NC0057720_Fact Sheet_20220901

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require full Fact
Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile home parks, etc)
that can be administratively renewed with minor changes, but can include facilities with more complex
issues (Special Conditions, 303(d) listed water, toxicity testing, instream monitoring, compliance
concerns).
Basic Information for Expedited Permit Renewals
Permit Writer / Date
Siying Chen 06/15/2022
Permit Number
NC0057720
Facility Name /Facility Class
Hidden Lakes Village Mobile Home Park
WWTP / WW-2
County / Regional Office
Stokes / WSRO
Basin Name / Sub -basin number
Roanoke / 03-02-01
Receiving Stream / HUC
UT Timmons Creek / 030101030201
Stream Classification / Stream Segment
C / 22-25-2
Does permit need Daily Maximum NH3 limits?
Already present
Does permit need TRC limits/language?
Already present
Does permit have toxicity testing? IWC (%) if so
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes — Dissolved oxygen and temperature
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
26 violation and enforcement cases (including 7
NODs and 15 NOVs) during the permit cycle.
Most of the violations were for BODS and TSS
limit exceedance.
Any permit mods since last permit?
Updated owner's name
Updated facility's address
Added WWTP classification
Updated eDMR requirements
Updated ammonia nitrogen limits
Updated outfall map
New expiration date
2/28/2027
Comments on Draft Permit?
No comment received
Most Commonly Used Expedited Language:
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote: "The
facility shall report all effluent TRC values reported by a NC certified laboratory including field
certified. However, effluent values below 50 µg/L will be treated as zero for compliance
purposes."
Fact Sheet for Permit Renewal
June 2022 -- NPDES Permit NC0057720 - Page 1

Section 1. Facility Overview:
This facility is a minor facility (flow < 1 MGD) discharging 100% domestic wastewater with a design
capacity of 0.02 MGD. This WWTP utilizes the following treatment components:
• Bar screen [aluminum]
• Extended aeration tank
• Two blowers for basin air, return sludge, and sludge wasting
• Dual final clarifiers
• Sludge holding tank
• Tablet chlorine disinfection (2 sets)
• Tablet dechlorination (2 sets)
• Stevens flow meter
Section 2. Compliance History (June 2017 — June 2022):
- NOVs and NODs
• Three NOVs for BOD5 limit violation in March 2018, July 2020, and September 2021.
• Five NOVs for fecal coliform limit violation in March 2018, July 2018, February 2019, July
2020, and October 2020.
• Five NOVs for total suspended solids limit violation in March 2018, December 2018, March
2019, June 2019, December 2019.
• One NOV for total residual chlorine limit violation in May 2018.
• Two NOVs for ammonia nitrogen limit violation in May 2019 and June 2019.
• Two NOVs for permit conditions violation detected during inspection in June 2017 and August
2018.
• One NOD for fecal coliform limit violation in February 2018.
• Two NODs for ammonia nitrogen limit violation in February 2018 and April 2019.
• One NOD for permit conditions violation detected during inspection in July 2018.
• One NOD for total suspended solids limit violation in January 2019.
• One NOD for pH monitoring violation in April 2020.
• Two NODs for BOD5 limit violation in November 2021 and December 2021.
- Penalty assessed
• One limit violation for ammonia nitrogen in October 2019.
• Two limit violations for fecal coliform in February 2020 and December 2020.
• One limit violation for BOD5 in August 2020.
Section 3. Changes from previous permit to draft:
• Updated owner's name on cover sheet and supplement to permit cover sheet.
• Updated facility's address on cover sheet and supplement to permit cover sheet.
• Added facility grade in A. (1).
• Updated eDMR footnote in A. (1) and language in A. (2).
Fact Sheet for Permit Renewal
June 2022 -- NPDES Permit NC0057720 - Page 2

• Updated ammonia nitrogen limits based on 0.02 MGD flow in A. (1). The new limits were
calculated using the WLA worksheet.
• Updated outfall map.
Section 4. Comments received on draft permit:
• No comment received on draft permit.
Section 5. Changes from draft to final:
• No change to final permit.
Fact Sheet for Permit Renewal
June 2022 -- NPDES Permit NC0057720 - Page 3

NORTH CAROLINA
STOKES COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Sandra Hurley who being first duly
sworn, deposes and says: that he (she) is Regional Publisher
(Publisher or other officer or employee authorized to make affidavit) of
ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a
newspaper known as THE STOKES NEWS, published, issued, and entered
as periodicals class mail in the city of King in said County and State; that
he (she) 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 STOKES NEWS on the following dates:
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 of 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 ICI day of
Signature of person making affidavit
Sworn to and subscribed b fore me, this
Notary Public
My Commission expires: 5tE\b c
JENNAJOHNSON
Notary Public - North Carolina
Surry County
My Commission Expires September 13, 2026
Public Notice
North Carolina
Environmental Management
Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
NC0057720 Hidden Lakes
Village Mobile Home Park
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public hear-
ing should there be a signific-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
http ://d eq. nc. gov/abouUd ivi-
sions/water-resources/water-
resources-permits/wastewater-
branch/n pdes-wastewater/pub-
lic-notices,or by calling (919)
707-3601. Jones Estate Hid-
den Lakes, LLC (2310 S Miami
Blvd Ste 238, Durham, NC
27703) requested renewal of
NPDES permit NC0057720 for
the Hidden Lakes Village Mo-
bile Home Park WWTP in
Stokes County. This permitted
facility discharges treated
wastewater to an unnamed
tributary to Timmons Creek in
the Roanoke River Basin. Cur-
rently, BOD, ammonia -nitro-
gen, dissolved oxygen, fecal
coliforn, and total residual
chlorine are water quality lim-
ited. This discharge may affect
future allocations in this por-
tion of the Basin.
Publish: 7-14-22 70062652
107549

NH3/TRC WLA Calculations
Facility: Hidden Lakes Village Mobile Home Park WWTP
PermitNo. NC0057720
Prepared By: Siying Chen
Enter Design Flow (MGD):
Enter s7Q10 (cfs):
Enter w7Q10 (cfs):
0.02
0.08
0.18
Total Residual Chlorine (TRC)
Daily Maximum Limit (ug/I)
s7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (UG/L)
Upstream Bkgd (ug/I)
IWC (%)
Allowable Conc. (ug/I)
Fecal Coliform
Monthly Average Limit:
(If DF >331; Monitor)
(If DF<331; Limit)
Dilution Factor (DF)
0.08
0.02
0.031
17.0
0
27.93
61
Ammonia (Summer)
Monthly Average Limit (mg NH3-N/I)
s7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (MG/L)
Upstream Bkgd (mg/I)
IWC (%)
Allowable Conc. (mg/I)
Ammonia (Winter)
Monthly Average Limit (mg NH3-N/I)
w7Q10 (CFS)
200/100m1 DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (MG/L)
3.58 Upstream Bkgd (mg/I)
IWC (%)
Allowable Conc. (mg/I)
Total Residual Chlorine
1. Cap Daily Max limit at 28 ug/I to protect for acute toxicity
Ammonia (as NH3-N)
1. If Allowable Conc > 35 mg/I, Monitor Only
2. Monthly Avg limit x 3 = Weekly Avg limit (Municipals)
3. Monthly Avg limit x 5 = Daily Max limit (Non-Munis)
If the allowable ammonia concentration is > 35 mg/L, no limit shall be imposed
0.08
0.02
0.031
1.0
0.22
27.93
3.0
0.18
0.02
0.031
1.8
0.22
14.69
11.0
Fecal Coliform
1. Monthly Avg limit x 2 = 400/100 ml = Weekly Avg limit (Municipals) = Daily Max limit (Non -Muni)

