NC0070033_Permit (Issuance)_20090507

NPDES DOCIMENT !;CANNING COVER SHEET
NPDES Permit:
NC0070033
Quail Run MHP
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Application
Instream Assessment (67b)
Environmental
Assessment (EA)
Permit
History
Document Date:
May 7, 2009
This document is printed on reuse paper - ignore arty
content on the reizerse side

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Govemor
Mr. Fred P. Cox
P.O. Box 631
Stanleytown, VA
Dear Mr. Cox:
24168-0631
Coleen H. Sullins Dee Freeman
Director Secretary
May 7, 2009
Subject: Issuance of NPDES Permit NC0070033
Quail Run Mobile Home Park WWTP
Davidson County
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
• This final permit includes no major changes from the draft permit sent to you on March
11, 2009.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Quality or permits
required by the Division of Land Resources, the Coastal Area Management Act or any other Federal or Local
governmental permit that may be required. If you have any questions concerning this permit, please
contact Charles Weaver at telephone number [phone].
Sin rely,
41
oleen H. Sullins
cc: Central Files '
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarolina
Naturally

Permit NC0070J033
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Fred P. Cox
is hereby authorized to discharge wastewater from a facility located at
Quail Run Mobile Home Park
136 Quail Place Drive
Winston-Salem
Davidson County
to receiving waters designated as Miller Creek in subbasin 03-07-04 of the Yadkin -Pee Dee
River Basin in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, and IV hereof.
The permit shall become effective June 1, 2009.
This permit and the authorization to discharge shall expire at midnight on May 31, 2014.
Signed this day May 7, 2009
all
een H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

•
Permit NC0070033
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are
hereby revoked, and as of this issuance, any previously issued permit bearing this number is
no longer effective. Therefore, the exclusive authority to operate and discharge from this
facility arises under the permit conditions, requirements, terms, and provisions included
herein.
Fred P. Cox is hereby authorized to:
1. Continue to operate an existing 0.017 MGD wastewater treatment plant that includes the
following components:
• Two 3,200 gallon septic tanks
• One 4,000 gallon septic tank
• Two 4,500 gallon septic tanks
• 8,400 gallon recirculating dosing tank
• 4,250 square foot recirculating surface sandfilter
• Tablet chlorinator
• 350 gallon chlorine contact tank
This permitted facility is located at the Quail Run Mobile Home Park WWTP [136 Quail
Place Drive, Winston-Salem] in Davidson County.
2. Discharge from said treatment works at the location specified on the attached map into
Miller Creek, currently classified C waters in subbasin 03-07-04 of the Yadkin -Pee Dee
River Basin.

Quail Run Mobile Home Park
Latitude: 35° 59' 12" N Longitude: 80° 15' 59" W
Stream Class: C Receiving Stream: Miller Creek
Sub -Basin: 03-07-04 USGS Quad: Kernersville, NC
River Basin: Yadkin -- Pee Dee
Facility
Location .
[not to scale]
Permit NC0070033
Davidson County

Permit NC0070033
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is
authorized to discharge from Outfall 001. Such discharges shall be limited and monitored by the Permittee
as specified below:
PARAMETER
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly Average
Daily Maximum
Measurement
Frequency
Sample Tyco
_
_...
Sple
Loationi
cation
Flow
0.017 MGD
`
Weekly
+
Instantaneous
Influent or
Effluent
BOD5
30.0 mg/L
45.0 mg/L
2/month
Grab
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/month
Grab
Effluent
NH3-N
(April 1— October 31)
6.9 mg/L
34.5 mg/L
2/month
Grab
Effluent
NH3-N
(November 1— March 31)
25.8 mg/L
35.0 mg/L
2/month
Grab
Effluent
Dissolved Oxygen
(April 1— October 31)
y Weeki
Grab
Effluent,
U & D
Fecal Coliform
(Geometric Mean)
200/100 ml
400/100 ml
2/month
Grab
Effluent
Total Residual Chlorine2
28 pg/L
21Week
Grab
Effluent
Temperature
Daily
Grab
Effluent
Temperature
Weekly
Grab
U & D
Total Nitrogen
(TKN + NO2 + NO3)
Quarterly
Grab
Effluent
Total Phosphorus
Quarterly
Grab
Effluent
pH
> 6.0 and < 9.0 Standard Units
2/month
Grab
Effluent
Notes:
1 U: upstream approximately 100 feet from the outfall. D: downstream at least 300 feet from the outfall.
2 The Permittee shall report all effluent TRC values reported by a NC -certified laboratory [including field -
certified]. Effluent values below 50 µg/L will be treated as zero for compliance purposes.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE
AMOUNTS.

