NC0059536_Regional Office Historical File Pre 2016

AMA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
September 10, 2015
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
SUBJECT: Compliance Evaluation Inspection
Hilltop Living Center
Permit No. NCO059536
Davidson County
Dear Ms. Tuttle:
Donald R. van der Vaart
Secretary
On July 24, 2014, Jenifer Carter of the Winston-Salem Regional Office conducted a Compliance Evaluation
Inspection at Hilltop Living Center's wastewater treatment facilities. Mr. Luther Leonard, ORC, was present
during the inspection. The following is a summary of findings during the inspection:
A) As noted in the last inspection, it is recommended that a written record of maintenance be
maintained for review, should any problems arise (i.e. when septic tanks and the grease trap are
pumped out).
B) The discharge from the system was clear and odorless, a great improvement since the last
inspection
C) Overall, the treatment system appeared to be well maintained and operated.
Please refer to the attached report for more detailed information about the inspection. Should you have any
questions please contact me at [phone].
Sincerely,
` W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
Enclosure
cc: DWR central files
WSRO files
Mr. Luther Leonard (502 Northside Dr.; Lexington, NC 27295)
450 W Hanes Mill Rd., Suite 300, Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

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 IN 1 2 15 1 3 NCO059536 I11 121 15/08/07 I17 18 [, j 19 L G j 201 I
211 11J 1 1 11__I 1 1 1 1 11 1 1 1 I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 f6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --- ------------- --- Reserved -------------
67 70 71 I„ ] 72 LJ L �, � 73 L]J74 751
LJ I I I I I 1 180
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)
09:OOAM 15/08/07
14/06/01
Hilltop Living Center WWl•P
212 Plemmons Dr
Exit Time/Date
Permit Expiration Date
Linwood NC 27299
10:30AM 15/08/07
19/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Luther C. LeonardH336-249-7439 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Tisha T Tuttle,1025 Lamb Rd Lexington NC 27292//336-853-7670/3368537671
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program E Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
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
Je Carter r WSRO WQH336-776-9691f
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
r,
t
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCO059536 I11 121 15/08/07 117 18 JCJ
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#

I
Permit: NCO059536 Owner - Facility: Hilltop Living Center WWTP
Inspection Date: 08/07/2015 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
❑
❑
❑
# Are there any special conditions for the permit?
0
❑
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: There IS no upstream point to sample.
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
0
❑
❑
❑
Is all required information readily available, complete and current?
0
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
0
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
M
❑
❑
❑
Is the chain -of -custody complete?
0
❑
❑
❑
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?
0
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
0
❑
on each shift?
Is the ORC visitation log available and current?
0
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
M
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
M
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
Comment:
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ 0 ❑
Is sample collected below all treatment units? 0 ❑ ❑ ❑
Page# 3

Permit: NCO059536 Owner - Facility: Hilltop Living Center WWTP
Inspection Date: 08/07/2015 inspection Type: Compliance Evaluation
Effluent Sampling
Yes No NA NE
Is proper volume collected?
M
❑
❑
❑
Is the tubing clean?
❑
❑
0
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
0
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
❑
❑
❑
representative)?
Comment:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and 0 ❑ ❑ ❑
sampling location)?
Comment:
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
0
❑
❑
❑
Is flow meter calibrated annually?
0
❑
❑
❑
Is the flow meter operational?
0
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
M
❑
Comment:
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
❑
❑
❑
0
Is the distribution box level and watertight?
❑
❑
❑
Is sand filter free of ponding?
M
❑
❑
❑
Is the sand filter effluent re -circulated at a valid ratio?
0
❑
❑
❑
# Is the sand filter surface free of algae or excessive vegetation?
0
❑
❑
❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
❑
❑
❑
0
Comment:
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
0
❑
❑
❑
Are the tablets the proper size and type?
0
❑
❑
❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
0
❑
❑
❑
Page# 4

Permit: N00059536 Owner - Facility: Hilltop Living Center WWTP
Inspection Date: 08/07/2015 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Is the contact chamber free of growth, or sludge buildup? 0 ❑ ❑ ❑
Is there chlorine residual prior to de -chlorination? 0 ❑ ❑ ❑
Comment:
De -chlorination
Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
M ❑
❑
❑
Is storage appropriate for cylinders?
❑ ❑
M
❑
# Is de -chlorination substance stored away from chlorine containers?
0 ❑
❑
❑
Comment:
Are the tablets the proper size and type? M ❑ ❑ ❑
Are tablet de -chlorinators operational? 0 ❑ ❑ ❑
Number of tubes in use? 2
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? M ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ M ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: It is recommended that more complete maintenance records be kept (i.e. when the beds are
raked).
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? 0 ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? M ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ M ❑
Comment: The discharge was clear and odor -free
Page# 5

RECEIVED
N.C.Dept. of ENR
SEP 0 4 2015
NCDENK Winston-Salem
Regional Office
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor
Secretary
August 18, 2015
CERTIFIED MAIL ITEM 7013 2630 0001 8998 3509
RETURN RECEIPT REQUESTED
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject:UNPAID ANNUAL FEES
NPDES Permit NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
An audit of annual fee payments for NPDES permittees has noted unpaid fees for your
facility. Specifically, there are unpaid annual fees for 2012, 2013, and 2014.
Payment of annual fees is required by Part II B. (14) of your NPDES permit, as well as
15A NCAC 2H.0105 (b) (2). The unpaid fee invoices are enclosed. Please submit the fee
payments as soon as possible.
If you have evidence that the fees have already been paid, contact Mr. Charles Weaver of
my staff at the e-mail address or telephone number listed below.
We appreciate your assistance in this matter.
nce ely,
John Hennessy, Supervisor
Expedited Permits and Compliance Unit
cc: Central Files
Winston Salem Regional Office / Jenifer Carter
NPDES file
1617 Mail Service Center, Raleigh, North Carolina 27699-1617512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://portal.ncdenr.org/web/wq/swp/ps/npdes / [e-mail]
An Equal Opportunity/Affirmative Action Employer — 501/6 Recycled/10% Post Consumer Paper

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 14, 2015
Hilltop Living Center
Attn: Tisha Tuttle
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2015-LV-0517
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
Donald R. van der Vaart
Secretary
A review of Hilltop Living Center WWTP's monitoring report for April 2015 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
4/10/2015
7.500 mg/I
8.130 mg/I
Daily Maximum Exceeded
BOD, 5-Day (20 Deg. C)
4/30/2015
5.000 mg/I
6.420 mg/I
Monthly Average Exceeded
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W. Hanes Mill Rd, Suite 300; Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

WIVIn 1XVVIMVV mlou.oru
Facility: 41 IJW Permit No.:
F I C6C5q Pipe No,:
EO' wu�T�
Monthlv Average Violations
Month/Year
Ea—rameter
Permit Limit DIVIR Value
% Over Limit Action
a
Weekly/Daily Violations
Date
Parameter
Permit Limit Limit Type DIVIR Value
7
% Over Limit Action
Monitoring Frequency Violations
Date
Parameter
Permit Frequency Values Reported
# of Violations Action
Other Violations/Staff Remarks:
b1m -S I (VI
Supervisor Remarks: 46VI NOV 15-LV-05(-7
Completed by: �} 67j A-&� ill,
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign •
Off:
Date: 9112-11
Date:
Date:
i

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
June 19, 2015
Hilltop Living Center
Tisha Tuttle
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2015-LV-0403
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
Donald R. van der Vaart
Secretary
A review of Hilltop Living Center WWTP's monitoring report for March 2015 showed the following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF
3/6/2015
400.000 #/100m1
12,000.000 #/100ml
Daily Maximum Exceeded
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
i y W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W. Hanes Mill Rd, Suite 300; Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 30, 2015
Hilltop Living Center
Tisha Tuttle
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2015-LM-0020
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
Donald R. van der Vaart
Secretary
A review of Hilltop Living Center WWTP's monitoring report for January 2015 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20
Deg. C) -
Concentration
1/31/2015
10.000 mg/l
11.450 mg/1
Monthly Average Exceeded
Parameter
Date
Measuring Frequency
Violation
Surfactants (MBAS)
1/31/2015
2 X month
Monitored only 1 X
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W. Hanes Mill Rd, Suite 300; Winston-Salem, NC 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Acton Employer — Made in part by recycled paper

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Facility:
` f `
Permit No.; S& Pipe No,: NlonthNear: =S
Monthly Average Violations
Parameter
PermitLimit
%O/-ver Limit Action
/DIVIRLValue
Weekly/Daily Violations
Date
Parameter
Permit Limit Limit Type DMR Value
% Over Limit Aoft
Monitoring Frequency Violations
Date
Parameter
Permit Frequency Values Reported
# of Violations Adon
Other ViolationslStaff Remarks:
I?v on4iw'wv/b-
supervisor Remarks:
t-loV
Completed by: J l f�Oy
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign •
Off:
Date: S—
Date:
Date:~

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
December 22, 2014
Hilltop Living Center
Attn: Ms. Tisha Tuttle
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0546
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms Tuttle:
John E. Skvarla, III
Secretary
A review of Hilltop Living Center WWTP's monitoring report for September 2014 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal
9/19/2014
400.000 #/100ml
8,000.000 #/100m1
Daily Maximum Exceeded
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
450 W. Hanes Mill Rd, Suite 300; Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncdenr.gov
An Equal Opportunity \ Affirmative Action Employer — Made in part by recycled paper

Facility: / Permit No.:D �5�js3O Pipe No.: Month/Year: y L�
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit Action
ADe Parameter
Date
Parameter
Weekly/Daily Violations
Permit Limit Limit Type DMR Value % Over Limit Action
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations Action
Other Violations/Staff Remarks: Z'70 IZ MOXA�5
Aff
0 o
Supervis Remarks:
Completed by: Date:
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign
Off: Date:

Tuttle & Associates, LLC
August 25, 2014
W. Corey Basinger
Water Quality Division
585 Waughtown Street
Winston-Salem.NC 27107
Dear Mr. Basinger:
1025 Lamb Road, Lexington, NC 27295
336-853-7670 est. 26 phone [e-mail]
336-853-7671fax
RECEIVED
N.C.Dept. of ENR
AUG 2 7 2014
Winston-Salem
Regional Office
I am in receipt of your notice of violation for Permit No. NCO059536 Hilltop Living Center. In response to the
violation (NOV-2014-LV-0387). I have met with the operator and discussed in detail. I am receiving this notice
dated August 12, 2014 on today's date of August 25, 2014. There was an issue with delivery. I am going to try
to response quickly as this is late. I left a message with Jenifer Carter to explain the delay. I have spoken with
the operator Luther Leonard and he is going to check the level of sand depth at the end of this week. The
operator will check sand depth in 4 areas of the treatment plant, 2 lower and 2 upper. We will then determine at
what level the system may operate optimally. I will have the operator check with the lab to see if the Ammonia
levels improve. We have in the last year reduced the amount of resident license capacity, this may help as well.
Please contact me at 336-853-7670 ext. 26 if you have future recommendations.
ncerely,
Tisha Tuttle
Hilltop Living Center
Ms. _T#W M a1tf 1q --k) 0 (V't Mai
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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 12, 2014
CERTIFIED MAIL #7011 1570 00018546 3795
RETURN RECEIPT REQUESTED
Hilltop Living Center
Attn: Ms. Tisha Tuttle
1025 Lamb Rd
Lexington,.NC 27292
Subject: Notice of Violation and Recommendation for Enforcement
NOV-2014-LV-0387
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
John E. Skvarla, III
Secretary
A review of Hilltop Living Center WWTP's monitoring report for April 2014 showed the following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
04/30/14
2 mg/l
3.57 mg/1
Monthly Average Exceeded
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. NC0059536.
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) business days after receipt of this Notice. A review of your response will be considered
along with any information provided on the April 2014 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.
Remedial actions, if not already implemented, should be taken to correct any problems. The Division of
Water Resources 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. �r
continued on reverse...
C]
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper d`\

If you have questions concerning this matter, please do not hesitate to contact Jenifer Carter or me at
[phone].
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, DENR
cc: Compliance & Expedited Permitting Unit
Luther C. Leonard (502 Northside Drive; Lexington, NC 27295)
DWR — Central Files
WSRO Files
i
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,ti DV lvvJ- ---7 AJUrV -ako t q- a �-Idl �-
DMR Review Record
Facility: Permit No.: 5' ��, Pipe No.: C% MonthNear: r ?01
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit Action
Weekly/Daily Violations
Date Parameter Permit Limit Limit Type DMR Value
Date Parameter
Monitoring Frequency Violations
Permit Frequency Values Reported
Other Violations/Staff Remarks: Z,,- l2 %LrGd/! �hS
Ire6 --/, U/ ,�- #7 /1/
supervisor Remarks: Ij dT,
% Over Limit Action
# of Violations Action
Completed by: (-P r 6 f I — Date: /
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign
Off: Date: d��~

EFFLUENT VI�"f
NPDES PEM]? RMIT NO. N00059536 DISCHARGE NO. 01 MONI'l 6'1'I:AR (�
FACILITY NAHilltop living Center CLASS 1 C )l1N'I l' Uavids�u�
OPERATOR IN RIESPONSIBLE CHARGE (ORC) Luther Leonard GRAIN'. 1 stsfc_I'1 ION]: _336-24V-743,)_
CERTIFIED LABORATORIES (1) R & A Laboratories. Inc. (2)
CHECK BOX IF ORC HAS CHANGED F7 1']ERSON(S) C' )I,LECI'1NG SAMPLES (Operators
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Mail ORIGINAL, and ONl: COPY to:
ATTN: CENTRAL FILES \ J 3 O 1
DIVISION OF RATER QUALITY � (SI �', RE Ol: PF A7'OR IN RI?SYONSIBLE CHARGE) EIVED
�• Pt. of ENR
1617 MAIL SERVICE CENTF,R Bl"IGNATURE, I C'ERTIFI" THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETED TO THE, BEST OF MY KNOVA'LF.I GE. JUN 18 2014
Winston-Sdjem
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Cop} DEM Form MR-1 (12/93

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Facility Status: (Please check one ol'the JbIlowing)
All monitoring data and sampling lrequencies meet permit requirements
Compliant
All monitoring data and sampling lrequencies do NOT meet permit requirements
Noncompliant
f the facility is noncompliant, please comment on corrective actions being taken in respect to equipment 'operation, maintenance. etc..
nd a timetable for improvements to be made. 1
1 e C.i r Wl U'r Y_ G r� C 1� GG �'► G : is T M. J-e u S crr�
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supen-ision in accordance
ith a system designed to assure that a qualified personnel properly gather and evaluate the information submitted. Based on my
.iquiry of the person or persons who manage the si.stem, or those persons directly responsible for gathering the information, the
zformation submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
,enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
'ermittee Address
)0010 Temperature 00556 Oil & Grease
)0076 Turbidity 00600 Total Nitrogen
)0080 Color (Pt -Co) 00610 Ammonia Nitrogen
)0082 Color (ADMI) 00625 Total Kjeldhal
Nitrogen
)0095 Conductivity 00630 Nitrates/Nitrites
)0300 Dissolved O%ygen
)0310 BODS
00665 Total Phosphorus
)0340 COD .
00720 Cyanide
)0400 pl3
00745 Total Sulfide
)0530 Total Suspende
00927 Total Magnesium
Residue
00929 Total Sodium
)0545 Settleable Matt
00940 Total Chloride
Judy M Whitley
rmit (Please print or type)
tur fPerm ee**
Phone Number
PARAMETER CODES
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
01032 Hexavalent Chromium
01034 Chromium
01037
Total Cobalt
01042
Copper
01045
Iron
01051
Lead
01062
Molybdenum
01067 Nickel
01077 Silver
01092 Zinc
01105 Aluminum
Date
Permit E\p. Date
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolic 81551 Xylene
34235 Benzene
34481 Toluene
38260 MBAS
395.16 PCBs
50050 Flow
'arameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone], or by visiting
ie Water Quality Section's web site at h2o.enr.state.nc.us/wgs and linking to the Units information pages.
Jse only units designated in the reporting facility's permit for reporting data.
ORC must visit facility and document visitation of facility as required 15A NCAC 8G.0204.
* If signed by other than the Permittee. delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)
2)(D).

A
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 29, 2014
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
SUBJECT: Compliance Evaluation Inspection —
Ongoing Ammonia Permit Limit Violations
Hilltop Living Center
Permit No. NCO059536
Davidson County
Dear Ms. Loflin:
John E. Skvarla, III
Secretary
On July 24, 2014, Jenifer Carter of the Winston-Salem Regional Office conducted a Compliance Evaluation Inspection
at Hilltop Living Center's wastewater treatment facilities. Mr. Luther Leonard, ORC, was present during the
inspection. The following is a summary of findings during the inspection:
A) The permit was renewed and became effective on June 1, 2014.
B) Mr. Leonard does not maintain a written record of maintenance that Hilltop Living Center staff performs and/or
hires out (i.e. when septic tanks and the grease trap are pumped out). Please make sure you do so.
C) Periodic ammonia limits violations continue to occur, and the discharge from the system, though clear,
had a strong ammonia -like odor to it. If violations cannot be abated using the existing system, additional
measures need to be considered, such as changes/upgrades to the existing system. An outside contractor/
engineer should be consulted, and prior approval from the Division obtained prior to any changes being
made.
Please refer to the attached report for more detailed information about the inspection. Should you have any questions
please contact Jenifer Carter in our Winston-Salem Regional Office at [phone].
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
Enclosure
cc: DWR central files
WSRO files
Mr. Luther Leonard (502 Northside Dr.; Lexington, NC 27295)
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www,ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

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 IN 2 u 3 1 NC006M36 111 121 14/07/24 117 18 [, I 19 I S ti 20 LJ
2111_11 1 1 1 1 1 111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 111 1 11 1 1 IRA
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA --- —---- -------Reserved----------
67
180
70 71 L� ti � 72 L N 73 I I I74 751 III 1 1.1
L_I LJ I I
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)
01:OOPM 14/07/24
14/06/01
Hilltop Living Center WWTP
212 Plemmons Dr
Exit Time/Date
Permit Expiration Date
p
Linwood NC 27299
02:OOPM 14/07/24
19/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Luther C. Leonard//336-249-6704 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Tisha T Tuttle,1025 Lamb Rd Lexington NC 27292//336-853-7670/3368537671 Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program 0 Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
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
Jenifer Carter WSRO WQ//336-771-5000/
L�
Signature of Managemen Q A Revi;wer Agency/Offiiccee/Phoneand Fax Numbers Date
y�
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type 1
31 NC0059536 I11 121 14/07/24 117 18 [(;
Section D: Summary of Finding/Comments (Attach additionalsheetsof narrative and checklists as necessary)
Mr. Leonard does not maintain a written record of maintenance performed by outside contractors hired
by Hilltop (i.e. when septic tanks or grease trap are pumped out).
Ongoing ammonia violation must be addressed. If violations cannot be abated using the existing
system, additional measures may need to be considered, such as changes/upgrades to the system, in
consultation with a wastewater consultant/engineer.
Page# 2

f
Pertnit: NCO059536 Owner -Facility: Hilltop Living Center WWTP
Inspection Date: 07/24/2014 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
❑
❑
❑
# Are there any special conditions for the permit?
0
❑
❑
❑
Is access to the plant site restricted to the general public?
M
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment:
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
0
❑
❑
❑
Is all required information readily available, complete and current?
0
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
0
❑
❑
❑
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?
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
M
❑
❑
❑
on each shift?
Is the ORC visitation log available and current?
M
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
0
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
M
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
0
Comment:
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? ❑ ❑ 0 ❑
Is sample collected below all treatment units? ❑ ❑ ❑
Page# 3

Permit: NCO059536 Owner - Facility: Hilltop Living Center VWVFP
Inspection Date: 07/24/2014 Inspection Type: Compliance Evaluation
Effluent Sampling
Yes No NA NE
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
❑
❑
M
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
0
❑
❑
❑
representative)?
Comment:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and 0 ❑ ❑ ❑
sampling location)?
Comment: There is no uDstream to sample from.
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
0
❑
❑
❑
Is flow meter calibrated annually?
0
❑
❑
❑
Is the flow meter operational?
0
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
N
❑
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? M ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
❑
❑
❑
Is the distribution box level and watertight?
0
❑
❑
❑
Is sand filter free of ponding?
0
❑
❑
❑
Is the sand filter effluent re -circulated at a valid ratio?
0
❑
❑
❑
# Is the sand filter surface free of algae or excessive vegetation?
0
❑
❑
❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
❑
❑
❑
Comment:
Page# 4