Max of Value
3
un
2.5
E
a) 2
nn
as
L
v 1.5
Q
>• 1
c
13 0.5
0
Ammonia Nitrogen
Monthly Average (Maximum)
2019-2022
2.66
1.11
0.89
0.45 0.57
0.14 0.17 0.17 0.19 0.12 0.16 0.26
1 2 3 4 5 6 7 8 9 10 11 12
Month
Month -

Max of Value
6
5
J
OA
4
E
3
•X
l0
2
1 1
0
Ammonia Nitrogen
Daily Maximum (Per Month)
(2019-2022)
5.44
3.75
2.47
1.12
0.24 0.25 0.36 0.31 0.18 0.25
0.50 0.56
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
Date _T

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 1 0113
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region: %
County: %
Violation Category:% Program Category:
Subbasin:%
Violation Action: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
03 - 2018 001 Effluent BOD, 5-Day (20 Deg. C) - 03/27/18 Weekly
Concentration
07 - 2020 001 Effluent BOD, 5-Day (20 Deg. C) - 07/30/20 Weekly
Concentration
07 - 2020 001 Effluent BOD, 5-Day (20 Deg. C) - 07/31/20 Weekly
Concentration
08 - 2020 001 Effluent BOD, 5-Day (20 Deg. C) - 08/27/20 Weekly
Concentration
08 - 2020 001 Effluent BOD, 5-Day (20 Deg. C) - 08/31/20 Weekly
Concentration
09 - 2021 001 Effluent BOD, 5-Day (20 Deg. C) - 09/09/21 Weekly
Concentration
11 -2021 001 Effluent BOD, 5-Day (20 Deg. C) - 11/18/21 Weekly
Concentration
12 - 2021 001 Effluent BOD, 5-Day (20 Deg. C) - 12/16/21 Weekly
Concentration
02 -2022 001 Effluent BOD, 5-Day (20 Deg. C) - 02/10/22 Weekly
Concentration
02 -2022 001 Effluent BOD, 5-Day (20 Deg. C) - 02/17/22 Weekly
Concentration
02 - 2022 001 Effluent BOD, 5-Day (20 Deg. C) - 02/22/22 Weekly
Concentration
02 - 2022 001 Effluent BOD, 5-Day (20 Deg. C) - 02/28/22 Weekly
Concentration
03 - 2022 001 Effluent BOD, 5-Day (20 Deg. C) - 03/03/22 Weekly
Concentration
03 - 2022 001 Effluent BOD, 5-Day (20 Deg. C) - 03/24/22 Weekly
Concentration
03 - 2022 001 Effluent BOD, 5-Day (20 Deg. C) - 03/30/22 Weekly
Concentration
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
33 46 39.4 Daily Maximum Proceed to NOV
Exceeded
33 230 597.0 Daily Maximum Proceed to NOV
Exceeded
22 50.37 129.0 Monthly Average Proceed to NOV
Exceeded
33 73 121.2 Daily Maximum Proceed to
Exceeded Enforcement Case
22 26.38 19.9 Monthly Average Proceed to
Exceeded Enforcement Case
33 44.5 34.8 Daily Maximum Proceed to NOV
Exceeded
33 37.3 13.0 Daily Maximum Proceed to NOD
Exceeded
33 38.2 15.8 Daily Maximum Proceed to NOD
Exceeded
33 37.7 14.2 Daily Maximum Proceed to NOV
Exceeded
33 37.3 13.0 Daily Maximum Proceed to NOV
Exceeded
33 33.2 0.6 Daily Maximum Proceed to NOV
Exceeded
22 28.22 28.3 Monthly Average Proceed to NOV
Exceeded
33 37.1 12.4 Daily Maximum None
Exceeded
33 40.7 23.3 Daily Maximum None
Exceeded
33 41.7 26.4 Daily Maximum None
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 2 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720 FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
03-2022 001
04-2022 001
04-2022 001
04-2022 001
04-2018 001
04-2018 001
04-2018 001
05-2018 001
05-2018 001
05-2018 001
05-2018 001
05-2018 001
05-2018 001
06-2018 001
06-2018 001
06-2018 001
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
BOD, 5-Day (20 Deg. C) - 03/31/22 Weekly
Concentration
BOD, 5-Day (20 Deg. C) - 04/06/22 Weekly
Concentration
BOD, 5-Day (20 Deg. C) - 04/13/22 Weekly
Concentration
BOD, 5-Day (20 Deg. C) - 04/30/22 Weekly
Concentration
Chlorine, Total Residual 04/03/18 2 X week
Chlorine, Total Residual 04/04/18 2 X week
Chlorine, Total Residual 04/11/18 2 X week
Chlorine, Total Residual 05/08/18 2 X week
Chlorine, Total Residual 05/09/18 2 X week
Chlorine, Total Residual 05/15/18 2 X week
Chlorine, Total Residual 05/22/18 2 X week
Chlorine, Total Residual 05/23/18 2 X week
Chlorine, Total Residual 05/30/18 2 X week
Chlorine, Total Residual 06/05/18 2 X week
Chlorine, Total Residual 06/12/18 2 X week
Chlorine, Total Residual 06/19/18 2 X week
mg/I
mg/I
mg/I
mg/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
ug/I
22 24.7 12.3 Monthly Average None
Exceeded
33 38.9 17.9 Daily Maximum None
Exceeded
33 42.4 28.5 Daily Maximum None
Exceeded
22 23.98 9.0 Monthly Average None
Exceeded
28 44 57.1 Daily Maximum No Action, BPJ
Exceeded
28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
28 46 64.3 Daily Maximum No Action, BPJ
Exceeded
28 41 46.4 Daily Maximum No Action, BPJ
Exceeded
28 48 71.4 Daily Maximum No Action, BPJ
Exceeded
28 417 1,389.3 Daily Maximum Proceed to NOV
Exceeded
28 38 35.7 Daily Maximum No Action, BPJ
Exceeded
28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
28 47 67.9 Daily Maximum No Action, BPJ
Exceeded
28 39 39.3 Daily Maximum No Action, BPJ
Exceeded
28 50 78.6 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 3 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
06 - 2018 001 Effluent Chlorine, Total Residual 06/20/18 2 X week ug/I 28 41 46.4 Daily Maximum No Action, BPJ
Exceeded
06 - 2018 001 Effluent Chlorine, Total Residual 06/26/18 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded
06 - 2018 001 Effluent Chlorine, Total Residual 06/27/18 2 X week ug/I 28 41 46.4 Daily Maximum No Action, BPJ
Exceeded
07 - 2018 001 Effluent Chlorine, Total Residual 07/03/18 2 X week ug/I 28 43 53.6 Daily Maximum No Action, BPJ
Exceeded
07 - 2018 001 Effluent Chlorine, Total Residual 07/10/18 2 X week ug/I 28 48 71.4 Daily Maximum No Action, BPJ
Exceeded
07-2018 001 Effluent Chlorine, Total Residual 07/11/18 2 Xweek ug/I 28 31 10.7 Daily Maximum No Action, BPJ
Exceeded
07 - 2018 001 Effluent Chlorine, Total Residual 07/17/18 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
07 - 2018 001 Effluent Chlorine, Total Residual 07/18/18 2 X week ug/I 28 46 64.3 Daily Maximum No Action, BPJ
Exceeded
07 - 2018 001 Effluent Chlorine, Total Residual 07/25/18 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
08 - 2018 001 Effluent Chlorine, Total Residual 08/07/18 2 X week ug/I 28 44 57.1 Daily Maximum No Action, BPJ
Exceeded
08 - 2018 001 Effluent Chlorine, Total Residual 08/14/18 2 X week ug/I 28 35 25 Daily Maximum No Action, BPJ
Exceeded
08 - 2018 001 Effluent Chlorine, Total Residual 08/21/18 2 X week ug/I 28 35 25 Daily Maximum No Action, BPJ
Exceeded
08 - 2018 001 Effluent Chlorine, Total Residual 08/29/18 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
10-2018 001 Effluent Chlorine, Total Residual 10/16/18 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
10-2018 001 Effluent Chlorine, Total Residual 10/30/18 2 X week ug/I 28 40 42.9 Daily Maximum No Action, BPJ
Exceeded
12 - 2018 001 Effluent Chlorine, Total Residual 12/12/18 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 4 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
12 - 2018 001 Effluent Chlorine, Total Residual 12/27/18 2 X week ug/I 28 46 64.3 Daily Maximum No Action, BPJ
Exceeded
04 - 2019 001 Effluent Chlorine, Total Residual 04/28/19 2 X week ug/I 28 47 67.9 Daily Maximum No Action, BPJ
Exceeded
07 - 2019 001 Effluent Chlorine, Total Residual 07/16/19 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
09 - 2019 001 Effluent Chlorine, Total Residual 09/10/19 2 X week ug/I 28 33 17.9 Daily Maximum No Action, BPJ
Exceeded
09-2019 001 Effluent Chlorine, Total Residual 09/11/19 2 Xweek ug/I 28 35 25 Daily Maximum No Action, BPJ
Exceeded
02 - 2020 001 Effluent Chlorine, Total Residual 02/17/20 2 X week ug/I 28 31 10.7 Daily Maximum No Action, BPJ
Exceeded
03 - 2020 001 Effluent Chlorine, Total Residual 03/18/20 2 X week ug/I 28 35 25 Daily Maximum No Action, BPJ
Exceeded
03-2020 001 Effluent Chlorine, Total Residual 03/24/20 2 X week ug/I 28 36 28.6 Daily Maximum No Action, BPJ
Exceeded
04 - 2020 001 Effluent Chlorine, Total Residual 04/02/20 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded
05 - 2020 001 Effluent Chlorine, Total Residual 05/12/20 2 X week ug/I 28 31 10.7 Daily Maximum No Action, BPJ
Exceeded
06-2020 001 Effluent Chlorine, Total Residual 06/30/20 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded
07 - 2020 001 Effluent Chlorine, Total Residual 07/07/20 2 X week ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
09-2020 001 Effluent Chlorine, Total Residual 09/08/20 2 X week ug/I 28 29 3.6 Daily Maximum No Action, BPJ
Exceeded
11-2020 001 Effluent Chlorine, Total Residual 11/16/20 2 X week ug/I 28 48 71.4 Daily Maximum No Action, BPJ
Exceeded
03-2021 001 Effluent Chlorine, Total Residual 03/01/21 2 Xweek ug/I 28 37 32.1 Daily Maximum No Action, BPJ
Exceeded
03 - 2021 001 Effluent Chlorine, Total Residual 03/03/21 2 X week ug/I 28 30 7.1 Daily Maximum No Action, BPJ
Exceeded

