NC0060259_Regional Office Historical File Pre 2016

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
RE_ C- CEi
Mail the complete application to: N.0
N. C. DENR / Division of Water Quality / NPDES Unit NOV (�
1617 Mail Service Center, Raleigh, NC 27699-1617 2 2015 r
Winston -fate n
NPDES Permit NCO060259L Re Tonal Office I
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
NC Land Lease, LLC
Facility Name
Willow Oak Mobile Home Park WWTP
Mailing Address
PO BOX 2533
OCT
City
Christiansburg
Water 4 a1ii\J
S
Permlttinc! 'oT
State / Zip Code
VA 24068
Telephone Number
540-552-3034
Fax Number
540-552-5528
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road Dares ;1 C , V P_ - /A � R T • !,50
City
State / Zip Code AlJ �rC / ZS n D
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
Paul Smith
Mailing Address PO Box 269
1 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
City Reidsville
State / Zip Code North Carolina 27323
Telephone Number ( 336) 932-9347
Fax Number ( )
e-mail Address smithindustriekbellsouth net
2 of 6 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 applztr
Industrial Number of Employees
Commercial Number of Employees
Residential ✓ Number of Homes c3
School Number of Students/Staff b
Other Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served: + [5
5. Type of collection system
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 No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfallr
Little Troublesome Creek
S. Frequency of Discharge: Continuous Intermittent
If intermittent:
Days per week discharge occurs: 5 Duration: 24 hrs
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.
3 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Manual bar screen, Two stage Facilitative lagoon, Alum Feed & alum feed tanks, chlorine
disinfection, tablet dechlorination.
4 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.0175 MGD
Annual Average daily flow .011 MGD (for the previous 3 years)
Maximum daily flow 0.014 MGD (for the previous 3 years)
11. Is this facility located on ian country?
Yes 00
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 nermit- Mnrk nthpr nnrnrnotorc aN/ A»
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (SODS)
10.7
m9/1
Fecal Coliform
124
15.7
200/100 ml
Total Suspended Solids
9.8
7.5
mg/1
Temperature (Summer)
29
25
C
Temperature (Winter)
14
13
C
pH
7.5
NA
SU
13. List all permits, construction approvals and/or applications:
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.
s' )a. n-, e-5 &1L�
Printed name of Person Signing
of Applicant
Title
—,� —/
5 of 6 Form-D 11/12

qqqq
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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.)
6 of 6 Form-D 11/12

North Carolina Department of Environmental Quality
Pat McCrory
Governor
James Radford, Managing Member
NC Land Lease, LLC
PO Box 2533
Christiansburg, VA 24068
Dear Permittee:
October 26, 2015
Donald R. van der Vaart
Secretary
N.C.Dept. of ENR
NOV 011015
Winston-Salem
Subject: Acknowledgement of Permit Renewal
Application No. NCO060259
Willow Oak Mobile Home Park WWTP
Rockingham County
The Water Quality Permitting Section has received your permit renewal application on October
23, 2015. A member of the NPDES Unit will review your application. They 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
Wren Thedford at 919-807-6304 or [e-mail].
Sincerely,
W re*L, -rkz&f gr,),
Wren Thedford
Wastewater Branch
cc: Central Files
Winston Salem Regional Office, Water Quality Regional Operations Section
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]Customer Service: 1-877-623-6748
Internet:: www.ncwater.orq
An Equal Opportunity�Affirmative Action Employer

North Carolina Department of Environmental Quality
Pat McCrory
Governor
James Radford, Managing Member
NC Land Lease, LLC
PO Box 2533
Christiansburg, VA 24068
Dear Permittee:
October 26, 2015
Donald R. van der Vaart
Secretary
KECEIVEC
N.C.Cept. of ENR
NOV 0 2 2015
Winston-Salem
Subject: Acknowledgement of Permit Renewal
Application No. NCO065412
Peasant Ridge WWTP
Rockingham County
The Water Quality Permitting Section has received your permit renewal application on October
23, 2015. A member of the NPDES Unit will review your application. They 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
Wren Thedford at 919-807-6304 or [e-mail].
Sincerely,
wre2 TktAf rd'
Wren Thedford
Wastewater Branch
cc: Central Files
Winston Salem Regional Office, Water Quality Regional Operations Section
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone]M Fax: [phone]ICustomer Service: 1-877-623-6748
Internet:: www.ncwater.orq
An Equal Opportuni"ffirmative Action Employer

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 NCO065412
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.
n=��ivEp
N4C
1. Contact Information:
NOV U 7 2015
Owner Name NC Land Lease, LLC Winston 9aiern
Facility Name Pleasant Ridge WWTP
Mailing Address PO BOX 2533 RECEIVEDIDENRIDWR
city Christiansburg O C T t 015
Water UUaii'Y
State / Zip Code VA 24068 permitting Section
Telephone Number 540-552-3034
Fax Number 540-552-5528
e-mail Address [e-mail]
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:
_ oAaoc L -N ole, -off o� RT o
6;1SV'I R e
c / a73,�o
4CLIQ�arv­\
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
Mailing Address
Paul Smith
PO Box 269
1 of 6 Form-D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 200% domestic wastewaters <1.0 MGD
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Reidsville
North Carolina 27323
( 336 ) 932-9347
smithindustriekbellsouth.net
2 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
PpFoprprivately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.0235 MGD
Annual Average daily flow .013 MGD (for the previous 3 years)
Maximum daily flow 0.014 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
Yes 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 currentlu in uour hermit_ Mark nthpr nnramotorc 'AT/A"
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
5.3
4
m9/1
Fecal Coliform
133
16
200/100 ml
Total Suspended Solids
10
5
mg/1
Temperature (Summer)
28
25
C
Temperature (Winter)
18
16
C
pH
7.3
N/A
SU
13. List all permits, construction approvals and/or applications:
5M
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.
Printed name of Person Signing
Applicant
Title
Date
5 of 6 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewater
s
<1.0 MGD
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 deviceor 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.)
6 of 6 Form-D 11/12

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E. Dee Freeman
Governor Director Secretary
27 September 2012
Mr. Christopher Berry
Affordable Communities Group
301 Felspar Way
Cary, NC 27518
Subject: Compliance Evaluation Inspection
NPDES Permit #NC0065412 — Willow Clubhouse Wastewater Treatment Plant
NPDES Permit 4NCO060259 Wastewater Treatment Plant
Rockingham County
Dear Mr. Berry:
Mr. Mike Thomas of the Winston-Salem Regional Office of the North Carolina Division of Water
Quality conducted a compliance evaluation inspection of the Willow North and Willow Clubhouse
Wastewater Treatment Plants on 11 September 2012. These facilities are located off NC Highway 150 in
the town of Reidsville, in Rockingham County, North Carolina. The cooperation of the Operator in
Responsible Charge, Mr. Paul Smith was greatly appreciated.
Mr. Smith informed Mr. Thomas that you have recently acquired these two facilities. According to Mr.
Smith you have completed the required forms for change of ownership but have not returned them to this
Division. Please be advised that those forms must be returned as soon as possible so that the ownership
change can be processed.
Willow Clubhouse Site Review
The plant is well operated and managed however, there are several issues that need to be addressed.
Although everything seems to function sufficiently, some components are in various states of disrepair.
Most notably the plant structure itself is severely rusted/corroded. The grating that makes up the walkways
has severely deteriorated and been replaced with wooden planks that are not any safer. This situation
presents a danger to anyone visiting the facility. Please be advised of the urgency of this situation. Failure
to address the corrosion problem could result in the facilities inability to remain in compliance or in the
failure of the entire treatment system.
Willow North Site Review
Overall the facility appears to be in good shape and operating appropriately. Both of the lagoons were
in good shape with the exception of some minor erosion in a few spots. Mr. Smith believes that the erosion is
being caused by large turtles climbing in and out. The major components of this facility appear to be in good
shape. However, Mr. Thomas did note that there were open pits with no fall protection at the site which are
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] Customer Service:1-877-623-6748 NorthCarolina
Internet www.ncwaterquality.org Naturaltrf
An Equal Opportunity 1 Affirmative Action Employer

11
potential hazards for anyone visiting the facility. It is also important to note that there was a significant blue-
green algae bloom taking in the first lagoon. Although there are no documented reports of people getting sick
from blue-green algae in North Carolina, people should follow these common-sense, practical precautions
around blue-green algae blooms:
• Don't wade or swim in water containing visible blooms, and avoid direct contact with dense mats
of algae.
• Don't drink untreated water or let children, livestock or pets get into or drink untreated water.
• Make sure children are supervised at all times when they are near water. Drowning, not exposure
to algae, remains the greatest hazard of water recreation.
• If you do come into contact with the algae or water around a bloom, simply rinse off with fresh
water as soon as possible.
Documentation Review for Willow North and Willow Clubhouse
Mr. Thomas evaluated laboratory data during the inspection. Comparison of available lab reports and
field monitoring data with discharge monitoring reports (DMR) showed no concerns or errors. Chain of
custody records were available and complete. Mr. Smith provided calibration forms for his monitoring
equipment which were accurate and complete. Visitation and maintenance logs were also provided by Mr.
Smith.
We greatly appreciate your efforts to operate and maintain these two wastewater treatment plants.
Please reply in writing to this letter within 30 days of receiving it. Your reply should detail corrective actions
and implementation schedules for each deficiency detailed above.
Sincerely,
,f
I
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments:
1. BIMS Inspection Report
Cc: WSRO — SWP w/ atch
Central Files w/ atch
NPDES West Unit

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Complinare Insperfion Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 I S I 31 NCO060259 111 121 12/09/11 117 18I C I 191S I 201 I
Remarks
211IIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIII6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 61 QA —--------- —-------------- Reserved ----------- ---------
67 I 169 701 I 71 UI 72 UN 73 LU 74 751 I I I I I I 180
�--�
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:30 AM 12/09/11
11/05/01
Willow Oak Mobile Home Park
Exit Time/Date
Permit Expiration Date
200 Southfork Dr
Reidsville NC 27320
12:15 PM 12/09/11
16/04/30
Name(s) of Onsite Representative(s)/Titles(syPhone and Fax Number(s)
Other Facility Data
///
Paul Matthew Smith/ORC/336-932-9347/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Eric Fairman,3714 Walkers Cove Trl Charlotte NC 28266H248-399-7755/2483999975 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenance 0 Records/Reports
Self -Monitoring Program E Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Michael S Thomas WSRO WQ///
Signature of Q A Reviewer Agency/Office/Phone and Fax Numbers Date
gManagement
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
31 NCO060259 11 12, 12/09/1, 117
Inspection Type
18t
71
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

Permit: NC0060259
Inspection Date: 09/11/2012
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment:
Lagoons
Type of lagoons?
# Number of lagoons in operation at time of visit?
Are lagoons operated in?
# Is a re -circulation line present?
Is lagoon free of excessive floating materials?
# Are baffles between ponds or effluent baffles adjustable?
Are dike slopes clear of woody vegetation?
Are weeds controlled around the edge of the lagoon?
Are dikes free of seepage?
Are dikes free of erosion?
Owner - Facility: Willow Oak Mobile Home Park
Inspection Type: Compliance Evaluation
Are dikes free of burrowing animals?
# Has the sludge blanket in the lagoon (s) been measured periodically in multiple locations?
# If excessive algae is present, has barley straw been used to help control the growth?
Is the lagoon surface free of weeds?
Is the lagoon free of short circuiting?
Comment:
Disinfection -Tablet
Are tablet chlorinators operational?
Are the tablets the proper size and type?
Number of tubes in use?
Yes No NA NE
Yes No NA NE
Facultative
FA
Yes No NA NE
Page # 3

Permit: NC0060259 Owner - Facility: Willow Oak Mobile Home Park
Inspection Date: 09/11/2012 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
Is there chlorine residual prior to de -chlorination?
Comment:
De -chlorination
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
Are the tablets the proper size and type?
Comment: Both are housed in the same storage building.
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment:
Flow Measurement - Influent
# Is flow meter used for reporting?
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: System uses a 22.5 degree V-nothc weir for flow measurement.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
Yes No NA NE
Tablet
Yes No NA NE
Yes No NA NE
Yes No NA NE

Permit: NCO060259
Inspection Date: 09/11/2012
Owner - Facility: Willow Oak Mobile Home Park
Inspection Type: Compliance Evaluation
Effluent Sampling
Yes
No
NA
NE
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
0000
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
■
n
n
Q
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
0
Is the facility as described in the permit?
■
❑
❑
Q
# Are there any special conditions for the permit?
0
Q
■
0
Is access to the plant site restricted to the general public?
■
0
0
0
Is the inspector granted access to all areas for inspection? ■ 0 0 Q
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ 0 0 ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ 0 0 ❑
Judge, and other that are applicable?
Comment:
Page # 5

