NC0078271_Fact Sheet_20220818

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 Ex edited Permit Renewals
Permit Writer/Date
Charles H. Weaver — 8/18/2022
Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Educational Center
WWTP
Basin Name/Sub-basin number
Roanoke / 03-02-03
Receiving Stream
Carroll Creek
Stream Classification in Permit
C
Does permit need Daily Maximum NH3 limits?
No — already present
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No enforcements since 2007. One NOD, one
NOV during this permit cycle
Any permit mods since last permit?
No
New expiration date
4/30/2027
Changes in Draft Permit?
Updated eDMR requirements
Changes to final permit?
None
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".

Rockingham Now
Advertising Affidavit
1921 Vance Street
Reidsville, NC 27320
[phone] Fax: [phone]
NCDEQ-DIVISION OF WATER RESOURCES
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Account Number
4019534
Date
July 03, 2022
PO Number Order
Category
Description
0000790518
Public Notice
North Carolina Environmental Man-
agement Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES
Wastewater Permit NC0078271
Besty Jeff Penn 4H Education The
North Carolina Environmental Man-
agement Commission proposes to is-
sue a NPDES wastewater discharge
permit to the person(s) listed below.
Written comments regarding 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 hearing should
there be a significant degree of pub-
lic interest. Please mail comments
and/or information requests to DWR
at the above address. Interested per-
sons may visit the DWR at 512 N.
Salisbury Street, Raleigh, NC 27604
to review information on file. Addi-
tional information on NPDES permits
and this notice may be found on our
website: http://deq.nc.gov/about/di
visions/water-resources/water-
resou rces-perm its/wastewater-
b ranch/npdes-wastewater/pu bl ic-
notices,or by calling [phone].
NC State University has requested
renewal of NPDES permit
NC0078271 for the Betsy -Jeff Penn
4-H Educational Center WWTP (804
Cedar Lane, Reidsville, NC 27320) in
Rockingham County. This permitted
facility discharges treated domestic
wastewater into Carroll Creek in the
Roanoke River Basin. Currently am-
monia nitrogen and fecal coliform
are water quality limited. This dis-
charge may affect future allocations
in this portion of the basin.
Legal Notices
Public Notice North Carolina Environmental Management Commission/NPDES Unit 1617 Mail
Publisher of the
Rockingham Now
Before the undersigned, a Notary Public duly commissioned, qualified, and authorized by
law to administer oaths, personally appeared the Publisher's Representative who by being
duly sworn deposes and says: that he/she is authorized to make this affidavit and sworn
statement; that the notice or other legal advertisement, a copy of which is attached hereto,
was published in the Rockingham Now on the following dates:
07/03/2022
and that the said newspaper in which such notice, paper document, or legal advertisement
was published, was at the time of each and every such publication, a newspaper meeting all
the requirements and qualifications of Section 1-597 of tl3e General Statutes of North
Carolina.
Sworn to and subscribed before me the 3rd cjay of July, 202 .
State of Virginia
County of Hanover
My commission expires:
Billing Representative
(Notary P
Kimberly Kay Harris
NOTARY PUBLIC
Gnmmonwealth of Virginia
Reg. No. 356753
Commission Exp. Jan. 31, 2025
blic)
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
NC State University
Attn: Jeffery Johnson, Maintenance Supervisor
804 Cedar Lane
Reidsville, NC 27320
Subject: Permit Renewal
Application No. NC0078271
Betsy Jeff Penn 4H Education
Rockingham County
NORTH CAROLINA
Environmental Quality
January 14, 2022
Dear Applicant:
The Water Quality Permitting Section acknowledges the January 12, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely, jQ
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes Mill Road, Suite 300 1 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
A N 12 2022
NCDEQIDWRINPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
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 ma result in denial of the application.
Facility Information
N 1. BASIC
1.1
APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9))
Facility name
Betsy -Jeff Penn 4-H Educational Center
Mailing address (street or P.O. box)
804 Cedar Lane
City or town
Reidsville
State
NC
ZIP code
27320
Contact name (first and last)
Jeffery Johnson
Title
Maintenance Supervisor
Phone number
336-349-9445
Email address
[e-mail]
Location address (street, route number, or other specific identifier)
FA
Same as mailing
address
City or town
State
ZIP code
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
Applicant Information
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
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.)
❑ Owner ❑ Operator ❑ Both
1.5
To
►I
which entity should the NPDES permitting authority send correspondence? (Check only one response.)
Facility ❑ Applicant ❑ Facility and applicant
(they are one and the same)
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
►4
NPDES (discharges to surface
water)
NC0078271
❑ RCRA (hazardous waste)
❑ UIC (underground injection
control)
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
404)
❑ Other (specify)
Page 1