Permit: NC0059536 Owner - Facility: Hilltop Living Center WWTP
Inspection Date: 07/24/2014 Inspection Type: Compliance Evaluation
De -chlorination Yes No NA NE
Type of system ? Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)? 0 ❑ ❑ ❑
Is storage appropriate for cylinders? ❑ ❑ M ❑
# Is de -chlorination substance stored away from chlorine containers? M ❑ ❑ ❑
Comment:
Are the tablets the proper size and type? 0 ❑ ❑ ❑
Are tablet de -chlorinators operational? 0 ❑ ❑ ❑
Number of tubes in use? 2
Comment:
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
0
❑
❑
❑
Are the tablets the proper size and type?
0
❑
❑
❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
0
❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
0
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
M
❑
❑
❑
Comment:
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? 0 ❑ ❑ ❑
Are the receiving water free of foam other than trace amounts and other debris? 0 ❑ ❑ ❑
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ 0 ❑
Comment: The discharge smelled strongly of ammonia, as evidenced by ongoing ammonia limit
violations.
Page# 5

Ajp2
4 3A
—.....,�
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
June 4, 2014
Ms. Tisha Tuttle
1025 Lamb Rd
Lexington NC 27292
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0247
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
John E. Skvaria, III
Secretary
A review of Hilltop Living Center WWTP's monitoring report for February 2014 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
02/28/14
4 mg/1
4.57 mg/l
Monthly Average Exceeded
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

DMR R ' R d /vaV-g®i�-zV G�7--
ev�ew w%&W
Facility: p r efi}@v Permit No.:/ Pipe No.: (, MonthNear:
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit Action
4,S2-
Weekly/Daily Violations
Date Parameter Permit Limit Limit Type DMR Value % Over Limit Action
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations Action
Other Violations/Staff Remarks: 5�' /2- /P qn A S•
en�rr.�.nQ�1f ,�`�t�lGtcc ►'y 2a! 3 � /�v�, �rv+rti�
iti/� d-Z.AV/nv -dir-Hw acfiai: `c.b 2013 CAmM,' 1'W IY ; 14�7,10 20)3 6�oD, M g4-s )
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Completed by:
Date: D zD %
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign
Off: Date:

4
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 4, 2014
Tisha Tuttle
1025 Lamb Rd
Lexington NC 27292
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0151
Permit No. NCO059536
Hilltop Living Center WWTP
Davidson County
Dear Ms. Tuttle:
John E. Skvarla, III
Secretary
A review of Hilltop Living Center WWTP's monitoring report for December 2013 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal
12/17/13
400 #/100ml
780 #/100ml
Daily Maximum Exceeded
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 Resources for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: DWR — Central Files
WSRO Files
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper

NOV-0�-04-Gv' Or� J
Q_
Facility:.. llpe
DMR Review Record
Permit No.: O � Pipe No.: MonthNear: / C _,7C) 13
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit Action
Weeklv/Daily Violations
Date
alLL
Parameter
re Lai,_
Permit Limit Limit Type DMR Value
Are,
% Over Limit Action
Monitoring Frequency Violations
Date
Parameter
Permit Frequency Values Reported
# of Violations Action
Other Violations/Staff Remarks:
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I r TC1 n 2013 (go 1) A4 v1 M )
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SGtna� r-el,21,aeed �J-urV Z013
Supervisor Remarks:
Completed by: �w� Date:�/Z/ 126 I
Assistant Regional %��/�
Supervisor Sign Off: / 4 6y Date:
Regional Supervisor Sign
Off: Date: O�(.��/�'�" 70 ell—

� �
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
January 31, 2014
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Road
Lexington, North Carolina 27295
Subject: DRAFT NPDES PERMIT
Permit Number NCO059536
Hilltop Living Center — Class I
Davidson County
Dear Ms. Tuttle:
Enclosed with this letter is a copy of the draft permit for your facility. Please review the draft very
carefully to ensure thorough understanding of the conditions and requirements it contains. Your permit is
among several in the Yadkin -Pee Dee River Basin that the Division has targeted for expedited renewal.
Please note the following modifications to this draft:
• Parameter codes have been added to Section A.(L) Effluent Limitations and Monitoring
Requirements.
• A Nutrient Re -opener has been added to all dischargers in sub -basins 03-07-01 thru 03-07-07,
see Special Condition A. (3.).
• A requirement to begin reporting discharge monitoring data electronically using the NC DWR's
Electronic Discharge Monitoring Report (eDMR) internet application has been added to this
draft. [See Special Condition A. (.3.)] For information on eDMR, registering for eDMR and
obtaining an eDMR user account, please visit the following web page:
http://portal.ncdenr.orf;/web/wq/admin/bo r ipu/ednir.
Proposed federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and
specify that, if a state does not establish a system to receive such submittals, then permittees must submit
DMRs electronically to the Environmental Protection Agency (EPA). The Division anticipates that these
regulations will be adopted and is beginning implementation.
For information on EPA's proposed NPDES Electronic Reporting Rule, please visit the following web
site: http://www2.epa.�=,ov/compliance/proposed-npdes-electronic-reportink rule.
Please confirm that the permit is accurate and reflects the actual treatment system components (See
Supplement to Cover Page). You may submit any comments to me no later than thirty (30) days
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]
Internet:: www rimateraualitv.org
An Equal Opportunity'Afrmative Action Employer

Hilltop Living Center
NC0059536
January 31, 2014
Page 2
following your receipt of the draft. Comments should be sent to the address listed at the bottom of this
page. If no adverse comments are received from the public or from you, this permit will likely be issued
in late -March 2014, with an effective date of May 1, 2014.
If you have any questions or comments concerning this draft permit, please contact me at (919)
807-6388 or [e-mail].
Sincerely,
GAC( o
Maureen Kinney
cc: NPDES Unit
ec: Winston-Salem Regional Office, Surface Water Protection Section
Steve Reid, NCDENR

Permit NCO059536
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
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,
Tisha Tuttle
is hereby authorized to discharge wastewater from a facility located at
Hilltop Living Center
212 Plemmons Drive
Linwood
Davidson County
to receiving waters designated as an unnamed tributary to the Yadkin River in the Yadkin -Pee Dee
River Basin in accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV hereof.
The permit shall become effective
, 2014.
This permit and the authorization to discharge shall expire at midnight on May 31, 2019.
Signed this day
, 2014.
DRAFT
Thomas A. Reeder, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NC0059536
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.
Tisha Tuttle is hereby authorized to:
1. Continue to operate an existing 0.003 MGD wastewater treatment plant, consisting of:
• two septic tanks
• flow splitter
• grease trap
• two pump tanks
• two surface sandfilters
• recirculation diversion box
• tablet chlorinator
• chlorine contact tank
• dechlorination
The facility is located at the Hilltop Living Center, 212 Plemmons Drive, Linwood, NC in
Davidson County, and
2. Discharge from said treatment works at the location specified on the attached map into an
unnamed tributary to the Yadkin River, currently classified WS-V waters in the Yadkin -Pee Dee
River Basin.
Page 2 of 6

. Permit NCO059536
PART I
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - DRAFT
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized
to discharge from Outfall 001. Such discharges shall be limited and monitored' by the Permittee as specified
below:
'1` CS
y
M1
ns. S
P
/yp y^ppa
+�/y y��pyy�y
.may y�
Flow
0.003 MGD
Weekly
Instantaneous
I or E
50050
BOD5 —Summer*
5.0 mg/L
7.5 mg/L
2/month
Grab
E
C0310
BOD5 — Winter*
10.0 mg/L
15.0 mg/L
2/month
Grab
E
C0310
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/month
Grab
E
C0530
NH3-N — Summer*
2.0 mg/L
10.0 mg/L
2/month
Grab
E
C0610
NH3-N — Winter*
4.0 mg/L
20.0 mg/L
2/month
Grab
E
C0610
Dissolved Oxygen
Daily Average > 5.0 mg/L
Weekly
Grab
E
00300
—
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
2/month
Grab
E
31616
Total Residual Chlorine
17 µg/I.
2/Week
Grab
E
50060
Temperature
Daily
Grab
E
00010
Total Nitrogen (TKN + NO2 + NO3)
Quarterly
Grab
E
C0665
Total Phosphorus
Quarterly
Grab
E
C0665
MBAS
750 µg/L
2/month
Grab
E
38260
pH
Between 6.0 and 9.0
2/month
Grab
E
00400
Standard Units
Dissolved Oxygen
Weekly
Grab
U, D
00300
Temperature
Weekly
Grab
U, D
00010
*Summer: April 1 — October 31
*Winter: November 1 — March 31
Footnotes:
1. No later than 270 days from the effective date of this permit, begin submitting discharge monitoring reports
electronically using NC DWR's eDMR application system. See Special Condition A.(3.).
2. E - Effluent, I — Influent, U — Upstream approximately 50 feet above the discharge point, D — Downstream from the
discharge point approximately 300 feet from the outfall.
3. The Division shall consider all effluent TRC values reported below 50 µg/L to be in compliance with the permit.
However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory
(including field certified), even if these values fall below 50 µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
Page 3 of 6

Permit NCO059536
A. (2.) NUTRIENT REOPENER FOR HIGH ROCK LAKE
This permit may be reopened and modified to implement nutrient requirements in accordance with any future
TMDL and/or nutrient management strategy for High Rock Lake.
A. (3.) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Proposed federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and specify
that, if a state does not establish a system to receive such submittals, then permittees must submit DMRs
electronically to the Environmental Protection Agency (EPA). The Division anticipates that these regulations
will be adopted and is beginning implementation in late 2013.
NOTE: This special condition supplements or supersedes the following sections within Part II of this permit
(Standard Conditions for NPDES Permits):
• Section B. (11.)
• Section D. (2.)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning no later than 90 days from the effective date of this permit, the permittee shall begin reporting
discharge monitoring data electronically using the NC DWR's Electronic Discharge Monitoring Report
(eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and submitted
electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring data and
submit DMRs electronically using the internet. Until such time that the state's eDMR application is
compliant with EPA's Cross -Media Electronic Reporting Regulation (CROMERR), permittees will be
required to submit all discharge monitoring data to the state electronically using eDMR and will be required
to complete the eDMR submission by printing, signing, and submitting one signed original and a copy of the
computer printed eDMR to the following address:
NC DENR / DWR / Information Processing Unit
ATTENTION: Central Files/eDMR
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility being
physically located in an area where less than 10 percent of the households have broadband access, then a
temporary waiver from the NPDES electronic reporting requirements may be granted and discharge
monitoring data may be submitted on paper DMR forms (MR 1, 1. 1, 2, 3) or alternative forms approved by
the Director. Duplicate signed copies shall be submitted to the mailing address above.
Requests for temporary waivers from the NPDES electronic reporting requirements must be submitted in
writing to the Division for written approval at least sixty (60) days prior to the date the facility would be
required under this permit to begin using eDMR. Temporary waivers shall be valid for twelve (12) months
and shall thereupon expire. At such time, DMRs shall be submitted electronically to the Division unless the
permittee re -applies for and is granted a new temporary waiver by the Division.
Page 4 of 6

