NC0061204_Renewal (Application)_20240603

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Thomas Alphin, Jr
Thomas M Alphin
PO Box 5
Walkertown, NC 27051-0005
Subject: Permit Renewal
Application No. NCO061204
Scarlett Acres MHP WWTP
Forsyth County
Dear Applicant:
NORTH CAROLINA
Environmental Quality
June 03, 2024
The Water Quality Permitting Section acknowledges the June 3, 2024 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://www.deg.nc.gov/permits-rules/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,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1 450 West Hanes 6811 Road, Suite 300 1 Winston-Salem North Carokna 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
JUN 0 3 2024
NCDEQ/DWR/NPDES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

FE10"ll�aEIVED
NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
r,; t, Modified March 2021
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
NPDES
MINOR SEWAGE FACILITIES (Before completing this form,,jTaw-Mad jr s u t�. jl i9 p11q v
�I!!��
the instructions may result in denial of the application.) E I-J `'
SECTION•N
INFORMATION FOR
1.1
Facility name
Scarlett Acres
Mailing address (street or P.O. box)
P.O Box 5
City or town
State
ZIP code
o
Walkertown
NC
27051
w
EContact
name (first and last)
Title
Phone number
Email address
c
Riene Alphin
Owner
[phone]
N/A
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
R
U-
5528 Sherene Lane
City or town
State
ZIP code
Walkertown
NC
27051
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes -+ See instructions on data submission ❑ No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes 0 No SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
w
c
City or town
State
ZIP code
w
Contact name (first and last)
Title
Phone number
Email address
c.
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
El Owner ❑ Operator ❑ Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑ Facility El Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
w
number for each.
d
Existing Environmental Permits
CL
R
0 NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
E
c
NCO061204
o
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
W
H
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
Ul
404)
Page 1

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
1.7
Provide the collections stem information requested below for the treatment works.
Municipality
Population
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
385
100 % separate sanitary sewer
0 Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
d
❑ Unknown
❑ Own ❑ Maintain
c
% separate sanitary sewer
❑ Own ❑ Maintain
R
% combined storm and sanitary sewer
❑ Own ❑ Maintain
ElUnknown
❑ Own ❑ Maintain
a
a
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
E❑
Unknown
❑ Own ❑ Maintain
a
% separate sanitary sewer ❑ Own ❑ Maintain
combined storm and sanitary sewer ❑ Own ElMaintain
Cl)%
c
❑ Unknown ❑ Own ❑ Maintain
0
Total 385
Population
0
Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
100 % %
1.8
Is the treatment works located in Indian Country?
c
o
U
❑ Yes 0 No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
c
❑ Yes ❑� No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
024 mgd
cEi
ti
Annual Average Flow Rates Actual
Two Years Ago
Last Year
This Year
c o
mgd
mgd
mgd
`L
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
mgd
mgd
mgd
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 ointsbyType
CL
T
Combined Sewer
Constructed
T
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
a
Overflows
2
1
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
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 Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
o
❑ Intermittent
w
1.14
Is wastewater applied to land?
M
❑ Yes 0 No 4 SKIP to Item 1.16.
c
1.15
Provide the land application site and discharge data requested below.
CL
Land Application Site and Discharge Data
Average Daily Volume
Continuous or
o
`o
d
Location
Size
Applied
Intermittent
o'
check one
acres
d
gpd
❑ Continuous
o
❑ Intermittent
El Continuous
o
acres
gpd❑
Intermittent
o
acres
gpd
❑ Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatment prior to discharge?
El Yes ❑✓ No 4 SKIP to Item 1.21.
o
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.
Trans orter 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
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
facility.
—receiving
Receiving F cility Data
a
Facility name
Mailing address (street or P.O. box)
d
City or town
State
ZIP code
0
U
Contact name (first and last)
Title
0
s
Phone number
Email address
QNPDES
number of receiving facility (if any) ❑ None
Average daily flow rate mgd
N
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
0
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
L
❑ Yes ❑ No 4 SKIP to Item 1.23.
U
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other Dis osal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
=
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
acres
gpd
❑ Continuous
❑ Intermittent
I]Continuous
acres
gpd
❑ Intermittent
acres
gpd
❑ Continuous
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
„ w
Consult 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
Cr
Section 301(h)) 302(b)(2))
ce-
❑� Not applicable
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
c
Contractor name
Bell Enterprises LLC
compan name
E
Mailing address
c
street or P.O. box)P.O.
Box 1291
S
City, state, and ZIP
Q
code
Clemmons, NC 27012
15-
tact name (first and
last)
Randall Bell
Phone number
[phone]
Email address
[e-mail]
Operational and
All operations and
maintenance
Maintenance liason
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NCO061204 Scarlett Acres Modified March 2021
SECTIONDD• •' • 1
o Outfalls to Waters of the State of North Carolina
EZ
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
rn
o
❑ Yes ❑ No 4 SKIP to Section 3.
c
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
and infiltration.
god
w
Indicate the steps the facility is taking to minimize inflow and infiltration.
v
_
3
0
_
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
R
specific requirements.)
R
0
0
_0 "
❑ Yes ❑ No
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
o A
(See instructions for specific requirements.)
_ c"
`1 0
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
=
v
1.
d
E
c
2.
E
0
0
y
d
3.
d
4.
Cn
R
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
d
Scheduled
Affected
Begin
End
Begin
Attainment of
>
a
Improvement
Outfalls
(list l
Construction
Construction
Discharge
Operational
Level
E
(from above)
number)
)
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
d
d
--
v
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
Facility Name Modified Application Form 2A
NC0061204
Scarlett Acres Modified March 2021
SECTION•'
• ON 1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number 001
Outfall Number
Outfall Number
State
NC
y
County
Forsyth
0
0
City or town
Walkertown
0
c
Distance from shore
ft.
ft.
ft.
a
L
Depth below surface
ft.
ft.
ft.
0
Average daily flow rate
mgd
mgd
mgd
Latitude
36' 1675 N"
°
Longitude
-so 185 v('
"
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
R
o
❑ Yes 0 No + SKIP to Item 3.4.
a�
3.3
If so, provide the following information for each applicable outfall.
s
y
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
g
discharge occurs
a
Average duration of each
`o
discharge (specify units
Average flow of each
mgd
mgd
mgd
R
discharge
Cn
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑r No + SKIP to Item 3.6.
3.5
Briefly describe the diffuser type at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
d
0
vi
3.6
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
one or more discharge points?
y
0 Yes ❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number 00,
Outfall Number
Outfall Number
Receiving water name
UT to Mill Creek
Name of watershed, river,
c
or stream system
Yadkin Pee Dee
s.
U.S. Soil Conservation
N
Service 14-digit watershed
o
code
Name of state
3
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
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
E1 Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
0
a
Design Removal Rates by
Outfall
y
N
o
BOD5 or CBODs
%
%
%
d
E
m
TSS
%
%
%
F-
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
%
%
%
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
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.
Sodium Hypochlorite tablets
-0
d
c
c
0
cOutfall
Number 001
Outfall Number
Outfall Number
Disinfection type
Sodium Hypochlorite tablets
4)
m
0
Seasons used
yearlong
d
E
M
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
f-
❑r Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes 0 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 0 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
R
0
Number of tests of discharge
rn
water
FNumber
of tests of receiving
water
m
W
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
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
Facility Name
Modified Application Form 2A
NCO061204
Scarlett Acres
Modified March 2021
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 our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DD/YYYY
d
c
c
0
w3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
c
toxicity?
CO
❑ Yes ❑ No + SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
m
3
Uj
W
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 permitting authority.
Page 9