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
Modified Application Fomi 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
100 % separate sanitary sewer
la Own ❑ Maintain
Betsy Jeff
Penn 4-H
AVG. 175
% combined storm and sanitary sewer
0 Own 0 Maintain
C:antar ICI
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
separate sanitary sewer
0 Own 0 Maintain
combined storm and sanitary sewer
❑ Own 0 Maintain
❑ 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
175
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
100 %
°/°
Indian Country
1.8
Is the treatment works located in Indian
❑ Yes
Country?
❑ No
1.9
Does the facility discharge to a receiving
❑ Yes
water that flows through Indian Country?
❑ No
Design and Actual
Flow Rates
1.10
Provide design and actual flow rates
in the designated spaces.
Design Flow Rate
0.0131 mgd
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
0.0031 mgd
0.0013 mgd
.0028 mgd
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
0.0078 mgd
0.0071 mgd
0.018 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
1
0
0
0
0
Page 2

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
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 ❑ 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
0 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
gp d
❑ Continuous
❑ Intermittent
acres
d
gip'
❑ Continuous
❑ Intermittent
acres
gp d
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
❑ Yes ❑ No 4 SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant?
❑ 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
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
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 those a
not have outlets to waters of the State of North Carolina (e.g.,
❑ Yes ❑ No
ready mentioned in Items 1.14 through 1.21 that do
underground percolation, underground injection)?
4 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
acres
gpd
❑ Continuous
❑ Intermittent
acresgpd
❑ Continuous
❑ Intermittent
Variance
Requests
1.23
Do
Consult
❑
►4
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 wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
❑ Yes ❑ 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
Contact name (first and
last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
Page 4

SECTIIN
rn2.1
o
2. ADDITIONAL INFORMATION
Outfalls to Waters of
NPDES Permit Number Facility Name
NC0078271 Betsy -Jeff Penn 4-H Center
(40 CFR 122.21(j)(1) and (2))
the State of North Carolina
Modified Application Form 2A
Modified March 2021
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑ Yes ❑ No 4 SKIP to Section 3.
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
(See instructions for specific requirements.)
❑ Yes
or schematic to this
application that contains all the required information?
• 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 outfall
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
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
Modified Application Form 2A
Modified March 2021
SECTION
3. INFORMATION
ON
EFFLUENT DISCHARGES (40 CFR
122.21(j)(3) to (5))
co
o
0
c
s
Q
-L
d
0
3.1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 1
Outfall Number
Outfall Number
State
North Carolina
County
Rockingham
City or town
Wentworth
Distance from shore
2 ft.
ft.
ft.
Depth below surface
0 ft.
ft.
ft.
Average daily flow rate
.0021 mgd
mgd
mgd
Latitude
36' 23 35' N0
° II
Longitude
7g 42 15' W
'"
PI
Seasonal or Periodic Discharge Data
3.2
Do any of the outfalls described
❑ Yes
under Item 3.1 have seasonal or periodic 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 ❑ 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
one
►/
the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
or more discharge points?
Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
Modified Application Foram 2A
Modified March 2021
Receiving Water Description
3.7
Provide the receiving water and related information (if known) for each outfall.
Outfall
Number 1
Outfall Number
Outfall Number
Receiving water name
Carroll Creek
Name of watershed, river,
or stream system
Roanoke river
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 1
Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
m
0
❑
❑
❑
Primary
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
80 %
TSS
80 %
%
%
Phosphorus
I Not applicable
0 Not applicable
0 Not applicable
Nitrogen
0 Not applicable
65 %
0 Not applicable
%
0 Not applicable
%
Other (specify)
0 Not applicable
ok
0 Not applicable
%
0 Not applicable
Page 7

