NC0038822_Fact Sheet_20180312

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Emily DelDuco 12/11/2018
Permit Number
NCO038822
Facility Name
Central Care WWTP
Basin Name/Sub-basin number
03-07-03
Receiving Stream
UT Stewarts Creek
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
No — already resent
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Dissolved Oxygen, Temperature
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
Central Care WWTP had no violations or
enforcements this permit cycle
Any permit modifications since last permit?
None.
New expiration date
2/28/2024
Comments on Draft Permit
➢ Added regulatory citations
➢ Added HUC to outfall description
➢ Updated outfall map
➢ Brought eDMR language current
DMR Summary March 2014 — Nov 2018
Analysis Variable: Value
arameter I
Meanj
Minj
Maxj
N
0010 - Temperature, Water Deg. Centigrade
15.636
1.00
30.00
1563
0300 - Oxygen, Dissolved (DO)
7.139
1.90
16.40
644
0400 - pH
6.634
6.00
8.00
121
1616 - Coliform, Fecal MF, MFC Broth, 44.5 C
74.00
1.00
2420.00
117
0050 - Flow, in conduit or thru treatment plant
0.002
0.00
0.01
974
0060 - Chlorine, Total Residual
11.233
10.00
50.00
484
'0310 - BOD, 5-Day (20 Deg. C) -Concentration
7.889
2.00
40.30
112
'0530 - Solids, Total Suspended - Concentration
6.848
2.00
20.00
112
'0600 -Nitrogen, Total -Concentration
33.405
14.10
65.60
19
'0665 -Phosphorus, Total (as P) -Concentration
5.457
2.35
7.45
19
'GP3B - Pass/Fail Static Renewal 7Dav Chronic Ceriodaahnia
1.00
1.00
1.00
19

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
ROY COOPER NORTH CAROLINA
Gotwitar Environmental Quality
N 1CHAEI_. S- REGAN
Sacrsfw�-'-
L=A CTJLPEPPER
Interim Direclor
August 29, 2018
Billy Payne
Central Care Inc
139 Apex Ln
Mount Airy, NC 27030
Subject: Permit Renewal
Application No. NCO038822
Central Care WWTP
Surry County
Dear Applicant:
The Water Quality Permitting Section acknowledges the August 28, 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. 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://deg.nc.ciov/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.
cc: Central Files w/application
ec: WQPS Laserfiche File w/application
Sincerely,
'x d
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
nrnrH c+wtYr� D_E Q��
`ripa"oVgmim om�mtl O+Wry�
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-707-6301

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
RESEARCh & ANA[yTICAL
I LABORATORIES, INC.
Analytical/Process Consultations
August 5, 2018
Mr. Charles H. Weaver, Jr.
NPDES Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Renewal of NPDES Permit No. NCO038822
Central Care WWTP
Dear Mr. Weaver,
RECEIVEDIDENRIDWR
AUG 218 2018
Water Resources
Permitting
In response to your request for NPDES Permit Renewal concerning Central Care W WTP
(NPDES Permit No. NC0038822), Research & Analytical Laboratories, Inc. (RAL) has prepared
the enclosed required renewal package information for your review, The signed application fornr
in triplicate and a description of the method of sludge disposal are all attached.
Sincerely,
Research & Analytical Labs
James M. Cheshire
Authorized Agent
3iVIC/jm
Cc. David Payne, Central Care Inc.
P.0 Box 473 • 106 Short Street . Kernersville, North Carolina 27284. 336-996-2841 • Fax [phone]
www.randalabs.com

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
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 / NPDE8 Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit 000038822
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
Central Care, Inc.
Facility Name
Central Care W WTP
Mailing Address
139 Apex Lane
City
Mt. Airy
State / Zip Code
NC / 27030
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road
City
State / Zip Code
County
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 Research & Analytical Laboratories, Inc.
Mailing Address
106 Short Street
City
Kernersville
State / Zip Code
NC / 27284
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
[e-mail]
1 of 3 Form-D 11112