Winston-Salem Journal
Advertising Affidavit
Winston-Salem Journal
P.O Box 3159
Winston-Salem, NC 27102
NCDENR/DWQ/POINT SOURCE BRANCH
ATTN: DINA SPRINKLE
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Account Number
3376309
Date
March 13, 2009
Date
Category
Description
Ad Size
Total Cost
03/13/2009
Legal Notices
PUBLIC NOTICE STATE OF NORTH CAROLINA EN
2x78L
529.65
PUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT
COMMISSION/NPDES UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
NOTIFICATION OF INTENT TO ISSUE
A NPDES WASTEWATER PERMIT
On the basis of thorough staff review and applica-
tion of NC General Statute 143.215.1 and 15A NCAC
02H.0109 and other lawful standards and regula-
tions, the North Carolina Environmental Manage-
ment Commission proposes to issue a National
Pollutant Discharge Elimination System (NPDES)
wastewater discharge permit to the person(s) list-
ed below effective 45 days from the publish date of
this notice.
Written comments regarding the proposed permit
will be accepted until 30 days after the publish date
of this notice. All comments received prior to that
date are considered in the final determinations
regarding the proposed permit. The Director of the
NC Division of Water Quality may decide to hold
a public meeting for the proposed permit, should
the Division receive a significant degree of public
interest.
Copies of the draft permit and other supporting
information on file used to determine conditions
present in the draft permit are available upon
request and payment of the costs of reproduction.
Mall comments and/or requests for Information
to the NC Division of Water Quality at the above
address or call Dina Sprinkle [phone] at the
Point Source Branch. Please Include the NPDES
permit number (below) in any communication.
Interested persons may also visit the Division of
Water Quality at 512 N. Salisbury Street, Raleigh
NC 27604-1148 between the hours of 8:00 a.m. and
5:00 p.m. to review information on file.
Wilderness -NC, Inc. (P.O. Box 2136, Lexington, NC
27293) has applied for renewal of NPDES permit
NC0023604 for its Lumber Plant in Davidson County.
This permitted facility discharges treated wastewa-
ter to an unnamed tributary to Flat Swamp Creek
in the Yadkin -Pee Dee River Basin. Currently BOD,
ammonia nitrogen, dissolved oxygen, fecal coliform
and total residual chlorine are water quality limit-
ed. This discharge may affect future allocations in
this portion of the Yadkin -Pee Dee River Basin.
Mr. Fred P. Cox (P.O. Box 631, Stanleytown, VA
24168-0631) has applied for renewal of NPDES per-
mit NC0070033 for his Quail Run Mobile Home Park
WWTP in Davidson County. The permitted facility
discharges treated domestic wastewater to Miller
Creek in the Yadkin -Pee Dee River Basin. Currently
ammonia nitrogen. Total Residual Chlorine, and Fe-
cal Collform are water quality limited. This dis-
charge may affect future allocations In this portion
of Miller Creek.
Mr. Robert Walser [1210 Snider Kines Road, Lin-
wood, NC 27299] has applied for renewal of his
permit NC0040045 for Bill's Truck Stop In Davidson
County. This permitted facility discharges treated
domestic wastewater to South Potts Creek In the
Yadkin -Pee Dee River Basin. Currently Total Residu-
al Chlorine and Fecal Collform are water quality
limited. This discharge may affect future alloca-
tions in this portion of South Potts Creek.
WSJ: March 13, 2009
Media General Operations, Inc.
Publisher of the
Winston-Salem Journal
Forsyth County
Before the undersigned, a Notary Public of Forsyth County, North Carolina, duly
commissioned, qualified, and authorized by law to administer oaths, personally appeared
D.H. Stanfield, who by being duly sworn deposes and says: that he is Controller of the
Winston-Salem Journal, engaged in the publishing of a newspaper known as Winston-Salem
Journal, published, issued and entered as second class mail in the City of Winston-Salem, in
said County and State: that he is authorized to make this affidavit and sworn statement: that
the notice or other legal advertisement, a true copy of which is attached hereto, was
published in the Winston-Salem Journal on the following dates:
03/13/2009
and that the said newspaper in which such notice, paper document, or legal advertisement
was published was, at the time of each and every such publication, a newspaper meeting all
the requirements and qualifications of Section 1-597 of the General Statutes of North
Carolina and was a qualified newspaper within the meaning of Section 1-597 of the General
Statutes of North Carolina.
This 13th day of March, 2009
If IA.1 /1
(signature of person maridavit)
Sworn to and subscribed before me, this 13th day of March, 2J0
My Commission expires
•
(NotryYub!ic)
•
NOTARY PUBLIC
FORSYTH COUNTY
Z Q rid STATE OF NORTH CAR•* at, 0 Jo
:y COMMISSION EXPIRES A_..,......_
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

