NC0046035_Regional Office Historical File Pre 2016

North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor -
December 4, 2014
Neil L. Pruitt, Jr.
Pruitthealth — Highpoint LLC
1626 Jeurgens Ct
Norcross, GA 30093-
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0515
Permit No. NCO046035
UPAC High Point Wastewater Treatment Plant
Forsyth County,
Dear Mr. Pruitt:
John E. Skvarla, III
Secretary
A review of UPAC High Point Wastewater Treatment_ Plant's monitoring report for 09/2014 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Flow
09/30/2014
-
0.01
0.013
Monthly
Average
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 Ron Boone at [phone].
cc: DWR — Central Files
tmi
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
450 West Hanes Mill Road, Suite #300, Winston-Salem, NC 27105
Phone: [phone] Internet: wwlw.ncdenr.gov
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

Di R I RZccorIs!
Facility: C R[A C r'' SI- Pai o.4- Permit No.: 6 6 :3 5 Pipe No.: MonthNear: Oq I
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit Action
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
IOther ViolationslStaff Remarks:
Supervisor Remarks:
Completed by: �0 (/N 4Jc78-1n <,
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign
Off:
Date: (2 / 3 j 14
Date:
Date: ?j �G C LO (4—

art .
NPDES PERMIT NO.: N00046035 DISCHARGE NO.: 001
MONTH: SEPTEMB
14
FACILITY NAME: HIGH POINT CARE CLASS:
COUNTY: Forsyth
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL
GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES: (1) STATESVILLE ANALYTICAL
(2 ETS
Check box if orc has changed [ ] PERSON(S) COLLECTING SAMPLES:
RANDY BELL
Mail ORIGINAL and ONE COPY to:
Lf
ATTN: CENTRAL FILES
X
Lid% '
DIVISION OF WATER QUALITY
(SIGNATURE OF O )
DATE
DENR
BY THIS SIGNATURE, I CERTIFY
THAT THIS REPORT IS
1617 MAIL SERVICE CENTER
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
RECEIVE) 20i
OCT 2 0 2014
CENTRAL FILES
DWR SECTION
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00^065
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Orc
on
Site
Flaw
[ ] Inf
Eft
Temp-
pH
Res
Cl2
BOD5
@
20C
NH3-N
T
S
S
Fecal
Colirom,
Geometric
Mean
Disso!vd
Oxygen
(DO)
TOXCICTY
MBAs
Total
Nitrogen
Tout
Poo
D
A
T
E
# JHRS
JHRS
Y/N I
MGD I
C
UNITS I
u
m
m
m91L I
#/104m1
mg/L
m L
m
mq/L
#
:..1
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n'0M;1 O
.'28
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18;15
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0.0170
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28
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31
AVERAGE
00030 �1
18
16.0
3.3
1.50
2.4
2
6.8
#DIV/0!
0.28
9.68
140
#
MAXIMUM: ;, .,
0.0t70.
21",
7.4 .'
",.42.0
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r20' : ', :,,.
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. , 0.36 S- .
9.68:
°^' 3.4G'-
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MINIMUM
0.0080
14
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#
,':COMP/GRAB.'-,:"._.-',-'.-,_:GRAB-;!GRAB--'GRAB
=GRAB-;'_-''GRABt„-=:-GRAB-:;'`.
GRAB-
;'=GRAB_,:'*='GRAB_.i.=GRAB-_
_GRAB.
GR}93,{
;: GRAB
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
N/A
NA
2A
NA
NA
#
QUARTERLY,LIMIT ; .-
NA .
. NA '
- NA"
NP'"
-.= NA
rttA :'
NA,
NA
NA.
NA
NA
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
G' d UENCY.
MONITORINI, FREp
Cont.,
Dai! y�
2PNic 3
I
rNtdy:';�.
;''Wkiyr .
Vftity
WEdy'..
'z- irrley
aVYldy '
Wk1y
Vykly,R
FREQUENCY MET
0
YES
YES
YES
YES
YES
YES
NO
NO
YES
NO
NOJj
NO
#
i'."COMPLIANT? "`.
" -,',-NO;""
,YES.,
' AYES
".YES`;,
'- YES^''
YES'�
'. .YES -.•
NO '::. `.
� .'NO
, -YES �: �(
', N01
YES,'',
#.
Total Monthly Flow I 0.3760 MG TN Monthly Loading (ibs.) 30
DEM Form MR-1 (12103) Annual TN Mass Loading (lbs./yr)
DEM Form MR-1 (12/03) Annual TN Mass Loading (lbs./yr)

NPDES PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH PIE YEAR: 2014
FACILITY NAME: HERITAGE HEALTHCARE COUNTY: Forsyth
STREAM: LOCATION: @ 1WR Above Discharge Point
1 IDCT92pam
STREAM: LOCATION: Q NCSR 1892
DOWNSTREAM
DEM Form MR-3 (12193) DEM Form MR-3 (12193)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
Signature of Permitt Da e
Phone Number: P rmit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal 34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A _0202(b)(5)(B)
** 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)

North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
December 3, 2014
Neil L. Pruitt, Jr.
Pruitthealth — Highpoint LLC
1626 Jeurgens Ct
Norcross, GA 30093
Subject: NOTICE OF DEFICIENCY
NOD-2014-LV-0113
Permit No. NCO046035
UPAC High Point
Forsyth County
Dear Mr. Pruitt:
John E. Skvarla, III
Secretary
A review of UPAC High Point's monitoring report for 8/2014 showed the following deficiencies:
Parameter
Date
Limit Value
Reported Value
Limit Type
Flow
8/31/2014
0.010
0.008
Monthly
Average
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
Resources 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(ies) will be considered in any future actions
undertaken.
If you should have any questions, please do not hesitate to contact Ron Boone at (336) 776.-9690
cc: SWP — Central Files
LEFT
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
450 West Hanes Mill Road, 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

t OMR ReAe r Record
Facility: !,AP
AC �' h ®i"`� Permit No.: 46U3S Pipe No.:
Monthly Average Violations
Parameter Permit Limit DMR Value
Flaw vo$
Date Parameter
Date Parameter
Weekly/Daily Violations
Permit Limit Limit Type DMR Value
Monitoring Frequency Violations
Permit Frequency . Values Reported
Other Violations/Staff Remarks:
av oq +s 6.Ci16-3t471.
Supervisor Remarks:
Completed by: 6aar+ °"
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign
Off:
®-N Month/Year: %u 2610
% Over Limit Action
% Over Limit Action
# of Violations Action
IV�,P- 2Dl4- L.V- 0113
Date: il12/i'�
Date:
Date: l 2-014 --

A
SEP 2 2 2014
NPDES PERMIT NO.: N00046035 DISCHARGE NO.: 001
FACILITY NAME: HIGH POINT CARE CLASS:
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL
CERTIFIED LABORATORIES: (1) STATESVILLE ANALYTICAL
Check box if ore has changed [ ] PERSON(S) COLLECTING SAMPLES:
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
DENR
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
MONTH: AUG
COUNTY: Forsyth
GRADE:3
(2 ETS
RANDY BELL
YEAR: 2014
PHONE: [phone]P 20%
0
(SIGNATURE OF ORC) DATE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPO LKNO
ACCURATE AND COMPLETE TO THE BEST OF MY
N.C,Dept, of ENR
(0 �M. 9 2014
Winston-Salem
ECEIVD
SEP 19 2014
-JENTRAL FILES
DWR SECTION
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
[on
Flow
[ ] Inf
Pq Eff
Temp.
pH
Res
Cl2
BOD5
@
20C
NH3-N
T
S
S
Fecal
Coliform
Geometric
Mean
oissolvd
Oxygen
(DO)
TOXCICTY
MBAs
Total
Nitrogen
Total
Po4
D
A
T
E
# JHRS
JHRS
Y/N I
MGD I
C
UNITS
u /L
m /L
m /L
m (L
# / 100 ml
mg/L
m /L
m /L
m
mgLL#
0
�':0.2
RB
`":.0;0:151a
1.,�.
2
0.0110
2
4
17;40
0.5
RB
0.0090
28
6.8
16
7.6
4
5: .
19;3-
.0.25
RB ,'
0.0]00
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9;20
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0.0070
27
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11.61
2.20
6
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,„80
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8
117;151
0.25
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0.0120
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10
11
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15•
12
7;05
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0.0110
26
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12
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; 28
14
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6.7
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18
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19;25
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6;55
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28
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28
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.'0.0100,.--27..,,
31..:
-
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28:,
30
0.0130
30
AVERAGE
18
16.0
1.5
1.50
0.0
8
6.8
#DIV/0!
0.37
11.61
2.20
#
_
MAXIMUM< ;;,., -., 'r�.OA150
.:.
^;21
,,:6.81-:
.,.-OO,.
x.36A.;=
5,6:'T=.
6.00 rt'
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,, 7 ,
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61 ,.
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MINIMUM
0.0060
14
6.6
<15
<2
<5
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<.1
7.4
0.0
0.32
11.61
2.20
#
COMP/GRAB -
GRAB
GRAB
"GRAB '
GRAB .
' GRAB ;
GRAB"
,GRAB
", GRAB ;'
GRAB
GRAB"
, `, GRAB
_ •GRAB -,
`' GRAB
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
WA
NA
2.4
NA
NA
#
-�--„-:;-_----�----_---..,.ter--_'------�--
_--al-,
",QUARTERL-YLIMIT-.: ,"
".:,..-�NA :::
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-
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---_
_ _-
.i . NA-:.^-� .:,
--_------_
_ '2.0' •.
.._
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
1 NA
J NA
I NA
NA
NA
#
MONITORING,FREQUENCY
,','� Conn-
Daliy
dVkly�.
,.2NVk.
YVkly ���
`�Vkl�
�: Wkly.,.
., �--VNdy r
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,'INkiy-"VUkly
FREQUENCY MET
0
YES
YES
YES
YES
NO
NO
NO
YES
YES
NO
NO
NO
#
-NQ=..
'YES'.•
YES" - -'YES
YES`,-.-'
- `NO -
"',NO.` ...:.NO..
--':.
''_YES:',
: . YES- -
'rc_NO-... -
--':YES= �•-
-. : L• ,-
::#--
Total Monthly Flow 0,3220 MG I ' NOT ag EAT 2i G - TN Monthly Loading (Ibs.) 31
DEM Form MR-1 (12/03) Annual TN Mass Loading (lbsJyr)
OEM Form MR-1 (12103) Annual TN Mass Loading (lbslyr)

NPDES P�RMIT NO:NCOD46035 DISCHARGE NO.: 001 MONTH: AUG YEAR: 2014
FACILITY NAME: HERITAGE HEALTH CARE COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
nnw mcTp;:& i
00010
00300
31616
00010
00300,
31616
D
Fecal
D I
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
COliform
T
Temp
Oxygen
T
Temp
Oxygen
E
2400
Geometric
E,
2400
Geometric
Clock
DO
Mean
Clock
DO
Mean
#
HRS
C
m /L
#/100m1
#
HRS
C
mg/L
#100ml
1
1
2
2
3
3.
4
17;55
26.0
8.0
4
18;00 26.0
7.8
5
5
6
6
7
7•
8
6
9
9
10
10
11
9:05
24.0
8.1
11
9;10
25.0
8.0
12
12
13
13
14
114
15
15 .,
16
16
17
17,
18
14:00
25.O
7.9
18
14;05
26.0
7.8
19
19
20
20
21
21
22
22
23
23
24
24
25
12;55
24.0
8.1
25
13;00
25.0
7.9
26
26
27.
27
28
28
29
29 .
30
30
31
-
31'
AVERAGE
1 25.0
8.0
T-JAVERAGE
26.0
7.9
MAXIMUM
26.0
8.1
MAXIMUM
26.0
8.0
MINIMUM
24.0
7.9
MINIMUM
25.0
7.8
COMP/GRAB
GRAB
GRAB
COMP/GRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
X
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
/I
Signature of Permittee** Date
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

�ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
October 6, 2014
Neil L Pruitt, Jr.
Pruitthealth - Highpoint LLC
1626 Jeurgens Ct
Norcross, GA 30093
Subject: . NOTICE OF DEFICIENCY
NOD-2014-LV-0091
Permit No. NCO046035
UPAC High Point
Forsyth County
Dear Mr Pruitt, Jr:
John E. Skvarla, III
Secretary
A review of UPAC High Point's monitoring report for July 2014 showed the following deficiencies:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC Broth,44.5C
7/29/2014
400.000
#/100m1
6,000.000 #/100ml
Daily Maximum
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
Resources 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(ies) will be considered in any future actions
undertaken.
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
cc: SWP — Central Files
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
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

Facility: ,li L A 1 4--
Parameter
Permit No.: 2160 3S Pipe No.: 6" �
Monthly Average Violations
iWonth[Year:O"l Zcsi
Permit Limit DMR Value % Over Limit
Weekiv/Daily Violations
Action
Date
Parameter
Permit Limit Limit Type
DMR Value % Over Limit Action,
L-C
-— t IXI dyd
c�
a
Monitoring Frequency Violations
Date
Parameter
Permit Frequency
Values Reported # of Violations Action
Other Violations/Staff Remarks:
ti 8 6 - .2a iq -- Lu- vvg r
Supervisor Remarks:
Completed by: Date:
Assistant Regional `
Supervisor Sign Off: �' Date:
Regional Supervisor Sign
Off: Date:

61
NPDES PERMIT NO.: NCO046035 DISCHARGE NO.: 001 MONTH: JULY YEAR: 2014
FACILITY NAME: HIGH POINT CARE CLASS: COUNTY: Forsyth
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES (1) S,,T�[IATTEESVILLE ANALYTICAL (2 ETS
Check box if orc has chap k� �9�y1E 13
�LECrTING SAMPLES: RANDY BELLMail OR�1
ATTN: CI/1ENTRAL FILES and ONEGINAL COPU G 18 2o 1144 X_� `� ,U ( 01, Ll
DIVISION OF WATER QUALITY (SIGNATURE OF ORCf DATE
DENR CENTRAL FILESBY THIS SIGNATURE, ICERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER DWQ/B G ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
' RECEIVED
C. Dept of ENR
SEP 0 3 2014
FEAUG REGIONAL OF
fl
AUG 18 20%
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Orc
on
Site
Flow
[ ] Inf
Eff
Temp.
pH
Res
Cl2
BOD5
@
20C
NH3-N
T
S
S
Fecal
Coliform
Geometric
Mean
Dissolvd
Oxygen
(DO)
TOXCICTY
MBAs
Total
Nitrogen
Total
Poo
D
A
T
E
# IHRS
IHRS
Y/N I
MGD I
C
UNITS I
u /L
m /L I
m /L
m L I
#1100m1
mg/L
m /L
m /L
m /L
m
#
1 i.11;00
`: 0.2
RB.
:.,'0;0,1DQ,
�� 26,
-:
�
2:1
3.40^.
"E : <28,
^-c1, '
:.�
"0.1T _
5.15_; :.
._1.70, :
_'_1.
2
14;00
0.25
RB
0.0100
28
26
2
3
18;05
0.2
RB
0.0100
28.
.-. ..
'3
4
H H H
0.0090
4
0.0090
-..-5
6
0.0110
6
7 ; ;
47;00
: 0.5
BTF
;- -0.0080-,
26
7 -
8
17;05
0.25
BTF
0.0090
27
8
-9;
17;05,
0.25
BTF
0.0100,
-27
10
05;05
1 0.2
RB
0.0090
27
2.0
<0.5
3.9
<1
10
10;50
0.25
BTF
•^ : 0:0080
;. 26 ,
'
-2$''r'.`.'
.. : •
'=--_:. =
;:
- •:._- -.`
=
11:
0.0090
12
13
F12
0.0076
11;22
0.5
RB
0.0080
29
6.8
<15
6.4
14
10;10
'0.25
RB `
'0.0090
28
-.- . ,,
z2 -"•
<0.5 ``
. <2163 .
` _3 ':. .. :..-
' .
Z._
16
111;501
0.25
RB
0.0120
27
N.C. Dep.
of ENR
J-
16
17
19;35
r" 0.2
RB
0.0210'
. 27
=-
... •.-;_ ....
: --
' -
a . -
17
18
114;251
0.25
RB
0.0040
28
31
SEV U
jU
18
' •19
20
0.0030
EGIO
20
,21
19;35
0.25
RB- _
6.0030
26
_
<15'
-
-
21 -
22
15;05
0.2
RB
0.0110
27
22
10;00
` 0,25
RB
0,0110
27
2.4 -
0.90
<2.2
1'1423"
"' 43
= ' '
._
0.53
23
24
12;00
1 0.25
RB
0.0121)
28
6.9
34
6.6
24
25
19;30
.0.2
RB -
..0:0110
'2'8
25
26
0.0090
26
27 :.`..:
:0.0100
Z.
27
28
11;15
0.5
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28
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28
29
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- 0.01',70
' 27
r :-
. _ 52,. '..
': . <.5 -- -.
' :_ <2.82'-
1 ?6000
,,; ..'
29
30
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0.2
BB
0.0150
27
30
31 .
13;50
0.25
RB-
0,0080
: 27
31.
-
.31
AVERAGE
0.0060
18
16.0
2.12
0.90
1 3.9
9
6.8
#DIV/0!
0.42
5.15
1.70
#
r'-- - - - _
MAXIMUM '
0.0210
',,:21 . o'-,'.6.9
34.0'
2:4 ^�.; -.:.,.
3;40 r-�,'
.3.9
-... 43 . :u
, .�6.8
.::
'. 0.0
': 0.57- - ''
`5.15' :..,.
1:70
# ^
MINIMUM
0.0030
14
6.8
<15
<2
<5
<2.5
<.I
6.4
0.0
0.17
5.15
1.70
#
COMP/GRAB , .
-GRAB
+'GRAB
'GRAB
GRAB
- GRAB.
GRAB :
GRAB
'GRAB
;GRAB.
'- GRAB--
-GRAB
-•--GRAB
GRAB_
#
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
N/A
NA
2.4
NA
NA
#
QUARTERLY.LIMIT ,, v ,
o'"" NA'.
NA'.'.',
< NA
NA`':
NA ''
NA',' ::
: NA'
NA ., : „
_, NA .'
NA ":. `.,:
NA,. '.. ,
,. NA , .:.,
^ 2.0-, ::
# .
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY.
-' Con.
Daily
- ° Wkly
21WR
: Wkly
Wkly
- Wkly
_VM "
WidY
Yty
Widy -
WkiY
- Wkly-
#
FREQUENCY MET
0
YES
YES
YES
YES
NO
NO
NO
NO
YES
NO
NO
NO
#
COMPLIANT
NO
YES
YES
I YES`:
NO'
'NO
NO
NO
NO
YES "
NO ,
YES
# ,
Total Monthly Flow 0.2950 MG t_DfD NiaJ1• CIEP.I:EA�!' 2 Ii1Q TN Monthly Loading (lbs.) 13
DEM Form MR-1 (12/03) Annual TN Mass Loading (lbs./yr)
OEM Form MR-1 (12103) Annual TN Mass Loading (lbs./yr)

NPDES PERMIT NO:N00046035 DISCHARGE NO.: 001 MONTH: JULY YEAR: 2014
FACILITY NAME: HERITAGE HEALTH CARE COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
1IPQTRFAM
nnbVNSTRFAM
00010
00300
31616
00010
00300
31616
D
Fecal 1
ID
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Coliform
T
Temp
Oxygen
T
Temp
Oxygen
E
2400
Geometric
E
2400
Geometric
Clock
DO
Mean
Clock
DO
Mean
# IHRS
C
m /L
#/100m1
1#
HRS
C
m /L
#/100ml
1
1
2
2
3
3
4
4
5
5
6
5
7
17;30
22.0
8A
7
17;26
25.0
8.1
8
8
9
9
10
10
11
11
12
12
13
13
14
11;35
23.0
7.6
14
11;40
1 24.0
7.4
15
15
16
16
17
1
17
18
18
19
19
20
20
21
21
22
22
23
1
23
24
12;00
21.0
7.7
24
12;05
22.0
7.6
25
25
26
26
27
27
28
11;30
26.0
7.9
28
11;40
27.0
7.6
29
29
30
30
31
31
AVERAGE
1 24.0
7.9
VERAGE
25.0
1 7.8
MAXIMUM
26.0
8.1
MAXIMUM
27.0
8.1
MINIMUM
21.0
7.6
MINIMUM
22.0
7.4
COMP/GRAB
GRAB
GRAB
COMP/GRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12193)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made. X
HIGH FECAL NOT SURE WHY ALL OT ER PAREMETERS WELL WITHIN LIMITS
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
./_;5114A� mS %/-f
Signature of Permittee** Date
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

rui lv.._iealt.-h
Cnnl"vft"' f C(nnq
August 6, 20.I9
Point Source Branch
Surface Water Protection Section
Division of Water Resources
1617 Mail Selvice Center
Raleigh, NC 27699-1617
Subjeet: Delegation of Signature Authority
PrtritfHealth. High Point
NPDES No. NCO046035
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the folloNving
individuals for all permit applications, discharge monitoring reports, and other
information relating to the operations atPruittHealth High Point as required by all
applicable federal, state, and local environmental agencies specifically Nvith the
requirements for signatory authority as specified in 15A NCAC 213-0506.
Stacey Kraft Administrator
If you have /anquesti ns regarding this letter, please feel free to contact me at 770-279-
6.200. ,/"
SeniorVi'ce President of Supply Chaht Alanagement, Adman -Open. Executive
cc: D)YR, NC DE\TR Winston-Salem Regional Office
Division of Water Resources, Surface Water Protection
Regional Office, Surface Water Protection Section
Technical Assistance and Certification Utut
1626 Jeurgens Court 770-279-6200 Phone pruitthealth.com
Norcross, GA 3oo93 770-925.4619 Fax

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 8, 2014
Neil L. Pruitt, Jr.
Pruitthealth _ Highpoint LLC
1626 Jeurgens Ct.
Norcross, GA 30093
Subject: NOTICE OF VIOLATION
NOV-2014-LV-0385
Permit No. NCO046035
UPAC High Point
Forsyth County
Dear Mr Pruitt:
John E. Skvarla, III
Secretary
A review of UPAC High Point's monitoring report for May 2014 showed the following violations:
Parameter
Date,
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
05/06/14
400 #/100ml
490 #/100m1
Daily
Broth,44.5 C
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 Ron Boone at [phone].
cc: DWR—_Central Files
mI`F1 s?�
Sincerely,
� � 1
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity1 Affirmative Action Employer— Made in part by recycled paper