Permit NC0059536
Information on eDMR and application for a temporary waiver from the NPDES electronic reporting
requirements is found on the following web page: http://portal.ncdenr.orWweb/wq/admin/boWipu/edmr
Regardless of the submission method, the first DMR is due on the last day of the month following the
issuance of the permit or in the case of a new facility, on the last day of the month following the
commencement of discharge.
2. Signatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B. (11.) (d)l
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part Il, Section
B. (I I.)(a) or by a duly authorized representative of that person as described in Part II, Section B. (I 1.)(b). A
person, and not a position, must be delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user account and
login credentials to access the eDMR system. For more information on North Carolina's eDMR system,
registering for eDMR and obtaining an eDMR user account, please visit the following web page:
http://portal.ncdenr.or web/wg/admin/boWipu/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall make the
following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL BE
ACCEPTED:
"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 manage 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. "
3. Records Retention [Supplements Section D. (6.)]
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions. These
records or copies shall be maintained for a period of at least 3 years from the date of the report. This period
may be extended by request of the Director at any time [40 CFR 122.41].
Page 5 of 6

Tisha Tuttle
Hilltop Living Center
County:
Davidson Stream Class: WS-V
Receiving Stream:
UT to Yadkin River Sub -Basin: 03-07-04
Latitude:
35' 43' 39" Grid/Quad: E17NW/Salisbury (W)
Longitude:
80° 23' 05" HUC#: 03040101
Facility Amp
Location
(not to scale)
North NPDES Permit: NCO059536

Y®
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2013-LV-0656
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
Division of Water Resources
Water Quality Programs
Thomas A. Reeder
Director
October 24, 2013
John E. Skvarla, III
Secretary
A review of Hilltop Living Center's monitoring report for July 2013 showed the following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
07/25/13
7.5 mg/1
12.2 mg/1
Daily Maximum Exceeded
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 Jenifer Carter at [phone].
cc: SWP — Central Files
WSRO Files
North Carolina Division of Water Resources, 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.ncwater.org
An Equal Opportunity 1 Affirmative Action Employer
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
NorthCarolina
Naturally

Cover Sheet from
'o
o 13 _ (�
`F'
Staff Member to
Regional Supervisor
DMR Review Record
Facility.: Nj-Aae khnj4jI fiut1Pipe No.: 11 OtIR. 34 Month/Year o? d 13
0
Monthly Average Violations
Parameter Pen -nit Limit DMR Value % Over Limit
Weekly ail Violations
Date Parameter Permit Limit/TVDe DMR Value % Over Limit
EVD ►� tea.
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations l,,�,W 12-
�'v enl'. Z01 U 14vvr�
n/nV/ "T w 0 rmet
0l✓- Dr Bee 2022(-,q%MA
-
Completed by: :T /�2 r' ✓ Date: 10 3 2aL
Regional Water Quality 2.613
Supervisor Signoff: N Date: ? 3 `�
�p4 v
1`

&W4 W
C E R
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder
Governor Acting Director
October 3, 2013
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
John E. Skvarla, ill
Secretary
A review of Hilltop Living Center's monitoring report for June 2013 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
06/30/13
2 mg/1
2.48 mg/l
Monthly Average Exceeded
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 Jenifer Carter at [phone].
cc: SWP — Central Files
WSRO Files
North Carolina Division of Water Resources, 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.ncwater.org
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Section
Division of Water Resources
NorthCarohna
Naturally
An Equal Opportunity 1 Affirmative Action Employer

Cover Sheet from
I d' Staff Member to
Regional Supervisor
/ DMR Review Record
Facility: Facility: 1�0 Permit/PipeNo.:/v� �s3'� Month/Year J�� aa�3
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limiff vpe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations L4 S � /2 mos .
Ton
AIW,: 60- c Zola
Completed by: ,I /—,%v Date:
Regional Water Quality
Supervisor Signoff: 496�--Date:
2I)13 6011,0te�-r
�/l°C� a✓1a'd S C��� c-� �1-74kit kr -D s� Y�Q`toe0
ini j4—

MVA
A=,4*P)A
E
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder John E. Skvarla, III
September 13, 2013
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
SUBJECT: Compliance Evaluation Inspection
Hilltop Living Center
Permit No. NCO059536
Davidson County
Dear Ms. Loflin:
On August 15, 2013, Jenifer Carter of the Winston-Salem Regional Office conducted a Compliance Evaluation Inspection
at Hilltop Living Center's wastewater treatment facilities. Mr. Luther Leonard, ORC, was present during the inspection.
The inspection consisted of two parts: an on -site inspection of the treatment facility and a review of facility files and self -
monitoring data.
A review of the submitted self -monitoring data for previous year revealed several ammonia and a couple of MBAS permit
limit violations. The violation has been addressed separately through the Division's monthly enforcement program.
The following is a summary of findings during the inspection:
A) Mr. Leonard will maintain a written record of maintenance that Hilltop Living Center staff and he performs. It is
important for you to assist Mr. Leonard, as necessary, with maintaining record of any maintenance performed (i.e.
having the septic tanks or grease trap pumped out).
B) Mr. Leonard should calibrate his field meters daily, and check them against standards as required by his field
parameter certification.
C) There was some sludge build-up in the dechlorination chamber during the inspection, which Mr. Leonard has
since had cleaned out.
Should you have any questions please contact Jenifer Carter in our Winston-Salem Regional Office at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Section
Division of Water Resources
Enclosure
cc: SWP central files
WSRO files
Mr. Luther Leonard (502 Northside Dr.; Lexington, NC 27295)
North Carolina Division of Water Resources, Winston-Salem Regional Office
Location: 585 Waughtown Street, Winston-Salem, NC 27107
Phone: [phone] Fax: [phone] Customer Service:1-877.623-6748
Internet: http://www.ncwater.org
Nne
orthCarolina
Naturallrf
An Equal Opportunity 1 Affirmative Action Employer

United States Environmental Protection Agency
Form Approved
Washington, D.C. 20460
EPA
OMB No.2040-0057
Approval Expires 8-31-98
Water Compliance Inspection Report
Section A: National Data S stem Codin
Transaction Code NPDES No. Yr/Mo/Day Inspection Type Inspector FacilityType
N 5 NCO059536 13/08/15 C S 1
Remarks
Inspection Work Days Facility Self Monitoring Evaluation Rating BI QA ..........Reserved...........
3 N N
Section B: Facility Data
Name and Location of Facility Inspected:
Entry Time:
Permit Effective
Hilltop Living Center
9:30 AM 13/08/15
Date:o9/09/Ol
592 Hilltop Dr
Linwood NC 27299
Exit Time:
Permit Expiration
10:00 AM 13/08/15
Date•14/05/31
Name(s) of On -Site Representative(s): Title(s): Phone No(s):
Luther C. Leonard/ ORC/ 336-249-6704/
Name, Address of Responsible Official:
Title: Owner
Phone No. 336-853-7670
Contacted? No
Ms. Tisha Tuttle/Hilltop Living Center
1025 Lamb Road
Lexington, NC 27292
Section C: Areas Evaluated During Inspection (Check only those areas evaluate
Permit 0 Flow Measurement 00perations/Maintenance Records/Reports
Self -Monitoring Program E Facility Site Review 0 Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See Cover Letter)
Name(s) and Signature(s) of Inspector(s):
Agency/Office/Telephone:
Date:
Jenifer CarV r
y
WQ WSRO//336-771-4957
09/13/2013
Signature of Management QA Reviewer:
Agency/Office/Phone and Fax Numbers:
Date:
W. Corey Basinger
WQ WSRO//336-771-4963
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3I NCO059536 111 12, 13/08/15 117 18 L�
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

I
Permit: NCO059536 Owner - Facility: Hilltop Living Center
Inspection Date: 08/15/2013 Inspection Type: Compliance Evaluation
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?
■
❑ ❑
❑
# Are there any special conditions for the permit?
❑
■ ❑
❑
Is access to the plant site restricted to the general public?
■
❑ ❑
❑
Is the inspector granted access to all areas for inspection?
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?
Has the facility submitted its annual compliance report to users and DWQ?
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
Is the ORC visitation log available and current?
Is the ORC certified at grade equal to or higher than the facility classification?
Is the backup operator certified at one grade less or greater than the facility classification?
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Comment:
Effluent Sampling
Is composite sampling flow proportional?
■ ❑ ❑ ❑
Yes No NA NE
Yes No NA NE
111300
Page # 3

Ir
Permit: NCO059536 Owner - Facility: Hilltop Living Center
Inspection Date: 08/15/2013 Inspection Type: Compliance Evaluation
Effluent Sampling Yes No NA NE
Is sample collected below all treatment units? ■ n 0 El
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 ■
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ ❑ n n
Comment: field meters should be calibrated each day that they are used, and checked
against standards daily.
Upstream / Downstream Sampling
Yes
No
NA
NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■
n
Comment: There is no upstream sampling point.
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
n
n
Is flow meter calibrated annually?
■
n
n
n
Is the flow meter operational?
■
n
n
n
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
■
Comment: Flow meter calibrated in Jan. 2013
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n n Cl
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n ■ ■ n
Judge, and other that are applicable?
Comment:
Septic Tank
Yes
No
NA NE
(If pumps are used) Is an audible and visual alarm operational?
n
n
■ n
Is septic tank pumped on a schedule?
■
n
Are pumps or syphons operating properly?
■
Are high and low water alarms operating properly?
n
n
n ■
Comment:
Sand Filters (Low rate) Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational? n n n ■
Is the distribution box level and watertight? ■ n n n
Is sand filter free of ponding? ■ ❑
Page # 4