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Comploanre insper-fion Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 15 I 31 NCO065412 111 121 12/09/1, 117 181 C I 19! Li 20I
Remarks
21111111111111111111111111 1111111111111111 11111jI6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----------- -------------- Reserved ----------- --- -----
67I 169 701 I 71 IU 72I N I 73 L U 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:00 AM 12/09/11
11/05/01
Pleasant Ridge WWTP
Exit Time/Date
Permit Expiration Date
200 Southfork Dr
Reidsville NC 27320
11:30 AM 12/09/11
16/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Paul Matthew Smith/ORC/336-932-9347/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Eric Fairman,3714 Walkers Cove Trl Charlotte NC 28266//248-399-7755/2483999975 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program ■ Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Michael S Thomas WSRO WQ///
2� Zo/Z
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
3 1 NC0065412 1
11 121
12/09/11 1 17
Inspection Type
18u
71
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

FF
Permit: NC0065412
Inspection Date: 09/11/2012
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment:
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Owner - Facility: Pleasant Ridge WWTP
Inspection Type: Compliance Evaluation
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment:
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Yes No NA NE
Yes No NA NE
Ext. Air
Diffused
■nnn
nn■n
■nnn
■nnn
■nnn
nnn■
n n n ■
Yes No NA NE
Page # 3

Permit: NC0065412
Inspection Date: 09/11/2012
Owner - Facility: Pleasant Ridge WWTP
Inspection Type: Compliance Evaluation
11
Secondary Clarifier
Yes
No
NA
NE
Is the overflow clear of excessive solids/pin floc?
■
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately'/. of the sidewall depth)
n
n
n
■
Comment:
Pumps-RAS-WAS
Yes
No
NA
NE
Are pumps in place?
■
❑
❑
n
Are pumps operational?
■
n
n
n
Are there adequate spare parts and supplies on site?
■
❑
❑
❑
Comment:
De -chlorination
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
■
❑
❑
❑
Is storage appropriate for cylinders?
n
o
■
❑
# Is de -chlorination substance stored away from chlorine containers?
❑
■
❑
❑
Are the tablets the proper size and type?
■
n
n
❑
Comment: Both are housed in the same storage building.
Are tablet de -chlorinators operational?
■
00
❑
Number of tubes in use?
2
Comment:
Flow Measurement - Influent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
n
n
Is flow meter calibrated annually?
n
n
■
❑
Is the flow meter operational?
■
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
■
❑
Comment: Facility utilizes a 22.5 degree V-notch weir.
Anaerobic Digester
Yes
No
NA
NE
Type of operation:
No cover
Is the capacity adequate?
❑
❑
❑
■
# Is gas stored on site?
❑
❑
❑
■
Is the digester(s) free of tilting covers?
❑
n
❑
■
Is the gas burner operational?
❑
❑
n
■
Page # 4

Permit: NCO065412
Inspection Date: 09/11/2012
Owner - Facility: Pleasant Ridge WWTP
Inspection Type: Compliance Evaluation
Anaerobic Digester
Is the digester heated?
Is the temperature maintained constantly?
Is tankage available for properly waste sludge?
Comment: Disregard wrong catagorie chosen in BIMS.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
Comment:
Record Keeping
Are records kept and maintained as required by the permit?
Is all required information readily available, complete and current?
Are all records maintained for 3 years (lab. reg. required 5 years)?
Are analytical results consistent with data reported on DMRs?
Is the chain -of -custody complete?
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
Yes No NA NE
Yes No NA NE
Yes No NA NE
Yes No NA NE
■
■nnn
Page # 5

Permit: NCO065412
Inspection Date: 09/11/2012
Owner - Facility: Pleasant Ridge WWTP
Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Has the facility submitted its annual compliance report to users and DWQ?
n
n
■
n
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
n
n
■
n
Is the ORC visitation log available and current?
■
n
n
n
Is the ORC certified at grade equal to or higher than the facility classification?
■
n
n
n
Is the backup operator certified at one grade less or greater than the facility classification?
■
n
n
n
Is a copy of the current NPDES permit available on site?
■
n
n
n
Facility has copy of previous year's Annual Report on file for review?
n
Cl
■
❑
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n ■ n
Is the facility as described in the permit?
■
n n
n
# Are there any special conditions for the permit?
n
■ n
n
Is access to the plant site restricted to the general public?
■
n n
n
Is the inspector granted access to all areas for inspection?
■
n n
n
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n n ■ n
Judge, and other that are applicable?
Comment:
Standby Power
Is automatically activated standby power available?
Is the generator tested by interrupting primary power source?
Is the generator tested under load?
Was generator tested & operational during the inspection?
Do the generator(s) have adequate capacity to operate the entire wastewater site?
Is there an emergency agreement with a fuel vendor for extended run on back-up power?
Is the generator fuel level monitored?
Comment: No back up power is available at this facility.
Yes No NA NE
Page # 6
11

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Governor
CHRIS BARRY
OPERATIONS OFFICER
ACG GREENSBORO, LLC
301 FELSPAR WAY
CARY, NC 27518
Dear Mr. Barry:
Tom Reeder
Director
October 23, 2013
John E. Skvarla, III
Secretary
RECEIVED
N.C.Dept. of ENR
NOV 0 6 2013
Winston-Salem
Regional Office
Subject: NPDES Permit Modification- Name and/or
Ownership Change
Permit Number NCO060259
ACG Greensboro, LLC
Guilford County
Division personnel have reviewed and approved your request to transfer ownership of the subject permit, received
on October 17, 2012. This permit modification documents the change of ownership.
Please find enclosed the revised permit. All other terms and conditions contained in the original permit remain
unchanged and in full effect. This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
807-6304.
Tom Reeder
cc: Central Files
Winston-Salem Regional Office
NPDES Unit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6; 48
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Af rn alive Action Employer
Nne
orthCarolina

Permit NCO060259
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
ACG North Carolina, LLC
is hereby authorized to discharge wastewater from a facility located at the
Willow Oaks
109 South Fork Drive
Reidsville
Rockingham County
to receiving waters designated as Little Troublesome Creek in subbasin 03-06-01 of the Cape Fear
River Basin in accordance with effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III and IV hereof.
This permit shall become effective October 24, 2013.
This permit and authorization to discharge shall expire at midnight on April 30, 2016.
Signed this day Monday, October 23, 2013
9/Reeder, Director
ision of Water Quality
Authority of the Environmental Management Commission

Permit NCO060259
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked, and as of this
issuance, any previously issued permit bearing this number is no longer effective. Therefore, the exclusive authority to
operate and discharge from this facility arises under the permit conditions, requirements, terms, and provisions included
herein.
ACG North Carolina, LLC is hereby authorized to:
1. Continue to operate an existing 0.0175 MGD wastewater treatment facility with the following
components:
♦ Manual bar screen
♦ Two -stage facilitative lagoon
♦ Alum feed & alum feed tanks
♦ Chlorine disinfection
♦ Tablet dechlorination
This facility is located southwest of Williamsburg off NC Highway 150 at the Willow Oak Mobile
Home Park WWTP in Rockingham County.
2. Discharge from said treatment works at the location specified on the attached map into Little
Troublesome Creek, classified WS-V NSW waters in hydrologic unit 03030002 of the Cape Fear
River Basin.

Permit NCO060259
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is
authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as
specified below:
Flow 0.0175 MGD
Weekly Instantaneous
Influent or
[50050]
Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
[CO310]
Total Suspended Solids
90.0 mg/L
135.0 mg/L
2/Month
Grab
Effluent
[C0530
NH3 as N (April 1 — October 31)
7.2 mg/L
35 mg/L
2/Month
Grab
Effluent
[C0610]
NH3 as N (November 1 — March 31)
2/Month
Grab
Effluent
[C0610]
Fecal Coliform (geometric mean)
200 / 100 ml
400 / 100 ml
2/Month
Grab
Effluent
[31616]
Total Residual Chlorine' 1
1
28 µg/I I
2/Week
I Grab
Effluent
Temperature (°C)
Weekly
Grab
Effluent
[00010]
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Grab
Effluent
[C0600
Total Phosphorus
Quarterly
Grab
Effluent
[C0665]
pH
> 6.0 and < 9.0 standard units
2,,[Month
Grab I
Effluent
Footnotes:
1. The facility shall report all effluent TRC values reported by a NC certified laboratory including field
certified. However, effluent values below 50 µg/L will be treated as zero for compliance purposes.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
A. (2) NUTRIENT REOPENER CONDITION
Pursuant to N.C. General Statutes Section 143-215.1 and the implementing rules found in the North Carolina
Administrative Code at 15A NCAC 2H.0112 (b) (1) and 2H.0114 (a) and Part II sections B-12. and 13-13 of this
permit, the Director may reopen this permit to require supplemental nutrient monitoring of the discharge. The
purpose of the additional monitoring will be to support water quality modeling efforts within the Cape Fear
River Basin and shall be consistent with a monitoring plan developed jointly by the Division and affected
stakeholders. In addition, the results of water quality modeling may require that limits for total nitrogen and
total phosphorus be imposed in this permit upon renewal.

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All
NCO060259 — Willow Oak Mobile
Latitude: 36' 16' 26" Longitude: 79° 36' 33"
Sub -Basin: 03-06-01 Stream Class: WS-V NSW
Hydrologic Unit: 03030002 River Basin: Cape Fear
USGS Quad: Williamsburg, N.C.
Receiving Stream: Little Troublesome Creek
Facility Z.
, r
Location
N099A Map not to scale

flE. W a r! 4 Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
_ North Carolina Department of Environment and Natural Resources
y 'f
Charles Wakild, P.E., Director
Division of Water Quality
a
S RFAC JI '!WATER PROTEC TI(. N .SE+CTIO V
PER' I TINA.y' M/l?WNER` I Il C.T3 A-.N
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
C p1 O b 10 1 2-5 1 CI I C G 1 5
II. Permit status prj2E to status change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
First M1 Last
Title
Permit Holder Mailing Address
City State Zip
Phone Fax
c. Facility name (discharge):
d. Facility address:
Address
City State Zip
e. Facility contact person: ( )
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: i.Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
G!,- �•s rh Y .,-ram
First \MI Last
b D z. `lam � t �-3"r'r• �e er
Title
look -
Permit Holder Mailing Address
City State Zip
(fit c) 9dy &07 e' �i, ;s , .a r,.;_'cC&,C-e,,,I , fv.
Phone 1 E-mail Address
n 4 S
l09 5o✓-�'Ft�yrl� 17�.
Address
41;�� JIle
City State Zip
R'- " 1 _45', , -/-A
First MI Last
Phone E-mail Address
Revised 512012

NAME/OWNERSHIP CHANGE FORM
)f 2
'ermit contact information (if different from the person legally responsible for the permit)
ermit contact:
First MI Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, !ad#L A ti - kK�VTi� , attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
this application package will be returned as incomplete.
Signature Date
APPLICANT CERTIFIC T� ION,
I, � Xc'f.`7 , attest that this application for a name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included,
this application kage will be returned as incomplete.
'<
Signature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 5/2012

Mickey, Mike
From: Weaver, Charles
Sent: Thursday, February 19, 2015 7:41 PM
To: Mickey, Mike
Subject: RE: Address changes in BIMS
BIMS has been updated. Thanks for the info, Mike.
CHW
Messages sent to or from this address are subject to the North Carolina Public Records Law.
From: Mickey, Mike
Sent: Thursday, February 19, 2015 1:14 PM
To: Weaver, Charles
Cc: Graznak, Jenny; Snider, Lon
Subject: Address changes in BIMS
Charles — Can you update the mailing addresses in BIMS for the four NPDES facilities listed below?
NCO022098 — Cranbrook Village — Guilford
NCO056201— Countryside MHP — Randolph
NCO065412 — Pleasant Ridge — Rockingham
NCO060259 — Willow Oaks — Rockingham
The new address should be: 2054 Kildaire Farm Rd., #413
Cary, NC 27518
See email below from Chris Barry noting the change. Thanks, Mike.
[e-mail]
NC DENR Winston-Salem Regional Office
Division of Water Resources —Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone]
From: Chris Barry [mailto:[e-mail]]
Sent: Thursday, February 19, 2015 12:46 PM
To: Mickey, Mike
Subject: Re: Cranbrook Village WWTP
Yes, Our new address is 2054 Kildaire Farm Rd. #413 Cary, NC 27518.
Also we have Willow Oaks and Pleasant Ridge in Reidsville and Countryside MHP in Randolph Co.
I apologize for not notifying you of the change and I appreciate your help in getting them updated.
Thanks for the email
Regards,
Chris Barry
919-924-8907