Facility:
i ��� irl Z.0 i , Permit No.:
Pipe No.:
Q Month/Year: 5 02 0 /
Monthly Average Violations
Parameter
Permit Limit
DMR Value
% Over Limit Action
Weekly/Daily
Violations
Date
Parameter
Permit Limit Limit Type
DMR Value
% Over Limit Action
—Doo' y.q--,
Tx
0
22, S'
Monitoring Frequency Violations
Date
Parameter
Permit Frequency
Values Reported
# of Violations Action
Other ViolationslStaff Remarks:
Je e �•�-� e�, ��i r e�o�-�-.
1Uv✓-2QLv --v38s
supervisor Remarks:
A16
Completed by: `�'L Date:
Assistant Regional
Supervisor Sign Off: Date:
Regional Supervisor Sign
Off:
Date: r'

-NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 14, 2014
Pruitthealth - High Point, LLC
Attn: Neil L. Pruitt, Jr.
1626 Jeurgens Ct.
Norcross, GA 30093
Subject: Compliance Evaluation Inspection
Permittee Pruittheath = High Point,,LLC
Facility: UPAC High Poini Wastewater1reatment Plant
NPDES Permit #: NCO046035
Forsyth County
Dear Mr. Pruitt:
John E. Skvarla, III
Secretary
Mr, Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the
Division) conducted a compliance evaluation inspection (CEI) of the UPAC High Point Wastewater Treatment Plant
(WWTP) on August 7, 2014. The assistance and cooperation of Randy Bell, Operator in Responsible Charge (ORC),
was greatly appreciated. An inspection checklist is attached for your records and inspection findings are summarized
below.
General Information
The UPAC High Point WWTP is located at 3830 North Main Street, in High Point, Forsyth County, NC, at
approximate coordinates 36.0139080N,-80.0482240W. Although in Forsyth County, the facility, is actually located at a
Highpoint address. The permit authorizes HPHC to operate this 0.01 MGD WWTP, which consists of a manual bar
screen, a grit chamber, dual aeration tanks, a clarifier, an aerated sludge holding tank, a tablet chlorinator, a chlorine
contact tank and a tablet dechlorinator, and discharge the treated effluent to Rich Fork via outfall 001, which is located
approximately 0.14 miles northwest of the facility on the north side of North Main Street where Rich Fork crosses under
N. Main Street. Rich Fork is currently classified as Class C waters and is located in the Yadkin Pee -Dee river basin.
Site Review
The only discrepancy noted during the site review was that the clarifier had a large amount of floating solids on
it. Mr. Bell indicated that this was because the skimmer air line was broken and needed to be repaired. Although there
was a large amount of floating solids on the clarifier, Mr. Boone noted that the water exiting the clarifier was still clear
and it appeared that no solids were escaping the clarifier over the weir. Mr. Bell informed Mr. Boone by phone on August
14, 2014 that the line would be repaired that day and that he would notify Mr. Boone when it was completed.
Documentation Review
All documentation reviewed was satisfactory, except that Mr Bell was missing some chains of custody (COC).
Mr. Bell was advised to be more careful with the documentation to avoid losing anymore COCs.
Mr. Bell has corrected some problems that were identified during the last inspection. Sludge is being pumped
more frequently to help manage solids levels in the plant and he has spent more time taking care of the chlorination and
585 Waughtown Street, Winston-Salem, North Carolina 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity \ Affirmative Action Employer —Made in part by recycled paper

In
dechlorination units in an effort to prevent the tablets from caking up at the bottom of the tubes. All in all, the plant was in
better shape than it was during the previous inspection, Mr..Bells positive efforts are recognized.
You are reminded that, in accordance with NC General Statute 143-215.6A, the Director of the Division of
Water Resources may assess civil penalties not to exceed $25,000 per day, per violation, for violations of NCGS 143-
215.1 and the NC0046035 NPDES permit.
If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at [phone].
Thank you for your cooperation in this matter.
Sincerely,
9
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments:
BIMS Inspection Report
CC: 0 aS'
Central Files
NPDES Unit

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)
NPDES yr/mo/day Inspection Type Inspector Fac Type
Transaction Cod'e-
''
1 u 2 I5 3 I NC0046035 I11 12 14/08/07 17 18 i C i 19 i G j 201
21111111 11111111111111111111111111111II11111 l66
inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA --- —Reserved-- --
67
I 71 L lI 72 L N 731 I 174 75I I I I I I I I80
70 � J li
LLJ I 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)
09:OOAM 14/08/07
14/08/01
UPAC High Point
3830 N Main St
Exit Time/Date
Permit Expiration Date
High Point NC 27265
10:30AM 14/08/07
19/04/30
Name(s) of Onsite Representative(s)lTitles(s)/Phone and Fax Number(s)
Other Facility Data
///
Randall Keith Bell/ORC/336-433-7221/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Kim Lapointe,3830 N Main St High Point NC 27265//336-869-3524/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit E Flow Measurement Operations & Maintenanc6 Records/Reports
Self -Monitoring Program 0 Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//336-771-4967/
Signature of Management QQA Reviewer Agency/Office/Phone and Fax Numbers Date
d
y '
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCO046035 I� 12 14/08/07 17 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page#

i
Permit: NCO046035 Owner -Facility: UPAC High Point
Inspection Date: 08107/2014 Inspection Type: Compliance Evaluation
Record Keeping
Yes No NA NE
Are records kept and maintained as required by the permit?
A
❑
❑
❑
Is all required information readily available, complete and current?
0
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
M
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
0
❑
❑
❑
Is the chain -of -custody complete?
M
❑
❑
❑
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?
❑
❑
0
❑
(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?
0
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
0
❑
❑
❑
Is a copy of the current NPDES permit available on site?
M
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
0
❑
Comment: Some chains of custody were missing. Mr. Bell advised to be slightly more careful with
records to prevent anymore losses.
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?
0
❑
❑
❑
# 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: None
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? 0 ❑ ❑ ❑
Page# 3

Permit: NCO046035 Owner - Facility: UPAC High Point
Inspection Date: 08/07/2014 Inspection Type: Compliance Evaluation
Laboratory
Yes No NA NE
Are all other parameters(excluding field parameters) performed by a certified lab?
0
❑
❑
❑
# Is the facility using a contract lab?
■
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
❑
❑
❑
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
Comment: None
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
representative)?
Comment: None
Upstream / Downstream Sampling
Is the facility sampling performed as required by the permit (frequency, sampling type, and
sampling location)?
Comment: None
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment: None
❑ ❑ ❑
❑ ❑ ❑
Yes No NA NE
❑ ❑ M ❑
❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ M ❑
❑ ❑ ❑ ■
■ ❑ ❑ ❑
Yes No NA NE
■ ❑ ❑ ❑
Yes No NA NE
M
EJ
❑ ❑ ❑
M ❑ ❑ ❑
■ ❑ ❑ ❑
M ❑ ❑ ❑
Page# 4

1
Permit: NCO046035
Owner -Facility: UPAC High Point
Inspection Date: 08/07/2014
Inspection Type: Compliance Evaluation
Grit Removal
Yes No NA NE
Type of grit removal .
a.Manual
b.Mechanical
❑
.
Is the grit free of excessive organic matter?
❑
❑
❑
Is the grit free of excessive odor?
0
❑
❑
❑
# Is disposal of grit in compliance?
S
❑
❑
❑
Comment: • None
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?'
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment: 1.21 mg/I
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
Yes No NA NE
Ext. Air
Diffused
❑ ❑ ❑
❑ ❑ ■ ❑
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ❑
Yes No NA NE
■ ❑ ❑ ❑
❑ ■ ❑ ❑
❑ ❑ ❑
W ❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ■ .❑
■ ❑ ❑ ❑
■ ❑ ❑ ❑
❑ ❑ ❑ ■
Page# 5

r
Permit: NC0046035
Inspection Date: 08/07/2014
Owner -Facility: UPAC High Point
Inspection Type: Compliance Evaluation
Secondary Clarifie'r
Yes No NA NE
Comment: Skimmer air line broken during inspection which caused excessive solids on the surface of
the clarifier. It is to be repaired 8/14/14.
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
M❑
❑
❑
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?
M
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
❑
❑
❑
Comment: None
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?
❑
❑
0
❑
# Is de -chlorination substance stored away from chlorine containers?
0
❑
❑
❑
Are the tablets the proper size and type?
0
❑
❑
❑
Comment: None
Are tablet de -chlorinators operational? M ❑ ❑ ❑
Number of tubes in use? 2
Comment: None
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? M ❑ ❑ ❑
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: None
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
M
❑
❑
❑
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
❑
❑
❑
Page# 6

I
Permit: N00046035 Owner -Facility: UPAC High Point
Inspection Date: 08/07/2014 Inspection Type: Compliance Evaluation
Flow Measurement - Effluent Yes No NA NE
Comment: None
Pumps-RAS-WAS
Yes No NA NE
Are pumps in place?
0
❑
❑
❑
Are pumps operational?
M
❑
❑
❑
Are there adequate spare parts and supplies on site?
❑
❑
❑
E
Comment: None
Aerobic Digester
Yes No NA NE
Is the capacity adequate?
N
❑
❑
❑
Is the mixing adequate?
0
❑
❑
❑
Is the site free of excessive foaming in the tank?
0
❑
❑
❑
# Is the odor acceptable?
M
❑
❑
❑
# Is tankage available for properly waste sludge?.
0
❑
❑
❑
Comment: None
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable M ❑ ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Page# 7

•wu V CU
Dec.23. 2013 11:34AM HHHP HIGH POINT No 8 54 "PCDJpi�c�fErvR
APR 3 0l 2014
NPDES APPLICATION - FORM D Winston-Salem
For .privately- ,aed treattnient syate ms treating 10000 domeatia Wastawat al office �
Mail the complete application to,
X Q -DENR / Diviaion of Water F-ur-ces 1. lk!PD!-.+'-S
261$ -Mall Service CeAter,-R-aleighs ]MC 27699-161.7
W;n�,i,� _Ater„
kPons P6rmit ocooq(,C) Vs
: y(w are completing tW form in computer use the TA8 key or the up - down arrows to move fimm one
field to the nW. To check the boxes click your mouse on top of the box. Othenuise, please print of type,
1. Contact Information;
Owner Name
`
Facility Name
i
-Modli ],g Address
city
-
State / Zip Code
Z77•Z.45
Telephone Number
� ��jfp � �'(� 9�-
PaxNumber—
e-mail Address
b-)Q V\ `)hj-- PIiV . �
2, Looattot;t of facility producing discharge. -
Check here if same address as above
Street Address or StateRoad 3a3C� J��lDrf
City l i Q%1 7'C? 'A
State I Zip Code N C
County
13, Opetatcr Information:
Name of the firm, public organization or other entity that operates the ,facility, (jVote that this is not
referring to the Operator in Regponsibie Cha77#e or ORC)
Name
Mailing Address , 0, i3 o X 1 L l
City Lie_ i,),7 117 0 ✓1 5
State / Zip Code 7 0 1 O�
Telephone Number (336 I s g 5- 8) (f 3
Fax Number ( l REC-En/-E0fnENR/DWR
e-mail.Aridress / I ! n
i Ct r\ci ci' 1 1 e � � �o G/ f. P �i ��LL� - n "-y n7al—fez - L 0
4
Water Resources
Permitting Section
1 ID Form' D 912013

Dec.23. 2013 11:34AM HHHF HIGH NOWT
fir,.8654 P. 4/5 r
NIMES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater;
.Facility Generating Wastewater(checic all that cappl p.
Industrba,
[]
Commercial
El
Residential
Er
School
�]
Other
❑
Number of &4ploy'ees
Number of Employees
Number of Homes
Number of Students/Staff
Explain.:
Describe the source(s) of Wastewaterr (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): nj U r-5 f` n 0 1.0 n-) C -
Number of persons served:
S. Type of collection system
9Y9-eparate (sanitary sever only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points �
outfali Identification number(s) 0 Q {
Is the outfaall equipped with a dl ffusers? ® Yes No
7. Name o£ receiving streamis) (iVl W applicants., Protride a map shoidng the exact Iocation. of each
outfattjo
a. Frequeney Or Discharges continuous ❑ Intermittent
If intermittent:
Days per weep discharge occurs: __ -- _ Duration:
9. neserlhe the treatment system'
List alt instated Components, inc tiding cacities, provide design Yemoval fbr €it3D, TSS, n&oayen and
phosphorus If the space provided is not sufficient, attach the description of the treatment system in a
- eptxrate Sheet ,o� ofpaper.
Po, n i- 1-1c •�c , i 5 c� O O l 1MG-I� c,Ja5-he0cz-1-erP(c�i-v-
ConS�
i.aI le-� C1'10r1')jCA+o,-
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-C�� IoI`I n C,
(DOO-�al (�,� Cp ���t C(�a,�n�P.�
�uc�l S(on aci-al;o K5
C `-Q r, K CC (q r ref 1
K Form-D912013
2Of3

` Dec. 23.. 2013-11:35AM HHHP HIGH POINT I(o.8654 P. 5/5
NP DES PLICAnO W - FOPX D
For privately -owned treatment systems, treating 100% domestic wastevraters <1.0 MGD
10. Plow Information:
Treatment Plant -Design $1 j 0 I MGD
Annual Average daily Raw . MLl MGD (for the previous 3 years)
Maximum daily flow NGD (for the previous 3 years)
11. Is this facility located on IndjAn country?
U Yes No
12. Effluent Data
.t W APPIJGANTk--ftaide data for the parameters listed. Few Coli, farm, TempemWMdndpHshaU be gran
samples, for att other, parameters 24-hour compoaft sampling shall be used. If ware than one analysis is rqporMd,
report daily mw mum and monthly average. If only one anaoisis is reported, report as dozily maximum
RE11E WAL AIpI UCANTS. ft vice the highest singte reading (Daily Maximum) and Monthly Average over
the nrx�f..�'di mnnihc fnr �arr�•ratn�f�rs arlrre�eflu Pr2 urrur nP.Ba'ntt._ ,'bfrarir. nth�r nnrrxmr�t�a:� "NrAj°
]Parameter
Doily
Maximum
A+ oAthly
Avera a
Units of
Measurement
Wochemioal Oxygen Demand (BODs)
" C0 , I
ffn#&
Fecal Coliform
6 cco
Total 'Ruspended. Solids
I � . •7
Temperature (Summer)
Temperature (Winter)
1 14
°C
PH
-7 .
7..
13. List all permits, construction approvals and/or applicatioAsi
Type. Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NC.Qbg6d)3,5 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
.14. APPLICANT CXRTIPICATION
Permit Number
I dertify 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.
name of Person Signing
'title
Applicant , Date
North Carolina General Statute 143-215.0 (bX2) states: Any person who lmuwingly makes any false statement tepreswlation. or wrlification in any
appllcallan, rewd, report, plan. or other docam%l Piles or required to be maintained under Article 21 or regulations of the Environmental Manegement
Commission implementing that Article, or who Wiles, hers with, or knmingty rendors inaccurate any recording or monitoring device or method
required to be operated or maintained under Arlide 21 or regulations of the Environmental Menopm%t Commission lrWementing that Article, shall be
guilty of a misderne mor 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 One of not mm then $25,600 or Impdsomment pol more Than 5 years, or loth, for a similar offense.)
3 of 3 Fonn-D WO13

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fip*:2
High Point Healthcare, Inc.
Latitude: 36' 00' 52" N Longitude: 80' 02' 52" W
Stream Class: C Receiving Stream: Rich Fork
Sub -Basin: 03-07-07 State Grid/ USGS Quad: C 18 SE/Kemersville, NC
Drainage Basin: Yadkin -- Pee Dee Permitted Flow: 0.010 MGD
Facility a
Location
not to scale
NPDES Permit NC0046035
Forsyth Count

N.C.Dept. of ENR
APR 3 0 2014
Winston-Salem
NC®EN R L Reg - Office
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory
Governor
Attn: Randall Bell
Pruitt Health
3830 North Main St.
Highpoint, NC 27012
Dear Mr. Fuqua:
John E. Skvarla, III
Secretary
April 14, 2014
Subject: Acknowledgement of Permit Renewal
Pen -nit NCO046035
Forsyth County
The NPDES Unit received your permit renewal application on April 11, 2014. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit,.please contact Bob
Sledge [phone].
Sincerely,
r�k � JIL
Wren Thedford
Wastewater Branch
cc: Central Files
Wms @n Salem egiorial-6ffic
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]Customer Service:1-877-623-6748
Internet:: www.ncwater.orq
An Equal OpportunityWffirrnativeAction Employer

, � "
E
HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P:E. John E. Skvarla, III
Governor Director Secretary
February 24, 2014
Neil L. Pruitt, Jr.
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION: NOV-2014-LV-0076
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt, Jr:
A review of High Point Healthcare's monitoring report for November 2013 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
11/19/13
400 #/100m1
600 #/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct the above
noncompliance problem(s). 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 Ron Boone at (336)
771-5000.
cc: SWP — Central Files
*WS1RT 01es
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,
65-t, 9__�0.
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
One
NortchCarolina
9ty1r ly
An Equal Opportunity 1 Affirmative Action Employer

Ifiv R���cor%4aj
Facility:
Pdi g6
Permit No.: 46-035
Pipe No.:
OP11 Month/Year: /1 • R e 1._
r�.
Monthly Average Violations
Parameter
Permit Limit
DMR Value
% Over Limit Action
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 ViolationslStaff Remarks:
31-7// 2. rd /t cJ /111 AIM didV- aa!�-
G130//'2 ::54q r fA*-Fd.&1JS 41"1114-arin7
V1'0A . 4i 04 l/UV
g/3 r/t r- S� r �a� AnJ s q ,, f -k cr-%�j V/60-1bn ,vv.1)
Supervisor Remarks:
0`
Completed by: er, 4on R-
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign
Off: I -A
Date: 2
Date:
Date:

IDi,vision of Water Quality
July 3, 2013
MEMORANDUM
To: Corey Basinger, Regional Supervisor, Surface Water Protection, WSRO
Through: Cindy A. Moore, Supervisor, Aquatic Toxicology Unit C4 _
From: Carol Hollenkamp, Quality Assurance Officer, Aquatic Toxicology Unit (lr`
Subject: Whole effluent toxicity test results
High Point Care Center
NPDES Permit # NC0046035/001
Forsyth County
The aquatic toxicity test using grab samples of effluent discharged from High Point Care Center has been
completed. High Point Care Center has.a permitted effluent discharge that is 0.01 MGD entering Rich Fork
Creek (7Q10 of 0.06 CFS). Whole effluent samples were collected on June 11 and June 13 by Jenifer
Carter and facility representative Randy Bell for use in a chronic Ceriodaphnia dubia pass/fail toxicity test.
The test using these samples resulted in a fail. Toxicity information follows.
Test Type
Test Concentrations
Test Result
Control Survival
Control Mean Reproduction
Test Treatment Survival
Treatment Mean Reproduction
First Sample pH
First Sample Conductivity
First Sample Total Residual Chlorine
Second Sample pH
Second Sample Conductivity
Second Sample Total Residual Chlorine
3-Brood Ceriodaphnia dubia pass/fail
21 % sample
Fail
100%
26.1
73%
l l .4
7.83 SU
485 micromhos/cm•
<0.10 nng/L
7.55 SU
488 micromlios/cm
0.32 mg/L
Test results for the above samples indicate that the effluent may be predicted to have water quality impacts
on receiving water. A concurrent toxicity test was run by Environmental Testing Solutions using samples
collected immediately after the ATU samples. The chronic Ceriodaphni.a dubia pass/fail toxicity test run
by Environmental Testing Solutions, Inc. resulted in a pass. Although these samples were not true split .
samples, ATU discussed the discrepancy in results with ETS and 2 differences were noted between the
samples collected on 6/13/13. The second sample received by ETS had a significant amount of air space in
the sample, and it had a chlorine value of less than 0.1 .ing/L. The second sample received by ATU had no
air space in the sample, and it had a chlorine value of 0.32 mg/L. The sample collector for High Point
Health Care should be notified that sample containers must be completely filled, with no air pockets, to
minimize loss of volatiles. The sample collector must minimize the air space in the sample. Samples with
a signnificant amount of airspace left in the containers have the potential to be deemed invalid upon receipt
at the laboratory.
Please contact us if further effluent toxicity monitoring is desired. We may be reached at [phone].
Basin: YAD07
cc: Central Files; Jenifer Carter, W SRO
Aquatic toxicology Unit Environniental Sciences Section

lve L�lvx - lliv. of water Quality Region
TOXICITY SAMPLE COLLECTION FORM page 1 of ARO FRO MRO RRO WaRO WiRO WSRO
r
Facility/Water Body
n �
NPDES # FNC 0 0 Outfall # C
County Y"t-)lrvt ` -6 Basin/Sub-basin 7Z
Receiving Stream
Collector(s) (print) [ je li / f -,e r (-! v &
Grab Sample Q Composite Sample ❑ Composite Type:
❑ Constant Time/Constant Volume: samples/hour for
❑ Flow Proportional
Sampling Equipment Used: ❑ DWQ Portable Sampler or ❑ Facility's Sampler IV11 6iv-a b
Date Began Time Began Date End Time End
6o l lJ l i / n:
Sampling Site
Description
hours
Container: [AIL 0 gal) PE cubitainer ❑Other (describe)it., # of container
Chlorinated: tulles ❑ No Collected on Ice or in Refrigerated Sampler: ❑Yes ❑ N hipped on Ice: es ❑ No
Method of Shipment: Courier 0"' •Bus ❑ Staff her (explain):
Date/time of transfer to shipper or courier box:
Comments: b-Ve j'l, I(,'% 54
bG:. /r, ��L f� G 5: z � � �✓y/i�7Pr( fs
6yr1
I Split" sample, splitting lab.name: (f G
Did DWQ staff perform the split? If NO, then did
Collector(s) ' n�
Signature: J6�, A--l- ,
Additional s&nle h ncller records
staff witness the
Date: 4b / 1-3 / /
Relinquished by:
Received by:
Date:
Time:
Relinquished by:
Received by:
Date:
Time:
Relinquished by:
Received by:
Date:
Time:
Relinquished by:
Received by:
Date:
Time:
hiiia" 'tes.to < DWQ/Environmental Sciences Section
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
ESS Courier #: 520101
Use street address only if shipping FedFx or UPS
Street address: 4401 Reedy Creek Road
Raleigh, NC 27607
phone: [phone]

