NCG550977_Regional Office Historical File 2001 to 2013

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North Carolina Department of Environment and Natural Resources
Division of water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
August 26, 2013
Jane H Simmons
Mountain View Properties LLC
100 Medical Hts Dr
Morganton NC 28655
SUBJECT: Compliance Evaluation Inspection
3431 Morganton Boulevard
Permit No: NCG550977
Caldwell County
Dear Ms. Simmons:
Enclosed please find a copy of the compliance evaluation inspection conducted on
August 12, 2013. The facility was found to be in compliance with permit NCG550977.
Please refer to the enclosed inspection report for additional observations and comments.
If you or your staff have any questions, please call me at 828-296-4500.
Enclosure
cc:
Central Files
Asheville Files
Sincerely,
Katherine H. Jimison
Chemistry Technician III
SURFACE WATER PROTECTION — ASHEVILLE REGIONAL OFFICE
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778 One
Phone: [phone]\FAX: [phone] NoithCarollina
Internet: www.ncwaterauality om ;V49A1ni1& G:\WQ\SWP\Caldwell\Wastewater\General\NCG55 SFR\Mtn View Pediatrics\NCG550977 CEI 2013.doc

4 !1
United States Environmental Protection Agency
Washington, D.C. 20460
Form Approved.
OMB No. 2040-0057
Water Complianre InspPrtion 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 NCG550977 111 121 13/08/12 117 181 C I 19101 20I-I
Remarks
211IIIIIIIIIIIIIII
IIII IIIIIIII IIIIIIIIIIII IIII II16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ----------------------
67I 169 70141 71 I I 72 I N I 73 L_U 74 75I I I I I III 80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
Entry Time/Date
Permit Effective Date
3431 Morganton Boulevard
12:30 PM 13/08/12
13/08/01
Exit Time/Date
Permit Expiration Date
3431 Morganton Blvd
Lenoir NC 28645
12:50 PM 13/08/12
18/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Jane H Simmons,100 Medical Hts Dr Morganton NC 28655//828-433-0276/8284334608 Contato
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Facility Site Review
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
Kathy Jimison ARO WQ//828-296-4500/
Z
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
G
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3 NCG550977 I11 12I 13/08/12___j 17 18Id
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The subsurface sand filter appears to be operating properly.
There was no discharge at the time of this inspection.
Page # 2

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�� United States Environmental Protection Agency
Washington, D.C. 20460 Form Approved.
57
Water com lianc57
e Ins eCtlOn Re OI { OMB No. 208-31-98
Approval expires
Section A: National Data System Coding (i.e., PCS)
Transaction Code. NPDES
1 (�� I 2 yr/mo/day Inspection Type
I_I 3 I YP Inspector Fac Type
aGG_I9 11 12I .
v6/Oi./19 117 18 0• 19
21 Remarks I I 20I I
6E
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1
--------------------------- Reserved ------ -------------
7I 69 70I I 71I I 72I AI 731 I 174 75
i i I1 Li80
Section B: Facility Data
rName(s)
ocation of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date
and NPDES permit Number)
Permit Effective Date
view Pediatrics L'2:=+5 PM 06/ 7 01/19 02/08/0l
rton B1-vd
Exit Time/Date Permit Expiration Date
NC28'c45
03:00 PM 06/01/19 07/07/3-1
nsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
lane Slll'TrJ:lS, 10Ci Medical Hts Dr Mrrganton x7c
28655//828-433-0276/828433•4608
Section - Areas Evaluated During
. Facility Site Review
Section D: Summary of Finf7in..�r�
(See attachment summary)
Name(s) and Signature(s) of Inspector(s)
Keith Haynes
K//,
Contacted
=�0
only those areas evaluated
Agency/Office/Phone and Fax Numbers
ARO WQ//828-296-4500/
Date
/o3.�6
Signature of Management 0 A Reviewer
Agency/Office/Phone and Fax Numbers
Date
Larry `^rose 1 e,
ARO ;a4//i328-296-4500 Ext.4o'SB,� �12111�
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

