dinitrophenol ❑MDL
❑ML
2-nitrophenol ❑MDL
0 ML
4-nitrophenol ❑MDL
0 ML
Pentachlorophenol ❑MDL
❑ML
Phenol ❑MDL
❑ML
2,4,6-trichlorophenol ❑MDL
Base-Neutral Compounds
❑ML
Acenaphthene ❑MDL
0 ML
Acenaphthylene ❑MDL
❑ML
Anthracene ❑MDL
❑ML
Benzidine ❑MDL
ML
Benzo(a)anthracene ❑MDL
0 ML
Benzo(a)pyrene ❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
0 ML
Benzo(ghi)perylene ❑MDL
0 ML
Benzo(k)fluoranthene ❑MDL
ML
Bis(2-chloroethoxy)methane ❑MDL
0 ML
Bis(2-chloroethyl)ether ❑MDL
0 ML
Bis(2-chloroisopropyl)ether ❑MDL
ML
Bis(2-ethylhexyl)phthalate ❑MDL
ML
4-bromophenyl phenyl ether ❑MDL
ML
Butyl benzyl phthalate ❑MDL
0 ML
2-chloronaphthalene ❑MDL
ML
4-chlorophenyl phenyl ether ❑MDL
0 ML
Chrysene ❑MDL
ML
di-n-butyl phthalate ❑MDL
0 ML
di-n-octyl phthalate ❑MDL
ML
Dibenzo(a,h)anthracene ❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
0 ML
Diethyl phthalate ❑MDL
0 ML
Dimethyl phthalate ❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
0 ML
1,2-diphenylhydrazine ❑MDL
Fluoranthene ❑ML
❑MDL
Fluorene 0 ML
❑MDL
Hexachlorobenzene 0 ML
❑MDL
Hexachlorobutadiene 0 ML
❑MDL
0 ML
Hexachlorocyclo-pentadiene ❑MDL
Hexachloroethane ❑ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene ❑MDL
❑ML
Isophorone ❑MDL
0 ML
Naphthalene ❑MDL
Nitrobenzene ❑ML
_ ❑MDL
0 ML
N-nitrosodi-n-propylamine ❑MDL
0 ML
N-nitrosodimethylamine ❑MDL
0 ML
N-nitrosodiphenylamine ❑MDL
Phenanthrene ❑ML
❑MDL
0 ML
Pyrene ❑MDL
1,2,4-trichlorobenzene 0 ML
❑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 I,Subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 17

NPDES Permit Number Facility Name Outfall Number Modified Application Form 2A
NC0057720 HIDDEN LAKES VILLAGE MHP Modified March 2021
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar e
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method1 (include units)
Samples
❑ No additional sampling is required by NPDES permitting authority.
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
❑MDL
0 ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑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 I,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18

Part I.
A.(1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
Grade Il Biological Water Pollution Control System[15A NCAC 08G .0302]
Beginning with the effective date of this 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:
PARAMETER EFFLUENT LIMITATIONS MONITORING REQUIREMENTS
Parameter Code Monthly Daily Measurement Sample Sample
Average Maximum Frequency Type Location
Flow 50050 0.02 MGD Continuous Recording Influent or
Effluent
80D,5-day,(20°C) C0310 22.0 mg/L 33.0 mg/L Weekly Grab Effluent
Total Suspended Solids C0530 30,0 mg/L 45.0 mg/L Weekly Grab Effluent
NH3 as N-Summer' C0610 2.0 mg/L 10.0 mg/L Weekly Grab Effluent
NH3 as N-Winter" C0610 6.4 mg/L 32.0 mg/L Weekly Grab Effluent
Dissolved Oxygen 00300 Daily average>6.0 mg/L Weekly Grab Effluent
Dissolved Oxygen 00300 Monitor&Report Weekly Grab Upstream&
Downstream
Fecal Coliform
(geometric mean) 31616 200/100 ml 400/100 ml Weekly Grab Effluent
Total Residual Chlorine(TRC) 50060 28 pgiL 2iWeek Grab Effluent
Temperature(°C) 00010 Monitor&Report Daily Grab Effluent
Temperature(SC) 00010 Monitor&Report Weekly Grab Upstream&
Downstream 2
pH 00400 >6.0 and<9.0 standard Weekly Grab Effluent
units
*Summer: April I-October 31
*Winter: November 1—March 31
Footnotes:
1. The Permittee shall submit discharge monitoring reports electronically using the Division's eDMR application system
[see A.(2)).