NC DENR - Div. Of Water Quality
OXICITY SAMPLE COLLECTION FORM — page 2of 2
o�
-- =,. --
ATU
Temperature
Red
Sample No.
@ receipt, °C
on Ice
RECEIVED
CONDUCTIVITY,
TRC,
date
mhos/cm - µmhos/cm
mg/L
time
date
date
by
time
time
from
by
by
Lab
Comments:
Additional Notes (include date, time, signature, with notes):
Sampling instructions
I. SPLIT TESTS: Make sure the collector fills out, prints, and signs both the ATU sample collection form and the facility/contract
laboratory Chain of Custody (COC) form. If one person collects the sample, and another individual splits the sample, both should
sign the COC and the ATU sample collection form. All information on both COC and the ATU sample collection form should agree
(i.e., the date/time/signature for the collector, relinquished by/date/time, site description, pipe #, etc.) ATU uses only "true" splits for
certified laboratory evaluations. A split sample is a single, well mixed, equally divided, composite or grab sample, sent to different
laboratories to conduct whole effluent toxicity tests. A well mixed sample before each'/4 pour is critical to keep any effluent solids
from settling to the bottom. DWQ staff should be there to observe and instruct the facility staff in the collection/split process to
insure the sample is handled correctly. Ideally the DWQ staff should perform the split. If extenuating circumstances (i.e. late sample
collection times, etc.) would make this impractical, it should be noted on the sample collection form that DWQ staff was not present
at the time of the sample split. If the facility personnel collects and splits the sample, they need to sign the ATU sample collection
form as the collector, and also that they relinquished the sample to DWQ staff. DWQ staff will then need to sign and put the time
that they received the sample. Also, any additional information noted about the sample would be helpful to record on the ATU
sample collection form and the facility's COC (things such as color, smell, floating solids, suspended solids, etc.)
2. The person collecting the sample must sign the form for "Collector (signature)" at the bottom of page 1. Any subsequent transfer of
the sample must be recorded in the "Additional Sampler Handler records". In the "Collectors (print)" section at the top of page 1,
print the name of all collectors involved in the process. If the collector or additional sampler handler is a facility representative,
indicate this on the form.
3. With the adoption of the new chronic toxicity sampling schedule on January 1", 2011, samples may be collected earlier than 1000
hours. We do request notification, however, if a sample is to be collected earlier than 0600 hours. The maximum holding time for
chronic toxicity samples is 36 hours for first use and 72 hours from first use for test renewals. The maximum holding time is 36
hours for acute toxicity samples. The holding time for composite samples begins at the time of completion of the 24-hr composite.
4. Rinse sample container with sample before filling. Completely fill the sample with no air space.
5. Constant Time/Constant Volume composite samples should be at least 100 mLs volume per sample and collected at least every 20
minutes unless the detention time of the facility is >24 hours. More information on types of composites can be found in "NPDES
Permit Standard Conditions".
6. Sample collection material may be tempered glass, polyethylene, perfluorocarbon plastics including Teflon®, 304 or 316 stainless
steel, polypropylene, polyvinylchloride, Tygon , or silicone. All non-perfluorocarbon plastics should be discarded after use. DWQ
staff should not reuse non-perfluorocarbon plastics (polypropylene, LDPE, HDPE, polyvinylchloride, etc.) at different facilities for
collecting effluent samples. Tempered glass and perfluorocarbon (Teflon plastics may be reused after bioassay cleaning.
7. All samples should be iced during collection and transport to ensure a sample holding temperature of <6°C. The sample must be
received at <6°C or the sample will be invalid. Be sure to completely fill the coolers with ice and use large coolers whenever
possible. This is particularly crucial for shipping samples during warm weather months. Also, please notify ATU staff if samples
are being mailed in multiple coolers.

NC DENR - Div. Of Water Quality Region
ITO)aCITY SAMTLE COLLECTION FORM page 1 of ARO FRO MRO RRO WaRO WiRO WSRO
Facility/Water Body �'I l JL�/� C��f 1 C, ve —T/l
NPDES # NC 1 0 1 0 �qS Outfall # I
r,
CountyBasin/Sub-basin ( �%
Receiving Stream
Collector(s) (print)
Grab SampleComposite Sample ❑ Composite Type:
❑ Constant Time/Constant Volume: samples/hour for hours
❑ Flow Proportional
Sampling Equipment Used: ❑ DWQ Portable Sampler or ❑ Facility's Sampler /tl% 7V
Date Began Time Began Date End Time End
F(o / ff/%-�'3 /0: 0 , Il l
Sampling Site
Description
Container: 1 gal) PE cubitainer ❑Other (describe) # of containers /
Chlorinated: s ❑ No '�Alected on Ice or in Refrigerated Sampler: ❑ Yes ❑ No t'�1 ipped on Ice: [ es ❑ No
m
Method of Shipment: Courier � Bus ❑ Staff ❑ pthe(explain):
/ Date/time of transfer to shipper or courier box: & "t I'
Comments: j j 124
.SG.Zi�r�%'� ��vi1t�' %i'l.�r����`��c°Y ��''. �ar��l•� %cGz��n :>�a 5%��c��r/ � ��:� /1,c��' ��<<
�L� �� r/ G*,t'f�Grr ij FrY' !, tif3�' � � fiC' lLf rs' t- •mil � r`� r �4 ..GL�iY' �1`r� - Ii?%L`7 �k'" .iflr'ilr.�ler" ,A
`Split" sample, splitting lab name: v(I/14u'A' 'C"
Did DWQ staff perform_the split? If NO, then did DWQ staff witness the split?
r.-„4�.,.�,��..�-����. �,. r.,�3u - ,Ye'�g`� ,:rr;`i '�,i' ti,'S.",?Y'tu�'�4 fix.;- _ -.t1� '>', - `�,`y'�. :';�'e" .:..,,q..,�;._.�i:. ;.•x.-,_::�s r�� -< - ,s
y�'�rc���.- ���%rit��a% ,{c �e����.�; ,l�icrr.�. _�'p�t►:X�l�a�u�:�-�ui%� I ���
Collector(s) ,� , /�
Signature— ,� ,y / Date: l l J
Additional s` Dien ndler recnrrl.s:
Received by:
Date:
Time:
Relinquished by:
Relinquished by:
Received by:
Date:
Time:
Relinquished by:
Received by:
Date:
Time:
Relinquished by: I
Received b :
Date:
ITime:
.lei` h ._esos DWQ/Environmental Sciences Section
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
ESS Courier #: 520101
Use street address only if shipping FedEx or UPS
Street address: 4401 Reedy Creek Road
Raleigh, NC 27607
phone: [phone]

NC DENR - Div. Of Water Quality
TOXICITY SAMPLE COLLECTION FORM — page 2of 2
.&'
�,.
—:���
,ram �y�..=3�"--�.-s �-�.iK,� -_- �
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i�,.. a:,. �-�--�`'� s;.,�,.,.�' ��,1.
G����c.��'-` �4��
ATU
Sample No.
Temperature
receipt, °C
.:i.�
Rcd
on Ice
RECEIVED
date
time
by
from
CONDUCTIVITY,
mhos/cm µmhos/cm
date
time
by
TRC,
mg/L
date
time
by
Lab
Comments:
Additional Notes (include date, time, signature, with notes):
Sampling instructions
L SPLIT TESTS: Make sure the collector fills out, prints, and signs both the ATU sample collection form and the facility/contract
laboratory Chain of Custody (COC) form. If one person collects the sample, and another individual splits the sample, both should
sign the COC and the ATU sample collection form. All information on both COC and the ATU sample collection form should agree
(i.e., the date/time/signature for the collector, relinquished by/date/time, site description, pipe #, etc.) ATU uses only "true" splits for
certified laboratory evaluations. A split sample is a single, well mixed, equally divided, composite or grab sample, sent to different
laboratories to conduct whole effluent toxicity tests. A well mixed sample before each pour is critical to keep any effluent solids
from settling to the bottom. DWQ staff should be there to observe and, instruct the facility staff in the collection/split process to
insure the sample is handled correctly. Ideally the DWQ staff should perform the split. If extenuating circumstances (i.e. late sample
collection times, etc.) would make this impractical, it should be noted on the sample collection form that DWQ staff was not present
at the time of the sample split. If the facility personnel collects and splits the sample, they need to sign the ATU sample collection
form as the collector, and also that they relinquished the sample to DWQ staff. DWQ staff will then need to sign and put the time
that they received the sample. Also, any additional information noted about the sample would be helpful to record on the ATU
sample collection form and the facility's COC (things such as color, smell, floating solids, suspended solids, etc.)
2. The person collecting the sample must sign the form for "Collector (signature)" at the bottom of page 1. Any subsequent transfer of
the sample must be recorded in the "Additional Sampler Handler records". In the "Collectors (print)" section at the top of page 1,
print the name of all collectors involved in the process. If the collector or additional sampler handler is a facility representative,
indicate this on the form.
3. With the adoption of the new chronic toxicity sampling schedule on January 1", 2011, samples may be collected earlier than 1000
hours. We do request notification, however, if a sample is to be collected earlier than 0600 hours. The maximum holding time for
chronic toxicity samples is 36 hours for first use and 72 hours from first use for test renewals. The maximum holding time is 36
hours for acute toxicity samples. The holding time for composite samples begins at the time of completion of the 24-hr composite.
4. Rinse sample container with sample before filling. Completely fill the sample with no air space.
5. Constant Time/Constant Volume composite samples should be at least 100 mLs volume per sample and collected at least every 20
minutes unless the detention time of the facility is >24 hours. More information on types of composites can be found in "NPDES
Permit Standard Conditions".
6. Sample collection material may be tempered glass, polyethylene, perfluorocarbon plastics including Teflon®, 304 or 316 stainless
steel, polypropylene, polyvinylchloride, Tygone, or silicone. All non-perfluorocarbon plastics should be discarded after use. DWQ
staff should not reuse non-perfluorocarbon plastics (polypropylene, LDPE, HDPE, polyvinylchloride, etc.) at different facilities for
collecting effluent samples. Tempered glass and perfluorocarbon (Teflon) plastics may be reused after bioassay cleaning.
7. All samples should be iced during collection and transport to ensure a sample holding temperature of <6°C. The sample must be
received at <60C or the sample will be invalid. Be sure to completely fill the coolers with ice and use large coolers whenever
possible. This is particularly crucial for shipping samples during warm weather months. Also, please notify ATU staff if samples
are being mailed in multiple coolers.

Kim Lapointe
High Point Healthcare, Inc.
3830 N Main St
High Point, NC 27265
Dear Permittee:
September 27, 2013 FRelorlal`
R
3
Subject: Renewal Notice
NPDES Permit NCO046035
HighPoint Healthcare
Forsyth County
Your NPDES permit expires on April 30, 2014. Federal (40 CFR 122.41) and
North Carolina (15A NCAC 2H.0105 (e)) regulations state that permit renewal
applications must be filed at least 180 days prior to expiration of the current
permit. If you have already mailed your renewal application, you may disregard this
notice.
Your renewal package must be sent to -the Division postmarked no later than
November 1, 2013. If any wastewater discharge will occur after April 30, 2014, the
current permit must be renewed. Failure to submit a renewal application by the
deadline would deny the subject facility the automatic permit extension granted by
NCGS 150B.
If all wastewater discharge has ceased at your facility and you wish to
rescind this permit, contact me at the telephone number or address listed below.
Use the enclosed checklist to complete your renewal package. The checklist
identifies the items you must submit with the permit renewal application. If you
have any questions, please contact me at the telephone number or e-mail address
listed below.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
Ttnsat on Sa�lel Regz no al of ice S3 facer:water' Protects car3
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / [e-mail]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper

r,
NPDES Permit NCO046035
High Point Healthcare
Forsyth County
The following items are REQUIRED for all renewal packages:
➢ A cover letter requesting renewal of the permit and documenting any
changes at the facility since issuance of the last permit. Submit
one signed original and two copies.
➢ The completed application form (copy attached), signed by the
permittee or an Authorized Representative. Submit one signed
original and two copies.
➢ If an Authorized Representative (such as a consulting engineer or
environmental consultant) prepares the renewal package, written
documentation must be provided showing the authority delegated to
any such Authorized Representative (see Part II.B.11.b of the
existing NPDES permit).
➢ A narrative description
facility. Describe how
wastewater treatment are
has no such plan (or the
solids) , explain this ir.
two copies.
of the sludge management plan for the
sludge (or other solids) generated during
handled and disposed. If your facility
permitted facility does not generate any
writing. Submit one signed original and
The following items must be submitted by any Municipal or
Industrial facilities discharging process wastewater:
Industrial facilities classified as Primary Industries (see Appendices
A-D to Title 40 of the Code of Federal Regulations, Part 122) and ALL
Municipal facilities with a permitted flow >- 1.0 MGD must submit a
Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part
122.21.
The above requirement does NOT apply to privately owned
facilities treating 100% domestic wastewater, or facilities
which discharge non -process wastewater (cooling water,
filter backwash, etc.)
Send the completed renewal package to:
Charles H. Weaver
NC DENR / DWR / NPDES Program
1617 Mail Service Center
Raleigh, NC 27699-1617

June 6, 2013
Randall K Bell
PO Box 1291
Clemmons, NC 27012
Corey Basinger
NC Division of Water Quality
585 Waughtown Street
Winston Salem, NC 27107
RE: Compliance Evaluation Inspection & Notice of Violation
NOV-2013-PC-0190
Permit: High Point Healthcare, Inc
Facility: High Point Healthcare Wastewater Treatment Plant
NPDES Permit#: NCO046035
Forsyth County
RECEIVED
N.C. Dept. ul :`iA
JUN p 7 2013
Winston-Salem
Regional office
To Whom It May Concern;
In response to High Care inspection on May 16, 2013 the following issues/discrepancies were
noted as the following. I will give an explanation,on each item that was addressed.
#1- Bar screen: As of 6/07/13 meeting with maintenance department at High Point Care, to go
over the new construction of the -new bar screen: New bar screen will be replaced within the next two
weeks.
#2 — Grit Tank: To'resolve this problem maintenance will install a sanitary T, and the plant will
be pumped more frequently.
#3 — Lids Over Access Holes: Maintenance will resolve this problem by making metal lids to be
placed over the access holes.
#4 — Aeration Basins: Discoloration was due to heavy solids. Pumping truck was call that day,
5/16/2013, and 3000gals was removed from the High Point Waste Treatment Plant. This repaired the
plant F/M ratio.
#5 — Clarifier: Pumping truck fixed the dilemma of small floating solids. In which the turbidity in
the water going over the weir became clear.
#6 — Chlorine Tablets: Operator will pull the tubes and clean weekly in order for the chlorine not
to stick inside tubes.
#7 — Digester Tank: Resolved by pumping digester and will have diffuser installed in digester
#8 — Effluent Turbid: This was fixed by having plant pumped.
These issues/discrepancies have and will be resolved within the next few weeks. If you have any
questions or concerns please feel free to contact me. Thank you in advance,
Sincerely,
L"_ l3�
andy Bell /0 C
Bell Enterprise
336-399-8243
la- : of

T
lRn
MCDrs NR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
High Point Healthcare, Inc.
Attn: Neil L. Pruitt, Jr., Owner
P.O. Box 1210
Toccoa, GA 30577
Division of Water Quality
Charles Wakild, P. E.
Director
May 22, 2013
Subject: Compliance Evaluation Inspection & Notice of Violation
NOV-2013-PC-0190
Permittee: High Point Healthcare, Inc.
Facility: High Point Healthcare Wastewater Treatment Plant
NPDES Permit #: NCO046035
Forsyth County
Dear Mr. Pruitt:
John E. Skvarla, III
Secretary
Mr. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ or the
Division) conducted a compliance evaluation inspection (CEI) of the High Point Healthcare (HPHC) Wastewater
Treatment Plant (WWTP) on May 16, 2013. The assistance and cooperation of Randy Bell, Operator in Responsible
Charge (ORC), was greatly appreciated. An inspection checklist is attached for your records and inspection findings
are summarized below.
General Information
The High Point Healthcare WWTP is located at 3830 North Main Street, in High Point, Forsyth County, NC,
at approximate coordinates 36.0139080N,-80.0482240W. Although in Forsyth County, the facility is actually located
at a Highpoint address. The permit authorizes HPHC to operate this 0.01 MGD WWTP, which consists of a manual
bar screen, a grit chamber, dual aeration tanks, a clarifier, an aerated sludge holding tank, a tablet chlorinator, a
chlorine contact tank and a tablet dechlorinator, and discharge the treated effluent to Rich Fork via outfall 001, which
is located approximately 0.14 miles northwest of the facility on the north side of North Main Street where Rich Fork
crosses under N. Main Street. Rich Fork is currently classified as Class C waters and is located in, the Yadkin Pee -
Dee river basin.
Site Review
Some issues/discrepancies were noted during the site review, as follows:
The bar screen is constructed with what appears to be 2" angle aluminum with the bars spaced
approximately 2" apart. The inspector believes the bar screen is minimally effective at its intended purpose.
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
An Equal Opportunity \ Affirmative Action Employer
One
Nd thCarofina.

High Point Healthcare, LLC, Attn: Mr. Neil L. Pruitt, Jr., Owner
Compliance Evaluation Inspection & Notice of Violation NOV-2013-PC-0190
High Point Healthcare Wastewater Treatment Plant, NCO046035
May 22, 2013, Page 2 of 3
2. The grit tank was full during the inspection with a heavy, black, solids -laden crust on top. Mr. Bell did
provide records of a recent pumping but stated that the grit tank was pumped in error and that he intended
the pumper to pump the digester, not the grit tank. The inspector believes this tank acts more like a septic
tank. The nature of the liquid and solids flowing from the grit tank to the aeration basin is likely not ideal for
an extended air activated sludge system.
3. The lids that cover the access holes (2) on the grit tank are nothing more than square, thin, flat
(approximately 3/16") metal plates that just lay across the square holes. The plates are easily moved,
purposely or inadvertently. This is a significant safety hazard for all personnel who enter the facility and also
allows foreign objects to fall into the tank.
The aeration basins each have a single air diffusion pipe that parallels the short ends of the tanks. This
system provides plenty of mixing but only moderate diffusion. Mr. Bell did not have a dissolved oxygen (DO)
meter at the time of the inspection so the DO could not be measured. The foam in the basins covered a
good 90% of the surface and the mixed liquor was dark in color and heavily -laden with suspended solids. A
sample pulled from the northern aeration basin showed no settling after thirty minutes, demonstrating the
poor settling characteristics of the sludge and indicating a high sludge age and the presence of filamentous
organisms, neither of which should be present in a properly operated activated sludge plant.
5. The clarifier had a small amount of floating solids on its surface at the time of the inspection. The water
overflowing the weirs was very turbid, although no actual solids were seen overflowing the weir, which could
be attributed to low flow at the time. A sludge sample pulled during the inspection exhibited a very turbid
water column and no well defined sludge layer. The column gradually became darker toward the bottom.
This also demonstrated the poor settling characteristics of the sludge.
The chlorine tablets in the chlorinator were severely caked up near the center of the tube depth, preventing
the tablets from actually contacting the effluent flow. Although there were small bits of chlorine at the bottom
of the tubes, most of the chlorine was stuck in the middle. The heavy buildup of the chemical inside the
tubes indicates that this has been occurring for quite some time now.
7. The digester tank was full at the time of the inspection and it had a thick crust layer on top. Mr. Bell stated
that he does not normally aerate the sludge in the digester. When asked how he decants the digested
sludge Mr. Bell stated there are no provisions for properly decanting the sludge and that he did not have a
pump he could use to do so. He then stated that decanting occurs when sludge is wasted and that the
sludge wasted from the clarifier to the digester simply displaces sludge that's already in the digester,
pushing it back into the aeration basin. This is not actually decanting .the sludge. It appears that, until sludge
is removed from the digester via pumper truck, that all sludge is kept inside the plant and recirculated
constantly.
8. Effluent flow during the inspection was highly turbid with some solids.
The issues enumerated above are highly indicative that sludge is not being properly managed at the facility.
The characteristics of the mixed liquor and sludge (light frothy thick foam covering a majority of the aeration basin,
dark watery sludge with dark specks, poor settleability, unusual industrial -type odor) indicate that the sludge is very
old and that the facility may frequently receive substances that may be toxic to a viable bacterial population.
Although Mr. Bell does have sludge removed and has records of its removal, more frequent removal may be
necessary for optimal operation of the facility.
Documentation Review
16

High Point Healthcare, LLC, Attn: Mr. Neil L. Pruitt, Jr., Owner
Compliance Evaluation Inspection & Notice of Violation NOV-2013-PC-0190
High Point Healthcare Wastewater Treatment Plant, NCO046035
May 22, 2013, Page 3 of 3
All documentation reviewed was satisfactory. Mr. Bell had the required records on hand during the
inspection.
Please work with Mr. Bell to address the problems noted above and keep the plant in optimum working.
order. Please reply in writing to this letter within 20 business days of its receipt. Your written reply should provide
corrective actions with implementation schedules for each of the deficiencies/violations enumerated above.
You are reminded that, in accordance with NC General Statute 143-215.6A, the Director of the Division of
Water Quality may assess civil penalties not to exceed $25,000 per day, per violation, for violations of NCGS 143-
215.1 and the NCO046035 NPDES permit. The timeliness and content of HPHC's written reply will weigh heavily in
our decision of whether to initiate enforcement actions for the deficiencies/violations enumerated above.
If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at (336) 771-
5000. Thank you for your cooperation in this matter.
Sincerely,
1;1ex e,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Attachments:
BIMS Inspection Report
CC: E:'SRQ SUtiIP
Central Files
NPDES Unit