V
Permit: NC0059536 Owner - Facility: Hilltop Living Center
Inspection Date: 08/15/2013 Inspection Type: Compliance Evaluation
Sand Filters (Low rate)
Yes
No NA
NE
Is the sand filter effluent re -circulated at a valid ratio?
■
0 ❑
Q
# Is the sand filter surface free of algae or excessive vegetation?
■
Q ❑
0
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
■
n 0
n
Comment:
Disinfection -Tablet
Yes
No NA
NE
Are tablet chlorinators operational?
■
❑ C1
13
Are the tablets the proper size and type?
■
Number of tubes in use?
2
Is the level of chlorine residual acceptable? ■ ❑ 0
Is the contact chamber free of growth, or sludge buildup? ■ 1=1 n
Is there chlorine residual prior to de -chlorination? ■
Comment:
De -chlorination Yes No NA NE
Type of system ? Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)? ■ 0
Is storage appropriate for cylinders? ■ El ❑ 11
# Is de -chlorination substance stored away from chlorine containers? ■ n Q Q
Are the tablets the proper size and type? ■ ❑ 0 Q
Comment: some sludge build-up in the dechlor chamber... Mr. Leonard said it was
supposed to have been cleaned out at the same time the septic tanks were pumped.
He has had it cleaned out since the inspection.
Are tablet de -chlorinators operational? ■ Q ❑
Number of tubes in use? 2
Comment:
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? ■ ❑ El 0
Are the receiving water free of foam other than trace amounts and other debris? ■ ❑ f] ❑
If effluent (diffuser pipes are required) are they operating properly? 0000
Comment:
Page # 5

Tuttle & Associates, LLC
July 18, 2013
W. Corey Basinger
Water Quality Division
585 Waughtown Street
Winston-Salem. NC 27107
Dear Mr. Basinger:
1025 Lamb Road, Lexington, NC 27295
336-853-767phone Loflintna ptmg.nef RECEIVED
336-853-7671 fax
N.C.Dept. of ENR
JUL 24 2013
Winston-Salem
Regional Office
I am in receipt of your notice of violation for Permit No. NCO059536 Hilltop Living Center. In response to the
violation (NOV-2013-LV-0405). I have met with the operator and discussed in detail. On June 21 the scheduled
sand change was complete and reduce the sand level to raise the pipe 3 inches closer to the surface in order to 2 receive more oxygen to the system. The lab was contacted today to check levels since the changes have been
made and the lab has verbally reported that BOD are within limits and Surfactants have not been Posted yet tom.
the system. We are working with the staff and vendors regarding Surfac ant level to reduce to a satisfactory
level. Please contact me at 336-853-7670 ext. 26 if you have future recommendations.
Sincerely,
Tisha Tuttle
Hilltop Living Center

A4J;A
NCENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
July 15, 2013
CERTIFIED MAIL #7012 2920 0000 36561226
RETURN RECEIPT REQUESTED
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: Notice of Violation and Recommendation for Enforcement
NOV-2013-LV-0405
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
John E. Skvarla, III
Secretary
A review of Hilltop Living Center's monitoring report for April 2013 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Surfactants (MBAS)
04/04/13
750 ug/1
1,170 ug/1
Daily Maximum Exceeded
BOD, 5-Day (20 Deg. C)
04/04/13
7.5 mg/1
12.8 mg/1
Daily Maximum Exceeded
BOD, 5-Day (20 Deg. C)
04/30/13 1
5 mg/1
6.4 mg/1
Monthly Average Exceeded
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. NC0059536.
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) business days after receipt of this Notice. A review of your response will be considered
along with any information provided on the April 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
continued on reverse...
NorthCarolina
Nah(rallry
An Equal Opportunity', Affirmative Action Employer

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 Jenifer Carter or me at
[phone].
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: Point Source Branch
SWP — Central Files
'""Rf) Piles'

L-v, 0405- Cover Sheet from
��V 40i�- Staff Member to
Regional Supervisor
,,II DMR Review Record
FacilitywVL �eahfl Permit/Pipe No.: N 3 Month/Year a0 13
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
017
,L
Weekly Cai�yViolations
Date Parameter Permit Limit/Tvpe DMR Value % Over Limit
,LSD 11 --h) 5-
0
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations te7t f,� /2 Inel is:
� ���c'?I'��i�'?Or1f' lc�`� 2U r � U� f�'II�'►
,3 06,f 2012 l'Aagyh),
3 NO)t< 441 20122WD) &I /116V 201,2 LeZaiNt
Completed by: 1 '` P r- Date: D/ 3
Regional Water Quality
Supervisor Signoff: `� (d Date:
54hcl K,,01214Uj &/;Zr1Zo r3

c
EFFLUENT 11
NPDES PERMIT NO. N00059536 D1SC'1IARGE NO. 01 MONT ] 1 13
FACILITY NAM]: Hilltop Livinp, Center CLASS 1 Cot 1NT Y Davidson
OPERATOR IN RESPONSIBLE CHARGE (ORC) I. cr I,conard --- - CYRADP-I,, Stsfe_PHONI: _330-241)-7 31)_
CERTIFIED LABORATORIES (1) R & A Laboratories. Inc. 2)
CHECK BOX IF ORC HAS CHANGED F—] PERSON(S COI.1.1; "1'l G SAMPIj-.S (,aerators
Mai] ORIGINAL, and OM: COPY to: '
JUN 19 2013
�. 13
ATTN: CENTRAL FILES \ F=.
DIVISION OF "'ATER QI:ALITV (SI .4T1 TRl: )F 'ER.4"I'OR IN R1 SPONSIBLE CHARGE)
1617 MAIL SERVICE CENTER aUAi Q 20�`: 1" THIS SIG.. TIiRI:, I (l,RTII'1 I IIA"P THIS REPORT IS MALI
R4LEIGH, NC 27699-1617 I I ACCURATE AND COMPLETED TO THE BEST OF MY KNOWLEDGE.$m,? 'f
I I I
�
11 1
1 1. 1
I I I
��®®�ii��
1 1� � '� •�
Enter Parameter Code
®�-
io
®�Belom
-
•
•
Ems
�a���®�������������
Copy DEM Form MR-1 (12/93)

I-acilit Status: (Please check one ofthc lollowing)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NO.1• meet permit requirements
Noncompliant
f the facilit is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance. etc..
nd a time table for improvements to be made.
h�z/ i ✓� ''��Ci
c..i- b tip— b Jti-g ' 4 -x
d w,1k ar
r 4. S%art _ �I v Inns 1�
I certifi , under penalty of lacy, that this document and all attachments were prepared under my direction or supervision in accordance
ith a system designed to assure that a qualified personnel properly gather and evaluate the information submitted. Based on my
.iquin of the person or persons who manage the system, or those persons direct]- responsible for gathering the information. the
,formation submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
,enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Ju < Whitlev
Pe it e (Plegse . /or/t,\ �
W _1
Si
t of Pe ,tee**
Date
'ermittee Address
V Phone Number
Permit Exp. Date
PARAMETER CODES
)0010 Temperature
00556 Oil & Grease
00951
Total Fluoride
01067 Nickel 50060 Total
)0076 Turbidit•
00600 Total Nitrogen
01002
Total Arsenic
01077 Silver Residual
)0080 Color (Pt -Co)
00610 Ammonia Nitrogen
01092 Zinc Chlorine
)0082 Color (ADMI)
00625 Total Kjeldhal
01027
Cadmium
01105 Aluminum
Nitrogen
)0095 Conductivity-
00630 Nitrates/Nitrites
01032
Hexavalent Chromium
01147 Total Selenium 71880 Formaldehyde
)0300 Dissolved O\:vgen
01034
Chromium
31616 Fecal Coliform 71900 Mercury
)0310 BODs
00665 Total Phosphorus
32730 Total Phenolic 81551 Xylene
)0340 COD
00720 Cyanide
01037
Total Cobalt
34235 Benzene
)0400 pH
00745 Total Sulfide
01042
Copper
34481 Toluene
)0530 Total Suspende
00927 Total Magnesium
01045
Iron
38260 MBAS
Residue
00929 Total Sodium
01051
Lead
39516 PCBs
)0545 Settleable Matt
00940 Total Chloride
01062
Molybdenum
50050 Flow
'arameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone], or by visiting
ie Water Quality Section's web site at h2o.enr.state. nc.us'wgs and linking to the Unit's information pages.
?se only units designated in the reporting facility's permit for reporting data.
ORC must visit facility and document visitation of facility as required 15A NCAC 8G.0204.
= If signed by other than the Permittee_ delegation of signatory authority must be on file with the state per 15A NCAC 213.0506 (b)
2)(D).

May 29, 2013
W. Corey Basinger
Water Quality Division
585 Waughtown Street
Winston-Salem. NC 27107
Dear Mr. Basinger:
1025 Lamb Road, Lexington, NC 27295
336-853-7670 phone Loflint(a ptmc.net
336-853-7671 fax
RCCEii F
N.C.Dept. cf ENR
MAY 3 0 20113
Winston-Salem
Regional Office
I am in receipt of your notice of violation for Permit No. NCO059536 Hilltop Living Center. In response to the
violation (NOV-2013-LV-0330). I have met with the operator and discussed in detail how to resolve the
exceeded limits. It is my understanding that the current labs are incompliance. I have spoken with the on -site
staff regarding detergents use with the vendor that sells us chemicals so we are using the proper items to
reduce Surfactant (MBAS) limits. In regards to the Nitrogen, Ammonia it was discussed when the sand (end of
June) is changed that reducing the layer might increase oxygen to the bed to help with Nitrification. Please
contact me at 336-853-7670 ext. 26 if you have future recommendations.
Sincerely,
Tisha Tuttle
Hilltop Living Center

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P.E.
Governor Director
May 21, 2013
CERTIFIED MAIL #7011-1570-0001-8546-1876
RETURN RECEIPT REQUESTED
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: Notice of Violation and Recommendation for Enforcement
NOV-2013-LV-0330
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
John E. Skvaria, III
Secretary
A review of Hilltop Living Center's monitoring report for February 2013 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Surfactants (MBAS)
02/08/13
750 ug/1
779 ug/1
Daily Maximum Exceeded
Surfactants (MBAS)
02/21/13
750 ug/l
751 ug/1
Daily Maximum Exceeded
[Nitrogen, Ammonia Total (as N)
02/28/13
1 4 mg/1
6.42 mg/1
Monthly Average Exceeded
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. NC0059536.
Pursuant to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($25,000.00) maybe
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) business days after receipt of this Notice. A review of your response will be considered
along with any information provided on the February 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
continued on reverse...
Nne
orthCarolina
N z(,rall
v •
An Equal Opportunity i AYrmative Action Employer