Chris Barry
Chief Operating Officer
Affordable Communities Group
www.acgmhc.com
E-Mail: chrisbgn292gmail.com
Cell: 919-924-8907
Fax: [phone]
On Thu, Feb 19, 2015 at 12:18 PM, Mickey, Mike <mike.mickey(j ,ncdenr. gov> wrote:
Chris — The attached inspection letter was returned as undeliverable. Has your mailing address changed for
NPDES permit correspondence?
Should the address for Countryside MHP in Randolph be updated also? Any others?
Thanks, Mike.
[e-mail]
NC DENR Winston-Salem Regional Office
Division of Water Resources — Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone]

PPPPPPF'
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
July 2, 2013
CERTIFIED MAIL #7012 2920 0000 3656 1424
RETURN RECEIPT REQUESTED
Chris M. Barry, Officer of Operations
Affordable Communites Group LLC
301 Felspar Way
Cary, NC 27518
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(6)
and NPDES Permit NCO060259
Affordable Communites Group LLC
Willow Oak Mobile Home Park
Case No. MV-2013-0009
Rockingham County
Dear Mr. Barry:
John E, Skvarla, III
Secretary
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $185.72 ($50.00 civil penalty + $135.72
enforcement costs) against Affordable Communites Group LLC.
This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report (DMR) submitted
by Affordable Communites Group LLC for Willow Oak Mobile Home Park for the month of March 2013. This review has shown the
subject facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES Permit NC0060259.
The violations, which occurred in March 2013, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that the Affordable Communites Group LLC violated the terms, conditions
or requirements of NPDES Permit NCO060259 and G.S. 143-215.1(a)(6) in the manner and extent shown in Attachment A. In
accordance with the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may be assessed against any person who violates
the terms, conditions or requirements of a permit required by G.S. 143-215.l(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the Secretary of the
Department of Environment and Natural Resources and the Director of the Division of Water Quality, I, W. Corey Basinger, Division
of Water Quality Regional Supervisor for the Winston-Salem Region, hereby make the following civil penalty assessment against
Affordable Communites Group LLC:
$100.00
For 1 of the 1 failures to properly monitor Total Nitrogen in violation of NPDES Permit No.
NC0060259.
69.00
For 1 of the 1 failures to properly monitor Total Phosphorus in violation of NPDES Permit
No. NC0060259.
169.00
TOTAL CIVIL PENALTY
135.72
Enforcement Costs
$304.72
TOTAL AMOUNT DUE
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.newaterquality.org
Nne
orthCarolina
Naturally
An Equal Opportunity � Affirmative Action Employer

Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact and
Conclusions of Law and the factors set forth at G.S. 14313-282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property resulting from
the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the Environmental Management
Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Within thirty days of receipt of this notice, you must do one of the following:
1. Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural Resources (do not include waiver form).
Payment of the penalty will not foreclose further enforcement action for any continuing or new violation(s). Please submit payment to
the attention of
NC DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
OR
2. Submit a written request for remission including a detailed justification for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may relate to the
reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper procedure for contesting whether
the violation(s) occurred or the accuracy of any of the factual statements contained in the civil penalty assessment document. Because
a remission request forecloses the option of an administrative hearing, such a request must be accompanied by a waiver of your right
to an administrative hearing and a stipulation and agreement that no factual or legal issues are in dispute. Please prepare a detailed
statement that establishes why you believe the civil penalty should be remitted, and submit it to the Division of Water Quality at the
address listed below. In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b) were wrongfully applied to the
detriment of the violator;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator has been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The Director of the
Division of the Division of Water Quality will review your evidence and inform you of his decision in the matter of your remission
request. The response will provide details regarding the case status, directions for payment, and provision for further appeal of the
penalty to the Environmental Management Commission's Committee on Civil Penalty Remissions (Committee). Please be advised
that the Committee cannot consider information that was not part of the original remission request considered by the Director.
Therefore, it is very important that you prepare a complete and thorough statement in support of your request for remission.
In order to request remission, you must complete and submit the enclosed "Request for Remission, Waiver of Right to an
Administrative Hearing, and Stipulation of Facts" form within thirty (30) days of receipt of this notice. The Division of Water Quality
also requests that you complete and submit the enclosed "Justification for Remission Request." Both forms should be submitted to the
following address:
NC DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

OR
3. File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an administrative hearing. You
may obtain the petition form from the Office of Administrative Hearings. You must file the petition with the Office of Administrative
Hearings within thirty (30) days of receipt of this notice. A petition is considered filed when it is received in the Office of
Administrative Hearings during normal office hours. The Office of Administrative Hearings accepts filings Monday through Friday
between the hours of 8:00 a.m. and 5:00 p.m., except for official state holidays. The original and one (1) copy of the petition must be
filed with the Office of Administrative Hearings. The petition may be faxed - provided the original and one copy of the document is
received in the Office of Administrative Hearings within five (5) business days following the faxed transmission. The mailing address
for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Telephone [phone] Facsimile: [phone]
A copy of the petition must also be served on DENR as follows:
Lacy Presnell, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, NC 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal date/time
received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for collection of the penalty
through a civil action. Please be advised that additional penalties may be assessed for violations that occur after the review period of
this assessment.
If you have any questions, please contact Aana Taylor -Smith or me at the Winston-Salem Regional Office at 336-771-5000.
Sincerely,
W. Corey Basinger i
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments: Attachment A
cc: WSRO Files w/attachments
SW Central Files w/attachments
PSB-NPDES — Charles Weaver

FATPEOF NORTH CAROLINA
COUNTY OF ROCKINGHAM
Affordable Communites Group LLC
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Willow Oak Mobile Home Park
PERMIT NO. NCO060259
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
REQUEST FOR REMISSION
WAIVER OF RIGHT TO AN
ADMINSTRATIVE HEARING AND
STIPULATION OF FACTS
FILE NO. MV-2013-0009
Having been assessed civil penalties totaling $304.72 for violation(s) as set forth in the assessment document of the Division
of Water Quality dated July 2, 2013, the undersigned, desiring to seek remission of the civil penalty, does hereby waive the right to an
administrative hearing in the above -stated matter and does stipulate that the facts are as alleged in the assessment document. The
undersigned further understands that all evidence presented in support of remission of this civil penalty must be submitted to the
director of the Division of Water Quality within thirty (30) days of receipt of the notice of assessment. No new evidence in support of
a remission request will be allowed after (30) days from the receipt of the notice of assessment.
This the day of , 20
SIGNATURE
ADDRESS
TELEPHONE

ppppppp,
JUSTIFICATION FOR REMISSION REQUEST
DWQ Case Number: MV-2013-0009 County: Rockingham
Assessed Party: Affordable Communites Group LLC, Willow Oak Mobile Home Park
Permit No. (if applicable): NCO060259 Amount Assessed: $304.72
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For Remission, Waiver of
Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of this civil penalty. You should attach any
documents that you believe support your request and are necessary for the Director to consider in evaluating your request for
remission. Please be aware that a request for remission is limited to consideration of the five factors listed below as they may relate to
the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper procedure for contesting
whether the violation(s) occurred or the accuracy of any of the factual statements contained in the civil penalty assessment document.
Pursuant to N.C.G.S. § 143B-282.1(c), remission of a civil penalty may be granted only when one or more of the following five
factors applies. Please check each factor that you believe applies to your case and provide a detailed explanation, including copies of
supporting documents, as to why the factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 14313-282.IN were
wrongfully applied to the detriment of the petitioner (the assessment factors are listed
in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the
violation (i.e., explain the steps that you took to correct the violation and prevent future
occurrences);
(c) the violation was inadvertent or a result of an accident (i. e., explain why the violation
was unavoidable or something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penaLty will prevent payment for the remaining necessary remedial
actions (i.e., explain how payment of the civil penalty will prevent you from performing
the activities necessary to achieve compliance).
EXPLANATION:

Pppppp'
PATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
COUNTY OF ROCKINGHAM
Affordable Communites Group LLC
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST:
Willow Oak Mobile Home Park
DWQ Case Number MV-2013-0009
REQUEST FOR ORAL PRESENTATION
I hereby request to make an oral presentation before the Environmental Management Commission's Committee on Civil Penalty
Remissions in the matter of the case noted above. In making this request, I assert that I understand all of the following statements:
• This request will be reviewed by the Chairman of the Environmental Management Commission and may be either granted or
denied.
• Making a presentation will require the presence of myself and/or my representative during a Committee meeting held in Raleigh,
North Carolina.
• My presentation will be limited to discussion of issues and information submitted in my original remission request, and because
no factual issues are in dispute, my presentation will be limited to five (5) minutes in length.
The North Carolina State Bar's Authorized Practice of Law Committee has ruled that the appearance in a representative capacity at
quasi-judicial hearings or proceedings is limited to lawyers who are active members of the bar. Proceedings before the Committee on
Remissions are quasi-judicial. You should consider how you intend to present your case to the Committee in light of the State Bar's
opinion and whether anyone will be speaking in a representative capacity for you or a business or governmental entity. If you or your
representative would like to speak before the Committee, you must complete and return this form within thirty (30) days of receipt of
this letter.
Depending on your status as an individual, corporation, partnership or municipality, the State Bar's Opinion affects how you may
proceed with your oral presentation. See www.ncbar.com/ethics, Authorized Practice Advisory Opinion 2006-1 and 2007 Formal
Ethics Opinion 3.
• If you are an individual or business owner and are granted an opportunity to make an oral presentation before the Committee,
then you do not need legal representation before the Committee; however, if you intend on having another individual speak
on your behalf regarding the factual situations, such as an expert, engineer or consultant, then you must also be present at the
meeting in order to avoid violating the State Bar's Opinion on the unauthorized practice of law.
• If you are a comoration, partnership or municipality and are granted an opportunity to make an oral presentation before the
Committee, then your representative must consider the recent State Bar's Opinion and could be considered practicing law
without a license if he or she is not a licensed attorney. Presentation of facts by non -lawyers is permissible.
If you choose to request an oral presentation, please make sure that signatures on the previously submitted Remission Request form
and this Oral Presentation Request form are: 1) for individuals and business owners, your own signature and 2) for corporations,
partnerships and municipalities, signed by individuals who would not violate the State Bar's Opinion on the unauthorized practice of
law.
Also, be advised that the Committee on Civil Penalty Remissions may choose not to proceed with hearing your case if the Committee
is informed that a violation of the State Bar occurs.
This the day of 20
SIGNATURE
TITLE (President, Owner, etc.)
ADDRESS
TELEPHONE

ATTACHMENT A
Affordable Communites Group LLC
CASE NUMBER: MV-2013-0009
PERMIT: NCO060259 FACILITY: Willow Oak Mobile Home Park
COUNTY: Rockingham REGION: Winston-Salem
Monitoring Violations
MONITORING OUTFALL/
VIOLATION
UNIT OF CALCULATED % OVER
PENALTY REPORT PPI LOCATION PARAMETER
DATE
FREQUENCY
MEASURE LIMIT VALUE LIMIT
VIOLATION TYPE
$25.00 3-2013 001 Effluent TOTAL N - Conc
03/31/13
Quarterly
mg/I
Frequency Violation
$25.00 3-2013 001 Effluent TOTAL P - Conc
03/31/13
Quarterly
mg/l
Frequency Violation

RECEIVED
N.C. Dept. of ENR
NCDENR JUN 2 6 2013
Winston Salem Region Winston-Salem
Division of Water Quality Regional Office
June 23, 2013
Subject: Notice of Violation and Recommendation for Enforcement
NOV-2013-MV-0085
Permit No. NC0060259 COPY
Willow Oak Mobile Home Park
Corey Basinger,
This letter is in response to the NOV for Willow Oak Mobile Home Park for missing
Total Nitrogen and Total Phosphorous samples for the March 2013 DMR. The samples
were not collected due to error in sampling. We will collect a second set of Total
Nitrogen and Phosphorous samples for the second quarter 2013 sampling schedule.
Please advise if there is anything else we can do to immediately return to compliance
with DMR permit requirements.
If you have any questions regarding our response or actions taken to correct items in
the Notice of Violation please give Paul Smith a call at [phone]. Thank you
Respectfully,
Paul Smith
Smith Industries