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NPDES
yr/mo/day Inspection Type
17 18
9I NCG550977 I11 12I 06�0 �.19 `^I
ch additional sheets of narrative and checklists as
Section D: Summary of Finding/Comments (Atta
The subsurface sand filter appeared to be operating properly.
1
Page # 2

cow
NOENR
North Carolina Department of Environment and Natural Resources
Michael F. Easley, Governor Division of Water Quality
William G. Ross, Jr., Secretary
July 27, 2007 Coleen H. Sullins, Director
Jane H. Simmons
Mountain View Properties, LLC
100 Medical Heights Dr
Morganton, NC 28655
Subject: Renewal of coverage / General Permit NCG550000
Mountain View Pediatrics
Certificate of Coverage NCG550977
Caldwell County
Dear Permittee:
In accordance with your renewal application [received on January 22, 20071, the Division is renewing
Certificate of Coverage (CoC) NCG550977 to discharge under NCG550000. This CoC is issued pursuant to the
requirements of North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection agency dated May9, 1994 for as subsequently amended].
If any parts, measurement frequencies or sampling requirements contained in this General Permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to the
Division. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Asheville Regional Officelldgr to anv sale nr tr-„-4�- - 1L _
his permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning the requirements of the General Permit, please contact Toya
Fields 1919 733-5083, extension 551 or [e-mail] or Susan Wilson [919 733-5083, extension 510
or susan.a.wilson@ncmail netl.
Sincerely,
for Coleen H.
cc: Central Files
Asheville Regional Office / Surface Water Protection
NPDES file
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org
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WATER '"LiLITY`E TiON y
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An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
F
NCES AND
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE � CHILYARACTERISTICS RESSTI CEUNDE HE
OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR - -
arolina General
In compliance with the provision of North Cof na Environmental Management Commission,standards
and
regulations promulgated and adopted by the North Car
the Federal Water Pollution Control Act, as amended,
Jane H. Simmons
Mountain View Properties, LLC
eb authorized to discharge domestic wastewater [700 GPD] from a facility located at
is her y
Mountain View Pediatrics
Lenoir
Caldwell County
to receiving Ovate.gn rs desi ated as Husband Creek in subbasin 03-08-31 of the
Caand
River Basin in accordance with the effluent limitations, monitoring requirements,
other conditions set forth in Parts I, II, III and IV hereof.
This certificate of coverage shall become effective August 1, 2007.
This Certif
icate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 27, 2007.
for Coleen H. Sullins, Director
Division of Water Quality
mental Management Commission
By Authority of the Environ

NCDENR
North Carolina Department of Environment
Michael F. Easley, Governor Division of Water Quality
January 9, 2007
Jane Simmons
100 Medical Heights Dr
Morganton, NC 286,155
4
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d Na urailResources
`'
�Iry't
AWriliam G Ross, Jr., Secretary,
Alan W. Klimek, P.E., Director
Subject: Renewal Notice / General Permit NCG550000
Certificate of Coverage NCG550977
Caldwell County
Dear Permittee:
You are receiving this notice because you currently own a property covered under the subject
General Permit for the discharge of domestic wastewater. NCG550000 will expire on July 31 2007.
Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105(e)) regulations require
that permit renewal applications be filed at least 180 days prior to expiration of the current ermit.
renewal request postmarked n
To satisfy this requirement, the Division must receive a p
February 1, 2007. o later than
The Certificate of Coverage (CoC) specific to your property was last issued on August 1, 2002.
The Division needs information from you to determine if coverage under NCG550000 is still
necessary.
➢ If your property still has a wastewater system like the ones described in the enclosed
Technical Bulletin, you must renew the subject CoC. Complete the enclosed form and
submit it to the address on the form.
➢ If you are not sure what type of system your property has, contact Larry Frost in th
DENR Asheville Regional Office at. That person or other staff members] can help e NC
determine if you p [ p you
Y should renew your CoC.
➢ If you know that your property no longer discharges wastewater, contact me
address or phone number listed below to request rescission of the CoC, at the
procedure The .Annual Fee is like the fee you annually is re uired for this
V for the stick
your vehicle's license plate. Renewal of your CoC is like the re ewnal of your Driver'sr on
License [ca. every five years].
➢ If you have already mailed a renewal request, you may disregard this notic
e.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
One
Phone: [phone], extension 511 / FAX [phone] /[e-mail] N%o�rthtCarro/l/ina
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/1 0% Post Consumer Paper f/ ► Jd`h` �"