QUAIL RUN MOBILE HOME PARK
P. O. BOX 631
STANLEYTOWN, VA 24168
November 6, 2008
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, N.C. 27699-1617
_ .. NOV 1 7 2J08
Re: Renewal, NPDES Permit NC0070033
Please accept my request for renewal of the permit for our sewage treatment
operation. Enclosed is the application and related forms.
There has been no changes made to the system since our last renewal.
Respectfully,
QUAIL RUN MOBILE HOME PARK
Fred P. Cox
Owner
Enclosures
9

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
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit
'NC00 IT OD 3
If you are completing this form in computer use the TAB key or the up — down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
FreA- plc
Gu ;( 21,111 / zrk
P, O. ex -,,A 3 /
311-o. t L..11
1-m,t
in ,.Vt1-1
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road , I Mace, 1
City
State / Zip Code
County
(21 •v\ 44) v \ C7,LY)
nl C•�1,��
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
viir (auv.p Lei/
83,U) Bee Vs CquA refit Ici
Le -XI vlC : r�
hl• e• v r)aga
(33 3S-1)-s_ciK
1 of 3 Form-D 05/08

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 0 Number of Employees
Commercial 0 Number of Employees
Residential lir Number of Homes
School 0 Number of Students/Staff
Other 0 Explain:
9C
Describe the source(s) of wastewater -(example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Population served:
5. Type of collection system
Er Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points %
Outfall Identification number(s) CO 1
Is the outfall equipped with a diffuser? ❑ Yes [WNo
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
8. Frequency of Discharge: ©' Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
2 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow fi, C / r MGD
Annual Average daily flow D. Ce:•eS MGD (for the previous 3 years)
Maximum daily flow G. C % I MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes [EKNo
12. Effluent Data
Provide data for the parameters listed. Fecal Conform, 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.
ParameterDaily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
.3{
3c. c
r11 L L
Fecal Coliform
Lt-cc
x Cc.
Ccx) rne4t-iC; Week 1
Total Suspended Solids
,:.{. 5 C
��
h1 L
Temperature (Summer)
Temperature (Winter)
pH
ry - `'
c - °
STa.olcictsA Lft':, {'
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES /)J 6c - (_7r 3_3 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
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.
(Minted name Person S,igrZng .7 Title
j
r
// ,/f- ,-/- 5 -D Y
Signature of A licant / Date
North Carolina General Statute '43-215.6 (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 tha Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring aevice or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3 of 3
Form-D 05i08

QUAIL RUN MOBILE HOME PARK
P.O. BOX 631
STANLEYTOWN, VA 24168
276-629-2415
November 6, 2008
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, N.C. 27699-1616
Re: Renewal, NPDES Permit NC0070033
DESCRIPTION OF SLUDGE MANAGEMENT PLAN
Septic Tanks are pumped every three months by Forsyth Rooter Service, Inc,
P 0 Box 24248, Winstoin-Salem, N.C. 27114, phone [phone].

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Basic Information to determine potential for expedited permit renewal
Reviewer/Date
1/014 ii/i/zooS-
Permit Number
A(CvD 1003 3
Facility Name
fa%U 4;/ ? ur) /A ,
Basin Name/Sub-basin number
'Ag/t;,, ,-7-- Der-
,)- c
-v4/
Receiving Stream
G+/I,',G/-r G,.,_
Stream Classification in Permit
C,
Does permit need NH3 limits?
do ' ,r, s,7;�
Does permit need TRC limits?
we • ,� -
Does permit have toxicity testing?
do
Does permit have Special Conditions?
n%
Does permit have instream monitoring?
fis
Is the stream impaired (on 303(d) list)?
00
Any obvious compliance concerns?
Any permit mods since last permit?
Existing expiration date
5/3// 2
New expiration date
5/3 / / 2-v/.V'
New permit effective date
—
Miscellaneous Comments
YES/ This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NH3,
name/ownership changes). Include conventional WTPs in this group.
YES_ This is a MORE COMPLEX EXPEDITED permit renewal (includes
Special Conditions (such as EAA, Wastewater Management Plan), 303(d)
listed, toxicity testing, instream monitoring, compliance concerns, phased
limits). Basin Coordinator to make case -by -case decision.
YES_ This permit CANNOT BE EXPEDITED for one of the following reasons:
• Major Facility (municipal/industrial)
• Minor Municipals with pretreatment program
• Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS,
etc)
• Limits based on reasonable potential analysis (metals, GW remediation organics)
• Permitted flow > 0.5 MGD (requires full Fact Sheet)
• Permits determined by Basin Coordinator to be outside expedited process
TB Version 8/18/2006 (NPDES Server/Current Versions/Expedited Fact Sheet)