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 5 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region:
County: %
Violation Category:%
Subbasin:%
Program Category: %
Violation Action: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes
REGION: Winston-Salem
Limit Violation
MONITORING OUTFACE
REPORT
LOCATION
PARAMETER
VIOLATION UNIT OF
DATE FREQUENCY MEASURE
LIMIT
CALCULATED
VALUE
Over
VIOLATION TYPE VIOLATION ACTION
05-2021 001
06-2021 001
06-2021 001
02-2018 001
02-2018 001
02-2018 001
03-2018 001
03-2018 001
03-2018 001
03-2018 001
03-2018 001
07-2018 001
07-2018 001
07-2018 001
02-2019 001
02-2019 001
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Chlorine, Total Residual
Chlorine, Total Residual
Chlorine, Total Residual
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
05/11/21 2 X week ug/I
06/07/21 2 X week ug/I
06/14/21 2 X week ug/I
02/21/18 Weekly #/100m1
02/27/18 Weekly #/100m1
02/28/18 Weekly #/100m1
03/06/18 Weekly #/100m1
03/14/18 Weekly #/100m1
03/20/18 Weekly #/100m1
03/27/18 Weekly #/100m1
03/31/18 Weekly #/100m1
07/17/18 Weekly #/100m1
07/24/18 Weekly #/100m1
07/31/18 Weekly #/100m1
02/08/19 Weekly #/10om1
02/15/19 Weekly #/100m1
28 33 17.9 Daily Maximum
Exceeded
28 40 42.9 Daily Maximum
Exceeded
28 29 3.6 Daily Maximum
Exceeded
400 1,990 397.5 Daily Maximum
Exceeded
400 1,730 332.5 Daily Maximum
Exceeded
200 746.84 273.4 Monthly Geometric Mean
Exceeded
400 1,550 287.5 Daily Maximum
Exceeded
400 1,200 200 Daily Maximum
Exceeded
400 2,420 505 Daily Maximum
Exceeded
400 2,420 505 Daily Maximum
Exceeded
200 1,816.71 808.4 Monthly Geometric Mean
Exceeded
400 1,300 225 Daily Maximum
Exceeded
400 921 130.3 Daily Maximum
Exceeded
200 336.09 68.0 Monthly Geometric Mean
Exceeded
400 579 44.8 Daily Maximum
Exceeded
400 536 34 Daily Maximum
Exceeded
No Action, BPJ
No Action, BPJ
No Action, BPJ
Proceed to NOD
Proceed to NOD
Proceed to NOD
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 6 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region:
County: %
Violation Category:%
Subbasin:%
Program Category: %
Violation Action: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes
REGION: Winston-Salem
Limit Violation
MONITORING OUTFACE
REPORT
LOCATION
PARAMETER
VIOLATION UNIT OF
DATE FREQUENCY MEASURE
LIMIT
CALCULATED
VALUE
Over
VIOLATION TYPE
VIOLATION ACTION
02-2020 001
07-2020 001
10-2020 001
12-2020 001
02-2018 001
04-2019 001
05-2019 001
05-2019 001
06-2019 001
06-2019 001
06-2019 001
10-2019 001
03-2018 001
03-2018 001
11-2018 001
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Coliform, Fecal MF, MFC
Broth, 44.5 C
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
02/07/20 Weekly #/100m1
07/15/20 Weekly #/100m1
10/22/20 Weekly #/100m1
12/29/20 Weekly #/100m1
02/28/18 Weekly mg/I
04/30/19 Weekly mg/I
05/31/19 Weekly mg/I
05/31/19 Weekly mg/I
06/07/19 Weekly mg/I
06/14/19 Weekly mg/I
06/30/19 Weekly mg/I
10/31/19 Weekly mg/I
03/27/18 Weekly mg/1
03/31/18 Weekly mg/I
11/21/18 Weekly mg/1
400 2,420 505 Daily Maximum
Exceeded
400 2,420 505 Daily Maximum
Exceeded
400 2,420 505 Daily Maximum
Exceeded
400 2,420 505 Daily Maximum
Exceeded
6.4 12.29 92.0 Monthly Average
Exceeded
2 2.19 9.6 Monthly Average
Exceeded
10 11.3 13 Daily Maximum
Exceeded
2 3.93 96.3 Monthly Average
Exceeded
10 19.4 94 Daily Maximum
Exceeded
10 16.8 68 Daily Maximum
Exceeded
2 9.58 378.8 Monthly Average
Exceeded
2 2.66 33.2 Monthly Average
Exceeded
45 80.8 79.6 Daily Maximum
Exceeded
30 30.38 1.3 Monthly Average
Exceeded
45 52.5 16.7 Daily Maximum
Exceeded
Proceed to
Enforcement Case
Proceed to NOV
Proceed to NOV
Proceed to
Enforcement Case
Proceed to NOD
Proceed to NOD
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to NOV
Proceed to
Enforcement Case
Proceed to NOV
No Action, BPJ
No Action, BPJ

