NC0055255_Permit Issuance_20161130

N,
Water Resources
ENVIRONMENTAL QUALITY
November 30, 2016
Mr. Bob Hahn
P.O. Box 1000
Pittsboro, NC 27312-1000
PAT MCCRORY
r�
DONALD R. VAN DER VAART
s' to
S. JAY ZIMMERMAN
Subject: Issuance of NPDES Permit NCO055255
Crown Mobile Home Park WWTP
Guilford County
Class WW-2
Dear Mr. Hahn:
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 July 15,
2016.
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.
Sinc ely,
S. Jay Zimmerman
Director, Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
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/di vi sions/water-resourceslwater-resources-permits/wastewater-branch/npdes-wastewater-permits

Permit NCO055255
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 provisions of North Carolina General Statute 143-215.1, other lawful standards
and.,regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Parkins, LLC
is hereby authorized to discharge wastewater from a facility located at the
Crown Mobile Home Park WWTP
6201 Jonquil Road
Greensboro
Guilford County
to receiving waters designated as an unnamed tributary to Hickory Creek in subbasin
03-06-08 of the Cape Fear River Basin in accordance with effluent limits, monitoring
requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective January 1, 2017.
This permit and authorization to discharge shall expire at midnight on August 31, 2021.
Signed this day November 30, 2016
4X /Z�
S immerman, P. G.
ector, Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NCO055255
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.
Parkins, LLC is hereby authorized to:
1. Continue to operate an existing 0.042 MGD wastewater treatment facility with the
following components:
♦ Bar screen
♦ Aerated equalization basins
♦ Aeration tanks in parallel
♦ Clarifiers [one per aeration tank]
♦ Tertiary filters
♦ UV disinfection
♦ Backup tablet chlorination with chlorine contact tank
♦ Backup tablet dechlorination
♦ Reaeration tank with diffused air
♦ Flow recording device
This facility is located south of Groometown at the Crown Mobile Home Park. WWTP
off Jonquil Drive in Guilford County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Hickory Creek, classified WS-IV* waters in Yydrologic
unit 03030003 of the Cape Fear River Basin.
G_• 5
Page 2 of 6

„l
1�
Permit N60055255
Part I•:;: „ ,
A. (1) EFFLUENT LIMITS AND MONITORING REQUIREMENTS
Tj5A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
During the.per`iod beginning on the effective date of this permit and lasting until expiration, the Permittee is
authorized fo discharge treated wastewater from outfalf 001. Such discharges shall be limited and monitored'
by the Per`•mittee as specified below:
PARAMETER-
EFFLUENT LIMITS
MONITORING REQUIREMENTS
Monthly
Daily .
Unit of
Measurement-
Sample
m Sale
p
PCs Code ` ` •”'
Average
Maximum
.
Measure
Frequency.
T pe
Locition2
Flow
0.042
MGD
Continuous
Recorder
Influent or
50050
.
Effluent
5-Day (20 Deg. C)
16.0
24.0
mg/L
Weekly
Composite
Effluent
CO3 10
CO3
Total Suspended Solids
C0530
30.0
45.0
mg/L
Weekly
Composite
Effluent
Ammonia Nitrogen (as N) (April 1 - October 31)
2.0
10.0
mg/L
Weekly
Composite
Effluent
C0610
Ammonia Nitrogen (as N) (November 1 - March 31)
4.0
20.0
mg/L
Weekly
Composite
Effluent
C0610
Fecal Coliform (geometric mean)
200
400
#1100ml
Weekly
Grab
Effluent
31616
Total Residual Chlorine 3
17
Ng/L
2 / week
Grab
Effluent
50060
Temperature, Deg. Centigrade
deg. C
Daily --
Grab
Effluent
00010
weekdays
Dissolved Oxygen
00300
Daily average > 6.0 mg/L
Weekly
Grab
Effluent
pH
00400
> 6.0 and < 9.0 standard units.
— —
Weekly
Grab
Effluent
Temperature, Deg. Centigrade / 00010
1
deg. C
Weekly
Grab
U & D
Dissolved'Oxygen / 00300
mg/L
Weekly
Grab
U & D
Footnotes:
1. No later than December 21, 2016, the permittee shall begin submitting discharge monitoring reports
electronically using the Division's eDMR system [see A. (3)].
2. Upstream: at least 100 feet upstream from the outfall; Downstream: at NCSR 1132.
3. Limit. and monitoring requirements apply only if chlorine is used for disinfection. The
Permittee shall report all effluent TRC values reported by a NC -certified laboratory [including field -
certified]. Effluent values below 50 µg/L will be treated as zero for compliance purposes.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2) PERMIT RE -OPENER: SUPPLEMENTARY MONITORING
[NCGS 143-215.1 ]
Pursuant to N.C. General Statutes Section 143-215.1 and the implementing rules found in the North
Carolina Administrative Code at 15A NCAC 2H.0112 (b) (1) and 2H.0114 (a) and Part II sections B-12
and B-13 of this permit, the Director may reopen this permit to require supplemental nutrient
Page 3 of 6