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
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.
We use a Trojan UV2000 Ultraviolet disinfection system
Outfall Number
1
Outfall Number
Outfall Number
Disinfection type
Ultraviolet
Seasons used
4
Dechlorination used?
14
Not applicable
❑ Not applicable
❑ Not applicable
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
Effluent Testing Data
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
►I 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?
►1 Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
❑ Yes ❑ No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
Modified Application Fomi 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
(MMIDDNYYY)
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 .ermittin. authorit .
Page 9

NPDES Permit Number
NC0078271
SECTION 6. CHECKLIST AND CERTIFICATION STATEMENT (40
Facility Name
Betsy -Jeff Penn 4-H Center
CFR 122.22(a) and (d))
Modified Application Form ZA
Modified March 2021
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section 1: Basic Application
Information for All Applicants
•
w/ variance request(s) ❑ wi additional attachments
III
Section 2: Additional
Information
•
❑
w/ topographic map ❑ w/ process flow diagram
wl additional attachments
m
Section 3: Information on
❑ Effluent Discharges
❑ w/ Table A • w/ Table D
❑ w/ Table B ❑ w/ additional attachments
❑ w/ Table C
m
is
'ii
c
0
Section 4: Not Applicable
:~
r
m
Section 5: Not Applicable
-0
=
Section 6: Checklist and
❑ Certification Statement
❑ w/ attachments
0
o
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. lam 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)
Jeffery Johnson
Official title
Maintenance Supervisior
Signs r
E% .`� !
//
Date signed
01/12/2022
Page 10

NPDES Permit Number
Facility Name
0utfall Number
NC0078271
Betsy -Jeff Penn 4-H Center
Modred Application Form 2A
Modified March 2021
TABLE
A. EFFLUENT PARAMETERS FOR ALL POTWS
Discharge
Average Daily Discharge
Analytical
Method1
ML or MDL
(include units)
Pollutant
Maximum Daily
Value
Units
Value
Units
Number of
Sam . Ies
Biochemical oxygen demand
0 BOD5 or o CBOD5
re.ort one
5.0
mg/I
30.0
mg/I
2/month
SM 5210B-2016
0 ML
mg/I IM MDL
Fecal coliform
00/100
ml
00/100
ml
2/month
Colilert-18
55 ML
MPN/100 ❑MDL
Design flow rate
'.0131
MGD
MGD
Weekly
pH (minimum)
>6.0
standard
pH (maximum)
<9.0
standard
Temperature (winter)
eekly
Temperature (summer)
eekly
Total suspended solids (TSS)
45.0
mg/I
c0.0
mg/I
2/month
SM 2540D-2015
ID ML
mg/I Pi 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
TABLE B. EFFLUENT PARAMETERS
NPDES Permit Number
NC0078271
FOR ALL POTWS WITH A FLOW
Betsy
EQUAL
Facility Name
-Jeff Penn 4-H Center
TO OR GREATER THAN
0utfall Number
0.1 MGD
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
Ammonia (as N)
35.0
mg/I
12.0
mg/I
2/month
EPA 350.1
0 ML
mg/I m MDL
Chlorine
(total residual, TRC)2
❑ ML
❑ MDL
Dissolved oxygen
❑ ML
D MDL
Nitrate/nitrite
0 ML
❑ MDL
Kjeldahl nitrogen
❑ ML
❑ MDL
Oil and grease
0 ML
0 MDL
Phosphorus
0 ML
❑ MDL
Total dissolved solids
0 ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
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
NC0078271
FOR SELECTED POTWS
Maximum Daily Discharge
Betsy
Facility Name
-Jeff Penn 4-H Center
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
Metals, Cyanide, and Total Phenols
Hardness (as CaCO3)
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑ MDL
Arsenic, total recoverable
❑ ML
❑ MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
❑ ML
❑ MDL
Copper, total recoverable
❑ ML
❑ MDL
Lead, total recoverable
❑ ML
❑ MDL
Mercury, total recoverable
❑ ML
❑ MDL
Nickel, total recoverable
❑ ML
❑ MDL
Selenium, total recoverable
❑ ML
❑ MDL
Silver, total recoverable
❑ ML
❑ MDL
Thallium, total recoverable
❑ ML
❑ MDL
Zinc, total recoverable
❑ ML
❑ MDL
Cyanide
❑ ML
❑ MDL
Total phenolic compounds
❑ ML
❑ MDL
Volatile
Organic Compounds
Acrolein
o ML
❑ MDL
Acrylonitrile
❑ ML
❑ MDL
Benzene
❑ ML
❑ MDL
Bromoform
❑ ML
❑ MDL
EPA Fomi 3510-2A (Revised 3-19)
Page 13

