NC0070033_Owner (Name Change)_20121126

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Ferdue Chuck Wakild I )ee Freeman
Governor Director Secretary
November 26, 2012
CAROLYN A CALDWELL
ASSISTANT MANAGER
QUAIL RUN MOBILE HOME PARK
PO BOX 935
STANLEYTOWN VA 24168
Subject: NPDES Permit Modification- Name and/or
Ownership Change
Permit Number NC0070033
Quail Run Mobile Home Park
Davidson County
Dear Ms. Caldwell:
Division personnel have reviewed and approved your request to transfer ownership of the subject permit, received
on November 7, 2011. This permit modification documents the change of ownership.
Please find enclosed the revised permit. All other terms and conditions contained in the original permit remain
unchanged and in full effect. This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
807-6304.
Chuck Wakild
cc: Central Files
Winston-Salem Regional Office, Surface Water Protection
NPDES Unit File NC0070033
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Permit NC0070033
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 December 1, 2012.
This permit and the authorization to discharge shall expire at midnight on May 31, 2014.
Signed this day November 28, 2012.
Chuck Waklid, 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.

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 Type
Sample
Location
Flow
0.017 MGD
Weekly
Instantaneous
r
Influent Effluent
BOD5
30.0 mg/L
45.0 mg/L
2lmonth
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)
Weekly
Grab
Effluent,
U & D
Fecal Coliform
(Geometric Mean)
200/100 ml
400/100 ml
2lmonth
Grab
Effluent
Total Residual Chlorine2
28 pg/L
21Week
Grab
Effluent
Temperature
Weekly
Grab
Effluent,
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.

Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
Charles Wakild, P.E., Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or)
N
C
0
0
7
0
0
3
II. Permit status prior to status change.
a. Permit issued to (company name):
Certificate of Coverage
N
C
G
5
t-4 A i ( Fu nl ` o �,/e / o in g eAle
b. Person legally responsible for permit: E/&/an/a/f /4. 74 v,q /,q
First MI Last
cuN eye
Title
//I/ .DA/eA 4ZL1//
Permit Holder Mailing Address
�O u NOL Rock 7x 7 47‘ 5
City State Zip
( ) ( )
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
Phone Fax
(QtAAi / R b1(P /-fU Ole # e
l 34 uf+r`1 A-ce D%, ✓'
Address
LcJ/N5`710AJ — /r�,r, N oz 7/a7
City State / Zip
F/e.4No,e A- %, w/A (
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name): F,e d 3 1, R7' hI- J,8/1 �,4 ; / /u n1 i'Yi o b/ /e-
c. Person legally responsible for permit: F,eeat 16 . C' Ox 1A/eA."
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
First MI
Sale `73') e in b �2
Title
P.D. 6ay- 63/
Last
Permit Holder Mailing Address
—tAi/e/-TDWA/ jM o49,6 8
City State Zip
(.3 ) S/'%- D/9r7 fi aeeome,4571.,✓e/
PhonetrA
mailAdddress
C Ar( t,l11)e l4iJ!rie £9,k
Address
Ci State Zi
�? ���j��l 29 � �/ iee//
First MI Last
Revised 5/2012
276 )e' ve
/g - /Sa9 a/ wl_ eclay
Phone E-mail Address OD��C�S

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for th ermit)
Permit contact: CAlep y9 / . ,q (dwe /1
First MI Last
V.
VI.
A 5 S(154• Y1, •
Title
�.D • ,g cp 935
Mailing Address
5-/Akfey-�wJ (% 02i7L./6F
City State Zip
) 6iS2-/;a9 d A/d u,e// AA2dly_ v1 G yL
Phone E-mail Address d p inCA�T• Ne
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
M Yes
No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, T/eANoe 4. ,Zi Vi -/4 , attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
this application package will be returned as incomplete.
Signature
APPLICANT C TII ICATION
e as/ c„?
Date
, attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
packa_e will . - return -i as incomplete.
Sig ature
/0/09,5h )
Date
PLEASE SEND, THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 5/2012