Pat McCrory
Governor
�A
NCDENR
North Carolina Department of Environment and natural Resources
Division of Water Quality
Thomas A. Reeder John E. Skvarla, III
Acting Director Secretary
June 19, 2013
CERTIFIED MAIL #7012 2920 0000 3656 0953 bop Li 1 t� ywc'd (o 2 (� 3
RETURN RECEIPT REQUESTED
Chris M. Barry, Officer of Operations
Affordable Communites Group LLC
301 Felspar Way
Cary NC 27518
Subject: Notice of Violation and Recommendation for Enforcement
NOV-2013-MV-0085
Permit No. NCO060259
Willow Oak Mobile Home Park
Rockingham County
Dear Mr. Barry:
A review of Willow Oak Mobile Home Park's monitoring report for March 2013 showed the following
violations:
Parameter
Date
Measuring Frequency
Violation
Nitrogen, Total (as N) - Concentration
03/31/13
Quarterly
1
Phosphorus, Total (as P) - Concentration
03/31/13
Quarterly
1
A Notice of Violation/Notice of Recommendation for Enforcement (NOV/NRE) is being issued
for the noted violation of North Carolina General Statute (G.S.) 143-215.1 and NPDES Permit No.
NC0060259. Pursuant to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars
($25,000.00) may be assessed against any person who violates or fails to act in accordance with the
terms, conditions, or requirements of any permit issued pursuant to G.S. 143-215.1. If you wish to
provide additional information regarding the noted violation, request technical assistance, or discuss
overall compliance please respond in writing within ten (10) days after receipt of this Notice. A review
of your response will be considered along with any information provided on the March 2013 Discharge
Monitoring Report. You will then be notified of any civil penalties that may be assessed regarding the
violations. If no response is received in this Office within the 10-day period, a civil penalty
assessment may be prepared.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
ne
NorthCarohna
Naturallrf
An Equal Opportunity 1.Affrmative Action Empioyer

Remedial actions, if not already implemented, should be taken to correct any problems. The
Division of Water Quality may pursue enforcement actions for this and any additional violations. If the
violations are of a continuing nature, not related, to operation and/or maintenance problems, and you
anticipate remedial construction activities, then you may wish to consider applying for a Special Order
by Consent.
If you have questions concerning this matter, please do not hesitate to contact Aana Taylor -Smith
or me at [phone].
Sincerely,
P
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: Point Source Branch
SWP — Central Files
WSRO Files

c;
Z Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Perrnit/PipeNo.: Month/Year
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Lirrit/Tvp-e DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations
L.
Completed by:
Regional Water Quality
Supervisor Signoff:
Date:
Date:

y m

All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
F-1
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for
improvements to be made as required by Part H.E.6 of the NPDES permit.
"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 managed 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
fines and imprisonment for knowing violations"
Permittee Address Phone Number
Permittee (Please print or type)
Signature of Permittee* Date
(Required unless submitted electronically)
OL zo 16
e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory (2) Certification No.
Certified Laboratory (3)
Certification No.
Certified Laboratory (4) Certification No.
Certified Laboratory (5)
PARAMETER CODES
Certification No.
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wos and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and,document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the. Onto now 15A WW M 0r%nA(,u7)mj

I'
30
31
DATE
7
4
W
MM
I
TH: ; ,A& l
YEAR: Z L FAgILITY NAME: jJl ' l j., , 2 �
ORC SIGN IN HEFT
y i1) (2) , 3)
IFIE OPERATOR
A RIVAL CERTIFIED ORC/BACKUP ORC'S
TI E 240o OPERATOR I SIGNATURE EXPLANATION OF eACKVp 0
OCK TIME SIGI(A
ON SITE ORC TORE
H. R. UR ON SITE?
N/a/
Wim
0 ._5
/2-3c:
/Z3o
o, S
00
o�
zy
(�) peralo Arrlval Time: Record the time of arrival of a cerillied Operator t1nq 2400 clock value, If facility Is staffed b
4 hoursie day, record the arrival Ilme of the 1 shift operator,
(z) peralo Time on Site; y operators
hif(s, a Jer'24', If more than on ehoralornumbs oner duty
spent
ale y GentSed oprs•ai the faclllly, f! the facility Is s(a(feQ on all three
I e tol'ai umber of hours the facility was staffed, me Ilma, Ihls alue Is no( (he sum or sit hours workeC by the operators, but
(3) RC-0 n Ilo9: Record Yes (Y) or No (N) as'.(o whether (he designated O
perilor erved as ORC on o parllcularday, record'e'In (his for(fii It date. 'It Is also appropriate (o'record'H'In lhecelilflha
ale Is el drat holiday, C visited the site on lhal:da(e, If (he deslgna(ad backvp
h

Willow Oaks North
Month M c"(C-
Effluent
Date
Time
Flow
Temperature
pH
Chlorine
1
'a 30�
2
3
4
R ( ��
6
7
8
9
10
11
2
12
S
rL
13
31��-
O,v 3
7
i 0
14
2,3
15
16
17
18
l21
19
1 Z 30 ,,.r.
< 0
20
/DO ,..
C) , 0
21
22
23
24
25
26
�Z
27
28
130
0,0 1
7.3
/cam
29
/5cA�—
30
31

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Chris M. Barry
Affordable Communites Group LLC
301 Felspar Way
Cary NC 27518
Division of Water Quality
Charles Wakild, P.E.
Director
11 March 2013
Subject: NOTICE OF VIOLATION
NOV # NOV-2013-MV-0037
Permit No. NCO060259
Willow Oak Mobile Home Park
Rockingham County
Dear Mr. Barry:
John E. Skvarla, III
Secretary
A review of Willow Oak Mobile Home Park's monitoring report for December 2012 showed the
following violations:
Parameter
Date
Measuring Frequency
Violation
Total Nitrogen
Q4 2012
Quarterly
1
Remedial actions, if not already implemented, should be taken to correct the above
noncompliance problem. Please be aware that violations of your NPDES permit could result in
enforcement action by the Division of Water Quality for this and any additional violations of
State law.
If you should have any questions, please do not hesitate to contact Aana Taylor -Smith or me at
[phone].
cc: SWP — Central Files
WSRO Files
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
NorthCarohna
Naturally
An Equal Opportunity l Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: ►%iiljD\ni O(AVS W IP Pernut/Pipe No.: piCjztcr)g-Scj-- - Month/Year .L&Q
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Tvpe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
20 �tt� t �► f uAx+�XI u �_
Other Violations
Completed by: Aaw I -MA L - Shn iM
Regional Water Quality
Supervisor Signoff:
PJ
Date: t � AA" 1.0 63

EFFLUENT A
DES PERMIT NO. L U06025 DISCHARGE NO. C_ ONTH YEAR 2pt,Z
FACILITY NAME ' rlx� or CLASS2_ COUNTY
CERITIFIED LABORATORY (1) C 1 CERTIFICATION NO._&C p / 3$
(list additional laboratories on the backside/page 2 of this form
OPERATOR IN RESPONSIBLE CHARGE (OR C) rr.l� GRADE__ CE TIFICATION NO. 2.4 k73
PERSON(S) COLLECTING SAMPLES Jk ORC PHON
CHECK BOX IF ORC HAS CHANGED, NO FLOW / DISCHARGE FROM STI'E
Mail !ORIGINAL and ONE COPY to:
FEB
2 J
DIV,1'10N OF WATER QUALITY
(SIGNATURE OF OPERATOR IN SPONSIBLE CHARGE) DATE
1617 MAH. SERVICE CENTER
CENTRAL RAL F
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
LLB,
RALLIGH, NC 27699-1617
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. RECEIVED
N.C. Dept. of ENR
50050
1 00610
1 00400
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1 00530
1 31616
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MINIMUM
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ompll4)f'tabt.�s'1.,�_
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All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliqq
ant
a
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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
fines and imprisonment for knowing violations."
Permittee jydress
Pa J 1 SrY. ►a'�
Permittee (Please print or type)
1-25-13
Signature ofPainittee*** Date
(Required unless submitted electronically)
Lk
= A 2732V
Phone Number e-mail address
v
Permit Expiration Date
Certified Laboratory (2) r, ( .C� ,cam. I Certification No. 1t(w�3U
Certified Laboratory (3) Certification No.
Certified Laboratory (4) Certification No.
Certified Laboratory (5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting the Surface
Water Protection Section's web site at h2o.enr-state.ne.us/wgs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the etatP rwr 1 SA vrAr )R ntn6thv,))m)

PV
DATE
4
5
P
YEAR: Z- FACILITY NAME:
1
ORC SIGN IN JHEET
'I
(2) (3)
Ci(10PERATOR • •
I OP CERTIFIED ORCIOACKUP ORC'S EXPLANATION OF BACKUP Of
,RIVAL
2400 OPERATOR I SIGNATURE
_OCK TIME SIGNATURE
ON SITE _ _ ORO
•
i
10 I t
300
Ts -
On
2
Y
31
T(2)
of Arrival Time: Record the time of arrival of a certined operator u ing a 2400 clock value. If the facility Is staffed by operators
s, a day, record the arrival time of the 1 shift operator,
ol Time on Site: Record the number of hours spent by certined op, rators-at the facility. if the faclllly Is staffed on all three
ri)er'24', If more than one orator Is on duty at the same lime, this alue Is not the sum of all holurs worked by the operator, but
i umber of hours the faclllly was staffed,
r-l%Ite1: Record Yes (Y) or No (N) as to whether the designated O Cvislied the site on that:date. If the designated backup
erved as ORC on a particular day, record 'S' In this column for t t date. •11Is also appropriate torecord•'H'In the call if the
I egal holiday.

Willow Oaks North
Effluent
Date
Time
Flow
Temperature
pH
Chlorine
1
2
3
12
4
/Z3
4/0
5
2 3
6
23
D,DO
/d
7,3
-111 /O
7
8
9
10
Z
11
00
12
j D �.-
�. DO
/
7 .
1< to
13
12,11
14
3
��
4 /D
15
16
17
18
J� 19
O :.,-
D. O
/O
/ O
20
IS
9<
�C�
21a-
22
23
24
25
26
00
/Q
28
160
29
30
31

AJa
NCDENR
North Carolina Department of Environment and (natural Resources
Division of Water Quality
Pat McCrory Chuck Wakiltl RECEIVJohn E. Skvarla, III
Governor
Director N.CDept. of Secretary
January 28, 2013 JAN 31 2013
Winston-Salem
CHRIS BARRY Regional Office
OPERATIONS OFFICER
ACG GREENSBORO, LLC
301 FELSPAR WAY
CARY, NC 27518
Subject: NPDES Permit Modification- Name and/or
Ownership Change
Permit Number NCO060259
ACG Greensboro, LLC
i5u44d rd County
Dear Mr. Barry: 'k
Division personnel have reviewed and approved your request to transfer ownership of the subject permit, received
on October 17, 2012. This permit modification documents the change of ownership.
Please find enclosed the revised permit. All other terms and conditions contained in the original permit remain
unchanged and in full effect. This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
807-6304.
Chuck Wakild
cc: Central Files
Winston-Salem Regional Office, Surface Water Protection
NPDES Unit File NCO060259
161711sd Servi.:e k- anter, Paleigh, tJorth C xoi is 27o91;-161-
I-cration: c;12 N Salisbury SI. R.,leigt Jorth ur oliu^ 2-694 �TQlle
Phon(-.919-807-6300 FF.X 919-b07�64921Cus'c erSorvi(;;.1-8i7-u23-67a Noi-thCarolina
lnteniet: W1':W.nCW3!?iquaftv.org /A,/pYfOjN6b/➢l
ti i quad .pn Wily n, rmali.. Pd' n

Permit NCO060259
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
ACG Greensboro, LLC
is hereby authorized to discharge wastewater from a facility located at the
Willow Oak Mobile Home Park WWTP
NC Highway 150
Reidsville
Rockingham County
to receiving waters designated as Little Troublesome Creek in subbasin 03-06-01 of the Cape Fear
River Basin in accordance with effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III and IV hereof.
This permit shall become effective February 1, 2013.
This permit and authorization to discharge shall expire at midnight on April 30, 2016.
Signed this day Monday, January 28, 2013, 2011
Wakild, Director
Pri'vision of Water Quality
By Authority of the Environmental Management Commission

Permit NCO060259
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked, and as of this
issuance, any previously issued permit bearing this number is no longer effective. Therefore, the exclusive authority to
operate and discharge from this facility arises under the permit conditions, requirements, terms, and provisions included
herein.
ACG Greensboro, LLC is hereby authorized to:
1. Continue to operate an existing 0.0175 MGD wastewater treatment facility with the following
components:
♦ Manual bar screen
♦ Two -stage facilitative lagoon
♦ Alum feed & alum feed tanks
♦ Chlorine disinfection
♦ Tablet dechlorination
This facility is located southwest of Williamsburg off NC Highway 150 at the Willow Oak Mobile
Home Park WWTP in Rockingham County.
2. Discharge from said treatment works at the location specified on the attached map into Little
Troublesome Creek, classified WS-V NSW waters in hydrologic unit 03030002 of the Cape Fear
River Basin.

Permit NCO060259
EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is
authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as
specified below:
Flow
0.0175 MGD
Weekly
Instantaneous
Influent
50050
Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
C03101
Total Suspended Solids
90.0 mg/L
135.0 mg/L
2/Month
Grab
Effluent
C0530
NH3 as N (April 1 — October 31)
7.2 mg/L
35 mg/L
2/Month
Grab
Effluent
C0610
NH3 as N (November 1 — March 31)
2/Month
Grab
Effluent
[C0610
Fecal Coliform (geometric mean)
200 / 100 ml
400 / 100 ml
2/Month
Grab
Effluent
31616
Total Residual Chlorines
28 µg/L
2/Week
Grab
Effluent
[50060
Temperature (°C)
Weekly
Grab
Effluent
00010
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Grab
Effluent
C0600
Total Phosphorus
Quarterly
Grab
Effluent
C0665
pH
> 6.0 and < 9.0 standard units
2/Month
Grab
Effluent
00400
Footnotes:
1. The facility shall report all effluent TRC values reported by a NC certified laboratory including field
certified. However, effluent values below 50 µg/L will be treated as zero for compliance purposes.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
A. (2) NUTRIENT- REOPENER CONDITION
Pursuant to N.C. General Statutes Section 143-215.1 and the implementing rules found in the North Carolina
Administrative Code at 15A NCAC 21-1.0112 (b) (1) and 2H.0114 (a) and Part II sections B-12 and B-13 of this
permit, the Director may reopen this permit to require supplemental nutrient monitoring of the discharge. The
purpose of the additional monitoring will be to support water quality modeling efforts within the Cape Fear
River Basin and shall be consistent with a monitoring plan developed jointly by the Division and affected
stakeholders. In addition, the results of water quality modeling may require that limits for total nitrogen and
total phosphorus be imposed in this permit upon renewal.

NCO060259 - Willow Oak Mobile
Latitude: 36' 16' 26" Longitude: 79° 36' 33"
Sub -Basin: 03-06-01 Stream Class: WS-V NSW
Hydrologic Unit: 03030002 River Basin: Cape Fear
USGS Quad: Williamsburg, N.C.
Receiving Stream: Little Troublesome Creek
Facility
Location
NeJ x Map not to scale

NPDES yr/mo/day Inspection Type 1
3I N00060259 I11 12I 10/03/29 I17 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to attached inspection summary letter.
Page # 2

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 3I NCO060259 111 121 10/03/29 117 18I CI 19I SI 20I
Remarks
2111111111111111111111 1111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CA -------------------------- Reserved ----------------------
67I 169 70I I 711 I 72I N I 73' f 174 751 Ill I I I 180
t�J
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
Willow Oak Mobile Home Park
09:00 AM 10/03/29
06/05/01
Exit Time/Date
Permit Expiration Date
200 Southfork Dr
Reidsville NC 27320
10:00 AM 10/03/29
11/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Paul Matthew Smith/ORC/336-932-9347/
Name, Address of Responsible Official/Title/Phone and Fax Number
Sam Misuraca,301 W 4th St Royal Oak MI 48067//248-399-7722/24839999.7No. cted
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program E Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//704-663-1699 Ext.2202/
��4// 3/2--y`2
L
�-
Signature of Management Q A Reviewer Agency/Of tce/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

Permit: NCO060259 Owner - Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Disinfection -Tablet
Yes No NA NE
n n n ■
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
n n n ■
Is there chlorine residual prior to de -chlorination?
n n n ■
Comment: Please refer to attached inspection summary letter.
De -chlorination
Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
■ n ❑ n
n n ■ n
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
■ n n n
Are the tablets the proper size and type?
■ n n n
Comment: Please refer to attached inspection summary letter.
Are tablet de -chlorinators operational?
■ n n n
Number of tubes in use?
4
Comment: Please refer to attached inspection summary letter.
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
■ n n n
n ■ n n
Is flow meter calibrated annually?
Is the flow meter operational?
■ Cl n n
(If units are separated) Does the chart recorder match the flow meter?
n n ■ n
Comment: 22.5 degree v-notch weir used to obtain instantaneous flow measurement.
Effluent Pipe
Yes No NA NE
Is right of way to the outfall properly maintained?
■ n 00
Are the receiving water free of foam other than trace amounts and other debris?
n n n ■
If effluent (diffuser pipes are required) are they operating properly?
n n ■ n
Comment: Please refer to attached inspection summary letter.
Laboratory
Yes No NA NE
Are field parameters performed by certified personnel or laboratory?
■ n 00
Are all other parameters(excluding field parameters) performed by a certified lab?
■ n n n
■ n n n
# Is the facility using a contract lab?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
n n n ■
Page # 4

Permit: NC0060259 Owner - Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Bar Screens
Yes
No NA
NE
Type of bar screen
a.Manual
■
b.Mechanical
n
Are the bars adequately screening debris?
■
0 ❑
❑
Is the screen free of excessive debris?
■
n n
Q
Is disposal of screening in compliance?
■
00
n
Is the unit in good condition?
■
n n
n
Comment: Please refer to attached inspection summary letter.
Lagoons
Yes
No NA
NE
Type of lagoons?
Facultative
# Number of lagoons in operation at time of visit?
2
Are lagoons operated in?
Series
# Is a re -circulation line present?
❑
■ n
n
Is lagoon free of excessive floating materials?
■
0 0
# Are baffles between ponds or effluent baffles adjustable?
n
❑ Q
■
Are dike slopes clear of woody vegetation?
■
❑ Q
Are weeds controlled around the edge of the lagoon?
■
Q ❑
❑
Are dikes free of seepage?
■
❑ n
0
Are dikes free of erosion?
■
n n
0
Are dikes free of burrowing animals?
■
n Q
n
# Has the sludge blanket in the lagoon (s) been measured periodically in multiple locations?
❑
0 Q
■
# If excessive algae is present, has barley straw been used to help control the growth?
n
n ■
n
Is the lagoon surface free of weeds?
■
n n
n
Is the lagoon free of short circuiting?
n
n n
n
Comment: Please refer to attached inspection summary letter.
Disinfection -Tablet
Yes
No NA
NE
Are tablet chlorinators operational?
■
n n
n
Are the tablets the proper size and type?
■
n n
n
Number of tubes in use?
Page # 3

Permit: NCO060259 Owner • Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Laboratory
Yes
No
NA
NE
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
n
■
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
n
n
n
■
Comment: Please refer to attached inspection summary letter.
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
n
n
■
n
Is sample collected below all treatment units?
■
n
n
n
Is proper volume collected?
■
n
n
n
Is the tubing clean?
n
n
■
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
n
n
n
■
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
n
Is the facility as described in the permit?
n
■
n
n
# Are there any special conditions for the permit?
n
■
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector granted access to all areas for inspection?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
n
n
n
Is all required information readily available, complete and current?
■
n
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
n
n
n
Are analytical results consistent with data reported on DMRs?
■
n
n
n
Is the chain -of -custody complete?
■
n
n
n
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses ■
Transported COCs ■
Page # 5

Permit: NCO060259 Owner • Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Record Keeping Yes No NA NE
Are DMRs complete: do they include all permit parameters? ■ n n n
Has the facility submitted its annual compliance report to users and DWQ? n n n ■
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? n n ■ n
Is the ORC visitation log available and current? ■ n n n
Is the ORC certified at grade equal to or higher than the facility classification? ■ n n n
Is the backup operator certified at one grade less or greater than the facility classification? ■ n 0 n
Is a copy of the current NPDES permit available on site? ■ n n n
Facility has copy of previous year's Annual Report on file for review? n n n ■
Comment: Please refer to attached inspection summary letter.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ .n 00
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ n Cl Cl
Judge, and other that are applicable?
Comment: Please refer to attached inspection summary letter.
Page # 6

47t)
NCDENR 0 3
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 29, 2010
ERIC FAIRMAN
OPERATIONS MANAGER
WILLOW OAK LLC
301 WEST FOURTH STREET, SUITE 440
ROYAL OAK MI 48067
Subject: Receipt of permit renewal application
NPDES Permit NCO060259
Willow Oak MHP
Rockingham County
Dear Mr. Fairman:
The NPDES Unit received your permit renewal application on December 28, 2010. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to complete
your permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing
permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Jeff Poupart at
[phone].
Sincerely,
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarol ina
Internet: www.ncwaterquality.org r,N� l//�
An Equal Opportunity 1 Affirmative Action Employer NatK [

WILLOW OAK, L.L.C.
301 West Fourth Street, Suite 440
Royal Oak, MI 48067
Phone: [phone] ext 21 • Fax: [phone]
E-Mail: eric®oakridgemgt.com
December 21, 2010
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Renewal Notice
NPDES Permit NCO060259
Owner: Willow Oak, L.L.C.
Facility Name: Willow Oaks Mobile Home Park WWTP
Rockingham County
Dear Mrs. Sprinkle:
Please consider this letter our request to renew NPDES Permit NCO060259 for
Willow Oaks Mobile Home Park WWTP. Enclosed you will find all the necessary
completed forms and copies per your instructions.
RECEIVED
N.C. Dent. of ENR
JAN032011
Winstcn-5,,;
Regional C' ,
Please note that we have added a dechlorination tablet feeder (see attached November
8, 2007 "Authorization to Construct" letter) to this facility since the issuance of the
last permit.
Very truly yours,
Eric Fairman
Operations Manager
/lsw
Enclosures —
Cover Letter (original and 2 copies)
Completed application (original and 2 copies)
Sludge narrative (original and 2 copies)
Authorization to Construct letter (original and 2 copies)
SAAAPARMACTIVEWorth Carolina\WO - Willow Oaks\Permanent\Sewer\Permit\5-1-1I to )DOMApplication documents\NPDES App for Permit Renewal
Cvr Ltr 12-21-IO.doc

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to: RECEIVED
N. C. DENR / Division of Water Quality / NPDES Unit N.C. oeot. of ENF
1617 Mail Service Center, Raleigh, NC 27699-1617 JAN O 3 mi
NPDES Permit C0060259 I W -
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
Willow Oak Mobile Home Park
Willow Oak, L.L.C.
301 West Fourth Street, Suite 440
Royal Oak
MI 48067
248-399-7755
248-399-9975
lelaa,,oakridgem tg com
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road Highway 150 West
City Reidsville
State / Zip Code North Carolina 27320
County Rockingham
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility
referring to the Operator in Responsible Charge or ORC)
Name Paul Smith
Mailing Address 235 Richardson Road
City Reidsville
State / Zip Code NC 27320
Telephone Number [phone]
Fax Number [phone]
(Note that this is not
1 of 3 Form-D 05/08

1• 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 83
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile home park
Population served: 166
S. Type of collection system
® 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 ® No
7. Name of receiving stream(s) (Provide a map shouring the exact location of each outfall):
Little Troublesome Creek
S. Frequency of Discharge: ® 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.
Two stage facilitative lagoon; alum feed; alum feed tanks; chlorination; dechlor tablet
feed
2 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.0175 MGD
Annual Average daily flow 0.010 MGD (for the previous 3 years)
Maximum daily flow 0.016 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
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.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
25
10
mg/ L
Fecal Coliform
100
10
200µ
Total Suspended Solids
40
20
mg/ L
Temperature (Summer)
29
22
Deg. C
Temperature (Winter)
16
6
Deg. C
pH
7.6
7.0
S.U.
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO060259
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.
Eric Fairman Operations
PrintZ11-
e of Person Signing Title
1
&Aaa
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.)
3 of 3 Form-D 05/08

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DISCHARGE
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Willow Oak Mobile Home Park
'ounty: Rockingham Stream Class: C-NSW
deceiving Strcam: Little Troublesome Creek Suh-Basin: 030601
Latitude: 36' 16' 26" Grid/Ouad: B20SE
Longitude: 79' 36 33"
Facility
Location
(not to scale)
NORTH NPDES Permit No. NCO060259