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0078271
FOR SELECTED POTWS
Betsy
Facility Name
-Jeff Penn 4-H Center
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
❑ ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl ether
0 ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
0 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
❑ MDL
Ethylbenzene
0 ML
❑ MDL
Methyl bromide
O ML
❑ MDL
Methyl chloride
0 ML
❑ MDL
Methylene chloride
0 ML
❑ MDL
1,1,2,2-tetrachloroethane
0 ML
❑ MDL
Tetrachloroethylene
0 ML
0 MDL
Toluene
ID 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
NC0078271
FOR SELECTED POTWS
Betsy
Facility Name
-Jeff Penn 4-H Center
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
o ML
0 MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethylphenol
❑ ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
0 MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
0 MDL
Pentachlorophenol
❑ ML
0 MDL
Phenol
❑ ML
0 MDL
2,4,6-trichlorophenol
❑ ML
0 MDL
Base -Neutral Compounds
Acenaphthene
❑ ML
0 MDL
Acenaphthylene
❑ ML
❑ MDL
Anthracene
ID ML
❑ MDL
Benzidine
❑ ML
0 MDL
Benzo(a)anthracene
❑ ML
0 MDL
Benzo(a)pyrene
❑ ML
0 MDL
3,4-benzofluoranthene
ID ML
0 MDL
EPA Form 3510-2A (Revised 3-19)
Page 15

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
Pollutant
NPDES Permit Number
NC0078271
FOR SELECTED POTWS
Maximum Daily Discharge
Betsy
Facility Name
-Jeff Penn 4-H Center
Average
Outfall Number
Daily Discharge
Modified
Analytical
Methods
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
Benzo(ghi)perylene
0 ML
❑ MDL
Benzo(k)fluoranthene
0 ML
❑ MDL
Bis (2-chloroethoxy) methane
0 ML
❑ MDL
Bis (2-chloroethyl) ether
0 ML
❑ MDL
Bis (2-chloroisopropyl) ether
0 ML
❑ MDL
Bis (2-ethylhexyl) phthalate
0 ML
❑ MDL
4-bromophenyl phenyl ether
0 ML
❑ MDL
Butyl benzyl phthalate
0 ML
❑ MDL
2-chloronaphthalene
0 ML
❑ MDL
4-chlorophenyl phenyl ether
0 ML
0 MDL
Chrysene
0 ML
❑ 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
❑ ML
❑ MDL
1,4-dichlorobenzene
0 ML
❑ MDL
3,3-dichlorobenzidine
❑ ML
❑ MDL
Diethyl phthalate
0 ML
❑ MDL
Dimethyl phthalate
0 ML
❑ MDL
2,4-dinitrotoluene
❑ ML
❑ MDL
2,6-dinitrotoluene
❑ ML
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 16

