NC0057223_Regional Office Historical File Pre 2016

RECEIVED
N.C. Deot. of ENR
d P-! C ^ 7000
tl,
Uf ostrn-saleim
Regional Office
July 2, 2008
Mr. Steve W. Tedder, Supervisor
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to the May 12, 2008 Notice of Violation (NOV-2008-LV-0211)
at Wilkinson Mobile Home Haven during February, 2008.
As the NOV noted, the February wastewater discharge experienced two (2) effluent
chlorine residual excursions and one (1) effluent Fecal Coliform exceedance.
These problems are felt to be related to the required balance of tablet chlorination to
reduce Fecal Coliform concentrations and the subsequent use of tablet dechlorination to
remove excess chlorine levels and meet the permitted chlorine residual limit of 17
micrograms per liter.
Periodically the tablets get hung in the tablet dispenser which contributes to a variability
in the desired chemical dosages. As a corrective measure, we will increase our inspection
of this process and routinely shake the dispenser to make sure the tablets are well
positioned in the wastestream flow.
I hope this information is helpful in addressing your request.
Sincerely,
Wilkinson M;IZ111
ome Have
A�
Denis Wilkinson
Permittee/Manager

r
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facilitit'I'X4
�mvso/L/
� Permit/Pipe No.: �DQS'�l ��3 Month/Year
Zoo g
Parameter
Monthly Average Violations
Permit Limit DMR Value % Over Limit
Weekly/Daily olations
Date Parameter Permit LimiDMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violatio s
Completed by: Date:
Regional Water Quality
Supervisor Signoff: Date:
919

O�O� wA7,�pG
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
-- Coleen H. Sullins Director '
Division of Water Quality
May 12, 2008
CERTIFIED MAIL 7007 3020 0000 6279 6955
RETURN RECEIPT REQUESTED
Dennis F Wilkinson
2880 S Stratford Rd
#6
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION- NOV-2008-LV-0211
Permit No. NCO057223
Wilkinson Mobile Home Haven
Forsyth County
Dear Mr Wilkinson:
A review of Wilkinson Mobile Home Haven's monitoring report for February 2008 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Chlorine, Total Residual
02/11/08
17 ug/l
42 ug/l
Daily Maximum
Exceeded
Coliform, Fecal MF, M-FC
02/25/08
400 #/100ml
6,000 #/100ml
Daily Maximum
Broth,44.5C
Exceeded
Chlorine, Total Residual
02/25/08
17 ug/1
51 ug/l
Daily Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
(�& rrlfl.-
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files —SWP
%, ®
— —----585 Waughtown Street — Winston-Salem, NC 27107 ----- 336-771-5000 (Telephone)--336-771-4630-(Fax)----- -

NPDES PERMIT NO: N00057223
FACILITY NAME: HEAD TRAILER PARK WWTP
OPERATOR IN RESPONSIBLE CHARGE (ORC):
CERTIFIED LABORATORY: 1 Tritest
CRECK BLOCK IF ORC HAS CHANGED
Mail original and one copy to:
ATT: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
N.C. Deot. of ENR u
Q 4100� APR 14 2008� .y6�`� RCN
Winston-Salem Y w
Regional Off - I I\6� MAR 2 8 2008
EFFLUENT 1 1�
DISCHARGE NO: 001 COUNTY t _QRSYTH ^/'K
CLASS: �V
MONTH: FEBRUARY YEAR:
Gar_k kd-
GRADE: IV PHONE: [phone]
PERSON(s) COLLECTING MPLES: (3alyWin0acK
5)/O)ll
(signature of opera r f responsible charge) DATE
BY THIS SIGNAP5E I CERTIFY THAT THIS REPORT IS
ACCURATE AN OMPLETE TO THE BEST OF MY KNOWLEDGE
50050
00010
00400
50060
00310
00610
00530
31616
00300 1
00600
00665
00545
00625
00340
00095
D
Operator
Certified
FLOW
GMETRIC
A
Arrival
Operator
ORC
EFF [XI
MEAN
T
Time:
Time On
on
INF [ I
RES.
BOD-5
FECAL
SETT.
E
2400 Clock
Site
Site?
RATE
TEMP.
pH
CL2
20DEG.0
NH3-N
TSS
COLIF.
` D.O.
T.-NIT.
T: PHO.
MATTER TKN
COD
COND.
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/L
MG/L
MG/L
umhos/cm
2
0.00060
4
1200
1.00
Y
0.00006
16.00
< 4.0
2.00
2.0
1.0
6
330 1
2.00
Y
0.00057
14.0
6.8
12.00
7.2
7
Y
AVERAGE
0.00051
13.3
21.4
1.3
1.48
2.3
51.8
7.4
MINIMUM
0.00006
12.0
6.7
10.0
< 4.0
1.00
1.0
< 1.0
7.0
�
���.;
:.:::::::::
�:::.:.:::::::
�::::::::::::
�.:::::::::::::
�::::..::..........................................................................................................
MONTHLY AVG. LIMIT
0.0016
10.0
4.00
30.0
200.0
iii£1<t!x3......................................................
.........
'
<
%<< <??�
'•< <Y''
z s
DAILY MAXIMUM LIMIT
1 1
6-9 1
17.01
15.0
20.00
45.0
400.0
REPLICA DEM FORM MR-1 (12/93)
NOTE: A numerical value of zero (one for Fecal Colifonns) was used for calculation on those
numbers reported as'less than' (<).

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements F7
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
ie facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
.. fi+...0 fn1,10 4— imT,Yn--Pnto to hP. T71Afj P.
ertify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
a a system designed to assure that qualified personnel properly gather and evaluate the information submitted. B ased on my inquiry
he person or persons who manage the system, or those persons directly responsible for gathering the information, the information
mitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
witting false information, including the possibility of fines and imprisonment for knowing violations."
Permittee (Please print or type)
�w-V zwr'
Signature of Permittee** Date
(Required)
Head Mobile Home Park 336-724-5911 May 31m 2009
mittee Address
Phone Number
PA12AMIC' TER CODES
110
Temperature
00556
Oil & Grease 00951 Total Fluoride
176
Turbidity
00600
Total Nitrogen 01002 Total Arsenic
180
Color (Pt -Co)
00610
Ammonia Nitrogen
182
Color (ADMI)
00625
Total Kjeldhal 01027 Cadmium
.
Nitrogen
195
Conductivity
00
Dissolved Oxygen
10
BOD5
,40
COD
-00
pH
�30
Total Suspended
Residue
45
Settleable Matter
00630 Nitrates/Nitrites 01032 Hexavalent Chromium
01034 Chromium
00665
Total Phosphorous
00720
Cyanide
00745
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
01067 Nickel
01077 Silver
01092 Zinc
01105 Aluminum
rermit izxp. Lace
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coli.form 71900 Mercury
32730 . Total Phenolics 81551 Xylene
01037
Total Cobalt
34235 Benzene
01042
Copper
34481 Toluene
01045
Iron
38260 MBAS'
01051
Lead
39516 PCBs
01062
Molybdenum
50050 Flow
ameter Code assistance may obtained by calling the Point Source Compliauce/Enforcement Unit at [phone] or by visiting
Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
s only units designated in the reporting facility's permit for reporting data.
RC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
f signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A Ok 2b-'O-
(D).

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Lithe Creek
LOCATION: 50 ft. Uostream of discharge point
** UPSTREAM **
001 MONTH: FEBRUARY YEAR: 2007
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge Point
E I2400
CLOCT MEK TEMP D.O. I pH I BOD-5 COD I F-COLIN I CONDUCTIVITY
18
::<:E
20
22
23
24
26
28
m
30
330 1 15.0
13.5 1 1.4
NOTE: A numerical value of zero (one for Fecal Coliforms) was used for calculation on those
numbers reported as lass than' (<).
** DOWNSTREAM **
2400
CLOCK I 20 C I G.MEAN
TIME TEMP I D.O. I pH BOD-5 COD F-COLI
MIN 1 13.0

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: LvILlimrt-onl Perri t/PipeNo.: N(,006 2,Z?2 Month/Year"ft76
COE4 b) M ffC 2,00-7
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Date Parameter
2-11-01k 'f�L
215-o8
2'25' ��c�g.� CAI, IF
Date . Parameter
Other Violations
Weekly 6olations
Permit Limitgype DMR Value % Over Limit
�
1 ,0 D ° o
Monitoring Frequency Violations
Permit Frequency Values Reported, # of Violations
Completed by: I Date: - L5 " Z - 0
Regional Water Quality
Supervisor Signoff: Date: cJ
Nov
► V0

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 05/02/08 Page: 1 of 2
u`Permif: r3 ^a�_ r. .`�;t�'�L*rre K77 ra-r,7 -.
an%�_
MRsBetw.e22D07 te orylic105722-
-..;s 61,
.n
'Facilit" Name,,°�° c,; Param,tVame °J° , Count °l° _ _ , - Subbasin:%i Violatian'Actian °fe
" Ma�OrrMinor '°f°-
.i
„T s.�..,a..._,.�.,.
PERMIT: NCO057223
FACILITY: Dennis F Wilkinson - Wilkinson Mobile Home Haven
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING
OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/09/07
Weekly
mg/I
7.5
14
Daily Maximum Exceeded
Proceed to
Enforcement Case
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/25/07
Weekly
mg/I
7.5
12
Daily Maximum Exceeded
Proceed to
Enforcement Case
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/30/07
Weekly
mg/I
5
6
Monthly Average Exceeded
Proceed to
Enforcement Case
08 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
08/08/07
Weekly
mg/I
7.5
8
Daily Maximum Exceeded
Proceed to NOV
10 -2007
001
Effluent
Chlorine, Total Residual
10/31/07
2 X week
ug/1-
17
31
Daily Maximum Exceeded
Proceed to
Enforcement Case
02 -2007
001
Effluent
Coliform, Fecal MF, M-FC
02/12/07
Weekly
#/100ml
400
1,100
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
08 -2007
001
Effluent
Coliform, Fecal MF, M-FC
08/08/07
Weekly
#/100ml
400
1,400
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
07 -2007
001
Effluent
Nitrogen, Ammonia Total (as
07/31/07
Weekly
mg/I
2
2.96
Monthly Average Exceeded
Proceed to
N)
Enforcement Case
10 -2007
001
Effluent
Nitrogen, Ammonia Total (as
10/31/07
Weekly
mg/I
2
3.38
Monthly Average Exceeded
Proceed to
N)
Enforcement Case
11 -2007
001
Effluent
Nitrogen, Ammonia Total (as
11/30/07
Weekly
mg/I
4
4.93
Monthly Average Exceeded
Proceed to NOV
12 -2007
001
Effluent
Nitrogen, Ammonia Total (as
12/31/07
Weekly
mg/l
4
4.66
Monthly Average Exceeded
No Action, BPJ
Monitoring
Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
05 -2007
001
Effluent
Chlorine, Total Residual
05/05/07
2 X week
ug/I
Frequency Violation
None

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 05/02/08 Page: 2 of 2
y,.� fr;
§ k o' t
Cate
�' 4g
-Violation o
Permit: noQ87223r Via, i MRs;Between 2 2007 and a 2048 r y"Region. l0 9 ry: %
Program Categoryto
te
.fa/
Fadili# Name Param,Naifie °f� r Count : °lo° Subbasm _°l¢
Y Y
Vlblatiari Action
x r.
Major
...n.L tl,.rcm:.aum..aVri+u✓._t:1., t �.a�u.a�.::r.. 'ems-Yii��, wa+.u_.u..w.....bu..a��.x, a. n...:.. �.+w:..«:_.Lu� a.0 :..�.bi.�iL�atkr.�uj re.3.b.wn.rr.. �xa6.W�.air� �u�_._.a.�.v__.__.�.>s�^ ....,rd>di...amcd,a._.a. .. wwc+,sw wc,. t���w�susaE
A.aFL4oce,g✓ab,
PERMIT: NCO057223 FACILITY: Dennis F Wilkinson - Wilkinson Mobile Home Haven COUNTY: Forsyth REGION: Winston-Salem
Reporting Violation
MONITORING OUTFALL/
REPORT PPI LOCATION
02 -2007 001 Effluent
03 -2007 001 Effluent
04 -2007 001 Effluent
VIOLATION
UNIT OF CALCULATED
PARAMETER
DATE
FREQUENCY
MEASURE LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
Temperature, Water Deg.
02/28/07
Weekly
deg c
Parameter Missing
No Action, BPJ
Centigrade
Temperature, Water Deg.
03/31/07
Weekly
deg c
Parameter Missing
None
Centigrade
Temperature, Water Deg.
04/30/07
Weekly
deg c
Parameter Missing
No Action, Data Entry
Centigrade
Error

f
i'. d_
LA
NCDENR
North Carolina Department of Environment and Natural. Resources
Division' of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Coleen H. Sullins, Director
March 27, 2008 RECEIVED
N.C, Dept. of EtNR
Mr. Dennis F. Wilkinson APR 0 12008
2880 South Stratford Rd, #6 Onston-sale-n ,
Winston-Salem, NC 27103 Regional °`"°e _
Subject: Issuance of Certificate of Coverage NCG551437
Rescission of NPDES Permit NCO057223
Wilkinson Mobile Home Haven WWTP
Forsyth County
Dear Mr. Wilkinson:
The Division has received and approved your request to transfer ownership of the former
Head Mo i1e H n e:Park' - WWTP, previously covered by permit NC0057223. Your request,
combined with,a revised facility evaluation from the NCDENR Winston-Salem Regional Office,
has resulted in a change in permit status for your facility.
The Division hereby issues Certificate of Coverage (CoC) NCG551437 to discharge under
wastewater General Permit NCG550000. This CoC is issued pursuant to the requirements of
North Carolina General Statue 143-215.1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection agency dated October 15, 2007 [or as
subsequently amended] .
Issuance of NCG551437 automatically rescinds permit NC0057223. Please carefully read
the attached General Permit and Technical Bulletin, as the limits and monitoring
requirements are very different from those in NC0057223. NOTE: The, annual fee for this
permit type is $60.00/year. You will,bebilled at a later date by the Division's Budget office.
If any parts, measurement frequencies or sampling requirements contained in this General _
Permit are unacceptable to you, you have the right to request an individual permit by submitting . _ .
an individual permit application. Unless such demand is made, the certificate of coverage shall
be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to
the Division. The Division may require modification or revocation and reissuance of the
certificate of coverage. Contact the Winston-Salem Regional Office prior to any sale or
transfer of the permitted facility. Regional Office staff will assist you in documenting
the transfer of this CoC.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
Nne
orthCarolina
naturally

r
o
If you have any questions concerning the requirements of the General Permit, please contact
Toya Fields [919 733-5083, extension 551 or [e-mail] or Susan Wilson [919 733-
5083, extension 510 or [e-mail]].
If you have any questions concerning the basis for this permit modification, please contact
Charles Weaver of the NPDES Unit at [phone], extension 511.
Sincerely,
Coleen H. Sullins
cc: Central Files
Winston-Salem Regional Office / Rose Pruitt`F
NPDES Unit

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG551437
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision 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,
Dennis F. Wilkinson .
is hereby authorized to discharge domestic wastewater [<1000. GPD] from a
facility located at
Wilkinson Mobile Home Haven
2880 South Stratford Road
Winston-Salem
Forsyth County
to receiving waters designated as an unnamed tributary to Little Creek, a class C stream in .
subbasin 03-07-04 of the Yadkin -Pee Dee River Basin in accordance with the effluent limitations,
monitoring requirements, and, other conditions set forth in Parts I, II, III and IV hereof.
This certificate of coverage shall become effective March 27, 2008.
This Certificate of Coverage shall expire on July 31, 2012. _
Signed this day March 27, 2008.
for Coleen- H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission.

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCO057223 111 121 08/03/26 117 18I CI 19I SI 20III
Remarks
211IIIIIII IIII IIII IIIIIIIIIIIIIIII IIIIIIIIIIII II16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ----------------------
67I 169 70III 711 I 721 NI 73I Iu_1 174 751 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):_:: .::• ..".
'
01=:30 PM 08/03/26
05/05/01 -
Wilkinson Mobile Home Haven
Exit Time/Date
Permit Expiration Date
2880 S Stratford Rd
Winston Salem NC 27103
02:30 PM 08/03/26
09/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Dennis F Wilkinson ,2880 S Stratford Rd Winston Salem NC
27103//336-575-8054/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit
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/Qffice/Phone and Fax Numbers Date
Rose Pruitt WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. '
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO057223 I11 12I 08/03/26 1
17 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Permittee Mr Head died 02/24/2008. Site visit to determine fate of Head MHP permit. Spoke with Mr
Head's sisters and partner Dennis Wilkinson. Mr Wilkinson submitted name/ownership change at that time.
Permit will change to SFR at that time. New permit # NCG551437 to Dennis F Wilkinson issued March 27,
2008.
Received notice from Thomas Moore in UST that ground water remediation site next door had broken
through and contaminated well. Residents notified by him not to drink water.
Page # 2

Permit: NC0057223
Inspection Date: 03/26/2008
Owner - Facility: Wilkinson Mobile Home Haven
Inspection Type: Compliance Evaluation
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
n
■
Is the facility as described in the permit?
n
n
n
■
# Are there any special conditions for the permit?
❑
0
❑
■
Is access to the plant site restricted to the general public?
0
0
El
■
Is the inspector granted access to all areas for inspection?
f_I
❑
01
■
Comment:
Page # 3

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E, Director
Division of Water Quality
SITRF CE, ER ROTECTION S:ECTT01�1:;.° '. ` •; , ,';:' : T
"PERMIT1VAIVIE/®WNEFZSIiIP;. CIKA'NG]E,EO1,:
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
II. Permit status pr to status change.
a. Permit issued to (company name): Anof)I Lb 't kMI—=: I?a&K�-
b. Person legally responsible for permit: 1P-- 4:4 EGAD
First / MI / Last
Title
Permit Holder Mailing Address
1N wSZp,k)- 5g1Em NC__ 2. 7/®3
City State Zip
( ) ( )
Phone Fax Q
c. Facility name (discharge): -0 U-,6 D (hot->) Le -�AQ,(Y)T-,-
d. Facility address: Soul-li 61-"
Address
Vy,N��cN 9Lan tzc 76o3
City State Zip
e. Facility contact person: ( )
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain.-
b. Permit issued to (company name): oy/,(
c: Person legally responsible for permit: 7J,= ,r.�; C %'� 1i�/Z<_&110V;6 j
First / MI / Last
Title
Permit Holder Mailing Address
VJ - ¢ y, N C .D.716 3
City State Zip
(334 5 %55!
Phone E-mail Address 1
d. Facility name (discharge): 11st 14, titj S o,vt l?gOBi 41t_ /.7;VtE._
e. Facility address:
Address
City State Zip
f. Facility contact person:o
First / MI / Last
Phone E-mail Address
Revised 7/2005

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact: ,1 emuI
T First / MI / Last
`tom Title � 1
7 PC rZjJ 1` P
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
l�Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed, or a bill
of sale) is required for an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
.................................................................................................
The certifications. below must be completed and signed by both the permit holder prior to the change, and the new
applicant in the case of an ownership change request. For a name change request, the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1 -Y� �L . • F11 S e-?:> , attest that this application for a name/ownership
change. has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included, this
application package will be returned as incomplete.
Signature
APPLICANT CERTIFICATION:
Date
I 7 ii✓✓,i�% del/ O ,k, .,V ' attest that this application for a name/ownership
change has been reviewed and is accurate and complete to the best of my knowledge. I understand.that if all required
parts of this application are not completed and that if all required supporting information is not included, this
application package will be returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2005

NORTH CAROLINA
DEPARTMENT OF
ENVIRONMENT AND
NATURAL RESOURCES
FAX TRANSMITTAL
Water Quality Section
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, N.C. 17107
Phone: [phone]
TO:
Fax: [phone]
FAX NUMBER: , ' . —7 9 0 -7 I Gf
FROM: ��5y I I
DATE: 3 — Z 7
Number of pages (including cover page):
COMMENTS:

[Fwd: Bennett and Bailey]
f .. 4
Subject: [Fwd: Bennett and Bailey]
From: Thomas Moore <[e-mail]>
Date: Thu, 27 Mar 2008 12:58:38 -0400
To: Rose Pruitt <[e-mail]>
------- Original Message--------
Subject:Bennett and Bailey
Date:Tue, 25 Mar 2008 17:03:17 -0400
From:Joe Best <[e-mail]>
To:thomas moore <[e-mail]>
Thomas,
I just received the lab report for Bennett and Bailey. We have four PAHs in the water supply well sample.
One, benzo (a) anthracene is above the 2L. For some reason the lab did not send an electronic copy of
the lab report ... so I am just sending the relevant page.
Thanks,
Joe Best
Best Geological and Environmental Consulting, P.A.
1009 Hayfield Lane
Greensboro, NC 27410
[phone] Phone
[phone] Fax
[phone] Cell
best6778(c)-bel[south. net
Thomas Moore
NC DENR Winston-Salem Regional Office
Division of Waste Management, UST Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
Thomas Moore <Thomas. Moorea,NCmail.net>
WSRO
NC DENR
j� Content -Type application/pdf
03-39-1ab.pdf
Content -Encoding: base64
1 of 1 3/27/2008 1:08 PM

Pace Analytical Services, Inc. Pace Analytical Services, Inc.
/f ® 2225 Riverside Dr. 9800 Kincey Ave. Suite 100
* aceAnalytical Asheville, NC 28804 Huntersvilie, NC 28078
/ www.pacalabS.cam
[phone] [phone]
ANALYTICAL RESULTS
Project: BENNETf & BAILEY 03-39
Pace Project No.: 9214544
Sample: WWI Lab ID: 9214544007 Collected: 02/28/08 14:30 Received: 02/29/08 16:08 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qua[
602 Purgeable Aromatics Analytical Method: EPA 602
Benzene
ND ug/L
1.0
1
03/04/08 00:31
71-43-2
Chlorobenzene
ND ug/L
1.0
1
03/04/08 00:31
108-90-7
1,2-Dichlorobenzene
ND ug/L
1.0
1
03/04/08 00:31
95-50-1
1,3-Dichlorobenzene
ND ug/L
1.0
1
03/04/08 00:31
541-73-1
`1,4-Dichlorobenzene
ND ug/L
1.0
1
03/04/08 00:31
106-46-7
Diisopropyl ether
ND ug/L
1.0
1
03/04/08 00:31
108-20-3
Ethylbenzene
ND ug/L
1.0
1
03/04/08 00:31
100-41-4
Methyl-tert-butyl ether
ND ug/L
1.0
1
03/04/08 00:31
1634-04-4
Toluene
ND ug/L
1.0
1
03/04/08 00:31
108-88-3
m&p-Xylene
ND ug/L
2.0
1
03/04/08 00:31
1330-20-7
o-Xylene
ND ug/L
1.0
1
03/04/08 00:31
95-47-6
1-Chloro-3-fluorobenzene (S)
98 %
65-137
1
03/04/08 00:31
625-98-9
200.7 MET ICP, 3030C
Analytical Method: EPA 200.7 Preparation Method: SM 3030C
Lead
ND ug/L
5.0
1
03/02/08 08:30
03/03/08 21:35
7439-92-1
8270 MSSV PAH by SIM SPE
Analytical Method: EPA 8270 by SIM Preparation
Method: EPA 3535
Acenaphthene
ND ug/L
2.0
1
03/06/08 00:00,
03/10/08 18:40
83-32-9
Acenaphthylene
ND ug/L
1.5
1
03/06/08 00:00
03/10/08 18:40
208-96-8
Anthracene
0.23 ug/L
0.050
1
03/06/08 00:00
03/10/08 18:40
120-12-7
Benzo(a)anthracene
0.16 ug/L
0.10
1
03/06/08 00:00
03/10/08 18:40
56-55-3
Benzo(a)pyrene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
50-32-8
Benzo(b)fluoranthene
ND ug/L
0.30
1
03/06/08 00:00
03/10/08 18:40
205-99-2
Benzo(g,h,i)perylene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
191-24-2
Benzo(k)fluoranthene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
207-08-9
Chrysene
0.16 ug/L
0.10
1
03/06/08 00:00
03/10/08 18:40
218-01-9
Dibenz(a,h)anthracene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
53-70-3
Pluoranthene
ND ug/L
0.30
1
03/06/08 00:00
03/10/08 18:40
206-44-0
_Fluorene
ND ug/L
0.31
1
03/06/08 00:00
03/10/08 18:40
86-73-7
Indeno(1,2,3-cd)pyrene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
193-39-5
1-Methylnaphthalene
ND ug/L
2.0
1
03/06/08 00:00
03/10/08 18:40
90-12-0
2-Methyl naphthalene
ND ug/L
2.0
1
03/06/08 00:00
03/10/08 18:40
91-57-6
Naphthalene
ND ug/L
1.5
1
03/06/08 00:00
03/10/08 18:40
91-20-3
Phenanthrene
ND ug/L
0.20
1
03/06/08 00:00
03/10/08 18:40
85-01-8
Pyrene
0.17 ug/L
0,10
1
03/06/08 00:00
03/10/08 18:40
129-00-0
Nitrobenzene-d5 (S)
70 %
50-150
1
03/06/08 00:00
03/10/08 18:40
4165-60-C
2-Fluorobiphenyl (S)
79 %
50-150
1
03/06/08 00:00
03/10/08 18:40
321-60-8
Terphenyl-d14 (S)
85 %
50-150
1
03/06/08 00:00
03/10/08 18:40
1718-51-C
Date: 03/18/2008 04:33 PM REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
E N _c COqq
Page 10 of 25

i
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Vo 3 a�
it
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i

Re: Head MHP penalties
Subject: Re: Head MHP penalties
From: Charles Weaver <[e-mail]>
Date: Mon, 24 Mar 2008 12:43:55 -0500
To: [e-mail]
CC: "Susan. A. [e-mail]" <[e-mail]>, [e-mail]
Steve Tedder wrote:
Charles, what outstanding penalties are floating around??? I'd be willing to zero theirs out.
There's only one unpaid case: LV-2008-0039, total due = $539.50. All other cases in BIMS are paid /
closed. .
We obviously will need to do a name change. I'll ask Rose to get up with the other person listed on
the tax listings to see if he will request a naive change. Would be nice if we could do the naive
change and issuance if the GP all at once.
That would be my preference also.
If they paid their previous annual fee for the individual, hopefully we can find a way to issue the
GP without additional fees.
We should be able to - I just need help from Fran / Jenn to figure out how it can be done.
CHW
l of 1 3/24/2008 2:24 PM

Re: Head MHP NCO057223
Subject: Re: Head MHP NCO057223 I
From: Steve Tedder <[e-mail]>
Bate: Mon, 24 Mar 2008 13:36:10 -0400
To: Charles Weaver <[e-mail]>
CC: "[e-mail]" <[e-mail]>, [e-mail]
Charles,
The system has the minimum treatment units (septic tank, sandfilter, chlorine and dechlor.)
Charles, what outstanding penalties are floating around??? I'd be willing to zero them out.
We obviously will need to do a name change. I'll ask Rose to get up with the other person listed on the
tax listings to see if he will request a name change. Would be nice if we could do the name change and
issuance if the GP all at once. If they paid their previous annual fee for the individual, hopefully we can
find a way to issue the GP without additional fees.
Tedder
Steve Tedder
[e-mail]
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336)-771-4950
Fax [phone]
On 3/24/2008 1:08 PM, Susan.A.Wilson(a,ncniail.net wrote:
That does sound like a good solution based on the flow being less than
1000 gpd - and we didn't think of that either. Do they have the
minimum treatment units required of NCG55?
Charles - I think we can do that and just modify the COC to state that
no more units should be connected while under the GP (also put in the
cover letter). and they have the option/requirement to go to an
individual permit if it is sold and they want to add more mobile homes
(unless they're at zero 7g10/ 0 30g2).
Charles - since I'm out of the office - just work with Tedder re.
however you guys want to resolve the penalties, etc. (can't remember
all the details on this one).
Steve Tedder <Steve.Tedder(a),NCmail.net>
WSRO
NC DENR
1 of 1 3/24/2008 2:25 PM

Re: Head MHP NCO057223
Subject: Re: Head MHP NCO057223
From: Charles Weaver <[e-mail]>
Date: Mon, 24 Mar 2008 12:33:')6 -0500'
To: " Susan.A. Wilson@ncmail. net" <[e-mail]>
CC: [e-mail], [e-mail]
I'll prepare the documents to convert this to a CoC under NCG550000.
I'll need help from Jenn to figure out how to make the switch in BIMS. I'll need to create an
application, which I can't do without a fee ... but i think I can transfer part of the annual fee from the
existing permit.
Steve / Rose - to whom should I address the cover letter? Wilkinson or Head's brother?
Thanks,
CHW
1 of 1 3/24/2008 2:26 PM

Re: Head MHP NCO057223
Subject: Re: Head MHP NCO057223
From: "[e-mail]" <[e-mail]>
Date: Mon, 24 Mar 2008 13:08:12 -0400 (EDT)
To: <[e-mail]>, Charles Weaver <[e-mail]>
CC: <[e-mail]>
That does sound like a good solution based on the flow being less than
1000 gpd - and we didn't think of that either. Do they have the
minimum treatment units required of NCG55?
Charles - I think we can do that and just modify the COC to state that
no more units should be connected while under the GP (also put in the
cover letter). and they have the option/requirement to go to an
individual permit if it is sold and they want to add more mobile homes
(unless they're at zero 7g10/ 0 30g2).
Charles - since I'm out of the office - just work with Tedder re.
however you guys want to resolve the penalties, etc. (can't remember
all the details on this one).
] of 1 3/24/2008 2:26 PM

RECEIVED
N.C. Dept. of ENR
MAR 1 7 2008
Winston-Salem
Regional Office
March 6, 2008
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618 -- --
Dear Sirs,
I am writing to notify your office that effective March 14, 2008, Gary Stainback
(certification 99674) will no longer serve as the Operator -in -Responsible Charge (ORC)
for Head Mobile Home Park Wastewater Treatment System (NC0057223).
Please modify your records to reflect this change.
If you have any questions, please contact me at your convenience.
Cc: Dennis Wilkinson, Head MHP
Jamie Whitten, Backup ORC
Rose Pruitt

March 6, 2008
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Dear Sirs,
I am writing to notify your office that effective March 14, 2008, Jamie Whitten
(certification #16889) will no longer serve as the Back-up Operator -in -Responsible
Charge (ORC) for Head Mobile Home Park Wastewater Treatment System
(NC0057223).
Please modify your records to reflect this change.
If you have any questions, please contact me at your convenience.
Sincerely,
0-�
Jamie Whitten
Back-up ORC
Cc: Dennis Wilkinson, Head MHP
Gary Stainback
Rose Pruitt