Permit NC0055255
monitoring of the discharge. The purpose of the additional monitoring will be to support. water quality
modeling efforts within the Cape Fear River Basin and shall be consistent with a monitoring.plan
developed jointly by the Division and affected stakeholders. In addition, the results of water.quality
modeling may require that limits for Total Nitrogen and Total Phosphorus be imposed in this permit
upon renewal.
A. (3) 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 and specify that, if a state does not establish a system to receive such
submittals, then permittees must submit monitoring data and reports electronically,to the
Environmental Protection Agency (EPA). 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. ReportinLr Requirements [Supersedes Section D. (2.1 and Section E. (5.1 (all
Effective December 21, 2016, 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 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.
Page 4 of 6
i

Permit'NC0055255
2.
3.
Reg dless of the submission method, the first DMR is due on the last day of the month
folio g 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.
Staring on December 21, 2020, the permittee must electronically report the following
co'fiance monitoring data and reports, when applicable:
• ewer Overflow/Bypass Event Reports;
• pretreatment Program Annual Reports; and
• lean: Water Act (CWA) Section 316(b) Annual Reports.
The;' `- ernittee may seek an electronic reporting waiver from the Division (see "How to
Regiestt'd Waiver from Electronic Reporting" section below).
1
In aM
ance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at
'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.-- ,ty (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'pls to establish a website that will also link to the appropriate electronic reporting
tool: reach 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.jzov/compliance/final-national-pollutant-discharge-elimination-system.
6n c submissions must start by the dates listed in the "Reporting Requirements"
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
repoting 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) 'da"y;s 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
repo Ertu ,g waivers are not transferrable. Only permittees with an approved reporting
wai,Wt,�,r'equest may submit monitoring data and reports on paper to the Division for the
per,#od;that the approved reporting waiver request is effective.
Page 5 of 6

55255
Information on eDMR 'and the application for a temporary electronic reporting wailer are
found on the following web page:
http://deg.nc.gov/about/divisions/­water-resources/­edmr
i.
4. Signatory Requirements [Supplem* ents Section B. (11.) (b) and Supersedes 'lSection I
(11.) (d)l
All 'oDMRs submitted to the permit issuing authority shall be signed by a persbna'q
described in Part II, Section B. (11.) (a) or by a duly authorized represent i e'*
personas described in Part II, Section B. (11.) (b). A person, and not a posi o'. ;st be
del6gaqed signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must n obt,a-,- -gn
eDMR'Vkr account and login credentials to access the eDMR system. For 1110TIP
information on North Carolina's eDMR system, registering for eDMR and obtad'h'`,ifiig1';" aneDMR ,:user account, please visit the following web page:
http:,//deg.nc.gov/about/divisions/water-resources/edmr
Certification. Any person submitting an electronic D*MR using the state's eD1V
IR!"system
shall r ' �iake the following certification [40 CFR 122.221. NO OTHER STATEMENTS OF
CERTIFICATION WILL BE ACCEPTED:
7 certify;under of law, that this document and all attachments were 5oa
r110 ?.q , P,*_�k�iv,'
under, my direction or supervision in accordance with a system designed to as;��W" t
qualtfied properly gather and evaluate the information submitted. B m
znquir,ybf the person or persons who manage the system, or those persons dire
0-
resppTiLsible for gathering the information, the information submitted is, to the b&Y-6 Amy
knb ledge and belief, true, accurate, and complete. Tam aware. that there are "s"ight ,.cant
penalties for submitting false information, including the possibility of fines and!k-;;"
zmpri� nment for knowing violations."
A
U
5. Records' Retention [Supplements Section D. (6.
The permittee shall retain records of all Discharge Monitoring Reports, including R
b eDMR
submissions. These records or copies shall be maintained for a period of at least years
from the date of the report. This period may be extended by request of the ]34recto'' at any
time [40-CFR 122.41].
Page 6 of 6