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0078271
FOR SELECTED POTWS
Maximum Daily Discharge
Betsy
Facility Name
-Jeff Penn 4-H Center
Average
Outfall Number
Daily Discharge
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Pollutant
Value
Units
Value
Units
Number of
Samples
1,2-diphenylhydrazine
❑ ML
❑ MDL
Fluoranthene
o ML
❑ MDL
Fluorene
o ML
0 MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
o ML
❑ MDL
Hexachlorocyclo-pentadiene
ID ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
❑ ML
0 MDL
lsophorone
❑ ML
0 MDL
Naphthalene
❑ ML
0 MDL
Nitrobenzene
❑ ML
0 MDL
N-nitrosodi-n-propylamine
❑ ML
❑ MDL
N-nitrosodimethylamine
❑ ML
0 MDL
N-nitrosodiphenylamine
❑ ML
❑ MDL
Phenanthrene
❑ ML
❑ MDL
Pyrene
❑ ML
❑ MDL
1,2,4-trichlorobenzene
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).
EPA Form 3510-2A (Revised 3-19)
Page 17

NPDES Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Center
Outfall Number
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
TABLE D. ADDITIONAL POLLUTANTS
AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar. e
Pollutant
(list)
Value
Units Value
Units
Number of
Samples
•
No additional sampling is required by NPDES permitting authority.
❑ ML
❑ MDL
0 ML
❑ MDL
0 ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
❑ ML
❑ MDL
0 ML
0 MDL
0 ML
❑ MDL
0 ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
❑ ML
0 MDL
0 ML
0 MDL
❑ ML
0 MDL
0 ML
❑ MDL
❑ ML
0 MDL
❑ ML
❑ MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18

ROY COOPER
Governor
Water Resources
ENVIRONMENTAL QUALITY
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
May 15, 2017
Mr. Jeffery Johnson
Betsy -Jeff Penn 4H Educational Center
804 Cedar Lane
Reidsville, NC 27320
Subject: Issuance of NPDES Permit NC0078271
Betsy -Jeff Penn 4H Educational Center
Rockingham County
Class WW-1
Dear Mr. Johnson:
Director
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
This final permit includes no major changes from the draft permit sent to you on March 8,
2017.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles H. Weaver at telephone number (919)
807-6391.
S. Jay Zimmermanr'G.
Director, Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES files
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-per[nits/wastewater-branch/npdes-wastewater-permits

Permit NC0078271
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMJT
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,
North Carolina State University
is hereby authorized to discharge wastewater from a facility located at the
Betsy Jeff Penn 4-H Educational Center WWTP
804 Cedar Lane
Reidsville
Rockingham County
to receiving waters designated as Carroll Creek in subbasin 03-02-03 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 April 30, 2022.
Signed this day May 15, 2017
Stf Zimmerman, P G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 5

Permit NC0078271
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked.
As of this permit 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.
North Carolina State University is hereby authorized to:
1. Continue to operate a 0.0131 MGD wastewater treatment facility that includes the
following components:
• • 13,000-gallon septic tank
• Filter chamber with two PL-525 filters
• Two 8100-gallon recirculation tanks in series
• 8100-gallon dosing tank
• E-Z Treat System with three pod zones
• 1350-gallon discharge tank with fitter sock
• Ultraviolet disinfection
2. Discharge from said treatment works at the location specified on the attached map into
Carroll Creek, currently classified C waters in hydrologic unit 03010103 of the Roanoke
River Basin.
Page 2 of 5

Permit NC0078271
Part I
A. (1) EFFLUENT LIMITATIONS AND,MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 02B.0500 et seq.]
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is
authorized to discharge from outfall 001. Such discharges shall be limited and monitored' by the Permittee as
specified below
PARAMETER
[PCS Code]
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location
Flow
[50050]
0.0131 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5-day (20°C)
[00310j
30.0 mg/L
45.0 mg/L
Month
Grab
Effluent
Total Suspended Solids
[00530]
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NH3 as N (April 1—October 31)
[00610]
12.0 mg/L
35.0 mg/L
2/Month
Grab
Effluent
NH3 as N (November 1— March 31)
(00610]
2/Month
Grab
Effluent
Fecal Coliform (geometric mean)
j31616]
200 / 100 ml
400 / 100 ml
2/Month
Grab
Effluent
Temperature (°C)
[00010j
Weekly
Grab
Effluent
pH
[00400]
> 6.0 and < 9.0 standard units
2/Month
Grab
Effluent
I
1. The permittee shall submit discharge monitoring reports electronically using the Division's eDMR system [see A.
(2)].
There shall be no discharge of floating, solids or visible foam in other than trace amounts.
A. (5) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
[NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program reports. The
final NPDFS Electronic Reporting Rule was adopted and became effective on December 21, 2015.
NOTE: This special condition supplements or supersedes the following sections within Part 11 of this permit
(Standard Conditions for NPDES Permits):
1.
• Section B. (11)
• Section D. (2)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
Reporting Requirements [Supersedes Section D. (2.) and Section E. (5.)(a)I
The permittee shall report discharge monitoring data electronically using the NC DWR's Electronic Discharge
Monitoring Report (eDMR) internet application.
Page 3 of 5