Head t IHP NCO057223
i
Subject: Head MHP NC0057223
From: Steve Tedder <Steve. Tedder@ncmail. net>
Date: Mon, 24 Mar 2008 11:04:43 -0400
To: Charles Weaver <[e-mail]>, Susan A Wilson <[e-mail]>
CC: [e-mail]
The issues at at this facility have been continuous since Feb 2003, when the limits changed from 30/30
to 5/2. I think the attached information that Rose has compiled gives a good picture of what we are
dealing with.
This is one that that there are no easy answers and that the ability to upgrade the facility or tie on to
municipal system is not available financially to whomever ends up owning this property.
After looking at the entire history of this facility and with the current ownership issues and based on the
small flows (494 gpd based on last 12 months avg) that enter this facility, it is my recommendation that
we change this individual permit to a NCG550000 general permit.
When I think of all the NOVs, assessments, and all the work associated with the compliance end of
things, I hate I did not come to this conclusion back in 2004. I guess the light bulb illuminates slower
now.
I think a GP could be issued and the cover letter qualify that no additional units (trailers) can be
connected to the system and if any connected then this would then again become an individual permit
with the limits in the current permit. I think the Division's resources and the AG's would be better spent
working on other compliance and enforcement issues.
Lets us know what you guys think. Give me a call if questions.
Tedder
-------- Original Message--------
Subject:Head
Date:Mon, 24 Mar 2008 09:40:53 -0400
From:Rose Pruitt <Rose.Pruitt(a,ncmail.net>
Reply -To : Rose.Pruitt(a,NCmail.net
Organization:NC DENR - Winston-Salem Regional Office
To: Steve Tedder <Steve.Tedder(a,ncmail.net>
Attached write up about Head. Let me know if you want anything added or subtracted. Feel free to
make changes.
Rose Pruitt
NCDENR-DWQ Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
Steve Tedder
Steve.Tedderdncmail.net
NC DENR Division of Water Quality
1 of 2 3/24/2008 11:23 AM

b
Mr. Hubert Head, owner of Head Mobile Home Park, held an NPDES Permit
(NC0057223) to discharge wastewater from his facility. Mr Head died February 24,
2008 without a will. He is survived by a brother and several sisters. His family does not
appear to be interested in running the MHP. Additionally, Mr Head is reported to have a
business partner, Mr Dennis Wilkinson who still resides at the mobile home park. The
future of the park is uncertain. Mr Wilkinson has expressed an interest in remaining and
possibly operating the park and WWTP but may be unable to financially achieve that
goal.
The Head Mobile Home Park consists of four occupied mobile homes, Mr Wilkinson
lives in one, his mother lives in one and the other 2 are rented out. It has been reported
that Mr Head's trailer will be sold and removed from the property.
The WWTP is currently without an operator as of March 14, 2008 when ORC Gary
Stainback and backup ORC Jamie Whitten resigned. There appear to be some financial
restraints that prevent Mr Wilkinson from hiring another operator. Mr Head was
reportedly subsidizing the operation of the WWTP from his personal funds.
The Head Mobile Home Park is permitted to discharge 0.0016 million gallons per day
from a design subsurface treatment system that incorporates a septic tank, distribution
box, subsurface sand filter, tablet chlorinator, and a contact chamber/post aeration
chamber into an Unnamed Tributary to Little Creek in the Yadkin River Basin. The
facility currently discharges around 450 gallons/day. There are only 4 trailers at this
MHP.
Operations at this facility have been marginal over the last decade, BIMS shows this
permit was originally issued in 1984. The facility was constructed many hears ago and
really hasn't been updated since. Over the past 3 years the facility has had violations for
26 of the last 36 months. There were 9 daily and 2 monthly BOD violations, 5 daily max
violations for fecal coliform, 14 monthly violations for ammonia, 3 violations for total
suspended solids and 1 violation for total residual chlorine.
Winston Salem/Forsyth County Utilities has confirmed that connection to water and
sewer would be cost prohibitive for this location. There is a 42" water transmission line
nearby that carries water from the Yadkin River to the Neilson WTP but taps are not
allowed to this line. There is a newer neighborhood with water and sewer uphill about
1000 feet but easements and connection to their lines (which come in through the back of
the development) would be cost prohibitive at approximately $50-$100 per foot of line,
and/or the necessity of building a pump station for wastewater.
While this waste water facility may appear on paper to be a significant violator it is in
fact more similar to the numerous single family residences DWQ permits in this county.
It may be prudent to consider a change in classification for this facility from small
package plant to single family residence. Doing so will remove most of the financial
pressure from the owner and allow him to remain on his property. The effect on the
environment will remain about the same.

i
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Permit/Pipe No.: NC 00 5 7 Z onth/Year DfL
0 '7
(Monthl' verage Violations
Parameter Permit Limit DMR Value % Over Limit
" .,P 1A,
O
Weekly/Daily Violations
Date - Parameter Permit LirrijuTvpe DMR Value % Over Limit
Monitorin,- Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
r
Completed by:. Date: F � � —0e
Regional Water Quality
Supervisor Sianoff: Date:

RECEIVED
N.C• DeDt Of ENR
P
FEB 2 5 2008
Winston sale,-
I
A
Reoional077iCA
'
FEB
1 � 2008
EF ENT
KN
15 2008
001 COUNTY: ORSYTFI :17FEB
NPDES PERMIT NO: N00057223
DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
CLASS: I
MONTH: DECEMBER
YEAR: 2007
OPERATOR IN RESPONSIBLE CHARGE (ORC):
Ga Sfai Ck
GRADE: IV
PHONE: [phone]
CERTIFIED LABORATORY: 1 Tritest
PERSON(s) COLLECTIN SAMPL S:
Ga Ste' Ck
['HECK BLOCK IE ORC HAS CHANGED
Mailoriginalandone copy to:
Z/-A
ATT: Central Files
(si ur f opera r
f res onsible charge) DATE
Division of Water Quality
1617 Mail service Center
BY THIS SIGNA
I CERTIFY THAT THIS REPORT IS
Raleigh, NC 27699.1617
ACCURATE A
MPLETE TO THE BEST OF MY KNOWLEDGE
50050
00010
00400
50060
00310
00610
00530
31616
00300
00600
00665
00545
00625
00340
00095
D
operator
Certified
FLOW
GMETRIC
A
Arrival
Operator
ORC
EFF IX]
MEAN
SETT.
T
Time:
Time On
On
INF j I
H
RES.
CL2
BOD-5
20DEG.0
NH3-N
TSS
FECAL
COLIF.
' D.O.
T.-NIT.
T: PHO.
MATTER TKN
COD
COND.
E
2400 clock
Site
Site?
RATE
MGD
TEMP.
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/L
MG/LX.
MG/
umhos/cm
:::::: a ::: :::
................::
2
0.00051
4
946
2.00
Y
0.00049
15.0
6.7
15.00
< 4.0 L
9.20
2.0
1 3.0
6.9
---LIA/i11/k1=1•--
Nam
ME
®
-__
1 111 .
__------------
ZMEME
1 //9.e
EM
W
mom
lots.
__-----------
24
750
2.00
Y
0.00041
14.0
6.8
10.00
< 4.0
1.80
1.0
< 1.0
7.1
26
0.00042
28
0.00040
30
0.00042
AVERAGE
0,00067
14.6
12.6
1.4
4 j 4T86
2.0
4.7
6.9
19.85
7.40
14.00
MINIMUM
0.00039
14.0
6.6
10.0
< 4.0
1.20
<
1.0
< 1.0
6.8
19.85
7.40
14.00
�acnR>��;Jar;ab���>:�>::>:«:::>::>:�>::<::�
:<:::>:z::;;>:<:::;:.:;.;:.:.::.;�;:.::.:;.;�;;;:
<.;:.::;.::
�:.:::::::.�:::�.•
::..:::::::.................................
MONTHLY AVG. LIMIT
0.0016.
1
10.0
4.00
30.0
200.0
::?::::f::Y:;::i:�;;:
:.,;:..>�.i`EEIVEET'���?�'i`?E���>
il11EEf4Ll!:1�..>..........:..........................
`��?`�
�''EEy'��E
s?>`>'�`?
� ��E
:<?�c?'�'SE`#
�3`�
:::::::isis:`>::'?:•'S
:::::::::::::::::E:E�::::::
:::>;`;:?::::::::
%:i:::?:::::<::i:
DAILY MAXIMUM LIMIT
6-9
17.0
15.0
20.00
45.0
400.0
REPLICA DEM FORM MR-1 (12193)
NOTE: A numerical value of zero (one for Feral Coliforms) was used for calculation on those
numbers reported as 'less than' (<).

r
Facility 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, facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
a. time -table for imurovements to be made. e
ertify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
1 a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
ie person or persons who manage the system, or those persons directly responsible for gathering the information, the information
pitted ig, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
hitting false information, including the possibility of fines and' priso (Nit fo know-
n ,violations."
Permittee (Please print or type)
� I -- zS - o
Signature of Permittee" Date
(Required)
Head Mobile Home Park
nittee Address
336-724-5911
Phone Number
pARAME TER CODES
10
Temperature
00556
Oil &z Grease
00951
Total Fluoride
76
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
80
Color (Pt -Co)
00610
Ammonia Nitrogen
82
Color (ADMI)
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
95
Conductivity
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
00
Dissolved Oxygen
01034
Chromium
10
BOD5
00665
Total Phosphorous
40
COD
00720
Cyanide
01037
Total Cobalt
00
pH
00745
Total'Sulfide
01042
Copper
30
Total Suspended
00927
Total Magnesium
01045
Iron
Residue '
00929
Total Sodium
01051
Lead
45
Settleable Matter
00940
Total Chloride
01062
Molybdenum
May 31m 2009
Permit Exp. Date
01067
Nickel 50060 Total
01077
Silver Residual
01092
Zinc Chlorine
01105
Aluminum
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 . Total Phenolics 81551 Xylene
34235 Benzene
34481 Toluene
38260 MBAS'
39516 PCBs
50050 Flow
ureter Code assistance may obtained by calling the Point Source CompliancclEnforcement Unit at [phone] or by visiting
Water Quality Section's web site at h2o enr.state.nc.us/was and linking to the Unit's information pages.
only units designated in the reporting facility's permit for reporting data.
RC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
f signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCA&2B .0506"($)

NPDES NO: N00057223 DISCHARGE NO: 001
FACILITY NAME: HEAD TRAILER PARK VAVTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
UPSTREAM
-
-
Nrrr r
1N
E
I
=mom
MMEIMMMEM
EM
EM
MEN=
Em
MMIM
ONE=
EMIMIM
MMENEM
ME
EMEM
JIM
MMIMIM
ENRON
111gling
EM
OEM=
Ewm�z=
Em
RUNIM
MEMMEMM
NOTE: A numerical value of zero (am for Fecal Coliforms) was used for calculation on those
numbers reported as 'less than' (c).
MONTH: DECEMBER
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge point
** DOWNSTREAM **
YEAR: 2007
00010 00300
2400
CLOCK 20 C G.MEAN
TIME TEMP D.O. pH BOD-5 COD F-COLI CONDUCTIVITY
15.0
1010 1 14.0
3.7
41,2
3.2

ULow"-,
(,a.* -
vVW,5 o y
MONITORING REPORT(MR) VIOLATIONS for:
S
Report Date: 03/20/08 Page: 1 of 5
`Permit:• �nc0457223
:n = MRs Bettinieerr 1 2005 ' and 12-2007
'i
' ` Re ionLL %
Violation Categdry: %
Pro ram Cate o % i
g g ry;
Facility Name: 116.
Param Name: %
County: %
Subbasin: %
Violation Action:% -
Major Minor: %..
r.
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI,
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
09 -2005
001
Effluent
BOD, 5-Day (20 Deg. C)
09/13/05
Weekly
mg/I
7.5
9
10 -2005
001
Effluent
BOD, 5-Day (20 Deg. C)
10/13/05
Weekly
mg/I
7.5
10
05
03 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
03/13/06
Weekly
mg/I
15
20
�• s
3�
03 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
03/31/06
Weekly
mg/I
10
11.25
05 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
05/01/06
Weekly
mg/1
7.5
12
10 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/02/06
Weekly
mg/I
7.5
8
10 -2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/16/06
Weekly
mg/I
7.5
9
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/09/07
Weekly
mg/I
7.5
14
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/25/07
Weekly
mg/I
7.5
12
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/30/07
Weekly
mg/I
5
6
08 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
08/08/07
Weekly
mg/I
7.5
8
10 -2007
001
Effluent
Chlorine, Total Residual
10/31/07
2 X week
ugh
17
31
02 -2005
001
Effluent
Coliform, Fecal MF, M-FC
02/22/05
Weekly
#/100ml
400
3,500
Broth,44.5C
02 -2005
001
Effluent
Coliform, Fecal MF, M-FC
02/28/05
Weekly
#/100ml
400
3,500
Broth,44.5C
11 -2006
001
Effluent
Coliform, Fecal MF, M-FC
11/29/06
Weekly
#/100ml
400
430
Broth,44.5C
VIOLATION TYPE
VIOLATION ACTION
Daily Maximum Exceeded
Proceed to NOV
Daily•Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
Proceed to
Enforcement Case
Monthly Average Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Penalty Retracted
Daily Maximum Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Proceed to
Enforcement Case
Monthly Average Exceeded
Proceed to
-_,
Enforcement Case
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
Proceed to
Enforcement Case
Daily Maximum Exceeded
Proceed to NOV
Daily Maximum Exceeded
No Action, Data Entry
F rr0 f
Daily Maximum Exceeded
Proceed to NOV

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 03/20/08 Page: 2 of 5
Permit:„6c0057223 MRs Between 1 2005 . ;.and 12-200? Re Iori: % Violation Category: % ,Program Category:°fo
k �.� :: �„ �x ,. "'E' .:: � < `� � tYN: 7 i r��g
9 -. ;
FacilityNarne: °f� �� ° Pararri Name °lay>County'°/d Subbasin: °loVtolation�Action:
MaJorMinor % �°
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALLI
VIOLATION
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
01 -2007
001
Effluent
Coliform, Fecal MF, M-FC
01/16/07
Weekly
Broth,44.5C
rr
'I3w
02 -2007
001
Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
02/12/07
Weekly
08 -2007
001
Effluent
Coliform, Fecal MF, M-FC
08/08/07
Weekly
Broth,44.5C
02 -2005
001
Effluent
Nitrogen, Ammonia Total (as
02/28/05
Weekly
06 -2005
001
Effluent
Nitrogen, Ammonia Total (as
06/30/05
Weekly
s
07 -2005
001
Effluent
Nitrogen, Ammonia Total (as
07/19/05
Weekly
3/
07 -2005
001
Effluent
Nitrogen, Ammonia Total (as
07/31/05
Weekly
01 -2006
001
Effluent
Nitrogen, Ammonia Total (as
01/31/06
Weekly
02 -2006
001
Effluent
Nitrogen, Ammonia Total (as
02/28/06
Weekly
03 -2006
001
Effluent
Nitrogen, Ammonia Total (as
03/31/06
Weekly
04 -2006
001
Effluent
Nitrogen, Ammonia Total (as
04/30/06
Weekly
09 -2006
001
Effluent
Nitrogen, Ammonia Total (as
09/30/06
Weekly
10 -2006
001
Effluent
Nitrogen, Ammonia Total (as
10/31/06
Weekly
07 -2007
001
Effluent
Nitrogen, Ammonia Total (as
07/31/07
Weekly
UNIT OF
CALCULATED
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
#/100ml
400
410
Daily Maximum Exceeded
No Action, BPJ
#/100ml
400
1,100
Daily Maximum Exceeded
Proceed to NOV
#/100ml
400
1,400
Daily Maximum Exceeded
Proceed to NOV
mg/I
4
5.95
Monthly Average Exceeded
Proceed to NOV
mg/I
2
2.43
Monthly Average Exceeded
Proceed to
Enforcement Case
mg/I
10
10.6
Daily Maximum Exceeded
Proceed to
Enforcement Case
mg/1
2
4.97
Monthly Average Exceeded
Proceed to
Enforcement Case
mg/I
4
4
Monthly Average Exceeded
No Action, BPJ
mg/I
4
6.65
Monthly Average Exceeded
Proceed to
Enforcement Case
mg/I
4
6.7
Monthly Average Exceeded
Proceed to
—
Enforcement Case
mg/I
2
2.78
Monthly Average Exceeded
Proceed to NOV
mg/I
2
2.05
Monthly Average Exceeded
No Action, BPJ
mg/I
2
2.9
Monthly Average Exceeded
Proceed to
Enforcement Case
mg/I
2
2.96
Monthly Average Exceeded
Proceed to
Enforcement Case

MONITORING REPORT(NR)VIOLATIONS for:
Report Date: omumo
page 3m5
rMn
PERMIT: NCO057223
FACILITY: Head Mobile Home Park ' Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MownnmwonurpALL/
mouAT/ow
UNIT OF
CALCULATED
«Ep»nr pp/
LooAnow
pAnAmsTsn
o»Ts
rnsouswov
MEASURE
um/r VALUE
VIOLATION TYPE
VIOLATION ACTION
10'2007 001
Effluent
Nitrogen, Ammonia Total (as
10/31/07
Weekly
mg/|
u 3.38
Monthly Average Exceeded
Proceed to
N)
Enforcement Case
11 2007 001
Effluent
Nitrogen, Ammonia Total (as
11/3nm7
Weekly
mg/|
4 493
Mont6|yAverage Exceeded
Proceed tuNOV
N)
~--
1u'2oo7 001
Effluent
Nitrogen, Ammonia Total (as
12/3107
VVoomy
mg8
4 4.66
Monthly Average Exceeded
mono
------
m)
--
n0'znun 001
Effluent
nu|idn Total
'
n01o0o
��omy
mg8
4o 4e
Daily
Proceed to
Enforcement Case
Ap
�,
Proceed to
� no'cuos 001
Effluent
8o|�s.To�|Susn*nueu
na�10m
vvo�Ny
mg�
45 76
oai�M��mumExonodod
(o�
�_
Enforcement Case
00'2005 001
Effluent
Solids, Total Suspended
06/3005
Weekly
mg/I
an 40.5
Monthly Average Exceeded
Proceed to
Enforcement Case
Monitoring Violation
mow/romwo ourFAu/
wouT/ow
UNIT OF
CALCULATED
REPORT pp/
LooArmw
pAnxmersn
o*re
Fneouewov
msAaunE
um/r VALUE
VIOLATION TYPE
VIOLATION ACTION
04'2006 001
Effluent
sOD.o'Day(aoDeg. C)
04/2e06
Weekly
mg/|
Frequency Violation
NuAction, ePJ
07'2006 001
Effluent
Chlorine, Total Residual
07/2206
zXweek
ug/|
Frequency Violation
None
05'2007 001
Effluent
Chlorine, Total Residual
0505/07
uX week
ug8
Frequency Violation
None
04'2000 001
Effluent
o»|«»nn'Fecal MF'w-F«
04/2e06
Weekly
#UOUm|
Frequency Violation
woAction, opu
omm.44.5n
o*'z000 001
Effluent
DO, Oxygen, Dissolved
04/2906
VVoomy
mg/I
Frequency Violation
NoAction, aPJ
04'2008 001
Effluent
Nitrogen, Ammonia Total (as
04/29/08
Weekly
mg8
Frequency Violation
No Action, epJ
N)
os zonn 001
Effluent
Nitrogen, Total (as N)
06/3005
Quarterly
m0/I
Frequency Violation
Proceed to
Enforcement Case

MONITORING REPORT(NR)VIOLATIONS for:
Report Date: 03/20/08
page: 4 of
Param Name: W
%
Violation Action' IX
ajor Minor,
PERMIT: NCO057223
FACILITY: Head Mobile Home Park - Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Monitoring Violation
wmwnomwaoornAu/
vmuATmw
UNIT OF
CALCULATED
nEp»nr pp/ uooArow
pAnAMersn
oArs
pmsuuswo,
MsAa»ne
LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
ws'000* 001
Effluent
Phosphorus, Total (as P)
003005
Quarterly
mo8
Frequency Violation
Proceed to
Enforcement Case
04'2006 001
Effluent
Solids, Total Suspended
04/2906
vVnoNy
mg8
Frequency Violation
wvAction, oPJ
04 uOOO 001
Effluent
Temperature, Water Deg.
04/2e06
Weekly
deg
Frequency Violation
NoAction, BrJ
Centigrade
04'2806 001
Effluent
pH
04/2906
Weekly
ou
Frequency Violation
NuAction, oPJ
Reporting Violation
mownnmwu uuTFALL/
wouTmw
UNIT OF
oALouuATso
nEPonr pp/ Loo/Tmm
PARAMETER
oArs
pRsouEwo'
MsAouns
uM/r VALUE
VIOLATION TYPE
VIOLATION ACTION
Oo 0000 001
Effluent
Temperature, Water Deg
0581/00
Weekly
deg
Parameter Missing
NuAction, BpJ
uonooraoo
07'2006 001
Effluent
Temperature, Water Deg.
07/3106
VVoemy
deg o
Parameter Missing
None
Centigrade
oo'aoOn 001
Effluent
Temperature, Water Deg.
08/3106
Weekly
deg
Parameter Missing
muno
Centigrade__
09'2005 001
Effluent
Temperature, Water Deg.
08/30/00
Weekly
deg
Parameter Missing
None
Centigrade
10'2006 001
Effluent
Temperature, Water Deg.
10/3106
vvveNy
deg
Parameter Missing
No Action, oPJ
Centigrade
11 onos 001
BMuom
Temperature,«»atero«Q.
11/30/06
VVoemy
deg
Parameter Missing
mvAction, eFo
Centigrade
12zno6 001
Effluent
Temperature, Water Deg.
12m1m6
vveomy
deg
Parameter Missing
wnno
Centigrade

MONITORING REPORTUMRjVIOLATIONS for:
�
Report Date: omemo Page: oofo
OX
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Reporting Violation
Mnwnomw000rFAu/
nsponr pPI uooAnom
03'2007 001 Effluent
pAnAmeTsn
Temperature, Water Deg
Centigrade
Temperature, Water Deg
Centigrade
moumow
"°'= pRsouEwo,
03m107 Weekly
04/30/07 Weekly
UNIT OF
MEASURE LIMIT
CALCULATED
vnLuc VIOLATION TYPE
Parameter Missing
Parameter Missing
mouAT/owAormw
No Action, Data Entry
Error

[Fwd: Notice for Hubert Franklin Head]
Subject: [Fwd: Notice for 14mhe anklinOHead]
From: Steve Tedder <[e-mail]>
Date: Tue, 26 Feb 2008 08:12:05 -0500
To: [e-mail], Charles Weaver <[e-mail]>
I would suggest we hold or suspend any actions we have pending (not assessed to date) for this MHP.
No use getting more assessments that will be tied up in probate stuff. We need to find out who will
be the legal owner of the MHP and if they are to continue operation. Rose can follow up on that in 2-3
weeks. We need to talk to the new owner (which I assume will be his son).
Tedder
-------- Original Message--------
Subject:Notice for Hubert Franklin Head
Date:Tue, 26 Feb 2008 07:50:10 -0500
From:Mike Mickey <[e-mail]>
'Organization:NC DENR - Winston-Salem Regional Office
To: Steve Tedder <Steve. Teddera,ncmail.net>, Rose Pruitt <Rose.Pruitt a,ncmail.net>
FYI - Obituary for Hubert Head.
---------------------------------
Please visit the Notice for Hubert Franklin Head.
http://www.legacy.com/Link.asp?I=LS000I04280064X
Mike Mickey
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Main Office: [phone]
Voice: [phone]
FAX: [phone]
Steve Tedder
Steve.Tedderancmail.net
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336)-771-4950
Fax [phone]
Steve Tedder <[e-mail]>
WSRO
NC DENR
1 of 1 2/27/2008 8:46 AM

Obituaries I Death Notices I Newspaper Obituaries I Online Obituaries... http://www.legacy.com/WinstonSalem/DeathNotices.asp?Page=LifeS...
View/Sign Guestbook
HEAD Mr. Hubert Franklin Head, 77, of Winston-Salem passed away Sunday, Feb. 24,
2008, at his home. He was born July 26, 1930 in Guilford County to the late William and
Sallie Head. Mr. Head was a veteran of the U.S. Army and had retired from R.J. Reynolds
Tobacco Co. He was preceded in death by his parents; two sisters; and a brother.
Surviving are six sisters; Louis Sprinkle of Kernersville; Gladys Hine of Lexington; Thelma
Head of Oceanside, Calif.; Alma H. Crosby and husband Charles of Clemmons; and
Frances Head and Laura Head, both of Advance; a brother, Norman Head, and wife
Margie of Roanoke, Texas; a sister-in-law, Jane Head of Keller, Texas; and several nieces
and nephews. A graveside service will be conducted at 2 p.m. Wednesday, Feb. 27, at
Westlawn Gardens of Memory in Clemmons, with the Rev. Brian Whitaker officiating. The
family will receive friends after the service. Memorials may be made to a charity of the
donor' s choice.
Published in the Winston-Salem Journal on 2/26/2008.
Notice • Guest Book • Flowers • Gift Shop • Charities
Today's Winston-Salem Journal death notices
Questions about death notices or Guest Books?
Contact Legacv.com • Terms of use
obituaries nationwide
Back
1 of 1 2/27/2008 8:46 AM

A (1). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS Permit Number: NCO057223
During the period beginning on the effective date of the permit and lasting until expiration, the permittee is authorized to discharge treated wastewater from
Outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
z EFFLUENT CHAR , CT.ERISTICS' EFFLUENT LIMITSE t MONITORING REQUIFtEMENT5
Parameter Description - PCS Code
Monthly Average
Weekly Average
Daily Maximum
Measurement
Frequency
Sample
Type
Sample
Location
Flow, in conduit or thru treatment plant - 50050
0.0016 mgd
Weekly
Instantaneo
E
BOD,.5-Day (20 Deg. C) - 00310 - Winter
10 mg/1
15 mg/I
Weekly
Grab
E
BOD, 5-Day (20 Deg. C) - 00310 - Summer
5 mg/1
7.5 mg11
Weekly
Grab
E
Solids, Total Suspended - 00530
30 mg/1
45 mg/1
Weekly
Grab
E
Nitrogen, Ammonia Total (as N) - 00610 - Winter
4 mg/I
20 mg/1
Weekly
Grab
E
Nitrogen, Ammonia Total (as N) - 00610 - Summer
2 mg/l
10 mg/I
Weekly
Grab
E
Coliform, Fecal MF, M-FC Broth,44.5C - 31616 (geom.mean)
200 #/100ml
400 #/100ml
Weekly
Grab
E
Chlorine, Total Residual - 50060
2 X week
Grab
E
Chlorine, Total Residual - 50060
17 ug/I
2 X week
Grab
E
Temperature, Water Deg. Centigrade - 00010
Weekly
Grab
D,E,U
DO, Oxygen, Dissolved - 00300
Weekly
Grab
E
Phosphorus, Total (as P) - 00665
Quarterly''
Grab
E
Nitrogen, Total (as N) - 00600
Quarterly
Grab
E
DO, Oxygen, Dissolved - 00300
Weekly
Grab
D,U
Winter: November 1 - March 31
Summer: April 1 -October 31
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Mar,20, 2008 11:30AM UNITED WATER
No, 0024 P. 1
=,s°United Water
TO: FROM:
l
FAX NO:
DATE:
SUBJECT:
unite Watt
PO Box 1279
Clemmons, NC 27012
telephone [phone]
facsimile 336-766-0469
Fax
NO. PACES:
(including cover)
GC:
❑ Urgent Cr or Review ❑ Please Reply ❑Please Recycle
COI%fNMNTS:

Mar.20, 2008 11:30AM UNITED WATER
No, 0024 P. 2
March 3, 2008
Mr. Dennis Wilkinson
Head Mobile Home Park
2880 South Stratford Road, Unite 6
Winston-Salem, *NC 27103
Dear Mr. Wilkinson,
It is my understanding that you will serge as the permittee of the Head MHP system
following the death of Mr. Hubert Head.
Previously, all correspondence regarding the wastewater treatment system was directed to
Mr.'Head's attention. I understand that it will take some time to sort out Mr. Head's
estate, including the files regarding the wastewater treatment operation.
I am enclosing recent pertinent information regarding the Head MHP Wastewater
Treatment System for your file. This information should be helpful until you can obtain
the entire file, which was maintained at Mr. Head's residence.
This enclosure includes the following:
1. Copies of all 2007 Discharge Monitoring Reports that are submitted to the state
each month. These files also include the sampling and monitoring certificates of
analysis along with other monitoring data pease note that you were mailed a
copy of the January, 2008 DMR which was sent to the state this week.
2. Copies of recent Notice of Violations and responses to those violations. Plesse
note that many of these violations required penalty payment. I am not sure which
penalties Mr. Plead has already paid and which ones have not been paid.
3. I have included a copy of my field parameter lab certification acknowledgement
which must be maintained by the system operator.
4. Copies of the 2006 aud. 2007 Annual Performance Reports which are required by
the state. This report summarizes the individual monthly reports.

Mar, 20. 2008 11:30AM UNITED WATER No, 0024 P, 3
Z hope this information is helpful as you work toward closer involvement in the
wastewater system.

Mar. 20. 2008 11:30AM UNITED WATER No.0024 P. 4
March 3, 2008
Mr. Dennis Wilkinson
Head Mobile Hoene Park
2880 South Stratford Road, Unit 6
Winston-Salem, NC 27103
Dear Mr. Wilkinson,
Due to Mr. Head's death, it is my understanding that you will be more involved with the
day to day operation of the Head MHP Wastewater System, particularly in regards to
serving as the system perrnittee.
There are several items that will be helpful to bring to your attention some of which you
are already aware. In any case these are items of concern that will need attention as you
move forward with management of the system.
These items are presented subsequently:
1. The current Head MHP NPDES Permit, which I have provided you with a copy
under separate cover, will expire on May 31, 2009. Please note that the renewal
permit application must be received by the state within 180 days of permit
expiration.
2. The current NPDE Permit incorporates limitations that are beyond the design
criteria of the existing septic tank and sand filter treatment scheme. The Head
MHP experienced approximately 5 permit violations in 2006 and approximately
12 permit violations in 2007. Most of these violations were for ammonia -
nitrogen. The existing system is not capable of nitrifying consistently throughout
the year to meet the current permit limitations. During the interim, I have added a.
side stream zeolite filter media to improve the ammonia reduction and minimize
permit excursions. The zeolite media is fairly expensive and must be replaced
routinely.
As you know, eventually the Head System will have to upgrade the existing
treatment system to meet current and fixture limits or pursue a gravity sewer
connection to the City of Winston-Salem.
3. The current NPDES Permit incorporated an effluent residual chlorine limit. The
current permit was initially provided to Mr. Head on July 13, 2004. The permit
required Head MHP to add treatment capabilities to dechlorinate to meet this new
chlorine limitation. The Head MHP uses tablet chlorination to disinfect the
treated effluent. This information was communicated to Mr. Plead. In order to

Mar. 20. 2008 11:30AM UNITED WATER No.0024 P. 5
meet to the new chlorine limit, I provided the existing' temporary" dechlorination
unit which I obtained from another facility. While this unit is performing fairly
well it is not an approved installation by the state. The state has criteria for a
permanent installation which should be met. This involves design criteria and the
redundancy of a second tablet debhlorination.
It has been my impression that Mr. Head was working toward the hopeful
connection to the City of Winston-Salem system. In that case, I'm sure he did not
want to invest additional money in a unit process that would not be used very
long. In any case, this issue will need attention. The state may consider a
Schedule of Compliance (SOC) to allow the M1HP adequate time to connect to the
City.
4. I have added a small post aeration system to the effluent boss: to maintain proper
dissolved oxygen concentrations. Please note that without this supplemental
aeration the DO levels will fall below the permit limitations.
5. The septic tank will need to be pumped out fairly soon. I would suggest having
one load removed in the nett 4-8 weeks. Currently, the effluent solids and BOD
are well below permit limits. Please note that the tank should not be completely
emptied, but only a portion removed. .
I hope this inforniation is helpful.
ORC

Mar.20. 2008 11:30AM UNITED WATER No.0024 P. 6
March 3, 2008
Mr. Dennis Wilkinson
Head Mobile Home Park
2880 South Stratford Road, Unit 6
Winston-Salem, NC 27103
Dear Mr. Wilkinson,
I am writing to notify you that I will be terminating my operational service to Head
Mobile Home Park Wastewater Treatment System as the Operator -In -Responsible
Charge (ORC) effective March 14, 2008.
I have enjoyed serving Head MHP. However, my current job requires an increased
amount of out of town travel which makes it increasingly challenging to provide work of
this nature.
As we have discussed, the Head MHP Wastewater System is unable to consistently meet
it's permit limitations. These issues will need attention, The most feasible solution
would be to connect to the City of Winston-Salem system.
I have attached a listing of certified wastewater operators in the Forsyth County area for
your review and use in obtaining a new operator for your system.
Due to the permitted sampling and monitoring requirements, this system will need
routine operational visits, by a properly certified wastewater treatment operator, at least
twice a week.
I will be generating the February, 2008 monthly state report which is due by March 30
and I will also provide the report with information through March 14, 2008.
You should continue to collect the daily water meter readings to be included in the
report.