United States Environmental Protection Agency
Form Approved.
EPA Washington, D:C.20460
OMB No. 2040-0057
Water Complianne Inspection Repart
Approval expires 8-31-98
Section A: National Data System Coding (Le., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 1 5 ! 31 NC0046035 111 121 13/05/16 117 181 C I 19I S I 20I I
Remarks
211111111111111111 11111111 1111 11111111 1111111I II16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ------------------------Reserved-------- ----
67I. 169 70I I 711 I 72I N I 73I I 174 751 I I I I I I 180
W
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:00 AM 13/05/16
09/07/01
High Point Healthcare
3830 N Main St
Exit Time/Date
Permit Expiration Date
High Point NC 27265
12:00 PM 13/05/16
14/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Randall Keith Bell/ORC/336-433-7221/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Kim Lapointe,3830 N Main St High Point NC 27265//336-869-3524/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//336-771-4967/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
e •�&V a
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3 NC0046035 111 12, 13/05/16 117 181
CI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page # 2

" Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 05/16/2013 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 ■
Is the facility as described in the permit? ■ n n n
# Are there any special conditions for the permit? n ■ n n
Is access to the plant site restricted to the general public? n ■ n n
Is the inspector granted access to all areas for inspection? ■ n ❑ ❑
Comment: .Security is minimal. There is only a 36" high, or so fence around the facility
and it is in a very poor state of disrepair. The fence is easily breached and there a many
safety hazards inside the fence, not only for unauthorized personnel but for the
operator(s) as well. Please refer to the attached inspection summary letter.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
n
❑
n
Is all required information readily available, complete -and current?
■
n
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
n
n
n
Are analytical results consistent with data reported on DMRs?
■
n
n
n
Is the chain -of -custody complete?
■
n
n
n
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do.they include all permit parameters?
■
n
n
n
Has the facility submitted its annual compliance report to users and DWQ?
n
n
■
n
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
n
■
n
n
Is the ORC visitation log available and current?
■
n
n
❑
Is the ORC certified at grade equal to or higher than the facility classification?
n
n
n
Is the backup operator certified at one grade less or greater than the facility classification?
■
.n
n
n
Is a copy of the current NPDES permit available on site?
■
n
n
n
Facility has copy of previous' year's Annual Report on file for review?
n
n
■
n
Comment:. Please refer to the attached inspection summary letter.
Page # 3

M
Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 05/16/2013 Inspection Type: Compliance Evaluation
Laboratory Yes No NA NE
Are field parameters performed by certified personnel or laboratory? ® n n n
Are all other parameters(excluding field parameters) performed by a certified lab? 0 n n n
# Is the facility using a contract lab?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
Comment: Please refer to the attached inspection summary letter.
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
n n n im
nnn®
Yes No NA NE
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ® n ❑ n
Comment: Please refer to the attached inspection summary letter.
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ n n n
Comment: Please refer to the attached inspection summary letter.
Bar Screens Yes No NA NE
Type of bar screen
a.Manual
b. Mechan ical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment: Bar screen is not optimal, but appears to be adequate. Please refer to the
attached inspection summary letter.
Type of grit removal
Yes No NA NE
Page # 4

" 0
Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 05/16/2013 Inspection Type: Compliance Evaluation
Grit Removal Yes No NA NE
a.Manual ■
b.Mechanical n
Is the grit free of excessive organic matter?
n n n ■
Is the grit free of excessive odor? n ■ n n
# Is disposal of grit in compliance? ■ ❑ n n
Comment: Grit removal is achieved through a 1,000 gallon tank that is surely
capturing most of the solids whether organic or inorganic. It is more like a septic tank.
The lids (2), which cover the access holes to this tank, consist only of thin
(approximately 3/16"), flat steel plating, which have no means by which they're held in
place. They're therefore easily moved and present a safety/falling hazard. Please refer
to the attached inspection summary letter.
Aeration Basins
Yes No
NA
NE .
Mode of operation
Ext. Air
Type of -aeration system
Diffused
Is the basin free of dead spots?
n ■
n
Are surface aerators and mixers operational?
nn■p
Are the diffusers operational?
■ n
n
n
Is the foam the proper color for the treatment process?
■ n
n
n
Does the foam cover less than 25% of the basin's surface?
n ■
n
n
Is the DO level acceptable?
n n
n
■
Is the DO level acceptable?(1.0 to 3.0 mg/1)
n n
n
■
Comment: Air diffusion is far from optimal. Operator did not have a DO meter at the
time of the inspection but stated he tries to maintain DO in the basins at about 2.0 mg/I.
There is only one diffusion pipe inside each of the tanks, each of which run parallel to
the short ends of the aeration tanks. There are dual blowers and the operator stated
they cycle 15 minutes on/15 minutes off. There appeared to be a large overabundance
of solids in the system at the time of the inspection. A MLSS sample pulled from the
northern aeration basin during the inspection showed absolutely no settling after 30
minutes. The color of the mixed liquor is very dark with foam covering the majority of the
surface of the basins and an odd industrial odor unusual of activated sludge plants.
Please refer to the attached inspection summary letter.
Secondary Clarifier -
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Yes No NA NE
■nnn
nn■n
Page # 5

Permit: NC0046035
Inspection ®ate: 05/16/2013
Secondary Clarifier
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Owner - Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
Comment: The clarifier had some floating chunks of sludge and the overflow was very
turbid, although no actual solids were seen flowing over the weirs. The sludge blanket in
the clarifier was not well defined and the water column exhibited very poor settling.
Please refer to the attached inspection summary letter.
Pumps-RAS-WAS
Are pumps in place?
Are pumps operational?
Are there adequate spare parts and supplies on site?
Comment: The plant uses air lift pumps that run constantly when the blowers are on.
The return sludge was dark but quite thin/watery. Please refer to the attached inspection
summary letter.
Disinfection -Tablet
Are tablet chlorinators operational?
Are the tablets the proper size and type?
Number of tubes in use?
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
Is there chlorine residual prior to de -chlorination?
Yes No NA NE
®nnn
®nnn
® n n n
n 6 0 0
n®nn
nn®n
® n n n
®nnn
n®nn
Yes No NA NE
®nnn
n n n
nnn®
Yes No NA NE
Page # 6

rr
a
Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date:.05/16/2013 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Comment: During the inspection the tablets in the tubes were severely caked: up and
very little chlorine was actually contacting effluent flow. The tubes were badly enough
caked up to make the inspector suspect that this was not just a one time occurence.
The plant has had a high number of Fecal violations in the past, also indicating that this
occurs regularly. The chlorinator is not in optimal condition and even in the best of
circumstances it appears that it is open, at least to some degree, to the atmosphere,
allowing moisture to enter the tubes from above and exacerbating the caking problem.
The chlorinator should be repaired/replaced, to provide a better seal and protect the,
chlorine tablets from excessive moisture.. The hole in the concrete tank that the
chlorinator sits in is not covered. Covering it would also help protect it from precipitation
and the like, as well as mitigate another safety/falling hazard. Please refer.to the
attached inspection summary letter.
De -chlorination
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
■
n
n
n
Is storage appropriate for cylinders?
n
.n
■
n
# Is de -chlorination substance stored away from chlorine containers?
■
n
n
n
Are the tablets the proper size and type?
■
n
n
n
Comment: Please refer to the attached inspection summary letter.
Are tablet de -chlorinators operational?
n
n
n
Number of tubes in use?
2
Comment: Please refer to the attached inspection summary letter.
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
❑
(If units are separated) Does the chart recorder match the flow meter?
■
n
n
n
Comment: The flow meter was last calibrated on March 19, 2013. Please refer to the
attached inspection summary letter.
FfFlinnnf Pina Yes No NA NE
Is right of way to the outfall properly maintained? ■ n n n
Are the receiving water free of foam other than trace amounts and other debris? ■ n n n
If effluent (diffuser pipes are required) are they operating properly? n ❑. ■ n
Page # 7

M
Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 05/16/2013 Inspection Type: Compliance Evaluation
Effluent Pipe
Yes
No
NA
NE
Comment: Please refer to the attached inspection summary letter.
Aerobic Digester
Yes
No
NA
NE
Is the capacity adequate?
®
n
n
n
Is the mixing adequate?
n
®
n
n
Is the site free of excessive foaming in the tank?
®
n
n
n
# Is the odor acceptable?
®
n
n
n
# Is tankage available for properly waste sludge?
®
n
n
n
Comment: The digester exhibited signs of having too much solids in it. The operator
stated he does not typically aerate the digester, so at the time of the inspection the
contents had not been aerated for quite some time, yet there was no supernate. When
questioned as to how he decants the digester the operator stated there are no
provisions for effectively decanting the digested sludge and he did not have a pump he
could use to do so. He stated decanting actually occurs when he wastes sludge and
during sludge wasting the sludge that is pumped from the clarifier to the digester simply
displaces sludge that's already in the digester and forces it back into the aeration basin.
This is not actually decanting. Except for when a sludge hauler comes in and removes
sludge from the digester, the solids in the plant are constantly recycled through the
entire plant. At the time of the inspection there was an obvious extreme overabundance
of solids in the plant.
Operations & Maintenance Yes No' NA NE
Is the plant generally clean with acceptable housekeeping? n ® n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ® n n n
Judge, and other that are applicable?
Comment: The plant is old and moderately dilapidated. There are many safety
hazards present that could easily be mitigated. At the time of the inspection, the plant
was not being operated effectively. There were too many solids in the plant and the
inspector is surprised that the plant hadn't had more limit violations prior to the
inspection. The inspector believes that the inadequate operations/maintenance of the
facility is due in part to limited funding, but the operator's actions obviously play a part in
this as well.
Page # 8

WSRO MONTHLY DMR VIOLATIONS REPORT FOR:
Forsyth
NCO046035
#MULTIVALUE
High Point Healthcare
ImParameterDesc
Violation Action
Number
Daily Maximum Coliform, Fecal MF, M-
1 �09-12-2011
per 100
Exceeded 2011 9 001 FC Broth,44.5C Weekly
Milliliters 400 800 100 Proceed to NOV
Daily Maximum
1
Solids, Total Suspended
Milligrams
Exceeded
2011
10
001
Concentration
10-24-2011
Weekly
per Liter
45
53
17.77778
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
2011
11
001
FC Broth,44.5C
11-07-2011
Weekly
Milliliters
400
2000
400
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
20121
3
001
FC Broth,44.5C
03-07-2012
Weekly
Milliliters
400
1100
175
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
2012
12
001
1 FC Broth,44.5C
12-04-2012
Weekly
Milliliters
400
991
147.75
Proceed to NOV

WSRO MONTHLY ®MR VIOLATIONS REPORT FOR:
Forsyth
NCO046035
#MULTIVALUE
High Point Healthcare
I
!,-
..
.. I M, i . Parameter Des-c
V. I
Number
Daily Maximum
Coliform, Fecal MF, M-
IFC
L-12-2011
per 100
Exceeded
2011
9 001 Broth,44.5C
Weekly Milliliters 400
800
100
Proceed to NOV
Daily Maximum
Solids, Total Suspended -
Milligrams
Exceeded
2011
10
001
Concentration
10-24-2011
Weekly
per Liter
45
53
17.77778
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
2011
11
001
FC Broth,44.5C
11-07-2011
Weekly
Milliliters
400
2000
400
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
2012
3
001
FC Broth,44.5C
03-07-2012
Weekly
Milliliters
400
1100
175
Proceed to NOV
Number
Daily Maximum
Coliform, Fecal MF, M-
per 100
Exceeded
2012
12
001
FC Broth,44.5C
12-04-2012
Weekly
Milliliters
400
991
147.75
Proceed to NOV

Boone, Ron
From: Beth Bega <[e-mail]>
Sent: Wednesday, June 12, 2013 8:11 AM
To: Boone, Ron
Subject: RE: High Point Health Care
Great. I'll talk with you tomorrow at 9am. My direct number is listed below. Thank you.
Beth Bega
Property Manager
UHS-Pruitt Corporation
1626 Jeurgens Court
6
o�e:78) 533-6338
Fax-
E-mail: bbega@uhs-r)ruitt.com
SPRUITT
C 0 R P 0 R A T! 0 N
Goal muted & Gaming
URR,eaQycon
From: Boone, Ron jmailto:[e-mail]
Sent: Wednesday, June 12, 2013 7:39 AM
To: Beth Bega
Subject: RE: High Point Health Care
Beth,
We will go ahead and call you. Please confirm your direct line and we'll talk tomorrow at 9AM.
Regards,
Ron Boone
NC DENR Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Email: ron.boone(@ncdenr.eov
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: Beth Bega [mailto:[e-mail]]
Sent: Tuesday, June 11, 2013 4:25 PM
To: Boone, Ron
Subject: RE: High Point Health Care
Thank you for sharing the email attachments.

I'd be most happy to speak with you and your Mr. Basinger this Thursday; 9am works fine. Would you like me
to call you or will you be calling me? Thanks so much for your cooperation, patience and willingness to work
with us. I look forward to speaking with you.
Beth Bega
Property Manager
UHS-Pruitt Corporation
1626 Jeurgens Court
Norcross, GA 30093
Phone: [phone]
UM*PRMT
Fax: [phone]
E-mail: [e-mail]
C 0 R P© R A T 8 0 N
commadb cvinq
From: Boone, Ron Imailto:[e-mail]1
Sent:.Tuesday, June 11, 2013 3:40 PM
To: Beth Bega
Subject: High Point Health Care
Ms. Bega,
The Notice of Violation (NOV) that we sent to Mr. Pruitt, as well as Mr. Bell's written response to that NOV, are
attached. I spoke with my boss and we'd like to suggest a conference call on Thursday morning at around 9AM. Let us
know if this will work for you. Thanks in advance for your cooperation and have a great day!
Best Regards,
Ron Boone
NC DENR Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Email: [e-mail]
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.
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended
recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure
or distribution is .prohibited. If you are not the intended recipient, please contact the sender by e-mail and
destroy all copies of the original.

a x i.
V,
MCDENR
,North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
August 12, 2013
High Point Healthcare; Inc:
Attn: Neil L. Pruitt, Jr., Owner
P.O. Box 1210
Toccoa, GA 30577
Subject: Follow -Up to Compliance Evaluation Inspection
Permittee: High Point Healthcare, Inc.
Facility: High Point Healthcare Wastewater Treatment Plant
NPDES Permit #: NCO046035
Forsyth County
Dear Mr. 'Pruitt:
l
On August 12, 2013, Ron Boone and I, of the Winston-Salem Regional Office of the. NC Division of
Water Resources (DWR or the Division), conducted a follow-up visit to the compliance evaluation
inspection (CEI) of the High Point Healthcare (HPHC) Wastewater Treatment Plant (WWTP) that was
conducted on May 16, 2013. Also in attendance at this site visit were:
Beth Bega, Property Manager, UHS-Pruitt Corporation;
Raymond Cooper, Administrator UniHealth Post -Acute Care High Point;
Randall Bell, Wastewater Treatment Plant Operator; and,
Bradley Flynt, Wastewater Treatment Plant Operator
During this follow-up visit Mr. Boone and I evaluated the results of actions taken to correct
deficiencies noted during the May 16, 2013 inspection. All deficiencies noted during the inspection had
been corrected and the plant appeared to be operating more effectively and was discharging a clear
effluent.
It is noted that some issues still exist, which the operators will address in coordination with UHS
personnel, but that the plant is currently in compliance with its discharge permit. The Division remains
committed to protecting the surface waters of the State of North Carolina, and we are available to consult
with the plant operators and UHS personnel in order to help identify and implement potential solutions to
any problems discovered at the plant.
North Carolina Division of Water Quality, Winston-Salem Regional Ofrice
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service;1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer
ofl NthCarohna

High Point Healthcare, LLC, Attn: Mr. Neil L. Pruitt, Jr., Owner
Follow -Up Site Visit
High Point Healthcare Wastewater Treatment Plant, NCO046035
August 12, 2013, Page 2 of 2
If you have any questions regarding the follow-up visit or this letter, please call Mr. Boone or me at
[phone]. Thank you for your cooperation in this matter.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Resources
CC: 4W
Central Files
NPDES Unit
Mr. Randall Bell
P.O. Box 1291
Clemmons, NC 27012

, Af
NCDENR
North Carolina.Department of Environment and natural Resources
Division of Water Quality
Beverly Eaves Perdue Chuck Wakild, P.E. Dee Freeman
Governor Director Secretary
October 2, 2012
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subj ect: NOTICE OF VIOLATION
NOV-2012-MV-0095
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
A review of High Point Healthcare's monitoring report for June 2012 showed the following
violations:
Parameter
.Date
Measuring
Frequency
Violation
Surfactants (MBAS)
06/30/12
2 X month
1
Kemedial 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 Ron Boone at [phone].
cc: SWP — Central Files
QS'1'®O�F�I'es
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
Nakilally
One
NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 4V
,Ye44Y6ceU,,e Permit/Pipe No.: 1�UO IAonth/Year
Monthly Averace Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit LimitfTvT)e DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Fre uencv Valueseported # of Violations
�� M J3As 2
Other Violations ,/
03119- - FL - 1T�I( /UU 9%' to lV
N6V' rig r/ -T�C r
r- One
Completed by: Date: q l�l v772
Regional Water Quality 70 �L
Supervisor Sianoff://"�' Date,: Zo ;1
Y 7vr ` r L� !� �5 J C 6� ` �J e
�, �` ��7� % u�/��Jl� 6� /��S C .�' [vi

Forsyth
NCO046035
Monitorinq Violation
NCO051713
Limit Violation
High Point Healthcare
Lakeview Mobile Home Park
per 100
Milliliters 400t
440. 10

Forsyth
NCO046035
Monitoring Violation
NCO051713
Limit Violation
High Point Healthcare
Lakeview Mobile Home Park

NPDES PERMIT NO.: NC 0046035 DISCHARGE NO.: 001 MONTH: JULY YEAR: 2012
FACILITY NAME: High Point Care CLASS: COUNTY: Forsyth
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES: (1) PACE (2) ETS
Check box if orc has changed[ ] PERSON(S) COLLECTING SAMPLES: RANDY BELL q %
Mail ORIGINAL and ONE COPY to: `I +L lie& o4 1 / f J-
ATTN: CENTRAL FILES X G �
DIVISION OF WATER QUALITY (SIGNATURE OF OR) DATE
DENR BY THIS SIGNATURIt, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
40RECEIVED
N-C, Dept. of ENR
4D,SEP2-42012
Winston-Salem
�RegionalOfiic2
MMLGUM, INU 41 DWW-ID Ir 1 W
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D
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Time
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pH
2x wk
Res
CL2
1 x wk
BOD5
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1 x wk
NH3-N
1 x wk
T
S
S
1 x wk
Fecal
Coliform
Geometric
Mean
1x wk
Dissowd
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TGP3B
2x mthly
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lxmo
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.., -_
_
_.._.
-
28
29-
---
-'-
0.0110
1<2.5
29
30
08;00
.5
RB
0.0100
27
6.6
32
<0.1
2.6
1
6.9
7.80
0.23
30
31
",
12;20
25
RB
0:0106
� .28 ' '
- °'
41;
31
AVERAGE
0.0040
18
27.2
2.0
0.25
2.8
0
6.7
11
0.20
7.80
023
#
0.0170',
28 ,:'6.8
48.0
'- '2:5,
0.87:
3.6
"
�, 6,9
,. 00 ',.".
0.20
7.80
0.23 ,
#„
MINIMUM
0.0030
25
6.5
<11
2.0
<1
<5
<1
6.5
0.0
0.20
7.80
0.23
#
-- COMP/GRAB: -
,�: .GRAB
', GRAB
GRAB
GRAB °.
�' GRAB.=;,
GRAB : '
GRAB
GRAB'' ' -
-GRAB --r
GRAB
GRAB
GRAB :-
GRAB'
#
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
N/A
NA
2.4
NA
NA
#
-QUARTERLY LIMIT -. '
° NA
I
°'NA
:NA
NA-'
; NA' .,
_.NA�
NA
- :.NA4NA.-
'.'-NA
-' NA '�
NA' -
, 2.0#
MONTHLY LIMIT
0.0432
NA
>6 <9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
ConL
'Daily
Wkl y
. z/wk
vVkry
VUkly`
�Wkly'
VVkly'
Wkly=
, wkly.
. Wkly:
"Wkly'-
WWy
#
FREQUENCY MET
0.0089
FALSE
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
#
.COMPLIANT:
a
,YES"
' YES
YES:.
YES
YES'..
:NO.
YES,
YES
:''.YES
YES'
YES
YES
# -
Total Monthly Flow 0.2800 MG DID:;AfG1_TrDEP.4PA,_T 2 MGL TN Monthly Loading (Ibs.)
DEM Form MR-1 (12/03) 1
DEM Form MR-1 (12103) 0
18

NPDES PERMIT NO:N00046035 DISCHARGE NO.: 001 MONTH: JULY YEAR: 2012
FACILITY NAME: High Point Care COUNTY:_ Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
I OCTOCARH
DOWNSTREAM
00010
00300
31616
00010
00300
31616
D
Fecal
D I
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Colifomt
T I
Temp
O en
T
Temp
0 en
E
2400
Geometric
E
2400
Geometric
Clock
DO
Mean
Clock
DO
Mean
#
HRS
C
m /L
#/100m1
#
HRS
C
m IL
#/100ml
1
1
2
2
3
11;25
23.0
7.8
3
11;30
24.0
7.7
4
4
5
5
6
6
7
7
g
1
8
9
19;50
25.0
7.9
9
19;56
25.0
7.6
10
10
11
11
12
12
13
13
14
14
15
15
16
18;00
25.0
8.3
116
18;06
25.0
8.5
17
17
18
I
I
18
19
19
20
20
21
21
22
122
23
18;10
26.01
8.4
23
18;16
26.0
8.6
24
24
25
25
26
26
27
27
28
1
28
29
E
08;20
24.0
8.4
30
08;25
25.0
8.2
31
AVERAGE
24.6
8.0
AVERAGE
25.0
7.5
MAXIMUM
26.0
8.4
MAXIMUM
26.0
8.6
MINIMUM
23.0
7.8
MINIMUM
24.0
7.6
COMP/GRAB
GRAB
GRAB
I
MP/GRAB
GRAB
GRAB
OEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
X
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
Signature of Permittee**
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics x
01034 Chromium 34235 Benzene
01037 Total Cobal 34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
-----------------------------------------------------------------------------------------
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)
Date

