NC0071897_Renewal (Application)_20200610

.,n STATE
1 IIROY COOPER`
Governor r� v
MICHAEL S. REGAN -.•..,^�
Secretory : Q"" ``v
S. DANIEL SMITH NOR III CAROL INA
Director Environmental Quality
June 10, 2020
Mizah Healthcare, Inc.
Attn: Cathy Crawley, CEO
260 Centerway Drive
Hendersonville, NC 28792
Subject: Permit Renewal
Application No. NC0071897
Henderson's Assisted Living WWTP
Henderson County
Dear Applicant:
The Water Quality Permitting Section acknowledges the June 9, 2020 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
!ere:yr)
AIX
Wren Th dford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
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^E QNorth Caro,,na Department of Env,ronmentsl Quart I D vs on of Water Resources
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NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 � f V�
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit JUN 0 9 2020
1617 Mail Service Center, Raleigh, NC 27699-1617
NCDEQ/DW,R,NP,
NPDES Permit f NCOO 7 it 7
If you are completing this form in computer use the TAB key or the up -down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise,please print or type.
1. Contact Information:Owner Name Lath LI Cl n
edw`e_1A
Facility Name Hende_r— ASS;s t ed t 'i o 1 nck
Mailing Address CDCz -BE-.Cvn8/ cAe Car`Cn-) -Eck
City Her\de -sormo k ke
State / Zip Code NtC 7 P').-Fi 7
Telephone Number C5ZEk. Loci Z' At0Q -
Fax Number e . (s)9 C -c k
e-mail Address Ca1h1 los-d11Pi , Z c 6)C cc c ' , • C no
2. Location of facility producing discharge: (�
Check here if same address as above 0
Street Address or State Road (D 2 B c 0014.5 e. Cc M 7.o y&`)
City I-1 e;,, .,[5 u+)v t 1\2
State / Zip Code tv u r 1•h -L`b-1 412.
County N n C .l
3. Operator Information:
Name of the firm,public organization or other entity that operates the facility. (Note that this is not referring
to the Operator in Responsible Charge or ORC)
Name N1,A 12.N_ Su+,-%C S
Mailing Address y s 'sect.sG,A. r✓�,
City
State / Zip Code C, 2113 t
Telephone Number ($213,) 2/ 3 - o ? (y p
Fax Number ( )
e-mail Address � 5 � Cow,
p;1L S b r G.l
1 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial 0 Number of Employees
Commercial El Number of Employees
Residential Number of Homes 7
School 0 Number of Students/Staff
Other El Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
AS; St-e-A 1-12v' ✓k5
Number of persons served: 50
5. Type of collection system
[ } Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s) D 0 1_
Is the outfall equipped with a diffuser? 0 Yes g/] No
7. Name of receiving streams) (NEW applicants:Provide a map showing the exact location of each
outfall):
1-Q44-,1Cr5kw'C Crest(.
8. Frequency of Discharge: m Continuous 0 Intermittent
If intermittent:
Days per week discharge occurs: '7 Duration: ).c,' r•
9. Describe the treatment system
List all installed components, including capacities,provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
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2of3 +-a•b`tV `ch �vr\h0. c� r Form-D 11/12
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NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow * U d 17 MGD
Annual Average daily flow O+()Di(' MGD (for the previous 3 years)
Maximum daily flow t 00 7 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes 0 No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed.Fecal Coliform, Temperature and pH shall be grab
samples,for all other parameters 24-hour composite sampling shall be used.If more than one analysis is reported,
report daily maximum and monthly average.If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading(Daily Maximum) and Monthly Average
over the past 36 months for parameters currently in your permit. Mark other parameters "N/A"
.
Daily Monthly Units of
Parameter
Maximum Average Measurement
Biochemical Oxygen Demand (BOD5) $ 7 ,r1 12 , (Y 76 Y11 j 1
Fecal Coliform Co 00 Z 3 , q5 1 11.7/UO rr► I
Total Suspended Solids 12.5 12 , 203 iv15
Temperature (Summer) l/,(o I '-1 . 7 G
Temperature (Winter) 0 r I 144. r7 G
pH I -7, 1Oj7 5u
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS(CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES Dredge or fill(Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the best
of my knowledge and belief such information is true, complete, and accurate.
G-ell Of_ Cf-ot,)\al C)L.L., ic_en
Printed name of Person Signing Title
CC . Cr;LCUL-010-8
ns a�- zozo
Signature Applicant Date
North Carolina General Statute 143-215.6(b)(2) states:Any person who knowingly makes any false statement representation,or certification in any
application,record,report,plan,or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article,or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device or method required
to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be guilty of a
misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (18 U.S.C.Section 1001 provides a
punishment by a fine of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)
3 of 3 Form-D 11/12