Mar, 20. 2008 11:30AM UNITED WATER No, 0024 " P. 7
I will leave full tubes of chlorination and dechlorination tablets in the chemical feeders.
These should last for a few weeks, but should be checked routinely.
If you have any questions, please contact me at your convenience.
SENT: Hance Delivery
Cc: Rose Pruitt
Certification Office
Hubert Head Estate Contact

Mar, 20, 2008 11:30AM UNITED WATER No. 0024 P. 8
Mauch 6, 2008
Mr. Dennis Wilkinson
Head Mobile Home Park
2880 South Stratford Road, Unit 6
Winston-Salem, NC, 27103
Dear Mr. Wilkinson,
As you requested, I have drafted an operator position flyer for your use in direct mailing
to potential operators to serve as ORC of your wastewater system. Please feel free to
modify or edit to better suit your needs. I have included 50 copies of the flyer if you
desire to use the information without change. I have also enclosed another copy of the
listing of certified operators in the Forsyth County area for your use. I have marked out
the individuals that I feel would not be interested based on their current position.
I hope this is helpful in your effort to secure a certified operator.
Sincerely,

Mar.20. 2008 11:30AM UNITED WATER
No.0024 P. 9
PART TIME OPERATIONAL OPPORTUNITY
Certified wastewater treatment plant operator needed to serve as Operator -in -Responsible
Charge (ORC) of small 0.0016 MGD subsurface treatment system with surface
discharge. Successful candidate should possess the following:
• Desire minimum of NC Grade 11 wastewater operator's certification.
• Working knowledge of subsurface treatment units and NC regulations.
• Responsible for day to day operations and maintenance, permit sampling,
recordkeeping, regulatory reporting and communication with permittee.and
regulatory agents.
• Responsible for providing field instrumentation for system monitoring.
• Must possess or be able to obtain field parameter certification for associated
permitted parameters.
• Compensation will be negotiated along with contract terms for part time
operational duties.
Interested applicants should contact:
Mr. Dennis Wilkinson
Head Mobile ]Home park
2880 South Stratford Road, Unit6
Winston-Salem, XC 27103

Mar. 20, 2008 .11; 30AM UNITED WATER No, 0024 P. 10
March 13, 2008
Ms. Tonja Springer
NCDENR, Laboratory Section
1623 Mail Service Center
Raleigh, NC, 27699-1623
Dear Ms. Springer,
I am writing in regards to the current "Field Parameter" Laboratory Certification for
Plead Mobile Home Park WWTP' (certificate number 5076). 1 initiated this certification
to correspond with my operational service at Head MHP. This correspondence is to
notify your office that, effective March 14, 2008, I will no longer be serving the WWTP
operational needs for Head NMP which includes the route field parameter testing.
I have enclosed the current laboratory certification to your office as I will be tenxlinating
my service with Head MHP on 3/14/08. As you know, the Head MHP is a very small
park. that discharges approximately 450 gallons per day. This has been a part time
operational service to maintain the WWTP needs. I assume that the replacement facility
operator will need to coordinate the ongoing certification program with your office to
nieet the specific needs at the Head MHP WWTP.
It is my understanding that any future Head MHP correspondence should be directed to
Mr. Dennis Wilkinson due to the recent death of Mr. Hubert Head. Mr. Wilkinson's
mailing address is: '
Bead MHP
2880 South Stratford. Road, Unit 6
Winston-Salem; NC, 27103
if you have any questions, please contact me at your convenience.
ack
Wilkinson, Dead MHP

STA TE OF NORTH CAROLINA DEPARTMENT OF THE
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
LABORATORY CERTIFICATION PROGRAM
In accordance with theprovfsions of N,G.G.S. 143-215.3 (a) M 943-215.3 (aff10) and NCAC 2H.0800:
Field Parameter Only
HEAD MOBILE HOME PARK WWTP
Is hereby certilied to perform environmental analysis as fisted on Attachment 1 and report monitoring data to DWQ for
compliance taidh iVPDES efffoend, surface water, groundwater, and pretreatment regulations.
By reference 15A NCAC 2H .0800 is made a pall of this certfcate.
This certificate does not guarantee validity of data gonerafei, but indicates the methodology, equipment, quality sort trot procedures,
records, and proficiency of the laboratory have been examined and found to fie acceptable.
This cerffftcate shall be valid until December 31, 2008
Certificate No_ 5076
,4U4- a
-Pal Donnelly

Mar, 20, 2008 11:31AM UNITED WATER No. 0024 P. 12
Attachment
North Carolina Wastewater/Groundwater Laboratory Certification
Certified Parameters Listing
FIELD PARAMETERS ONLY
Lab Name; Head Mobile Home ParK WWTP Certificate Number: 5075
Address: 140 Linbrook Dr.: : Effective Date: 01/01/2008
Winston-Salem, NC 27106• Expiration Date: 12/31/2008
Date of Last Amendment:
The above named laboratory, having duly met the requirements of 16A NCAC 2H.0800, is hereby certlffed for the measurement of the parameters listed below,
CERTIFIED PARAMETERS I
INORGANICS
RESIDUAL CHLORINE
EPA Method 330.5
DISSOLVED OXYGEN
EPA Method 360.1
PH
EPA Method 150,1
TEMPERATURE
EPA Method 170.1

Mar.20. 2008 11:31AM UNITED WATER No.0024 P. 13
March 6, 2008
Mr. Dennis Wilkinson
Head, Mobile Home Park
2880 South Stratford Road, Unit 6
Winston-Salem, NC, 27103
Dear Mr. Wilkinson,
I am writing as a follow up to providing you with a copy of the NPDES permit for Head
M11P Wastewater System. As we -discussed during my recent visit, the wastewater
system requires routine sampling and monitoring of various permitted parameters. Many
of these parameters are performed in the field by the operator (which must possess field
parameter certification) and other samples must be collected and delivered to a
commercial laboratory for certified analysis.
I am sending this correspondence as a reminder that my last week of providing the
operational service will end on March 14, 2008. I will collect samples that week;
however, other provisions will need to be made to provide the permitted sampling and
monitoring beginning during the week of March 17. Please refer to the monitoring page
on your permit to make sure that the correct samples ate collected. Also, please be
advised that the quarterly Total Nitrogen and Total Phosphorous samples must be
collected before the end of March, 2008.
Sincerely,

Mar.20. 2008 11;31AM. UNITED WATER
No.0024 P. 14
March 6, 2008
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Dear Sirs,
I am writing to notify your office that effective March 14, 2008, Crary Stainback
(certification #9674) will no longer serve as the Operator -in -Responsible Charge (ORC)
for Head Mobile Home Park Wastewater Treatment System (NC0057223).
Please modify your records to reflect this change.
If you have any questions, please contact me at your convenience.
Cc: Dennis Wilkinson, Head MHP
Jamie Whitten,13ackup ORC
Rose Pruitt

Mar,20. 2008 11:31AM UNITED WATER
No, 0024 P. 15
March 6, 2008
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Dear Sirs,
I am writing to notify your office that effective March 14, 2008, Jamie Whitten
(certification 416889) will no longer serve as the Back-up Operator -in -Responsible
Charge (ORC) for Plead Mobile Home Park -Wastewater Treatment System
(NC0057223).
Please modify your records to reflect this change.
If you have any questions, please contact me at your convenience.
Sincerely,
)"'� Otl�'
Jamie Whitten
Back-up ORC
Cc: Dennis Wilkinson, Plead MHP
Gary Stainback
Rose Pruitt

Print Preview
http://maps2.co.forsyth.nc.us/geodata/printPreview.aspx?PrintOptDa...
INN
N
�.: •� •1.} ��r nnaab� �
Forsyth County, NC
Block Lot
Property Address
Additional Lots
PIN
Tax Jurisdiction
Anx
Taxable Owner Name
Taxable Owner Name2
Taxable Owner Address
Taxable Owner City St Zip
Taxable Deed Bk-Pg
Taxable Deed Date
Taxable Deed Stamps
New Owner Nam
I
New Owner Nam
New Owner Addr
New Owner City
New Deed Bk-Pg
3897 014Y
2880 Stratford Rd S
016Y
6803-21-6966
Forsyth County / Clemmons FD
N
HEAD, HUBERT F
WILKINSON, DENNIS
2880 Stratford Rd, Apt/Unit 3
Winston-Salem, NC 27103-6940
1827-3398
6/15/1994
$120
New Deed Date
New Deed Stamps
Map Number
WIP
Land Value
Dwellina Value
c;ommerciai value
Industrial Value
Misc Imp Value
Total Value
Acreage
Sq Ft Living Area (Res)
Gross Sq Ft (Com)
Year Built (Res)
Year Built (Com)
Census Tract
Zoning
Last Qualified Sale Price
600830
1.27
38.02
RS9
$60,000
1 of? 3/20/2008 1 1:54 AM

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HEAD MOBILE HOME PARK
WASTEWATER TREATMENT FACILITY
RECEIVED
N.C. Deot. of ENR
Winston-Salem
Regional Office
ANNUAL PERFORMANCE REPORT
For the Calendar Year 2007
Prepared:
February 2008

2007 Annual Performance Report
for the
Head Mobile Home Park
Wastewater Treatment Facility
General Information
Facility/System .Name: Head Mobile Home Park Wastewater Treatment Plant
Responsible Entity: Head Mobile Home'Park
Person in Charge/Contact: Mr. Hubert Head
Head Mobile Home Park
2880 South Strafford Road
Winston Salem, NC 27103
[phone]
Description of Collection System or Treatment Process:
The Head Mobile Home Park WWTP consists of a septic tank and a sand filter with
a small tablet type chlorinator and dechlorination. The flow enters into -the septic
tank_ and then into the sand filter. After the flow passes through the sand filter, it
goes through the chlorinator and dechlorination and is then discharged to the
receiving stream. The flow is about 200-500 GPD at this facility.
II. Compliance Performance
The North Carolina Department of Environment and Natural Resources
(NCDENR) regulates the Head Mobile Home Park's effluent discharge under the
National Pollutant Discharge Elimination System .(NPDES). The NCDENR
issued to the Park a NPDES Permit that includes water quality limits and
sampling and monitoring requirements. The NPDES Permit requires the Park to
test more than 11 different constituents in the treated water. The monitoring
frequency for these constituents are set at various intervals such as weekly,
twice per month, and quarterly. During the previous year, the Park conducted
752 tests of the treated water before it was discharged to the creek. The WWTP
achieved a Compliance Level of 99.33% with its NPDES Permit requirements.
Following is a summary of the testing for the parameters that are assigned Water
Quality Standards by the NPDES Permit. Please ,note. the summary includes
parameters that only incorporate a monitoring requirement, it not does include
daily process control testing.

L
Constituent
Number of Test
Required
Number of Test
Conducted
Flow
52
365
Biochemical O en Demand BOD
50
53
Total Suspended Solids (TSS)
50
53
Ammonia
50
53
Fecal Coliform
50
53
Chlorine
104
104
Total Nitrogen
4
4
Total Phosphorus '
4
4
* Testing is not required during Holidays or Inclement Weather.
In addition to the required testing, the Park conducted over 600 in-house test to
ensure the proper operation of the wastewater treatment plant.
Following is a summary of permit violations, which occurred during the year:
January 2007
The daily maximum limit for Fecal Coliform was exceeded on January 16.
February 2007
The daily maximum limit for Fecal Coliform was exceeded on February 12.
April 2007
The monthly average BOD limit was exceeded. The daily maximum limit for
BOD was exceeded on -April 9 and April 25.
July 2007
The monthly average limit for Ammonia -Nitrogen was exceeded.
August 2007
The daily maximum limit for BOD was exceeded on August 8. The daily
maximum limit for Fecal Coliform was exceeded on August 8.

October 2007
The monthly average limit for Ammonia -Nitrogen was exceeded. A daily
maximum for Chlorine was exceeded.
November 2007
The monthly average limit for Ammonia -Nitrogen was exceeded.
December 2007
The monthly average limit for Ammonia -Nitrogen was exceeded.

Part III- Certification
I have personally examined and am familiar with the information submitted in this
document and attachments. Based upon my inquiry of those individuals
immediately responsible for obtaining the information reported herein, I believe
that the submitted information is true, accurate, and complete. I am aware that
there are significant penalties for submitting false information.
Signed this
day of2008.
(Name) Owner

Head Mobile Home Park
280 South Stratford Road
Winston-Salem, NC 27103
February 19, 2007
System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Head Mobile Home Park WWTP
NPDES Permit Number: NCO057223
Forsyth County
Dear Sirs,
Enclosed you will find the Annual Performance Report for the year of 2007 for the
Head Mobile Home Park, North Carolina Wastewater Treatment Plant. We
believe the report to be complete and accurate. Each of the residents will be
provided a copy of the report.
If you have any questions, please advise.
Gary
ORC
RECEIVED.'
F E B 2 6 2008
DENR - WATER QUALITY
POINT SOURCE BRANCH

11"e
November 29, 2007
Mr. Steve Tedder
Water Quality Regional Supervisor
NCDENR
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
RECEIVED
r N.C. Dept of ENR
NOV 2007
Winston-Sa6ern
Reglona) Office
As you requested, I am responding to your November 19, 2007 Notice of Violation
regarding the August, 2007 exceedance of a daily maximum BOD and Fecal Coliform
level on August 8.
As you may know, the Head Mobile Home Park WWTP consists of a septic tank and
subsurface sand filter treatment system. This treatment system does experience some
variability in operating efficiencies, particularly in regards to adverse influences of
rainfall and seasonal temperature changes. While the discharge did violate the daily
maximum limits on 8/8/07, the WWTP was compliant with the monthly average BOD
and Fecal Coliform concentrations at 2.0 mg/l and 15.3 colonies/100mis, respectively.
The samples collected during the following month in September, also.indicated
compliance. '
We will continue to strive for consistent compliance of our permit limits.
Sincerely,
Head Mobile Home Park
Hubert Head
Cc: Gary Stainback

Michael F. Easley, Governor
William G. Ross Jr., Secretan;
North Carolina Department of Environment and Natural+Resources
February 11, 2008
CERTIFIED MAIL 70071490 0004 9565 0573
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
Coleen H. Sullins Director
Division of Water Quality
A review of Head Mobile Home Park's monitoring report for November 2007 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total
11/30/07
4 mg/1
4.93 mg/l,
Monthly
(as N)
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files —SWP
G& RO
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

n
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Y14Ab MRe Permit/Pipe No.: NG0057 u3 MondvYear No
Z0©7
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Date
Date
Weekly/Daily Violations
Parameter Permit LunitlTVDe DMR Value % Over Limit
Monitoring Frequency Violations
Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:.
Regional Water Quality
Supervisor Sianoff:
'0A
Date:
2 vtT
Date: oL - 7,G��

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 02/05/08 Page: 1 of 2
.'r.:,,+•-_ ^-.`r . s, ..' i..,�"`�.`..�mre t .? ^fig r r fiar.,,,a,.� , - .�� ;., ,'NI', .. °Per' rt..-nc0057228 :° r 'sBetween 1`1`= Q06. °'and i 2007' Re loci'.„°fo °Violatlon Cate o z°fa Pro yam Ca#e o
m MR 2 g 9 rY 9 g. ry
°
Violatlo e ° °GOU(1 °fo Sllbb�Sm °�, - nActi6n °f°
Factllty Name Param Nam 1° ty _
r
Ma)orera
._..._._.___=.._�r..�w..�s.,...m.,.......—,..........,..,....s.W.z.......a.u.:._"�''?�s��._,:..u...._.� .�w�.e,c��.�a.. .... ....e.�......—..m....,:
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI
LOCATION
PARAMETER
-DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/09/07
Weekly
mg/I_
7.5
14
Daily Maximum Exceeded
Proceed to
Enforcement Case
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/25/07
Weekly.
mg/I
7.5
12
Daily Maximum Exceeded
Proceed to
Enforcement Case
04 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/30/07
Weekly
mg/I
5 .
6
Monthly Average Exceeded
Proceed to
Enforcement Case
08 -2007
001
Effluent
BOD, 5-Day (20 Deg. C)
08/08/07
Weekly
mg/I
7.5
8
Daily Maximum Exceeded
Proceed to NOV
10 -2007
001
Effluent
Chlorine, Total Residual
10/31/07
2 X week
ug/]
17
31
Daily Maximum Exceeded
Proceed to
Enforcement Case
11 -2006
001
Effluent
Coliform, Fecal MF, M-FC
11/29/06
Weekly
#/100ml
400
430
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
01 -2007
001
Effluent
Coliform, Fecal MF, M-FC
01/16/07
Weekly
#/100ml
400
410
Daily Maximum Exceeded
No Action, BPJ
Broth,44.5C
02 -2007
001
Effluent
Coliform, Fecal MF, M-FC
02/12/07
Weekly
#/loom]
400
1,100
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
08 -2007
001
Effluent
Coliform, Fecal MF, M-FC
08/08/07
Weekly
#/100ml
400
1,400
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
07 -2007
001
Effluent
Nitrogen, Ammonia Total (as
07/31/07
Weekly
mg/1
2
2.96
Monthly Average Exceeded
Proceed to
N)
Enforcement Case
10 -2007
001
Effluent
Nitrogen, Ammonia Total (as
10/31/07
Weekly
mg/I
2
3.38
Monthly Average Exceeded
Proceed to
N)
Enforcement Case
Monitoring
Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF
CALCULATED
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
05 -2007
001
Effluent
Chlorine, Total Residual
05/05/07
2 X week
ug/I
Frequency Violation
None

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 02/05/08 Page: 2 of 2
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Reporting Violation '
MONITORING OUTFALL /
VIOLATION
UNIT OF
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE LIMIT
11 -2006
001
Effluent
Temperature, Water Deg.
11/30/06
Weekly
deg c
Centigrade
12 -2006
001"
Effluent
Temperature, Water Deg.
12/31/06
Weekly
deg c
Centigrade
02 -2007
001
Effluent
Temperature, Water Deg.
02/28/07
Weekly
deg c
Centigrade
03 -2007
001
Effluent
Temperature, Water Deg.
03/31/07
Weekly
deg c
Centigrade
04 -2007
001
Effluent
Temperature, Water Deg.
04/30/07
Weekly
deg c
Centigrade
CALCULATED
VALUE
VIOLATION TYPE
VIOLATION ACTION
Parameter Missing
No Action, BPJ
Parameter Missing
None
Parameter Missing
No Action, BPJ
Parameter Missing
None
Parameter Missing
No Action, Data Entry
Error

RECEIVED
N.C, Dept. of ENR
FEB0 4 2000
Winston-Salem I EFFLUENT
Reoional r)ff,,.
--�'I1 A (r"'
T[A S
JAN 14 2006,
A
JAN 3 0 2007
NPDES PERMIT NO: NC0057223 DISCHARGE NO: 001
COUN
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS: I
MONTH: NOVEMBER YEAR: 2007
OPERATOR IN RESPONSIBLE CHARGE (ORC): Ga St nback
GRADE: IV PHONE: [phone]
CERTIFIED LABORATORY: 1 TrlteSf
PERSON(s) COLLECTING SAWC�S'. Gary Stainb Ck
CHECK BLOCK IF ORC HAS CHANGED �/j[ /��c %
Mail original and one copy to: �l/ v /
ATT: Central Files
Division of Water Quality (signature "MPLETE
arge) DATE
1617 Mail Service Center BY THIS ST THIS REPORT IS
Raleigh, NC 27698.7677 ACCURATBEST OF MY KNOWLEDGE
REPLICA DEM FORM MR-1 (12/93)
NOTE: A numerical value of zero (one for Fecal Colifonns) was used for calculation on those
numbers reported as 'less than' (<).

Facility 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
he facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
1 n tima_tahla fnr imnrl rP.TlP.nt.0 tCl'hf-. TTlafle_
;ertify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
h a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
he person or persons who manage the system, or those persons directly responsible for gathering the information, the information
omitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
emitting false information, including the possibility of fines and
imprisonment for knowing violations."
Permittee (Pleaseprint or type)
Head Mobile Home Park
�V9�J� ,'Z. 2f--0/
Signature of Permittee" Date
(Required)
336-724-5911 May 31m 2009
mittee Address
Phone Number
Permit Exp. Data
PARAMETER CODES
)10 Temperature
00556
Oil &L Grease
00951 Total Fluoride
01067 Nickel
50060 Total
)76 Turbidity
00600
Total Nitrogen
01002 Total Arsenic
01077 Silver
Residual
)80 Color (Pt -Co)
00610
Ammonia Nitrogen
01092 Zinc
Chlorine
)82 Color (ADNE)
00625
Total Kjeldhal
01027 Cadmium
01105 Aluminum
)95 Conductivity
00630
Nitrogen
Nitrates/Nitrites
01032 Hexavalent Chromium
01147 Total Selenium
71880 Formaldehyde
@0 Dissolved Oxygen
01034 Chromium
31616 Fecal Coliform
71900 Mercury
S10 BOD5
00665
Total Phosphorous
32730 . Total Phenolics
81551 Xylene
S40 COD
00720
Cyanide
01037 Total Cobalt
34235 Benzene
100 pH
00745
Total'Sulfide
01042 Copper
34481 Toluene
60 Total Suspended
00927
Total Magnesium
01045 Iron
38260 MBAS'
Residue
00929
Total Sodium
01051 Lead
39516 PCBs
;45 Settleable Matter
00940
Total Chloride
01062 Molybdenum
50050 Flow
ameter Code assistance
may obtained by calling the
Point Source Compliance/Enforcement Unit at [phone] or by visiting
Water Quality Section's
web site
at h2o.enr.state.nc.us/was and linking to the Unit's
information pages.
s only units designated in the reporting facility's permit for reporting data. LO L Z 330
RC must visit facility and document visitation of facility as required per 15A NCAC 8G .=�4.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(D)

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM **
001 MONTH: NOVEMBER YEAR: 2007
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge Point
00010
00300
00400
00310
1 00340
31616
95
D
2400
A
CLOCK
20 C
G.MEAN
T
TIME
TEMP
D.O.
pH,
BOD-5
COD
F-COLI
CONDUCTIVITY
E
HRS
DEG.0
MG/L
UNIT
MG/L
MG/L
100 ml
umhos/cm
1 12 1 1100 1 15.0 1 1.8 1 1 1 1 1 1 1
16
7W
18
22
24
28
30
AVERAGE 16.3 1.8
MINIMUM 1 15.0 1 1.5
NOTE: A numerical value of — (one for Fecal Coliforms) was used for calculation on those
numbers reported as less than' (<).
** DOWNSTREAM **
00010 00300 00400 00310 00340 31616 95
2400
CLOCK 20 C G.MEAN
TIME TEMP D.O. pH BOD-5 COD F-COLI CONDUCTIVITY
16.0 1 2.7
1 1100 1 16.0 1 1.8 1 1 1 1 1 1 1

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
November 19, 2007
CERTIFIED MAIL 7007 0710 0001 5586 9394
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
Coleen H. Sullins Director "
Division of Water Quality
a
A review of Head Mobile Home Pa_rk's monitoring report for August 2007 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
08/08/07
7.5 mg/l
8 mg/l
Daily
Maximum
Exceeded
Coliform, Fecal MF, M-FC
08/08/07
400 #/100ml
1,400 #/100ml
Daily
Broth,44.5 C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at (336).771-5000.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
up
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

AN V" Zoo -NV,
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: �AA Permi't/Pipe No.: NCD0S`7 7-2-25 Month/Yeaf �3C
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly aily Vio tions
Date
Parameter
-.5rd6a,
Permit Lunit�Iv�e DMR Value
7.6 rw.�, / 2 ILO
% Over Limit
7 °
joT
.P It-k
o
ie=50
4�;ECP,4— C& uP.
too 12 400 too ,w�
7,50 �7,0
Monitoring Frequency Violations
Date
Parameter
Permit Frequencv Values Reported
# of Violations
Other Violations
c-
Completed by:
Regional Water Quality
Supervisor Signoff:
-Ilk /
Date: 7 ) " 4,17K . D _�
Date: ��' l S —0 %

DMR VIOLATIONS for: Report Date: 1.1/08/07 Page: 1 of 1
t Per'mit::nc0057223.' DMRs'Bet%4een: `8-2006= and �7� 2007`� �Regi6h'%o , � � Violation Category`LimitVio�ations "'�.CG&L REPORT F
Parameter Names: FLOW, BOD, TSS, NH3
PERMIT: NCO057223 FACILITY: Head Mobile Home Park -Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
VIOLATION
UNIT OF
CALCULATED
DMR
OUTFALL
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
10-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/02/06
Weekly
mg/1
7.5
8
10-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/16/06
Weekly
mg/1
7.5
9
04-2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/09/07
Weekly
mg/1
7.5
14
04-2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/25/07
Weekly
mg/1
7.5
12
04-2007
001
Effluent
BOD, 5-Day (20 Deg. C)
04/30/07
Weekly
mg/l
5
6
09-2006 .
001
Effluent
Nitrogen, Ammonia Total (as N)
09/30/06
Weekly
mg/l
2
2.05
10-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
10/31/06
Weekly
mg/l
2
2.9
07-2007
001
Effluent
Nitrogen, Ammonia Total (as N)
07/31/07
Weekly
mg/I
2
2.96
VIOLATION TYPE
VIOLATION ACTION
Daily Maximum Exceeded
Penalty Retracted
Daily Maximum Exceeded
Proceed to Enforcement
Case
Daily Maximum Exceeded
Proceed to Enforcement
Case
Daily Maximum Exceeded
Proceed to Enforcement
Case
Monthly Average Exceeded
Proceed to Enforcement
Case
Monthly Average Exceeded
No Action, BPI
Monthly Average Exceeded
Proceed to Enforcement
Case
Monthly Average Exceeded
Proceed to Enforcement
Case

RECEIVED El i+
N.C. Dept of ENR
�f, OCT 1 2 2007
�jr 13
Winston-Salem EFF UENT
Regional office
NPDES PERMIT NO: N00057223 DISCHARGE NO: 001 CO
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS: I
MONTH: W'�` "SDI` YEAR: 2007
OPERATOR IN RESPONSIBLE CHARGE (ORC): Gary Stainback GRADE: IV PHONE: [phone]
CERTIFIED LABORATORY: 1 Trltesl
PERSON(s4A(CCURATE:
tainback
VEIL K BLOCK IF ORC HAS CHANGED
Mail original and one copy to:
ATT: Central Files
Division of water Quality f responsible charge) DATE
1617 Mail Service Center CERTIFY THAT THIS REPORT IS
Raleigh, NC 27699.1617 PLETE TO THE BEST OF MY KNOWLEDGE
50050
00010
004001
50060
00310
00610
00530
31616
00300 1
00600
00665
00545
D
operator
Certified
FLOW
GMETRIC
MEAN
A
Arrival
Operator
ORC
EFF [XI
INF
RES.
BOD-5
FECAL
SETT.
T
E
Time:
2400 Clock
Time On
site
On
site?
RATE
TEMP.
pH
CL2
20DEG.0
NH3-N
TSS
COLIF.
' D.O.
T.-NIT.
T: PHO.
MATTE
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/L
2
0.00063
4
0.00042
6
0.00041
:::::iE:
$
1030
2.00
Y
0.00042
24.0
6.8
11.000
JW8k0L �
2.60
1.0
.4V0107 j
djj'
6.6
10
0.00044
12
0.00039
:2;4fi>>
14
0.00040
16
0.00040
x. x.
18
0.00039
20
932
2.00
Y
0.00039
25.0
6.7
12.00 <
4.0
0.80
2.0
< 1.0
6.8
':'."`7%::
':f `iis::>:i
:z`:is »::::: ::`•:>
<:>:i:`:>s:>'•'.i?
c<»» <:
?3S%r>[t>t: t
..........
22
518
1.00
Y
0.00048
10.00
24
0.00046
26
0.00045
>:2<:::
X.
28
535
1.00
Y
0.00042
12.00
30
0.00043
AVERAGE
0.00044
24.5
12.0
2.0
1.38
2.5
15.3
6.6
iJlt#CE33.:;.;
:.a �x.:..::6:$
:.:::::::
t,.:.:.:::.:...................................
MINIMUM
0.00038
24.0
6.6
10.0 <
4.0
0.80
1.0
< 1.0
6.4
MONTHLY AVG. LIMIT
0.0016
5.0
2.00
30.0
200.0
DAILY MAXIMUM LIMIT
6-9 1
17.0
7.5
10.00
45.0
400.0
REPLICA DEM FORM MR-1 (12193)
NOTE: A numerical value of zero (one for Fecal CCliforms) was used for Calculation on those
numbers reported as -less than- (<).
COD
MG/L

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements F-1
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Fv
Noncompliant
he facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
1 a time -table for improvements to be made.
;ertify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
h a system designed to assure that qualified personnel properly gather and evaluate the information submitted. B ased on my inquiry
he person or persons who manage the system, or those persons directly responsible for gathering the information, the information
witted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
emitting false information, including the possibility of fines and ' prisonme t for kn wing vi lations."
_Lube� XW
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Head Mobile Home Park 336-724-5911 May 31m 2009
mittee Address Phone Number Permit hxp. liace
PARAMETER CODES
)10
Temperature
00556
Oil & Grease 00951 Total Fluoride
)76
Turbidity
00600
Total Nitrogen 01002 Total Arsenic
)80
Color (Pt -Co)
00610
Ammonia Nitrogen
)82
Color (ADMI)
00625
Total Kjeldhal 01027 Cadmium
.
Nitrogen
)95 Conductivity
@0 Dissolved Oxygen
910 BOD5
S40 COD
100 pH
60 Total Suspended
Residue
45 Settleable Matter
00630 Nitrates/Nitrites 01032 Hexavalent Chromium
01034 Chromium
00665
Total Phosphorous
00720
Cyanide
00745
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xyleme
01037
Total Cobalt
34235
Benzene
01042
Copper
34481
Toluene
01045
Iron
38260
MBAS
01051
Lead
39516
PCBs
01062
Molybdenum
50050
Flow
ameter Code assistance may obtained by calling the point Source Compliance/Enforcement Unit at [phone] or by visiting
Water Quality Section's web site at h2o.enr.stat6.nc.us/w9s and linking to the Unit's information pages.
! I 0
s only units designated in the reporting facility's permit for reporting dafa.
,RC must visit facility and document visitation of facility as reghft per 1'5A NCAC 8G:6204.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(D).