Permit NC0078271
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 internee. Until such time that the state's eDMR application is compliant with
EPA's Cross -Media Electronic Reporting Regulation (CROIVIERR), 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 DENR / 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;
• Pretreatment Program Annual Reports; and
• Clean Water Act (C'WA) 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/ fin al-na tional-p ollutan t-discharge-elimination-sv stem-npdes-electronic-
reporting-rule.
Electronic submissions must start by the dates listed in the "Reporting Requirements" section above.
Page 4 of 5

Permit NC0078271
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 permit -tee 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)]
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 information on North Carolina's eDMR system,
registering for eDMR and obtaining an eDMR user account, please visit the following web page:
http: %;`dey.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 STA I MENTS OF CERTIFICATION WILL BE ACCEPTED:
"I cert, under penalty of law, that this document and all attachments were prepared under my direction orsupervirion in accordance
with a system designed to assure that qualified properly gather and evaluate the information submitted Based on my inquiry
of the person orpersons who manage the system, or those persons directly responsible forgathering 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 possibiliDI of fines and imprisonment for knowing violations. "
5. Records Retention [Supplements Section D. (6.)]
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 5 of 5

USGS Quad: Southeast Eden, N.C.
Latitude: 36° 23' 35"
Longitude: 79* 42' 18"
Stream Class: C
River Basin: Roanoke
Subbasin: 03-02-03
Receiving Stream: Carroll Creek
4 r j
1 -.:
„ ..1 tZ u
NC0078271
Betsy -Jeff Penn 4-H
Educational Center WWTP

Reidsville Review
. Advertising Affidavit
NCDEQ-DIVISION OF WATER RESOURCES
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Public Notice
North Carolina Environmental
Management Commrosuuni
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES
Wastewater Permit
The North Carolina Environmental
Management Commission proposes
to issue a NPDES wastewater dis-
charge permit to the person(s) listed
below. Written comments regarding
the proposed permit will be accept-
ed until 30 days after the publish
date of this notice. The Director of
the NC Division of Water Resources
(DWR) may hold a public hearing
should there be a significant degree
of public interest. Please mail com-
ments 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. Addi-
tional information on NPDES permits
and this notice may be found on our
website: http://deq.nc.gov/about/di
visions/water-resources/water-
resources-permits/wastewater-
branch/npdes-wastewater/pubiic-
notices,or by calling [phone].
Sterling A. Weaver requested renew-
al of NPDES permit
NC0060623/Stone Highway Mobile
Home Park WWTP/Rockingham
County. Facility discharges to an un-
named tributary to Buffalo
Creek/Roanoke River Basin. Cur-
rently, BOD, ammonia -nitrogen, dis-
solved oxygen, fecal coliform, and
total residual chlorine are water
quality limited.
Fred D. Curl requested renewal of
permit NC0077135/Hidden Valley Es-
tates WWTP/Rockingham County.
Facility discharges to an unnamed
tributary to Lick Fork
Creek/Roanoke River Basin. Cur-
rently, dissolved oxygen, ammonia
nitrogen, and fecal coliform are wa-
ter quality limited.
N ' c' anevr ' of permit
NCO'; ' 71/Betsy-Jeff :' -n; i 4-H Ed-
ucatior I Ce teq :iagham Coun-
•r disi.i,.iges into Carroll
Creek/r;oano,e Myer Basin. Cur-
rent'', -,mmon' , rugen and fecal
are w...er quality limited.
1921 Vance Street
Reidsville, NC 27320
[phone] Fax: [phone]
Account Number
4019534
Date
March 12, 2017
Category
Description
1123 Legal Notices Public Notice North Carolina Environmental Management Commission/ NPDES Unit 1617 M&
Publisher of the
Reidsville Review
Before the undersigned, a Notary Public of Guilford, North Carolina, duly commissioned,
qualified, and authorized by law to administer oaths, personally appeared the Publisher
Representative who by being duly sworn deposes and says: that he/she is the Publisher's
Representative of the Reidsville Review, engaged in the publishing of a newspaper known
as Reidsville Review, published, issued and entered as second class mail in the City of
Reidsville, 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 copy of which is attached
hereto, was published in the Reidsville Review on the following dates:
03/12/2017
and that the said newspaper in which such notice, paper document, or legal advertisement
was published was, at the time of each and every such publication, a newspaper meeting all
the requirements and qualifications of Section 1-597 of the General Statutes of North
Carolina and was a qualified newspaper within the meaning of Section 1-597 of the General
Statutes of North Carolina.
Pt
signature of person mg affidavit)
Sworn to and subscribed before me the 12 day of March, 2017
LEA ANNE LAMB
NOTARY PUBLIC
STATE OF NORTH CAROLINA
GUILFORD COUNTY
MY COMMISSION EXPIRES 06-15-19
(Notary Public)
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