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 Jenifer Carter or me at
[phone].
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: Point Source Branch
SWP — Central Files
WSRO Files- "

,Von ,20 15- Z-V — �U Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility.: l/ram ��n Permit/Pipe No.: I (( Month/Year �� h
Monthly Average Violations
Parameter Pen -nit Limit DMR Value % Over Limit
rr,m� a%
Date. Parameter
Weekly aily Violations
Permit LimitlTvpe DMR Value
Fs/
% Over Limit
o -$ 4*
6 _Z _ �m #(.e>
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations a In 0,1 his
Completed by: Date: - =L�llzg
Ij
Regional Water Quality
Supervisor Signoff: Date: �� /�=

A&A
®
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2013-LV-0198
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
Division of Water Quality
Charles Wakild, P.E.
Director
March 28, 2013
John E. Skvarla, III
Secretary
A review of Hilltop Living Center's monitoring report for December 2012 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
12/31/12
4 mg/1
5.95 mg/1
Monthly Average Exceeded
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 for this 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 Jenifer Carter at [phone].
cc: SWP — Central Files
NSRO 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
Nne
orthCarohna
An Equal Opportunity 1 Affirmative Action Employer

Qv-,) oG —W' 0 q Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility.: �i �� 1�'✓� t rep Permit/Pipe No.: (00 q5u Month/Year
Monthly Average Violations
Parameter Pernut Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limiff ype DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations %Z MoOMS
Aa b",20/-Z
Completed by: J r fey Date: lv1,-2v t
Regional Water Quality
Supervisor Signoff: Date:
�o Yhj

Ar
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'T ) AA
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2013-LV-0031
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Division of Water Quality
Charles Wakild, P.E.
Director
January 10, 2013
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for October 2012 showed the following violation:
Parameter
Date
Limit
Reported
Limit Type
Nitrogen, Ammonia Total (as N)
10/31/12
2 mg/1
2.46 mg/1
Monthly Average Exceeded
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 for this 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 Jenifer Carter at [phone].
cc: SWP — Central Files
WSRO Files
40,
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
One
NorthCarolina
11
An Equal Opportunity 1 Affirmative Action Employer

�'Cw
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OVA PM
IqGV_au C3- Lil- 6031
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Kf lh iVi �� ermit/Pipe No.: �� _7t).S�/S3 Month/Year ZfZi-c>20 l�
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Type
Date
Parameter
DMR Value % Over Limit
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations
Other Violations �4Sf "Z M it S "
% �/DV UGf o10 �1 Any IIA )
Regional Water Quality
Supervisor Signoff: A!�
Date: 4A., 7-::� G

W
NCDENR
North Carolina Department of Environment and Natura
Pat McCrory
Governor
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF DEFICIENCY
NOD-2013-LV-0035
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
Division of Water Quality
Charles Wakild, P.E.
Director
February 22, 2013
Resources
John-E. Skvarla, III
Secretary
A review of Hilltop Living Center's monitoring report for November 2012 showed the following deficiency:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
11/30/12
4 mg/l
4.21 mg/1
Monthly Average Exceeded
Remedial actions should be taken to correct the cause(s) of these deficiencies. Unresolved deficiencies may
lead to the issuance of a Notice of Violation and/or assessments of civil penalties by the Division of Water
Quality of up to $25,000.00 per day for each violation. Any efforts undertaken to bring the facility back into
compliance are not an admission of culpability. Your response, the degree and extent of harm to the
environment, and the duration and gravity of the deficiency will be considered in any future actions undertaken.
If you should have any questions, please do not hesitate to contact Jenifer Carter 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] l 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
Nne
orthCarolina
Natur 11Y
An Equal Opportunity 1 Affirmative Action Employer

ho v av I-5 -LV - (-x) 35-
DMR Review Record
Cover Sheet from
Staff Member to
Regional Supervisor
Facility.: hr / )bj perniit/Pipe No.:/�K,yCJJq�3� Month/Year ktV o?()13
Monthly Average Violations
Parameter Permit Liimmiit� DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Tvoe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations ��/ /Z %YIU 'L1 S
/ e?k enZ22ar o2012 el,, vvi
i k0V.
IVaJ?s z214 « �o �� off) 9 n�0 r�d�i ��,
Completed by: e! • ��t e� Date: C 13
Regional Water Quality3
Supervisor Signoff: Date:
*�e �r y�j j Coil f AZm C>� /`rj/G 741 i' Ms /G /h NoteAA `

Carter, Jenifer 0 v
From: Randy Swicegood [[e-mail]]
Sent: Wednesday, December 12, 2012 10:11 AM
To: Carter, Jenifer
Subject: RE: Hilltop Nursing Home
Thanks for the info. Just a FYI, we had several complaints within a two or three week period. One of them was from our
F&L inspector who was doing their inspection of the facility. The others were from neighbors and folks who were just
driving along Old Salisbury Rd.
From: Carter, Jenifer [mailto:[e-mail]]
Sent: Monday, December 10, 2012 10:51 AM
To: Randy Swicegood
Subject: RE: Hilltop Nursing Home
They have been having sporadic issues with ammonia, and the ORC has been working with the staff to make sure no one
is flushing anything they shouldn't be (cleaning/laundry chemicals, medicines, etc.). I talked to him again this morning
and he said he would pay them a visit to check on things. The sand was replaced a few years ago, so it should not need
to be replaced again already. I will let you know if I hear anything.
If you continue to get complaints, please let me know and I will schedule an inspection.
Jenifer
Before printing this email, please consider your budget and the environment.
If you must print, please print only what you need and save ink with the free Eco-Font.
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Randy Swicegood [mailto: Randy. Swicegood(& DavidsonCountyNC.gov]
Sent: Thursday, December 06, 2012 9:33 AM
To: Carter, Jenifer
Subject: Hilltop Nursing Home
Jenifer,
I have received a complaint on the Hilltop Nursing facility in reference to strong sewage odor coming from their sand
filter. I was just curious if you had received one as well or if you aware of any problems they were having?
Randy Swicegood, REHS
Environmental Health Supervisor I

Davidson County Health Department
915 Greensboro Street
Lexington, NC 27292
336-242-2377
If you are not the intended recipient, you must destroy this message and inform the sender
immediately. This electronic mail message and any attachments, as well as any electronic mail
message(s) sent in response to it may be considered public record and as such subject to request
and review by anyone at any time. It also may contain information which is confidential within the
meaning of applicable federal and state laws.
Davidson County Government, PO Box 1067, Lexington, NC, USA, www.co.davidson.nc.us
If you are not the intended recipient, you must destroy this message and inform the sender
immediately. This electronic mail message and any attachments, as well as any electronic mail
message(s) sent in response to it may be considered public record and as such subject to request
and review by anyone at any time. It also may contain information which is confidential within the
meaning of applicable federal and state laws.
Davidson County Government, PO Box 1067, Lexington, NC, USA, www.co.davidson.nc.us

Carter, Jenifer
From: Carter, Jenifer
Sent: Monday, December 10, 2012 10:51 AM
To: 'Randy Swicegood'
Subject: RE: Hilltop Nursing Home
They have been having sporadic issues with ammonia, and the ORC has been working with the staff to make sure no one
is flushing anything they shouldn't be (cleaning/laundry chemicals, medicines, etc.). I talked to him again this morning
and he said he would pay them a visit to check on things. The sand was replaced a few years ago, so it should not need
to be replaced again already. I will let you know if I hear anything.
If you continue to get complaints, please let me know and I will schedule an inspection.
Jenifer
Before printing this email, Tease consider your budget and the environment.
If you must print, please print only what you need and save ink with the free Eco-Font.
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Randy Swicegood [mailto: Randy. [e-mail]]
Sent: Thursday, December 06, 2012 9:33 AM
To: Carter, Jenifer
Subject: Hilltop Nursing Home
Jenifer,
I have received a complaint on the Hilltop Nursing facility in reference to strong sewage odor coming from their sand
filter. I was just curious if you had received one as well or if you aware of any problems they were having?
Randy Swicegood, REHS
Environmental Health Supervisor I
Davidson County Health Department
915 Greensboro Street
Lexington, NC 27292
336-242-2377
If you are not the intended recipient, you must destroy this message and inform the sender
immediately. This electronic mail message and any attachments, as well as any electronic mail

message(s) sent in response to it may be considered public record and as such subject to request
and review by anyone at any time. It also may contain information which is confidential within the
meaning of applicable federal and state laws.
Davidson County Government, PO Box 1067, Lexington, NC, USA, www.co.davidson.nc.us

Carter, Jenifer
From: Randy Swicegood [[e-mail]]
Sent: Thursday, December 06, 2012 9:33 AM
To: Carter, Jenifer
Subject: Hilltop Nursing Home
Jenifer,
I have received a complaint on the Hilltop Nursing facility in reference to strong sewage odor coming from their sand
filter. I was just curious if you had received one as well or if you aware of any problems they were having?
Randy Swicegood, REHS
Environmental Health Supervisor I
Davidson County Health Department
915 Greensboro Street
Lexington, NC 27292
336-242-2377
If you are not the intended recipient, you must destroy this message and inform the sender
immediately. This electronic mail message and any attachments, as well as any electronic mail
message(s) sent in response to it may be considered public record and as such subject to request
and review by anyone at any time. It also may contain information which is confidential within the
meaning of applicable federal and state laws.
Davidson County Government, PO Box 1067, Lexington, NC, USA, www.co.davidson.nc.us

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF DEFICIENCY
NOD-2012-MV-0085
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
Division of Water Quality
Charles Wakild, P.E.
Director
November 19, 2012
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for August 2012 showed the following deficiencies:
Parameter
Period Ending
Required Frequency
Violation
Chlorine, Total Residual
08/18/12
2 X week
No TRC data reported for week
Failure to provide timely and accurate DMRs is a violation of your NPDES permit. If this deficiency is due to a
transcription error, and certifiable data are available to rectify the noncompliance, we ask that you please submit
an amended DMR(s) to the Division of Water Quality. Send a copy of the amended report to:
Central Files and Winston Salem Regional Office
Division of Water Quality Division of Water Quality — Surface Water
1617 Mail Service Center 585 Waughtown St.
Raleigh, NC 27699-1617 Winston-Salem, NC 27107
Unresolved deficiencies may lead to the issuance of a Notice of Violation and/or assessments of civil penalties.
Violations are subject to a civil penalty assessment of up to $25,000.00 per day for each violation. Any efforts
undertaken to bring the facility back into compliance are not an admission of culpability. Your above -
mentioned corrective actions, the degree and extent of harm to the environment, and the duration and gravity of
the deficiency(ies) will be considered in any future actions undertaken.
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
continued on reverse...
Nne
orthCarohna
An Equal Opportunity 1 Affirmative Action Employer