NPDES PERMIT NO.: NC 0046035 DISCHARGE NO.: 001 MONTH: JUNE YEAR: 2012
FACILITY NAME: High Point Care CLASS: COUNTY: Forsyth
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES: (1) PACE (2) ETS
Check box if orc has changed [ ] PERSON(S) COLLECTING SAMPLES: RANDY BELL 1
Mail ORIGINAL and ONE COPY to:i
ATTN: CENTRAL FILES X o�
DIVISION OF WATER QUALITY (SIGNATURE OF O C) DATE
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
N.C.Dept. of ENR
,. SEP 107.2012
Winston-Salem
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Ore
on
Site
Flow
[ ] Inf
X Eff
Temp.
1X wk
pH
2x wk
Res
CL2
1x wk
BOD5
@
20C
1x wk
NH3-N
1x wk
T
S
S
1 x wk
Fecal
Coliform
Geometric
Mean
ix wk
Dissolvd
Oxygen
(DO)
TGP3B
x htthly
AS
1 x Mth
Total
Nitrogen
1xmo
total
PO4
D
A
T
E
#
#
„ 1
11;15,
0.25
RB'.
`' ,'0.0130."
22-,
-
2
0.0030
2
.0.0040
3
4
05;45
.25
RB
0,0070
19
2.0
0.70
4.0
1
PASS
8.10
<1
4
50".5
R6.:
`' 0.6060.,
. 201.
... 6.9
36 .:
6.7�'-
6
12;25
.25
RB
0.0040
18
6
J 1j25
s.25
RB .
.�',0':0030
19,:
.:,
p:
"
8
11;00
.25
RB
0.0020
21
21
8
9 }
Oi0030
_
9.
10
0.0040
10
11"
17;00.
_'---.25
RB":
0.0050 `
-',21
12
16;30
.25
RB
1 0.0050
22 1
6.7 1
12
6.5
12
13';
r
67;10
=- _
==':25
RB B.
', 0.0050
., .20 .:
2:0 ., :
:.1.50 ..
.. 2:9 ',
1. .,
13,
14
10;15
.25
RB
0.0030
21
44
14
15
13;00
'-i , .5
RB'
O'.0030
23,
16
0.0030
16
17,
18
06;00
.25
RB
0.0050
20
38
2.0
0.10
2.9
1
18
19 ,
08;20
- :25
RB.-
0.0050
..'20 :._
_ ,6:8 •
,' 32
`' .. ;
,.- • .
."'-
6.8 =
19
20
19;35
.25
RB
0.0050
23
20
21-`
09;00
.25
RB'•
10,0050'
22'
2�
22
12;00
.25
RB
0.0070
24
22
23
0.007-023',
24
0.0070
24
25
1,1'10
=.25
RB'
„.
' ,'0,0040-r
25
;;,-.,,
,
25',
26
09;00
.25
RB
0.0030
24
26
2Z.'
08;50
'-, .5
RB_'
0.0060.24
_
';
:. 44
2.2'
S1::
2.7....'
;,.,.<1','..
3.60 ,.
.':(Y.52,:
27
28
12;00
.25
RB
0.0070
26
6.7
38
7.6
28
:29':
•1715-
-.25
RB.'
0.0070
!28
30
0.0070
30
p, c
AVERAGE
0.0040
1 18
27.2
1 2.0
0.57
2.6
0
6.7
<1
<.1
5.85
0.52
#
�MAXIMUM,`F•` - _-
' ,D00170--
2&x-
6.9
'48.0+��
.- 2.2 .r,.=�:.
• 1.50t' ,',
.�4:0,'• -
'..`.,1' ''
o- 7.6,
'�••,0.0 _
<2. �..
�'-8A0 ''.
- ',0:52 ,..,
#-
MINIMUM
0.0030
18
6.7
<11
2.0
<1
<5
<1
6.5
0.0
<1
3.60
0.52
#
COMPlGRAB s,' ' "'
""GRAB',
' GRAB-
- GRAB.'
'GRAB
- 'GRAB._.
�' ''GRAB; :`
- GRAB
" -GRAB" -
'GRAB -
GRAB
GRAB'.
GRAB
'GRAB
#-':
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
NIA
NA
2.4
NA
NA
#
QUARTERLY`. LIMIT
NA ''
'. NA
NA
NA.
NA
NA'
NA'
NA
NA
NA' -
20
#
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
MONITORING' FREQUENCY
Cont
'Daily'-
''y
Wkl a.
.2/VVk'
Wkly
Wkly
Wkfy
Wky
Wkty :
;Wkly
r' Wk ly,
Wkl y
"Wkly
#
FREQUENCY MET
0.0050
FALSE
I YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
#
:'`COMPLIANT
YES'"
YES
YES-
YES =
: �YES:
il
]: YES
YES'
Total Monthly Flow I 0.1520 MG 'DIVNgTXEP,LG _ TN Monthly Loading (lbs.)
DEM Form MR-1 (12/03) 1
DEM Form MR-1 (12/03) 0
1

NODES PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH: JUNE YEAR: 2011
FACILITY NAME: High Point Care COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
IDCTDCAM
n(')V.'MSTRFGM
00010
00300
31616
00010
00300
31616
D
Fecal
D
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Coliform
T
Temp
Oxygen
T
Temp
Oxygen
E 12400
1
1
Geometri I
E
2400
Geometric
Clock
DO
Mean
Clock
(DO)
Mean
#
HRS
C
m /L
#/100ml
#
HRS
C
m /L
#/100m1
1
1
2
16;20
18.0
7.6
2
16;30
19.0
7.4
3
3
4
4
5
5
6
6
7
08;25
17.0
7.8
7
08;30
18.0
7.4
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16;15
18,0
7.6
16
16;20
19.0
7.5
17
17
18
18
19
19
20
20
21
08;15
18.0
7.4
121
08;20
19.0
7.2
22
22
23
23
24
24
25
25
26
26
27
13;45
16.01
7.8
27
13:12
17.0
7.6
28
128
29
29
30
30
31
31
AVERAGE
1 17.0
7.6
AVERAGE
18.01
7.3
MAXIMUM
18.0
7.8
MAXIMUM
19.0
7.6
MINIMUM
16.0
7.4
MINIMUM 1
17.0
7.2
COMP/GRAB
GRAB
IGRA13
COMP/GRAB
GRAB
GRAB
I
DEM Form MR-3 (12/93) DEM Form MR-3 (12193)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
Compl ant A6
Noncompliant
,X
Signature of Permittee"
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics x
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
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)
Date

't
, r iG1,2
NPLSES PERMIT NO.: NC 0046035 DISCHARGE NO.: 001 MONTH: JUNE- YEAR: 2012
FACILITY NAME: High Point Care CLASS: COUNTY'_Forsytti.---
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL GRADE: 3 P ONE: 336-766-9626
CERTIFIED LABORATORIES: (1 ) PACE (2) ETS
Check box if orc has changed[ ] PERSONS) COLLECTING SAMPLES: RANDY BELL
Mail ORIGINAL and ONEi O;Qjt
ATTN: CENTRAL FILES �y X
DIVISION OF WATER QUALITAU C, 0 1� (SIGNATURE OF ORC) DATE
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL
SERVICENC 16N7TER CENTRAL �' LES ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIG(�
KtL;tIVtU
N.C.Dept. of ENR
AUG 3 0 2012
Winston-Salem
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Orc
on
Site
Flow
[ j Inf
X Eff
Temp.
1Xwk
pH
2x wk
Res
CL2
Ix wk
BOD5
@
20C
1xwk
NH3-N
lxwk
T
S
S
1xwk
Fecal
Coliform
Geometric
Mean
lxwk
Dissolvd
Oxygen
(DO)
TGP38
2x mthly
MBAS
1xMth
Total
Nitrogen
limo
total
PO4
D
A
T
E
#
#
1 '.
1115'
0.25
RB 1,.
0.0130 .
'.._22 '
`.,
.,
-
__
-1
2
0.0030
2
3
0.0040
j
3
4
05;45
.25
RB
0.0070
19
2.0
0.70
4.0
1
PASS
8.10
<1
4
5'
12;50
5
RB'
0.0060;
20
6.9',
36 %
6.7
6
12;25
.25
RB
0.0040
18
6
7
11;25
.25
RB
0.0030
19
-
7
8
11;00
.25
RB
0.0020
21
21
8
0.0030
91
10
0.0040
10
11 '
17;00
.25
RB -
0.0050
21
1 T
12
•16;30
25
RB
0.0050
22
6.7
12
6.5
12
13"
07;10
'.25
RB'
&0050
20
2.0
1.50
.2':9
-1
13
14
10;15
.25
RB
0.0030
21
44
14
T5'
13;00-
.5
RB
0.0030
23'
15
16
0.0030
16
17
0:0040
17
18
06;00
.25
RB
0,0050
20
38
2.0
0.10
2.9
1
18
19
08;20
.25
RB -
0.0050,
-20 '
, 6.8
32
6.8
19.
20
19;35
.25
RB
0.0050
23
20
21
09;00
.25
RB
0.0050
22
21
22
12;00
.25
RB
0.0070
24
22
23"I.
0.0070.
23
24
0.0070
24
,25
11-,10
.25
RB
0.0040
25
-
-
25
26
09;00
.25
RB
0.0030
24
26
27
08;50
.5
RB •
0.0060',.
24 _--
44``
2.2 `
<1,
2.7
<1
3,60 "
0.52- `
27
28
12;00
.25
RB
0.0070
26
6.7
38
7.6
28
29
17;15.
.25
RB,
10.0070
28
29
30
0.0070
30
31
31
AVERAGE
0.0040
1 18
27.2
13.0
3.42
3.4
3
6.7
<1
<.1
5.85
0.52
#
. MAXIMUM
0.0170 ,
28
6.9
-� 48.0 -,
23.01
1.50
4.0
• 25
7.6
0.0
<2.
8.10
0.52
#
MINIMUM
0.0030
18
6.7
<11
<2
0.30
<5
<1
6.5
0.0
<1
3.60
0.52
#
. . COMP/GRAB
GRAB
GRAB
GRAB
GRAB
GRAB,.
'- GRAB-
- GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
GRAB
#
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
NIA
NA
2.4
NA
NA
#
QUARTERLY LIMIT
NA
-NA._'
, 'NA' .
N'A.•'
: NA,
NA •
NA'
'_NA- . NA
NA
NA
NA
NA
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont.
Daily
Wkly'
,. 2MB
Wkly
Wkly'
Wkiy
Wkly
Wkly
Wkly
Wkly
Wki,
FREQUENCY MET
0.0050
FALSE
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
#
•`,,' COMPLIANT . " �` '
YES°
YES
YES
YES' '"'
YES '
NO
YES
YES.
YES
YES
NO
`YES
Total Monthly Flow 0.1520 MG JOIDINONDEPLISAT 21MGl. TN Monthly Loading (lbs.) 7
DEM Form MR-1 (12/03) 2
DEM Form MR-1 (12/03) 3
6

NPDaS PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH: JUNE YEAR: 2012
FACILITY NAME: High Point Care COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
I IPRTRFGM
DOWNSTREAM
00010
00300
31616
00010
00300
31616
D
Fecal
D
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Coliform
T
Temp
Oxygen
T
Temp
Oxygen
E 12400
1
Geometric
I
E 12400
1
Geometric
Clock
DO
Mean
I
Clock
(DO)
Mean
#
FIRS
C
m /L
#/100ml
#
HRS
C
m /L
#/100ml
1
1
2
2
3,
3
4
14
5
13;05
18.0
7.9
5
13;15�
19.0
7.9
6
6
7
7
g
8
9
9
10
10
11
11
12
12
13
13
14
14
15
08;40
18.01
7.8
15
13;25
21.0
7.7
16
16
17
17
18
18
19
08;40
18.0
7.8
19
08;50
19.0
7.7
20
20
21
21
22
22
23
23
24
24
25
100
19.0
7.6
25
1.1;35
20.0
7.4
26
26
27
27
28
28
29
29
30
130
31
31
AVERAGE
1 18.3
7.81
AVERAGE
1 19.51
7.6
MAXIMUM
19.0
7.9
MAXIMUM
21.0
7.9
MINIMUM
18.0
7.6
MINIMUM
19.0
7.4
COMP/GRAB
GRAB
GRAB
COMPIGRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
X
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or type)
5 #Y-. —.00e AL--- 27 tZ
Sign f Permittee* to
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
----------------- --------------------------------------------- --------- -------- ---------
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

RCU.NR
North Carolina Department of Environment and Natura
Division of Water Quality
Pat McCrory Charles Wakild, P.E.
Governor Director
March 15, 2013
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2013-LV-0170
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
Resources
John E. Skvarla, III
Secretary
A review of High Point Healthcare's monitoring report for December 2012 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
12/04/12
400 #/100m1
991 #/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct the above
noncompliance problem(s). 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 Ron Boone at (336)
771-5000.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
' Winston-Salem Regional Office
Division of Water Quality
cc: SWP — Central 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
NorthCarollna
)UMI lly
An Equal Opportunity 1 Affirmative Action Employer

Facility: High Point Healthcare
Parameter
Date
Date
Completed by: Ron Boone
DMR Review Record
Permit No: 46035 Pipe No
Monthly Average Violations
Permit Limit DMR Value
Weekly/Daily Violations
Permit Limit Limit Type DMR Value
�00 �ai�ly M'ax 9g1
Monitoring Frequency Violations
Permit Frequency Values Reported
�r,arterly 0
Criteria
Failure to monitor parameter with limit: $50
Failure to monitor parameter without limit: $25
Any facility with just a single daily max violation to receive NOV only.
No civil assessment cases for less than $100, not including cost of investigation. NOV only.
Threshold for flow is 10%; threshold for all other parameters is 20%.
Stipulated demand letters for SOCs..... automatic.
Failure to obtain a permit ..... $4,000.
001 Month/Year: 12/12
% Over Limit
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
% Over Limit
1'4'7.7'S
#DIV/0!
#DIV/0!
#DIV/0!
Date: 3/8/13
Action
Multipliers:
Number of assessments for previous 12 months:
0-2 Multiply base penalty by 1.0
3-5 Multiply base penalty by 1.25
6-8 Multiply base penalty by 1.5
9-12 Multiply base penalty bu 2.0
Delgated Fast Track Penalties/Base Penalty Amounts:
DMR Monthly Flow Avg
Monthly Average
Weekly Average
Daily Max
50.05 MGD---------
$250 ($0-500)
$150 ($0-200)
$100 ($0-200)
>0.05 but <0.1 MGD
$500 ($0-1,000)
$250 ($0-500)
$100 ($0-200)
>_0.1 but <0.5 MGD
$750 ($0-1,500)
$300 ($0-500)
$200 ($0-500)
>_0.5 but <1.0 MGD
$1,000 ($0-2,000)
$350 ($0-500)
$200 ($0-500)
>_1.0 but <10.0 MGD
$1,500 ($0-3,000)
$500 ($0-1,000)
$250 ($0-500)
>_10.0 but <25.0 MGD
$2,000 ($0-4,000)
$750 ($0-1,000)
$350 ($0-500)
>_25.0 MGD
$2,500 ($0-5,000)
$750 ($0-1,000)
$350 ($0-500)
Supervisor Remarks: 46
Regional Water Quality j/
Supervisor Sign Off: Date:

WSRO MONTHLY DMR VIOLATIONS REPORT FOR:
Forsyth
NC0046035
#MULTIVALUE
High Point Healthcare

A4
MC®EN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor
Neil L. Pruitt, Jr, CEO -
High Point Healthcare, Inc.
PO Box 1210
Toccoa, GA 30577
Director
November 16, 2012
Subject: NOTICE OF DEFICIENCY
NOD-2012-NW-0078
Neil L. Pruitt, Jr.
Permit No. NCO046035
High Point Healthcare, Inc. Wastewater Treatment Plant
Forsyth County
Dear Mr. Pruitt:
Dee Freeman
Secretary
A review of the August, 2012 Discharge Monitoring Report (DMR) revealed a violation of the
following parameter(s) at Outfall 001:
Parameter
Date
Frequency
Violation
MBAS, Surfactants
-Measuring
08/31/2012
2x/month
Only once sample
taken for the month of
August, 2012
Remedial actions should be taken to correct the cause(s) of this violation. The violations
described above should be abated immediately and properly resolved.
Thank you for your attention to this matter. This office requires that the violations as described
above be properly resolved. Unresolved violations may lead to the issuance of a Notice of
Violation and/or assessments of civil penalties.
N. C. Division of Water Quality
Winston Salem Regional Office
585 Waughtown Stree, Winston Salem, NC 27107
Phone: [phone] FAX: [phone]
Customer Service:1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
One
N&AhCarolina
Nwal ally

Page 2 of 2
Neil L. Pruitt, Jr.
Forsyth County
If you have any questions or require any additional information, please contact Ron Boone at
[phone] or ron.boonegncdenr.go_v.
Sincerely,
TA__1 Uelit"V-1001-
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: y� • i e Cody
DWQ Central Files

Cover Sheet from
Staff Member to
Regional Supervisor
DMR. Review Record
Facility: &7 L Ab � :-1aln Permit[Pipe No.: A036-o' Month/Year
Parameter
Date ' Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
DMR Value % Over Limit
?8- 6
Monitoring Frequency Violations
Date Parameter / Permit Frequency Values Reported # of Violations
4 Aa` -- -
a
it
Other Violations
Cu- .lLlid.J - j 1 - A. -Le i. r 7 b l�G� —Ata�'
Completed by: ��— Date:
Weekly/Daily Violations
Permit Lirnit/Tvi)e
Regional Water Quality /G 14V U2,
Supervisor Signoff: _� Date:
��'! ®i�✓
g� a

e
NPDES PERMIT NO.: NC 0046035
DISCHARGE NO.: 001
MONTH: AUG
YEAR: 2012
FACILITY NAME: High Point Care
CLASS:
COUNTY'.'Forsyth'
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL
GRADE:-3
PHONE: [phone]
ocr
CERTIFIED LABORATORIES:
(1) PACE
(2) ETS
q
Check box if orc has changed;[ �]^
F74P'I SONS �COLLEC ING SAMPLES:
RANDY BELL
Mail ORIGINAL and ONE COPYto:q
ATTN: CENTRAL FILES OCT
/ �b��
0 5 zd tz X (((!� ���
�/%
:Csf
/ % / g
/ �/ / ✓�-C a
6� q
yr 5 ZD IZ
DIVISION OF WATER QUALITY (SIGNA I URE Ut- UK . U/', I t
DENR S SIGNATURL� I CERTIFY THAT THIS REPORT IS
11617 MAIL SERVICE CENTER�'��:�,y; 4" �r a ACCUIRATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE
MAK)IRM
RALEIGH, NC 27699-1617 I.,
RECEIVED
N,C.Dept. of ENR
'OV 0 2 2012
Winston-Salem
50050 1
00010
00040
50060
00310
00610
00630
31616
00300
00625
00630
006001
00665
D
Opr.
Opr.
1Xwk
2xwk
1xwk
lxwk
1xwk
1xwk
1xwk
mthiy.'
1xMth
lxmo
D
A
Arrive
Time
Orc
Flow
Res
BOD5
T
Fecal
Dissolvd
MBAS
Total
total
A
T
Time
on
on
Temp.
pH
@
NH3-N
S
Colifonn
Oxygen
TGP3B
Nitrogen
PO4
T
E
2400
Site
Site
[ ] Inf_ .
CL2
20C
S
Geometric
(DO)
E
clock
X Eff
Mean
1
05:00 1
0.2
RB
o ob7,o
24
2
08:55
'. ' .25
BB
0.0070
25
42
2
3
06;00
=.25
RB',.
.,- 0.0070,
25'
3..
4
0.0060
4
'5.
=
0.0060
_.5 ..
6
19;30
.2
RB 1
0.0080
27
6.7
--11
6.7
6
71106"
"'„ 75
RB
•0:0080
28
T-
8
11;00 1
.25
RB
0.0100
28
5.6
0.13
6.4
40
6.30
0.24
8
,9
13;10
, 25
RB
0.0060
29„
37•
10
20;00
.2
RB
0.0100
27
11
0.0070.'
11
12
0.0030
12
13
06z0oo
0
25
BTF
0.0040t
6
IW5M
2'b"
0:]0
5:3'
14
\11;40
.5
RB
0.0090
27
6.8
6.9
14
15. -
11;20
25
RB
0.0100
26
15'
16
13;00
.2
RB
0.0050
26
16
17 ;
13;45
25
RB
-0.0050=
27,.
x 39
17,;
18
0.0050
18
19
v...
, -
010100 .
..
19
20
10;35
.5
RB
0.0080
25
6.8
16
7.1
20
21,
-1310
.2
RB
0.0080.'
21-
22
10;35
.2
RB
0.0060
25
2.0
0.10
2.5
42
22
23
104Q
.5
RB
0:0060 •,`
25
,x ,.
44
23`.
24
05;00
.2
BB
0.0060
24
24
25
0.0050
- 25
26
0.0050
26
27 `
09;45
25
RB
0.0050
25
2.0
0.10 "
2.6
`1"
2.00
27
28
12;45
.5
RB
0.0040
26
6.7
37
7.3
28
29
13;00�
,:25
RB
0„.0 040
:27
30
19;40
.25
RB
0.0060
26
31
30
31
05,00
.2
RB
0.0060'
25
31
AVERAGE
0.0080
26
32.9
2.9
0.11
4.2
6
6.8
< 1
<.1
6.30
024
#
MAXIMUM,., ., ,�'
• 0.0170
�'„ 29 `''
6.8 -.
-
48.0•��
�.'' 2.6
-'.�0.13'
6.4 ' -
� ,42
7.3
'0.0 � �-
� .� <2 -
�•6.30�-
0.24� -;
�#
MINIMUM
0.0030
24
6.7
<11
2.0
<1
<5
<1
6.7
0.0
<1
6.30
0.24
#
COMP/GRAB''.'GRAB
AB
•'GRABr
GRAB
.GRAB',
GRAB
GRAB
GRAB''
'GRAB
'GRAB'
GRAB
GRAB
GRAB
#
DAILY LIMIT
NA
NA
NA
28
45.0
45
400
N/A
NA
2.4
NA
NA
#
QUARTERLY'LIMIT
NA'
NA
NA
"NA ",-"NA
NA''
-NA
NA
-NA'
NA' '.
NA
NA.
2.0
#
MONTHLY LIMIT
0.0432
NA
>6,<9
NA
30.0
30
200
NA
NA
NA
NA
NA
#
..'
h�ONITORING FREQUENCY
' ConL
Daily
Wkly. �_
2'/UVk,,
Wkly, <
r' . Wkly,
�Wkty ', .
' . ' Wkiy� "� "
�'r WkIY
' � .' Wkly'
c �, Wkly.' ����'
� � Wkty ` ��
' ° Wkly
FREQUENCY MET
0.0066
FALSE
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
#
COMPLIANT.
YES
YES -
YES
'YES.•,'
YES'
"YES
YES
YES,'
YES -
YES
YES
YES
#
Total Monthly Flow 0.2020 MG ID N0.T bEPLE'faT 2 MGL TN Monthly Loading (lbs.) 11
8
OEM Farm MR-1 (12/03) 16
OEM Form MR-1 (12/03)
22

