NC0059536_Renewal Application_20181211

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S_REGAN
Secretary
LINDA CULPEPPER
Interim Director
December 11, 2018
Tisha Tuttle
Tisha T Tuttle
1025 Lamb Rd
Lexington, NC 27292
Subject: Permit Renewal
Application No. NC0059536
Hilltop Living Center WWTP
Davidson County
Dear Applicant:
The Water Quality Permitting Section acknowledges the December 10, 2018 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. 150E-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://deq.nc.gov/permits-regulations/permit-guidance/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.
Sincerely, 6-32c
-Alta-
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
DEQ
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300

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 INC0059536
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 Plemmons Enterprises, Inc. t/a Hilltop Living Center by Tisha
Tuttle, President
Facility Name Hilltop Living Center
Mailing Address 1025 Lamb Rd
City Lexington
State / Zip Code NC
Telephone Number 336-853-7670 ext 26 RECEIVED/DENRJDWR
Fax Number [phone] DEC 10 2018
e-mail Address [e-mail] Water Resources
Prsrinitting Section
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 212 Plemmons Dr.
City Linwood
State / Zip Code NC 27299
County Davidson
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 Luther Leonard
Mailing Address 502 Northside Dr.
City Lexington
State / Zip Code NC 27295
Telephone Number (336-)239-0842
Fax Number ( )
e-mail Address [e-mail]
1 of 5 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 ❑ Number of Homes
School ❑ Number of Students/Staff
Other Xg) Explain: Assisted
Living
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Waste water for Assisted Living 65 bed capacity
Number of persons served: 65
5. Type of collection system
X] Separate (sanitary sewer only) El Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) See Map
Is the outfall equipped with a diffuser? El Yes X❑ No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
n/a - renewal application maps on file (Yadkin river)
8. Frequency of Discharge: X® Continuous El Intermittent
If intermittent:
Days per week discharge occurs: 7 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.
Two Septic Tanks
Flow Splitter
Grease Trap
Two pump tanks
Two Surface Sand filters
Recirculation diversion box
Tablet chlorinator
Chlorine Contact tank
Dechlorine
2 of 5 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
3 of 5 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Iriforination: 0, 0 3
Treatment Plant`Design flow MGD
Annual Average daily flow 0. Dv,117 MGD (for the previous 3 years
Maximum daily flow O. 00 / MGD (for the previous 3 years) ,
11. Is this facility located on Indian country?
❑ Yes XEj9,. 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
the past 36 months for parameters currently in your permit. Mark other parameters "N/A".
Parameter Daily Monthly , Units of
Maxi um {i. Average Measurement
Biochemical Oxygen Demand (BOD5) (S-7,Sm' 16u-/5.0 t")/0.6►``�o
Fecal Coliform C,/U .o o 4.L 1116 Alb m L
Total Suspended Solids (RA I. 3 O. U 141
Temperature (Summer) •
Temperature (Winter)
pH 4. 0 cr,N,{ q,
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NC0059536 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
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.
Plemmons Enterprises, Inc t/a Hilltop Living Center by Tisha Tuttle
President
Printed name of Person Signing Title
Signatuf 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
4 of 5 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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.0 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.)
1
•
5 of 5 Form-D 11/12