If you have any questions or require any additional information, please contact Jenifer Carter or myself at (336)
771-5000.
Sincerely,
W. Corey Basinger
Regional Office Supervisor
Surface Water Protection Section
Winston-Salem Regional Office
cc: .WSRO SWP Files
SAT Central Files

Cover Sheet from
v1/ Staff Member to
Regional Supervisor
DNIR Review Record
Facility: i V� Permit/Pipe No.: NCQ0153� Month/Year Zv 1
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 Fre uencv Values Reported # of Violations
Other Violations
LnS+ lZ /A&ors.'
NO
lum - i%y /-Vou Z/
Completed by: Date: 1 1h 12
Regional Water Quality
Supervisor Signoff:
�oj
Date: W% AAI-'`M—""

NODE R
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Rd.
Lexington NC 27292
Subject: NOTICE OF DEFICIENCY
NOD-2012-LV-0076
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Tuttle:
Division of Water Quality
Charles Wakild, P.E.
Director
August 22, 2012
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for May 2012 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
05/31/12
5 mg/l
5.42 mg/1
Monthly Average Exceeded
Remedial actions should be taken to correct the cause(s) of this violation. Unresolved violations may lead to the
issuance of a Notice of Violation and/or assessments of civil penalties by the Division of Water Quality of up to
$25,000.00 per day for each violation. Any efforts undertaken to bring the facility back into compliance are not
an admission of culpability. Your response, the degree and extent of harm to the environment, and the duration
and gravity of the violation(s) will be considered in any future actions undertaken.
If you should have any questions, please do not hesitate to contact Jenifer Carter 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,
jv,vhve
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Nne
orthCarohna
Natura"l�
An Equal Opportunity ` Affirmative Action Employer

LAI 00'7 �p Cover Sheet from
V Staff Member to
Regional Supervisor
DNIR Review Record
Facility: m _ Permit/Pipe No.: %VCIiO��%Sjo Month/Year o74�a
( okr
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/7ype DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations !'1'/aw-W
� forte �nL�l t a %%'1Gt►� a�/� C f�CJ17 , /�Zyi lZt
Completed by: Date: ele 1 `
Regional Water Quality 3
Supervisor Signoff: Date:

A%��
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0062
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Division of lNater Quality
Charles Wakild, P.E.
Director
January 24, 2012
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for October 2011 showed the following violations:
Parameter
Date
Limit
Reported
Limit Type
Nitrogen, Ammonia Total - Concentration
10/31/11
2 mg/l
4.64 mg/1
Monthly Average Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that these violations of your NPDES permit, and any additional violation of State law, could
result in enforcement action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter 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] l 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
Nne
orthCarolina
Naturally
An Equal Opportunity 1 Affirmative Action Employer

Noy- awa ,L V -ooVa
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: �� ►VJ'r, �r PermiLfPipe No.:
S Month/Year O&
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Parameter
Weekly/Daily Violations
Date Parameter
Date Parma r
9"Gr
other Violations
9�
Permit I:m- trrvpe D= Value °10 Over Limit
Monitoring Frequency Violations
Permit Freauencv Valueed # of Violations
rvlm,l
�15 1 �� �� ✓y —
Completed by: Date:
Regional Water Quality Date: 23 j �--4 Lp rZ
Supervisor Signoff:

v 4�-'
NCDENR
North Carolina Departrnelit of L,,virer anent and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 21, 2011
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2011-LV-0651
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
A review of Hilltop Living Center's monitoring report for September 2011 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N)
09/30/11
2 mg/1
3.62 mg/l
Monthly Average Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that these violations of your NPDES permit, and any additional violation of State law, could
result in enforcement action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
Sincerely, {
Jlt����
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: SWP — Central Files
WSRO F:i
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
None
rthCarolina
Natuta!!y
An Equal Opportunity \ Affirmative action, Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: 1C Perrnit/Pipe No.: � O .5 3 Month/Year
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
2
Weekly/Daily Violations
Date Parameter Permit Urnitli'vpe DMR Value % Over Limit
Monitorin.- Frequency Violations
Date Parameter Pernvt Frequencv Values Reported # of Violations
Other Violationsin
1 ,�i, �f ,
1 I., &w-/A1 7,Aje 12 a I/1/l in �l,,c 7 �� MRAS
S ,W
Completed by: ,� �D�� e Date: 2� �l
Regional Water Quality Date: IQ' � LI
Supervisor Sianoff:
Imo'

Arj,;1AV
NCDENR
North Carolina Depa tfneid,, ut E.itVli-onin.ent arid Natural R=sourkcle
Beverly Eaves Perdue
�. overi Ioi
l �f Vl:J itJli ol, Vt ater \.' Uali O,i
Co'ee f !�. Si,ilfli!S
Director
November 23, 2011
Ms. Tisha Loflin
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
SUBJECT: Compliance Evaluation Inspection
Hilltop Living Center
Permit No. NCO059536
Davidson County
Dear Ms. Loflin:
0c F re(rnail
Secretary
On November 1, 2011, Jenifer Carter of the Winston-Salem Regional Office conducted a Compliance Evaluation
Inspection at Hilltop Living Center's wastewater treatment facilities. Mr. Luther Leonard, ORC, was present
during the inspection. The inspection consisted of two parts: an on -site inspection of the treatment facility and a
review of facility files and self -monitoring data.
A review of the submitted self -monitoring data for the period of August 2010 through July 2011 revealed a few
minor limits violations, which have been addressed separately through the Division's monthly enforcement
program. It is important that staff at the facility continue to be educated on the proper use and disposal of products
used throughout their daily routines to help ensure proper wastewater treatment and therefore compliance with your
permit to discharge treated wastewater.
With respect to the administrative portion of the facility's self -monitoring program, no deficiencies were noted.
The following is a summary of findings during the inspection.
A) Facility records were well organized and current.
B) The grease trap and septic tanks are pumped out regularly.
C) Copies of the permit are kept on site and with the operator.
D) The system appears to be well operated. Your cooperation with Mr. Leonard is essential in maintaining
compliance with your permit limits.
Should you have any questions please contact Jenifer Carter in our Winston-Salem Regional Office at (336) 771-
4957.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
enclosure
cc: SWP central files
WS-RO files -
Mr. Luther Leonard - ORC
North Carolina Division of Water'liality, �;1linston-Salem Regional Office
Location: 585 Waughtown St. V'Vinston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Sewice: 1-877-623 6748
Internet wvm.ncwaterquality.crg
NorthCarolina
Naturally
An Equal Opportunity', ".f r a;ive Action Employer

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Complianinp nn 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 I s 31 NCO059536 111 121 11/11/0, 117 181 rl 191 c I 201 I
u tJ U U LJ
Remarks
211111111111111111111111111111111111111111111111J6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA --------------------Reserved----------
67 I 169 70 L3 ! 71 U N( 72 I N I 73 W 74 751 I I I I I I � 80
�
Section B: FacilityData
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)
10:30 AM 11/11/01
09/09/01
Hilltop Living Center
Exit Time/Date
Permit Expiration Date
592 Hilltop Dr
Linwood NC 27299
11:00 AM 11/11/01
14/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
N
Luther C. Leonard//336-249-6704 /
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Tisha T Loflin,1025 Lamb Rd Lexington NC 27292//336-853-7670/3368537671 No
Section C: Areas Evaluated During Inspection Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenance 0 Records/Reports
Self -Monitoring Program 0 Facility Site Review Effluent/Receiving Waters
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
Jenifer Carter WSRO WQ//336-771-5000/
�G L
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
� 4. sMk� ws9-o wQ 73-6vn�-%ZD tt%23/11
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type y
3I NCO059536 I11 12, 11/11/01 17 18 Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

f
Permit: NCO059536 Owner - Facility: Hilltop Living Center
Inspection Date: 11/01/2011 Inspection Type: Compliance Evaluation
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? ■ ❑ ❑ ❑
Is the facility as described in the permit? ■ ❑ ❑ ❑
# Are there any special conditions for the permit? ❑ ■ ❑ ❑
Is access to the plant site restricted to the general public? 0110 ❑
Is the inspector granted access to all areas for inspection? ■ ❑ ❑ ❑
Comment:
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
■ ❑ ❑ ❑
Is all required information readily available, complete and current?
■ 110 ❑
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?
■ 1100
Has the facility submitted its annual compliance report to users and DWQ?
❑ ❑ ❑ ■
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑ ❑ ■ ❑
Is the ORC visitation log available and current?
■ ❑ ❑ ❑
Is the ORC certified at grade equal to or higher than the facility classification?
■ ❑ ❑ ❑
Is the backup operator certified at one grade less or greater than the facility classification?
■ ❑ ❑ ❑
Is a copy of the current NPDES permit available on site?
■ ❑ ❑ ❑
Facility has copy of previous year's Annual Report on file for review?
❑ ❑ ❑ ■
Comment: Be sure to submit a copy of the 2011 Performance Annual Report to DWQ
within 60 days of the end of the calendar year, or your fiscal year, whichever you use.
Effluent Sampling Yes No NA NE
Is composite sampling flow proportional? DONO
Page # 3

■ ❑ ❑ ❑
❑ ❑ ■ ❑
# 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:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ ❑ ❑ ❑
Comment: There is no upstream sampling point. It is a dry ditch.
Flow Measurement - Effluent Yes No NA NE
# Is flow meter used for reporting?
Is flow meter calibrated annually?
Permit: NCO059536 Owner - Facility: Hilltop Living Center
Inspection Date: 11/01/2011 Inspection Type: Compliance Evaluation
Effluent Sampling Yes No NA NE
Is sample collected below all treatment units? E ❑ ❑ ❑
Is proper volume collected?
Is the tubing clean?
■ ❑ ❑ ❑
■ ❑ ❑ ❑
Is the flow meter operational? ❑ ❑ ❑
(If units are separated) Does the chart recorder match the flow meter? ❑ ❑ ■ ❑
Comment:
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? E ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑ ❑ ■ ❑
Judge, and other that are applicable?
Comment:
Grease Removal
Yes No NA
NE
# Is automatic grease removal present?
0 ❑ ❑
❑
Is grease removal operating properly?
❑ ❑
❑
Comment:
Septic Tank
Yes No NA
NE
(If pumps are used) Is an audible and visual alarm operational?
❑ ❑ M
❑
Is septic tank pumped on a schedule?
MOO
❑
Are pumps or syphons operating properly?
MOO
❑
Are high and low water alarms operating properly?
❑ ❑ ❑
N
Comment:
Sand Filters (Low rate)
Yes No NA
NE
Page # 4