2. Upstream=at least 100 feet upstream from the outfall.Downstream=0.2 miles downstream from the outfall.
3. The Division shall consider all effluent TRC values reported below 50 µgil to be compliant with the permit.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 nil,
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM/N OTHER THAN TRACE AMOUNTS.
Page 3 of 6

EXHIBIT A
Legal Description
BEGINNING at a placed railroad spike in the center of State Road #1966 (Slate Road) in the corner
of Jimmy D. Welborn's line(see Deed Book 229, page 416 of the Stokes County Registry) and runs
South 27 dogs. 58 min. 39 sec. West 454.22 feet to a placed railroad spike 4 feet East of the center of
State Road #1966 (Slate Road); thence South 10 degs. 34 min. 30 sec. West 34.06 feet to an iron
placed 16 feet East of the center line of State Road#1966(Slate Road);thence North 72 degs.36 min.
42 sec. West 629.50 feet (passing over a 3f4' iron found at 50 feet) to a placed iron; thence South 10
degs. 13 min. 47 sec. West I26.65 feet to a 20 inch marked oak tree; thence North 82 degs. 39 min.
49 sec. West 1,486.25 feet to an axle found at a stone; thence North 8 degs. 40 min. 22 sec. East
1,369,81 feet to a found stone 6 feet East of a marked oak tree;thence South 82 dogs. 34 min.27 sec.
East 99.89 feet to a found iron stake; thence South 82 degs. 32 min. 58 sec. East 1,380.07 feet to a
found iron stake;thence South 5 degs. 36 min. 13 sec. West 485.72 feet to an 18 inch marked oak tree;
thence South 80 degs. 09 min. 22 sec. East 893.96 feet (passing over a rebar found at 858.64 feet) to
the BEGINNING and containing 60.902 acres.
This description taken from the survey plat established by C. Ray Cates bearing the date of October
13th, 1982, See Deed Book 259 at Page 286, Stokes County Registry.
SAVE AND EXCEPT: BEGINNING at a point in the West right of line of State Road#1966 (Slate
Road), said point being South 27 degs.30 min.57 sec. West 270 feet from the Jimmy D.Welborn line
(see Deed Book 229 at Page 416 of the Stokes County Registry) and runs thence South 27 degs. 30
min. 57 sec. West 173.24 feet; thence (continuing with the right of way) South 28 degs. 29 min. 53
sec.West 116.76 feet;thence with the North right of way of the proposed road North 72 degs.04 min.
57 sec. West on a chord 62.73 feet to a point in the North right of way of proposed road;thence North
82 degs. 39 min.49 sec.West 122 feet to a point;thence North 11 degs. 18 min. 28 sec. East 340 feet
to a point;thence South 65 degs. 50 min. 08 sec. East 273.38 feet to the BEGINNING and containing
1.61 acres. This description taken from the survey plat of C. Ray Cates established on March 18th,
1983.
SAVE AND EXCEPT the following lots:
(1) Lot#1 in the Twin Lakes Subdivision as per deed recorded in Book 290, page 670.
(2) Lot#2 in the Twin Lakes Subdivision as per deed recorded in Book 290, page 674.
(3) Lot#3 in the Twin Lakes Subdivision as per deed recorded in Book 289,page 770.
(4) Lot#4 in the Twin Lakes Subdivision as per deed recorded in Book 298,page 887.
REID: 14608
Address: 0 Slate Road,King,NC 27021

- •,....-,fe.i ,-- ' ., -4- :- ..\...-,,,;f2-Z.-....'..; .-f..' ,2.9,1%- v. if ,
J, , ,.. ,:'- ,,;14q .,4,-,..- •.' -;;;; '''4'. .,efr ,.i. 44,' ''''• -- •,r', - 7.4,._ 't!I .,' i,,,i;_z `--1,. if.".,t 4, .
c.....#0
r44411111r,
tp,,,,.,401
7 Attlxy
,f j • _A) {tom.. _ • , •✓.. • ♦r !' l�i5t.�7:-- °N r• - lee'Zi ' '•::,..4(,• '--` ...'`'''‘, diri- ,.. .,-,i„,.\_. r.......; x• - 'i '>'�' �� �� �
• . ,, i.;,_ y ,..,..,. , .
...,... e.,„.. ...., ,, ,,f—Tomp
r„::.:;, ..