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
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 5-10
Residential ® Number of Homes 5
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served: 10-20
S. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
OutfaU Identification number(s) 001
Is the outfall equipped with a diiiuser? ❑ Yes ® No
7. Name of receiving stream(s) (NEW applicants: Provide a map shotUng the exact location of each
outfall):
Unnamed Tributary to Stewarts Creek
S. Frequency of Discharge: ❑ Continuous ® Intermittent
If intermittent:
Days per week discharge occurs: Random Duration: Random
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.
0.010 Wastewater Facility consisting of the following:
• Septic Tank
• Dosing Chamber
• Surface Sandfilter
• Tablet Chlorination
• Tablet Declorination
2 of 3 Form-D 11112

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.010 MGD
Annual Average daily flow 0.0018 MGD (for the previous 3 years)
Maximum daily flow 0.0086 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
NEW APPLICAH'1"S: 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 APPWCANTS: Provide the highest single reading (Daffy Maximum) and Monthly Average over
thepast 36 months for parameters currenthuinjuourpermit. Mark other parameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
40
7.27
mg/L
Fecal Coliform
2
2420
MPN/ 100 ml
Total Suspended Solids
2.8
16.4
mg/L
Temperature (Summer)
19.5
28
°C
Temperature (Winter)
11.26
19
°C
pH
7.8
N/A
Std. Units
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NCO038822 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
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.
James M. Cheshire Authorized Agent
Printed name of Person Signing Title
Applicant
Date
North Cafali6a 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.)
3 of 3 Form-D 11112

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
NCO038822 - Central, Care, Inc.
Latitu • 36027'11" Sub -Basin: 03-07-03
Longitude: W38'W' River Basin: Yadkin -Pee Dee
USG& Quad: Dobson Stream Class: C
Receiving Stream: UT to Stewarts Creek
Facility
` Location
Surry County
a/ i� Map not to Scale

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
RESEARCh & ANA[yTICAL
LABORATORIES, INC.
}
Analytical/Process Consultations
SLUDGE MANAGEMENT PLAN
CENTRAL CARE, INC.
WASTEWATER TREATMENT PLANT
NPDES PERMIT NO. NCO038822
Sludge from the Central Care wastewater treatment plant (WWTP) is disposed of in the
following way:
Central Care WWTP consists of a documented sludge hauling subcontractor
(V&S Septic, Inc.) who periodically removes digested sludge from septic tank and
delivers waste sludge to a documented or approved wastewater treatment
facility. Information found in documented log includes date, time, volume of
sludge removed and location, date and time sludge transported to final
destination. The designated ORC coordinates the frequency in which digested
sludge is removed.
P.O. Box 473 • 106 Short Street . Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randatabs.com

DocuSign Envelope ID: 66A7A58D-3BF1-44CE-AA40-1B3B3374718F
NORTH CAROLINA
SURRY COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Sandra Hurley who being first duly
sworn, deposes and says: that he (she) is Regional Publisher
(Publisher or other officer or employee authorized to make affidavit) of
ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a
newspaper known as MOUNT AIRY NEWS, published, issued, and
entered as periodicals class mail in the city of Mount Airy in said County
and Slaic; that he (she) is authorized to make this affidavit and sworn
statement; that the notice or other legal advertisement, a true copy of which
is attached hereto, was published in MOUNT AIRY NEWS on the
following dates:
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 of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
This 10 day of 41 Q 4&".AAe3�' , 2019
Signature of person making affidav
Sworn toandsubscribed before me, this I6 day of
2019
Notary Public
My Commission expires: January 18, 2023
FERPIS W. SIMPSON
NOTARY PUSLIG
$t(RAY COUNTY, N.G.
CLIPPING OF
LEGAL
ADVERTISEMENT
ATTACHED HERE
Public Notice
North Carolina
Environmental
Management
Commissiori/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the propos6d 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 hear-
ing should there be a signific-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
http://deq. nc.gov/abc)ut/divi-
sions/water-resources/water-
resou rces-perm its/wastewater-
branchlnpdes-wastewater/pub-
lic-notices,or by calling (919)
707-3601. NCO058815: Hope
Valley, Inc. requested renewal
permit for Hope Valley
WWTP/Surry County. Facility
discharges to the Fisher
River/Yadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water quality limited.
NCO038822: Central Care, Inc
requested renewal of permit fc
Central Care WWTP/Surry
County. Facility discharges to
an unnamed tributary to Stew -
arts Creek/Yadkin-Pee Dee
River Basin. Currently ammo-
nia nitrogen, fecal coliform anc
total residual chlorine are wa-
ter quality limited.
Publlsh:12/21/2018