Permit: NC0059536 Owner - Facility: Hilltop Living Center
Inspection Date: 11/01/2011 Inspection Type: Compliance Evaluation
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
■ ❑ ❑ ❑
Is the distribution box level and watertight?
■ ❑ ❑ ❑
Is sand filter free of ponding?
■ ❑ ❑ ❑
Is the sand filter effluent re -circulated at a valid ratio?
■ ❑ ❑ ❑
# Is the sand filter surface free of algae or excessive vegetation?
■ ❑ ❑ ❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
■ ❑ ❑ ❑
Comment:
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
■ ❑ ❑ ❑
Are the tablets the proper size and type?
■ ❑ ❑ ❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
■ ❑ ❑ ❑
Is the contact chamber free of growth, or sludge buildup?
MOO ❑
Is there chlorine residual prior to de -chlorination?
■ ❑ ❑ ❑
Comment:
De -chlorination
Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
0110 ❑
Is storage appropriate for cylinders?
❑ ❑ ■ ❑
# Is de -chlorination substance stored away from chlorine containers?
■ ❑ ❑ ❑
Comment:
Are the tablets the proper size and type?
■ ❑ ❑ ❑
Are tablet de -chlorinators operational?
■ ❑ ❑ ❑
Number of tubes in use?
2
Comment:
Effluent Pipe
Yes No NA NE
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:
Page # 5

aJIA
NCDENR
North Carolina Departrfie it ul �r!"/: UIi;'1[1ef t and `natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2011-LV-0575
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms Loflin:
Division of V11ater Quality
Coleen H. Sullins
Director
November 22, 2011
Jpe Freeman
Secretary
A review of Hilltop Living Center's monitoring report for August 2011 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N) -
08/19/11
10 mg/l
11.9 mg/l
Daily Maximum Exceeded
Concentration
Nitrogen, Ammonia Total (as N) -
08/31/11
2 mg/1
6.68 mg/1
Monthly Average Exceeded
Concentration
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that these violations of your NPDES permit, and any additional violation of State law, could
result in enforcement action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
Sincerely,
l)� 4. d��
4Y W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: SWP - Central Files
WSRO Files d
North Carolina Division of Water Quality, Winston-Salem Regional Office One
Location: 585 Waughtown St. Winston-Salem. North Carolina 27107 NorthCarolina
Phone: [phone] \ FAX: [phone] \ Customer Service 1-877-623-6748 //
Internet vvww.ncwaterquality.org Naturally
An Equal Opportunity + Affirmative Action Employer

rA lo� �" 1(—� V �S�S Cover Sheet from
AJ Staff Member to
Regional Supervisor
MIR Review Record
II)) PernutlPipeNo.: J�Ck�s _534 MontlNear ��)l
Facility: l'I+ D +
Monthly Avera;e Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/7vpe DMLim
R Value % Over it
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
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Supervisor Signoff:

4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Wafer Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor Director
July 19, 2011
Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2011-LM-0032
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
A review of Hilltop Living Center's monitoring report for April 2011 showed the following violations:
Dee Freeman
Secretary
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N) -
Concentration
04/30/11
2 mg/l
2.17 mg/l
Monthly Average Exceeded
Parameter
Week Ending
Measuring Frequency
Violation
Chlorine, Total Residual
04/02/11
2 X week
Frequency not met
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problems. Please be
aware that these violations of your NPDES permit, and any additional violation of State law, could result in enforcement
action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter 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: 336-771A630 \ 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
Nne
orthCarohna
Naturally
An Equal Opportunity 1 Affirmative Action Employer

LM
�ov�-� a Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review
Record
Facili ,�
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"-61' i'Permit[Pipe No.:
595�'
Month/Year r, / � 6//
Parameter
Date Parameter
Monthly Average Violations
Permit Limit DMR Value
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Weekly/Daily Violations
Permit Limit/7vpe DMR Value
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Date Parameter Permit Frequencv Value Reported # of Violations
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NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd.
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2011-LV-0158
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Division of Water Quality
Coleen H. Sullins
Director
May 2, 2011
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for January 2011 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C) -Concentration
01/21/11
15 mg/1
17.2 mg/1
Daily Maximum Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that these violations of your NPDES permit, and any additional violation of State law, could
result in enforcement action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter 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
Nne
orthCarolina
Naturally
An Equal Opportunity k Affirmative Action Employer

540
Cover Sheet from
Staff Member to
Regional Supervisor
IImo�, DMR Review Record
Facility: A 1Tt% Vj PermitlPipe No.: IVI;�5q-0 Month/Year
Monthly Averacle Violations
Parameter Permit Limit DMR Value % Over Limit
Date Parameter
Date
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Parameter Permit Frequency Values Reported # of Violations
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Parameter Permit Limit DMR Value % Over rrut
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Ak1V_,r*WJ
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Road
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2010-LV-0178
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Division of Water Quality
Coleen H. Sullins
Director
May 14, 2010
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for February 2010 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
02/12/10
400 #/100ml
980 #/100m1
Daily Maximum Exceeded
Broth,44.5 C
Coliform, Fecal MF, M-FC
02/09/10
400 #/100ml
12,000 #/100ml
Daily Maximum Exceeded
Broth,44.5 C
Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem.
Please be aware that these violations of your NPDES permit, and any additional violation of State law, could
result in enforcement action by the Division of Water Quality.
If you should have any questions, please do not hesitate to contact Jenifer Carter at [phone].
cc: SWP — Central Files
VVSRO Filesvrm
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
Sincere
ly,,
t
Steve W. Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
NorthCarohna
Aaturq!!ff
An Equal Opportunity 1 Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record �LL I,,Z5?%� Month/Year i eb o�l0
Faciliryt�t� f�� "t; Permit/Pipe No.:
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Date
Date
Weekly 6
Violations
Parameter Permit Limit/Type DMR Value % Over Limit
Monitoring Frequency Violations
Parameter Permit Frequency Values Reported # of Violations
Other Violations
)(') i' c4rvi-,
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Completed by: ��1�� Date:►� /v
Regional Water Quality
Supervisor Signoff: Date:

NCDENR
North Carolina Department of Environment and Natural
Beverly Eaves Perdue
Governor
Division of Water Quality
Coleen H. Sullins
Director
April 14, 2010
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Rd
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2010-LV-0119
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Resources
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for January 2010 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C) -
01/31/10
10 mg/1
11.14 mg/1
Monthly Average
Concentration
Exceeded
Nitrogen, Ammonia Total (as
01 /31 / 10
4 mg/l
4.69 mg/1
Monthly Average
N) - Concentration
Exceeded
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 for this 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 Jenifer Carter at (336) 771-
4957.
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: wwnmaterquality.org
Sincerely,
Steve W. Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
NorthCarolina
Naturally
An Equal Opportunity 1 Atfimiative Action Employer

Cover Sheet from
Nov -go l o 'U,1_61Y Staff Member to
Regional Supervisor
DMR Review Record
Facility: Permit/Pipe No.: lUGD��C1�v Month/Year 2LO10
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Un-it/Tvpe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency_ Values Reported # of Violations
Other Violations
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Completed by: ,1. �'�°✓ ___ Date: ih,6zd
Regional Water Quality
Supervisor Signoff: Date:
gyp!/

Alfflri�_Ky
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Coleen H. Sullins
Director
January 20, 2010
Ms. Tisha T. Loflin
Hilltop Living Center
1025 Lamb Road
Lexington, NC 27292
Subject: NOTICE OF VIOLATION
NOV-2010-LV-0041
Permit No. NCO059536
Hilltop Living Center
Davidson County
Dear Ms. Loflin:
Dee Freeman
Secretary
A review of Hilltop Living Center's monitoring report for September 2009 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as
N) - Concentration
09/30/09
2 mg/1
3.34 mg/l
Monthly Average
Exceeded
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 for this 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 Jenifer Carter at (336) 771-
4957.
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,
Steve W. Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
NorthCarolina
Naturally
An Equal Opportunity 1 Affirmative Action Employer

UNITED STATES POSTAL SERVICE 111
• Sender: Please print your name,
I RECEI stage i� ees Paid
N.C.Dept. fUS9PS
Permit No. -10
MAY 9
and 4f?s+A_4tys box •I
Regional Office
NICDENR-Division of ,
J��>�J�___.___ --
585 Waughtown Street
Winston-Salem, NC 27107
=I

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so thatwe can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Road
Lexington, NC 27292
A. Signature
X
❑ Agent
❑ Addre
B. ec>sived by (Pri ted Name) C. Date of C
( c -
D. Is delivery address differen from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. SServige Type
ft ertified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandisf
❑ Insured Mail ❑ C.O.D.
-v _O ) 14. Restricted Delivery? (Extra Fee) ❑ Yes
7011 1570 0001 8546 1876
ran r__.v 00-4 —_,_ . --- — — —

UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCGEN Division of Water 0.,'Ait.-y
U/aughtown Street
Winston-Salem;, NC 27107

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Road
Lexington, NC 27292
7012 2920 0000 3656 1226
A. §W, ture
❑ Agent
X. ❑ Addressee
B. -Re c ived by (Pr m Name) G,Dat of Del' er
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Servjee Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
7/i6 No !- -

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4' in this box•
NCDENR - Division of Water Resources
585 WaUghtown Street
Winston-Salem., NC 27107

Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Ms. Tisha Tuttle
Hilltop Living Center
1025 Lamb Road
Lexington, NC 272.92
A. Signature
Agent
X 4�J „� �C7
/�� —tea ❑Addressee
B ceived by (Printed Name) I C. Date of De ivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ' e Type
CgrCertified Mail` ❑ Priority Mail Express"
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ Collect on Delivery
a 0144 _ u/ _ 0 3 R2 14. Restricted Delivery? (Extra Fee) ❑ Yes
!. Artirla Ni--K-,
7011 1570 ❑001 8546 3795_
-.