NC0044750_Fact Sheet_20231018

NCDEQ / DWR / NPDES
EXPEDITED FACT SHEET - NPDES PERMIT RENEWAL
NPDES Permit NCO044750
Sydney Deuterman / Compliance & Expedited Permitting Unit / sydney.deutermangdeq.nc.gov / Sept 2023
FACILITY INFORMATION
Facility Name
Jacob's Creek Nursing & Rehabilitation Center
Applicant Name / Contact
Granite Falls Ltc LLC
Applicant Address
1721 Bald Hill Loop, Madison, NC 27025
Facility Physical Address
1721 Bald Hill Loop, Madison, NC 27025
Permitted Flow (MGD)
0.025 MGD
Type of Waste
100% Domestic, Commercial wastewater
Facility Class
WW-2
County
Rockingham
Permit Status
Renewal
Regional Office
WSRO
STREAM CHARACTERISTICS
Receiving Stream
Hogans Creek
Stream
Classification
C
Stream Segment
22-31
Outfall Lat.
360 22' 53" N
7Q10 - Summer (cfs)
1.4
Outfall Long.
790 54' 28.1" W
7Q 10 - Winter (cfs)
4.6
Drainage basin
Roanoke
30Q2 (cfs)
5.3
Subbasin
03-02-02
Average Flow (cfs)
0
HUC
030101030501
IWC (%)
2.69% (summer) /
0.84% (winter)
303(d) List
Not listed as impaired.
BASIC INFO FOR EXPEDITED PERMIT RENEWAL
Yes — current permit only has monitoring. Limits were
previously removed in a past renewal for an unknown
reason. Based on WLA spreadsheet, summer NH3-N
Does permit need Daily Max NH3 limits?
limits will be added back in, with monitoring only for
winter. A review of the DMRs from the previous permit
cycle shows the facility will be able to meet the new
limit without the need for a compliance period.
Does permit need TRC limits/footnote?
Already present in permit.
Does permit have toxicity testing?
No — not a complex wastestream
Does permit have any Special Conditions?
Yes — Temporary Means of Disinfection
Does permit have instream monitoring?
No
New expiration date:
May 31, 2027
Facility Summary
Jacob's Creek Nursing & Rehabilitation Center serves an estimated population of 161 people with a private,
closed collection system that sends 100% domestic wastewater to their private wastewater treatment
system. The Jacob's Creek Nursing & Rehabilitation Center WWTP is a minor facility (flow < 1 MGD)
with a design capacity and permitted wastewater discharge of 0.025. This facility utilizes the following
treatment components:
• Flow equalization
• Influent screening box
• Aeration basins
• Clarifiers
Fact Sheet for Permit Renewal
Sept 2023 - NPDES Permit NCO044750 - Page 1

• Sand filter
• UV disinfection
• Back —up chlorine disinfection with contact chamber
• Flow measurement
• Aerobic digester
• Effluent pump station
Renewal Summary
This renewal contains the following changes:
• Updated the Supplement to Cover Sheet with the stream index number and HUC.
• Added the facility grade to A. (1.).
• Added summer Ammonia Nitrogen limits to the table in A. (L) based on the results of the WLA
spreadsheet. Monitoring frequency for Ammonia Nitrogen has been changed to Weekly.
• Updated A. (3) to reflect current federal requirements for Electronic Reporting of Discharge
Monitoring Reports.
Compliance History
Jacob's Creek Nursing & Rehabilitation Center has only three enforcement cases on record since 1979, with
one occurring during the previous permit cycle. A civil penalty was assessed in Jan 2020 for exceeding the
Daily Max limit for Fecal Coliform. The remitted penalty amount is still outstanding (LV-2020-0039), but
the permittee has been unresponsive. The facility has been issued six NOVs for Fecal Coliform Daily Max
limit exceedances (5 violations) and TSS Daily Max exceedance (1 violation) during the previous permit
cycle. The most recent inspection (February 2022) showed the facility to be in compliance, but noted that
fats, oils and grease (FOG) are causing issues affecting treatment efficacy.
Fact Sheet for Permit Renewal
Sept 2023 - NPDES Permit NC0044750 - Page 2

IWC Calculations
Facility: Jacob's Creek Nursing and Rehabiliation Center
Permit No.: NC0044750
Prepared By: Sydney Deuterman
Enter Design Flow (MGD): 0.025
Enter s7Q10 (cfs): 1.4
Enter w7Q10 (cfs): 4.6
Total Residual Chlorine (TRC)
Daily Maximum Limit (ug/1)
s7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (UG/L)
Upstream Bkgd (ug/1)
IWC (%)
Allowable Conc. (ug/1)
Fecal Coliform
Monthly Average Limit:
(If DF >331; Monitor)
(If DF<331; Limit)
Dilution Factor (DF)
Total Residual Chlorine
Design Permitted
1.4
0.025
0.03875
17.0
0
2.69
631
Design Permitted
200/100ml - #VALUE!
37.13 #VALUE!
1. Cap Daily Max limit at 28 ug/I to protect for acute toxicity
<= Permitted Flow if Different from Design
Ammonia (Summer)
Monthly Average Limit (mg NH3-N/1)
Design Permitted
s7Q10 (CFS)
1.4
DESIGN FLOW (MGD)
0.025
DESIGN FLOW (CFS)
0.03875
STREAM STD (MG/L)
1.0
Upstream Bkgd (mg/1)
0.22
IWC (%)
2.69
Allowable Conc. (mg/1)
29.2
Ammonia (Winter)
Monthly Average Limit (mg NH3-N/1)
Design Permitted
w7Q10 (CFS)
4.6
DESIGN FLOW (MGD)
0.025
DESIGN FLOW (CFS)
0.03875
STREAM STD (MG/L)
1.8
Upstream Bkgd (mg/1)
0.22
IWC (%)
0.84
Allowable Conc. (mg/1)
189.4
*2B .0404 (c) Applies
Ammonia (as NH3-N)
1. If Allowable Conc > 35 mg/l, 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
* By Policy dischargers < 1 MGD get limits no lower than 2 & 4 due to BAT
* From 2B .0404(c) - Winter Limits can be no less stringent than 2 times the summer limits
Fecal Coliform
1. Monthly Avg limit x 2 = 400/100 ml = Weekly Avg limit (Municipals) = Daily Max limit (Non -Muni)

From:
Jessica Mize
To:
Deuterman.Sydney
Subject:
Re: [External] Fw: NCO044750 Jacobs Creek Permit Renewal
Date:
Wednesday, June 21, 2023 10:39:48 AM
Attachments:
imaae002.g_na
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Outlook-jce4lca 14. g_na
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
We discharge into Hogan's Creek currently classified C Waters in sub basin 03-02-02 of
Roanoke River Basin as said on the last permit. We have not had any changes or updates to
the Plant. This is how we were told to fill out our Permit renewals for all of our plants, none
have flow greater than 0.1 mgd. We don't really understand the section 3.6 and what it is
asking. I was told by other people doing permit renewals that this is a standard renewal for
EPA and just to fill it out as best we can even though most of it doesn't apply.
The contacts at this facility are still correct.
If you should have any questions or require any additional information please so advise.
Thank you!
Kind Regards,
Jessica Mize
Project Coordinator 1 1 Pace Environmental Services
1377 South Park Dr., Kernersville, NC 27284
d: 704.977.0982 1 pacelabs.com
(A"?ace
From: Deuterman, Sydney <[e-mail]>
Sent: Wednesday, June 21, 2023 9:57 AM
To: Jessica Mize <[e-mail]>
Subject: RE: [External] Fw: NCO044750 Jacobs Creek Permit Renewal
CAUTION: This email originated from outside Pace Analytical. Do not click links or open attachments
unless you recognize the sender and know the content is safe.
Hi Jessica,

I am the permit writer assigned to the renewal for Jacob's Creek Nursing and Rehab Center WWTP. I
apologize for the time it has taken for us to get to this renewal request. We have had a number of
issues, including an ongoing staffing shortage, that has led to a backlog of permit renewals for us to
process. Because we have a renewal application on file, the current permit will remain
administratively continued even though it is passed the expiration date. The discharge is covered
and the permittee should continue to follow the monitoring and other requirements in their permit
until the renewal issued.
Since it has been a while since the renewal application came in, I wanted to see if there had been
any changes or if there was any additional information you wanted to pass along for my review. I
noticed that the renewal application indicates that the treatment works does not discharge or plan
to discharge wastewaters to the waters of the State (section 3.6). Can you confirm that this facility is
currently discharging?
Additionally, I have attached a report showing the contact information that we currently have in our
database for this permit. Please review this information and let me know if the contacts are correct
or if any changes, updates or additions need to be made.
Lastly, I wanted to pass along information regarding electronic submittal of permit documents —
please see the information below on this issue.
Electronic Transmission of Documents
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 at this email address.
Thanks,
Sydney Deuterman (Carpenter) (she/her)
Environmental Specialist II
Compliance and Expedited Permitting Unit
Division of Water Resources
N.C. Department of Environmental Quality
Office: 919-707-3712
NEWEMA/LADDRESS. svdnev.deuterman0deq.nc.aov

1617 Mail Service Center
Raleigh, NC 27699-1617
E QF:�
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Corporon, Joe <[e-mail]>
Sent: Wednesday, June 21, 2023 6:49 AM
To: Deuterman, Sydney <[e-mail]>
Subject: FW: [External] Fw: NCO044750 Jacobs Creek Permit Renewal
Ms. Sydney— FYI, BIMS says this belongs to you.
=jrc
From: Jessica Mize <Jessica.Mize(@pacelabs.com>
Sent: Tuesday, June 20, 2023 3:45 PM
To: Corporon, Joe <ioe.corporon(@deq.nc.gov>; Young, Brianna A <Brianna.Young(@deq.nc.gov>;
[e-mail]
Subject: [External] Fw: NCO044750 Jacobs Creek Permit Renewal
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
Please see the email below which was sent December 2021. My client at Jacobs Creek is
concerned because he has not received a new permit and his expired last year. Can you please
let me know the status?
If you should have any questions or require any additional information please so
advise. Thank you!
Kind Regards,
Jessica Mize
Project Coordinator 1 1 Pace Environmental Services
1377 South Park Dr., Kernersville, NC 27284
d: 704.977.0982 1 pacelabs.com

(A"'lace
From: Jessica Mize
Sent: Wednesday, December 29, 2021 1:23 PM
To: Weaver, Charles <charles.weaver(@ncdenr.gov>
Cc: Corporon, Joe <ioe.corporon(@ncdenr.gov>; brianna.young(@ncdenr.gov
<brianna.young(@ncdenr.gov>; emily_phillips(@ncdenr.gov <emily_phillips(@ncdenr.gov>
Subject: NC0044750 Jacobs Creek Permit Renewal
Please find attached the permit renewal application for Jacobs Creek. Please let me know
when this has been received.
If you should have any questions or require any additional information please so
advise. Thank you!
Kind Regards,
Jessica Mize
Project Coordinator 1 1 Pace Environmental Services
1377 South Park Dr., Kernersville, NC 27284
d: 704.977.0982 1 pacelabs.com
(A"�?ace
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Rockingham Now
Advertising Affidavit Account Number
4019534
Date
July 30, 2023
NCDEQ-DIVISION OF WATER RESOURCES
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
PO Number Order Category Description
0000842579 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 swom 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:
07/30/2023
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.
Billing Representative
Swom to and subscribed before me the 30th day ?Pfaty?, 023.
�w
i (Notary Public)
�
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10
State of Virginia ' �'�:;'�-310•.
County of Hanover
= U) REGISTR„AT Otj
My commission expires:—
% cC T'S'RY FLc✓�`�.
G,`. • J �• 'v., \Pv \``��
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

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 NCO044750 for Ja-
cob's Creek Nursing and Rehabilitation Center The North Carolina Environ-
mental Management Commission proposes to issue a NPDES wastewater
discharge permit to the person(s) listed below. Written comments regard-
ing 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
public interest. Please mail comments and/or information requests to
DWR at the above address. Interested persons may visit the DWR at 512
N. Salisbury Street, Raleigh, NC 27604 to review the information on file.
Additional information on NPDES permits and this notice may be found on
our website: https:Hdeq.nc.gov/public-notices-hearings,or by calling
[phone]. Granite Falls Ltc LLC [1721 Bald Hill Loop, Madison, NC
27025] has requested renewal of permit NCO044750 for Jacob's Creek
Nursing and Rehabilitation Center located in Rockingham County. This per-
mitted facility discharges treated wastewater to Hogans Creek in the Roa-
noke River Basin. Currently, Total Residual Chlorine and Fecal Coliform
are water quality limited. This discharge may affect future allocations in
this segment of Hogans Creek.