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 7 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720 FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Limit Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
11-2018 001 Effluent Solids, Total Suspended - 11/30/18 Weekly mg/I 30 33.95 13.2 Monthly Average No Action, BPJ
Concentration Exceeded
12-2018 001 Effluent Solids, Total Suspended - 12/28/18 Weekly mg/I 45 69.3 54 Daily Maximum Proceed to NOV
Concentration Exceeded
12-2018 001 Effluent Solids, Total Suspended - 12/31/18 Weekly mg/I 30 37.25 24.2 Monthly Average Proceed to NOV
Concentration Exceeded
01-2019 001 Effluent Solids, Total Suspended - 01/31/19 Weekly mg/I 30 31.3 4.3 Monthly Average Proceed to NOD
Concentration Exceeded
03-2019 001 Effluent Solids, Total Suspended - 03/08/19 Weekly mg/I 45 47 4.4 Daily Maximum Proceed to NOV
Concentration Exceeded
03-2019 001 Effluent Solids, Total Suspended - 03/29/19 Weekly mg/I 45 50.9 13.1 Daily Maximum Proceed to NOV
Concentration Exceeded
03-2019 001 Effluent Solids, Total Suspended - 03/31/19 Weekly mg/I 30 34.44 14.8 Monthly Average Proceed to NOV
Concentration Exceeded
06-2019 001 Effluent Solids, Total Suspended - 06/29/19 Weekly mg/I 45 48 6.7 Daily Maximum Proceed to NOV
Concentration Exceeded
12-2019 001 Effluent Solids, Total Suspended - 12/13/19 Weekly mg/I 45 63 40 Daily Maximum Proceed to NOV
Concentration Exceeded
12-2019 001 Effluent Solids, Total Suspended - 12/27/19 Weekly mg/I 45 45.4 0.9 Daily Maximum Proceed to NOV
Concentration Exceeded
12-2019 001 Effluent Solids, Total Suspended - 12/31/19 Weekly mg/I 30 34.85 16.2 Monthly Average Proceed to NOV
Concentration Exceeded
Monitoring Violation
MONITORING VIOLATION UNIT OF CALCULATED %
REPORT OUTFALL LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE Over VIOLATION TYPE VIOLATION ACTION
01-2018 001
01-2018 001
01-2018 001
Effluent
Effluent
Effluent
BOD, 5-Day (20 Deg. C) -
Concentration
BOD, 5-Day (20 Deg. C) -
Concentration
BOD, 5-Day (20 Deg. C) -
Concentration
01/06/18 Weekly
01/13/18 Weekly
01/20/18 Weekly
mg/I
mg/I
mg/I
Frequency Violation No Action, BPJ
Frequency Violation No Action, BPJ
Frequency Violation No Action, BPJ

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 8 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720 FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Monitoring Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
01 -2018 001 Effluent BOD, 5-Day (20 Deg. C) - 01/27/18 Weekly mg/I Frequency Violation No Action, BPJ
Concentration
02 - 2018 001 Effluent BOD, 5-Day (20 Deg. C) - 02/03/18 Weekly mg/I Frequency Violation No Action, BPJ
Concentration
02 - 2018 001 Effluent BOD, 5-Day (20 Deg. C) - 02/10/18 Weekly mg/I Frequency Violation No Action, BPJ
Concentration
01-2018 001 Effluent Chlorine, Total Residual 01/06/18 2 X week ug/I Frequency Violation No Action, BPJ
01-2018 001 Effluent Chlorine, Total Residual 01/13/18 2 X week ug/I Frequency Violation No Action, BPJ
01-2018 001 Effluent Chlorine, Total Residual 01/20/18 2 X week ug/I Frequency Violation No Action, BPJ
01-2018 001 Effluent Chlorine, Total Residual 01/27/18 2 X week ug/I Frequency Violation No Action, BPJ
02 - 2018 001 Effluent Chlorine, Total Residual 02/03/18 2 X week ug/I Frequency Violation No Action, BPJ
02 - 2018 001 Effluent Chlorine, Total Residual 02/10/18 2 X week ug/I Frequency Violation No Action, BPJ
01-2018 001 Effluent Coliform, Fecal MF, MFC 01/06/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
01-2018 001 Effluent Coliform, Fecal MF, MFC 01/13/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
01-2018 001 Effluent Coliform, Fecal MF, MFC 01/20/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
01-2018 001 Effluent Coliform, Fecal MF, MFC 01/27/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
02-2018 001 Effluent Coliform, Fecal MF, MFC 02/03/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
02 -2018 001 Effluent Coliform, Fecal MF, MFC 02/10/18 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
02-2021 001 Effluent Coliform, Fecal MF, MFC 02/20/21 Weekly #/100m1 Frequency Violation No Action, BPJ
Broth, 44.5 C
01 -2018 001 Effluent Flow, in conduit or thru 01/01/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 9 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720 FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Monitoring Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
01 -2018 001 Effluent Flow, in conduit or thru 01/02/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/03/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/04/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/05/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/06/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/07/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/08/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/09/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/10/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/11/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/12/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/13/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/14/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/15/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/16/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 10 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720 FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Monitoring Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
01 -2018 001 Effluent Flow, in conduit or thru 01/17/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/18/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/19/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/20/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/21/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/22/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/23/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/24/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/25/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/26/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/27/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/28/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/29/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/30/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant
01 -2018 001 Effluent Flow, in conduit or thru 01/31/18 Continuous mgd Frequency Violation No Action, BPJ
treatment plant

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 11 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region:
County: %
Violation Category:%
Subbasin:%
Program Category: %
Violation Action: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes
REGION: Winston-Salem
Monitoring Violation
MONITORING
REPORT OUTFALL
LOCATION
PARAMETER
VIOLATION UNIT OF
DATE FREQUENCY MEASURE
LIMIT
CALCULATED
VALUE
Over
VIOLATION TYPE VIOLATION ACTION
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
02 - 2018 001 Effluent
02 - 2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
01-2018 001 Effluent
02 - 2018 001 Effluent
02 - 2018 001 Effluent
04 - 2020 001 Effluent
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Nitrogen, Ammonia Total (as
N) - Concentration
Oxygen, Dissolved (DO)
Oxygen, Dissolved (DO)
Oxygen, Dissolved (DO)
Oxygen, Dissolved (DO)
pH
pH
pH
pH
pH
pH
pH
01/06/18 Weekly
01/13/18 Weekly
01/20/18 Weekly
01/27/18 Weekly
02/03/18 Weekly
02/10/18 Weekly
01/06/18 Weekly
01/13/18 Weekly
01/20/18 Weekly
01/27/18 Weekly
01/06/18 Weekly
01/13/18 Weekly
01/20/18 Weekly
01/27/18 Weekly
02/03/18 Weekly
02/10/18 Weekly
04/04/20 Weekly
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
su
su
su
su
su
su
su
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
Proceed to NOD