Weaver, Charles
From: Smith, George
Sent: Monday, March 06, 2017 2:45 PM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NC0078271
Recommend the permit be reissued.
No comments.
George Smith, Assistant Regional Supervisor
email: [e-mail]
Division of Water Resources
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Direct phone: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Weaver, Charles
Sent: Monday, March 06, 2017 2:28 PM
To: Smith, George <[e-mail]>; Kinney, Maureen <[e-mail]>
Subject: DRAFT permit renewal for NC0078271
Importance: High
This is a class WW-1 facility in Rockingham County.
Send me any comments by April 7th.
Charles H. Weaver
Environmental Specialist
N.C. Division of Water Resources
N.C. Department of Environmental Quality
919-807-6391
charles.„,, . rAncdenr.gov
(physical address) 512 North Salisbury Street, Raleigh, NC 27604
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617
="-" Nothing Compares
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties.
1

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
Charles H. Weaver — 3/6/2017
Permit Number
NC0078271
Facility Name
Betsy -Jeff Penn 4-H Educational Center
WWTP
Basin Name/Sub-basin number
Roanoke / 03-02-03
Receiving Stream
Carroll Creek
Stream Classification in Permit
C
Does permit need Daily Maximum NH3 limits?
No — already present
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No
Any permit mods since last permit?
No
New expiration date
4/30/2017
Comments on Draft Permit?
Added eDMR requirements
Added regulatory citations
Most Commonly Used Expedited Language:
• 303(d1 Ianguate for Draft/Final Cover Letters: "Please note that Cane Creek is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters. List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".

•
804 Cedar Lane-• 'Reidsville, N.C. 27320 • [phone] • FAX-(336) 634 110
•
Wren_Thedford
c DENRI D WR J PDES Linit
1617 Mail Service Center .
Raleigh,NC 27699-1617
DE WR. .
RE: 'Permit # -NCi 78271 JAN 10 2017
water Q
61-04-17 _ Permitting Section
. To Whom It May Concert
.We are requesting renewal of the permit..
There have. been no changes since_ our last renewal.
Please find enclosed Application Form D:
Thank You's-
ery.io nson
.Facilities Maintenance Supervisor
Betsy -Jeff Penn.4-H Educational.Center.
:804 Cedartane Reidsville, IBC 27320
Cooperative Exte psion' Service, N rth Carolina State Uri ity, College of Agriculture and Life Sciences