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK VANTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM **
0 2400
A CLOCK 20C G.MEAN
T TIME TEMP � D.O. pH BOD-5 COD F-COLI
E
HIRS loom[
AVERAGE I #DIV/01 I
001 MONTH: AUGUST YEAR: 2007
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge point
NNE=
NOTE- A numerical value of — (one for Fecal Wiforms) was uwd'for calculation on [how
numbers reported as less than' (<).
*No flow in the stream sampld,site.
** DOWNSTREAM **
2400
CLOCK 20C� G.MEAN
TIME I TEMP � D.O. � pH BOD-5 COD F-COLI
mom I= W-M

W
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
May 3, 2007
CERTIFIED MAIL 7006 0100 0001 8758 7112
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
For I yth County
i
Dear Mr. Head:
Alan W. Klimek, P.E. Director
Division of Water Quality
A review of Head Mobile Home Park's monitoring report for February 2007 showed the
following violations:
Parameter
Date
Limit Value '
Reported Value
Limit Type
Coliform, Fecal
MF, M-FC
02/12/07
400 #/100m1
1,100 #/100m1
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of nonclompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
6W. 5RD
585 Waughtown Street Winston-Salem, NC 27107 - 336-771-5000 (Telephone) 336-771-4630 (Fax)

Cover Sheet from
Staff Member to
Regional Supervisor
MAP
DMR Review Record
�l
Facility: TJ � D M A PermitTipe No.: /1/CD0571-73 Month/Year � g
200�
Monthly Avera-e Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly aily iolations
Date Parameter Permit'Limit/Type DMR Value % Over Limit
Z � ri li cot-fe / 00 nj J pa b061W
Monitorin- Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date: / r
Regional Water Quality S, .2- , 0 7
Supervisor SiQnoff: Date:

DMR VIOLATIONS for: Report Date: 05/01/07 Page: 1 of 1
Permit: n60057223, DMRs Between:. 1-2006 _ •and 1 '-� 2007 Region: -Violation Category: Limit Violation`s,„ _CG&GREPORT
Parameter Names: FL'OW,.BOD; TSS; NH3
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
VIOLATION
DMR
OUTFALL
LOCATION
PARAMETER
DATE
FREQUENCY
03-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
03/13/06
Weekly
03-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
03/31/06
Weekly
05-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
05/01/06
Weekly
10-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/02/06
Weekly
10-2006
001
Effluent
BOD, 5-Day (20 Deg. C)
10/16/06
Weekly
01-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
01/31/06
Weekly
02-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
02/28/06
Weekly
03-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
03/31/06
Weekly
04-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
04/30/06
. Weekly
09-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
09/30/06
Weekly
10-2006
001
Effluent
Nitrogen, Ammonia Total (as N)
10/31/06
Weekly
UNIT OF
CALCULATED
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
mg/I
15
20
Daily Maximum Exceeded
Proceed to Enforcement
Case
mg/I
10
11.25
Monthly Average Exceeded
Proceed to Enforcement
Case
mg/l
7.5
12
Daily Maximum Exceeded
Proceed to Enforcement
Case
mg/l
7.5
8
Daily Maximum Exceeded
Penalty Retracted
mg/1
7.5
9
Daily Maximum Exceeded
Proceed to Enforcement
Case
mg/l
4
4
Monthly Average Exceeded
No Action, BPJ
mg/l
4
6.65
Monthly Average Exceeded
Proceed to Enforcement
Case
mg/I
4
6.7
Monthly Average Exceeded
Proceed to Enforcement
Case
mg/1
2
2.78
Monthly Average Exceeded
Proceed to NOV
mg/1
2
2.05
Monthly Average Exceeded
No Action, BPJ
mg/l
2
2.9
Monthly Average Exceeded
Proceed to Enforcement
Case

OR
RECEIVED
eDt of ENR
��
3 Z00�
EFFLUENT
r�Fj;
TOOT
on -Safer.
PERMIT NO: NCO057223rxr:F
nalMice 1
COUNTYX:,, F_O, � RSVTH
`NPDES
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS:
I
MONTH:
FEBRUARY YEAR: 2007
OPERATOR IN RESPONSIBLE CHARGE (ORC):
Ga SfY f37nDeC.k
I
GRADE:
IV PHONE: [phone]
CERTIFIED LABORATORY: 1 Trites
PERSON(5) COLL TING S PLES: a Stalnback
CHECK BLOCK IF ORC HAS CHANGED
A
Mail Original and one copy to:
(SIGNA UR
OF O RA OR IN RESPONSIBLE CHARGE) DATE
ATT: Central Files
BY THIS SIGNAT R , I CERTIFY THAT THIS REPORT IS
Division of Water Quality
1617 Mail Service Center
ACCURATE AND MPLETE TO THE BEST OF MY KNOWLEDGE
Raleigh, NC 27699-1617
50050
000101
004001
50060
00310
00610
00530
31616
00300
00600
00665
00545
00625
D
Operator
Certified
FLOW
GMETRIC
A
Arrival
Operator
ORD
EFF [XI
MEAN
T
Time:
Time On
On
INF
RES.
BOD-5
FECAL
SETT.
E
2400 Clock
Site
Site?
RATE
TEMP.
pH
CL2
20DEG.0
NH3-N
TSS
COLIF.
• D.O.
T.-NIT.
T: PHO.
MATTER TKN
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/L
MG/L
........................:........................
QA A46.................................................................................................
..
2
0.00040
i3E<'%'.'••.`•%:
<:'4v�
5<:«
:<:«>��'<«:<:E:fs
i>i��%i�
C'[<:::
4
0.00040
:.9�.4::..:.�.&::::::::.'I4ad:.
•:::::•.4.t?::.:::::.
�,'��F..........4..�?..........�A.�...:..6
...................................................................
6
415
1.00
Y
0.00041
15.00
.........................................................................................................................
8
0.00046
1 12 1 1116 1 1.50 1 Y 1 0.00046 112.0 1 6.7 1 11.001 7.0 1 3.00 1 1.0 IIliml-JOW.0317-16.5 I I I I I I I
o aoc•:
at
o aeo•:
0 000•;
a oao•
AVERAGE
0.00046
12.3
=
13.0
1.8
3.13 1
2.8
11.7 1
6.9
N11 :»>>::>
::::>
..........................................
::::fi�:09Q><:
<: f Xk:::::>::;0:::>::::::>::>::i
D:<:::::>::>:::::7sa::>::::::::>:::::+Ei3:4:::
.................................
;>:::>::::>::::>
...... ...................................................
::>::... E3........7
2
................................ ...
.................................... ....
.......................... ... .......
............... ................
.......................
...............
MINIMUM
0.00040
12.0
6.7
11.0
< 4.0
2.70
1.0
< 1.0
6.5
.im
:
.
.
..
....✓d..r
................................................:................:.:..:.........
XX
MONTHLY AVG. LIMIT
0.0016
10.0
4.00
30.0
200.0
1IU Ef£El?R1fCiz`fIPitET< ': >#
;
>>?>>»>>s>s>
> > >>>
><
':# E<»E>:>'.>
#>»»>»> >
» »»:»
» :
«
?' .....
»>%>'«>''•»
»»s »3»>>
.............
»»»<»><s>s><»»»>>
DAILY MAXIMUM LIMIT
6-9
17.0
15.0
20.00
45.0
1 400.0
REPLICA DEM FORM MR-1 (12193) ' Minimum 6mg/I
NOTE: A numerical value of zero (one for Fecal Colifonns) was used for calculation on those
numbers reported as "less than" (<). ..

e—
Facility 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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and' sonm t for ku ing violations."
Permittee (Please prints rjtype)
t1l zAt-' c
Signature of Permittee** Date
(Required)
BaiIPYIR Trailer Perk 336-724-5911 May 31, 2004
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
00556
Oil & Grease
00600
Total Nitrogen
00610
Ammonia Nitrogen
00625
Total Kjeldhal
Nitrogen
00630
Nitrates/Nitrites
00665 Total Phosphorous
PARAMETER CODES
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
01067 Nickel
01077 Silver,
01092 Zinc
01105 Aluminum
50060 Total
Residual
Chlorine
01032 Hexavalent Chromium 01147 Total Selenium 71880 Formaldehyde
01034 Chromium 31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00745
Total Sulfide
01042
Copper
34481
Toluene
00927
Total Magnesium
01045
Iron
38260
MBAS
00929
Total Sodium
01051
Lead
39516
PCBs
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at b2o.enr.state.nc.us/w9s and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
I i1 7 1'1'I J
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204. L.1 i
** 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)-

NPDES NO: NCO057223 DISCHARGE NO: 20-11
FACILITY NAME: HEAD TRAILER PARK WWT
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge Point
** UPSTREAM **
mr,011 me
11MINNEMEN
ONE=
ME
MEN=
E=lmm=liiliililllllmlll
I=
Emim
Em
EmEm
SEE=
mmommmmmmmom
OEM=
Em
Immm
Mom
MEN=
=mmmmmmmmmm
EMEMENIM
Em......
VWVA :I
NOTE: A numerical value of zero (one for Fecal Colfforms) was used for calculaton on those
numbers reported as less than' (<)
MONTH: FEBRUARY
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge Point
** DOWNSTREAM
YEAR: 2007
1 00010 1 00300100400 1 00310 1 00340 1 31616 1 95
2400
CLOCK 20C� G.MEAN
TIME � TEMP � D.O. � pH BOD-5 COD F-COLI � CONDUCTIVI
1 1115 1 11.0 1 2.8 1 1 1 1 1 1 1
1105 1 12.0

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: i-0,4D Permit/Pipe No.: N'G W 51712 Month/YearC L5
Monthly Average Violations
-Parameter Permit Limit DMR Value % Over Limit
Weekl O/Dailyiolations
Date Parameter Permit LimitfIvpe DMR Value % Over Limit
t -I b�o7 FOCAL (Af Ofltoo AtO 1® s
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations
Completed by: l
Regional Water Quality
Supervisor Signoff:
1
Date:
bf-� '®—?
Date: 10-2

eocte_
May 29, 2007
Mr. Steve Tedder, Regional Supervisor
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC, 27107
Dear Mr. Tedder,
RECEIVED
N.C. pent of ENR,
i
JUN 0 5 2001
Winston.sa!e-
Regicnal office
I am in receipt of your May 3, 2007 Notice of Violation regarding the February, 2007
exceedance of the Fecal Coliform Daily Maximum limit at the eHea d 1Vloibile-Home.-Park—
Wastewater System.
As you requested, I am providing a written response to this violation regarding the causes
of this violation and measures taken to correct this issue.
The Head MHP System uses a tablet chorinator to disinfect the treated effluent. A tablet
dechlorinator is also provided to dechlorinate the final effluent. The Head Wastwater
System is a subsurface treatment system which experiences adverse affects from rain and
subsequent intrusion of stormwater into the treatment system. The chorination system is
carefully monitored and indicated proper operation during the February sampling event.
Following this excursion, the chlorine contact chamber was evaluated for solids build up,
with very little solids found in the chamber. In addition, the laboratory Fecal sample
collection bottles and sampling technique will be evaluated for the potential of
contamination of this sample.
This violation appears to be an anomaly and does not represent a chronic problem. The
samples collected following this event demonstrate compliance with this parameter.
I hope this information is helpful in response to your May 3, 2007 correspondence.
Sincerely,
Hubert Head

O�O�WAT �RQG
o �
Mr. Hubert F. Head
Head Mobile Home Park
2880 S. Stratford Road
Winston Salem NC 27103
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
February 9, 2007
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
Alan W. Klimek, P.E. Director
Division of Water Quality
A review of Head Mobile Home Park's monitoring report for November 2006 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Fecal Coliform
11/29/06
400 #/100ml
430 #/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 Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Central Files - SWP
400 _R%_
N.C. Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107 [phone]
None Carolina
�tura!!�
Customer Service
1(800) 623-7748
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Cover Sheet from
Staff Member to
Regional Supervisor
i DMR Review Records �1 \
Facility: �`�� Permit/Pipe NoNWO JIa` Month/Year
Parameter
Average Violations
DMR Value
% Over Limit
`�� aily Violations
Date Parameter Permit Limit/ Tvpe DMR Value % Over Limit
Monito 'ng Frequency Violations
Date Parameter Perini re uencv Values Reported # of Violations
Other Violations
Completed by: ti Date:
Regional Water Quality
Supervisor SiQnoff: Date:

EFFLUENT
NPOES PERMIT NO: OOTa72237 DISCHARGE NO: 001 Gf -'.1M FORSYTH
FACILITY NAME: HEADiTRAI-LERR1Et6RRKWWTP -- CLASS: I
MONTH: �NO.V.EMBER:
OPERATOR IN RESPONSIBLE CHARGE (ORC): agrt, t in Ck GRADE: IV
CERTIFIED LABORATORY: 1 Trit St
PERSQ (s) COLLECTIN MPL
CHECK BLOCK IFORC HASCHANGED .(SIGNA R F ERA
Mail original and one copy to: BY THIS SIGNATURE, I
ATT: Central Files ACCURATE AND COM
Division of Water Quality
' 1617 Mall Service Center
Raleigh, NC 27699.1617
[phone]
^a t 'n
I R SPONSIBLE CHARGE) DATE
IFY THAT THIS REPORT IS
TO THE BEST OF MY KNOWLEDGE
50050
1000101
004001
500601
00310
1 006101
005301
3161610MMI
oogdol
006651
00545
1 00625
1 00340
1 00095
D
Operator
Certified
FLOW
GMETRIC
A
Arrival .
Operator
ORC
EFF [X]
MEAN
T
Time:
Time On
On
INF
RES.
BOD-5
FECAL
SETT.
E
2400 Clock
Site
Site?
RATE
TEMP.
H
CL2
20DEG.0
NH3-N
TSS
COLIF.
• D.O.
T.-NIT.
T: PHO.
MATTER
TKN
COD
COND.
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/1
MG/L
MG/L
umhos/cm
a o,r4
a o.re• I
a rae
r--�-�------
1 22 1 740 1 0.75 1 Y 1 0.00027 1 13.0 1 I 11.00 I< 4.0 1 0.90 1 3.0 1 22.0 1 6.8 1 1 1 1 ' I I I
AVERAGE
0.00033
13.0
12.8
1.8
2.95
10.0
22.1
7.0
iF1AUfvllltil`# z<<?><E>>>
.....................................................................................................................................
>II:i
fAi??$?>»?»::tit?><»�sSi
>»>63#1s»3>f1
...........................................................................................................................................
<`E
............
MINIMUM
0.00024
12.0
6.4
11.0
< 4.0
0.90
3.0
5.0
6.8
:
a''»:>:»':::'><<::>::<:>`:'>
...............
.......................................
............................................
MONTHLY AVG. LIMIT
0.0016
10.0
4.00
30.0
200.0
•:::.il!%il�i'isiAiiil`;?`:?
.. G........ ..............
';'<��E'•?!
��?�?s
;::±> �'}`:'•'
?<�"f%'�'�'
#'%:E<%`%f% �,�`%<'
f'?•`:'
........................
E...� ..``'+E'
'<<'
'�<X.
'?�??
:s#??E'
DAILY MAXIMUM LIMIT
6-9 1
17.0
1 15.0
20.00
45.0
400.0
REPLICA DEM FORM MR-1 (12/93) ' Minimum 13nq/l
NOTE: A numerical value of zero (one for Fecal CoVonns) was used for calculation on those
number; reported as -less than- (<).

CAM
JAN 0 3 2006
EFFLUENT
OA
JA
NPDES PERMIT NO: NCO057223 DISCHARGE NO: 001 COUNTY: FORSYT
FACILITY NAME: HEAD TRAILER PARK WV,/T CLASS;
MONTH: NOVEMBER YEAR: 2006
OPERATOR IN RESPONSIBLE CHARGE (ORC): aaU atl/ink GRADE: L [phone]
CERTIFIED LABORATORY:(1) Trites 11
PERS(�(S) COLLECTIN IVIPL t 'n
ERA R I SPONSIBLE
HASCHANGED (SIGNAT6415F CHARGE) DATE
=1.1 t9ff, =Cone copy to: BY THIS SIGNATURE, I FY THAT THIS REPORT IS
ATr: Central File$ & ACCURATE AND COMP TO THE REST OF MY KNOWLEDGE
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699.1 617
50050
00010
004001
50060
00310
00610
00530
31616
00300
00600
_00665
- 00545 1
00625
0
Operator
Certified
FLOW
GMETRIC
A
Arrival
Operator
ORC
-EFF (Xj
MEAN
T
Time:
Time on
on
INF [ I
RES.
BOD-5
FECAL
SETT.
E
2400 Clock
Site
Site?
RATE
TEMP.
PH
CL2
20DEG.0
NH3-N
TSS
COLIF.
* D.C.
T.-NIT.
T.-PHO.
MATTER TKIN
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
1100 ML
MG/L
MG/L
MGIL
MG/L
MG/L
7-
ELL
2
1 0.00030
x "IX
...
..........
...... ..
x.
4
0.00027
' WF
6
1225,
1.50
Y
0.00037
13.0
6.4
14.00
< 4.0
1.30
15.0
6.0
7.0
X:
8
0.00032
X
.:X7:�X
10
0.00024
12
0.00041
14
1145
1.10
Y
0.00038
12.0
6.6
12.0
< 4.0
8.70
19.0
5.0
6.9
.-.-Xlall .
.........
x
. .
...
X �x
..........
....
........
16
430
1.00
Y
0.00032
14.00
18
0.00027
........ ..... ..
20
0.00034
.............
17
7AO
1 0 75 1
Y
1 0.00027
113.0
1 1
11.00
I< 4.0
0.90
3.0
22.
mom
1.00
AVERAGE
0.00033
13.0
12.8
1.8
2.95 1
10.0
22.1
7.0
x.
MINIMUM
0.00024
12.0
6.4
11.0
<
4.0
0.40
3.0
5.0
6.8
MONTHLY AVG. LIMIT
.0.0016
10.0
4.00
30.0
200.0
.
. . . . . . . . . .
. . . . . . . . . .
,DAILY MAXIMUM LIMIT
1 20.001.
45.0 1
400.0
REPLICA DEM FORM MRA (12193)
NOTE: A numerical value of zero (one for Fecal Coftmis) was used for Calculation on these
number; reported as 'less than'(-).

miuTidui r. Cdblay, VVValfiul
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natur,='r2esources
Alan W. Klimek >.. Director
Division of er Quality
September 5, 2006
CERTIFIED MAIL 7006 0100 0001 8758 6405
RETURN RECEIPT REQUESTED
Mr Hubert Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston-Salem, NC 27103
SUBJECT: NOTICE OF VIOLATION
May 9, 2005 Compliance Evaluation Inspection
Head Mobile Home Park
Permit No: NCO057223
Forsyth County
Dear Mr. Head:
Enclosed please find a copy of the Compliance Inspection Inspection form from the inspection .
conducted on August 31, 2006. The Compliance Evaluation. Inspection was conducted by Rose
Pruitt of the Winston-Salem Regional Office. Gary Stainback, 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 violation of permit NCO057223 for the following
compliance issues found during the inspection:
Inspection Area Compliance Issue
Permit Facility not as permitted. Dechlor system installed without following
fast track authorization to construct notification and approval process.
Enclosed fast track app package with minimum design criteria.
I. Permit
The NPDES permit for the Head Mobile Home Park WWTP became effective August 1, 2004 and
expires on May 31, 2009. The permitted components of the 0.0016 MGD wastewater treatment
plant include: a septic tank, distribution box, subsurface sand filter, tablet chlorinator and contact
chamber/post aeration chamber.
MA
0 ENR
585 Waughtown Street Winston-Salem, NC 27107 Phone [phone] Fax [phone]

Head MHH
Page 2
August 31, 2006
II. Records/tports
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Head
Mobile Home Park WWTP for the period January 2005 through December 2005 revealed that the
facility had ten (10) Limit violations. Two were for daily maximum BOD violations in September
and October 2005. A Notice of Violation was issued by the Division for these violations. One
was for a daily maximum Fecal coliform violation in February 2005. A Notice of Violation was
issued by the Division for this violation. Three violations were for monthly average effluent
limitation violations for Ammonia -Nitrogen in February, June and July 2005, one daily maximum
violation occurred in July. The facility received a civil penalty assessment for three of these
violations and a notice of violation for one. Two violations for exceeding daily maximums and
one violation for exceeding monthly average Total Suspended Solids were issued in June 2005.
The facility received a civil penalty assessment for these violations. Operations records include all
sample analyses and process control tests that are performed. Please contact this office for
compliance assistance.
III. Facility Site Review
The facility site review indicated that the 0.0016 MGD treatment works is not consistent with the
permitted components. The actual treatment system consists of a septic tank, distribution box,
subsurface sand filter, tablet chlorinator and contact chamber/post aeration chamber, and an
unpermitted dechlorination unit.
The inspector found that a dechlorination unit had been added without following the fast
track authorization to construct notification and approval process. Enclosed is a fast track
application package and a copy of the minimum design criteria. Please complete and return
immediately.
IV. Effluent / Receiving Stream
The WWTP discharges to an unnamed tributary to Little Creek, a class C water in the Yadkin -Pee
Dee River Basin. The effluent was clear and free of visible solids on the date of inspection. The
receiving stream was free of solids, foam and debris.
V. Flow Measurement
Influent flow is measured with an in line county water meter.
VI. Self -Monitoring Program
kT
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Head
Mobile Home Park WWTP for the period January 2005 through December 2005 revealed that the
facility had ten (10) Limit violations. Two were for daily maximum BOD violations in September
and October 2005. A Notice of Violation was issued by the Division for these violations. One
was for a daily maximum Fecal coliform violation in February 2005., A Notice of Violation was
issued by the Division for this violation. Three violations were for monthly average effluent
limitation violations for Ammonia -Nitrogen in February, June and July 2005, one daily maximum
violation occurred in July. The facility received a civil penalty assessment for three of these
violations and a notice of violation for one. Two violations for exceeding daily maximums and

I IGO4 IVII IF
Page 3
August 31, 2006
one violation for exceeding monthly average Total Suspended Solids were issued in June.2005.
The facility received a civil penalty assessment for these violations.
VII. Compliance Schedules
No Compliance schedule to evaluate.
VIII. Laboratory
All of the sample analyses are conducted by Tritest Labs. The laboratory was not reviewed at the
time of the subject inspection.
IX. Operation and Maintenance
Operation and maintenance at the time of the subject inspection were deemed satisfactory since the
previous inspection. The effluent was clear and free of visible solids. The septic tank had been
pumped down by a licensed hauler. The contact chamber was free of solids. it was suggested to
the ORC that a meeting with the Division of Water Quality could be to their advantage in finding a
solution to ongoing problems meeting effluent limits.
X. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler (Transou) and
disposed of properly.
XI. Pretreatment
Not evaluated during this, inspection. No pretreatment program required.
XII.. Stormwater
Not evaluated during this inspection.
XIV. Sewer Overflow
None to report.
XV. Pollution Prevention
Not evaluated during this inspection.
XVI. Multimedia
Not evaluated during this inspection.

Head MHP
Page 4
August 31, 2006
Q. ,
Your continued oversight at this facility is still very important. The Division also encourages you
to continue to be proactive in your efforts to maintain compliance. Please do not delay scheduling
a compliance assistance meeting with the Division of Water Quality at your earliest convenience.
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,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: Gary M Stainback, ORC - 140 Linbrook Dr, Winston Salem NC 27106
Central Files
jW"s on-S-alem FAUMW
Forsyth County Health Dept.

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Com liance 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 SI 31 N00057223 111 121 06/08/30 117 181 CI 19I SI 20I II
Remarks
21IIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIII II16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------- ------ ------ Reserved --- ------- ------- —
67 I 169 70 13 I 711 I 721 NJ 73 I 174 751 I I I I I I 180
WI
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)
09:10 AM 06/08/30
05/05/01
Head Mobile Home Park
Exit Time/Date
Permit Expiration Date
2880 S Stratford Rd
Winston Salem NC 27103
10:00 AM 06/08/30
09/05/31
Name(s) of Onsite Representative(s)rfitles(s)/Phone and Fax Number(s)
Other Facility Data
Gary M Stainback/ORC/336-766-0270/ .
'Name, Address of Responsible Official/Title/Phone and Fax Number
Gar yy M Stainback,140 Linbrook Dr Winston Salem NC Contacted
271064539//336-659-0448/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance 0 Records/Reports
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
Rose Pruitt WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES
yr/mo/day
NCO057223 I11 121 06/08/30 117
Inspection Type
18ICI
(cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The inspector was met at the facility by the ORC Gary Stainback, at 9:10 am on August 30, 2006. The
facility appeared clean and well maintained at the time of the inspection. The effluent was clear and without
any traces of foam or solids at the time of the inspection. A Dechlorination system had been installed
without following the proper permitting fast track authorization to construct notification and approval
process. Enclosed is the fast track application package with minimum design criteria that should be
completed and returned immediately.
Page # 2

Permit: NCO057223
Inspection Date: 08/30/2006
Owner - Facility: Head Mobile Home Park
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping? ■
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:
Permit Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? n
n
■
n
Is the facility as described in the permit? Cl
■
n
n
# Are there any special conditions for the permit?
fl
n
■
n
Is access to the plant site restricted to the general public?
❑
❑
■
Is the inspector granted access to all areas for inspection?
■
❑
n
f=1
Comment: Dechlorination added.. Enclose fast track dechlor app
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
fl
n
Is all required information readily available, complete and current?
■
n
Cl
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
n
❑
Are analytical results consistent with data reported on DMRs?
■
Cl
n
❑
Is the chain -of -custody complete?
■
❑
❑
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
■
Q
O
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
Cl
■
❑
Is the ORC visitation log available and current?
■
n
n
n
Is the ORC certified at grade equal to or higher than the facility classification?
■
n
n
n
Is the backup operator certified at one grade less or greater than the facility classification?
■
n
n
n`
Is a copy of the current NPDES permit available on site?
■
n
n
n
Page # 3

Permit: NC0057223 Owner - Facility: Head Mobile Home Park
Inspection Date: 08130/2006 Inspection Type: Compliance Evaluation
J
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
■
n
Comment:
.Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
n
n
■
n
Is flow meter calibrated annually?
n
n
■
n
Is the flow meter operational?
n
n
■
n
(if units are separated) Does the chart recorder match the flow meter?
n
n
■
n
Comment: County water meter
De -chlorination
Yes
No
NA
NE
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
n
n
■
n
Is storage appropriate for cylinders?
00
■
n
# Is de -chlorination substance stored away from chlorine containers?
00
■
n
Are the tablets the proper size and type?
00
■
n
Comment: recently installed w/o fast track permitting process
Are tablet de -chlorinators operational?
n
n
■
Q
Number of tubes in use?
Comment:
Septic Tank
Yes
No
NA
NE
(If pumps are used) Is an audible and visual alarm operational?
n
n
■
n
Is septic tank pumped on a schedule?
n
n
■
n
Are pumps or syphons operating properly?
n
n
■
n
Are high and low water alarms operating properly?
❑
n
■
n
Comment: Pumped about once per year by Transou
Sand Filters (Low rate)
.Yes
No
NA NE
Page # 4

Permit: NCO057223 Owner - Facility: Head Mobile Home Park
Inspection Date: 08/30/2006 Inspection Type: Compliance Evaluation
Sand Filters (Low rate)
Yes
No
NA
NE
(If pumps are used) Is an audible and visible alarm Present and operational?
n
n
■
n
Is the distribution box level and watertight?
0
Cl
■
f_)
Is sand filter free of ponding?
n
n
■
Is the sand filter effluent re -circulated at a valid ratio?
n
❑
■
❑
# Is the sand filter surface free of algae or excessive vegetation?
n
n
■
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
Cl
n
■
11
Comment: sub -surface
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?
■
n
n
n
# Is the facility using a contract lab?
n
n
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
n
❑
■
❑
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
■
❑
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
❑
n
■
❑
Comment: Tritest
Field parameter certification for Head MHP #5076
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
Are the tablets the proper size and type?
■
n
n
n
Number of tubes in use?
Is the level of chlorine residual acceptable?
❑
❑
■
❑
Is the contact chamber free of growth, or sludge buildup?
n
n
■
n
Is there chlorine residual prior to de -chlorination?
M
n
■
n
Comment:
Page # 5

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality .
FAST -TRACK APPLICATION
for DECHLORINATION FACILITIES AUTHORIZATION TO
CONSTRUCT
THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL
INSTRUCTIONS: Indicate that you have included the following list of required application package items by
signing your initials in the space provided next to each item. Failure to submit all required items will lead to return
of the permit application.
A.
B.
C.
D
Application Form - Submit one original and one copy of the completed and appropriately
executed application form: Any changes to this form will result in the application being returned.
The Division of Water Quality (the Division) will only accept application packages that have been
fully completed with all applicable items addressed. You DO NOT need to submit detailed.nlans
ands ecificat'ions at this time. Plans andspecifications shall be maintained on -site.
Certification Form - Submit the completed engineers certification form_ signed and sealed. by a
professional engineer registered in the state of North Carolina.
Designated Representative - If the application is being filed by a party other than the owner, a
letter from the owner designating the . applicant as his/her authorized representative must be
included.
Read, understood, and followed the Dechlorination System Minimum Design Criteria
(adopted 4/18/03 and as subsequently amended).
THE COMPLETED APPLICATION PACKAGE SHOULD BE SENT TO THE FOLLOWING
ADDRESS:.
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
CONSTRUCTION GRANTS & LOANS SECTION
By U.S. Postal Service:
1633 Mail Service Center
Raleigh, North Carolina 27699-163.3
Telephone Number: [phone]
By Courier/Special Delivery:
2728 Capital Blvd., Rm. 1F-140
Raleigh, North Carolina 27604
For more information, visit our web site at http✓/www.nccgLned
FORM: DCL 4/2003

Certification
Fast -Track Authorization to Construct for Dechlorination Facilities
Professional Engineer's Certification:
attest that this application for
has been reviewed by me and is accurate,
complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation. I further attest that the proposed design has been prepared in accordance with all applicable
regulations and Minimum Design Criteria for Dechlorination Facilities, adopted April 18, 2003. Although certain
portions of this submittal package may have been prepared by other professionals, inclusion of these materials under
my signature and seal signifies that I have, reviewed this material and have judged it to be consistent with the
proposed design..' ....
NOTE: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes
any false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor .
which may include a fine not to exceed.$10,000 as well as civil penalties up to $25,000 per violation. Furthermore,
failure to design the -above referenced facilities in accordance with Minimum Design Criteria for Dechlorination
Facilities and good engineering practice could subject you to disciplinary action by the North Carolina Board for
Professional Engineers and Land Surveyors.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification:
I , attest that this application for
has been reviewed by me and is accurate
and complete to the best of my knowledge. By signing this certification I, certify that facilities have been designed
in accordance with the Division's Dechlorination System Minimum Design Criteria, and commit to insure
construction proceeds in accordance with said criteria. NOTE: In accordance with NC General Statutes 143-215.6A
and 143-2I5.6B, any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000 as well as civil
penalties up to $25,000 per violation.
Signature:
Date:
FORM: DCLC 4/200.3

State of North. Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION FORMATION TO.
for DECHLORINATION FACILITIES A UTHO
CONSTRUCT
THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL
---------------
1. Facility Name:
2. Facility Permit Number:
3. Facility Address:
4. Contact Person:
5. Contact"Telephone:
6. Project Description:
FORM: DCLb 4/2003

Dechlorination System 'Minimum Design Criteria
Adopted April 18, 2003
Introduction
The Triennial Review Committee's move to adopt a fresh water standard for total residual
chlorine (TRC) is driving the implementation of TRC effluent limitations for facilities that. use
chlorine or a chlorine derivative for disinfection. Such a limit may necessitate the use of a
dechlorinating agent such as sulfur dioxide br a sulfite derivative. The relatively simple nature
of dechlorination affords the Division the opportunity to develop a fast -track permitting
strategy for approval of such systems. The minimum design criteria outlined herein are meant
to provide the regulated community and their engineers the information necessary to ensure
proper system design and rapid project turn -around.
Applicability
This criteria document applies to the design of sulfur dioxide and sulfite derivative systems.
Facilities proposing to employ an alternate means for dechlorination, such as activated carbon,
authorization to construct (ATC) permitting process.
are required to follow the standard
Design Criteria
1.0 Dosage Rates
The following dosage rates are to be used for the design of dechlorination systems. These
dosage rates constitute the stoichiometric requirement plus a 10% margin of safety'.
2.0 Duality Requirements
Designs shall include dual ' feed systems to insure compliance with residual chlorination
limitations in the event the primary (if one is designated) system fails.
1 Recommended Standards for Wastewater Facilities; Great Lakes -Upper Mississippi River Board of State
and Provincial Public Health and Environmental Managers; page 100-7, 1997 Edition.