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 12 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022
Facility Name: % Param Nam( %
Major Minor: %
Region:
County: %
Violation Category:%
Subbasin:%
Program Category: %
Violation Action: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes
REGION: Winston-Salem
Monitoring Violation
MONITORING
REPORT OUTFALL
LOCATION
PARAMETER
VIOLATION UNIT OF
DATE FREQUENCY MEASURE
LIMIT
CALCULATED
VALUE
Over
VIOLATION TYPE
VIOLATION ACTION
01-2018 001
01-2018 001
01-2018 001
01-2018 001
02-2018 001
02-2018 001
01-2018 001
01-2018 001
01-2018 001
01-2018 001
02-2018 001
Reporting Violation
MONITORING
REPORT OUTFALL
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
Effluent
LOCATION
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Solids, Total Suspended -
Concentration
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
Temperature, Water Deg.
Centigrade
PARAMETER
01/06/18
01/13/18
01/20/18
01/27/18
02/03/18
02/10/18
01/06/18
01/13/18
01/20/18
01/27/18
02/03/18
Weekly
Weekly
Weekly
Weekly
Weekly
Weekly
5 X week
5 X week
5 X week
5 X week
5 X week
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
deg c
deg c
deg c
deg c
deg c
VIOLATION UNIT OF
FREQUENCY
DATE MEASURE
LIMIT
CALCULATED
VALUE
Over
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
Frequency Violation
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
No Action, BPJ
VIOLATION TYPE VIOLATION ACTION
06-2017
07-2017
08-2017
09-2017
07/31/17
08/31/17
10/01/17
10/31/17
Late/Missing DMR
Late/Missing DMR
Late/Missing DMR
Late/Missing DMR
Proceed to NOV
Proceed to NOV
No Action, BPJ
No Action, BPJ

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 06/16/22 Page 13 of 13
Permit: nc0057720 MRs Betweei 6 - 2017 and 6 - 2022 Region: % Violation Category:% Program Category: %
Facility Name: % Param Nam(% County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NC0057720
FACILITY: Jones Estates Hidden Lakes LLC - Hidden Lakes
Village Mobile Home Park WWTP
COUNTY: Stokes REGION: Winston-Salem
Reporting Violation
MONITORING UNIT OF
OUTFALL LOCATION PARAMETER VIOLATION FREQUENCY
REPORT DATE MEASURE
LIMIT
CALCULATED
VALUE Over
VIOLATION TYPE VIOLATION ACTION
10-2017 12/01/17 Late/Missing DMR No Action, BPJ
11 -2017 12/31/17 Late/Missing DMR No Action, BPJ
12-2017 01/31/18 Late/Missing DMR No Action, BPJ

Permit Enforcement History by Permit
Case
Permit:
Region:
NC0057720
Winston-Salem
Facility: Hidden Lakes Village Mobile Home Park WWTP
County: Stokes
Owner: Jones Estates Hidden Lakes LLC
Penalty Remission Enforcement EMC Collection Has
Assessment Penalty Enforcement Request Conference Hearing Memo Sent Payment Case
Approved Amount Costs Damages Received Held Held To AGO Total Paid Balance Due Plan Closed
RV-1993-0076 11/16/93
$250.00 $0.00 $0.00 11/23/93 02/02/94
$250.00
$0.00 No 02/17/94
LM-1998-0014 07/24/98 $3,500.00
$49.00 $0.00
04/15/99 $3,549.00 $0.00 No 05/11/01
LV-1998-0106 09/15/98 $1,000.00
$49.00 $0.00
03/29/01 $1,049.00 $0.00 No 07/15/02
LV-2000-0178 06/02/00 $1,000.00
$73.00 $0.00
03/29/01 $1,073.00 $0.00 No 07/15/02
LV-2003-0411 05/27/03
$100.00 $86.00
$186.00
$0.00 No 06/03/03
LV-2009-0458 12/28/09
$250.00 $110.20
$360.20
$0.00 No 01/20/10
LV-2010-0191 06/22/10
$100.00 $29.29
05/12/11 $129.29 $0.00 No 08/19/11
LV-2020-0081 02/18/20
$500.00 $108.53
$608.53 $0.00 No 03/06/20
LV-2020-0232 09/03/20
$200.00 $102.18
$302.18
$0.00 No 10/07/20
LV-2020-0351 12/08/20
$500.00 $94.99 01/06/21 04/01/21
$594.99 $0.00 No 05/05/21
LV-2021-0214 08/02/21
$200.00 $98.94
$298.94
$0.00 No 09/24/21
PC-2015-0040
$15,771.00 $464.42
$16,235.42 No
Total Cases: 12
$23,371.00
$1,265.55 $8,401.13 $16,235.42
Total Penalties: $24,636.55
Total Penalties after
$24,636.55

From:
To:
Cc:
Subject:
Date:
Attachments:
Kellen Buss
Chen, Siyinq
jmsouthern27Cagmail.com; Graznak, Jenny; Snider Lon; Weaver, Charles
[External] Re: NPDES Permit Issuance - Hidden Lakes Village Mobile Home Park WWTP NC0057720
Thursday, September 1, 2022 3:40:25 PM
NC0057720 Final Permit 20220901.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Received. Thank you
Kellen P. Buss (USAF, Ret.)
Director of Site Infrastructure
Mobile: [phone]
Email: [e-mail]
Stackhouse Management LLC/ Jones Estates LLC
2310 S. Miami Blvd, Suite 238
Durham, NC 27703
On Sep 1, 2022, at 3:36 PM, Chen, Siying <[e-mail]> wrote:
Hi Mr. Buss,
Attached is the final NPDES permit renewal for Hidden Lakes Village Mobile Home Park
WWTP (NC0057720). The permit will be effective on October 1, 2022.
Please respond to this email confirming that you received the attached document,
were able to open and view the document and have saved/printed a copy for your
records.