NCG550977 renewal notice,
January 9, 2007
The attached application form shows the information the Division has on file for your
property.
Please verify that the provided information is correct, or make correctionsonthe form.
Complete the additional questions, then sign and date the
leted form should be submitted to the address listed below the signature block.
.The comp
questions concerning this matter, please contact me at the telephone number
If you have any q or e-mail address listed below. (If it is difficult to reach me, please be aware that your facility's one
of over 1100 that I am contacting regarding the renewal of NCG550000.)
Thanks for your attention to this matter.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files Frost
Asheville Regional Office / Larry
NPDES file

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
JANE SIMMONS
MOUNTAIN VIEW PEDIATRICS
100 MEDICAL HEIGHTS DR
MORGANTON, NC 28655
Dear Permittee:
11/26/01
1•�
NCDENR
NORTHCAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: NPDES Wastewater Permit Coverage Renewal
Mountain View Pediatrics
COC Number NCG550977
Caldwell County
Your residence or facility is currently covered for wastewater discharge under General Permit NCG550000. This
permit expires on July 31, 2002. Division of Water Quality (DWQ) staff is in the process of rewriting this permit
with a scheduled reissue in the summer of 2002. Once the permit is reissued, your residence or facility would be
eligible for continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the DWQ for renewal of
your permit coverage. To make this renewal process easier, we are informing you in advance that your permit will
be expiring. Enclosed you will find a general permit coverage renewal application form. This will serve as
your application for renewal of your permit coverage. The application must be completed and returned with the
required information by February 01, 2002 in order to assure continued coverage under the general permit. There is
no renewal fee associated with this process.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of wastewater from your
residence or facility without coverage under a valid wastewater_NPDES permit would constitute a violation of
NCGS 1.43-215.1 and could result in assessments of civil penalties of up to $10,000 per day.
If the subject wastewater discharge to waters of the state has been terminated, please complete the enclosed
rescission request form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit coverage renewal procedures please contact the Asheville Regional
Office at 828-251-6208 or Bill Mills of the Central Office Stormwater Unit at [phone], ext. 548
Sincerely,
Bradley Bennett, Supervisor
cc: Central Files Stormwater and General Permits Unit
Stormwater and General Permits Unit Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
An Equal Opportunity Affirmative Action Employer An 1 3-5083 FAX [phone]
50 /° recyclled/ed/ 10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Alan W. Klimek, P.E., Director
JANE SIMMONS
MOUNTAIN VIEW PEDIATRICS
100 MEDICAL HEIGHTS DR
MORGANTON, NC 28655
Dear Permittee:
A4W�
*•
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 26, 2002
Subject: Reissue - NPDES Wastewater Discharge Permit
Mountain View Pediatrics
COC Number NCG550977
Caldwell County
In response to your renewal application for continued coverage under general permit NCG550000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued wastewater general permit Certificate of Coverage
(COC). This COC is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection Agency,
dated May 9, 1994 (or as subsquently amended).
The following information is included with your permit package:
* A copy of the Certificate of Coverage for your treatment facility
* A copy of General Wastewater Discharge Permit NCG550000
* A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG550000
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
Please note that effective January 1, 1999 the fees for all permits issued by DWQ were changed. This changed the
fee for your wastewater general permit coverage from a $240 fee paid once every five years to a yearly fee of $50.
If you have not already been billed this year for the yearly fee, you will receive a bill later this year.
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
for Alan W. Klimek, P.E.
cc: Central Files
Stormwater & General Permits Unit Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper