NC0060259_Renewal (Application)_20151026

North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
October 26, 2015
James Radford, Managing Member
NC Land Lease, LLC
PO Box 2533
Christiansburg, VA 24068
Subject: Acknowledgement of Permit Renewal
Application No.NCO060259
Willow Oak Mobile Home Park WWTP
Rockingham County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on October
23, 2015. A member of the NPDES Unit will review your application. They will contact you if
additional information is required to complete your permit renewal. 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. Please respond in a
timely manner to requests for additional information necessary to complete the permit application.
If you have any additional questions concerning renewal of the subject permit, please contact
Wren Thedford at 919-807-6304 or [e-mail].
Sincerely,
W rew Tltieol f orol�
Wren Thedford
Wastewater Branch
cc: Central Files
Winston Salem Regional Office, Water Quality Regional Operations Section
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] Fax:[phone]/Customer Service:1-877-623-6748
Internet::www.ncwater.oro
An Equal OpportumtykAffirmative Acton Employer

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 NCO060259
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 NC Land Lease, LLC
Facility Name Willow Oak Mobile Home Park WWTP
VtEr p jr=pnFNRIDWR
Mailing Address PO BOX 2533 OCT 2 2 2015
City Christiansburg Water Q avkt or
PefM009
State / Zip Code VA 24068
Telephone Number 540-552-3034
Fax Number 540-552-5528
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road kT• 150
City
kP-,
State / Zip Code AIC,/n,
/ n D
County l .0
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 Paul Smith
Mailing Address PO Box 269
1 of Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
City Reidsville
State / Zip Code North Carolina 27323
Telephone Number ( 336 ) 932-9347
Fax Number ( )
e-mail Address smithindustriegbellsouth.net
2 of 6 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 appltlr
Industrial Number of Employees
Commercial Number of Employees
Residential✓ Number of Homes G�
School Number of Students/Staff b
Other Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served: I��
5. Type of collection system
Separate sanitary sewer only) Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? Yes No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Little Troublesome Creek
S. Frequency of Discharge: Continuous Intermittent
If intermittent:
Days per week discharge occurs: 5 Duration: 24 hrs
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.
3 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Manual bar screen, Two stage Facilitative lagoon, Alum Feed & alum feed tanks, chlorine
disinfection,tablet dechlorination.
4 of 6 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 0.0175 MGD
Annual Average daily flow .011 MGD (for the previous 3 years)
Maximum daily flow 0.014 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
Yes o
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 the past 36 months for parameters currently in your permit. Mark other arameters "N/A'.
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODs) 10.7 mg/1
Fecal Coliform 124 15.7 200/100 ml
Total Suspended Solids 9.8 7.5 mg/1
Temperature (Summer) 29 25 C
Temperature (Winter) 14 13 C
pH 7.5 NA SU
13. List all permits, construction approvals and/or applications:
0.
14. APPLICANT CERTIFICATION
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.
GtMe o / �an�
Printed name of Person Signing Title
S' ature of Applicant ate
5 of 6 Form-D 11/12

O
NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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.)
6 of 6 Form-D 11112