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USGS Quad: Pleasant Garden, N.C.
Latitude: 35057`18" NCO055255
Longitude: 79052'24"
Stream Class: WS-IV:* Crown Mobile Home Park
Receiving Stream: LIT Hickory Creek WWTP
Subbasin: 03-06-08
River Basin: Cape Fear Hydrologic Unit: 03030003
Facility
Location
Guilford County
Nodh Map not to scale

Greensboro News Record
Advertising Affidavit
200 E. Market St
Greensboro, NC. 27401
(336) 373-72B7
NCDENR - DIVISION OF WATER RESOURCES
IBT PROGRAM, WATER SUPPLY PLANNING
BRANCH
1611 MAIL SERVICE CENTER �f /
RALEIGH, NC 27699 &Ce I'V Qh
Account Number
4019634
Date
July 15, 2016
PO Number Order Category Description
PARKINS LLC/SUN 0000241698 Legal Notices Public Notice North Carolina Environmental Management Commission /NPDES Ur
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
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 afterthe 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/ovate r-
resou rces-permits/wastewater-
branch/n pdes-wastewater/publ ic-
notices.or by calling [phone].
Parkins. LLC requested renewal of
NPDES permit NC0055255/Crown
Mobile Home Park WWTP/Guliford
County. Facility discharges to an un-
named tributary to Hickory
Creek/Cape rear River Basin. Cur-
rently, Boo, ammonia nitrogen, fecal
conform, dissolved oxygen, and total
residual chlorine are water quality
limited.
Sunrise & Sons, LLC requested re-
newal of permit NCO041483/Sunrise
Park WWTP/Gullford County. Facili-
ty discharges to Hickory Creek/Cape
Fear River Basin. Currently BOD,
ammonia nitrogen, dissolved oxy-
gen, fecal coliform, and total residu-
al chlorine are water quality limited.
Publisher of the
Greensboro News Record
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 Greensboro News Record, engaged in the publishing of a newspaper
known as Greensboro News Record, published, issued and entered as second class trail in
the City of Greensboro, in said County and State: that he/she is authorized to make this
affidavit and swom statement: that the notice or other legal advertisement, a copy of which
is attached hereto, was published in the Greensboro News Record on the following dates:
07/1512016
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.
(signature of person lllal(1ng affid-11�
Sworn to and subscribed before me theaS day ofQUitA— 20
LEA
NOTARY ANNE LAMB
�.
STATE OF NOffrH CAROLINA (Notary �Pubftc)
GUILFORD COUNTY
MY COMMISSION EXPIRES 06-15-19
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

PAT MCCRORY
"•e
Water Resources
ENVIRONMENTAL QUALITY
July 11, 2016
MEMORANDUM
To: ESk-HiTTs
NC DEQ / DWR / Public Water Supply
Winston-Salem Regional Office
From: Charles H. Weaver, Jr.
NPDES Unit
Subject: Review of Draft NPDES Permit NCO055255
Crown MHP WWTP
Guilford County
Governor
DONALD R. VAN DER VAAR'T
seereiory
S. JAY ZIMMERMAN
Direcior
Please indicate below your agency's position or viewpoint on the draft permit and return this
form by August 12, 2016. If you have any questions on the draft permit, please contact me
at 919-807-6391 or via e-mail [[e-mail]].
RESPONSE: (Check one)
Concur with the issuance of this permit provided the facility is operated and maintained properly,
the stated effluent limits are met prior to discharge, and the discharge does not contravene the
designated water quality standards.
Concurs with issuance of the above permit, provided the following conditions are met: ❑
F-1
Opposes the issuance of the above permit, based on reasons stated below, or attached:
SignedC�A
Date:
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:lldeq.ne. gov/aboutidivisionslwater-resources/water-resources-permits/wastewater-branchlnpdes-wastewater-permits