EFFLUENT
NPDES PERMIT NO. NC-J (DO 602-5 DISCHARGE NO. 00 1 MONTH YEAR
FACILITY NAME W ; O ! h i . CLASS_ COUN t ctt!�
CERTIFIED LABORATORY (1) w J i CERTIFICATION NO. hC,.,
(list additional laboratories on the backside/page 2 of this form
OPERATOR IN RESPONSIBLE CHARG (ORC) rvvt GRADE CE TIFICATION NO.
PERSONS) COLLECTING SAMPLES ORC PHONE
CHECK BOX IF ORC HAS CHANGED NO FLOW / DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
RALEIGH NC 27699-1617
BY THIS SIGNATURE, 1 CERTIFY THAT THIS REPORT IS
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WILLOW OAK, L.L.C.
301 West Fourth Street, Suite 440
Royal Oak, MI 48067
Phone: [phone] ext 21 • Fax: [phone]
E-Mail: eric®oakridgemgt.com
December 21, 2010
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Renewal Notice
NPDES Permit NCO060259
Willow Oaks Mobile Home Park WWTP
Rockingham County
Sludge Management
The sludge management plan and policy for this plant is as follows: Solids are
removed from the WWTP as necessary by a licensed contract hauler (Carolina
Septic) and disposed of properly.
Very truly yours,
Eric Fairman
Operations Manager
/lsw
S\AAPARKS\ACTIVE\North Carolina\WO -Willow Oaks\Permanent\Sewer\Permit\5-1-11 to XXXX\Application documents\NPDES App for Permit Renewal
CvrLtr 12-21-10.doc

�OtWAT�q RECEIVED NOV 1 9 2001
1O
y r
> .�
November 8, 2007
Mr. Eric Fairman
Project Manager
Willow Oak, LLC
301 West Fourth Street, Suite 440
Royal Oak, MI 48067
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
SUBJECT: Authorization to Construct
A to C No. 060259AOI
Willow Oak, LLC
Willow Oaks MHP
Dechlorination Facilities
Rockingham County
Dear Mr. Fairman:
Coleen H. Sullins, Director
Division of Water Quality
A fast track application for Authorization to Construct dechlorination facilities was
received on November 5, 2007, by the Division. Authorization is hereby granted for the
construction of modifications to the existing Willow Oaks MHP, with discharge of treated
wastewater effluent into Little Troublesome Creek in the Cape Fear River Basin.
This authorization results in no increase in design or permitted capacity and is awarded
for the construction of the following specific modifications:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on November 5, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
This Authorization to Construct is issued in accordance with Part III, Paragraph A of
NPDES Permit No. NCO060259 issued April 12, 2006, and shall be subject to revocation unless
the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No. NC0060259.
In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those as may
be required by this Division, such as the construction of additional or replacement wastewater
treatment or disposal facilities.
Nam` Carolina
�tur-2ty
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Intemet WwW *"t9Mt l�itv,Oto 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal opporhmiiy lAffamative Aclion Employer — 60% Re ydedll0% Post Conwmar Paper

Mr. Fairman
November 8, 2007
Page 2
The Winston-Salem Regional Office, telephone number [phone] shall be notified
at least forty-eight (48) hours in advance of operation of the installed facilities so that an on site
inspection can be made. Such notification to the regional supervisor shall be made during the
normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State
Holidays.
Pursuant to 15A NCAC 2H .0140, upon completion of construction and prior to operation
of these permitted facilities, the completed Engineering Certification form attached to this permit
shall be submitted to the address provided on the form.
Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of the
wastewater treatment facilities. The operator must hold a certificate of the type and grade at least
equivalent to or greater than the classification assigned to the wastewater treatment facilities by
the Certification Commission.
The Permittee must also employ a certified back-up operator of the appropriate type and
grade to comply with the conditions of T15A:8G.0202. The ORC of the facility must visit each
Class I facility at least weekly and each Class II, III and IV facility at least daily, excluding
weekends and holidays, must properly manage the facility, must document daily operation and
maintenance of the facility, and must comply with all other conditions of T15A:8G.0202.
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for the life of the facility.
During the construction of the proposed additions/modifications, the permittee shall
continue to properly maintain and operate the existing wastewater treatment facilities at all times,
and in such a manner, as necessary to comply with the effluent limits specified in the NPDES
Permit.
You are reminded that it is mandatory for the project to be constructed in accordance
with the North Carolina Sedimentation Pollution Control Act, and, when applicable, the North
Carolina Dam Safety Act. In addition, the specifications must clearly state what the contractor's
responsibilities shall be in complying with these Acts.
Prior to entering into any contract(s) for construction, the recipient must have obtained all
applicable permits from the State.
Failure to abide by the requirements contained in this Authorization to Construct may
subject the Permittee to an enforcement action by the Division of Water Quality in accordance
with North Carolina General Statute 143-215.6A to 143-215.6C.
The issuance of this Authorization to Construct does not preclude the Permittee from
complying with any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.

Mr. Fairman
November 8, 2007
Page 3
If you have any questions or need additional information, please do not hesitate to contact
Cecil G. Madden, Jr., P.E. at telephone number [phone].
Sincerely,
Coleen H. Sullins
AR/cgm
cc: Robert G. Burgin, Jr., P.E., Burgin Engineering, Inc., Irmo, SC
Ken Deaver, Kace Environmental, Rutherfordton
Rockingham County Health Department
DWQ Winston-Salem Regional Office, Surface Water Protection
Technical Assistance and Certification Unit
Daniel Blaisdell, P.E.
Point Source Branch, NPDES Program
Cecil G. Madden, Jr., P.E.
Anita Reed, E.I.
ATC File

A
RECEIVED
N.C. Dept. of ENR
!
DEC 2 9 2010
NCDENK
Winston-Salem
Regional Office
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 13, 2010
CERTIFIED MAIL ITEM 7009 1680 0002 2464 8481- RETURN RECEIPT REQUESTED
Mr. Sam Misuraca
Willow Oak LLC
301 W 4th St, Ste 440
Royal Oak, MI
Dear Permittee:
48067-2614
Subject: Notice of Violation
Failure to Submit Renewal Application
NPDES Permit NCO060259
Willow Oak Mobile Home Park
Rockingham County
The subject permit's expiration date is April 30, 2011. Federal [40 CFR 1221 and state (15A NCAC
2H.0105 (e)) regulations require that an application for permit renewal be filed at least 180 days prior to
expiration of the current permit. To satisfy this requirement, your renewal package should have been sent
to the Division postmarked no later than November 1, 2010.
As of this date, the Division has not received your renewal application. This is a violation of Part II.
B. 10. of your permit, which states "Any permittee that has not requested renewal at least 180 days prior to
expiration... will subject the permittee to enforcement procedures as provided in NCGS 143-215.6 and 33
USC 1251 et. seq.". To prevent an assessment of civil penalties you must submit a completed
permit application (see enclosed forms) no later than December 31, 2010.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you
must submit with the permit renewal application. If all wastewater discharge from your facility has ceased
and you wish to rescind this permit [or if you have any questions] please contact Charles H. Weaver of my
staff. His telephone number, fax number and e-mail address are listed at the bottom of this page.
Sincerely,
Coleen H. Sullins
cc: Central Files
Winston-Salem Regional Office, Surface Water Protection
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarolina
Phone: [phone] FAX [phone] / [e-mail] ;Vatwrally
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
Winston-Salem Regional Office
FILE ACCESS RECORD
SECTION SWP6 PO4TE/TIME 312-3 /2 ^ 3 , �5 100411
NAME REPRESENTING r,a,00r4 5� %i���
Guidelines for Access: The staff of the_Winston-Salem Regional Office is dedicated to making
public records in our custody readily available to the public for review and copying. We also have the
responsibility to the public to safeguard these records and to carry out our day-to-day program
obligations. Please read carefully the following before signing the form.
1. Due to the large public demand for file access, we request that you call at least a day in
advance to schedule an appointment for file review so you can be accommodated.
Appointments are scheduled between 9:00 a.m. and 3:00 p.m. Viewing time ends at 4:45
p.m. Anyone arriving without an appointment may view the files to the extent that time and
staff supervision are available.
2. You must specify files you want to review.
3. There is no charge for 25 copies or less. If making more than 25 copies - there is a charge of
2.5 cents per page. (A page refers to a "single impression". A double sided copy is to be
counted as 2 pages.) Costs for electronic copies will vary depending on the media type
(diskette, tape, cd-rom), please see Receptionist for information regarding electronic copy
. charges. Payment is to be made by check, money order, or cash (see Receptionist).
4. FILES MUST BE KEPT IN THE ORDER YOU RECEIVED THEM. Files may not be taken
from the office. No briefcases large totes, etc. are permitted in the file review area. To
remove, alter, deface, mutilate, or destroy material in one of these files is a misdemeanor for
which you can be fined up to $500.00.
5. In accordance with General Statute 25-3-512, a $25.00 processing fee will be charged and
collected for checks on which payment has been refused.
6. The customer must present a photo ID, sign -in, and receive a visitor sticker prior to reviewing
files.
FACILITY NAME COUNTY
1 �� M1M f tsP� (J., liyL.) 01. iV 1� ;p
2.
3.
4.
5.
Signature and Name of Firm/Business Date Time In Time Out
Please attach a business card to this form if available
cc: Kristie Douglas

OV
NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
13 April 2010
Willow Oak, LLC
Attn: Mr. Sam Misuraca
301 West Fourth Street, Suite 440
Royal Oak, MI 48067-2614
Natural Resources
Subject: Compliance Evaluation Inspections
Permittee: Willow Oaks LLC
Facility: Willow Oaks Mobile Home Park Wastewater Collection System
Permit #: WQCSD0227 &
Facility: Willow Oaks Mobile Home Park Wastewater Treatment Plant
Permit #: NCO060259
Rockingham County
Dear Mr. Misuraca:
Dee Freeman
Secretary
Mr. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ or
the Division) conducted compliance evaluation inspections (CEI) of the Willow Oaks Mobile Home
Park wastewater collection system (WWCS) and wastewater treatment plant (WWTP) on 29 March
2010. The assistance and cooperation of Paul Smith, Operator in Responsible Charge (ORC), was
greatly appreciated. Inspection checklists are attached for your records and inspection findings are
summarized below.
Wastewater Collection System, WQCSD0227
2. The system was given a cursory overview and no problems were detected.
3. As you are aware, owners of deemed permitted collection systems must comply with all rules listed
under NC Administrative Code 15A NCAC 02T .0400, et seq. Your compliance status with each of
these rules is summarized below:
a. 15A NCAC 02T .0403(a)(1): Requires that the system be effectively maintained and
operated at all times to prevent discharge to land or surface waters and any contravention of
ground or surface water standards.
Observations: No overflows or bypasses from the system have been reported to date and
Willow Oaks, LLC (Willow Oaks) is considered compliant with this rule.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(2): Requires that a map of the wastewater collection system be
developed and actively maintained.
Observations: Mr. Smith presented a system map that included all expected items and
appears to be up to date.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 Noi thCarohna
Internet: www.ncwaterquality.org Naturall'#
An Equal Opportunity 1 Affirmative Acton Employer

Willow Oaks, LLC
Attn: Mr. Sam Misuraca
Compliance Evaluation Inspections
WQCSD0227, Willow Oaks Mobile Home Park WWCS &
NC0060259,Willow Oaks Mobile Home Park WWTP
411312010
Page 2 of 4
Compliance Status: Compliant
'NN
15A NCAC 02T .0403(a)(3): Requires that an operation and maintenance (O&M) plan be
developed and implemented, which includes pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response.
Observations: Mr. Smith presented for inspection an O&M plan that is considered
sufficient. It is noted that there are no pump stations.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(4): Requires that the permittee or its representative inspect pump
stations that are not connected to a telemetry system (i.e., remote alarm system) every day
(i.e., 365 days per year) and pump stations that are connected to a telemetry system at
least once per week.
Observations: There are no pump stations within the collection system.
Compliance Status: Not Applicable
e. 15A NCAC 02T .0403(a)(5): Requires that the permittee or its representative inspect high -
priority sewers (HPS - as defined in 15A NCAC 02T .0402(2)) at least once every six months
and document the inspections.
Observations: According to Mr. Smith there are no HPSs within the collection system.
However, upon leaving the park, Mr. Boone noticed one pipe which is likely considered a
HPS and he asked Mr. Smith to investigate it. Mr. Smith later contacted Mr. Boone and
confirmed that it is in fact a sewer line. It is an aerial pipe located on the creek just upstream
of the bridge on Jonquil Lane. Mr. Smith stated that he would add this aerial to the O&M
plan as a HPS and would begin semi-annual checks on the line.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(6): Requires that the permittee or its representative conduct a
general observation of the entire wastewater collection system at least once per year.
Observations: Mr. Smith has a sufficient system in place to ensure the entire system is
observed at least annually and that the observations are recorded.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(7): Requires that overflows and bypasses from the system be
reported to the Division's Winston-Salem regional office in accordance with 15A NCAC 02B
.0506(a), and that public notice must be provided as required by G.S. 143-215.1 C.
Observations: No SSOs have been reported to date.
Compliance Status: Compliant