•
,„,.... ,_. 2 .,„,„
....,„,,,,,
•
.,,.., „.....,. , ..q„.,,,
•
, ,•, , . .,kv
i r,. elk ' ,,r.---- ,-- MitiPt° .•;;'';
kt:',.-4 /7,_e r'.4.4,,"t) --•'.5,0_ -,\V _ _. ,. - -OA • 'r--• `-'-',....-.:TO... ."- - _,..,.... ';V. ":!.: r, :- ,,,.1 ik'''' 'sll k , 0 .12
6,..irr 4F,,, -.1,--. -. ,,,:. ',....:4,---J-W a:, • : -, -)10,,,,,,,,,,.„:„.,,,,, v,_, .z.o ::).., •-_,.-.&,,- '.........„_."\P"*-,,,,,,,,, ''''''. ',..,-,:,,,,'''..--_, ,,,,A., .> ,',„-ii_,„.):1-,, 1 ' iPii
'.'...: .' ,I. "..); - 46.." ?' P.T ',,,,, `'l , ‘..-.`.-_-tw' li-•• . ",,,- ilk,/4 , '-"-----.„,, NA', 'r
•
,,.., `L\�a-M �"` €i �'�� eft �• �s f•; ` ..� :� _. }r� oe c 'er
�••A.' '�. ' y it ''_.- rw ►jj •. 1 ` ,\ .,4/ •• be Pk.;
i''' �� e N
in
ii,i
,I MI (--r_..? CI . A.- ir:' ,% 'N„,/,,LN4t) Nt,i'I-.6:,_ 1 ,..
ti,
i(
„, :
0 ,
,, , .i:...... 4 T r • 11'` V,10,4): N. ' , -• -•,., 1 '), \ • ';', --. .?.4),'AcT.,..-- r.,.,-; ',:-.47.,0
S i a, III
-AN. -11. 11 t '`,-)1\ ,r° fr,,„0,
, , 1:4‘,,,, N,,-.14 ?c-__ 'A, .t, - c." -.i...r&:\*J\' ,.'z, ,1 ''-;:--;
*td i
'1' - . friworapcm • - .:-.,:: / ' -.•-, k...1,•,1 ict‘..:-1-,..i - ',S, . - ., ---.4:.' ' N-
a.,.-11,.. ?-± : , if --4 ' .- • .!. is-..- 'It. . ) .1:ti , ' .,- cte.....*, .: ' ' --- ''"7- •.- -
_i
:-.. ..,J,-,;,„.....,1, ,_ , 1::. :„ , ,,,!, {,,. _.„--- 0, - -..,;...- `1, "N - e• t ; i•K't.-, '
17..,..v -i.--1 , . - . -i, iiii...--.)‘ L ,--.{..•
, —, ,Thi -, .. A-:.. _AN, 'Nz , i,(.c. ,- . .',J ,44`, --T.".
4
rig - iR : ` - 1 ' :I•`•;•44 r- A J ` �l Y' *.
. .r.- .
. , ,,,,,.... ..._
_. .. ,:, .
. . , . ......,.......,,,,,...,, , ,,.,,, . .
. , _ ,,_: ,.: ,. .,,
: .. , A,- - ..--„ -k• • 1.* :'4; ,'I r-,... , ,...,1- \ , _.,.-. z_vi ,,-,.,---..;.' • ----1 ; ' -, i ,--.,i,...„. -
4
i,....\_ ;,_ 1._ ..,... _,,,) . ,, „4"11,,, 11,4‘: '"I'''Illk ,,M.,,, ' ' ; '‘'' ',1-.; 1'-' : 1' ,. , ' //7..f'. . ' i-
1r4.
I.
-..•♦ , #46 ,.rb" �'t F , tom. • •~ ►��i�� . - •v..
1014:,,
•
4..:••,.? 111, )',. .,:- • ,z,.. .‘„, ,z-.,,-. j_if..„,,,,,,, . . : ,,r) .......-„,r-‘, Iv.- ......1,,,,,,, .. A ,......y? - .,5, ' 0-) 1
•,4;.. 1,; :.,-. •..b-'.--- .ii f. '.-v-,,-... - \44 ' ,...A..) . f •
;),1111
;',kr:\' !;:n.. I.,,..1,,,...4, .:::. .','' ..',!".: '''''-'\•. .,.._ .... .. t.t-r..--:145(-,./IirainTy4w. ..-. 'Isl.::ti._..... '" t -',.v., .4.. , ..t..M._.._ I ,
1 - �'M J i , \ter `�] Jr A / • •L�
1.
ll �' ? e ° 41 1�. .• Y r-�; ! �. y f' � ��^^-- i¢7�f re6_�f �( �