Weaver, Charles
From: Mickey, Mike
Sent: Friday, July 15, 2016 1:31 PM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NC0055255 / Crown MHP
Charles — Can you update the system description on the supplement page to include the following items in red?
• Clarifiers [one per aeration tank]
• Tertiary filters
• UV disinfection
• Backup tablet chlorination ....
• Backup tablet dechlorination
• Reaeration tank with ...
Mike. Mickey@ NCDEN R.gov
NC DEQ Winston-Salem Regional Office
Division of Water Resources —Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
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, July 11, 2016 2:34 PM
To: Kinney, Maureen <[e-mail]>; Mickey, Mike <[e-mail]>; Hudson, Eric
<[e-mail]>
Cc: [e-mail]
Subject: DRAFT permit renewal for NC0055255 / Crown MHP
Importance: High
This is a class WW-2 facility in Guilford County.
Please send me any comments by August 12cn
Charles H. Weaver
Environmental Specialist
N.C. Division of Water Resources
N.C. Department of Environmental Quality
919-807-6391
charles.weaver(a)ncdenr.gov
(physical address) 512 North Salisbury Street, Raleigh, NC 27604
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617

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 — 7/11/2016
Permit Number
NCO055255
Facility Name
Crown Mobile Home Park WWTP
Basin Name/Sub-basin number
C4pe Fear / 03-06-08
Receiving Stream
Unnamed tributary to Hickory Creek
Stream Classification in Permit
WS-IV*
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?
Cape Fear nutrient reopener
Does permit have instream monitoring?
Dissolved Oxygen and Temperature
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
Two enforcements in 2013. Sporadic
violations during permit cycle, but no severe
lapses in compliance.
Any permit mods since last permit?
No
New expiration date
8/31/2021
Comments received on Draft Permit?
Updated facility components
Added eDMR requirements
Added regulatory citations
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".

Mr Charles Weaver
Division of Water Resources
1617Mail Service Center
Raleigh, NC
27699-1617
March 1, 2016
Permit Renewal
Crown MHP
WWTP Operations
NPDES NCO055255
PO Box 1000
Pittsboro, NC
RECEIVED/NCDEQ/DVVR
MAR -42016
Water Quality
Permitting Section
This letter is a request to renew the permit for Crown Mobile Home Park. Since the last permit was
issued a new WWTP has been installed in Crown with the approval of and guidance from the Winston
Salem and Raleigh offices of the NPDES.
The Sludge is hauled to another facility by Jenkins Waste. They haul on an as needed basis which is
usually about 2 loads every second or third month.
Robert Hahn
Crown MHP

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NC00 SSi�(55_
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Parkins LLC
Facility Name
Crown MHP RECEIVEDINCDEUDVA
Mailing Address
PO Box 1000 MAR - 4 if116
City
Pittsboro water1ality
Gli._...r-
State / Zip Code
NC 27312 permitting Section
Telephone Number
[phone]
Fax Number
(888)5245011
e-mail Address
[e-mail]
2. Location of facility
producing discharge:
Check here if same address as above ❑
Street Address or State Road 6201 Jonquil RD
City
Greensboro
State / Zip Code
NC 27407
County
Guilford
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name KAB COnst
Mailing Address
PO Box 1000
City
Pittsboro
State / Zip Code
NC 27312
Telephone Number
919)545-0635
Fax Number
(888)5245011
e-mail Address
[e-mail]
1 of Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
x
Number of Homes 140
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile Home Park
Number of persons served: 361
5. Type of collection system
❑ Separate (sanitary sewer only)
6. Outfall Information:
x Combined (storm sewer and sanitary sewer)
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes x No
7. Name of receiving stream(s) (11TEW applicants: Providea. map showing the exact location of each
outfall):
Unnamed tributary to Hickory Creek
8. Frequency of Discharge: x Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration: _
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient; attach the description of the treatment system in a
separate sheet of paper.
Bar Screen
Aerated equializer basins
Aeration tanks in parallel (2)
Clarifiers 1 each for aeration tank
W with tablet chlorinator and contact chamber as backup
Reaeration tank with diffuser
Flow recording device
2 of 4 Form-D 11 /12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .050 MGD
Annual Average daily flow .017 MGD (for the previous 3 years)
Maximum daily flow .047 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes x No
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
s ?- .-.+1'.. f ...,--ford i..,—fli, in iiniir normif Mnrk- nthor nnrnmPtPTS "IV/A"—
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
61.2
4.05
Mg/1
Fecal Coliform
>640
9.2
#/ 100m1
Total Suspended Solids
43
5.5
Mg/1
Temperature (Summer)
28
22.7
Degrees C
Temperature (Winter)
24
12.6
Degrees C
pH
8,5
7.2
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
d1-1—
Printed name of, erson Signing
Title
I
of Applicant Date
QRo�.
144 CS-4 P'
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
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