Oaks, LLC
PPPA71U,now
MrSam Misuraca
pliance Evaluation Inspections
CSD0227, Willow Oaks Mobile Home Park WWCS &
NC0060259,Willow Oaks Mobile Home Park WWTP
411312010
Page 3 of 4
15A NCAC 02T .0403(a)(8): Requires that a grease control program be developed and
implemented as follows:
For privately owned collection systems the grease control program shall include at
least bi-annual distribution of grease education materials to users of the collection
system by the permittee or its representative.
Grease education materials shall be distributed more often than required above if
necessary to prevent grease -related sanitary sewer overflows.
Observations: Mr. Smith had documentation showing that the materials were distributed to
park residents in December 2009. Please ensure this continues to happen twice per year
and that the activities are sufficiently documented.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(9): Requires that right-of-ways (ROW) and easements be
maintained in the full easement width for personnel and equipment accessibility.
Observations: All ROWs are in common areas and within people's yards. No further
maintenance is required.
Compliance Status: Compliant
15A NCAC 02T .0403(a)(10): Requires that documentation be kept for all activities you
undertake to comply with the requirements of 15A NCAC 02T .0403, subparagraphs (a)(1)
through (a)(9), for a minimum of. three years, with the exception of the map, which shall be
maintained for the life of the system.
Observations: Mr. Smith had sufficient documentation to demonstrate compliance with all
requirements of 15A NCAC 02T .0403, Subparagraphs (a)(1) through (a)(10).
Compliance Status: Compliant
Wastewater Treatment Plant, NCO028746
General Information
4. The plant is located on the far west side of the Willow Oaks mobile home park at approximate
coordinates 36016'33.34"N by 79136'21.92' W, in Reidsville, Rockingham County, North Carolina.
The plant can be accessed from Jonquil Lane inside the park. The permit authorizes Willow Oaks to
operate this 0.0175 MGD plant, which consists of a manual bar screen, two -cell lagoon with
chlorination and alum feed. Minor changes to the plant description are needed, such as the
installation of a dechlorinator. These disparities should be resolved and the plant description
updated with the next permit renewal. The permit authorizes the discharge of treated effluent to
Little Troublesome Creek, which is currently classified as Class C, NSW (nutrient sensitive waters)
waters in the Cape Fear River Basin.
Site Review

Willow Oaks, LLC
Attn: Mr. Sam Misuraca
Compliance Evaluation Inspections
WOCSD0227, Willow Oaks Mobile Home Park WWCS &
NC0060259,Willow Oaks Mobile Home Park WWTP
411312010
Page 4 of 4
"NN
The plant is well operated and managed. The lagoons appeared to be in good condition. Some dike
erosion is occurring which will need to be addressed at some point in the future. Dike vegetation is
well maintained and no sign of burrowing animals was immediately visible.
6. The discharge point could not be accessed during the inspection because heavy rains the night
before caused severe flooding around the facility. The flooding did not directly affect the treatment
plant though. The flow leaving the plant appeared clear and free of solids, foam, odor, etc.
Documentation Review
All documentation was reviewed and no discrepancies were noted. Mr. Smith has kept very good
records, including his plant operations and maintenance log, plant visitation log, laboratory records,
calibration records, chains of custody, etc. The only discrepancy noted was that which was
mentioned above about updating the plant description in the permit. The plant description should be
updated the next time the permit is renewed.
8. You're not required to reply to this letter. If you have any questions regarding the inspection or this
letter, please call Mr. Boone or me at [phone]. Thank you for your cooperation in this matter.
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. Inspection Checklist Willow Oaks Mobile Home Park WWCS, WQCSD0227
2. Inspection Checklist Willow Oaks Mobile Home Park WWTP, NCO060259
CC: WSRO - SWP
Central Files
PERCS Unit
NPDES West Unit
Mr. Paul Smith
235 Richardson Road
Reidsville, NC 27230

Compliance Inspection Report
Permit: WQCSD0227 Effective: 03/01/00 Expiration: Owner: Willow Oak LLC
SOC: Effective: Expiration: Facility: Willow Oak MHP Collection System
County: Rockingham
Region: Winston-Salem
Contact Person: Sam Misuraca Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Paul Matthew Smith Certification: 21873 Phone: [phone]
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/29/2010 Entry Time: 10:00 AM Exit Time: 11:00 AM
Primary Inspector: Ron Boone Phone: [phone]
Secondary Inspector(s): c lily , — -•; b Ext.2202
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Deemed permitted collection system management and
operation
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions Performance Standards Operation & Maint Reqmts Records
■ Monitoring & Rpting Inspections Manhole Lines
Reqmts
(See attachment summary)
Page: 1

Permit: WQCSD0227 Owner - Facility: Willow Oak LLC
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Inspection Summary:
Please refer to attached inspection summary letter.
Reason for Visit: Routine
Page:2

PV
Permit: WQCSD0227 Owner - Facility: Willow Oak LLC
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Performance Standards
Is Public Education Program for grease established and documented?
What educational tools are used?
Flyers. Please refer to attached inspection summary letter.
Is Sewer Use Ordinance/Legal Authority available?
Does it appear that the Sewer Use Ordinance is enforced?
Is Grease Trap Ordinance available?
Is Septic Tank Ordinance available (as applicable, i.e. annexation)
List enforcement actions by permittee, if any, in the last 12 months
Please refer to attached inspection summary letter.
Has an acceptable Capital Improvement Plan (CIP) been implemented?
Does CIP address short term needs and long term \"master plan\" concepts?
Does CIP cover three to five year period?
Does CIP include Goal Statement?
Does CIP include description of project area?
Does CIP include description of existing facilities?
Does CIP include known deficiencies?
Does CIP include forecasted future needs?
Is CIP designated only for wastewater collection and treatment?
Approximate capital improvement budget for collection system?
Total annual revenue for wastewater collection and treatment?
CIP Comments
Please refer to attached inspection summary letter.
Is system free of known points of bypass?
If no, describe type of bypass and location
Please refer to attached inspection summary letter.
Is a 24-hour notification sign posted at ALL pump stations?
# Does the sign include:
Instructions for notification?
Pump station identifier?
24-hour contact numbers
If no, list deficient pump stations
Please refer to attached inspection summary letter.
Reason for Visit: Routine
Yes No NA NE
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Page: 3

Permit: WQCSD0227 Owner - Facility: Willow Oak LLC
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
# Do ALL pump stations have an "auto polling" feature/SCADA? n n ■ n
Number of pump stations
Number of pump stations that have SCADA
Number of pump stations that have simple telemetry
Number of pump stations that have only audible and visual alarms
Number of pump stations that do not meet permit requirements
# Does the permittee have a root control program?
n
■
n
n
# If yes, date implemented?
Describe:
Please refer to attached inspection summary letter.
Comment: Please refer to attached inspection summary letter.
Inspections
Yes
No
NA
NE
Are maintenance records for sewer lines available?
■
n
n
Cl
Are records available that document pump station inspections?
n
n
■
o
Are SCADA or telemetry equipped pump stations inspected at least once a week?
n
n
■
n
Are non-SCADA/telemetry equipped pump stations inspected every day?
n
n
■
o
Are records available that document citizen complaints?
■
n
n
n
# Do you have a system to conduct an annual observation of entire system?
■
n
n
n
# Has there been an observation of remote areas in the last year?
■
n
n
n
Are records available that document inspections of high -priority lines?
n
n
■
n
Has there been visual inspections of high -priority lines in last six months?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Operation & Maintenance Requirements Yes No NA NE
Are all log books available? ■ n n f=1
Does supervisor review all log books on a regular basis? n n ■ n
Does the supervisor have plans to address documented short-term problem areas? n n ■ n
What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas?
Please refer to attached inspection summary letter.
Are maintenance records for equipment available? n n ■ n
Is a schedule maintained for testing emergency/standby equipment? Cl n ■ n
What is the schedule for testing emergency/standby equipment?
Page: 4

Pr
Permit: WOCSD0227
Inspection Date: 03/29/2010
Owner - Facility: Willow Oak LLC
Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Do pump station logs include:
Inside and outside cleaning and debris removal?
n
n
■
o
Inspecting and exercising all valves?
n
n
■
n
Inspecting and lubricating pumps and other equipment?
❑
n
■
n
Inspecting alarms, telemetry and auxiliary equipment?
n
n
■
o
Is there at least one spare pump for each pump station w/o pump reliability?
n
n
■
n
Are maintenance records for right-of-ways available?
n
n
■
n
Are right-of-ways currently accessible in the event of an emergency?
n
n
■
n
Are system cleaning records available?
n
n
■
n
Has at least 10% of system been cleaned annually?
n
n
■
n
What areas are scheduled for cleaning in the next 12 months?
Please refer to attached inspection summary letter.
Is a Spill Response Action Plan available?
■
n
n
n
Does the plan include:
24-hour contact numbers
■
n
n
n
Response time
■
n
n
n
Equipment list and spare parts inventory
■
n
n
n
Access to cleaning equipment
■
n
n
n
Access to construction crews, contractors, and/or engineers
■
Cl
n
n
Source of emergency funds
■
n
n
n
Site sanitation and cleanup materials
■
n
n
n
Post-overflow/spill assessment
■
n
n
n
Is a Spill Response Action Plan available for all personnel?
■
n
n
n
Is the spare parts inventory adequate?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Records
Yes
No
NA
NE
Are adequate records of all SSOs, spills and complaints available?
n
n
■
n
Are records of SSOs that are under the reportable threshold available?
n
n
■
n
Do spill records indicate repeated overflows (2 or more in 12 months) at same location?
n
n
■
n
If yes, is there a corrective action plan?
n
n
■
o
Is a map of the system available?
■
n
n
n
Page: 5

Permit: WQCSD0227 Owner - Facility: Willow Oak LLC
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Does the map include:
Pipe sizes
Pipe materials
Pipe location
Flow direction
Approximate pipe age
Number of service taps
Pump stations and capacity
If no, what percent is complete?
List any modifications and extensions that need to be added to the map
Please refer to attached inspection summary letter.
# Does the permittee have a copy of their permit?
Comment: Please refer to attached inspection summary letter.
Monitoring and Reporting Requirements
Are copies of required press releases and distribution lists available?
Are public notices and proof of publication available?
# Is an annual report being prepared in accordance with G.S. 143-215.1C?
# Is permittee compliant with all compliance schedules in the permits?
If no, which one(s)?
Please refer to attached inspection summary letter.
Comment: Please refer to attached inspection summary letter.
Reason for Visit: Routine
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Page: 6

PV
Am
LT ' �XA
RECEIVED
N.C. Dept of ENR
NCDENR -
OCT o 2 2009
North Carolina Department of Environment and Natural Resources
Winston-Salem
Division of Water Quality
Regional Office
Beverly Eaves Perdue
Governor
Sam Misuraca
Willow Oak LLC
301 W 4th Street
Royal Oak, Michigan 48067
Dear Mr. Misuraca:
Coleen H. Sullins Dee Freeman
Director Secretary
September 25, 2009
Subject: Notification of Jordan Lake Nutrient Requirements
NPDES Permit NC0060259
Willow Oak Mobile Home Park
Rockingham County
Governor Bev Perdue recently signed legislation to complete passage of rules for the Jordan Lake
Nutrient Management Strategy. The Strategy includes a Wastewater Discharge rule (T15A NCAC 02B
.0270) that applies to your wastewater treatment facility. Pursuant to Sub -Item (6)(d) of the rule, I am
writing to notify you of the nutrient allocations assigned to your facility.
This letter addresses only certain provisions of the Jordan Lake Wastewater Discharge rule. I encourage
you to familiarize yourself with the remainder of this rule.
Nutrient Allocations. The Wastewater Discharge rule establishes the maximum loads of nitrogen and
phosphorus that can be released from wastewater treatment facilities into the Jordan Lake watershed.
The rule provides that these wasteload allocations are to be divided among the existing facilities in
proportion to (with specific exceptions) their 2001 permitted flows. It also provides that facilities
permitted to discharge 100,000 gpd or more are to receive nitrogen and phosphorus limits equivalent to
their individual allocations.
Your facility has been assigned nitrogen and phosphorus allocations. The allocations are expressed as
annual mass loadings delivered to the lake. Due to foreseeable losses between the discharge point and
the lake, they are also expressed as the equivalent discharge loads at the point of discharge. The
delivered and the corresponding discharge allocations assigned to your facility are as follows:
NCO060259
Delivered Allocation
(lb/yr)
Transport
Factor N
Discharge Allocation
(lb/yr)
Total Nitrogen
326
51
639
Total Phosphorus
48
45
107
2001 Permitted Flow: 0.0175 MGD
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] FAX: 91M07-64921 Customer Service: 1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org Naturally
An Equal Opportunity i Affirmative Action Employer