*sham Descrkotiort
Perm 441 Educational Center
NPDES PERMIT No. NC 0078271
The influent enters the plant at a 13,000 gallon septic tank were most of the solids settle out.
From there it passes through a baffle wall into a falter chamber, there are two Polylok PL 525
effluent filters in the chamber. From there it flows into the first of two 8100 gallon
septic/redreulatlon tanks. Each tank has a pair of Polylok PL-525 effluent filters. After exiting
the second 8100 gallon Septic/recirculation tank it flows into a 8100 gallon filter dosing pump
tank. Up to this point every thing has been gravity feed.
The dossing pump tank has 3 sets of submersible duplex turbine pumps rated @ 52 gallons per
minute. Each set of pumps operates a zone of E-Z treat Pods, and each set is controlled by a
float level switches and a timer that controls the dossing time for each E-Z treat pod: The
pumps in each set alternate after each cyde of 4 minutes on 2 minutes off. There is a low limit
float that shuts off the pumps in case of low level conditions, and high level float that sets off
the alarm and flashing lights at the control panel.
The E-Z treat pods are 7feet 9inch square and 34 in deep, they contain a lightweight, non -
biodegradable synthetic sphere in three different diameters encapsulated in a mattress 7 J6 feet
square by 2 feet thick. Each pod has a spray manifold system containing 12 - .0625 diameter
brass nozzles that maintains a consistent misting spray. The effluent flows through the mattress
coming In contact with the media as it exits the mattress. It flows through 7 large 4 inch under
drains, and then flows to the redreulation tank to start the cyde over again.
There are three zones of pods. Zone one and two have eight, E-Z treat treatment pods, and
zone three has four E-Z treat treatment pods. _2/3 of the influent from each zone is returned to
the first septic/redreulation tank were it returns through the system again. The other 3rd is
sent back to the pump tank through a cross over ball float valve at which time it returns to the
pump tank for recirculation through the system. When the effluent level in the pump tank
reaches an elevation of 671.07 the ball valve doses and the effluent is sent to the discharge
tank.
The control panel contains three set of Ohio Electric electronic panels. This is a 120/240 volt
200 amp system with a heavy duty transfer switch for back up generation. There is a 15000
watt Guardian Ultra Source generator on site for emergency stand by. This is all protected by a
weather proof shelter.

The discharge tank is a1350 gallon tank with one 60 gallon per minute pump controlled by a
float switch and timer. This tank also has a high level float that if activated W I set off a alarm
and flashing light at the control panel. The flow meter for the system is In this tank. it Is a r
brass ABB T3000 cold water turbine meter numerical display.
Once the float is activated in the discharge tank the effluent goes through a SIM/TECH STF
104/600 micron poly -knit filter sock, from here it enters the Trojan UV2000 ultraviolet
disktfecticn system- The discharge from the UV system goes into a 2'X2' catch basin and down a
4" schedule 40 PVC pipe to Carroll Creek.
The Betsy -Jeff Penn 4-H Educational Center has a NPDES permit that allows treated wastewater
from the camp to be discharged into Carroll Creek. The current permit, number N00078271,
allows a maximum dirge of 13100 gallons per day and has the following limits on the
quality of the discharge.
Item Monthly Average Limits Daily Maximum limits
SOD 30.0 mg/1 45.0 mel.
TSS 30.0 NA
NH3 as N 112.0 mg/L 35.0 mg/1
Fecal Coftform 200/100 ml 400/100ml
PH not less than 6.0 nor greater than 9.0

Design Removal
Character f' ric
SODS
TSS
Nitrogen
Phosphorous
System Influent
Concentration
01104
250
350
40 •
11
Septic Tank Effluent
Percent Concentration
Removal (mg►L)
40% 160
40% 160
6% 38
10% 9.9
E-Z Treat Treatment System
P a -Aht Concentration
Removal (ng/L)
80% 30
80% 30
65% 13.3
0°% 9.9
Permitted
Monthly
Average (mglL)
30
30
N/A
NIA

Sludge Manz r!:ernerit Plan
• The Betsy -Jeff Penn 4-H Education Center NPDES Permit * NC0078271 agrently contracts with
Minsky Septic Tenk Company located in Reidsville NC, to have our tanks pump once a year to remove
sollds and sludge. This -is normally done during the winter months when our system sees the least
amount of influent