NPDES PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH: AUG YEAR: 2012
FACILITY NAME: High Point Care COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
1IOQTOCAM
❑r)WNSTREAM
00010
00300
31616
00010
00300
31616
D
Fecal
D
Fecal
A
Time
IDissolved
Coliform I
IA
Time
Dissolved
Coliform
T
Tern
Oxygen
I
T
Temp
Oxygen
E 12400
Geometric
E 12400
Geometric
Clock
DO
Mean
Clock
DO
Mean
#
HRS
C
m /L
#/100ml
#
HRS
C
m /L
#/loom[
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
12;00
22.0
7.7
11
8
9
19
10;10
22.0
7.9
10
10
11
11
12
12
13
09;20
20.0
8.1
13
09;30
21,0
7.9
14
14
15
15
16
16
1.7
17
18
18
19
19
20
10;55
18.0
8.0
20
11;05
19.0
8.1
21
21
22
22
23
123
24
24
25
25
26
26
27
27 '
28
13;05
23.0
7.9
28
13;10
24.0
8.0
29
29
30__+
30
31
31
AVERAGE
1 20.8
8.01
1
1
1
1
AVERAGE
25.01
7.5
MAXIMUM
23.0
8.1
MAXIMUM
24.0
8.1
MINIMUM
18.0
7.7
MINIMUM
24.0
7.6
COMP/GRAB
GRAB
IGRAB
COMP/GRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made. X
PLANT NON COMPLIANT DUE TO LAB NOT RUNNING MBAS
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee (Please print or type)
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Sign ure of Perms ee** Date
Phone Number: Permit Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
-----------------------------------------------------------------------------------------
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

A/I
0°0
MCCONo
North Carolina Department of Environment and
Division of }Water Quality
Beverly Eaves Perdue Chuck Wakild, P.E.
Governor Director
June 20, 2012
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subj ect: NOTICE OF VIOLATION
NOV-2012-LV-0298
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
(Natural Resources
Dee Freeman
Secretary
A review of High Point Healthcare's monitoring report for March 2012 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
Broth,44.5C
03/07/12
400 #/100ml
1,100 #/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 Quality for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
cc: SWP — Centra Files
'`Sh Fit1e
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: 1-877-6623-6748
Internet: www.ncwatergUality.org
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
One
No thCc`1rolina
An Equal Opportunity 1, Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
MIR Review Record
Facility: . - Mcx.IVAz -ePerrnitlPipe No.: G , �19
MondvYear o3 /
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Dai y Violations
Date Parameter Permit Lirnit/Tvpe DMR Value % Over Limit
L17's
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations
Q � ' TSS - lU &1(- O �� — �S 5 3-/(�UV�
Complet9d by: /� ���`�- Date:
Reaional.Water Quality po
Date:
Supervisor Sianoff: �0 Zo ��---

n
V
o.
NPDES rnrtrS
FACILITY NAMIE: High Point Cares DISCHARGE NO. Q1,vy u 1COUNTY MARCH
orsyth YEAR: 2012
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL CLAIvy
II GRADE: 3 PHONE: [phone]
CERTIFIED LABORATORIES: ( 1 ) Tritest (2) ETS
Check box if ore has changed [ ]] PERSON(S) COLLECTING SAMPLES: RANDY BELL
Mail ORIGINAL and >� E.I IV Y�� - / , - �i ^� � 0
ATTN: CENTRAL FILES X ��G` L O�
DIVISION OF WATER QUAA11R 3 0 201,(SIGNATURE OF ORCI DATE
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CET1-� RAL F�L ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-16
q
N.C. Ueot. r., =NR
MAY 2 1 ' 2012
Winston-Salem
Regional Office
50050
00010
00040
50060
00310
00610
00630
31616
00300
00625
00630
00600
0066
D
A
T
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Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Ore
on
Site
Flow
[ ] Inf
[Xj Eff
Temp.
1X wk
pH
2x wk
Res
CL2
1x wk
BOD5
@
20C
1x wk
NH3-N
1x wk
T
S
S
1 x wk
Fecal
Coliform
Geometric
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lxwk
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Oxygen
(DO)
TGP3B
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1xmo
total
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D
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#
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DAILY LIMIT
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.
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NA
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MONTHLY LIMIT
0.0432
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NA
30.0
30
200
NA
NA
NA
NA
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#
iv50NITOR�NG FREQUEISCY
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0.0031
YES
YES
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#
COMPLIANT:`
YES,.
"'YES
YES!
YES
ry YES ,
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YES ",
YE3„
i' YES
drYES,
Total Monthly Flow 0.0940 MG .®IB:Nt9T_[%PW Ei f 2, 6- _ _il
- _ - _ TN Monthly Loading (Ibs.) 9
DEM Form MR-1 (12/03) 387
DEM Form MR-1 (12103) - 15
565

NPDES PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH: MARCH YEAR: 2012
FACILITY NAME: High Point Care COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point
STREAM: LOCATION: @ NCSR 1892
nnwtjATRFAM
00010
00300
31616
00010
00300
31616
p
I
Fecal
D
Fecal
A
Time
Dissolved
Coliform
A
Time
Dissolved
Coliform
T
Temp
Oxygen
T
Temp
Oxygen
E 12400
1
1
Geometriii
I
E 12400
1
Geometric
Clock
DO
Mean
I
Clock
DO
Mean
#
HRS
C
m /L
#1100ml
#
HRS
C
m /L
#/10Dml
1
19;55
120
8.3
1
20;00
13.0
8.3
2
2
3
13,
4
4
5
11;40 `,
12.0
8.2
5
11;50
11.0
8.0
6
6
7
7
8
8
9
9"
10
10
12
12;05
13.0
8.1
12
12;10
14.0
7.8
13,
13:
14
1
114
15
15,
16
16
17
17
18
18
19
19 ,
20
20
21
21
22
12;25
14.0
8.1
1
22
12;35
15.0
7.8
23
123
24
24
25
25,
26
26
27
27
28
28
29
29
30
30
31
31
AVERAGE
12.81
8.2
AVERAGE
13.3
8.0
MAXIMUM
14.0
8.3
MAXIMUM
1 15.0
.8.3
MINIMUM
12.0
8.1
1
1
IMINIMUMI
11.0
11.0
COMP/GRAB
GRAB
GRAB
I COMP/GRAB
GRAB
GRAB
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, X
maintenance, etc, and a time table for improvements to be made.
HIGH FECAL DUE TO CLOGGED RETURN UNCLOGGED RETURN
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations." j'
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 BOD 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Permittee (Please print or
Signature/of Permittee**
Phone umber: Permit Exp..Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal 34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)
�3i-Z,
Date

I r' ,
CENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Chuck Wakild, P.E. Dee Freeman
Governor Director Secretary
January 18, 2012
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0035
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
A review of High Point Healthcare's monitoring report for November 2011 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
Broth,44.5C
11/07/11
400 #/100m1
2,000 #/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 Quality for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
Sincerely,
7
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: SWP — Centr 1 Files
fi'+i�"I�l� •i,�l
North Carolina Division of \Hater 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.ncvpaterquality.org
ne
NorthCarolina
Natumlly
An Equal Oppoilunity `, Affirmarive .action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: I Permit/Pipe No.: ,35�6 Month/Year
t.
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter
Permit Lirnitflype
4�>6116 A"
DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter
Permit Frequency
Values Reported # of Violations
Other Violations
,1o12
FC - (%, ,, - �6v d �a � - .c1�.
Completed by: ��
Date: / 1Z
Regional Water Quality
Supervisor Sianoff:
Date: 2,J 4 2-0t Z-
"" V

A
®in
NCDER
North Carolina Depai"tn1Cnt of Environment and Natural IReS01urceS
Division of Water Quality
Beverly Eaves Perdue Chuck Wal,,ild, P.E. Dee Freen-lan
Governor Director Secrolary
January 6, 2012
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0015
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
A review of High Point Healthcare's monitoring report for October 2011 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Solids, Total Suspended -
10/24/11
45 mg/l
53 mg/1
Daily
Concentration
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.
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
Natzmally
Nne
orthCarolina
An Equal Opportunity 1 Affirmative Action Employer

High Point Healthcare, Inc.
Attn: Neil L. Pruitt, Jr., CEO
High Point Healthcare WWTP, NCO046035
NOV-2012-LV-0015
Page 2 of 2, January 6, 2012
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: SWP — Central Files
IU
S'RO*le�

iY ov, � r,1,2 - �- I
Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: r' �� re Permit/Pipe No.: Ags 00/ MontlllYear
Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter
Permit Lirnit/TviDe
DNIR Value
% Over Limit
MKS
3-3
1 i. 2 % 'P
Date Parameter
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations
Other Violations
Aohl IZL NVI: 0//0 711 fe- - 46 LI 106 - A) V;
Completed by: ®� D�/h� Date: - ZA&
Regional Water Quality
Supervisor Signoff: Date;
5-4A,-. 2--w,G ?.

jph®
NCDENR
Norris Carolina Department of Environrnerli and Natura
Division of Water.Quality
Beverly Eaves Perdue Coleen K Sullins
Governor Director
December 12, 2011
Neil L. Pruitt, Jr., CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2011-LV-0613
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr Pruitt:
resources
Dee rreenlan
secretary
A review of High Point Healthcare's monitoring report for September 2011 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
09/12/11
400 #/100ml
800 #/100ml
Daily
Broth,44.5 C
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 Ron Boone at [phone].
Sincerely,
r
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: SWP — Central Files
WSRO Files)
North Carolina Division of Udater Quality, Winston-Salem Regional Office
Location: 56511raughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: wwvv.ncwaterquality.org
NorthCarolina
An Equal Oppoitunity I Affirmative Action Employer

LV - 6 61'3
Cover Sheet from
Staff Member to
Regional Supervisor
` DMR Review Record
Facility: r�:! i-r. Permit/Pipe No.: 4-ny ©D Month/Year 9 I/
Monthly Average Violations
Parameter Permit Limit DMR Value
Date Parameter
Date Parameter
Weekly/Daily Violations
% Over Limit
Permit Limit/Tv e DMR Value % Over Limit
Monitoring Frequency Violations
Permit Frequency Values Reported # of Violations
Other Violations /
,6ih71& LV ,rG', .�AXA, l A) J 1//�4/!d� /�%� S✓+ri'�c°/rx;+�. /tl�U' �ib-6hd
/t/% V. /j%U (.Yl R c t l Y�lJ -A- N !/ I b
tUAs
Completed by:
Regional Water Quality
Supervisor Signoff:
lez:17t
Date: /2 `! A
Date: ��

4
M`F®
NC®ENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Pei -due Coleen H. Sullins
Governor Director
April 18, 2011
Neil L. Pruitt, Jr., CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2011-LV-0134
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr Pruitt:
Natural Resources
Dee Freeman
Secretary
A review of High Point Healthcare's monitoring report for January 2011 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
01/27/11
400 #/100m1
1,100 #/100ml
Daily
Broth,44.5C '
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 Ron Boone at [phone].
cc: SW = Aal Files
�WSRO
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.ncvvaterquality.org
Sincerely,
4.
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
Nne
orthCarohna
An Equal Opportunity \ Affirmative Action Employer

0- b"34
Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
h ® J� ( U%
Facility: r � �� �PermitlPipe No.MontYYear:
Monthly Average Violations
Parameter Permit Limit . DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit LimitlTv e
DMR V alue % Over Limit 6 j
llva—
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
42�f -5 .0
Other Violations
li%/J� j i' 0
ohs G' ��
Completed by: U �
Regional Water Quality
Super-,-isor Signoff:
Date:
Date:'
M--/,

Cover Sheet from
Staff Member to
Regional Supervisor
$�� DNIR Review Record
o3s
Facility:Permit/Pipe No.: �1116ol Month/Year i 0 "
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
r Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
Date:
Date:

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
January 31 st, 2011
High Point Healthcare, Inc.
Attn: Kim Lapointe, Administrator
3830 North Main Street
High Point, NC 27265
Subject: Compliance Evaluation Inspection
Permittee: High Point Healthcare, Inc.
Facility: High Point Healthcare Wastewater Treatment Plant
NPDES Permit #: NCO046035
Forsyth County
Dear Ms. Lapointe:
Dee Freeman
Secretary
Mr. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water
Quality (DWQ or the Division) conducted a compliance evaluation inspection (CEI) of the High
Point Healthcare Wastewater Treatment Plant (WWTP) on January 26th, 2011. The assistance
and cooperation of Mr. Randy. Bell, Operator in Responsible Charge (ORC), was greatly
appreciated. An inspection checklist is attached for your records and inspection findings are
summarized below.
General Information
The High Point Healthcare WWTP is located at 3830 North Main Street, in High Point,
Forsyth County, NC. Although in Forsyth County, the facility is actually located at a Highpoint
address. The permit authorizes you to operate this 0.01 MGD WWTP, which consists of a
manual bar screen, a grit chamber, dual aeration tanks, a clarifier, an aerated sludge holding
tank, a tablet chlorinator, a chlorine contact tank and a tablet dechlorinator, and discharge the
treated effluent to Rich Fork via outfall 001, which is currently classified as Class C waters in
the Yadkin Pee Dee River basin.
Site Review
Mr. Bell has done a good job operating and maintaining the plant using the resources
that are available to him. However, there are some issues as noted below:
1. The security fence is only 3 to 4 feet high and provides very little security. You should
at some point consider installing an actual security fence around the facility to best deter
unauthorized access to the plant.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] Customer Service:1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org Va furs//'/
An Equal Opportunity 1 Affirmative Action Employer `/ ` ` "y

High Point Healthcare, Inc.
Attn: Kim Lapointe, Administrator
Compliance Evaluation Inspection
NC0046035, High Point Healthcare WWTP
Page 2 of 3, January 31 ", 2011
2. The aeration basin has significant foam throughout (approximately 18" thick at the
furthest downstream access hole). The color and odor of the mixed liquor are also
slightly off for an activated sludge plant. The solids level in the mixed liquor is very low
(there were no detectable settleable solids after a thirty minute settleability test). These
characteristics are unusual for a well running activated sludge plant but Mr. Bell's
testing and analysis show that there have been very few permit limit violations over the
past year and indicate the plant is running fine. The unusual conditions may, at least in
part, be a result of the chemicals and cleaning agents used in the nursing home.
3. Mr. Bell manages sludge wasting using the settleability test and stated that he wastes
sludge once the level of solids in the mixed liquor gets to between 400 and 500. It was
suggested that he also obtain a sludge judge to help him better manage the solids. The
return of solids to the aeration tank from the clarifier is constant when the blowers run.
Mr. Bell had solids pumped out from the plant in March, June and November of 2010.
4. The plant is quite old and could use a bit more cleaning, maintenance and attention to
safety issues. Although everything operates sufficiently, some components are in
various states of disrepair. Also, there are several open pits with no fall protection
around them, presenting a considerable safety hazard.
5. The permit indicates that the first tank in the plant is a grit chamber but Mr. Bell stated it
is grease trap and that he usually has it pumped when he has the aerated digester
pumped. It is noted that this component is likely a combination grease trap/grit
chamber.
6. Mr. Bell should keep the weir and baffle wall of the clarifier and flow meter well cleaner.
During the inspection there were solids overflowing the weir; these were not sludge like
solids but rather solids that appeared to be sloughing off the weirs/baffles. A
daily/weekly brushing/spraying would help reduce large solids like these from being
discharged all at once.
7. There is no spare blower on hand. There are currently two blowers installed within
metal screened enclosures that provide some protection from the elements but a spare
blower should be kept on hand for when one of the installed units fails.
8. The second tube of the chlorinator does not have a cap. Mr. Bell stated that he would
acquire a cap and install it.
9. In general the plant is quite old and could use some significant maintenance and
improvement, such as the fence noted above, grating over the access holes, painting,
concrete repair, etc. It appears that these issues have so far not adversely affected the
operation of the plant.
Documentation Review

High Point Healthcare, Inc.
fy Attn: Kim Lapointe, Administrator
Compliance Evaluation Inspection
NC0046035, High Point Healthcare WWTP
Page 3 of 3, January 315, 2011
All documentation was reviewed. The only discrepancy noted is that Mr. Bell has been
reporting Total Kjeldahl Nitrogen on the discharge monitoring reports (DMR) in place of Total
Nitrogen. The Total Nitrogen values are being analyzed and reported but Mr. Bell has not
been reporting them. He was briefed and the proper way to do this and stated that he would
begin doing so on the next DMR submittal (January 2011). Other than that Mr. Bell's
documentation of all aspects of plant operations is good.
Please continue to work with Mr. Bell to address the problems noted above and keep
the plant in optimum working order. Also, please be aware that, in accordance with NC
General Statute 143-215.6A, the Director of the Division of Water Quality may assess civil
penalties not to exceed $25,000 per day, per violation, for violations of the NC0046035
NPDES permit. If you have any questions regarding the inspection or this letter, please call
Mr. Boone or me at [phone]. Thank you for your cooperation in this matter.
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section
Attachments:
1. BIMS Inspection Report
CC: SWJP.,
Central Files
NPDES Unit

. I A
United States EnI ironmental Protection Agency
Washington, D.C. 20460
Form Approved.
EPA
OMB No. 2040-0057
Water Com lialnce Inspection Report'
Approval expires 8-31-98
Section A: NationallData System Coding .(i.e., PCS)
i
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 I_I 11 NCO046035 Ill 121 11/01/26 117 18Icl 19ISI 20I II
j Remarks
211111 1111 1111111111111111 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ill
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------ ------ --------Reserved---------
67I 169 701 I 711 I 721 N I 73 L U 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging
to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
12:30 PM 11/01/26
09/07/01
High Point Healthcare
Exit Time/Date
Permit Expiration Date
3830 N Main St
High Point NC 27265
02:00 PM 11/01/26
14/04/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Quentin Lee Campbell,3630 N Main St High Point NC 27265//336-357-5398.
V.
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
Laboratory
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//704-663-1699 Ext.2202/
f
Signatur of Manage nt Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO046035 I11 121 11/01/26 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to attached inspection summary letter.
Page # 2

Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 01/26/2011 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?
■
n
n
n
# Are there any special conditions for the permit?
n
■
n
o
Is access to the plant site restricted to the general public?
■
n
n
❑
Is the inspector granted access to all areas for inspection?
■
n
In
n
Comment: Please refer to the attached inspection summary letter.
Laboratory
Yes
No
NA
NE
Are field parameters performed by certified personnel or laboratory?
■
n
Are all other parameters(excluding field parameters) performed by a certified lab?
■
n
n
n
# Is the facility using a contract lab?
■
n
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
n
n
n
■
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
n
■
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
n
n
n
■
Comment: Please refer to the attached inspection summary letter.
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional? ••
nn■n
Is sample collected below all treatment units?
■
In
n
n
Is proper volume collected?
■
n
n
n
Is the tubing clean? ❑ n ■ n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n ■
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?. ■ ❑ n
Comment: Please refer to the attached inspection summary letter.
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ n n n
Comment: Please refer to the attached inspection summary letter.
Record Keeping Yes No NA NE
Are records kept and maintained as required by the permit? ■ n In n
Is all required information readily available, complete and current? ■ n n n
Are all records maintained for 3 years (lab. reg. required 5 years)? ■ n n n
Are analytical results consistent with data reported on DMRs? n ■ n n
Page # 3

Permit: NCO046035 Owner- Facility: High Point Healthcare
Inspection Date: 01/26/2011 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No NA NE
Is the chain -of -custody complete?
■
n
Dates, times and location of sampling
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
n n n
Has the facility submitted its annual compliance report to users and DWQ?
n
❑ ■ n
(If the facility is = or> 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
n
■ n n
Is the ORC visitation log available and current?
■
n n ❑
Is the ORC certified at grade equal to or higher than the facility classification?
■
n n n
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑ ❑
Is a copy of the current NPDES permit available on site?
■
n n n
Facility has copy of previous year's Annual Report on file for review?
n
n ■ n
Comment: Mr. Bell is having effluent samples analyzed for Total Nitrogen as required
by the permit but is reporting only the Total Kjeldahl Nitrogen on the discharge
monitoring reports (DMR). He was briefed on the proper way to do this and will begin
doing so on the next DMR submittal. Please refer to the attached inspection summary
letter.
Bar Screens
Yes
No
NA
NE
Type of bar screen
a.Manual
■
n
b.Mechanical
Are the bars adequately screening debris?
■
n
n
n
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
❑
❑
171
Is the unit in good condition?
■
n
n
n
Comment: Please refer to the attached inspection summary letter.
Yes
No
NA
NE
Type of grit removal
Page # 4

U
Permit: NCO046035
Inspection Date: 01/26/2011
Grit Removal
a.Manual
b.Mechanical
Is the grit free of excessive organic matter?
Is the grit free of excessive odor?
Owner - Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
# Is disposal of grit in compliance?
Comment: Please refer to the attached inspection summary letter.
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment: Majority of aeration basin has concrete cover and cannot be evaluated. At
access holes, the mixed liquor/foam have grayish/brownish appearance and inspector
noted somewhat of a chemical/industrial odor, rather than typical musty/earthy odor.
Operator did not agree and likened it to be a musty odor. There are three access points
into aeration basin and foam in basin worsened progressively from first thru to last
access point. At last access point, when cover was lifted, foam was nearly up to bottom
of cover, probably at least 18" thick. Discussion with operator resulted in conclusion that
excessive foam was a result of low solids, high DO content and surfactants/other
chemicals in use in nursing home facility. Comparatively speaking, little foam was
released to clarifier, only a thin layer over it (1/8 to 114 " thick at most and it was not
being released over weir at time of inspection... it was being skimmed off and returned to
digester. Please refer to attached inspection summary letter..
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Ext. Air
Diffused
■ n n n
nn■n.
■nno-
n nn
n■nn
nnn■
n n n ■
I
i
Yes No NA NE'
■nnn'
■nnn
■ n n nI
■ n n n
■nnn
Page #; 5