Dechlorination System Minimum Design Criteria
3.0 Feed Systems
3.1 Sulfur Dioxide and carbon steel or
Gaseous sulfur dioxide feed systems shall employ vacuum pP t�zbing are acceptablepiping
steel piping. For aqueous solutions, PVC, PE, CPVC, rubber
alternatives.
3.2 Sulfite Derivatives
sulfite .and sodium metabisulfite solutions shall employ
Feed systems for both sodium bi
positive displacement pumps and stainless steel piping.
4.0 - Mixingo ating agent is
Proper turbulent mixing should be provided such that thel no less than 30 seconds detention
mixed within 20 seconds of application. Designs shall prove
time for mixing?
5.0 Chemical Storage
The dechlorinating agent storage area must route solution
in well ventil ed aoreas
area. Chlorine and. sulfur dioxide are tcontainment
o be stored separately.
6.0 Effluent Quality As proper
Dechlorination consumes alkalinity and e'and dissolved
oxygen d oxygen t o ensure that both
consideration must be given to effluent pH
parameters are within acceptable ranges at the point of discharge.
2 Recommended Standards for Wastewater Facilities; Great
Lakes-Upper aMiss997 issippi
River Board of State
and Provincial Public Health and Environmental Managers; page
version 4.18.2003
Page 2 of 2

193
Faxed To: Gary Stainback
Fax #: [phone] Phone [phone]
WWTP Annual Inspection Checklist `-� W
This information should be available to the inspector at inspection time.
Facility: Head MHP WWTP NPDES: NC0057223
0
Permit Effective Dates: Aug 1, 2004 to May 31, 2009 0 �
Inspection Dater ZO0 0 Inspection Time: to C%
r
DMRs (Dates: January 2005 to December 2005 )
LiL) Lab Data (per DMR dates)
,--3) Laboratories used for analysis & certification #'s
cv4) Chain of Custody forms (per DMR dates)
,5) Complete copy of current NPDES permit
�s of SOC or Moratorium issuance (if applicable) 1
..�) ORC and Back-up ORC current certification
8) Wastewater Annual Report (fiscal or calendar year — if applicable) Z`z
V9) Daily Operator's log / ORC visitation log
;/10) Maintenance log
L,A 1) Process control data (which includes field parameters tested and equipment
calibrations)
;�12) Field Parameter certification (if applicable) ma`s""®�(p. I` �/►i+'N-P
eter calibration records (if applicable)
J;-- Influent and/or effluent samplers
{ew charts (if applicable)
:I�---generator Inspection / under load checks
t/1_7) Spill Response Plan (with current emergency contact numbers)
went Sludge / Residuals permit (if applicable)
19) Sludge / Residuals hauling records (if applicable)
20) Sludge / Residuals Annual Report (if applicable)
Plant visual inspection of treatment units
q,,-22) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office
[phone]
Fax: [phone]

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 08/09/06 Page: 1 of 2
Pe MRs.Between. and 22005 Re Ion.,,/o
ViolationgGatego""ry
�.o
;,;,` `Program'Category:c•% -
,.., . rmlt. nc0057223
"�F I N o S
,122004
f. 9-
,< Name;:,/o< ty.
x{o;"`>;='
.Violation -Act 0
a e.. -la' : ,." .,,
acl rt m
Y
, . ;.:: y , ,.-..Param -``
r •; t<s
,�
Fv,
aMa oor.
J r-MI n
PERMIT: NCO057223
FACILITY: Head Mobile Home Park - Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING
OUTFALL
VIOLATION
UNIT OF
CALCULATED_
REPORT
/ PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
09 - 2005
001
Effluent
BOD, 5-Day (20 Deg. C)
09/13/05
Weekly
mg/I
7.5
9
Daily Maximum Exceeded
'. Proceed to NOV
10 - 2005
001
Effluent
BOD, 5-Day (20 Deg. C)
10/13/05
Weekly
mg/I
7.5
10
Daily Maximum Exceeded
Proceed to NOV
02 - 2005
001
Effluent
Coliform, Feral MF, M-FC
02/22/05
Weekly
#/100ml
400.
3,500
Daily Maximum Exceeded
Proceed -to NOV
Broth,44.5C
02 - 2005
001
Effluent
Coliform, Fecal MF, M-FC
02/28/05
Weekly
#/100ml
400
3,500
Daily Maximum Exceeded
No B n, Data Entry
Broth,44.5C
For
r
02 - 2005
001
Effluent
Nitrogen, Ammonia Total (as N)
02/28/05
Weekly
mg/I
4
5.95
Monthly Average Exceeded
Proceed to NOV
06 - 2005
001
Effluent
Nitrogen, Ammonia Total (as N)
06/30/05
Weekly
mg/I
2
2.43
Monthly Average Exceeded
Proceed to
Enforcement Case
07 - 2005
001
Effluent
Nitrogen, Ammonia Total (as N)
07/19/05
Weekly
mg/I
10
10.6
Daily Maximum Exceeded
Proceed to
Enforcement Case
07 - 2005
001
Effluent
Nitrogen, Ammonia Total (as N)
07/31/05
Weekly
mg/I
2
4.97
Monthly Average Exceeded
Proceed to
Enforcement Case
06 - 2005
001
Effluent
Solids, Total Suspended
06/16/05
Weekly
mg/I
45
48
Daily Maximum Exceeded
Proceed to
Enforcement Case
06 - 2005
001
Effluent
Solids, Total Suspended
06/21/05
Weekly
mg/I
45
76
Daily Maximum Exceeded
Proceed to
Enforcement Case
06 - 2005
001
Effluent
Solids, Total Suspended
06/30/05
Weekly
mg/I
30
40.5
Monthly Average Exceeded
Proceed to
Enforcement Case
Monitoring
Violation
MONITORING OUTFALL
VIOLATION
UNIT OF CALCULATED
REPORT / PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
06 - 2005 001 Effluent
Nitrogen, Total (as N)
06/30/05
Quarterly
mg/I
Frequency Violation
Proceed to
Enforcement Case
06 - 2005 001 Effluent
Phosphorus, Total (as P)
06/30/05
Quarterly
mg/I
Frequency Violation
Proceed to
Enforcement Case

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 08/09/06 Page: 2 of 2
r
. ; :..•- -.. "Uolation Gate" xo Jo ``%
..,..�, .
Perm �,_. <, , . ,,
>t. nc0057223 ....MRs Between. 122004�005,.� =,Re Ion. /0 9 rY•'
Fro raiim`Cafe o .../o <, .
9 9An
,... , .. •�
��
,< ,, .,. . ✓, . u . v , ., .,.,...x. .0
Fact Param Name. t � "`r
Subbas
'.VoatioriAction:./
Ma or, M 7
„r
PERMIT: NCO067223
FACILITY: Head Mobile Home Park- Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Reporting Violation
MONITORING OUTFALL
VIOLATION UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER DATE FREQUENCY MEASURE
LIMIT VALUE
VIOLATION TYPE VIOLATION ACTION
12 - 2004
12/31/04
Signature Missing None

Permit Inspection History
Permit:
NCO067223
Owner:
Head Mobile Home Park
Facility:
Head Mobile Home Park
Primary Inspector
Inspection Type
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
Max S Mauney
Compliance Evaluation
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Page 1
Report Date: 08/09/06
County:
Forsyth
Region:
Winston-Salem
Permit Type:
Discharging 100% Domestic
< 1MGD
Inspection Reason Inspection Date
Facility Status
Routine
07/31/86
Compliant
Routine
10/01/87
Neither
Routine
09/14/88
Neither
Routine
08/02/89
Compliant
Routine
09/27/90
Compliant
Routine
08/15/91
Compliant
Routine
05/18/95
Compliant
Routine
03/05/96
Compliant
Routine
10/29/96
Compliant
Routine
08/28/97
Compliant
Routine
07/15/98
Compliant
Routine
03/10/99
Compliant
Routine
02/14/00
Compliant
Routine
04/02/01
Compliant
Routine
04/09/02
Not Compliant
Routine
04/21/04
Not Compliant
Routine
05/09/05
Compliant
Routine
Neither

PERMIT NUMBER: NCO057223 PERIOD ENDING MONTH: 12 - 2005 DMR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park PAGE 3 OF 4
COUNTY:
CITY: Winston Salem Forsyth REGION: Winston-Salem,
OUTFALL: 001 EFFLUENT
00010
00300
00310
00400
00530
00600
00610
00665
deg c
mg/l
mg/l
su
mg/l
mg/1
mg/1
mg/1
Temperature,
D0, Oxygen,
Dissolved
BOD, 5-Day (20
Deg. C)
pH
Solids, Total
Suspended
Nitrogen, Total
(as N)
Nitrogen,
Ammonia Total
Phosphorus,
Total (as P)
Water Deg:
Centigrade
(as N)
10
30
4
1 - 05
14.5
6.3
0
6.8 - 6.9
13.6
24-.5
2.43
3.1
10
30
4
2-05
14
6.2
0.8
6.9 - 7.2
11.8
5.95 Violation
10
30
4
3-05
15.5
6.1
0
6.5-7.1
6.8
2.47
5
30
2
4-05
14.2
7.3
1.4
6.3 - 6.7
17.4
19.11
1.81
3.03
5
30
2
5-05
14.3
7.4
2
7.2-7.4
11.6
1.56
5
30
2
6-05
15.25
6.175
0
6.2 - 6.5
40.5 Violation
2.425 Violation
5
30
2
7-05
18.75
6.1
0
6.1 - 6.4
14
4.975 Violation
5
30
2
8-05
22
6.1
1.4
6.1 - 6.3
7.4
1.38
5
30
2
9-05
22.4
6.22
5
6.2 - 6.8
9.75
8.65
0.05
1.64
5
30
2
10-05
21.8
6.54
4.2
6.7 - 7
19
0.24
10
30
4
11 - 05
15.25
6.7
3.75
6.5 - 6.7
17.25
1
2
10
30
4
12-05
14
6.825
2.25
6.2 - 6.4
22.75
17.31
2.1
1 3.84

PERMIT NUMBER: NC0057223 PERIOD ENDING MONTH: 12 - 2005 DMR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park PAGE 4 OF 4
COUNTY:
CITY: Winston Salem Forsyth REGION: Winston-Salem
31616
50050
50060
#/100ml
mgd
mg/l
Coliform, Fecal
Flow, in
Chlorine, Total
MF, M-FC
conduit or thru
Residual
Broth,44.5C
treatment plant
0.002
1 - 05
26.2
0.00043
0.75
0.002
2-05
158.3
0.00043
0.96
0.002
3-05
7.4
0.00045
1.27
0.002
4-05
1.1
0.00036
1.19
0.002
5-05
1.430969
0.000351
1.754
0.002
6-05
15.394188
0.000387
1.502222
0.002
7-05
1.86121
0.000368
1.43125
0.002
8-05
8.308814
0.000375
1.255
0.002
9-05
1
0.000344
1.46
0.002
10-05
1
0.000319
1.406667
0.002
11 - 05
1
0.000344
1.157778
0.002
12-05
1
0.000314
1.0175

Mir iael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W, Klimek, P.E. Director
Division of Water Quality
FiErm;40
To:
S,)A \m 'Q/ 0(— From:
Fax: -7(Xo — 0 y CU17 Pages: 2,
Phone: (p
Z Date: —
Re CC: - .. -._..
❑ Urgent ❑ For Review El Please Comment ❑Please Reply ❑Please Recycle
• Comments:
-'5AI-Tt 0 1,-,
5G13QZEJ:>
North Carolina Division of Water Quality 585 Waughtown Street; Winston-Salem, NC 27107 Phone [phone] N� v Carol �n
w.
Customer Service: 1-877-623.6748 Internet: wwncwaterquality.org 336 )
An Equal Opportunity/Affirmative Action Employer— 50%Recycled/10% Post Consumer Paper

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: I{Y1 Permit/Pipe No.: NCZW77.,? Month/Year 5_E�f_F
2©O LP
Parameter
N�13 -t\1
Monthly Average Violations
Permit Limit DMR Value
�,P
Over Limit
0
Weekly/Daily Violations
Date Parameter Permit Limit/ TVDe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Violations
IVO
��0(0 � rG1�� � �� • �'41�JV1+4x
A} OV'AwATRL4 �A
3/® C - E N P- DD ,T 4l lJ�j �, �+A ��-l.�/ 11\1�t
Completed by:
Regional Water Quality
Supervisor Signoff:
Date: ) Z 7
Date:
�Z= -/—06
Fee

EFFLUENT NOV. 6 2006
A
NPDES PERMIT NO: N00057223 DISCHARGE NO: 001 COUNTY: FORSYTH NOV O v 9 2006
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS: I
MONTH:. SEPTEMBER YEAR: 2006
OPERATOR IN RESPONSIBLE CHARGE (ORC): Gary Stbilack GRADE: N PHONE: [phone]
CERTIFIED LABORATORY: : 1 Tritest -
PERSON(5) COL CTING S ES Ga InbaCk
rwr'rK BLOCK IPORC HAS CHANGED .(SIG OF OR IN RESPONSIBLE CHARGE) /�✓ DATE
Mail original and one Copy to: BY THIS SIGNA E, I CERTIFY THAT THIS REPORT IS
ATT: Central Files ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699.1617
50050
00010
00400
50060
00310
00610
00530
31616
00300
00600
00665
00545 1
00625
D
Operator
Certified
FLOW
GMETRIC
MEAN
A
Arrival
Operator
ORC
EFF [XI
INF
RES.
6OD-5
FECAL
SETT.
T
E
Time:
2400 Clock
Time On
Site
On
Site?
RATE
TEMP.
PH
CL2
20DEG.0
NH3-N
TSS
COLIF.
' D.O.
T.-NIT.
T: PHO.
MATTER
TKN
MGD
DEG C.
UNITS
UG/L
MG/L
MG/L
MG/L
1100 ML
MG/L
MG/L
MG/L
MG/L
MG/L
2
0.00035
4
0.00042
...... ...........................
.
6
0.00035
::>:::::::7::>::y:>::
>:{I,QAD47::<:::::;
;:;:;;:;.:E2.OEi:.:;+.;,.:.:Q:A;:.;:;:;::.1;4Qs;:.;:;:;•:
?.........300...
8
0.00039
10
0.00041
<:::�::::>:
«:::.:::::::::>'1:�9:<::::i:>>1''•::::>:
<::l�:LtZti��5::>::::�S�EI;::::::>::::><::::>::::>::>:::'i4:(1Ei:.::s.;:;.:?E:t1.;::.:.;:.;;:.�,�.R
:...::::::3�.::..:::.:
� 12A.�.....
�,...................
.
12
0.00040
14
0.00037
16
0.00035
18
742
0.90
Y
0.00033
26.0
11.00
4.0
3.10
4.0
70.0
6.6:
::
AM
20
0.00035
::+:;
......
:: I
` :EI :S[: [ :!
:s _:' :zz j:> I
;3 t>'it :
:t: z ?::3#<::s z::
: is zziz::::::
22
0.00028
24
0.00032
26
1132
1.10
Y
0.00037.
25.0
12:00........4:°.........1.60
1:012:O.;:a
6:6:•::•::;:::.12.28
::»::;50.851.90
:::::::>
28
0.00055
30
0.00035
AVERAGE
0.00036
25.3
12.3
2.0
2 45
8.5
41.7
6.7
12.28
0.85
1.90
ENE
.::.;:.;:;4Q.::::.:::3,3#I::..:::20
...........................
.
Egg
MINIMUM
0.00023
25.0
6.0
10.0
< 4.0
1.40
1.0
12.0
6.6
12.28
0.85
1.90
Gnmp>t ldC3r
:><::::::..........:::>:<0:::>::::>::>
MONTHLY AVG. LIMIT
0.0016
5.0
2.00
30.0
200.0
DAILY MAXIMUM LIMIT
6-9
17.0
7.5
10.00
45.0
400.0
REPLICA DEM FORM MR-1 (12/93)
NOTE: A numerical value of zero (one for Fecal Colifonns) was used_for calculation on those
numbers reported as "less Nan- (4).

Facility 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 actiods being taben in respell to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
071—./�
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my ingdw
-of the person or persons who manage the system, or those persons directly responsible for gathering the information. the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Hubert Head
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Head Mobile Home Park 336-724-5911 ma* 31 2004
Permittee Address Phone Number Permit Exp. Dal
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00095 Conductivity
00300 Dissolved Oxygen
00310 BOD5
00340 COD
00406 pH
-00530 Total Suspended
Residue
00545 Settleable Matter
PARAMETER CODES
00556 Oil do Grease
00951 Total Fluoride
00600. Total Nitrogen
01002 Total Arsenic
00610 Ammonia Nitrogen
00625 Total Kjeldhal
01027 Cadmiuriii .
Nitrogen
00630 Nitrates/Nitrites
01032 Hexavalent Chromium
01034 Chromium
00665 Total Phosphorous
00720 Cyanide
01037 Total Cobalt
00745 Total Sulfide
01042 Copper
00927 Total Magnesium
01045 Iron
00929 Total Sodium
01051 Lead
00940 Total Chloride
01062 Molybdenum
01067 Nickel
01077 Silver
0.1092 Zinc
01105 Aluminum
01147 Total Selenium
31616 Fecal Coliform
32730 Total Phenolics
34235 Benzene
34491 Toluene
39260 MBAS
39516 PCBs
50050 now
50060 Total
Residual
Chlorine
71990 FormaldA
71900 Mercury
91551 Xylene
Parameter Code assistance may obtained by calling the Point;Source, CompliancelEnforcement Unit at [phone] or by visit
the Water Quality Section's web siteat h2o.enr.staKne.us/wp's and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.E
** If signed by other than the permittee, delegation of signatory authority must be on file with the state Per 15A NCAC 2B -050

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge mint
** UPSTREAM **
D 2400
A CLOCK 20C
T TIME � TEMP � D.O. � pH � BOD-5 COD F-COLI
E
H R.q
10
w
_12
14
29
16
001 MONTH: SEPTEMBER YEAR: 2005
COUNTY: FORSYTH
STREAM: Little Greek
LOCATION: 0,1 Miles downstream of discharge point
95
minim
Em HEMMEMEM
Im
NOTE: A runnerical value of zero (am for Fecal Colffornns) was used for calculation on those
numbers reported as law than" (<).
** DOWNSTREAM **
2400 CLOCK I 20CI G.MEAN
TIME I TEMP I D.O. � pH BOD-5 COD F-COLI
26.0
0.4
25.0 1 0.4

Cover Sheet from
Staff Member to
Regional Supervisor
DAIR Rei-iew Record
Facility: H`�b P Permit/Pipe No.: NC. OOS7 Z23 �1onth/Year 3y u L
. Zo® �
Monthly Average Violadons
Parameter Permit Limit Dl\I2 Value
Date Parameter
(v to- o(p e.11U E
�D(P �� L02.1 ll► �
Date .Parameter
11'924P _V4LOe-we
-0 � G Lze-. N�
(0 - Ur-P(p Gq ucc) Nil"
Week]/Daily Vi lations
Permit LimitlT,,ve DN R
.Q
17
_1.7 ly,y
Weekly wily V' lations
Permit Limit/T�ve D�1R
/7
Other v1otations
-ZOO -- 0397 ,ROD- -/00
I-1/ ' off - �31 �/ - nF .11_ -
V--,t----
Completed by:
Regional Water Quality
Supervisor Signoff:' .
0
% Over Limit
Value
Value % Over Li,WYII
t
�1t`9
-11
v�
— iGI —
17- /6 ~®&
Date: JU' p -a

O C T 0 6 2006
September 22, 2006
NC Dept. of EHNR
ATTN: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Sirs,
Enclosed is anamenMonthly Monitoring Report for the month of- June 2enf 00 or Head Trailer
Park WWTP, NPDES Permit Nod: NC0057223.
The report is being amended due to inadvertently recording the units for residual chlorine in mg/1,
when they should be ug/1 and data for the 5t' and 7t' were recorded on the 6t' and 8t'.
We are sorry for any inconvenience this may have caused. If you have any questions or require
additional information, please advise.
Sincerely,
Gary Staid k
ORC
GS/lm
cc: Mr. Hubert Head

NPDES PERMIT NO: NCO057223
FACILITY NAME: HEAD TRAILER PARK WWTP
OPERATOR IN RESPONSIBLE CHARGE (ORC):
CERTIFIED LABORATORY: 1 Tritest
CHECK BLOCK ff ORC HAS CHANGED
Mail original and one copy to:
ATT: Central Files
Division of Water Quality
1617 Mall Service Center
Raleigh, NC 27699-1617
e IV. ECENE�
000t. of EN.q
L0,M
r 09 Z®0EFFLUENT
cs,rc
DISCHARGE NO: 001 C 11 "
CLASS: I
MONTH: - JUNE YEAR: 2006
Ga Stai ack GRADE: IV PHONE: [phone]
PERSON(s) COLLECTING S LES: a • back
x
(SIGNATURE OF OP TOR IN RESPONSIBLE CHARGE) DATE
BY THIS SIGNATUR CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE
50050
00010
004001
50060
00310 1
00610
005301
31616
'00300
00600
00665
00545
00625
00340
00095
D
A
T
E
Operator
Arrival
Time:
2400 crook
CerHfled
operator
Time on
Site
ORO
On
sit.?
FLOW
TEMP.
DEG C.
pH
UNITS
RES.
CL2
-M6ii+
BOD-5
2 MG/L
NH MG/L
MG/L
GMETRIC
MEAN
FECAL
UR
C 00 ML
MG/L
MGlL
T MG/L
SETT.
MG/L MATTER
MG/L
.w MG/L
umhos/cm
EFF N
INF [ ]
RATE
MGD
1_
.1.:1.Ot.,
• ,Y,
a[0{0,0044
0.00030
0.00042
„KO:UOOA5A„
0.00051
era,
..a �
18.0
...,...
6.7
,14
.,
1
_
2
2-0
4
1.155,,.-,
6
�600`
:,.1;207
:rY',Ft,
;,0,
.1
8
0.00040
-
10
0.000307.
�.,
12
1130
1.50
Y
0.00051
-
19.0
6.8
15.0
< 4.0
0.50
4.0
24.0
6.4
,. ., .
;
;,
: .:.., .
13 ,
50.7==, „
J`.00;.
Y:
00'-00041;-
.00022
0.00054
i
�frU.WU�rr:
0.00049
i'9,
14`:0;,
r
,
31
14
16
18
;;�19.,,....,
.,r
t.,,,928;:
;.rJ.50�•.
,
4:50;
„Y,._
,0.00028..E
0.00034
1;
+O 00050,..;
20.0 :::,$
,,,
20
220.00048
,,, , .., , .�,,
;21
24
1108
520
1.50
1.00
Y
Y
0.00032.
0.00037
c,0A0059a_,
0.00059
0.00040
6.6
14.0
12.0
< 4.0
0.40
2.0
_
< -1.0
.
L,
6.1
7
16.34
�.rc.7
1.63
, ,. ,,,26
0
;
28
30
AVERAGE
0.00042
19.5
13.0
0.0
0.55
• 3.81
4.9
6.3
,
16 .�
_.,:.-s'.,,r:,�•.
1.63
...:..:
....:.:.,,:._,..
. 0• 00
-,.:-.:,,.
MAXIMUM.
..
:...-,,.<„v,,.
. .....
,.. •,. _..,,..
e:_:..,_..,., ....,>
_ . _....
'
......,_
MINIM UM -
Corrip:(C);/Grab(G)
MONTHLY AVG. LIMIT
0.00022
0.0016
18.0
G .„G,
6.6
11.0
< 4.0
...
5.0
0
r ...
2.00
< 1.0
30.0
< 1.0
. 200.0
6.1
16.34
, , ...:,.-..
1
_ ..._
1.00
•
WEEKEY AVG:, LIMIT'777
-777
DAILY MAXIMUM LIMIT
6 9
17.0
7.5
10.00
45.0
400.0
REPLICA DEN FORM MR-1 (12193I
NOTE: A numerical value of zero (one for Fecal Coliforma) was used for calculation on those
numbers reported as 'less than* (<)•

t `*s
Facility 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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and 'mpris*dement for know, violations. "
gab Y'
Pe rnittee (Please print or type)
Signature of Permittee** Date
(Required)
Bay 1 e� G Tray 1 Pr Park Permit
May 31, 2004
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076.
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
$OD5
00340
COD
00406.
pH
00530
Total Suspended
Residue
00545
Settleable Matter
00556 Oil & Grease
00600 Total Nitrogen
00610 Ammonia Nitrogen
00625 Total Kjeldhal
Nitrogen
00630 Nitrates/Nitrites
00665 Total Phosphorous
00720
Cyanide
00745.
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
PARAMETER CODES
00951 Total Fluoride
01002 Total Arsenic
01027 Cadmium
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01032 Hexavalent Chromium 01147 Total Selenium 71880 Formaldehyde
01034 Chromium 31616 Fecal Coliform 71900. Mercury
32730 Total Phenolics 81551 Xylene
01037
Total Cobalt
34235 Benzene
01042
Copper
34481. Toluene
01045
Iron
38260 MBAS
01051
Lead
39516 PCBs
01062
Molybdenum
50050 Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o enr state.nc.us/wgs and linking to the Unit's inf6i•mation pages.
Use only units designated in the reporting facility's permit for rePorting data.
90 GE d3S
* ORC must visit facility and document visitation of facility.as required per 15A NCAC 8G .0204.
** If signed by other than the permittee, delegation of signatory authority must be bn file with the state per 15A NCAC 2B .0506 (b)
(2) (D)•

CA
EFFLUENT JUL 5 26"S QA
JUL 2 8 2006
NPDES PERMIT NO: NCO057223 DISCHARGE NO: 001 COUNTY• TH
FACILrrYNAME: HEAD TRAILER PARK WWTP CLASS: i
MONTH: • JUNE YEAR: 2006
OPERATOR IN RESPONSIBLE CHARGE (ORO): Ga t 'back GRADE: IV PHONE: [phone]
CERTIFIED LABORATORY: 1 I Tries
PERSON(.) COLLECT LES: a 'back
r
0EQf BIACK W ORC HAS CHANOED
M.110
all Original and One copy t0: !,,�,Gnaj
IGNATURE OF OP TOR IN RESPONSIBLE CHARGE) DATE
ATT: Central Files B THIS SIGNATUR CERTIFY THAT THIS REPORT IS
Division Ot Water QualityA CURATE AND COMPLETE TO THE' BEST OF MY KNOWLEDGE
1617 Mall Service Center jce
Raleigh, NC 27699-1617
11
50050
00010
00400
50060
00310
00610
00530
31616
'00300
00600
OD665
00545
00625
00340 1
00095
D
A
T
E
Operator
Arrive[
Time:
2400Clock
certified
Operator
Time On
site
ORC
On
SR.?
FLOW
TEMP.
pH
RES.
CL2
BOD-5
20DEG.0
NH3-N
TSS
GMETRIC
MEAN
FECAL
COLJF.
' D.O.
T.-NIT.
T: PHO.
SETT.
MATTE
TKN
COD
COND.
EFF [X]
INF [ ]
RATE
MGD
DEG C.
UNITS
niA:di�lf37[
A MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
MG/L
MG/L
MG/L
u cm
-
"-__
rr
f
r t t t
f ���•
Kmlwfic��
!
I��.
>
r
r ,r,
REPLICA DEM FORM MR-1 (12/93) ""•�"•1O �•
NOTE: A numerical value of z ro'(a— for Fecal Coliforms) vas used for calculation on those
numbers reported as •lee. than' (<).

Facility 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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisdhment for knowing violations."
Permittee (Please print or type)
0
Signature of Permittee** Date
(Required)
Basle-'s Tra,ierpark 336-724-5911 May'31, 2004
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
OW95
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00400.
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556 Oil & Grease
00951
Total Fluoride
00600 Total Nitrogen
01002
Total Arsenic
00610 Ammonia Nitrogen
00625 Total Kjeldhal
01027
Cadmium
Nitrogen
00630 Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
01042
Copper
00927
Total Magnesium
01045
Iron
00929
Total Sodium
01051
Lead
00940
Total Chloride
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147
Total Selenium
71880
Formaldehyde
31616
Fecal Coliform
71900
Mercury
32730
Total Phenolics
81551
Xylene
34235 Benzene
34481 Toluene
38260 MBAS
39516 PCBs
50050 Flow
Parameter Code assistance may obtained by calling the point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o enr state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204. 90
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per,P15A NCAC 2B —0506 (b)
i
(2) (D)•

NPDES; NO: NCO057223 DISCHARGE NO: 001
I
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM **
ori.i-ll me �m
ImmillEmEm
MENEM
NOTE: A numerical value of zero (one for Feral Colifamis) was used for calculation on ftse
nmbm reported as 'less twif (<).
MONTH: JUNE YEAR: 2005
COUNTY: FORSYTH
STREAM: UtHe Creek
LOCATION: 0.1 Miles downstream of discharge odnt
** DOWNSTREAM **
1 2400
CLOCK 20 C G.MEAN
TIME I TEMP I D.C. I pH I BOD-5 COD I F-COU

July 21, 2006
N.C. fleot. of BUR
JUL 2 4 20M
Winston-Salem
Regional Of` se
Mr. Steve Tedder, Regional Supervisor
NCDENR
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to your June 23, 2006 Notice of Violation at Head MHP WWTP
for Ammonia Nitrogen. The monthly average Ammonia Nitrogen concentration for April
was 2.78 mg/l, which marginally exceeded the summer limit of 2.0 mg/1.
Currently the facility indicates compliance; however, the septic tank, sand filter design
continues to be adversely affected by seasonal changes as well as excessive rain events.
We will continue to monitor this progress and take every measure to maintain
compliance.
Sincerelv_
Cc: Gary Stainback, ORC

MONITORING REPORT(MR) VIOLATIONS
for:
Report Date: 05/30/06 Page: I of I
Permlt.
16fation �Qatdg6i�y:.',Linift
6o6' 'P ""Vi Vid'M
nd
wv�
"' rogra rn Ckegbry:,NPIDE�S WW'',"
,Jo.ween
M
oil! Na ef'
ty
0,
n o
_,..,.joafionActl6,:,N fie
V
o in
Mr 0�.
"I"
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth
Limit Violation
MONITORING OUTFALL VIOLATION
REPORT / PPI LOCATION PARAMETER DATE FREQUENCY
01-2006 001 Effluent Nitrogen, Ammonia Total (as N) 01/31/06 Weekly
REGION: Winston-Salem
UNIT OF CALCULATED
MEASURE LIMIT VALUE VIOLATION TYPE
mg/I 4 4 Monthly Average Exceeded
19
VIOLATION ACTION
None

Cover Sheet from
Staff Member to
Regional Supervisor
DNIR Review Record
Facility: '�tE per�t/pipe No.: N(- OOS r?2 3 MondifYear ��4-N o co
Monthly Average Violations
Parameter Permit Limit DNMR Value
[v4.s-Nrn
Week] aily iolations
Date Parameter
I -3 -o,o 'I- 9,c—
fo
I (LC -
Date Parameter
18'Ob
t-23 -off
�-zY,-too i 1z-&
(-)[her violations
Completed by:
Permit Lire tvTvDe
-? /_1452
17 ,u-� /f
Weekly ail iolations
Permit L.irrdT 7vDe
/77
DMR Value
o l�
Date:
Regional Water Quality
Sugervisor.Signoff.
Date:
% Over Limit
% Over Limit
Over Limit
?Z oC
-76)
60
J4—,,�, -6

CAR
MAR 3
?006
MAR 0 7 2006
E ENT
NPDES PERMIT NO: NCO057223
FACILITY NAME: HEAD TRAILER PARK WWT
DISCHARGE 0'
001 CO �FQRSYT
CLASS: I
4'�JA-N
- �UARYI�
/.ck
MONTH:
6
YEAR: 20 6
-
OPERATOR IN RESPONSIBLE CHARGE (ORC):
921y .5t.'r,
GRADE: IV
PHONE: [phone]
CERTIFIED LABORATORY: (1) Tritest
PERSON(s) COLLECTING MPLES:
A'&4gt
HAS CHANGED
x
Mall original and ;no copy to: (SIGNAAKE OP 0 IN RESPONSIBLE CHARGE) DATE
CERTIFY TU 0
ATT: Central Files BY THIS SIG E, CERTIFY THAT THIS REPORT IS
T
Division of Water Quality ACCURATE AND OP
TO THE BEST OF MY KNOWLEDGE
1617 Mall Service Center
Raleigh, NC 27699.1617
50050
00010
00400
5GO60
00310
006101
00530
31616
00300
00600
D
A
T
E
Operator
Arrival
Time:
2400 Clock
Certified
Operator
Time On
Site
ORC
on
Site?
FLOW
TEMP,
pH
RES.
Cl-2
BOD-5
20DEG.0
NH3-N
TSS
GMETRIC
MEAN
FECAL
COLIF.
D.O.
T.-NIT.
EFF [)q
INF
RATE
MGD
DEG CUNITS
2N_
MG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
.....
...........
X
.... ..
.... .
........ .
.... . .
. . . ...
...
......
...............
2
1
1 0.00037
X
xT.
X
.......
4
0.00027
X.
6
0.00028
....
.......
8
0.00039
.... ....
.... . 4.0..
10
815
0.50
Y
0.00031
VOID
12
0.00032
:X
14
0.00026
VOW
..........
16
0.00032
wow
18
505
0.50
Y
0.00033
0'55
... ......
20
0.00032
-NOW:
...........
22
0.00042
:::: : z:;
� 777-7-
.......
-24
1145
1.00
Y
0.00037 .
14.0
6.8
018 6
8.0
< 0.10
2.0
< 1.0
6.6
AL
.........
-X
26
0.00033
12M
X.
.............
28
1015
2.00
Y
0.00025
....
.....
. .....
.......... .
30
1005
1.00
Y
0.00032
15.0
6.6
1 *61
6.0
0.10
5.0
< 1.0
6.7
.......
. . .
.. ......
AVERAGE
0.00035
14.4
0.8
2.8
VAIM
6.0
< 1.0
6.6
x X
. ... . ...... .
..........
........... - .
.. .
... ..
......... X
... .. ON.
...... X
....
k.
.
.........
.. ....
MINIMUM
0.00025
14.0
6.2
0.50
< 4.0
< 0.10
2.0
< 1.0
6.5
.........
i
X
MONTHLY AVG. LIMIT
0.0016
5.0
4.00
30.0
200.0
DAILY MAXIMUM LIMIT
7.5
45.0
400.0
REPLICA DEM FORM MR-1 (12193) . I I Minimum 6mg/l
NOTE: A numedmi value of zero (one for Fecal Cofforms) was used for calculation on those
numbers reported as *less than' (<).
SETT.
COND.