NPDES Permit Number
Facility Name Modified Application Form 2A
NCO061204
Scarlett Acres Modified March 2021
SECTION•
1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
6.1
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
❑ wi variance request(s) ❑ wl additional attachments
Information for All Applicants
❑ Section 2: Additional
w/ topographic map ❑ wl process flow diagram
Information
❑ w/ additional attachments
❑ w/ Table A ❑ w/ Table D
Section 3: Information on
El
El w/ Table B El wl additional attachments
Effluent Discharges
E
❑ w/ Table C
d
R
rn
Section 4: Not Applicable
r-
0
?�
Section 5: Not Applicable
f
d
U
Section 6: Checklist and
❑
❑ wl attachments
Certification Statement
N
Y
6.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
(S n A I pkn
�) �-o n le_,r
Signature
Date
siatte ned
07���
T✓ 9 9)9 L4
RECEIVED
NCDEQ/DWP/NPDES
Page 10

fjY i 1- w
! 3�
. mill Creek
w ♦ , `''
- CTe' 'v �
'�,, o2-�- '� ` tip• `� ; �' _°• o ."a
[I I to Mlli Vr xr r
is • ! g i � r a � p {,"^"-- ��
w
/ • ! 'ate»
f �;1 fir., � � h— ..,�! C._ '� ; ,• •� j If `.�
r
„� � < < '•-` Co tip 4k N ion�h,,ec�raph! •ciety. + Y
Thomas Alphin
Scarlett Acres MHP WWTP
NPDES Permit NCN61204
Receiving Stream: UT to Mill Creek Stream Class: C
Stream Segment: 12-94-7 Sub -Basin #: 03-07-04
River Basin: Yadkin -Pee Dee HUC: 030401011301
County: Forsyth
N
SCALE
1:16,000

NPDES Permit Number
Facility Name
Outfall Number
NCO061204
Scarlett Acres Mobile Home Park
001
Modified Application Form 2A
Modified March 2021
:7.11 M
Maximum Daily Discharge
Average Daily Discharge
Pollutant
Analytical
Numbers
ML or MDL
Value Units
Value Units Method'
(include units)
Samples
Biochemical oxygen demand
❑ BODs or ❑ CBODs
27.8
MG/I
<2
MG/L
104 SM5210 B-2016
OML
MG/L ❑ MDL
(report one
Fecal coliform
579.4
MPN/100
<1
MPN/100
104 IDEXX Coilert 18 MPI
MPN/100 OML
❑ MDL
Design flow rate
0.087
MGD
0.010
MGD
730
pH (minimum)
6.5
pH (maximum)
7.1
Temperature (winter)
18
Celcius
7
Celcius
520
Temperature (summer)
29
Celcius
13
Celcius
520
Total suspended solids (TSS)
17.25
MG/L
<1
MG/L
104 SM2540 D-2015
MG/L OML
MDL
' 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