W
Permit: NCO046035
Inspection Date: 01/26/2011
Owner - Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No
NA
NE
Is scum removal adequate?
■
n
n
n
Is the site free of excessive floating sludge?
■
n
n
n
Is the drive unit operational?
❑
n
■
Is the return rate acceptable (low turbulence)?
■
n
n
n
Is the overflow clear of excessive solids/pin floc?
n
■
n
n
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
n
n
n
■
Comment: Could not check the sludge blanket... Mr. Bell did not have a Sludge Judge
(SJ). There was no floating sludge but some floating foam as mentioned above. It was
highly suggested that he obtain a SJ and dip the clarifier at least weekly and annotate
the findings. Currently Mr. Bell manages sludge wasting by the amount of solids in the
mixed liquor. He performs a settability test weekly and annotates it and wastes sludge
once the solids reach 400 to 500 in the mixed liquor. It appears to be a sufficient
management strategy but he was still advised to get the SJ. The was some solids
overflowing the weir but they were larger type solids sloughing off the build up on the
weir and tank structures. Mr. Bell may want to keep those components more cleaned up
by brushing and/or spraying.
Pumps-RAS-WAS
Yes No NA NE
Are pumps in place?
■ n n n
Are pumps operational?
■ n n n
Are there adequate spare parts and supplies on site?
n n n ■
Comment: Two blowers which supply the aeration basin with air as well as the lift for
the sludge return and the skimmer waste lines are installed. There are no spares. Both
are within a metal screened housing that provides some protection from the elements. It
is suggested that a spare blower be purchased and kept on hand at all times. Please
refer to the attached inspection summary letter.
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
■ n n n
Are the tablets the proper size and type?
■ n n n
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
n n n ■
Is the contact chamber free of growth, or sludge buildup?
■ n n n
Is there chlorine residual prior to de -chlorination?
n n n ■
Comment: Second tube does not have a cap. This leaves tabs exposed to precip and
causes them to cake up at times. Operator advised to obtain a cap.
De -chlorination
Yes No NA NE
Page # 6

";'Is
Permit: NCO046035
Inspection Date: 01/26/2011
De -chlorination
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
Owner - Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
Are the tablets the proper size and type?
Comment: Please refer to the attached inspection summary letter.
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment: Please refer to the attached inspection summary letter.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: Please refer to the attached inspection summary letter.
Aerobic Digester
Is the capacity adequate?
Is.the mixing adequate?
Is the site free of excessive foaming in the tank?
# Is the odor acceptable?
# Is tankage available for properly waste sludge?
Comment:, Tank has a significant amount of foam/scum on top but will likely be
pumped again sometime within the next two months. Please refer to the attached
inspection summary letter.
Tablet
■nnn
2
Yes No NA NE
■n❑n
■nnn
❑❑■❑
■nnn
■nnn
■ n n n
■ n n n
■nnn
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑
Judge, and other that are applicable?
Comment: The plant is old and could use some significant maintenance and repair.
The fence around the facility is easily breached and cannot really be considered good
security.
Page # 7

NC®ENR
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
February 14, 2011
Neil L. Pruitt, Jr, CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION
NOV-2011-MV-0043
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt:
Resources
Dee Freeman
Secretary
A review of High Point Healthcare's monitoring report for November 2010 showed the following
violations:
Parameter
Date
Measuring
Frequency
Violation
Surfactants (MBAS)
11/30/10
2 X month
Failed to monitor for the
month of 11/2010
Temperature, Water Deg.
11/06/10
5 X week
Failed to monitor five times
Centigrade
during the week of
11/06/2010
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.
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section
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: wvmi.naAiaterquality.org
Nne
orthCarOlina
Naturally
An Equal Opportunity 1 Affirmative Action Employer

NICURR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 12, 2010
Neil L. Pruitt, Jr., CEO
High Point Healthcare, Inc.
P.O. Box 1210
Toccoa, GA 30577
Subject: NOTICE OF VIOLATION, NOV-2010-LV-0253
Permit No. NCO046035
High Point Healthcare
Forsyth County
Dear Mr. Pruitt,:
Dee Freeman
Secretary
A review, of High Point Healthcare's monitoring report for April 2010 showed the following
violations:
Parameter Date Li
Coliform, Fecal MF, M-FC 04/26/10 4
Broth,44.5C
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.
mit Value Reported Value Limit Type
00 4/100ml 600 4/100ml Daily
Maximum
Exceeded
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
cc: S WP — Central Files
!7'PSRQ Files_
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone]! FAX: [phone] t 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
NorthCaroliria
An Equal Opportunity t Affirmative Action Employer
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
cc: S WP — Central Files
!7'PSRQ Files_
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone]! FAX: [phone] t 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
NorthCaroliria
An Equal Opportunity t Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: !�//�%6t� �� PermitJPipe No.: �o�S do/ MondvYear
Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Lunit/Tvpe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Ot er Violations _
Completed by: " �— Date: ?�
Regional Water Quality.
Supervisor Signoff: Date: ((y

NPDES PERMIT NO.: NC 0046035 DISCHARGE NO.: 001 MONTH: IAPRIL YEAR: 2010 FACILITY NAME: High Point Care CLASS: COUNTY10LsF' AA
OPERATOR IN RESPONSIBLE CHARGE: RANDY BELL GRADE: 3 PHONE: [phone]!zCFIVFD
CERTIFIED LABORATORIES: (1) Tritest (2) ETS N.C, De ❑t. : c N R
Check box if orc has changed [ ] PERSON(S) COLLECTING SAMPLES: RANDY BELL J 1V N o 7 2010
Mall ORIGINAL and ONE COPY to: 2 <Regional
e17
ATTN: CENTRAL FILES X v „Le I RgionalOfTicz
Winston-Salem
L
DIVISION OF WATER QUALITY (SIGNATURE OF C) DATE C
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ��pp
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. MAY 2 4 2010
RALEIGH, NC 27699-1617 IU
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
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Opn
Arrive
Time
2400
clock
Opn
Time
on
Site
Orc
on
Site
Flow
[ ] Inf
Eff
Temp.
1Xwk
pH
2xwk
Res
CL2
lxwk
BOD5
@
20C
lxwk
NH3-N
lxwk
T
S
S
1 xwk
Fecal
Colironn
Geometric
Mean
lxwk
Dissolvd
Oxygen
(DO)
TGP3B
2xmthly
WAS
1 xMth
Total
Nitrogen
lxmo
PO4
D
A
T
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#
IHRS
IHRS
Y/N
I MGD
I
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I u /L
m /L
I m /L
m /L
I #/ 100 ml
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m /L
m /L
m /L
m /L
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#
--MONITORING FREQUENCY-
-_. • .Coat-_
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#
Total Monthly Flow D.1420 MG �DIDANOT DEPLEAT ; 2 MGL_- ?_;; TN Monthly Loading pbs.) 3
DEM Form MR-1 (12/03) 203
DEM Form MR-1 (12103) 6
227

NPDES PERMIT NO:NC0046035 DISCHARGE NO.: 001 MONTH: APRIL YEAR: 2010
FACILITY NAME: High Point Care COUNTY: Forsyth
STREAM: LOCATION: @ 100ft Above Discharge Point STREAM: LOCATION: @ NCSR 1892
DEM Form MR-3 (12/93) DEM Form MR-3 (12/93)

Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements X
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
high fecal due to c12 swelling in tubes as well as detention times reduced due to high flow from rain event
"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 sub-
mitted. 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 com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Permittee (Pleaseprint or type)
Date
Permittee Address:
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
PARAMETER CODES
00610 Ammonia Nitrogen
00625 Total Kjeldah
Nitrogen
00630 Nitrate/Nitrite
00665 Total Phosporous
00720 Cyanide
00745 Total Sulfide
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
Phone Numj er: Perm f Exp. Date
01032 Hexavalent
Chrc 32730 Total Phenolics
01034 Chromium 34235 Benzene
01037 Total Cobal 34481 Toluene
01042 Copper 38260 MBAS
01045 Iron 39516 PCBs
01051 Lead 50050 Flow
01067 Nickel 50060 Total Residual
01077 Silver Chlorine
01092 Zinc 71880 Formal-
01105 Alumimum dehyde
01147 Total Selen 71900 Mercury
31616 Fecal Colifc 81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting
facility's permit for reporting data.
* ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
** 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)

(1L'IHa1.2IVI10) ZIbkII'I ZIvu21Ad AllJixu L J1Nk anJ k w v
r rnn Lnnrl►T ITTTT70J
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Fennnit �NfCO046035
-" i/
Beginning with the effective date of the permit and lasting until expiration, the Permittee is authorized
to discharge treated domestic wastewater from Outfall 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
E
r ENT.
9.
3.
HAR+ RISTICS�-
,' - `rrr
-
G EQUIREMENTS `t :>
_
�-
e. a.rt
{
x.
I.
-
;Sam
"e
Li
ve
:A ra e "Nazi'
9 mu
Sam` le;`T`'`
a `ue :r.'.= -
„..
.F ric Y::=�:�� o a ion.
Flow
0.010' MGD
Continuous
Recording
I or E
BOD5, 5-day, 200C
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
NH3 as N
Weekly
Grab
E
Dissolved Oxygen2
Weekly
Grab
E, U, D
Fecal Coliform
(geometric mean
200/100 ml
400/100 ml
2/Month
Grab
E
Total Residual Chlorine3
28.0,ug/L
2/Week
Grab
E
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U, D
MBAS
2.4 mg/L
2/Month
Grab
E
Total Nitrogen
Monthly
Grab
E
Total Phosphorous
Monthly
Grab
E
pH4
Weekly
Grab
E
Chronic Toxicity5
Quarterly
Grab
E
Footnotes:
1. Sample Locations: E — effluent; I — Influent; U — upstream approximately 100 feet above the
discharge point. D — Downstream from the discharge point at SR 1892.
2. The daily average dissolved oxygen concentration shall not be less than 6.0 mg/L.
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
Ian-•
4. pH shall not fall below 6.0 nor exceed 9.0 standard units.
5. Chronic Toxicity (Ceriodaphnia) P/F at 21%; refer to Condition A. (2.).
Facility discharge shall contain no floating solids or foam visible in other than trace amounts.

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 07/07/10 Page: 1 of 1
PERMIT: NCO046036 FACILITY: High Point Healthcare, Inc. - High Point Healthcare COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL/ VIOLATION UNIT OF CALCULATED
REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE % OVER LIMIT VIOLATION TYPE VIOLATION ACTION
12 -2009 001 Effluent Flow, in conduit or thru 12/31/09 Continuous mgd 0.01 0.01 4.84 Monthly Average Exceeded No Action, BPJ
treatment plant

Permit Enforcement History by Owner
07/07/10
1
Owner: High Point Healthcare, Inc.
Facility: High Point Healthcare
Permit: NCO046035
Region: Winston-Salem County: Forsyth
Penalty Remission Enf EMC EMC OAH Collection Has
Assessment Penalty Enforcement Request Enf Conf Remission Hearing Remission Remission Memo Sent Pmt Case
Case Number MR Approved Amount Costs Damages Received Held Amount Held Amount Amount to AGO Total Paid Balance Due Plan Closed
LV-2002-0202 05/29/02 $250 $92.28 $342.28 $.00 No 06/19/02
LV-2006-0348 5-2006 09/06/06 $200 $94.00 $294.00 $.00 No 12/22/06
Total Cases: 2 $186.28 $636.28 $.00
Total Penalties: $636.28 Total Penalties after remission(s): $636.28

Beverly Eaves Perdue
Governor
5495
Mr. Randy Bell
Bell Enterprises
PO Box 1291
Clemmons, NC 27012-
e�
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
December 23, 2009
SUBJECT: Wastewater/Groundwater Laboratory Certification Renewal
FIELD PARAMETERS ONLY
Dear Mr. Bell:
RECEIVED
N.C. Dept of ENR
DEC 319 2009
Winston-Salem
Regional office
Dee Freeman
Secretary
The Department of Environment and Natural Resources, in accordance with the provisions of NC GS 143-215-
.3 (a) (10), 15 NCAC 2H .0800, is pleased to renew certification for your laboratory to perform specified
environmental analyses required by EMC monitoring and reporting regulations 15 NCAC 2B .0500, 2H .0900 and
2L .0100, .0200, .0300, and 2N .0100 through .0800.
Enclosed for your use is a certificate describing the requirements and limits of your certification. Please review
this certificate to insure that your laboratory is certified for all parameters required to properly meet your
certification needs.
Please contact us at 919-733-3908 if you have questions or need additional information.
Sincerely,
Pat Donnelly
Certification Branch Manager
Laboratory Section
Enclosure
cc: Ramon Cook
Dana Satterwhite-
Winston - Salem Regional Office r;-
DENR DWQ Laboratory Section NC Wastewater/Groundwater Laboratory Certification Branch
1623 Mail Service Center, Raleigh, North Carolina 27699-1623
Location: 4405 Reedy Creek Road. Raleigh, North Carolina 27607-6445
Phone: [phone]'1 FAX: [phone]
Internet: www.dwqlab.org
An Equal Opporlunity1 Affirmative Action Employer Customer Service: 1-877-623-6748 www.ncwaterquality.org
NorthCarohna
Ndtmrll llff

e
STATE OF NORTH CAROLINA DEPARTMENT OF THE
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
LABORATORY CERTIFICATION PROGRAM
In accordance with the provisions of N.C.G.S. 143-215.3 (a) (1), 143-215.3 (a)(10) and NCAC 2H.0800:
BELL ENTERPRISES
Is hereby certified to perform environmental analysis as listed on Attachment I and report monitoring data to DWQ for
compliance with NPDES effluent, surface water, groundwater, and pretreatment regulations.
By reference 15A NCAC 2H .0800 is made a part of this certificate.
This certificate does not guarantee validity of data generated, but indicates the methodology, equipment, quality control procedures,
records, and proficiency of the laboratory have been examined and found to be acceptable.
This certificate shall be valid until December 31, 2010
Certificate N 5495
Pat Donnelly

Attachment
North Carolina Wastewater/Groundwater Laboratory Certification
Certified Parameters Listing
Lab Name: Bell Enterprises
Address: PO Box 1291
Clemmons, NC 27012-
Certificate Number:
Effective Date:
Expiration Date:
Date of Last Amendment:
5495
01/01/2010
12/31 /2010
The above named laboratory, having duly met the requirements of 15A NCAC 2H.0800, is hereby certified for the measurement of the parameters listed below.
CERTIFIED PARAMETERS
INORGANICS
RESIDUAL CHLORINE
Std Method 4500 Cl G
DISSOLVED OXYGEN
Std Method 4500 O G
pH
Std Method 4500 H B
TEMPERATURE
Std Method 2550B
This certification requires maintance of an acceptable quality assurance program, use of approved methodology, and satisfactory performance on evaluation samples. Laboratories are
subject to civil penalties and/or decertification for infractions as set forth in 15A NCAC 2H.0807.

I
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
RECEIVED Secretary
Governor Director N.C. Dept. of ENR I
April 8, 2009 I PR 0 9 .11609
Winston-5alom
Regional Cifce I
Ms. Mal Keller
High Point Healthcare, Inc.
3830 North Main Street
High Point, NC 27265
Subject:
Dear Ms. Keller:
Draft NPDES Permit
Permit Number NCO046035
High Point HealthCa>re WWTP
Forsyth County
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. The draft
permit contains the following changes from the terms found in your current permit:
• The facility description has been updated to note the addition of dechlorination.
• A footnote has been added regarding the reporting and compliance determination of Total Residual
Chlorine values.
Please submit any comments to me no later than thirty days following your receipt of the draft.
Comments should be sent to the address listed at the bottom of this page. If no adverse comments ate
received from the public or from you, this permit will likely be issued in June 2009, with an effective
date of July 1, 2009.
If you have any questions or comments concerning this draft permit, call me at [phone], or via e-
mail at [e-mail].
Sincerely,
Bob Sledge
Point Source Branch
cc: Central Files
lins� �on:Saleegnal Office/Surface Water Protection Section
NPDES Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 NorthCarolina
Phone: [phone] FAX: [phone] Customer Service:l-877-623-6748 Aaturally
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer

Permit NCO046035
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
High Point Healthcare, Inc.
is hereby authorized to discharge wastewater from a facility located at
High Point Healthcare
3830 North Main Street
High Point
Forsyth County
to receiving waters designated as Rich Fork 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.
This permit and the authorization to discharge shall expire at midnight on April 30, 2014.
Signed this day .
1
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

i
Permit NC0046035
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.
High Point Healthcare, Inc.
is hereby authorized to:
1. Continue to operate an existing 0.01 MGD wastewater treatment plant, consisting of-
• a manual bar screen
• flow meter
• 1,000-gallon grit chamber
• dual 5,000-gallon aeration tanks in series
• 3,000-gallon settling tank (clarifier)
• 1,200-gallon aerated sludge holding tank
• tablet chlorinator
• a 540 gallon chlorine contact tank
• Dechlorination
This facility is located at the High Point Care Center, 3830 North Main Street, High Point, Forsyth
County; and
2. Discharge from said treatment works at the location specified on the attached map into Rich
Fork, class C waters in the Yadkin -Pee Dee River Basin.

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High
Point Healthcare Inc
Facility
R i � �����
Latitude:
36° 00' S2" N Longitude: 80' 02' 52" W
Location
not to scale
Stream Class:
C Receiving Stream: Rich Fork
Sub -Basin:
03-07-07 State Grid/ USGS Quad: C 18 SE/Kemersville, NC
h
NPDES Permit NCO046035
Drainage Basin:
Yadkin -- Pee Dee Permitted Flow: 0.010 MGD
North
I
Fors th Count

Permit NCO046035
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning with the effective date of the permit and lasting until expiration, the Permittee is authorized
to discharge treated domestic wastewater from Outfall 001. Such discharges shall be limited and
.monitored by the Permittee as specified below:
" EFFt:(JENTt
xq
£
x x .
REQUIREMENTS
Y
CHARACTERISTICS,;
LIMITS
1
ryVONITORING
sE
Daily
t
,4
Sam le
""P
kMonthlyxF
N
,Measurement
#Sample Types
,a , 1 r
..Maximum
Flow
0.010 MGD
Continuous
Recording
I or E
BOD5, 5-day, 200C
30.0 mg/L
45.0 mg/L
Weekly
Grab
E.
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
NH3 as N
Weekly
Grab
E
Dissolved Oxygen2
Weekly
Grab
E, U, D
Fecal Coliform
200/100 ml
400/100 ml
2/Month
Grab
E
(geometric mean)
Total Residual Chlonne3
28.0pg/L
2/Week
Grab
E
Temperature
Daily
Grab
E
Temperature
Weekly
Grab
U, D
MBAS
2.4 mg/L
2/Month
Grab
E
Total Nitrogen -
Monthly
Grab
E
Total Phosphorous
Monthly
Grab
E
pH4
Weekly
Grab
E
Chronic Toxicity5
Quarterly
Grab
E
Footnotes:
1. Sample Locations: E — effluent; I - Influent; U — upstream approximately 100 feet above the
discharge point. D — Downstream from the discharge point at SR 1892.
2. The daily average dissolved oxygen concentration shall not be less than 6.0 mg/L.
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
-µme-
4. pH shall not fall below 6.0 nor exceed 9.0 standard units.
5. Chronic Toxicity (Ceriodaphnia) P/F at 21 %; refer to Condition A. (2).
Facility discharge shall contain no floating solids or foam visible in other than trace amounts.

Permit NCO046035
.A. (2.) CHRONIC TOXICITY PERMIT LIMIT (QUARTERLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to
Ceriodaphnia dubia at an effluent concentration of 21 %.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the
"North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent
versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February
1998) or subsequent versions. The tests will be performed during the months of March, June, September
and December. Effluent sampling for this testing shall be performed at the NPDES permitted final effluent
discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV below
the permit limit, then multiple -concentration testing shall be performed at a minimum, in each of the two
following months as described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test
Procedure" (Revised -February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the highest
concentration having no detectable impairment of reproduction or survival and the lowest concentration that
does have a detectable impairment of reproduction or survival. The definition of "detectable impairment,"
collection methods, exposure regimes, and further statistical methods are specified.in the "North Carolina Phase
II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge
Monitoring Form (MR-1) for the months in which tests were performed. If reporting pass/fail results using the
parameter code TGP3B, DWQ Form AT-1(original) is sent to the below address. If reporting Chronic Value
results using the parameter code THP313, DWQ Form AT-3 (original) is to be sent to the following address:
Attention:' NC DENR / DWQ / Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later than 30
days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all
concentration/response data, and be certified by laboratory supervisor and ORC or approved designate
signature. Total residual chlorine of the effluent toxicity sample must be measured and reported if chlorine is
employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required,
the permittee will complete the information located at the top of the aquatic toxicity (AT) test form indicating
the facility name, permit number, pipe number, county, and the month/year of the report with the notation of
"No Flow" in the comment area of the form. The report shall be submitted to the Environmental Sciences
Section at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required, monitoring will be
required during the following month.
Should any test data from this monitoring requirement or tests performed by the North Carolina Division of
Water Quality indicate potential impacts to the receiving stream, this permit may be re -opened and modified to
include alternate monitoring requirements or limits.

Permit NC0046035
A. (2.), continued
If the Permittee monitors any pollutant more frequently then required by this permit, the results of such
monitoring shall be included in the calculation & reporting of the data submitted on the DMR & all AT Forms
submitted.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control
organism survival, minimum control organism reproduction, and appropriate environmental controls, shall
constitute an invalid test and will require immediate follow-up testing to be completed no later than the last day
of the month following the month of the initial monitoring.