Facility Status: (Please check one of the following) 'r
All monitoring data and sampling frequencies meet permit requirements L J
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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and Imprisonment f knowing violations."
P
er
mittee (Please prfni of type)
Signature of Permittee** Date
(Required)
Bailey's Trailer 1-ar1E 336-724-5911 May 31, 2004
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
'Dmtidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00406
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00745
Total Sulfide
01042
Copper
34481
Toluene
00927
Total Magnesium
01045
Iron
38260
MBAS
00929
Total Sodium
01051
Lead
39516
PCBs
00940
Total Chloride
01062
Molybdenum
50050
Flow
as}y
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.eDr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data. 90 z
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NeAC 2B .0506 (b)
(2) (D).

NPDES 40: NCO057223 DISCHARGE NO: 001 MONTH: JANUARY YEAR: 2005
FACILITY NAME: HEAD TRAILER PARK WWTP COUNTY: FORSYTH
STREAM: Little Creek STREAM: Little Creek
LOCATION: 50 ft: Upstream of discharge point LOCATION: 0.1 Miles downstream of discharge point
UPSTREAM DOWNSTREAM
I D
A E CLOCK 20C G.MEAN
2400 T I TIME I TEMP I D.O. I PH BOD-5 COD I F-COLI
3o 1 1005 1 14.0
X.
IMINIMUM 1 14.0 1 2.0 1 1 1
NOTE: A nunwimW value of mo (one for Fecal Poldonm) was used for caWation on those
nuffbm reported w 1ese than' (<).
1 2400
CLOCK 20C
TIME I TEMPI ' I D.C. I PH BOD-5I I COD F-COLIG.MEAN I C(
Nor,

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
June 23, 2006
CERTIFIED MAIL 7006 0100 0001 8758 6016
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
Alan W. Klimek, P.N. Director
Division of Water Quality
A review of Head Mobile Home Park's monitoring report for April 2006 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total
04/30/06
2 mg/1
2.78 mg/l
Monthly
(as N)
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing'to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
e/ /
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
GONSM
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone)
336-771-4630(Fax)

Staff Member to
Regional Supervisor
DMR Review Record
Facility: _ Pen-nit/Pipe No.: N (-C)D+i? 2-7-3 Month/Year �
Monthly verage Violations
Parameter Permit Limit DMR Value % Over Limit
-� 2.P 2P 6
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequericv Values Reported # of Violations
Other Violations
Completed by:
Regional Water Quality
Supervisor Signoff:
_ ! Date: w _ G l L,2
Date: a�� r

RECEIVED
N,C. Deot. of ENR rI 7 ZODg
!� JUN 21 MM
EF ENT Winston-Salem
Regional Office
NPDES PERMIT NO: NCO057223 DISCHARGE NO: 001
,COUNTY,--•--FORSYTH; '
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS:
I
YEAR: 2006 •,�'
%
MONTH: APRIL
..sill
OPERATARdN PESPONSIBLE CHARGE(ORC)+, G Stain ack
GRADE: IV
PHO E: [phone]
r
CERTIFIED LABORATORY: 1 Tritest
- _ - -
PERSON(.) COLLECTING PLES: a Stainba
'
^
•,��
CHECK BLOCK IP ORC HAS CHANGED
Mall original and one cop y'toc"
(SIGNA RE F`OP
TO. RESPONSIBLE CHARGE)
DATE
ATT: Central Files
BY THIS SIG NA E,
'CERrtIFY-.THAT THIS REPORT.ISz`:'�
,`
Division of water (]usury
ACCURATE AND O
PLETE TO THE BEST OF MY KNOWLEDGE '
1617 Mail Service Center
Raleigh, NC 27699-1617
... .
..•11
1..1
.. .
11. .
Ii .
®
.. 11
f1.1-.
11 ..
11
.+.
Ii •.
111•
-IIII_I_
.. .MEN
__--II�--_---II�--
__I�--IIIIII�-IIIIIIIIIIIIII�------
Emma
®ME=��®��������
m-__
1 111
m-__
1 111
®®®o®
II�I_II�III--II�--I�---II��-
m���
1 111 •
I�BJI���I��I�------
®®
11
I�
1 111.1
__�-I�--_------
__I�I�---_------
m--�
1 111 •
��0000000�0�0��
..
LIMIT
WEEKLY AVG.
1 11
• 11 1
___-___
DAILY
®-��®
REPLICA DEM FORM MR-1 (12/931
NME: A numerical value of Zero (one for Fecal Coliformel was used for calculation on those
numbers reported as •lese'than' (<).

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
ire :I data
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, maintenance, etc.,
and a time -table for improvements to be made.
n
"I certify, under penalty of law, that this document ana all attacnments were prepareu unuer illy U11MuUll UL bUjJcl V14LUTA 11! aVV VLUMIVv
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and ' ri onm t for kn wing vipplations. "
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Bailey's Trailer garb 336-724-5911 May 31, 2004
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease 00951
Total Fluoride
01067
Nickel
50060 Total
00076
Turbidity
00600
Total Nitrogen 01002
Total Arsenic
01077
Silver
Residual
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
01092
Zinc
Chlorine
00082
Color (ADMI)
00625
Total Kjeldhal 01027
Cadmium
01105
Aluminum
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites 01032
Hexavalent Chromium
01147
Total Selenium
71880 Formaldehyde
00300
Dissolved Oxygen
01034
Chromium
31616
Fecal Coliform
71900 Mercury
00310
BOD5
00665
Total Phosphorous
32730
Total Phenolics
81551 Xylene
00340
COD
00720
Cyanide 01037
Total Cobalt
34235
Benzene
00400
pH
00745
Total Sulfide 01042
Copper
34481
Toluene
00530
Total Suspended
00927
Total Magnesium 01045
Iron
38260
MBAS
Residue
00929
Total Sodium 01051
Lead
39516
PCBs
00545
Settleable Matter
00940
Total Chloride 01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Squrce Compliance/Enforcement
Unit at [phone] or by visiting
the Water Quality Section's
web site at b2o.enr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204. 90 I _ � �ni
** 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)•

i
A .
NPDES NO: NCO057223 DISCHARGE NO: 001
FACILITY NAME: HEAD TRAILER PARK W WTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge Point
** UPSTREAM **
ri.r r
EEEHMm�
NOTE: A numerical value of zero (one for Feral Colifonns) was used for calculation on those
numbers reported as'less than' (<).
MONTH: APRIL
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge Point
** DOWNSTREAM **
YEAR: 2005
rr, r
�� ��
�r.��
�� r
r. ,,
1��
..
r
:..
..
.
. .

� � � � M*, C, am
5.0 03
Faxed To: Gary Stainback
Fax #: [phone] Phone [phone]
WWTP Annual Inspection Checklist
Facility: Head MHP NPDES: NC0057223
Permit Effective Dates: Auqust 1, 2004 to May 31, 2009
PAOAPC41 Of
Inspection Date: ay May X, 2005 Inspection Time: -1-ec pm
1) DMRs (Dates: December 2003 to December 2004 )
2) Lab Data (per DMR dates)
3) Laboratories used for analysis & certification #'s
4) Chain of Custody forms (per DMR dates)
5) Complete copy of current NPDES permit
6) . Status of SOC or Moratorium issuance (if applicable)
7) ORC and Back-up ORC current certification
8) Wastewater Annual Report (fiscal or calendar year — if applicable)
9) Daily Operator's log / ORC visitation log
10) Maintenance log
11) Process control data (which includes field parameters tested and equipment
calibrations)
12) Field Parameter certification (if applicable)
13) Flow meter calibration records (if applicable)
14) Influent and/or effluent samplers
15) Flow charts (if applicable)
16) Generator Inspection / under load checks
17) Spill Response Plan (with current emergency contact numbers)
18) Current Sludge / Residuals permit (if applicable)
19) Sludge / Residuals hauling records (if applicable)
20) Sludge / Residuals Annual Report (if applicable)
21) Plant visual inspection of treatment units
22) Stream accessible for inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office
[phone]
Fax: [phone]

vIZ7
N a l�o
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Yes No NA NE
000 ❑
Is the facility as described in the permit?
/Z ❑ ❑ ❑
Are there any special conditions for the permit?
❑ Qe ❑ ❑
Is access to the plant site restricted to the general public?
❑ ❑ ;3' ❑
Is the inspector granted access to all areas for inspection?
❑ ❑ ❑
Comment:
Yes No NA NE
Operations & Maintenance
Does the plant have general safety structures in place such as rails around or covers over tanks, pits, or wells?
PT ❑ ❑ ❑
Is the plant generally clean with acceptable housekeeping?
❑ ❑ ❑
Comment:
Disinfection
Yes No NA NE
Type of system ?
Are cylinders secured adequately?
❑ ❑ ❑
Are cylinders protected from direct sunlight?
'a ❑ ❑ ❑
Is there adequate reserve supply of disinfectant?
❑ ❑ ❑ ❑
Is ventilation equipment operational?
❑ ❑ ❑
Is ventilation equipment properly located?
❑ ❑ ❑
Is SCBA equipment available on site?
❑ ❑ ❑
Is SCBA equipment operational?
❑ ❑ In ❑
Is staff trained in operating SCBA equipment?
❑ ❑ t� ❑
Is staff trained in emergency procedures?
❑ ❑ ET ❑
Is an evacuation plan in place?
❑ ❑ Er ❑
Are tablet chlorinators operational?
21,❑ ❑ ❑
Are the tablets the proper size and type?
❑ ❑ ❑
Number of tubes in use?
(Sodium Hypochlorite) Is pump feed system operational?
•❑ ❑ J21,0
Is bulk storage tank containment area adequate? (free of leaks/open drains)
❑ ❑ ❑ ❑
Is the level of chlorine residual acceptable?
❑ ❑ ❑ ❑
Is there adequate detention time
❑ ❑ ❑ ❑
Is the contact chamber free of growth, or sludge buildup?
J2' ❑ ❑ ❑
Comment:
Standby Rower
Yes No NA NE
❑/ ❑ ❑
Is automatically activated standby power available?
Is generator tested weekly by interrupting primary power source?
❑
❑
❑
Is generator tested under load at least quarterly?
❑
❑
❑
Was generator tested & operational during the inspection?
❑
❑
❑
Do the generator(s) have adequate capacity to operate the entire wastewater site?
❑
❑
❑
Does generator have adequate fuel?
❑
❑
❑
Is there an emergency agreement with a fuel vendor for extended run on back-up power?
❑
❑
❑
Comment:
Septic Tank Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational? ❑ ❑"ET ❑
Is septic tank pumped on a schedule? Z� r` o ❑ ❑ ❑ ❑
Is the distribution box level and watertight? ji ❑ 0 ❑�

Septic Tank
Are pumps or syphons operating properly?
Yes
❑
No NA NE
❑ �`El'
❑
❑
Are high and low water alarms operating properly?
Comment:
Yes
No NA NE
Sand Filters (Low rate)
(If pumps are used) Is an audible and visible alarm Present and operational?
❑
❑ .0 ❑
Is the distribution box level and watertight?
❑
❑ ❑ 0
Is sand filter free of ponding?
;fr'
❑ ❑ ❑
Is the sand filter effluent re -circulated at a valid ratio?
❑
❑ ❑
Is the sand filter surface free of algae or excessive vegetation?
❑
❑ ❑ g
Comment:
Laboratory Z
Are field parameters performed by certified personnel or laboratory? \ :�� � J�
Yes No
a ❑
NA
❑
NE
❑
Are all other parameters(excluding field parameters) performed by a certified lab?
;?, ❑
❑
❑
Is the facility using a contract lab?
.0 ❑
❑
• ❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑ ❑
❑
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑ ❑
❑
V
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
❑ ❑
❑
Comment:
FlQvyMeasurement - Influent �0.,...Yes No NA NE
Is flow meter used for reporting? 'j ❑ ❑ ❑ ❑
Is flow meter calibrated annually? Zoo _-Le.(o4 ❑ ❑ ❑ ❑
Is flow meter operating properly? ❑ ❑ ❑ ❑
If units are separated) Does the chart recorder match the flow meter? w"' a 2(4�J ❑ ❑ ❑ ❑
Comment:
Flow Measurement - Effluent
Is flow meter used for reporting?
Yes No NA NE
❑ ❑ / ❑
Is flow meter calibrated annually?
❑ ❑ ❑
❑
Is flow meter operating properly?
❑ ❑ ❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑ ❑ ❑
❑
Comment:
Retard Keel
Are records kept and maintained as required by the permit?
Yes No NA
Vf ❑ ❑
NE
❑
Is all required information readily available, complete and current?�
�-��
n (_j
llGc.
V El El
0
Are all records maintained for 3 years (lab. reg. required 5 years)?
1 C,��—
OL /
1Z ❑ ❑
❑
Are analytical results consistent with data reported on DMRs?
14 ❑ ❑
❑
Are sampling and analysis data adequate and include:
.0 ❑ ❑
❑
Dates, times and location of sampling
'Er
Name of individual performing the sampling
.�
Results of analysis and calibration
8
Dates of analysis
Name of person performing analyses
❑°
Transported COCs
r
Plant records are adequate, available and include
❑ ❑
❑

Record Keening
O&M Manual
Yes No
❑
NA
NE
As built Engineering drawings
❑
Schedules and dates of equipment maintenance and repairs
❑
Are DMRs complete: do they include all permit parameters?
/ ❑
❑
❑
Has the facility submitted its annual compliance report to users? .0-6w— Zo 0.5
RJ ❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 2417 with a certified operator on each shift?
❑ ❑
7
❑
Is the ORC visitation log available and current?
4 El
El
ElIs
p
the ORC certified at grade equal to or higher than the facility classification? G 40--`9 y 11 ❑ ❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification? o"Y'�� ��
� ❑
❑
❑
�)/
❑
❑
❑
Is a copy of the current NPDES permit available on site? bFeli r 77�a^^
'ET
Is the facility description verified as contained in the NPDES permit?
JZ ❑
❑
❑
Does the facility analyze process control parameters, for example: MLSS, MCRT, Settleable Solids, DO, Sludge
❑ ❑
❑
❑
Judge, pH, and others that are applicable?
Facility has copy of previous year's Annual Report on file for review?
l ❑
❑
❑
Comment
Is composite sampling flow proportional?
❑
❑
V1
❑
Is sample collected below all treatment units?
iN
❑
❑
❑
Is proper volume collected?
❑
❑
❑
CP
Is the tubing clean?
❑
❑
❑
11
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑
❑
❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
❑
❑
❑
Comment:
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? V ❑ ❑ ❑
Comment:
Compliance Srhedules Yes No NA NE
Is there a compliance schedule for this facility? ❑ ❑ ❑ ❑
Is the facility compliant with the permit and conditions for the review period? ❑ ❑ ❑ ❑
Comment:
Effluent Pipe
Is right of way to the outfall properly maintained?
Yes No
Z ❑
NA
❑
NE
❑
Are receiving water free of solids and floatable wastewater materials?
.0 ❑
❑
❑
Are the receiving waters free of solids / debris?
0 ❑
❑
❑
Are the receiving waters free of foam other than a trace?
0' ❑
❑
❑
Are the receiving waters free of sludge worms?
❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑ ❑
V ❑
Comment:

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 04/27/05
Page: 1 of 1
»..
: Permit:,, ncOQ57223 --; ` . "
_ :.., ' - MRs Between :12 -2003
and " 12 -2004 Re ion: °lo
"" `- ,"
Violation"Category: -%Q .:
`Program tegory" :
Facihty:Name:" °10 _ :. , :,;:.
Param Name., % :_;�,
�, - ..
County: °log:
- .
Sub6asin:- °lo '.
�ViolationActiori: °lo-
PERMIT: NCO057223
FACILITY: Head Mobile Home Park - Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
07 -2004 001 Effluent
BOD, 5-Day (20 Deg. C)
07/31/04
Weekly
mg/I
7.5
24
Daily Maximum Exceeded
Proceed to
Enforcement Case
07 - 2004 001 Effluent
BOD, 5-Day (20 Deg. C)
07/31/04
Weekly
mg/I
5
6
Monthly Average Exceeded
Proceed to
Enforcement Case
08 - 2004 001 Effluent
Coliform, Fecal MF, M-FC
08/31/04
Weekly
#/100ml
400
854
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
i 11 - 2004 001 Effluent
Coliform, Fecal MF, M-FC
11/30/04
Weekly
#/100m1
400
2,200
Daily Maximum Exceeded
Proceed to NOV
Broth,44.5C
01 -2004 001 Effluent
Nitrogen, Ammonia Total (as N)
01/31/04
Weekly
mg/I
4
6.04
Monthly Average Exceeded
Proceed to
Enforcement Case
04 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N)
04/30/04
Weekly
mg/I
2
3.85
Monthly Average Exceeded
Proceed to
Enforcement Case
05 -2004 001 Effluent
Nitrogen, Ammonia Total (as N)
05/31/04
Weekly
mg/I
2
3.4
Monthly Average Exceeded
Proceed to
Enforcement Case
06 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N)
06/30/04
Weekly
mg/I
2
2.86
Monthly Average Exceeded
Proceed to
Enforcement Case
07 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N)
07/31/04
Weekly
mg/I
2
5.45
Monthly Average Exceeded
Proceed to
Enforcement Case
Reporting Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
12 -2004
12/31/04
Signature Missing
None

PERMIT NUMBER: NCO057223 PERIOD ENDING MONTH: 12 - 2004 DMR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park
CITY: Winston Salem COUNTY: Forsyth
OUTFALL: 001 EFFLUENT
REGION: Winston-Salem
PAGE 1 OF 2
00010
00095
00300
00310
00340
00400
00500
00530
deg c
umhos/cm
mg/1
mg/1
mg/1
su
mg/1
mg/1
Temperature,
Specific
DO, Oxygen,
BOD, 5-Day (20
COD, Oxygen
pH
Solids, Total
Solids, Total
Water Deg.
Conductance
Dissolved
Deg. C)
Demand, Chem.
Suspended
Centigrade
(High Level)
1 - 04
10
30
9.3
6.2
2
6.1 - 6.3
1.8
2 - 04
10
30
11.5
6.2
0
6 - 6.1
0.8
t0
30
3-04
11.4
6.2
0
6 - 6.2
4.2
4 - 04
`'
30
13
6.1
0
6.1 - 6.2
2.8
5 - 04
5
30
14.3
6.3
0
6.2 - 6.3
8.3
6-04
5
30
12.4
6.1
0
6.1 - 6.3
3.2
7 - 04
5
30
20.8
6.1
6 '`"ian%
6.2 - 6.8
11
8 - 04
5
30
21.8
6.1
0.5
6.1 - 6.2
14.8
9 - 04
5
30
21
6.1
0
6.2 - 6.5
13.5
10 - 04
5
30
19
6.2
0
6.2 - 6.3
12.2
11 - 04
t 0
30
16.8
6.2
0
6.1 - 6.3
19
12 - 04
10
30
13.8
6.3
0
6.1 - 6.3
13.9

PERMIT NUMBER: NC0057223 PERIOD ENDING MONTH: 12 - 2004 DINR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park
CITY: Winston Salem
COUNTY: Forsyth
REGION: Winston-Salem
00545
00600
00610
00665
31616
50050
50060
ml/1
mg/l
mg/1
mg/1
#/100ml
mgd
mg/l
Solids,
Nitrogen,
Nitrogen,
Phosphorus,
Coliform,
Flow, in conduit
Chlorine,
Settleable
Total (as N)
Ammonia Total
Total (as P)
Fecal MF, M-FC
or thru
Total Residual
(as N)
Broth,44.5C
treatment plant
1 - 04
4
0.002
6.04 Giolation'==
3.9
0.00043
1.65
2 - 04
4
0' 002
2.85
16.4
0.00045
1.59
3 - 04
4
0.002
14.35
1.88
3.17
9.9
0.00043
1.75
4 - 04
2
0.002
3.85 Uiol`ation,
1
0.00042
1.62
5 - 04
2
0,002
3.4 ,yam Viola M"N
1
0.00043
1.75
6 - 04
2
0.002
5.4
2.86.V.,tolation
0.59
6.5
0.00047
1.67
7 - 04
2
0.002
5.45 Violation
9.4
0.00082
1.14
8 - 04
2
0.002
1.66
3.9
0.00056
1.43
9 - 04
2
0.002
1.05
4
0.00048
1.45
10 - 04
2
0.002
29.8
1.12
4.28
2
0.0004
1.4
11 - 04
4
0.002
1.97
13.9
0.00042
1.37
12 - 04
4
0.002
1.26
1 11
1
0.0004 1
1.73
PAGE 2 OF 2

Michael F. Easley, Governor
W ATFR William G. Ross Jr., Secretary
QG North Carolina Department of Environment and Natural Resources
O
Alan W. Klimek, P.E. Director
r Division of Water Quality
o �
NC Department of Environment and Natural Resources
Division of Water Quality
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
[phone] Fax [phone]
TO:
FAXNO.: -7(r4,'
FROM:�`� `c 'P, 1 T
DATE:
NUMBER OF PAGES (including this page):
Comments: N © N
f-f' T') 010
ca
0S
N. C. Division of Water Quality/Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 [phone]
INCDEf��t
Customer Service
1 800 623-7748

Permit Inspection History
Permit:
NCO057223
Owner:
Head Mobile Home Park
Facility:
Head Mobile Home Park
Primary Inspector
Inspection Type
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Sampling
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
Max S Mauney
Compliance Evaluation
Max S Mauney
Compliance Evaluation
BIMS Conversion
Compliance Evaluation
Rose Pruitt
Compliance Evaluation
Rose Pruitt
Compliance Inspection
Page 1
Report Date: 04/27/05
County:
Forsyth
Region:
Winston-Salem
Permit Type:
Discharging 100% Domestic
< 1MGD
Inspection Reason Inspection Date
Facility Status
Routine
07/31/86
Compliant
Routine
10/01/87
Neither
Routine
09/14/88
Neither
Routine
08/02/89
Compliant
Routine
09/27/90
Compliant
Routine
08/15/91
Compliant
Routine
05/18/95
Compliant
Routine
03/05/96
Compliant
Routine
10/29/96
Compliant
Routine
08/28/97
Compliant
Routine
07/15/98
Compliant
Routine
03/10/99
Compliant
Routine
02/14/00
Compliant
Routine
04/02/01
Compliant
Routine
04/09/02
Not Compliant
Routine
04/21/04
Not Compliant
Routine
Neither

N, R�C�� Ey D
�eot of ENR
MAR 0 2 2000
Kinston�8alern
February 28, 2006 Raglonal pq�oe
Mr. Steve Tedder, Supervisor
DWQ, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27106
Dear Mr. Tedder,
I am in receipt of the January 18, 2006 Notice of Violation for the October, 2005 Daily
Maximum exceedence of the BOD limitation at Head Mobile Home Park Wastewater
System.
As you requested, I am responding to this violation.
The facility experienced one (1) elevated BOD concentration from four sampling events
during the month. The one elevated level of 10.0 mg/l exceeded the daily maximum
level of 7.5 mg/1. Subsequent sampling events during the month of October as well as
following months indicated compliance.
We do not believe this excursion is representative of an ongoing compliance problem, but
a result of some variability typically experienced in subsurface systems, particularly
during rain events.
We will continue to monitor this situation.
I hope this information is helpful in resolving this matter.
Sincerely,
Head MHP
Hubert Head
Cc: Gary Stainback

O� W A 1 �9 Michael F. Easley, Governor
William G. Ross Jr., Secretary
O? QG North Carolina Department of Environment and Natural Resources
7 Alan W. Klimek, P.E. Director
j [ Divisi t (if Water Quality
.5
January 18, 2006
CERTIFIED MAIL 7005 2570 0001 4673 8845
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
A review of Head Mobile Home Park's monitoring report for October 2005 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
10/13/05
7.5 mg/l
10 mg/1
Daily
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: Centra Files —SWP
-004
585 Waughtown Street ' Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax) r /

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility:
A-A-D Mi+f
PermitlPipe No.: KG 0o51 2�?-3Month/Year nGTZ0o45
Monthly Average Violations
Parameter
Permit Limit DMR Value
% Over Limit
Weekl /Daily V olations
Date
Parameter
Permit Limit/Tvpe DMR Value
% Over Lin -Lit
!v-r 3'05-
K Xl
o b
Monitoring Frequency Violations
Date
Parameter
Permit Frequency Values Reported
# of Violations
Other Violations
Completed by: K-I
Regional Water Quality
Supervisor Signoff:
Date:
-�2-0
Date:
V - 00 �g
/ OV �000 L

-'V i.'—'A
DEC 12 05
L
'DEC 2 7 2005
IWA!nftn-6alem
EFFLUENT
Regional offie_b
NPOES PERMIT NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP CLASS: I
MONTH: OCTOBER YEAR: 2005
OPERATOR IN RESPONSIBLE CHARGE (ORC): G. 4Sti Lk GRADE: LV PHONE: ) [phone]
CERTIFIED LABORATORY: (1) Tritest
PERSON(s) COLLECTING; SAM S: (3arvaStgi :.7k�
HAS CHANGED
CHECK '64RAT4WFR PONSIBLE
Mail original r1l one copy to: (SIGNAURC-41F CHARGE) DATE
ATr: Central Files BY THIS SIGNATURE, I E FY THAT THIS REPORT IS
Division of Water Quality ACCURATE AND CONIC VE TO THE BEST OF MY KNOWLEDGE
1617 Mail Service Center
Raleigh, NC 27699-1617
NOTE: A numerical value of zero (one for Fecal Coillonns) was used for calculation on ftse
numbers reported as 'less VOW M.

Facility Status: (Please check one of the following)
All monitoring sampling data and ling frequencies meet permit requirements L—J
P
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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and ' risonment f knowing violations."
G'
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Bailey's Trnilpr P2rlc 336-724-5911 May 31, 2004
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADM)
00095
Conductivity
00300
Dissolved Oxygen
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
W655 Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
01042
Copper
00927
Total Magnesium
01045
Iron
00929
Total Sodium .
01051
Lead
00940
Total Chloride
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total. Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
34235
Benzene
34481
Toluene
38260
MBAS
39516
PCBs
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204. b Z fi0
lil
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)

ti
NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM **
00010 1 00300 00400 1 00310 1 00340 1 31616
D 1 2400
A CLOCK 20C G.MEAN
T TIME TEMP D.O. pH BOD-5 COD F-COLI
E
NOTE: A numerical Value of zero (ore for Fecal Colifonns) was used for calculation on these
maims reported as 'less than' (c}
001
MONTH: OCTOBER
COUNTY: OF RSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge point
** DOWNSTREAM **
CT41MOOECK
I TEMP I D.O. I pH I BOD-5I COD I FF-COLIG.MEA"
1141 1 21
MIN 20.0
YEAR: 2005

t,
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environm'^t and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 19, 2005
CERTIFIED MAIL 7005 2570 0001 4673 8760
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 271,03
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County .
Dear Mr. Head:
A review of Head Mobile Home Park's monitoring report for September 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
BOD, 5-Day (20 Deg. C)
09/13/05
7.5 mg/l
9 mg/l
Daily
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this'letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
OW. %S'R.O
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

i
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: I-i i, 1m Perrnit/Pipe No.: NLD 0 5 %LZ 3 MondvYear S��T
moos`
Monthly Avera;e Violations
Parameter Permit Limit DMR Value % Over Limit
Date
q-1'3.0,!�
Parameter
&IDD
Date Parameter
Other Violations
Completed by: lv12
Regional Water Quality
Supervisor SiQnoff:
Weekl Dlyiolations
Permit LimiQ/ e DN1R Value % Over Limit
Monitorinl- Frequency Violations
Permit Frequency Values Reported # of Violations
Date:
Date:
/yG'�

Regional
NPDES PERMIT NO: NCO057223 D
FACILITY NAME: HEAL) TRAILER PARK WWT
OPERATOR IN RESPONSIBLE CHARGE (ORC):
CERTIFIED LABORATORY: (1) Trites
CHECK BLOCK IF ORC RAC CHANGED
Mail original and one
ATT: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699.16`17
EFF IN T
ISCHARGE NO: 20-1COUNT-Y.:7-
1
CLASS:
MONTH: SEPTEMBER YEAR: 2005
Stai/ack GRADE: IV PHONE'.: 1(3232601766-0270
V
PERSON(s) in COLLECTING SA S:
75� A -0.
(SIGNATU 0 ERA RI E PONSIBLE CHARGE) DATE
BY THIS SIGNATU E, I TIFY THAT THIS REPORT IS
COMP
ACCURATE AND COMP6E TO THE BEST OF MY KNOWLEDGE
50050
00010
004001
50060
_003_10
�006ff
00530
311616
�00300
00600
00665
006651
00545
00625
00340
00095
D
operator
Certified
FLOW
GMETRIC
MEAN
A
Arrival
Operator
ORC
EFF [)9
INIF I I
RES.-
BOD-5
FECAL
SETT.
T
Time;
Time On
On
RATE
TEMP.
oH
CL2
20DEG.0
N'Hi�k'
TS§
COLIF.
* D.O.
T.-NIT.
0_
T.-PHO.
MAT TER TKN
COD
COND.
E
2400 Clock
Site
Site?
MGD
DEG C,
UNITS
MG/L
MG/L
MG/L
MG/L
/100 ML
MG/L
MG/L
MG/L
...........
MG/L
MG/L
MG/L
urnhos/crr
...... . ... .
..............
2
0.00039
- ------
EEL
.
..... . .
4
0.00038
6
1200
0.75
Y
0.00051
22.0
6.8
0.85
6.1
TRW
8
0.00048
----- -
10
0.00030
12
0.00048
MAIM
14
0.00032
.........
...........
oa,
...........
16
0.00032
18
0.00038
- -----
X
nit
goon
i nn
V
n nn032
23.0
6.5
1.61
6.0
< 0.10
6.0
< 1.0
6.2
..............
26
X.,
946
1.00
Y
0.00030
22.0
6.2
1.89
5.0
--------------
0.20
3.0
-
1.0
6.4
F .65
8
1 .64
< 1.00
.--
....
.....
..
.........
..
... .......
28
0.00036
.
. .......
30
1216
0.75
Y
0.00027
1.5
AVERAGE
0.00034
22.4
1.46
5.0
0.05
9.8
< 1.0
6.2
8.65
1.64
0.00_]_
...........
MINIMUM
0.00020
22.0
6.2
0.85
< 4.0
< 0.10
3.0
< 1.0
6.1
8.65
1.64
< 1.00
-MONTHLY AVG. LIMIT
0.0016'
5.0
4.00
30.0
200.0 77=
. . .
. ... x;
IWEF,
........ .
. .....
....
.. ... ...
JDAILY MAXIMUM LIMIT
6 -9
7.5
45.0
400.0
REPLICA DEM FORM MR-1 (12M)
NOTE: A nurnerk;31 vakw Of zero (one for Fecal Cali(orms) was used for calculation On UIM
numbers reported as 'Iess titan' (-).