Thank you!
Siying (Sylvia) Chen (She/Her/Hers)
Environmental Specialist
Compliance and Expedited Permitting Unit
Division of Water Resources
North Carolina Department of Environmental Quality
Email: siying.chenPncdenr.gov
Phone: [phone] (Office)
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties

From:
To:
Cc:
Subject:
Date:
Kellen Buss
Chen, Siying
[e-mail]; Randy Bell
[External] Re: NPDES Permit Renewal - Electronic Distribution for NC0057720
Wednesday, August 31, 2022 1:33:23 PM
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Slying,
Electronic is fine. Thank you
Kellen P. Buss (USAF, Ret.)
Director of Site Infrastructure
Mobile: [phone]
Email: [e-mail]
Stackhouse Management LLC/ Jones Estates LLC
2310 S. Miami Blvd, Suite 238
Durham, NC 27703
On Aug 31, 2022, at 1:28 PM, Chen, Siying <[e-mail]> wrote:
Hi Mr. Buss,
My name is Siying and I'm the permit writer for your NPDES permit renewal for Hidden
Lakes Village Mobile Home Park WWTP (NC0057720).
In order to provide more convenience, control, and security to our permittees and
assist them in processing their transactions, The Division of Water Resources is

currently transitioning towards electronic correspondence. This will hopefully provide
more efficient service to our permittees and other partners and will allow us to more
effectively process and track documents. We are writing to ask you for your approval of
the transmittal of documents related to your permitting and related activities with the
Division in an electronic format. Documents will be emailed to the appropriate contact
person(s) in your organization in a PDF format.
Please respond to me through email with verification that transmittal of your
documents in an electronic manner is acceptable to you. If you have any questions,
please feel free to contact me.
Thank you!
Siying (Sylvia) Chen (She/Her/Hers)
Environmental Specialist
Compliance and Expedited Permitting Unit
Division of Water Resources
North Carolina Department of Environmental Quality
Email: siying.chenPncdenr.gov
Phone: [phone] (Office)
D_E Q
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
ram. �Fufi
al Emitana• kVal umlnr

ROY COOPER
Governor
ELIZABETH S. BISER
Secretory
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
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://dea.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
D_EQ�
Sincerely,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality. Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27105
336.776.9800

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
13 2022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Form
NPDES
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
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))
Facility Information
1.1
Facility name
JONES ESTATES HIDDEN LAKES LLC
Mailing address (street or P.O. box)
2310 S MIAMI BLVD #238
City or town
DURHAM
State
NC
ZIP code
27703
Contact name (first and last)
KELLEN BUSS
Title
DIRECTOR
Phone number
[phone]
Email address
[e-mail]
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
1020 Twin Lakes B Drive
City or town
KING
State
NC
ZIP code
27021
1.2
Is this application for a facility that has yet to commence
❑ Yes 4 See instructions on data submission
requirements for new dischargers.
discharge?
v No
Applicant Information
1.3
Is applicant different from entity listed under Item
❑ Yes
1.1 above?
Item 1.4.
✓ No 4 SKIP to
Applicant name
Applicant address (street or P.O. box)
City or town
State
ZIP code
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.)
❑ Operator ❑ Both
v Owner
1.5
To which entity should the NPDES permitting
❑ Facility
authority
send correspondence? (Check
only
one response.)
Facility and applicant
(they are one and the same)
■ Applicant
✓
Existing Environmental Permits
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
v NPDES
(discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
control)
water)
NC0057720
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
404)
❑ Other (specify)
Page 1

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Collection System and Population Served
1.7
Provide the collection system information requested below for the treatment works.
Municipality
Served
Population
Served
Collection System Type
(indicate percentage)
Ownership Status
no % separate sanitary sewer
0 Own El Maintain
40
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own ❑ Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
❑ Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
0 Unknown
0 Own 0 Maintain
separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
Total
Population
Served
40
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
°
Zoo '°
°
o �°
Indian Country
1.8
Is the treatment works located in Indian
❑ Yes
Country?
v
No
1.9
Does the facility discharge to a receiving
❑ Yes
water that flows through
v
Indian Country?
No
Design and Actual
Flow Rates
1.10
Provide design and actual flow rates
in the designated spaces.
Design Flow Rate
.04 mgd
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
mgd
.02 mgd
.02 mgd
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
mgd
mgd
mgd
Discharge Points
by Type
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points by Type
Treated Effluent
Untreated Effluent
Combined Sewer
Overflows
Bypasses
Constructed
Emergency
Overflows
Page 2

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods
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 v 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
Location
Average Daily Volume
Discharged to Surface
Impoundment
Continuous or Intermittent
(check one)
gpd
❑ Continuous
❑ Intermittent
gpd
❑ Continuous
❑ Intermittent
gpd
❑ Continuous
0 Intermittent
1.14
Is wastewater applied to land?
❑ Yes ✓
No 4 SKIP to Item 1.16.
1.15
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Location
Size
Average Daily Volume
Applied
Continuous or
Intermittent
(check one)
acres
gpd0
❑ Continuous
Intermittent
acresgpd
0 Continuous
0 Intermittent
acres
gpd
0 Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment
❑ Yes V
prior to discharge?
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 ❑ 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
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods Continued
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)
City or town
State '
ZIP code
Contact name (first and last)
Title
Phone number
Email address
NPDES number of receiving facility (if any) 0 None
Average daily flow rate mgd
1.21
Is the wastewater disposed of in a manner other than
not have outlets to waters of the State of North Carolina
❑ Yes ✓
those already mentioned in Items 1.14 through 1.21 that do
(e.g., underground percolation, underground injection)?
No 3 SKIP to Item 1.23.
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal
Method
Description
Location of
Disposal Site
Size of
Disposal Site
Annual Average
Daily Discharge
Volume
Continuous or Intermittent
(check one)
acresgpd
❑ Continuous
❑ Intermittent
acresgpd
❑ Continuous
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
Variance
Requests
1.23
Do
Consult
❑
✓
you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
Not applicable
Contractor Information
1.24
Are any operational or maintenance aspects (related to
the responsibility of a contractor?
❑ Yes ✓
wastewater treatment and effluent quality) of the treatment works
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
Contractor name
(company name)
Mailing address
(street or P.O. box)
City, state, and ZIP
code
9455 HELSABECK ROAD,
RURAL HALL, NC 27045
Contact name (first and
last)
JON SOUTHERN
Phone number
[phone]
Email address
[e-mail]
Operational and
maintenance
responsibilities of
contractor
OPERATOR ORC
Page 4

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
SECTION 2. ADDITIONAL INFORMATION
(40 CFR 122.21(j)(1) and
(2))
o
rn
o
Outfalls to Waters of the State of North Carolina
2.1
Does the treatment works have a design
❑ Yes
flow greater
than or equal to 0.1 mgd?
No 3 SKIP to Section 3.
v
Inflow and Infiltration
2.2
Provide the treatment works' current average daily volume of inflow
and infiltration.
Average Daily Volume of Inflow and Infiltration
gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Topographic
Map
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
specific requirements.)
❑ Yes ❑ No
Flow
Diagram
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
(See instructions for specific requirements.)
❑ Yes ❑ No
Scheduled Improvements and Schedules of Implementation
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1.
2.
3.
4.
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Scheduled
Improvement
(from above)
Affected
Outfalls
(list outf I
number
Begin
Construction
(MM/DD/YYYY)
End
Construction
(MM/DD/YYYY)
Begin
Discharge
(MM/DD/YYYY)
Attainment of
Operational
Level
(MM/DD/YYYY)
1.
2.
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
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
SECTION 3. INFORMATION
ON
EFFLUENT DISCHARGES (40 CFR
122.21(j)(3) to (5))
Description of Outfalls
3.1
Provide the fo lowing information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number o01
Outfall Number
Outfall Number
State
NORTH CAROLINA
County
TIMMONS CREEK
City or town
STOKES COUNTY
Distance from shore
ft.
ft.
ft.
Depth below surface
ft.
ft.
ft.
Average daily flow rate
mgd
mgd
mgd
Latitude
°
°
°
Longitude
""
° ..
° „
Seasonal or Periodic Discharge Data
3.2
Do any of the outfalls described
❑ Yes
under Item 3.1 have seasonal or
periodic
v
discharges?
No 4 SKIP to Item 3.4.
3.3
If so, provide the following information
for each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Number of times per year
discharge occurs
Average duration of each
discharge (specify units)
Average flow of each
discharge
mgd
mgd
mgd
Months in which discharge
occurs
Diffuser Type
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes
v
No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
Outfall Number
Outfall
Number
Outfall Number
Waters of
the U.S.
3.6
Does the treatment works discharge or plan to discharge wastewater
one or more discharge points?
❑ Yes
v
to waters of the State of North Carolina from
No +SKIP to Section 6.
Page 6

