NC0075353_Fact Sheet_20200421

DocuSign Envelope ID: 9DEC7F82-2CD1-4F34-B2FC-51BOC842447A
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
Kristin Litzenberger 2/6/2020
Permit Number
NCO075353
Facility Name
McDowell Assisted Living WWTP
Basin Name/Sub-basin number
03-08-30
Receiving Stream
North Muddy Creek
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
No
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?
No
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
No enforcement cases since 2017. Three
violations in 2019 (1 OV, 1 MV, 1 LV)
Any permit modifications since last permit?
None.
New expiration date
12/31/2024
Comments on Draft Permit
➢ Added regulatory citations.
➢ Added parameter codes.
➢ Updated Section A. (2.).
➢ Updated footnotes.

DocuSign Envelope ID: 9DEC7F82-2CD1-4F34-B2FC-51BOC842447A
ROY COOPER
Govemor
MICHAEL S. REGAN
SEC-mary
LINDA CULPEPPER
Director
Linda Isaacs
McDowell Assisted Living LLC
PO Box 909
Marion, NC 28752-0909
Subject: Permit Renewal
Application No. NCO075353
McDowell Assisted Living WWTP
McDowell County
Dear Applicant:
NORTH CAR+OLINA
Environmental Quality
April 08, 2019
The Water Quality Permitting Section acknowledges the March 13, 2019 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. 15OB-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.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, 1
�f lU1 N �U
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
North CaroBns Department of Envirorkmental Quality I Div soon 6f 1'+'at=r F�sa4ra.5
AshsvT1e Reg.onai'Jffroa 120B0 U S. 70 Hi.&hviay I Sveannanoa, North Csrotina 2S77S
.�.a.oesauwacwalrsw, � QiCIY '86-TiIWYl

DocuSign Envelope ID: 9DEC7F82-2CD1-4F34-B2FC-51BOC842447A
James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
E-Mail: [e-mail]
McDowell Assisted Living
NCO075353
RECEIVED/CENR/1)WR
MAR 13 2019
Water Rezources
P@rmitting Section
Enclosed you will find your permit renewal. It is due to the state by 04/15/2019.
There are a couple of items that you will need to put on the form:
Section 1 & 3 —fax number and email address if needed
Section 4 — fill in number of employees, and the number of persons served
Section 13 — Print name & Title, sign & date
Original and 2 copies of everything enclosed needs to be sent to the address at the top of the 1st
page of the Application Renewal. I have also included a letter requesting that the permit be
renewed, one letter stating the sludge removal plan and a map of the Outfall. These 2 letters can
be adapted if you would like to do your own. If there are changes that you would like me to
make, I can do that and email the corrected form back to you.
This packet needs to be mailed to the State as soon as possible. We do recommend that you mail
it Certified with Return Receipt requested. Also, please email or mail us a copy of the completed
application for our records. It will be several months before you receive your new permit from
the State. Once you receive the new permit, please send us a copy for our records as we do not
receive one from the State.
If you have questions, please give me a call at the number below.
Thank you,
---
Ashley Ogle
Administrative Assistant
James & James Environmental Management, Inc.
[e-mail]
828.697.0063
828.697.0065 - Fax

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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 INCO075353
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
McDowell Assisted Living, LLC
Facility Name
McDowell Assisted Living
Mailing Address
P. O. Box 909
City
Marion
State / Zip Code
NC 28752
Telephone Number
828-652-3033
Fax Number
[phone]
e-mail Address
maIS235@,hotmafl.com
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 52 NC Highway 226 5o u
City Marion
State / Zip Code I v C alb 7 a
County McDowell
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 McDowell Assisted Living, LLC
Mailing Address P. O. Box 909
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Marion
NC 28752
828-652-3033
[phone]
[e-mail]
1 of 3 Form-D 11/12

DocuSign Envelope ID: 9DEC7F82-2CD1-4F34-B2FC-51BOC842447A
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 X
Number of Employees pZ�p
Residential
Number of Homes
School
Number of Students/Staff
Other X
Explain: Residents 49
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Assisted Living Home
Number of persons served:
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):
North Muddy Creek in Catawba River Basin
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 sufficient, attach the description of the treatment system in a
separate sheet of paper.
0.010 MGD facility with extended aeration basin, clarifier, chlorination equipment and
sludge digester
2 of 3 Form-D 11112

DocuSign Envelope ID: 9DEC7F82-2CD1-4F34-B2FC-51BOC842447A
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 0.0014 MGD (for the previous 3 years)
Maximum daily flow 0.007 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes
X 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
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
22.3
12.7
MG/L
Fecal Coliform
102
2.5
CFU/ 100ML
Total Suspended Solids
36.7
21.6
MG/L
Temperature (Summer)
27.1
24.9
C
Temperature (Winter)
14.0
13.0
C
pH
8.1
7.6
UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO075353
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.
Ndg'/A A )nje4
Printed name of Person Signing Title
n
Signature of Applicant
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.)
3 of 3 Form-D 11112

M DocuSign Envelope ID: 9DEC7F82-2CD1-41F34-132FC-51BOC842447A
March 1, 2020
Miscellaneous Notices
Public Notice North Carolina Environmental Management Commission/NPDES Unit 1617 Mail
Service Center Raleigh, NC 27699-1617 Notice of Intent to Issue a NPDES Wastewater Permit The
North Carolina Environmental Management Commission proposes to issue a NPDES wastewater
discharge permit to the person(s) listed below. Written comments regarding the proposed 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 hearing should there be a significant degree of public
interest. Please mail comments and/or information requests to DWR at the above address.
Interested persons may visit the DWR at 512 N. Salisbury Street, Raleigh, NC to review information
on file. Additional information on NPDES permits and this notice may be found on our website:
http:I/deq. nc.gov/about/d ivisions/water-resources/water-resources-perm its/wastewate r-
branchlnpdes-wastewaterlpublic-notices, or by calling [phone]. McDowell Assisted Living,
LLC requested renewal of permit for its wastewater treatment plant in McDowell
County; this permitted discharge is treated wastewater to North Muddy Creek in the Catawba River
Basin. McDowell County Adult Care One, LLC requested renewal of permit NC00351571Cedarbrook
WWTPIMcDowell County. Facility discharges to an unnamed tributary to South Muddy
Creek/Catawba River Basin. Currently ammonia nitrogen, fecal coliform, and total residual chlorine
are water quality limited. Publish: March 1, 2020.