Facility 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, 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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines animprisonment f knowing violations."
�l e
P ittee (Please print of type)
Signature of Permittee** Date
.(Required)
Bailey's Trailer Pnrk 336-724-5911 May 31, 2004 _
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen
00310
BODS
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00745
Total Sulfide
01042
Copper ;.
34481
Toluene
00927
Total Magnesium
01045
Iron
38260
MBAS
00929
Total Sodium
01051
Lead
39516
PCBs
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data. SO C ` A ojj
* ORC must visit facility and document visitation of facility as required per 15A NC A&8GA0ZQ4-.i, :, 3 .?E
** 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)•

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM,"
I D 1 2400
K I COD I F-COLI
A CLOCG.MEAN
20 C T TIME I TEMPI D.O. I PH I BOD-5
E
MEN I=
©-M
WREMIM
M_m
WEIMEMSEM
EvInIMIM
ME Iffill
001 MONTH: SEPTEMBER YEAR: 2005
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharae point
** DOWNSTREAM **
CLO20C G.M
2T41M00EI TEMPI D.O.1 PH I BOD-5I COD I F-COLI
EANCK
NOTE: A rumdod valve of zero (ore for Fecal QW*r=) wag used fw cdaMion on thew
nuff6as mpoftd w Un 1hW (-q
*No sample due to upstream location being dry due to no rainfall.

F W ATF Michael F. Easley, Governor
R William G. Ross Jr., Secretary
\0� pG North Carolina Department of Environment and Natural, Resources
Ul Alan W. Ylimek, Pip:. Director
Division of Water Quality
December 21, 2005
CERTIFIED MAIL 7005 2570 0001 4673 8791
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
A review of Head Mobile Home Park's monitoring report for February 2005 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
02/22/05
400 #/100ml
3,500 #/100m1
Daily Maximum
Broth,44.5 C
Exceeded
Nitrogen, Ammonia Total (as
02/28/05
4 mg/1
5.95 mg/l
Monthly
N)
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
0� �, 14/�
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
II-WSRO 1D
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 408t> M'�4' Q PermitlPipe No.: NC OoS? 2Z3 Month/Year 91Eb ZoOs
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
A.l r►�h �-P 5. q S ? �S• ?5- 20
Weeklf/DailvXiolations
Date Parameter
Permit Limit/Type
DMR Value
%Over Limit
2' ZL' OS
S 00 .o.•./
-7 ?5
Monitoring Frequency Violations
Date Parameter
Permit Freouencv
Values Reported
# of Violations
�Other Violations
ac,
Completed by: '�L-'
Regional Water Quality
Supervisor SiQnoff:
Date:
Date:
lI I

APR 0 5 2005
EFFLUENT
NPDES PERMIT NO: NC0057223
DISCHARGE NO: 001
FACILITY NAME: HEAD TRAILER PARK W WTP
CLASS:
Y
I_..
MONTH: FEBRUARY
�'
.n
GRADE:
PHONE: [phone] -
OPERATOR IN RESPONSIBLE CHARGE (ORC):
Ga St aback
CERTIFIED LABORATORY: 1 Tritet
'
PER COLLECTING /SPLES.
alnbaC �Q
RECEIVED
rs:^rK BLOCK IF ORC gAC CHANCED
i•
N.C. Dent. of ENR
(SIGNATU F T
`
IN NSIS E CHARGE) DATE
Mail original and one copy to:
APR i 2.2M
BY THIS SIGNAATURE,1
FY THAT THIS REPORT IS
ATT: Central Fues
ACCURATE AND COMP
TO THE BEST OF MY KNOWLEDGE
Division of WaterQualitj
Ylinston•Sate.
1617 Mail Service Center
Regional Office
REPLICA DEM FORM MR-1 (12/03)
NOTE: A numerical value of zero (one for Fecal Colilomrs) was used for calculation on those
numbers reported as'Iess than' (q. . .

Facility Status_ (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements - a
Compliant
All monitoring data and. sampling frequencies do NOT meet permit requirements -
Noncompliant
It" 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.
-2 certify, under'penalty -of law, dint this docaiineut and all attachments were prepared under my direction or supervision in accordanc
with a system designed to assure that qualified personnel properly gather and evaluate: the information submitted. Based on my inqui
-01 the person or persons who manage tho system, or those persons direedy responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that Mere are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations:'
Hubert Head
Permittee (Please print or type) j
Signature of Pexmittee. Date;
(Required)
Read Mobile'Home Park 336-724-5911 M-Y31, 9004
Permittee Address Phone Number Permit Fes. D
PARAMEI'F1L CODES
00010 Temperawre.
00076 'Turbidity
00060 Color (Pt -Co)
00082 Color (ADMI)
00556 Oil do Grease 00951 Total Fluoride
00600. Total Nitrogen 01002 Total Arsenic
00610 Ammonia Nitrogen
00625 Total Kjeldhal_ 01027 Cadmiuih
Nitrogen
00095 Conductivity 00630 NitratesMitrites 01032 Hexavalent Chromium
00300 Dissolved Oxygen 01034 Chromium
-00310 13OD5
00340 COD
M400 pH
.00530 Total Suspended
Residue
.00545 Settleable Matter
00665 Total Phosphorous
00720 Cyanide 01037 Total Cobalt
00745 Total Sulfide 01042 Copper
00927 Total Magnesium 01045 Iron
00929 Total Sodium 01051 Lead
00940 Total Chloride 01062 Molybdenum
01067 Nickel
01077 Silver
0.1092 Zinc
01105 Aluminum
01147 Total Selenium
31616 Feral Coliform
32736 Total Phenolics
34235 Benzene:
34491 Toluene
38260 MBAS
39516 PCBs
50050 Flow
50060 Total
Residua
Chlorine
71990 Formal
71900 Mercui
91551 Xylene
Parameter Code assistance may obtained by calling the Point Source CompliancelEnforcement Unit at [phone] or by Vis
the Water Quality Section's web siteat h2o.enr.stat6mc.us/was and linking to theUnits information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
** If signed by other than the permitte e, delegation of signatory authority nO be dh 4iiio` rith the state pee 15A NCAC 2B .05
(2) (D)-

NPDES; NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK VVWTP
STREAM: Little Creek
LOCATION: 50 ft. Uostream of discharge point
** UPSTREAM **
ALOCK I F-COLI G.MEAN
2400 20 C I COD DT I CTIME I TEMP I D.O. I pH I BOD-5
E
18
20
M
22
ig
24
14.0 1 4.
13.0
NOTE. A nunwied va%m of mo (one for Fecal Coltonw) was used for cWmWion on those
mnnbm roportad as lest itme (<}
001 MONTH: FEBRUARY YEAR: 2005
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge point
** DOWNSTREAM
-mv
.7.1 m.
r =7i
ff IT, M,
EmEmm�-

Permit Enforcement History
Permit: NCO057223
Region: Winston-Salem
Penalty
Assessment
Case Number Approved
Penalty
Amount
Facility: Head Mobile Home Park
County: Forsyth
Remission Enforcement
Enforcement Request Conference
Costs Damages Received Held
EMC Hearing
Held
Owner: Head Mobile Home Park
Collection
Memo Sent
to AGO Total Paid Balance Due
Has
Payment
Plan
Case Closed
LM-1999-0066
10/01/99
$1,075.00
$113.00 $.00
11/01/99
12/01/99
$1,113.00
.00
No
01/05/00
LV-2001-0164
05/08/01
$1,250.00
$76.00 $.00
$1,326.00
.00
No
05/25/01
LV-2003-0392
05/20/03
$450.00
$90.00
06/19/03
08/06/03
$540.00
.00
No
09/12/03
LV-2003-0496
07/24/03
$200.00
$90.00
08/19/03
03/11/04
$290.00
.00
No
04/14/04
LV-2003-0655
10/14/03
$450.00
$77.00
11/12/03
12/03/03
03/11/04
$527.00
.00
No
04/14/04
LV-2003-0772
12/01/03
$350.00
$88.00
12/31/03
02/04/04
$438.00
.00
No
03/09/04
LV-2003-0775
12/01/03
$250.00
$88.00
12/31/03
02/04/04
$338.00
.00
No
03/09/04
Jwul 0`k
LV-2004-0190
06/11/04
$312.50
$88.00
06/30/04
08/04/04
12/09/04
$400.50
.00
No
01/31/05
LV-2004-0354
08/06/04
$250.00
$88.00
09/10/04
10/06/04
05/12/05
$338.00
.00
No
06/28/05
LV-2004-0413
08/27/04
$312.50
$88.00
$400.50
.00
No
09/16/04
jv�1v`
LV-2004-0480
09/23/04
$312.50
$88.00
10/25/04
12/01/04
$400.50
.00
No
01/31/05
LV-2004-0508
10/12/04
$750.00
$88.00
10/25/04
12/01/04
$838.00
.00
No
01/31/05
Total Cases: 12
Total Penalties:
$5,962.50
$1,062.00
$7,024.50
6,949.50
Total Penalties after remission(s):
$.00
$6,949.50

�0� \N A rFjQQ Michael F. Easley, Governor
�0 William G. Ross Jr., Secretary
rNorth Carolina Department of Environment and Natural Resources
AlanW. Klimek, P.E. Director
Division of Water Quality
July 8, 2005
CERTIFIED MAIL #70041160 0002 2623 8358
RETURN RECEIPT REQUESTED
Mr. Hubert F. Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem, NC 27103
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(6)
and NPDES Permit NC0057223
Head Mobile Home Park
Case No. LV-2005-0230
Forsyth County
Dear Mr. Head:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount
of $525.50 ($437.50 civil penalty + $88.00 enforcement costs) against the Head Mobile Home
Park.
This assessment is based upon the following facts: areview has been conducted of the
discharge monitoring report (DMR) submitted by the Head Mobile Home Park for the month of
February 2005. This review has shown the subject facility to be in violation of the discharge
limitations and/or monitoring requirements found in NPDES Permit NC0057223. The violations,
which occurred in February 2005, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that the Head Mobile Home
Park violated the terms,, conditions or requirements of NPDES. Permit NCO057223 and G.S.
143-215.1(a)(6) in the manner and extent shown in Attachment A. In accordance with the
maximums established by G.S. 143-215.6A(a)(2), a civil penalty maybe assessed against any
person who violates the terms, conditions or requirements of a permit required by G.S. 143-
215.1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with
authority provided by the Secretary of the Department of Environment and Natural Resources
and the Director of the Division of Water Quality, I, Steve W. Tedder, Division of Water Quality
Regional .Supervisor for the Winston-Salem Region, hereby make the following civil penalty
assessment against the Head Mobile Home Park:
Noe Carolina
Nturu!!y
N.C: Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107- . [phone] Customer Service
Fax: [phone](800) 623-7748
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

1 of the 1 violations of G.S. 143-215.1(a)(6) and NPDES Permit No.
125.00 NC0057223, by discharging waste water into the waters of the State
in violation of the Permit Daily Maximum limit for FEC COLIFORM.
1 of the 1 violations of G.S. 143-215.1(a)(6) and NPDES Permit No.
312.50 NC0057223, by discharging waste water into the waters of the State
in violation of the Permit Monthly Average limit for NH3-N.
437.50 TOTAL CIVIL PENALTY
88.00 Enforcement Costs
525.50 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken
into account the Findings.of Fact and Conclusions of Law and the factors set forth at G.S. 14313-
282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health,
or. to private .property resulting from the, violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over
which the Environmental Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Within thirty days of receipt of this notice, you must do one of the following:
1. Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural
Resources (do not include waiver form). Payment of the penalty will not foreclose further
enforcement action for any continuing or new violation(s). ' Please submit payment to the
attention of:
Point Source Compliance/Enforcement Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
OR
2. Submit a written request for remission including a detailed justification for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed
below as they may relate to the reasonableness of the amount of the civil penalty assessed.
Requesting remission is not the proper procedure for contesting whether the violation(s)
occurred or the accuracy of any of the factual statements contained in the civil penalty

assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied. by a waiver of your right to an administrative
hearing and a stipulation and agreement that no factual or legal issues are in dispute. Please
prepare a detailed statement that establishes why you believe the civil penalty should be
remitted, and submit it to the Division of Water Quality at the address listed below. In
determining whether a remission request will 'be approved, the following factors shall be
considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b)
were wrongfully applied to the detriment of the violator;
(2) whether the violator promptly abated continuing environmental damage resulting from
the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator has been assessed civil penalties for any previous violations; or.
(5) whether payment of the civil penalty. will. prevent payment.for the remaining necessary
remedial actions.
Please note that all evidence presented in support of your request for remission must be
submitted in writing. The Director of the Division of the Division of Water Quality will review your
evidence and inform you of his, decision in the matter of your remission request. The response
will provide details regarding the case status, directions. for. payment, and provision for further
appeal of :the penalty to the Environmental Management Commission's Committee. on Civil
Penalty Remissions (Committee). Please be advised that the Committee cannot consider
information that was not part. of the original remission request considered by the Director.
Therefore, it is very important that you prepare a complete and thorough statement in support of
your request for remission.
In order to request remission, you must: complete and submit the enclosed "Request for
Remission of Civil Penalties, Waiver of Right to. an Administrative Hearing, and Stipulation of
Facts" form .within. thirty (30) days of receipt of this notice. The Division of Water Quality also
requests that you complete and submit the enclosed "Justification for Remission Request."
Both forms should be submitted to the following address:
Point Source Compliance/Enforcement Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
OR
3. File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a
petition for an administrative hearing. You may obtain the petition form from the Office of
Administrative Hearings. You must file the petition .with the Office of Administrative Hearings
within thirty (30) days of receipt of this notice. A petition is considered filed when it is received in
the Office of Administrative Hearings during normal office hours. The Office of Administrative
Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:OO.p.m.,
except for official state holidays. The original and one (1) copy of the petition must be filed with
the Office of Administrative Hearings. The petition may be faxed - provided the original'and one
copy of the document is received in the Office of Administrative Hearings within five (5)
business, days following the faxed transmission. The mailing address for the Office of

Administrative Hearings is;
Office of Administrative Hearings
6714 Mail Service Center _
Raleigh, NC 27699-6714
Telephone [phone] Facsimile: [phone]
A copy of the petition must also be served on DENR as follows:.
Mr. Dan Oakley, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, NC 27699-1601
Please indicate the case number (as found on .page one of this letter) on the petition. Failure to
exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by
an internal date/time received stamp (not a postmark), will result in this matter being referred to
the Attorney General's Office for collection of the penalty through a civil action. Please be
advised that additional penalties may beassessed for violations that occur after the review
period of this assessment.
If you have any questions, please contact the Water Quality staff of the Winston-Salem
Regional Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
attachments
cc: WSRO Files w/attachments
Central Files w/attachments .
PS Compliance/Enforcement Unit

ATTACHMENT A
Head Mobile Home Park
CASE NUMBER: LV-2005-0230
PERMIT: NCO057223 FACILITY: Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Limit Violations
MONITORING OUTFALL/ VIOLATION UNIT OF CALCULATED % OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE
$125.00 2-2005 001 Effluent FEC COLI 02/22/05 Weekly #/100ml 400 3,500 775.00 Daily Maximum Exceeded
$312.50 2-2005 001 Effluent. NH3-N 02/28/05 Weekly mg/I 4 5.95 48.75 Monthly Average Exceeded

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF Forsyth
Head Mobile Home Park
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINSTRATIVE HEARING AND
Head Mobile Home Park ) STIPULATION OF FACTS
PERMIT NO. NC0057223 ) FILE NO. LV-2005-0230
Having been assessed civil penalties totaling $525.50 for violation(s) as set forth in the
assessment document of the Division of Water. Quality dated July 8, 2005, the undersigned, desiring
to seek remission of the civil penalty, does hereby waive the right to an administrative hearing in the
above -stated matter and does stipulate that the facts are as alleged in the assessment document.
The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the director of the Division of Water Quality with thirty (30) days of
receipt of the notice of assessment. No new evidence in support of a remission request will be
allowed after (30) days from the receipt of the notice of assessment.
This the
day of
ADDRESS
TELEPHONE
SIGNATURE
20

JUSTIFICATION FOR REMISSION REQUEST
DWQ Case Number: LV-2005-0230 County: Forsyth
Assessed Party: Head Mobile Home Park
Permit No: NC0057223 Amount Assessed: $525.50
Please use this form when requesting remission of this civil penalty. You must also complete the
"Request For Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form
to request remission of this civil penalty. You should attach any documents that you believe support
your request and are necessary for the Director to consider in evaluating your request for remission.
Please be aware that a request for remission is limited to consideration of the five factors listed below
as they may relate to the reasonableness of the amount of the civil penalty assessed. Requesting
remission is not the proper procedure for contesting'whether the violation(s) occurred or the accuracy
of any of the factual statements contained in the civil penalty assessment document. Pursuant to
N.C.G.S. § 14313-282.1(c), remission of a civil penalty may be granted only when one or more of the
following five factors applies. Please check each factor that you believe applies to your case and
provide a detailed explanation, including copies of supporting documents, as to why the factor applies
(attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 14313-282.1(b) were
wrongfully applied to the detriment of the petitioner (the assessment factors are listed
in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the
violation (i.e., explain the steps that you took to correct the violation and prevent
future occurrences);
(c) the violation was inadvertent or a result of an accident (Le., explain why the violation
was unavoidable or something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial
actions (i.e., explain how payment 'of the civil penalty will prevent you from performing
the activities necessary to achieve compliance).
EXPLANATION:

DIVISION OF WATER QUALITY - CIVIL PENALTY ASSESSMENT
Violator: Head Mobile Home Park
County: Forsyth
Case Number: LV-2005-0230
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public
health, or to private property resulting from the violation;
2) The duration and gravity of the violation;
3) The effect on ground or surface water quantity or quality or on air quality;
4) The cost of rectifying the damage;
5) The amount of money saved by noncompliance;
6) Whether the violation was committed willfully or intentionally;
7) The prior record of the violator in complying or failing to comply with programs over
which the Environmental Management Commission has regulatory authority; and
8) The cost to the State of the enforcement procedures.
Date Supervisor Name

JAN 17 2006
rrnston-Salem
Regional Office
January 12, 2006
Mr. Steve Tedder
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to the December 27, 2005 Notice of Violation at Head MHP
WWTP during February, 2005.
The Head facility experienced an elevated Fecal Coliform level on 2/22/05 and exceeded
the monthly average limitation for Ammonia Nitrogen.
These excursions have been revised and subsequent sampling and monitoring have
shown overall compliance with the parameters.
The Fecal Coliform exceedence appears to be an isolated incident due to poor
disinfection or contamination.
As you know, the Head MHP WWTP is a subsurface treatment system with subsurface
filtration which provides some nitrification with seasonal inefficiencies due to loading,
rainfall and temperature changes. We have supplemented this treatment scheme with the
addition of Zeolite media to aid in the further reduction of Ammonia.
We will continue to make every effort to maintain compliance with out permit limits.
Sincerely
Cc: Hubert Head

January 12, 2006
Mr. Steve Tedder
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to the December 19, 2005 Notice of Violation for Head MHP
WWTP.
During September, 2005, the Head MHP experienced on elevated effluent BOD of 9.0
mg/l. The monthly average was compliant with the monthly limit; however the 9.0 mg/1
sample exceeded our daily maximum limit.
Overall the discharge maintains compliance with the Effluent BOD limit and the
September 13 sample appears to represent variability in the subsurface treatment system.
We will continue to monitor this situation and make every effort to maintain compliance.
I hope this information is helpful in addressing your question.
Sincerely,
He P
Sta. a k
ORC
Cc: Hubert Head

o��� WN a Q�
r
September 6, 2005
5076
Mr. Gary Stainback
Head Mobile Home Park WWTP
140 Linbrook Dr.
Winston-Salem, NC 27106-
SUBJECT: Laboratory Certification Maintenance Inspection
Dear Stainback::
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
RECEIVED
N.C. Dew ° =,-q
SEP 0 8 2005
Winston -oz,rrr,
Regional Office
Enclosed is a report for the inspection performed on, August 18, 2005 by Ms. Tonja Springer.
Where deficiencies are cited in this report, a response is required as well as for all lettered comments
and/or recommendations. Within thirty days -of receipt, please supply this office with a written item for
item description of how these deficiencies, comments and/or recommendations were corrected. If the
deficiencies cited in the enclosed report are not corrected, enforcement actions will be recommended.
For certification maintenance, your laboratory must continue to carry out the requirements set forth in
15A NCAC 2H .0800.
Copies of the checklists completed during the inspection may be requested from this office.
Thank you for your cooperation during the inspection. If you wish to obtain an electronic copy of this
report by email, or if you have questions or need additional information please contact us at 919-733-
3908.
Sincerely,
James W. Meyer
Laboratory Section
Enclosure
cc: Tonja Springer
Windyon Salem Regional Office
NorthCarolina
Laboratory Section 1623 Mail Service Center; Raleigh, NC 27699-1623
4405 Reedy Creek Road; Raleigh, NC 27607
Phone [phone] / FAX [phone] / Internet: www.dwqlab.org
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

On -Site Inspection Report
LABORATORY NAME:
ADDRESS:
CERTIFICATE NO:
DATE OF INSPECTION:
TYPE OF INSPECTION:
EVALUATOR:
LOCAL PERSON CONTACTED:
I. INTRODUCTION:
Head Mobile Home Park WWTP
140 Linbrook Dr.
Winston-Salem, NC 27106
#5076
August 18, 2005
Field Certification Inspection
Ms. Tonja Springer
Mr. Gary Stainback
This laboratory was inspected to verify its compliance with the requirements of 15A NCAC 2H .0800 for
the analysis of environmental samples.
GENERAL COMMENTS:
The inspection consisted of reviewing data for NPDES #NC0057223. The staff is congratulated for doing,
an excellent job of implementing the laboratory certification program..All equipment is well maintained.
Records are well kept and the most data appeared accurate. Some documentation needs to be
improved.
Comment: For all benchsheets, it is recommended that the lab indicate which edition of the method is
being referenced. This will aid the analysts,, when method changes are promulgated by EPA, to
maintain adequate documentation of their data.
Comment: A guidance field sheet was given to Mr. Stainback during the inspection. An electronic copy
was also sent on August 26, 2005.
DEFICIENCIES, REQUIREMENTS, COMMENTS AND RECOMMENDATIONS:
Benchsheet (all parameters);
1. Comment: Only one time was documented for all the parameters. The time documented was a time
range from the beginning of sampling until the completion. Also, units were not always documented on
the field sheets. During the inspection it was explained that each analysis would need an individual time
for collection and analysis. Mr. Stainback has indicated that he will be switching to the guidance field
sheet that includes all the required documentation.
Requirement: Certified Data must consist of date collected, time collected, sample site, sample collector,
and sample analysis time. The field benchsheets must provide a space for the signature or initials of the
analyst, and proper units of measure for all analyses. Reference: 15A NCAC 2H .0805 (a) (1).
TRC:
2. Comment: The gel standards were not checked against the annual verification curve.

Page 2
Head Mobile Home Park WWTP
IV.
Recommendation: It is recommended that Mr. Stainback look back in his record and check to see
what the value of the gel standard were after the annual verification curve was analyzed. The first
readings obtained for the gels after the curve was check will be the true values of the gels until next
years curve is analyzed.
Comment: Next year it is recommended that the curve range be in the range of 0.100 mg/L — 2.0 mg/L
since a chlorine limit has not yet been assigned. The gel standards will need.to be read against the
internal calibration curve to establish true values. The daily Q.C. standard should result in a recovery of
+/- 10 % of the true value. It is recommended that these true values be documented on the bench
sheet and the standard box. The gel standards can be used passed the manufacturer expiration date
as long as the standards continues to meet the acceptance criteria of +/- 10 % and shows no sign of
deterioration. This procedure will need to be performed annually at the time of the annual internal
calibration verification.
Recommendation: It is recommended that the 0.18 mg/L range gel standard be used as the daily
check standard. Currently the gel standards are being rotated. It is recommended that the daily check
standard be around the mid -point of the annual verification curve. - -
Comment: Mr. Stainback has indicated that a limit will be coming in the near future. The Mobile Home
Park owner is looking at possibly installing a UV system along with other options. If a limit is
implemented on the permit; a new meter will need to be purchased in order to meet the permit
requirements.
pH.
3. Comment: The pH buffers were being poured into smaller bottles for transport and some of the
pertinent information was not documented on the plastic containers.
Recommendation: It is recommended that the plastic container have documented on them the
manufacturer, lot# and the expiration dates.
PAPER TRAIL INVESTIGATION:
A paper trail was conducted at this facility. This consisted of comparing laboratory bench data with
DMR reports. There were two transcription errors detected.
Date:
Parameter
3/15/05
Temp
3/23/05
Temp
Value on Benchsheet Value on DMR
15.0 14.0
14.0 15.0
*In order to avoid questions of legality, it is recommended that amended DMRs be submitted
to this Division.
V. CONCLUSIONS:
Correcting the above cited comments and implementing the recommendations will help this lab to produce
quality data and meet certification requirements. Please respond to all lettered comments.
Report prepared by: Tonja Springer Date: August 26, 2005

J
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Wpter Quality
May 17, 2005
CERTIFIED MAIL 7002 0860 0000 7978 3720
RETURN RECEIPT REQUESTED
Mr Hubert Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston-Salem, NC 27103
Mr Gary Stainback
140 Linbrook Dr
Winston Salem NC 271064539
SUBJECT: May 9, 2005 Compliance Evaluation Inspection
Head Mobile Home Park
Permit No: NCO057223
Forsyth County
Dear Mr. Head:
Enclosed please find a copy of the Compliance Inspection Inspection form from the inspection
conducted on May 9, 2005. The Compliance Inspection Inspection was conducted by Rose Pruitt
of the Winston-Salem Regional Office.. The facility was found to be in Compliance with permit
NC0057223. Gary Stainback, ORC and Dennis Wilkinson were 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.
I. Permit
The NPDES permit for the Head Mobile Home Park WWTP became effective August 1, 2004 and
expires on May 31, 2009. The permitted components of the 0.0016 MGD wastewater treatment
plant include: a septic tank, distribution box, subsurface sand filter, tablet chlorinator and contact
chamber/post aeration chamber.
II. Records/Reports
A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Head
Mobile Home Park WWTP for the period December 2003. through December 2004 revealed that
the facility had nine (9) violations. Two were for daily maximum fecal coliform violations in
August and November 2004. A Notice of Violation was issued by the Division for these
violations. Five were for monthly average effluent limitation violations for Ammonia -Nitrogen in
January, April, May, June and July 2004. The facility received a civil penalty assessment for these
violations. Two were for BOD effluent violations, one daily and one monthly in July 2004. The
facility received a civil penalty assessment for these violations. Operations records include all 1�J
sample analyses and process control tests that are performed. Please contact this office for ` �J
compliance assistance.,
iVc6ON.
585 Waughtown Street Winston-Salem, NC 27107 Phone [phone] Fax [phone]

Head MHP
Page 2
May 17,2005
III. Facility Site Review
The facility site review indicated that the 0.0016 MGD treatment works is consistent with the
permitted components. The actual treatment system consists of a septic tank, distribution box,
subsurface sand filter, tablet chlorinator and contact chamber/post aeration chamber.
The following items were corrected as required in the previous inspection:
(1) Septic tanks were pumped by Transou in June of 2004 and are being placed on an annual
pump schedule.
(2) A spill response plan has been posted.
(3) Proper wastewater chlorine tablets are being used.
IV. Effluent / Receiving Stream
The WWTP discharges to an unnamed tributary to Little Creek, a class C water in the Yadkin -Pee
Dee River Basin. The effluent was clear and free of visible solids on the date of inspection. The
receiving stream was free of solids, foam and debris.
V. Flow Measurement
Influent flow is measured with an in line fresh water meter.
VI. Self -Monitoring Program
A review of the discharge monitoring reports (DMRs) for the time period of December 2003
through December 2004 demonstrated that the Head Mobile Home Park WWTP had nine (9)
violations. Two were for daily maximum fecal coliform violations in August and November 2004.
A Notice of Violation was issued by the Division for these violations. Five were for monthly
average effluent limitation violations for Ammonia -Nitrogen in January, April, May, June and July
2004. The facility received a civil penalty assessment for these violations. Two were for BOD
effluent violations, one daily and one monthly in July 2004. The facility received a civil penalty
assessment for these violations.
VII. Compliance Schedules
No Compliance schedule to evaluate.
VIII. Laboratory
All of the sample analyses are conducted by Tritest Labs. The laboratory was not reviewed at the
time of the subject inspection.
IX. Operation and Maintenance
Operation and maintenance at the time of the subject inspection were deemed satisfactory since the
previous inspection. The effluent was clear and free of visible solids. The septic tank had been
pumped down by a licensed hauler. The contact chamber was free of solids. It was suggested to
the ORC and Mr Dennis Wilkinson that a meeting with the Division of Water Quality could be to
their advantage in finding a solution to ongoing problems meeting effluent limits. Mr Wilkinson
agreed to schedule a meeting in the near future.

Head MHP
Page 3
May 17,2005
X. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of
properly.
XI. Pretreatment
Not evaluated during this inspection. No pretreatment program required.
XII. Stormwater
Not evaluated during this inspection.
XIV. Sewer Overflow
None to report.
XV. Pollution Prevention
Not evaluated during this inspection.
XVI. Multimedia
Not evaluated during this inspection.
The Division of Water Quality greatly appreciates your prompt attention to the non-compliance
issues noted in previous inspections. Your continued oversight at this facility is still very
important. The Division also encourages you to continue to be proactive in your efforts to
maintain compliance. Please do not delay scheduling a compliance assistance meeting with the
Division of Water Quality at your earliest convenience.
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 336-771-4600.
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: Gary M Stainback, ORC
Central Files
ImgTI � e
Dennis Wilkinson
Forsyth County Health Dept.

United States Environmental Protection Agency
Form Approved.
Washington, D.C. 20460
EPA
OMB No. 2040-0057
Water QompflancQInspection 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 U 2 U 31 NCO057223 111 121 05/05/09__j 17 18U 19U 20U
Remarks
211111Jill 11111111Jill 1111Jill III IIIIIIIIIIIII11166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved -----------------------
67 I 169 70 U 71 U 72 U 73 U 74 751 I I I I I 11
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)
09:00 AM 05/05/09
04/08/01
Head Mobile Home Park
Exit Time/Date
Permit Expiration Date
2880 S Stratford Rd
Winston Salem NC 27103
10:15 AM 05/05/09
09/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Gary M Stainback/ORC/336-766-0270/
Name, Address of Responsible Official/Title/Phone and Fax Number
Gary M Stainback,140 Linbrook Dr Winston Salem NC Contacted
No
271064539//336-659-0448/
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit N Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal Facility Site Review Compliance Schedules
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
Rose Pruitt WSRO WQ///
i
Signature Q A Reviewer Agency/Office/Phone and Fax Numbers Date
oManament
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

V/
NPDES yr/mo/day Inspection Type
3� NCO057223 I11 12I 05/05/09 117 18 U
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Gary Stainback and Dennis Wilkinson were on site for this inspection. Please schedule an appointment with
the Division of Water Quality at your earliest convenience to discuss solutions to your compliance issues
related to meeting your NPDES effluent limits.