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Receiving Water Description
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,
or stream system
U.S. Soil Conservation
Service 14-digit watershed
code
Name of state
management/river basin
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
low flow
mg/L of
CaCO3
mg/L of
CaCO3
mg/L of
CaCO3
Treatment Description
3.8
Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
0 Primary
0 Equivalent to
secondary
❑ Secondary
❑ Advanced
❑ Other (specify)
0 Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
0 Primary
0 Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
Design Removal Rates by
Outfall
BOD5 or CBOD5
%
%
%
TSS
%
%
%
Phosphorus
0 Not applicable
%
0 Not applicable
%
0 Not applicable
%
Nitrogen
❑ Not applicable
%
0 Not applicable
0 Not applicable
Other (specify)
0 Not applicable
0 Not applicable
0 Not applicable
%
Page 7

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Treatment Description Continued
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.
Outfall Number
Outfall Number
Outfall Number
Disinfection type
Seasons used
Dechlorination used?
❑ Not applicable
❑ Yes
❑ No
❑ Not applicable
❑ Yes
❑ No
❑ Not applicable
❑ Yes
❑ No
Effluent Testing Data
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ 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
Number of tests of discharge
water
Number of tests of receiving
water
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
3.18
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
Effluent Testing Data Continued
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?
❑ 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?
❑ Yes ❑ No 4 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
(MMIDDIYYYY)
Summary of Results
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.
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 results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES permittin• authorit .
Page 9

NPDES Permit Number
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
SECTION
6. CHECKLIST
6.1
AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
Checklist and Certification Statement
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
at applicants are required to provide attachments.
Column 1
Column 2
❑ wl variance request(s)
Section 1: Basic Application
vInformation
wl additional attachments
for All Applicants
❑ Section 2: Additional
Information
❑ w/ topographic map ❑ w/ process flow diagram
❑ w/ additional attachments
❑ Section 3: Information on
Effluent Discharges
❑ w/ Table A ❑ w/ Table D
❑ w/ Table B ❑ w/ additional attachments
❑ w/ Table C
Section 4: Not Applicable
Section 5: Not Applicable
❑ Section 6: Checklist and
Certification Statement
❑ w/ attachments
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)
ASHLEIGH A DAVIS
Official title
MANAGER OF SITE INFRASTRUCTURE
Signature
f/0 n
(.) AO
Date signed
06/08/2022
Page 10

NPDES Permit Number
Facility Name
Duffel' Number
NC0057720
HIDDEN LAKES VILLAGE MHP
Modified Application Form 2A
Modified March 2021
TABLE A. EFFLUENT PARAMETERS FOR ALL POTWS
Discharge
Average Daily Discharge
Analytical
Methods
ML or MDL
(include
units)
Pollutant
Maximum Daily
Value
Units
Value
Units
Number of
Samples
Biochemical oxygen demand
o BOD5 or ❑ CBOD5
(report one)
33.0
mg/L
22.0
mg/L
WEEKLY
GRAB
o ML
mg/L ❑ MDL
Fecal coliform
400/100
ml
200/100
ml
WEEKLY
GRAB
o ML
❑ MDL
Design flow rate
pH (minimum)
>_6.0
pH (maximum)
s 9.0
Temperature (winter)
MONITOR & REPOR1
Temperature (summer)
MONITOR & REPOR1
Total suspended solids (TSS)
45.0
mg/L
30.0
mg/L
WEEKLY
GRAB
El ML
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
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE B. EFFLUENT PARAMETERS
FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER
THAN 0.1 MGD
Daily Discharge
Analytical
Methods
ML or MDL
(include
units)
Pollutant
Maximum Daily Discharge
Average
Value
Units
Value
Units
Number of
Samples
Ammonia (as N)
see attached paramE
❑ ML
0 MDL
Chlorincl
e
(total residual, TRC)2
28
µg/L
2/week
GRAB
ML
µg/L ❑MDL
Dissolved oxygen
daily avg 26.0
mg/L
daily avg z6.0
mg/L
WEEKLY
GRAB
o ML
mg/L ❑ MDL
Nitrate/nitrite
see attached paramE
❑ ML
0 MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
❑ ML
❑ MDL
Phosphorus
❑ ML
❑ MDL
Total dissolved solids
0 ML
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
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0057720
FOR SELECTED POTWS
Facility Name
HIDDEN LAKES VILLAGE MHP
Outfall Number
Modified
Analytical
Method'
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Value
Units
Value
Units
Number of
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
0 MDL
Antimony, total recoverable
0 ML
0 MDL
Arsenic, total recoverable
0 ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
0 ML
0 MDL
Chromium, total recoverable
0 ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
0 ML
0 MDL
Mercury, total recoverable
0 ML
0 MDL
Nickel, total recoverable
0 ML
❑ MDL
Selenium, total recoverable
0 ML
0 MDL
Silver, total recoverable
0 ML
❑ MDL
Thallium, total recoverable
0 ML
0 MDL
Zinc, total recoverable
❑ ML
❑ MDL
Cyanide
0 ML
0 MDL
Total phenolic compounds
0 ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ ML
❑ MDL
Acrylonitrile
0 ML
0 MDL
Benzene
❑ ML
0 MDL
Bromoform
0 ML
0 MDL
EPA Form 3510-2A (Revised 3-19)
Page 13

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

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

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

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0057720
FOR SELECTED POTWS
HIDDEN
Facility Name
LAKES VILLAGE MHP
Outfall Number
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Value
Units
Value
Units
Number of
Samples
1,2-diphenylhydrazine
0 ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
❑ ML
❑ MDL
Hexachlorocyclo-pentadiene
III ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
0 ML
❑ MDL
Isophorone
0 ML
❑ MDL
Naphthalene
0 ML
❑ MDL
Nitrobenzene
❑ ML
❑ MDL
N-nitrosodi-n-propylamine
0 ML
❑ MDL
N-nitrosodimethylamine
0 ML
❑ MDL
N-nitrosodiphenylamine
0 ML
0 MDL
Phenanthrene
0 ML
❑ MDL
Pyrene
0 ML
❑ MDL
12,4-trichlorobenzene
❑ 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
NC0057720
Facility Name
HIDDEN LAKES VILLAGE MHP
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE D. ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING
AUTHORITY
Average Daily Dischar e
Analytical ML or MDL
Method1 (include units)
Pollutant
(list)
Maximum Daily Discharge
Value
Units Value
Units Number of
Samples
No additional sampling is required by NPDES permitting authority.
•
o ML
❑ MDL
0 ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
❑ ML
❑ MDL
0 ML
❑ MDL
❑ ML
❑ MDL
0 ML
❑ MDL
0 ML
0 MDL
❑ ML
0 MDL
0 ML
0 MDL
❑ ML
❑ MDL
❑ ML
0 MDL
❑ ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
0 ML
0 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 11 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
Parameter Cede
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample
Type
Sample
Location
Flow 50050
0.02 MGD
Continuous
Recording
Influent or
Effluent
BOD, 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 mgiL
Weekly
Grab
Effluent
Dissolved Oxygen 00300
Monitor & Report
Weekly
Grab
Upstream &
Downstream 2
Fecal Coliform
(geometric mean) 31616
200/100 ml
400/100 ml
Weekly
Grab
Effluent
Total Residual Chlorine (TRC) 50060
28141
2/Week
Grab
Effluent
Temperature (°C) 00010
Monitor & Report
Daily
Grab
Effluent
Temperature ('C) 00010
Monitor & Report
Weekly
Grab
Upstream &
Downstream 2
pH 00400
>- 6.0 and < 9.0 standard
units
Weekly
Grab
Effluent
*Summer: April 1 — 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 µel 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 µg/I.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN 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 t,' iron found at 50 feet) to a placed iron; thence South 10
degs. 13 min. 47 sec. West 126.65 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 degs. 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 41966 (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 #I 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