Sam Misuraca
Notification of Jordan Lake Nutrient Requirements
September 25, 2009
Nutrient Limits. Your facility will not receive new nutrient limits at this time. However, any nutrient
limits already in your NPDES permit will remain in effect.
If the facilities permitted for less than 100,000 gpd, as a group, approach their allocations for nitrogen
or phosphorus, the Division will consider whether nutrient limits are necessary to protect water quality
at that time. In the event that nutrient limits become necessary, the limits would equal your facility's
discharge allocations.
Nutrient Trading. The rule provides that, when one utility connects to another, the allocations held by
the closing facility are transferred to the remaining facility. The rule also provides for the trading of
allocations among dischargers within each of the major Jordan subwatersheds. Be sure to consult with
the Division's NPDES staff before you consider selling allocation: transactions can have profound
implications for your facility and its permit.
If you have any questions regarding these allocations, please contact me at [phone] or at
mike. [e-mail].
cc: Winston-Salem Regional Office
NDPES Files
Central Files
Sincerely,
Zk )-.1, &- � �
Coleen H. Sullins
Pa

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040.0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCO060259 111 121 10/03/29 117 18I CI 191 SI 20II
Remarks
21111111111111111111111111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 81 QA --------------------------- Reserved -------------------••-
67I 169 70 U 71 I I 721 NJ 73I I 174 751 I I I( I Li 80
W
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
Willow Oak Mobile Home Park
09:00 AM 10/03/29
06/05/01
Exit Time/Date
Permit Expiration Date
200 Southfork Dr
Reidsville NC 27320
10:00 AM 10/03/29
11/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Paul Matthew Smith/ORC/336-932-9347/
Name, Address of Responsible Official/Title/Phone and Fax Number
Co
Sam Misuraca,301 W 4th St Royal Oak MI 48067//248-399-7722/24839 997�5Cted
0
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program E Facility Site Review ■ Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//704-663-1699 Ext.2202/
i
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3I N00060259 I11 12I 10/03/29 1
17 18I_ls
'
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to attached inspection summary letter.
Page # 2

pr
Permit: NC0060259
Inspection Date: 03/29/2010
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Owner - Facility: Willow Oak Mobile Home Park
Inspection Type: Compliance Evaluation
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment: Please refer to attached inspection summary letter.
Lagoons
Type of lagoons?
# Number of lagoons in operation at time of visit?
Are lagoons operated in?
# Is a re -circulation line present?
Is lagoon free of excessive floating materials?
# Are baffles between ponds or effluent baffles adjustable?
Are dike slopes clear of woody vegetation?
Are weeds controlled around the edge of the lagoon?
Are dikes free of seepage?
Are dikes free of erosion?
Are dikes free of burrowing animals?
# Has the sludge blanket in the lagoon (s) been measured periodically in multiple locations?
# If excessive algae is present, has barley straw been used to help control the growth?
Is the lagoon surface free of weeds?
Is the lagoon free of short circuiting?
Comment: Please refer to attached inspection summary letter.
Disinfection -Tablet
Are tablet chlorinators operational?
Are the tablets the proper size and type?
Number of tubes in use?
Facultative
2
Yes No NA NE
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Page # 3

Permit: NCO060259 Owner - Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Is the level of chlorine residual acceptable? n n n ■
Is the contact chamber free of growth, or sludge buildup? n n n ■
Is there chlorine residual prior to de -chlorination? n n n ■
Comment: Please refer to attached inspection summary letter.
Yes No NA NE
De -chlorination
Type of system ? Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)? ■ n Cl n
Is storage appropriate for cylinders? n n ■ n
# Is de -chlorination substance stored away from chlorine containers? ■ n 00
Are the tablets the proper size and type? ■ n n n
Comment: Please refer to attached inspection summary letter.
Are tablet de -chlorinators operational? ■ n n n
4
Number of tubes in use?
Comment: Please refer to attached inspection summary letter.
Flow Measurement - Effluent Yes No NA NE
# Is flow meter used for reporting? ■ n ❑ n
Is flow meter calibrated annually? n ■ n ❑
Is the flow meter operational? ■ Cl 00
(If units are separated) Does the chart recorder match the flow meter? n n ■ n
Comment: 22.5 degree v-notch weir used to obtain instantaneous flow measurement.
Yes No NA NE
Effluent Pipe
Is right of way to the outfall properly maintained? ■ n 00
Are the receiving water free of foam other than trace amounts and other debris? n n n ■
Ci
If effluent (diffuser pipes are required) are they operating proerl ? n ❑ ■
Comment: Please refer to attached inspection summary letter.
Yes No NA NE
Laboratory
Are field parameters performed by certified personnel or laboratory? ■ n n n
Are all other parameters(excluding field parameters) performed by a certified lab? ■
nnn
■
# Is the facility using a contract lab? nnn
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n ■
Page # 4

PV
Permit: NCO060259 Owner - Facility: Willow Oak Mobile Home Park
Inspection Date: 03/29/2010 Inspection Type: Compliance Evaluation
Laboratory
Yes
No
NA
NE
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
n
■
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
n
n
n
■
Comment: Please refer to attached inspection summary letter.
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
Cl
n
■
n
Is sample collected below all treatment units?
■
n
Cl
n
Is proper volume collected?
■
n
n
n
Is the tubing clean?
n
n
■
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
n
n
n
■
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
Is the facility as described in the permit?
n
■
n
n
# Are there any special conditions for the permit?
n
■
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector granted access to all areas for inspection?
■
n
n
n
Comment: Please refer to attached inspection summary letter.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
n
n
n
Is all required information readily available, complete and current?
■
n
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
n
n
n
Are analytical results consistent with data reported on DMRs?
■
n
n
n
Is the chain -of -custody complete?
■
n
n
n
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration ■
Dates of analysis ■
Name of person performing analyses ■
Transported COCs ■
Page # 5

Permit: NCO060259
Inspection Date: 03/29/2010
Owner - Facility: Willow Oak Mobile Home Park
Inspection Type: Compliance Evaluation
"NN
Record Keeping
Yes
No NA
NE
Are DMRs complete: do they include all permit parameters?
■
n n
n
Has the facility submitted its annual compliance report to users and DWQ?
n
n n
■
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
n
n ■
n
Is the ORC visitation log available and current?
■
n n
n
Is the ORC certified at grade equal to or higher than the facility classification?
■
n n
n
Is the backup operator certified at one grade less or greater than the facility classification?
■
n n
n
Is a copy of the current NPDES permit available on site?
■
n n
n
nnn
Facility has copy of previous year's Annual Report on file for review? — — — ■
Comment: Please refer to attached inspection summary letter.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ n n n
Judge, and other that are applicable?
Comment: Please refer to attached inspection summary letter.
Page # 6

0�0� W AT �9QG
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December 19, 2008
5169
Mr. Paul Smith
Smith Industries
235 Richardson Road
Reidsville, NC 27320-
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
SUBJECT: Wastewater/Groundwater Laboratory Certification Renewal
FIELD PARAMETERS ONLY
Dear: Mr. Smith
RECEIVED
N C. Dent. of ENR
JAN 0 6 2009
Winston$alom
Regional Office
Coleen H. Sullins, Director
Division of Water Quality
The Department of Environment and Natural Resources, in accordance with the provisions of NC GS 143-215-
.3 (a) (10), 15 NCAC 2H .0800, is pleased to renew certification for your laboratory to perform specified
environmental analyses required by EMC monitoring and reporting regulations 15 NCAC 2B .0500, 2H .0900 and
2L .0100, .0200, .0300, and 2N .0100 through .0800.
Enclosed for your use is a certificate describing the requirements and limits of your certification. Please review
this certificate to insure that your laboratory is certified for all parameters required to properly meet your
certification needs.
Please contact us at 919-733-3908 if you have questions or need additional information.
Sincerely,
®R!
Pat Donnelly
Certification Branch Manager
Laboratory Section
Enclosure
cc: Ramon L. Cook
Dana Satterwhite
Winston-Salem Regional Office
t
Carolina
Laboratory Section 1623 Mail Service Center; Raleigh, NC 27699-1623 Phone [phone]
Location: 4405 Reedy Creek Road; Raleigh, NC 27607 FAX [phone]
Internet: www.dwglab.org/Customer Service 1-877-623-6748
An {=nual Onnnrfirnity/Affim,ativo Artinn Fmnlnver-50% Recvcled/10% Post Consumer Paoer

STATE OF NORTH CAROLINA DEPARTMENT OF THE
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
LABORATORY CERTIFICATION PROGRAM
In accordance with the provisions ofN.C.G.S. 143-215.3 (a) (1), 143-215.3 (a)(10) and NCAC 2H.0800:
Field Parameter Only
•
O'.
SMITH INDUSTRIES
Is hereby certified to perform environmental analysis as listed on Attachment I and report monitoring data to DWQ for
compliance with NPDES effluent, surface water, groundwater, and pretreatment regulations:
By reference 15A NCAC 2H .0800 is made a part of this certificate.
This certificate does not guarantee validity of data generated, but indicates the methodology, equipment, quality control procedures,
records, and proficiency of the laboratory have been examined and found to be acceptable.
This certificate shall be valid until December<31, 2009
Certificate No. 5169 C/
A�
Pat Donnelly

Attachment
North Carolina Wastewater/Groundwater Laboratory Certification
Certified Parameters Listing
FIELD PARAMETERS ONLY
Lab Name: Smith Industries Certificate Number: 5169
Address: 235 Richardson Road Effective Date: 01/01/2009
Reidsville, NC 27320- Expiration Date: 12/31/2009
Date of Last Amendment:
The above named laboratory, having duly met the requirements of 15A NCAC 21-1.0800, is hereby certified for the measurement of the parameters listed below.
CERTIFIED PARAMETERS
INORGANICS
RESIDUAL CHLORINE
Std Method 4500 Cl G
DISSOLVED OXYGEN
Std Method 4500 O G
)H
Std Method 4500 H B
TEMPERATURE
Std Method 2550E
his certification requires maintance of an acceptable quality assurance program, use of approved methodology, and satisfactory performance on evaluation samples. Laboratories are
ubject to civil penalties and/or decertification for infractions as set forth in 15A NCAC 21-1.0807.

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of Arrival Tlmo; Record the time of arrival of.a certified epe►alor u Ing a 2400 clock value. If lho facility Is staffed by operators
sla day, record the arrival Um8 of the 1" shift operator,
ofTime on SltC Record the number of hours spent by cenlned op raiam at the facility. If the facility Ic sloffed on ell Ihree
er'241% If more than one orator Is on duty al the same Irmo, this alue Is not Iho sum of all hours worked by the operators, but
lumber of hours the fatuity was staffed.
n Ife7: Record Yea (Y) or No (N) es to whether the oeslpnated 0 C visited Iho Via on thal bate. If the designated backup
f erved as ORC on a particular day, retort! 'B' In this coturnn for I 1 dafg, •II Is also appropriate toYecord`'H'InIhoeoaIfU+a
ogal holiday.

R CE E1VED
N �,
r)"t ,..r :NR
JAN 18 2008
�,;nsicn•�a.em
Regional office
Vs I
L�UEIWC
Burgin Engineering Inc.
&
Engineer's Certification iSTITMON GflANrSf.OVI SEC
UN
I, Robert G. Burgin, Jr.. as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe periodically the construction of the modifications
and improvements to the Willow Oak MHP, located on Southfork Road in Rockingham County
for Willow Oak, LLC, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast track
application received on November 5. 2007, and in conformity with the Minimum Design
Criteria Dechlorination Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Signature Registration No. 10184
Date