NC0057720_Renewal (Application)_20170121

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.Director
January 21, 2017
Mr. John Oakley
Hidden Lakes Village Mobile Home Park
2112 Zephyr Road
Dobson, NC 27017
Subject: Permit Renewal
Application No. NCO057720
Hidden Lakes Village Mobile Home Park WWTP
Stokes County
Dear Mr. Oakley:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on January 10, 2017. The primary reviewer for this renewal
application is John Hennessy.
The primary reviewer will review your application, and he 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 John Hennessy at 919-807-6377 or [e-mail].
Sincerely,
2A" '74*id
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6300

To: NPDES Program
From: Hidden Lakes Village Mobile Home Park (Permit # NC0057720)
Subject: Permit Renewal & Modification
Date: 1/4/2017
Hidden Valley is requesting permit renewal and modification of existing permit due to financial impact
of operating plant. Currently plant is permitted for .04 MGD. The park is at approximately half capacity,
it's designed for around 80 homes, however has been operating well below capacity, there are
approximately 40 homes in park, approximately 30 are actually occupied. The cost of sampling lab and
ORC services has created financial hardship to owner, therefore Hidden Lakes is requesting the
following:
1- Reduce Effluent flow rate from .04 MGD to .02 MGD, since taking over as ORC plant has been
averaging less than .0025 MGD. Continual flow totalizer was calibrated and used, I have
enclosed a copy of calibration report and last 3 DMR's to show flow rates for plant.
2- Allow Hidden Lakes to use grab samples for testing instead of requiring composite sampling.
3- Reduce Low Level Chlorine testing to 1 per week instead of 2 per week, this would allow current
lab to make 1 trip per week to plant site.
Any consideration that you could extend to Hidden Lakes Village Mobile Home Park would be
appreciated. -If you have any questions or comments, feel free to contact me at 336-240-5738. George
Smith from Winston-Salem Regional Office may also be contacted for clarification.
Sincerely yours,
Z�
Jon M. Southern, Plant ORC

Hidden Lakes Village Mobile Home Park #NC0057720
Note:
All data available for preparing permit application was taken from DMWs from the following months:
December 2012
January 2013
February 2013
June 2013
July 2013
August 2013
September 2013
September 2016
October 2016
November 2016
For clarification please contact George Smith @ Winston-Salem Regional Office

Hidden Valley Equipment List
2 Blowers (for basin air, return sludge, and wasting)
1 influent bar screen (Aluminum)
2 final clarifiers
2 de -chlorinators (tablets)
2 chlorinators (tablets)
1 Stevens Flow Meter
1 in ground aerobic digester (or waste tank)

The sludge management for Hidden Lakes is simple but effective. Once the solids from the Activated
Sludge Basin settles in final clarifiers it is returned back to basin for seed. When solids reach a certain
level wasting of sludge is critical. The return sludge lines coming from clarifiers has valves installed to
route sludge to an in ground aerobic digester (or waste tank). The plant blowers are used for wasting of
sludge and pumping return back to head of sludge basin. Air from in ground tank is shut down from time
to time to let solids settle, the clear supernate is pump off top of tank back to basin. Once tank can't be
decanted any more, a private septic hauler is called to completely evacuate tank, it is taken to an
approved wastewater treatment plant for final disposal.

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 Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit C0057720
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
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
John H. Oakley
Hidden Lakes Village Mobile Home Park
2112 Zephyr Rd
Dobson
North Carolina, 27017
[phone]
[phone]
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road NCSR 1966
City King
State / Zip Code North Carolina
County Stokes
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 ORQ
Name Jon M. Southern
Mailing Address 9455 Helsabeck Rd
City Rural Hall
State / Zip Code North Carolina, 27045
Telephone Number [phone]
Fax Number ( )N/A
e-mail Address [e-mail]
1 of 4 Form -D 9/2013

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater: wastewater from a mobile home park
Facility Generating Wastewater(check all that applyr
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential x Number of Homes *40
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
*Wastewater is from a mobile home park, there are approximately 40 homes in lot however
approximately 30 is occupied.
Number of persons served: 50-60
5. Type of collection system
x❑ 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 x❑ No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Timmons Creek
S. 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 su}�icient, attach the description of the treatment system in a
separate sheet of paper.
No data on design removals, Hidden Lakes has bar screen prior to basin to remove debris,
activated sludge basin with connecting final clarifiers, which has 2 return sludge lines in
each clarifier to remove blanket from bottom, valves on return sludge lines allows
wasting to aerobic in ground tank. Weir overflow from clarifier flows over chlorine tablets
for disinfection, at this point flow goes to stilling well where de chlorination tablets
remove residual chlorine. There is an effluent flow meter in this well which reads and
totalizes continual flow. Basin has 2 blowers which provides air to bacteria in basin and
also controls the return feed and wastage.
2 of 4 Form -D 912013

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .04 MGD
Annual Average daily flow .0037 MGD (for the previous 3 years)
Maximum daily flow .0092 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
0 Yes x0 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 duly maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters mirnently in ymir normit mgvL- 4-- anT/ A"
Parameter
Daily
Maximum
Monthly
Average
AV/.Cl
Units of
Measurement
Biochemical Oxygen Demand (BODS)
14.8
9.2
Mg/1
Fecal Coliform
2420
21
#100/ml
Total Suspended Solids
43
11
Mg/l
Temperature (Summer)
30
22.4
Degrees c
Temperature (Winter)
13
10.1
Degrees c
pH
7.6
6.87
su
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO057720
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
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.
Jon M. Southern Plant ORC
Printed name of Person Signing Title
A C'FM'.Xy
•e of Applicant
Date
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,)
4 of 4 Form -D 9/2013