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor. Director Secretary
April 29, 2009
Mal Keller
High Point Healthcare, Inc.
3830 N Main St
High Point NC 27265
Subject: Compliance Evaluation Inspection'
High Point Healthcare
Permit No. NCO04603 5
Forsyth County ;
Dear Mr Keller:
Enclosed please find a copy of the Inspection Report from the inspection conducted April 23, 2009. The Compliance Evaluation
Inspection was conducted Rose Pruitt of the Winston-Salem Regional Office. Randy Bell, ORC was present for the inspection. The
inspection consisted of two parts: an on -site inspection of the treatment facility and a file review. The following are the findings from
the subject inspection.
The treatment facility was found to be in compliance with permit NCO046035:
I. Permit
The NPDES permit for the High Point Care Center WWTP became effective August 1, 2004 and expires on April 30, 2009. The
facility has submitted a renewal application to the Division and it is in review. The permitted components of the 0.01 MGD
wastewater treatment plant include: a manual bar screen, flow meter, 1,000 gallon grit chamber, dua15,000 gallon aeration tanks in
series, 3,000 gallon settling tank (clarifier), 1,200 gallon aerated sludge holding tank, tablet chlorinator, a 540 gallon chlorine contact
chamber, and a dechlorination unit.
The facility is located at 3830 North Main Street, High Point, Forsyth County and discharges into the Rich Fork Creek which is
classified C waters in the Yadkin- Pee Dee River Basin.
A complete copy of the permit was on site at the time of the inspection. -
II. Records/Reports
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the High Point Care Center WWTP for the period
January 2008 through December 2008 revealed that the facility had no violations.
Lab data and chain of custody forms were available at the inspection.
The Daily Operator's / ORC visitation log and the Maintenance log were available for inspection. Process control data was available
as were flow meter calibration records and flow charts.
A spill response plan with emergency contact numbers was available- This spill plan should be updated.
III. Facility Site Review
The facility site review indicated that the 0.01 MGD treatment works is consistent with the permitted components. The actual
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] l Customer Service:1-877-623-6748 NorthCarohna.
Internet www.ncwaterquality.org Amorally
An Equal Opportunity l Affirmative Action Employer

k
treatment system consists of a manual bar screen, flow meter, 1,000 gallon grit chamber, dual 5,000 gallon aeration tanks in series,
3,000 gallon settling tank (clarifier), 1,200 gallon aerated sludge holding tank, tablet chlorinator, a 540 gallon chlorine contact
chamber and a dechlorination unit.
IV. Effluent / Receiving Stream
The WWTP discharges to Rich Fork Creek (Class C water in the Yadkin -Pee Dee River Basin). The effluent was clear and free of
visible solids on the date of inspection.
V. Flow Measurement
Effluent flow is measured with an Isco 4210 flow meter. It was last calibrated on 08/31/08 by Horizon Engineering. Meter
calibration records were available at the inspection. -
V1. Self -Monitoring Program.
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the High Point Care Center WWTP for the period
January 2008 through December 2008 revealed that the facility had no limit violations.
VII. Laboratory
All of the sample analyses are conducted by a certified lab, Tritest. The laboratory was not reviewed at the time of the subject
inspection.
VIH. Operation and Maintenance
Operations and maintenance at the time of the subject inspection were deemed adequate.
The inspector noted trash in the clarifier.
IX. Sludge Utilization/Disposal
Atlantic Utility last hauled 3,000 gallons of sludge on 3/21/2009.
Please refer to the enclosed Inspection Report for any additional observations and comments.
'The Division of Water Quality greatly appreciates your continued oversight at this facility. The Division also encourages you to
continue to be proactive in your efforts to maintain compliance.
Please refer to the enclosed inspection report for additional observations and comments. If you or your staff have any questions,
please call Rose Pruitt at 336-771-5000.
Sincerely,
(2v; el
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachment
Cc: Randy Bell, PO Box 1291, Clemmons NC 27012
WSRO
Central Files

United States Environmental Protection Agency
Form Approved. "
E P ^ Washington, D.C. 20460
OMB No. 2040-0057
/-1 Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 I 191I 1I I I 20
JI09/04/23
Remarks
211111IIIIIIIIIIIIIIIIIIIIIIIIIIIIII11111111111-]6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 OA ----------Reserved----- —
67 I 169 701 I 711 I 721 NJ 73 L Lj 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
08:50 AM 09/04/23
05/05/01
High Point Healthcare
Exit Time/Date
Permit Expiration Date
3830 N Main St
High Point NC 27265
09:50 AM 09/04/23
09/04/30
Name(s) of Onsite Representative (s)/ritles(s)/Phone and Fax Number(s)
Other Facility Data
Randall Keith Bell/ORC/336-433-7221/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted.
Quentin Lee Campbell,3830-N Main St High Point NC 27265//336-357-539�
0
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
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
Rose Pruitt WSRO WQ//336-771-5000/
Signature of ge nt Q A Reviewe Agency/Office/Phone and Fax Numbers Date
or
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
3I NC0046035 I11 12
yr/mo/day Inspection Type
09/04/23 I17 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The inspector was met at the facility by Randy Bell ORC. At the time of the inspection the facility appeared
to be operating efficiently. The effluent appeared clear with a trace of foam. The receiving stream
appeared clear with no visible solids.
Page # 2

Permit: NCO046035
Inspection Date: 04/23/2009
Owner - Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
Operations & Maintenance
Yes
No
NA NE
Is the plant generally clean with acceptable housekeeping?
■
❑
❑
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■
n
n
n
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted anew application?
■
❑
❑
❑
Is the facility as described in the permit?
■
❑
❑
n
# 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? -
■
❑
❑
n
Comment:
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
n
❑
❑
Is alb required information readily available, complete and current? -
■
n
n
n -
Are all records maintained for 3 years (lab. reg. required 5 years)?
n
n
❑
■
Are analytical results consistent with data reported on DMRs?
■
❑
❑
❑
Is the chain -of -custody complete?
■
❑
❑
n
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
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?
n
❑
0
n
Is the ORC visitation log available and current?
■
o
o
n
Is the ORC certified at grade equal to or higher than the facility classification?
■
n
n
❑
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?
■
n
n.
n
Page # 3

Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 04/23/2009 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Facility has copy of previous year's Annual Report on file for review?
n
n
n
■
Comment:
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
■
n
n
n
Are the receiving water free of foam other'than trace amounts and other debris?
■
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
n
❑
■
n
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
n
n
Is flow meter calibrated annually?
■
❑
n
Is the flow meter operational?
■
❑
n
n
(If units are separated) Does the chart recorder match the flow meter?
■
n
n
n
Comment: Isco 4210 last calibrated by Horizon Eng 8/31/2008
Bar Screens
Yes
No
NA
NE
Type of bar screen
a.Manual
■
b.Mechanical
n
Are the bars adequately screening debris?
■
n
n
n
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
n
n
n
Is the unit in good condition?
■
n
n
n
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext.
Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
n
n
Are surface aerators and mixers operational?
■
n
n
n
Are the diffusers operational?
■
n
n
n
Is the foam the proper color for the treatment process?
■
n
n
n
Does the foam cover less than 25% of the basin's surface?
■
n
n-
n
Page # 4

Permit: NCO046035 Owner - Facility: High Point Healthcare
Inspection Date: 04/23/2009 Inspection Type: Compliance Evaluation
Aeration Basins
Yes
No
NA
NE
Is the DO level acceptable?
❑
❑
❑
■
Is the DO level acceptable?(1.0 to 3.0 mg/1)
n
❑
❑
■
Comment:
Secondary Clarifier
Yes
No
NA
NE
.Is the clarifier free of black and odorous wastewater?
■
❑
n
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
n
■
❑
Are weirs level?
■
n
n
n
Is the site free of weir blockage?
■
❑
n
❑
Is the site free of evidence of short-circuiting?
■
n
n
n
Is scum removal adequate? ..
❑
■
n
n
Is the site free of excessive floating sludge?
■
❑
❑
❑
Is the drive unit operational?
n
❑
■
n
Is the return rate acceptable (low turbulence)?
n
n
■
n
Is the overflow clear of excessive solids/pin floc?
■
n
❑
❑
Is the sludge blanket level acceptable? (Approximately '/< of the sidewall depth)
❑
❑
❑
■
Comment: Trash in clarifier
IMP-r_hlnrinnfinn
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
■
❑
❑
❑
Is storage appropriate for cylinders?
■
❑
❑
❑
# Is de -chlorination substance stored away from chlorine containers?
■
n
n
n
Comment:
Are the tablets the proper size and type?
■
❑
❑
❑
Are tablet de -chlorinators operational?
■
n
❑
n
Number of tubes in use?
2
Comment:
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
n
Are the tablets the proper size and type?
■
n
n
n
Number of tubes in use?
2
Page # , 5

Permit: NC0046035
Inspection Date: 04/23/2009
Disinfection -Tablet
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
Is there chlorine residual prior to de -chlorination?
Comment:
Owner- Facility: High Point Healthcare
Inspection Type: Compliance Evaluation
Page # 6

Faxed To:
Fax #: [phone]
Phone [phone]
WWTP Annual Inspection Checklist
This information should be available to the inspector at inspection time.
��©3S
Facility: High Point Care NPDES: fe007502*7
Permit Effective Dates: 710112007 to 212912012
Inspection Date: April 23, 2009 Inspection Time: 9:00 am 1,�/^•-W'�V-/'�
1) DMRs (Dates: January 2008 to December 2008 )
2) Lab Data (per DMR dates)
3) Laboratories used for analysis & certification #'s -rg--�j
•�4) Chain of Custody forms (per DMR dates)
V-5) Complete copy of current NPDES permit
uance (if applicable)
nil) ORC and Back-up .ORC current certification &�w�
,,-8) Wastewater Annual Report (fiscal or calendar year - if applicable)
�-9) Daily Operator's log / ORC visitation log
o" 10) Maintenance log
1) Process. control data (which includes field parameters tested and equipment
calibrations) c�y�
c/12) Field Parameter certification (if applicable)
�13) Flow meter calibration records (if applicable) ��3//08� 1i co yZ/�
samplers
✓15) Flow charts (if applicable)
CAr load checks
u�f-17) Spill Response Plan (with current emergency contact numbers)
✓18) Sludge / Residuals hauling records (if applicable) 3 2!• p g 3,K. PL>�
—19) Plant visual inspection of treatment units
�0) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt -
NC Department of Environment & Natural Resources 2
Division of Water Quality ✓, /f,�
Winston-Salem Regional Office '(J�
[phone]
Fax: [phone] /f

•
MONITORING REPORT(MR) VIOLATIONS for: Report Date: 04/29/09 Page: 1 of 2
PERMIT: NCO046036 FACILITY: High Point Healthcare, Inc. - High Point Healthcare COUNTY: Forsyth REGION: Winston-Salem
Monitoring Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF CALCULATED
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
05 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
05/03/08
Weekly
mg/1
Frequency Violation
None
07 -2008
001
Effluent
BOD, 5-Day (20 Deg. C)
07/05/08
Weekly
mg/I
Frequency Violation
None
03 -2008
001
Effluent
Chlorine, Total Residual
03/08/08
2 X week
ug/I
Frequency Violation
None
03 -2008
001
Effluent
Chlorine, Total Residual
03/29/08
2 X week
ug/l
Frequency Violation
None
05 -2008
001
Effluent
Chlorine, Total Residual
05/17/08
2 X week
ug/l
Frequency Violation
None
05 -2008
001
Effluent
Chlorine, Total Residual
05/24/08
2 X week
ug/]
Frequency Violation
None
06 -2008
001
Effluent
Chlorine, Total Residual
06/07/08
2 X week
ug/I
Frequency Violation
None
05 -2008
001
Effluent
Coliform, Fecal MF, M-FC
05/03/08
Weekly
#/loom]
Frequency Violation
None
Broth,44.5C
07 -2008
001
Effluent
Coliform, Fecal MF, M-FC
07/05/08
Weekly
#/loom]
Frequency Violation
None
Broth,44.5C
05 -2008
001
Effluent
Nitrogen, Ammonia Total (as
05/03/08
Weekly
mg/I
Frequency Violation
None
07 -2008
001
Effluent
Nitrogen, Ammonia Total (as
07/05/08
Weekly
mg/1
Frequency Violation
None
03 -2008
001
Effluent
P/F STATRE 7Day Chr
03/31/08
Quarterly
pass/fail
Frequency Violation
None
Ceriodaphnia
06 -2008
001
Effluent
P/F STATRE 7Day Chr
06/30/08
Quarterly
pass/fail
Frequency Violation
None
Ceriodaphnia
09 -2008
001
Effluent
P/F STATRE 7Day Chr
09/30/08
Quarterly
pass/fail
Frequency Violation
None
Ceriodaphnia
12 -2008
001
Effluent
P/F STATRE 7Day Chr
12/31/08
Quarterly
pass/fail
Frequency Violation
None
Ceriodaphnia

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 04/29/09 Page: 2 of 2
PERMIT: NCO046035 FACILITY: High Point Healthcare, Inc. - High Point Healthcare COUNTY: Forsyth REGION: Winston-Salem
Monitoring Violation
MONITORING OUTFALLI
VIOLATION
UNIT OF CALCULATED
REPORT PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
05 -2008 001 Effluent
Solids, Total Suspended
05/03/08
Weekly
mg/I
Frequency Violation
None
07 -2008 001 Effluent
Solids, Total Suspended
07/05/08
Weekly
mg/I
Frequency Violation
None
05 -2008 001 Effluent
Surfactants (MBAS)
05/31/08
2 X month
mg/1
Frequency Violation
None
06 -2008 001 Effluent
Surfactants (MBAS)
06/30/08
2 X month
mg/I
Frequency Violation
None
11 -2008 001 Effluent
Surfactants (MBAS)
11/30/08
2 X month
mg/l
Frequency Violation
None
07 -2008 001 Effluent
Temperature, Water Deg.
07/05/08
5 X week
deg c
Frequency Violation
None
Centigrade
Reporting Violation
MONITORING OUTFALL/ VIOLATION UNIT OF CALCULATED
REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE VIOLATION TYPE
06-2008 07/31/08 Late/Missing DMR
VIOLATION ACTION
Penalty Retracted

MAL KELLER
ADMIN
HIGH POINT HEALTHCARE INC
3830 N MAIN STREET
HIGH POINT NC 27265
Dear Ms. Keller:
Michael F. Easley, Governor kof
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
September 3 2008 RE of of E
N C Not of ENR
SEP
Wanston-Salem
Regional office
Subject Receipt of permit renewal application
NPDES Permit NCO046035
High Point Healthcare
Forsyth County
The NPDES Unit received your permit renewal application on August 29, 2008; however,
on initial review we note that a Sludge Management Plan was not included in the submitted
paperwork. Please submit to this unit a Sludge Management Plan or a statement indicating that a
Sludge Management Plan is not required. Upon receipt, a member of the NPDES Unit will further
review your application and will contact you if additional information is required to complete your
permit renewal. You should expect to receive a draft permit approximately 30-45 days before your
existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact
Robert Sledge at [phone].
Sincerely,
Dina Sprinkle
NPDES Unit
cc: CENTRAL FILES
`Winston Sale Zeglo alFffif Surface Water Protection
NPDES Unit
Mailing Address Phone [phone] Location I�ofthCarol
1617 Mail Service Center Fax [phone] N. Salisbury St �trlra!!
Raleigh, NC 27699-1617 Raleigh, NC 27604
Internet: www.ncwateruualitv.ore Customer Service 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer— 50% Recycledl10% Post Consumer Paper

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDE (� i
1617 Mail Service _Center, Raleigh, NC 27699
NPDES Permit C00 AUG 2 9 2008'
If you are completing this form in computer use the TAB key. or the up - down one
field to the next. To check the boxes, click your mouse on top of the box. Otf eru 'se, A ype.
1. Contact Information: ' r (' Q�/1 I .
Owner Name ��� 1/l�J f / t�U�
Facility Name • 1l ^ ^ 7 /-
�I-tu�-I-�al�hcare r�F to yl� �
Mailing Address 3� `�, we `, Pry
City --�-`-=Pu►
y— l�l
State / Zip Code' -Y) r r7 i AO
Telephone Number (S?w-3'�So�
Fax Number 9 7 L) . - � —9 LIC49
e-mail Address MD I ale- 1 t^iD L hj —p 1'uL.- jf - bell
2. Location of facility producing disch e:
Check here if same address as above
Street Address or. State Road 100 D(Tk) 7rou ig flYcli--
City �
tt 1 L 14 PO; AZT
State / Zip Code
County
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name
Mailing Address l +� -r 92: 0
City
State / Zip Code
Telephone Number.
Fax Number ( )
1 of 3
Form-D 05/08

NPDES APPLICATION - FORM D V
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply
Industrial ❑ wu.,mber f-Emplcayees
Commercial -❑ Number of Employees
Residential ❑ Number of Homes
School ❑ Number of Students/ Staff .
Other Explain:
Describe the source(s) of wastewater (example:' subdivision, mobile.home park, shopping centers,
restaurants, etc.):
-n u(i
Population served:iJ
5. Type of collecti n system
❑ Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary.sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s)
Is the outfall equipped with a diffuser? ❑ Yes ❑ No
7. Name of receiving stream(s) (Provide a map shouiing the exact location of each outfall):
S. Frequency of Discharge:' Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
.phosphorus. ythe space provided is not sufficient, attach the.description of the treatment system in a
separate sheet of paper. ,
-
.2 /310 wt, cQ.s 1) �� �2�i'v �v 1",�r✓1 L (� l r41°�i'
l✓r� l-� c(� ! w i��� 1Jvc ��� i hJ c 4I✓1.9�. f ' L PAl1413-c
2 of 3 Form-D 05108

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0 MGD
Annual Average daily flow Ci MGD (for the previous 3 years)
Maximum daily flow MGD (for the previous 3 years)_
11. Is this facility located on Indian country?
❑ Yes No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum
and monthly average. If only one analysis is reported; report as daily maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
3o.,3
ti►/ �L
Fecal Coliform
ao
Total Suspended Solids
vt/ t c
Temperature (Summer)
Temperature (Winter)
pH
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES O Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14:., APPLICANT CERT-IF If:ATIO1iv
'i
I certify that I am familiar with the information contained in the applic
best of my knowledge and belief such information is true, complete, n�
I,
Printed name of Person Signing Title
Permit Number
rad4_hay't
i ILO
Ace
te.
a()r 2
Signatbxp-of A lic' t - / 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.) .
3of3
Form-D 05/08

M,
T—T.0
Pbint Caze Center
36'00'52"N Longitude 80'02'52"W
3himm Clam: C Receiving Sbreanr Rich Fork
3ub-Basin: 03-07-07 State Grid/ USGS C 18 SE/Kernersville, NC
)rainage M-don: Yadkin — Pee Dee Permitted Flow: 0.010 MGD
m
Facility
it
' f g",
S", "In
Orr
M
Location
�2
not to scale
I - DWDES PenrA NCO046035
No Forsyth Cotmty

NCDENR
North Carolina Department of Environment and Natural Resources
-Divigion of Water Quality
Michael F. Easley, Governor William G. Ross, -Jr., Secretary
Coleen H. Sullins, Director
August 15, 2008
RECEIVED
N.C. Dec)t of ENR
Mr. Quentin Lee Campbell
High Point Healthcare, Inc. AUG 1 2OQ8
3830 N Main St
Winston-Salem
High Point, NC 27265 Regional office
Subject: Renewal Notice
NPDES Permit NCO046035
High Point Healthcare
Forsyth County
Dear Permittee:
Your NPDES permit expires on April 30, 2009. Federal (40 CFR'122.41) and North Carolina (15A
NCAC 211.0105 (e)) regulations state that permit renewal applications must be filed at least 180 days prior
to expiration of the current permit. If you have already mailed your renewal application, you may
disregard this notice.
Your renewal package must be sent to the Division postmarked no later than November 1, 2008.
Failure to request renewal by this date may result in a civil penalty assessment. Larger penalties may be
assessed depending upon the delinquency of the request.
If any wastewater discharge will occur after April 30, 2009, the current permit must be renewed.
Discharge of wastewater without a valid permit would violate North Carolina General Statute 143-215.1;
unpermitted discharges of wastewater may be assessed civil penalties of up to $25,000 per day.
If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact
me at the telephone number or address listed below.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you
must submit with the permit renewal application. If you have any questions, please contact me at the
telephone number or e-mail address listed below.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarohna
Phone: [phone] / FAX [phone] / [e-mail] ;Vatmrally
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper -

NPDES PERMIT NCO046035
HIGH POINT HEALTHCARE
FORSYTH COUNTY
The following items are REQUIRED for all renewal packages:
➢ A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit. Submit one signed original and two copies.
➢ The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
➢ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, written documentation must be provided showing the authority delegated to any
such Authorized Representative (see Part II.B.11.b of the existing NPDES permit).
➢ A narrative description of the sludge management plan for the facility. Describe how sludge (or .other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following items must be submitted by anMunicipal or Industrial facilities discharging
process wastewater:
Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal
Regulations, Part 122) and ALL Municipal facilities with a permitted flow >_ 1.0 MGD must submit a
Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21.
The above requirement does NOT apply to privately owned facilities treating 100%
domestic wastewater, or facilities which discharge non process wastewater (cooling
water, filter backwash, etc.) _
Send the completed renewal package to:
Mrs. Dina Sprinkle
NC DENR / DWQ / Point Source ]Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

July 22, 2008
N.C. DENR Department
1617 Mail Service Center
Raleigh, N.C.27699-1617
To Whom It May Concern:
Atlantic Utility, Inc.
5320 Brittainywood Rd.
Kernersville, NC 27284
RECEIVED
N.C. Deot. of F"
JUL 2 9 2008
Winston-Salem
Regional office
r Carolina Meadows, Governor's
RC fo
Atlantic Utility, Inc. will no longer be ORC or Backup0our ORC and Backup ORC designation for
Club, and The Preserve as of July 31, 2008. In addition,
Woodlake ended as of June 30, 2008.
-� 5_4
Tim Waddell, ORC WW III #21891-SI#988694 ,, Sign and Date
7-2 -E
George Gatewood, ORC WWII #10684-CS-1-14160 '� �� �g7 Date
Richard Hughes, ORC WW III #12721, SS Sign and Date
Peter Saulsbury, ORC W W III #21219, Sign and Date
SI#986150,CS#25345
HIGH POINT CARE-WWTP" ^ 'NCU
CAROLINA MEADOWS WWTP NCO056413
GOVERNOR'S CLUB WWTP W00000088
THE PRESERVE WWTP W00018146
WOODLAKE WWTP NCO 19
1