SCALE
;:.a,a10

Permit NC0057720
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision 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,
John Henry Oakley
is hereby authorized to discharge wastewater from a facility located at the
Hidden Lakes Village Mobile Home Park WWTP
NCSR 1966
King
Stokes County
to receiving waters designated as an unnamed tributary to Timmons Creek in subbasin 03-
02-01 of the Roanoke River Basin in accordance with effluent limitations, monitoring
requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective June 1, 2017.
This permit and authorization to discharge shall expire at midnight on February 28, 2022.
Signed this day May 15, 2017
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NC0057720
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.
John Henry Oakley
is hereby authorized to:
1. Continue to operate an existing 0.07 MGD wastewater treatment system that
includes the following components:
• Bar screen [aluminum]
• Extended aeration tank
• Two blowers for basin air, return sludge, and sludge wasting
• Dual final clarifiers
• Sludge holding tank
• Tablet chlorine disinfection (2 sets)
• Tablet dechlorination (2 sets)
• Stevens flow meter
The facility is located at the Hidden Lakes Mobile Home Park (NCSR 1966, King) in
Stokes County.
2. Discharge from said treatment works via outfall 001, at the location specified on
the attached map, into an unnamed tributary to Timmons Creek [Stream Index
22-25-2] which is currently classified C waters in subbasin 03-02-01 [HUC:
0301010302] of the Roanoke River Basin.
Page 2 of 6

Permit NC0057720
Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
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
Parameter Code
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample
Type
Sample
Location
Flow 50050
0.02 MGD
Continuous
RecordingInfluent
or
Effluent
BOD, 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 Ox
Oxygen 00300
yg
Monitor & Report
p
WeeklyGrab
Upstream &
Downstream 2
Fecal Coliform 31616
(geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
Effluent
Total Residual Chlorine 3 50060
28 pg/L
2/Week
Grab
Effluent
Temperature (°C) 00010
Monitor & Report
Daily
Grab
Effluent
Temperature (°C) 00010
Monitor & Report
Weekly
Grab
Upstream &
Downstream 2
pH 00400
> 6.0 and < 9.0 standard
- units
Weekly
Grab
Effluent
*Summer: April 1 - 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 µg/1 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 µg/1.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN
TRACE AMOUNTS.
Page 3 of 6

Permit NC0057720
A. (2) ELECTRONIC REPORTING OF MONITORING REPORTS
[NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge monitoring reports
(DMRs) and program. The final NPDES Electronic Reporting Rule was adopted and
became effective on December 21, 2015.
NOTE: This special condition supplements or supersedes the following sections within
Part II of this permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting Requirements [Supersedes Section D. (2.) and Section E. (5.) (a)1
The permittee shall report discharge monitoring data electronically using the NC DWR's
Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each
month and submitted electronically using eDMR. The eDMR system allows permitted
facilities to enter monitoring data and submit DMRs electronically using the internet.
Until such time that the state's eDMR application is compliant with EPA's Cross -Media
Electronic Reporting Regulation (CROMERR), permittees will be required to submit all
discharge monitoring data to the state electronically using eDMR and will be required to
complete the eDMR submission by printing, signing, and submitting one signed original
and a copy of the computer printed eDMR to the following address:
NC DEQ / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due
to the facility being physically located in an area where less than 10 percent of the
households have broadband access, then a temporary waiver from the NPDES electronic
reporting requirements may be granted and discharge monitoring data may be submitted
on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by the Director.
Duplicate signed copies shall be submitted to the mailing address above. See "How to
Request a Waiver from Electronic Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the month
following the issuance of the permit or in the case of a new facility, on the last day of the
month following the commencement of discharge.
Starting on December 21, 2020, the permittee must electronically report the following
compliance monitoring data and reports, when applicable:
• Sewer Overflow/Bypass Event Reports;
Page 4 of 6

Permit NC0057720
• Pretreatment Program Annual Reports; and
• Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to
Request a Waiver from Electronic Reporting" section below).
2. Electronic Submissions
In accordance with 40 CFR 122.41(1) (9), the permittee must identify the initial recipient
at the time of each electronic submission. The permittee should use the EPA's website
resources to identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated facilities means
the entity (EPA or the state authorized by EPA to implement the NPDES program) that is
the designated entity for receiving electronic NPDES data [see 40 CFR 127.2(b)].
EPA plans to establish a website that will also link to the appropriate electronic reporting
tool for each type of electronic submission and for each state. Instructions on how to
access and use the appropriate electronic reporting tool will be available as well.
Information on EPA's NPDES Electronic Reporting Rule is found at:
http: / /www2.epa.gov/ compliance/ final-national-pollutant-discharge-elimination-
system-npdes-electronic-reporting-rule.
Electronic submissions must start by the dates listed in the "Reporting Requirements"
section above.
3. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division. To
obtain an electronic reporting waiver, a permittee must first submit an electronic
reporting waiver request to the Division. Requests for temporary electronic reporting
waivers must be submitted in writing to the Division for written approval at least sixty
(60) days prior to the date the facility would be required under this permit to begin
submitting monitoring data and reports. The duration of a temporary waiver shall not
exceed 5 years and shall thereupon expire. At such time, monitoring data and reports
shall be submitted electronically to the Division unless the permittee re -applies for and is
granted a new temporary electronic reporting waiver by the Division. Approved electronic
reporting waivers are not transferrable. Only permittees with an approved reporting
waiver request may submit monitoring data and reports on paper to the Division for the
period that the approved reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are
found on the following web page:
http: / / deq.nc.gov/ about/ divisions/water-resources/ edmr
4. Signatory Requirements [Supplements Section B. (11.) (b) and Supersedes
Section B. (11.) (d)1
All eDMRs submitted to the permit issuing authority shall be signed by a person
described in Part II, Section B. (11.)(a) or by a duly authorized representative of that
person as described in Part II, Section B. (11.)(b). A person, and not a position, must be
delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an
eDMR user account and login credentials to access the eDMR system. For more
Page 5 of 6

Permit NC0057720
information on North Carolina's eDMR system, registering for eDMR and obtaining an
eDMR user account, please visit the following web page:
http: / / deq.nc.gov/ about/ divisions/water-resources / edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system
shall make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF
CERTIFICATION WILL BE ACCEPTED:
"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 fines and
imprisonment for knowing violations."
5. Records Retention [Supplements Section D. (6.)1
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR
submissions. These records or copies shall be maintained for a period of at least 3 years
from the date of the report. This period may be extended by request of the Director at
any time [40 CFR 122.41].
Page 6 of 6