December 4, 2016
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
HIDDEN LAKES MOBILE HOME PARK
NPDES Permit Number NCO057720
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications, discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506.
Individual #1 Tndividnal :9'? 1;,r ---
Name:
- ,
Name:
Jon Southern
Title:
Plant Ore
Mailing Address:
9455 Helsabeck Rd
Rural Hall, Nc 27045
Physical Address:
(f different)
Email Address:
[e-mail]
Office Phone:
336 - 397 - 7600
Mobile Phone:
336 - 978 - 9658
If you have any questions regarding this letter, please feel free to contact me at [e-mail] or
336-978-9658.
Sincerely,
4 A " -" o
John H. Oakely
Owner
2112 Zephyr Rd Dobson, Ne 27017
[e-mail]
336-366-4161
336-325-9971
cc: Select a region Regional Office, Water Quality Permitting Section

d;
ILCO
CAL ISRA TIONS, L L C
CALIBRATION REPORT
CUSTOMER: Hidden Lakes Drive CITY: King
ADDRESS: 1020 Twin Lakes Drive STATE, Zip: NC 27021
ADDRESS: PLANT Waste Water Treatment Plant
-J -<
EQUIPMENT: Flow Indicator LOCATION: Eff cent Discharge Channel
MANFUC UREEL Stevens TAG 9: NA
MODEL #: 61R SERIAL 9: 11703"S
DESCRIPTION: Indicator Reads Thoasnds Gallon Per Day (TGPD)
RANGE UNITS SPECIFICATIONS
INPUT: 0.0 To 0375 Head Feet REQUIRED ACCURACY: 200 %
OUTPUT: 0.0 To 27.67 TGPD ALLOWABLE DEVIATION: om
CALIBRATION TEST 1
CAT—IBRATION "AS FOUND" "AS LEFT CALIBRATION
RESULTS HF FLOW TGPD HF FLOW TGPD RESULTS
STAFF GAUGE 0.21 6.5 0.21 63 STAFF GAUGE-
FLOW
AUGEFLOW METER: NA 7.5 NA 6.4 FLOW METER:
CALIBRATION TEST 2
CALIBRATION "AS FOUND" "AS LEFT" CALIBRATION
RESULTS HF FLOW TGPD HF FLOW TGPD . RESULTS
STAFF GAUGE 023 8.2 0.23 82 STAFF GAUGE
Flow METER: NA 8.0 NA 8.0 FLOW METER:
REPORT: Compared staff gauge readings to ISCO Handbook and Flow Meter
Had to adjust.
Performed second flow calibration test, all ok. Tighten down adjustment thumb screws.
TEST EQUIPMENT USED: ISCO Open Channel Measurment Handbook Third Edition
CALIBRATION DATE 9%20/2016 DUE DATE 9/20/2017 CALIBRATION
FREQUENCY- Yearly
.ITCEIIQAN- Tom Miller
RUORTNU21m STEVENS- 92016
Mffco CaBtra&w, LLC - PO Boxl= - King. NC 271W - Phone (SM 817-1799 - Fax (Mo 98316722

EFFLUENT
NPDES PERMIT NO. N00057720 DISCHARGE NO. 1 MONTH Sptember YEAR_ 20185
FACILITY NAME Hidden Lakes Village CLASS 2 COUNTY Stokes
CERTIFIED LABORATORY (1)_ Pace Analytical
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (OP don M. Southern
'PERSON(S) COLLECTING SAMPL. Charles Homback (Pace)
CHECK BOX IF ORC HAS CHANGED D
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES x
DIVISION OF WATER RESOURCES TST94
GRAD] 4 CERTIFICATION NO 986488
ORC PHONE [phone]
NO FLOW / DISCHARGE FROM SITE
.1617 MAIL SERVICE CENTER BYXHIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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lti?SES PERMIT N{3.: NCO057720 PERMIT VERSION: 4.'
fSCzI.YTY NAME: Hidden Lakes Mobile Home Pazk CLASS: WW-2 PERMIT STATUS: Active
TP COUNTY: Stokes
QW.-+"ER NAME: Joh. He, Oakley ORC: Jon Madison Southern
ORC CERT NUMBER: 986488
. Sr r:ilE.�' ORC HAS CHANGED: No
:DMR PERIOD: 11-20i6(Novcmber2016) VERSION: 1.0
— STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.; 001 NO DISCHARGE*: NO
— ---- --..wW .,.vr w=Noriow;HOLIDAY= NoVisitation— Holiday

DWR Form MR -1 (08/05)
EFFLUENT
Iv'PDES PERMIT NO. NCO057720
DISCHARGE NO.
FACILITY NAME Hidden Lakes v'dlage
--
MONTH October YEAR 2016
CERTIFIED LABORATORY)
( 1_ pace
CLASS
2 COUNTY Stokes
Analytical
(list additional laboratories on the backside/page 2 of this form) .
OPERATOR IN RESPONSIBLE CHARGE (OR
Jon
M. Southern
PERSON(S) COLLECTING SAMPL: Charles
GRAD] 4 CERTIFICATION NO 986466
Homback
CHECK BOX IF ORC HAS CHANGED
(Pace)
ORC PHONE [phone]
Mail ORIGINAL and ONE COPY to:
NO FLOW / DISCHARGE FROM SITE
ATTN: CENTRAL FILES
ZZ
DIVISION OF WATER RESOURCES
/ j�' /a
1617 MAIL SERVICE CENTER
(SI
TUBE OF OPERATOR
RESP SIB CHARGE )
RALEIGH NC 27699-1617
BY
NATURE, I CERTIFY THAT T DATE
SIGHIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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