�6
PPS
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Yes No
No
NA
O
NE
O
Is the facility as described in the permit?
■ O
O
O
Are there any special conditions for the permit?
O M
O
O
Is access to the plant site restricted to the general public?
S D
0
O
Is the inspector granted access to all areas for inspection?
M 0
O
O
Comment:
Yes No
NA
NE
Qpprations & Maintenance
Is the plant generally clean with acceptable housekeeping?
0 13
00
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge Judge,
00
O
and other that are applicable?
Comment:
Yes No
NA
NE
Disinfection -Tablet
Are cylinders secured adequately?
M
❑
Are cylinders protected from direct sunlight?
M
❑
O
Is there adequate reserve supply of disinfectant?
0 O
O
Are tablet chlorinators operational?
M 0
0
O
Are the tablets the proper size and type?
M C1
0
O
Number of tubes in use?
2
(Sodium Hypochlorite) Is pump feed system operational?
0 O
M
O
Is bulk storage tank containment area adequate? (free of leaks/open drains)
0 O
0
O
Is the level of chlorine residual acceptable?
O O
O
M
Is the contact chamber free of growth, or sludge buildup?
0 C1
O
O
Is there chlorine residual prior to de -chlorination?
O O
O
0
Comment:
Yes
No
NA
NE
Sgeptic Tank
(If pumps are used) Is an audible and visual alarm operational?
O
O
E
0
Is septic tank pumped on a schedule?
M
O
O
D
Are pumps or syphons operating properly?
O
O
0
M
Are high and low water alarms operating properly?
O
O
0
O
Comment: Last pumped by Transou in June 2004. Pumped yearly.
Yes
No
NA
NE
Sand Filters (Low rate)
(If pumps are used) Is an audible and visible alarm Present and operational?
O
D
0
Is the distribution box level and watertight?
❑
O
❑
M
Is sand filter free of ponding?
M
O
11
O
Is the sand filter effluent re -circulated at a valid ratio?
❑
O
0
E
Is the sand filter surface free of algae or excessive vegetation?
❑
❑
0
O
Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
O
O
O
0
Comment:
Yes No
NA
NE
aborato ^,
Are field parameters performed by certified personnel or laboratory?
0 Cl
O
O
Are all other parameters(excluding field parameters) performed by a certified lab?
M O
O
O
Is the facility using a contract lab?
E 0
0
0
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
O 0
O
M
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
O O
O
E
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
0 0
0
M

Lahoratnry
Comment: Tritest Labs
Yes No
Yes No
NA
NE
NA
NE
Flow MeasLrement - Influent
Is flow meter used for reporting?
N ❑
❑
❑
Is flow meter calibrated annually?
❑ ❑
❑
E
Is the flow meter operational?
No
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑ ❑
0
❑
Comment: Flow measured at in line fresh water meter.
Yes No
NA
NE
Record Keenino
Are records kept and maintained as required by the permit?
0 ❑
❑
❑
Is all required information readily available, complete and current?
N ❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
N ❑
❑
❑
Are analytical results consistent with data reported on DMRs?
0 ❑
❑
❑
Is the chain -of -custody complete?
E ❑
❑
0-
O&M Manual
❑
As built Engineering drawings
❑
Schedules and dates of equipment maintenance and repairs
Dates, times and location of sampling
■
Name of individual performing the sampling
0
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
0 ❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑ ❑
0
❑
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?
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
Comment: Annual report January 2005.
Jamie Whittier backup ORC.
Effluent Sam Ip
Yes No
NA
NE
ink
Is composite sampling flow proportional?
❑ ❑
0
❑
Is sample collected below all treatment units?
❑
❑
❑
Is proper volume collected?
❑ ❑
❑
0
Is the tubing clean?
❑ ❑
❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
❑ ❑
❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
E ❑
❑
❑
Comment:
Yes No
NA
NF
Upstream / Dnwnstream Sam IRlna
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)?
❑
❑
❑
Comment:
Is there a compliance schedule for this facility? 0000

.omnlian e Schedules
Is the facility compliant with the permit and conditions for the review period?
Comment:
Effl Dent Pepe
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:
' x
Yes No NA NE
❑ ❑ M ❑

RPCEIVED
N,G, OC-Pt, of ENR
NOV 2,3 2004
Winston-Salem
Regional Office
November 16, 2004
Mr. Steve Tedder, Regional Supervisor
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to your October 18, 2004 correspondence regarding compliance
issues at the Head Mobile Home Park Wastewater Treatment Plant.
As you indicated, the Head Mobile Home WWTP experiences challenges consistently
meeting the current stringent limitations in the NPDES Permit.
As you may know, the existing Head MHP WWTP consists of a septic tank treatment
system followed by subsurface sand filters. The effluent is disinfected through tablet
chlorination prior to discharge.
The Head MHP WWTP, which was originally designed for conventional effluent limits
of BOD and Total Suspended Solids of 30.0 mg/1 and no Ammonia Nitrogen limit or
requirement to nitrify.
Historically, the Head facility has effectively treated its wastestream to conventional
secondary standards.
As you know, the current Head WWTP permit requires an effluent limit for BOD of 5.0
mg/l on a monthly average and 7.5 mg/l on a daily maximum. The current summer and
winter Ammonia Nitrogen monthly effluent limits are 2.0 mg/l and 4.0 mg/l, respectively.
Operational strategies have been utilized to optimize treatment of the existing unit
processes.
These measures have included the testing of the recycling of sand filter filtrate to improve
treatment efficiency of the existing sand filter and the use of zeolite media to facilitate
additional removal of effluent Ammonia Nitrogen.

These measures have resulted in improvements. However, consistent compliance has
been challenged by the adverse affects of heavy rainfall and it's influence on a subsurface
system as well as the much reduced permit limitations and limits of the system.
These measures have been employed to maintain compliance until a more permanent
solution can be completed.
Head Mobile Home Park's long term goal is to connect to the sewer. This has also been
the recommendation of the current contract operator for Head MHP WWTP.
A corrective decision of this economic magnitude has been difficult for a small mobile
home park.
The Head Mobile Home consists of six mobile homes, most of which are occupied by
retired residents on fixed incomes. The average daily flow is less than 500 gallons per
day.
Connection to the sewer system is the desired approach to correct this problem and
eliminate the NPDES Permit and the increasing operational cost associated with this
discharge.
Head Mobile Home Park will investigate further the possible options of connecting to the
sewer and the costs associated with this modification.
The cost associated with such options will be a critical variable in our ability to complete
this task for such a small system.
We will also evaluate the use of a Schedule of Compliance to facilitate this process and
maintain compliance.
Thank you for your guidance and support in this matter.
Sincerely,
Head MHP Q
Hubert Head
Cc: Gary Stainback

F'bF �W A TC9p Michael F. Easley, Governor
'0 G William G. Ross Jr., Secretary
a r North Carolina Department of Environment and Natural Resources ;
-� Alan W. Klimek, P.E. Director
Division of Water Quality
October 18, 2004
CERTIFIED MAIL 7002 2410 0005 9361 9966
RETURN RECEIPT REQUESTED
Mr. Hubert Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston Salem, NC 27103
Mr. Gary Stainback, ORC
140 Linbrook Dr.
Winston Salem, NC 27106
Subject: Compliance Problems
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
In reviewing the file for Head Mobile Home Park, Permit No. NCO057223 it has become apparent that your
subsurface sand filter is not able to consistently meet the limits of your permit. During the past year you have
permit violations as follows:
Date Parameter Limit DMR Value Assessment
• July 2004 BOD 5 day 7.5mg/l 24 mg/l
BOD 5 day
5 mg/1
6 mg/1
NH3-N
2 mg/1
5.45 mg/1
$838.00
• June 2004
NH3-N
2 mg/l
2.86 mg/l
$400.50 .
• May 2004
NH3-N
2 mg/1
3.4 mg/l
$400.50
• April 2004
NH3-N
2 mg/1
3.85 mg/1
$338.00
• January 2004
NH3-N
4 mg/1
6.04 mg/1
$400.50
• October 2003
Late or Missing DMR
• April 2004
Inspection NOV
North Carolina Division of Water Quality 585 Waughtown Street Winston Salem, NC 27107
Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
5 / 10 a Carolina
V�Nawra!!y
Phone [phone] FAX [phone]

Head MHP
Page 2
October 18, 2004
Your NPDES Permit NC0057223 was issued with a duty to comply with all conditions of the permit.
Noncompliance constitutes a violation of the Clean Water Act. In addition to enforcement action this
could result in permit termination or revocation.
In a letter from this office dated September 26, 2003 it was suggested that you contact officials with
Stratford Crossing (TJL Development, LLC PO Box 846 Clemmons, NC 27012) about an easement to
connect to the sewer on their property. An alternate suggestion was obtaining an easement to connect to
the sewer on Little Creek. As this office has received no response from you on this matter it is with
some urgency that we request you to immediately examine your options and to respond in writing to
this office within thirty (30) working days of receipt of this letter. If the sewer connection is not a
viable option for you at this time you may wish to consider upgrading your plant to meet the established
permit limits.
Thank you for your prompt attention to this important matter. We would be happy to schedule a
meeting to discuss your options. If you would like to discuss this or any other matter please call Rose
Pruitt at 336-771-4600.
Sincerely,
W'ot�,e:iL
Steve W. Tedder
Water Quality Regional Supervisor
Winston Salem Regional Office
Division of Water Quality
Cc: Central Files
dupimm
IM

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 10/18/04
Page: 1 of 1
"Pemlit: , nc0057223
MRs`Between: 8_:2003 : and 8
o
-2004 Re ion. =0
9 /c
Violatioh>Cafe o :_
9 q : /a
Program Category to
3
Fadility:Name ` 4f°
Param Name: °70
.County 4h
x
,
Subbasm °ry° Violatlon Action °!p
riz
PERMIT: NCO057223
FACILITY: Head Mobile Home Park - Head Mobile Home Park
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
07 - 2004 001 Effluent
BOD, 5-Day (20 Deg. C) 07/31/04
Weekly
mg/I
7.5
24
Daily Maximum Exceeded
Proceed to
Enforcement Case
- 07 - 2004 001 Effluent
BOD, 5-Day (20 Deg. C) 07/31/04
Weekly
mg/I
5
6
Monthly Average Exceeded
Proceed to
Enforcement Case
08 - 2004 001 Effluent
Coliform, Fecal MF, M-FC 08/31/04
Weekly
#/loom[
400
854
Daily Maximum Exceeded
None
Broth,44.5C
01 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N) 01/31/04
Weekly
mg/1
4
6.04
Monthly Average Exceeded
Proceed to
Enforcement Case
- 04 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N) 04/30/04
Weekly
mg/I
2
3.85
Monthly Average Exceeded
Proceed to
Enforcement Case
05 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N) 05/31/04
Weekly
mg/I
2
3.4
Monthly Average Exceeded
Proceed to
Enforcement Case
�. 06 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N) 06/30/04
Weekly
mg/I
2
2.86
Monthly Average Exceeded
Proceed to
Enforcement Case
- 07 - 2004 001 Effluent
Nitrogen, Ammonia Total (as N) 07/31/04
Weekly
mg/I
2
5.45
Monthly Average Exceeded
Proceed to
Enforcement Case
Reporting Violation
MONITORING OUTFALL
VIOLATION
UNIT OF
CALCULATED
REPORT / PPI LOCATION
PARAMETER DATE
FREQUENCY
MEASURE
LIMIT
VALUE
VIOLATION TYPE
VIOLATION ACTION
10 - 2003
12/01/03
Late/Missing DMR
None

Permit Enforcement History
Permit: NCO057223
Region: Win ton -Salem
Penalty
Assessment
Case Number Approved
Penalty
Amount
Facility: Head Mobile Home Park
County: For yth
Remission Enforcement
Enforcement Request Conference
Costs Damages Received Held
EIVIC Hearing
Held
Owner: Head Mobile Home Park
Collection
Memo Sent
to AGO Total Paid Balance Due
Has
Payment
Plan
Case Closed
LM-1999-0066
10/01 /99
$1,075.00
$113.00 $.00
11 /01 /99
12/01 /99
$1,113.00
.00
No
01 /05100
LV-2001-0164
05/08/01
$1,250.00
$76.00 $.00
$1,326.00
.00
No
05/25/01
LV-2003-0392
05/20/03
$450.00
$90.00
06/19/03
08/06/03
$540.00
.00
No
09/12/03
LV-2003-0496
07/24/03
$200.00
$90.00
08/19/03
03/11/04
$290.00
.00
No
04/14/04
LV-2003-0655
10/14/03
$450.00
$77.00
11/12/03
12/03/03
03/11/04
$527.00
.00
No
04/14/04
LV-2003-0772
12/01 /03
$350.00
$88:00
12/31 /03
02/04/04
$438.00
.00
No
03/09/04
LV-2003-0775
12/01/03
$250.00
$88.00
12/31/03
02/04/04
$338.00
.00
No
03/09/04
�04
LV-2004-0190
06/11/04
$312.50
$88.00
06/30/04
08/04/04
400.50
No
1104
LV-2004-0354
08/06/04
$250.00
$88.00
09/10/04
10/06/04
338.00
No
7'p y
LV-2004-0413
08/27/04
$312.50
$88.00
$400.50
.00
No
09/16/04
2fULV-2004=0480
$312.50
$88.00
400.50
No
l
LV-2004-0508
$750.00
$88.00
838.00
No
Total Cases: 12
Total Penalties:
$5,962.50
$1,062.00
$7,024.50
4,972.50
Total Penalties after remission(s):
$1,977.00
$6,949.50

OTHER VIOLATIONS for: Report Date: 10/18/04 Page: I of 1
egion:,�o �o� -134 -P
P ncO057M Violation 661tegol.Y. Other ermit: rodrambaiegory:,
jFacility Namp-.Flo, ' County: % - Viol '
% aiiomA pton,
PERMIT: NCO057223 FACILITY: Head Mobile Home Park - Head Mobile Home Park COUNTY: Forsyth REGION: Winston-Salem
Other Violation
VIOLATION
DATE
06/01/99
01/01/01
04/21/04
VIOLATION TYPE
Conversion violation - Other Cat
Conversion violation - Other Cat
Violation detected during inspection
VIOLATION ACTION
Proceed to Enforcement Case
Proceed to Enforcement Case
Proceed to NOV
OPERATOR NAME CERT NUMBER ORC CLASS PERMIT CLASS

Head Mobile Home Park
280 South Stratford Road
Winston-Salem, NC 27103
February 4, 2004 �FB
13 2004
System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE:-Heamobile_ Home_-P-ark WWTP
NPDES Permit Number: NC0057223
Forsyth County
Dear Sirs,
Enclosed you will find the Annual Performance Report for the.year of 2003 for the
Head Mobile Home Park, North Carolina Wastewater Treatment Plant. We
believe the report to be complete and accurate. Each of the residents will be
provided a copy of the report.
If you have any questions, please advise.
in
ORC

HEAD MOBILE HOME PARK
WASTEWATER TREATMENT FACILITY
ANNUAL PERFORMANCE REPORT
For the Calendar Year 2003
Prepared: February 2004

2003 Annual Performance Report
for the
Head Mobile Home Park
Wastewater Treatment Facility
I. General Information
Facility/System Name: Head Mobile Home Park Wastewater Treatment Plant
Responsible Entity: Head Mobile Home Park
Person in Charge/Contact: Mr. Hubert Head
Head Mobile Home Park
2880 South Strafford Road
Winston Salem, NC 27103
[phone]
Description of Collection System or Treatment Process:
The Head Mobile Home Park WWTP consists of a septic tank and a sand filter with
a small tablet type chlorinator. The flow enters into the septic tank and then into the
sand filter. After the flow passes through the sand filter, it goes through the
chlorinator and is then discharged to the receiving stream. The flow is about 200-
500 GPD at this facility.
II. Compliance Performance
The North Carolina Department of Environment and Natural Resources
(NCDENR) regulates the Head Mobile Home Park's effluent discharge under the
National Pollutant Discharge Elimination System (NPDES). The NCDENR
issued to the Park a NPDES Permit that includes water quality limits and
sampling and monitoring requirements. The NPDES Permit requires the Park to
test more than 11 different constituents in the treated water. The monitoring
frequency for these constituents are set at various intervals such as weekly,
twice per month, and quarterly. During the previous year, the Park conducted
736 tests of the treated water before it was discharged to the creek. The WWTP
achieved a Compliance Level of 99.50% with its NPDES Permit requirements.
Following is a summary of the testing for the parameters that are assigned Water
Quality Standards by the NPDES Permit. Please note the summary includes
parameters that only incorporate a monitoring requirement, it not does include
daily process control testing.

Constituent
Number of Test
Required
Number of Test
Conducted
Flow
52
365
Biochemical Oxygen Demand (BOD)
50
50
Total Suspended Solids (TSS)
50
50
Ammonia
50
51
Fecal Coliform
50
51
Chlorine
104
106
Total Nitrogen
4
4
Total Phosphorus
4
4
* Testing is not required during Holidays or Inclement Weather.
In addition to the required testing, the Park conducted over 600 in-house test to
ensure the proper operation of the wastewater treatment plant.
Following is a summary of permit violations, which occurred during the year:
February 2003
The monthly average limit for BOD was exceeded, as well as the weekly average
limit during the weeks of February 4 and 11, 2003.
April 2003
The weekly average limit for BOD was exceeded during the week of April 2,
2003. The weekly average limit for Fecal Coliform was exceeded during the
week of April 9, 2003.
May 2003
The monthly average limit for Ammonia -Nitrogen was exceeded. The daily
maximum limit for BOD was exceeded on May 27, 2003.
June 2003
The monthly average limit for Ammonia -Nitrogen was exceeded. The weekly
average limit for Fecal Coliform was exceeded during the week of June 11, 2003.

July 2003
The monthly average -limit for Ammonia -Nitrogen was exceeded.
October 2003
The monthly average limit for Ammonia -Nitrogen was exceeded.

Part III- Certification
I have personally examined and am familiar with the information submitted in this
document and attachments. Based upon my inquiry of those individuals
immediately responsible for obtaining the information reported herein, I believe
that the submitted information is true, accurate, and complete. I am aware that
there are significant penalties for submitting false information.
Signed this ` day of
g y 2004.
_Hubert Head %/,,/ '-f -I' "
(Name) Owner

Faxed To:
Fax #: �� Phone #:
WWTP Annual Inspection Checklist
Facility: .( tOA-t> ✓ -B i" NPDES: N c- O V s 7 Z 23
Permit Effective Dates: 2 I '0 O to 31 L
Inspection Dater A Inspection Time: -D ED
ikwW
--i) DMRs (Dates: I Z-'d Z to 12 3 )
-2) Lab Data (per DMR dates)
,-- 3) Laboratories used for analysis & certification #'s +Pcw- .o ce,.�
­4) Chain of Custody forms (per DMR dates)
�5) ' Complete copy of current NPDES permit
6) Status of SOC or Moratorium issuance (if applicable)
7) ORC and Back-up ORC current certification JCL.,,,,;I f- wXA c
8) Wastewater Annual Report (fiscal or calendar year - if applicable)
'--9) Daily Operator's log / ORC visitation log
—10) Maintenance log
11) Process control data (which includes field parameters tested and equipment
calibrations)
12) Field Parameter certification (if applicable)
13) Flow meter calibration records (if applicable)
14) Influent and/or effluent samplers
15) Flow charts (if applicable)
16
17
Generator Inspection /under load checks
Spill Response Plan (with current emergency contact numbers)
18) -
Current Sludge / Residuals permit (if applicable)
r
19)
20)
Sludge / Residuals hauling records (if applicable)
Sludge / Residuals Annual Report (if applicable)
21)
Plant visual inspection of treatment units
�_-22) Stream accessible inspection (at effluent dischargepipe) - VWq cvtzz
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office
[phone]
wo V- 0,00 Y PG fl 05c7

SENDING CONFIRMATION
DATE APR-16-2004 FRI 09:31
NAME NC DIVISION OF WATER QUALITY
TEL [phone]
PHONE
: 97660469
PAGES
: 1/1
START TIME
: APR-16 09:30
ELAPSED TIME
: 00' 25"
MODE
: ECM
RESULTS
: OK
FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
Faxed To: f`-" �'�`�T�
330
Fax#: 7fe(P—DY(Pq —Phone#:766-0z 0
WWTP Annual Inspection Checklist
Facility: 40 fFp It'1 P NPDES: 0011
Permit Effective Dates: 2 -) O C _to S" 3
Inspection Date: �12-VR-S y � %Z "O1 Inspection Time: ame
1) DMRs (Dates: I -Z-" o Z to
2) Lab Data (per DMH dates)
3) Laboratories used for analysis & certification #'s
4) Chain of Custody forms (per DMR dates)
5) Complete copy of current NPDES permit
6) Status of SOC or Moratorium issuance (if applicable)
7) ORC and Back-up ORC current certification
8) Wastewater Annual Report (fiscal or calendar year - it applicable)
9) Daily Operator's log / ORO visitation log
10) Maintenance log
11) Process control data (which includes field parameters tested and equipment
calibrations)
12) Field Parameter certification (if applicable)
13) Flow meter calibration records (if applicable)
14) Influent and/or effluent samplers
15) Flow charts (if applicable)
16) Generator Inspection r under load checks
17) Spill Response Plan (with current emergency contact numbers)
18) Current Sludge / Residuals permit (if applicable)
19) Sludge / Residuals hauling records IF applicable)
20) Sludge / Residuals Annual Report (if applicable)
21) Plant visual inspection of treatment units
22) Stream accessible for Inspection (at effluent discharge pipe)
Please call with questions:
Rose Pruitt
NC Department of Environment & Natural Resources
Division of Water Quality
Winston-Salem Regional Office ..
[phone] nest -It' pax Note 7671 art. -
m _ S'(ni�5gck Fmmy .e A �> /
coio.pr. R o 5e f'r w ,7-1"-
P��., rz,q'o +rtHP co. pwQ
710�'o27a amn.n
re.a-7�b_uY(o9 F.vx 7ZI•Y faoo
0
D

Permit Inspection History
Page 1
Report Date: 04/14/04
Permit: NCO057223
County: Forsyth
Owner: Head Mobile Home Park
Region: Winston-Salem
Facility: Head Mobile Home Park
Permit Type: Discharging 100% Domestic
< 1 MGD
Primary Inspector
Inspection Type
Inspection Reason Inspection Date
Facility Status
BIMS Conversion
Compliance Sampling
Routine
07/31/86
Compliant
BIMS Conversion
Compliance Evaluation
Routine
10/01/87
Neither
BIMS Conversion
Compliance Sampling
Routine
09/14/88
Neither
BIMS Conversion
Compliance Sampling
Routine
08/02/89
Compliant
BIMS Conversion
Compliance Sampling
Routine
09/27/90
Compliant
BIMS Conversion
Compliance Evaluation
Routine
08/15/91
Compliant
BIMS Conversion
Compliance Evaluation
Routine
05/18/95
Compliant
BIMS Conversion
Compliance Sampling
Routine
03/05/96
Compliant
BIMS Conversion
Compliance Sampling
Routine
10/29/96
Compliant
BIMS Conversion
Compliance Evaluation
Routine
08/28/97
Compliant
BIMS Conversion
Compliance Evaluation
Routine
07/15/98
Compliant
BIMS Conversion
Compliance Evaluation
Routine
03/10/99
Compliant
Max S Mauney
Compliance Evaluation
Routine
02/14/00
Compliant
Max S Mauney
Compliance Evaluation
Routine
04/02/01
Compliant
BIMS Conversion
Compliance Evaluation
Routine
04/09/02
Not Compliant

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 04m4/04
Page: 1 of I
Cate
Facility !
'
i
�
�
PERMIT: NCO057223
FACILITY: Head Mobile Home Park' Head Mobile Home Pork
COUNTY: Forsyth
REGION: Winston-Salem
Limit Violation
wow/nom/wuoorFAu
v/ouATmw
UNIT OF
CALCULATED
nsponr /pp/
uooxrmw
pAnAmsrsn
oxrE
rnsouswo,
wsxnunE
uw/T
VALUE
VIOLATION TYPE
VIOLATION ACTION
02'2003 001
Effluent
BOo.s'ooy(uoDeg. C)
020*N3
Weekly
mg/I
15
18
Daily Maximum Exceeded
Proceed to
Enforcement Case
02 ' o003 001
Effluent
BOD.n'Doy(2oDeg. o)
02/1103
xYook|v
mg8
15
o^
Daily Maximum Exceeded
Proceed to
Enforcement Case
02'2003 001
Effluent
BOD.n'Doy(2nDeg. c)
02/2803
Weekly
mo/|
15
34
Daily Maximum Exceeded
NoAction, sPJ
ox'u000 001
Effluent
aoo.5'oay(uoDeg. C)
02/28m3
Weekly
mg/|
10
10.8
Monthly Average Exceeded
Proceed to
Enforcement Case
04 onoo 001
Effluent
oOo. s'oey(zo Deg. C)
040203
Weekly
mg/1
7.5
12
Daily Maximum Exceeded
Proceed to
Enforcement Case
04'2003 001
Effluent
aOD.5'Dav(2oDeg. c)
0*8003
Weekly
mg/1
7.5
12
Daily Maximum Exceeded
NoAction, ePJ
05'2003 001
Effluent
000.n'ouy(2oDeg. C)
05/3103
Weekly
mg8
7.5
13
Daily Maximum Exceeded
Proceed to
Enforcement Case
04'2003 001
emuom
C«nmnn'Fecal MF'M'pC
04/0903
woomy
#/1oom|
400
500
Daily Maximum Exceeded
Proceed to
enot».44.5o
Enforcement Case
o* ' znO3 001
Effluent
C»x»»nn' Fecal mF'M'FC
05/3103
Weekly
#/1oom|
400
1.o0O
Daily Maximum Exceeded
Proceed to
onx».44.no
Enforcement Case
oV u000 001
Effluent
C»|ifomn' r«»o| MF'M'FC
06/3803
Weekly
#/1oom|
400
1.800
Daily Maximum Exceeded
Proceed to
amm.44.5n
Enforcement Case
oo 2003 001
Effluent
Nitrogen, Ammonia Total (as N)
0e3103
Weekly
mn0
u
4.8
Monthly Average Exnoouou
pmn»»d to
Enforcement Case
06'2003 001
Effluent
Nitrogen, Ammonia Total (as N)
068003
Weekly
mg/|
u
334
Monthly Average Exceeded
Proceed to
Enforcement Case
07 '2003 001
Effluent
Nitrogen, Ammonia Total (as N)
030103
Weekly
mg/1
u
4.08
Monthly Average Exceeded
Proceed to
Enforcement Case
Reporting Violation
Mow/rom/woouTFALL
v/ouATmw
UNIT OF
u^uzouTso
eEponr /pp/
Loo*Tmw
pAnxwsrsn
DATE
Fnsouswc,
wsAouns
um/r
VALUE
VIOLATION TYPE
VIOLATION ACTION
10'2003
1201/03
La$e/MiasingoMn
None

PERMIT NUMBER: NCO057223 PERIOD ENDING MONTH: 12 - 2003 DMR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park
CITY: Winston Salem COUNTY: Forsyth
OUTFALL: 001 EFFLUENT
REGION: Winston-Salem
PAGE 1 OF 2
00010
00095
00300
00310
00340
00400
00500
00530
deg c
umhos/cm
mg/1
mg/l
mg/l
su
mg/l
mg/l
Temperature,
Specific
DO, Oxygen,
BOD, 5-Day (20
COD, Oxygen
pH
Solids, Total
Solids, Total
Water Deg.
Conductance
Dissolved
Deg. C)
Demand, Chem.
Suspended
Centigrade
(High Level)
1 - 03
30
30
12.8
6.1
4
6.6 - 6.7
6
10
30
2 - 03
10.4
6.2
16.8 Violation
6.6 - 6.8
3.5
3 - 03
1D
30
10.3
6.1
1.5
6.2 - 6.8
6
4 - 03
5
30
12
6.1
2.4
6 - 6.7
3.6
5 - 03
5
30
15.9
6.4
5
6 - 6.2
5
6 - 03
5
30
18.6
6.1
0
6 - 6.2
4.4
5
30
7 - 03
20
6.1
0
6-6.3
6.3
30
8 - 03
20.5
6.2
0
6-6.2
5.3
9-03
5
30
21
6.1
0
6 - 6.3
6.2
10 - 03
5
30
11 - 03
10
30
15.1
6.2
0
6 - 6.4
18
12 - 03
10
30
13.1
6.1
0
1 6 - 6.2
2

PERMIT NUMBER: NCO057223 PERIOD ENDING MONTH: 12 - 2003 DMR 12 Month Calculated
FACILITY NAME: Head Mobile Home Park - Head Mobile Home Park
CITY: Winston Salem
COUNTY: Forsyth
REGION: Winston-Salem
00545
00600
00610
00665
31616
50050
50060
ml/1
mg/l
mg/l
mg/l
ff/100ml
mgd
mg/l
Solids,
Nitrogen,
Nitrogen,
Phosphorus,
Coliform,
Flow, in conduit
Chlorine,
Settleable
Total (as N)
Ammonia Total
Total (as P)
Fecal MF, M-FC
or thru
Total Residual
(as N)
Broth,44.5C
treatment plant
1 - 03
0,002
2.35
4.4
0.00044
1.2
2 - 03
4
0.002
2.65
2.8
0.00047
1.1
3 - 03
4
0.002
20.4
2.78
4.2
1
0.00044
1.4
4 - 03
2
0.002
1.8
3.5
0.00038
2
5-03
0.002
35.85
4.8 Violation
5.2
4.1
0.0004
1.4
6 - 03
2
0.002
3.54 Violation
6.6
0.00044
2.6
7 - 03
2
0.002
4.08 Violation
1.3
0.00047
2.1
8 - 03
2
0.002
1.5
1
0.00041
2.1
9 - 03
2
0.002
4.4
1.38
2.22
1.2
0.00046
2.1
10 - 03
2
0.002
11 - 03
4
0.002
0.65
2.9
0.00046
2.06
12 - 03
4
0,002
3.67
2.74
4.4
1 1
1 0.00045
1 1.93
PAGE 2 OF 2

RrzcEiVE
N.C. Dept. of -
March 11, 2005
Winston.a,
gionai Office
Mr. Steve W. Tedder, Regional Supervisor
NCDENR, Winston-Salem Regional
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am in receipt of your February 25, 2005 Notice of violation for a November 2004
effluent Fecal Coliform daily maximum limit permit violation.
This permit excursion has been reviewed by the facility operator and discussed with the
commercial laboratory that performs the certified analysis.
In review, the Head MHP WWTP collected five (5) effluent Fecal Coliform samples
during the month of November 2004. The first three samples were all compliant with all
results being < 1.0/100mis. On November 23, the effluent Fecal Coliform result was
2200/100mis exceeding the daily maximum limit of 400/100mis. Subsequent analysis on
November 30, indicated compliance at 240/100mis and Fecal Coliform analyses have
been compliant since that period.
The effluent residual chlorine level on November 23 was 1.12 mg/l.
This daily maximum excursion is felt to be a result of a contaminated sample and not
representative of the typical Head MHP WWTP discharge.
Please note the November, 2004 monthly average Fecal Coliform limit was compliant at
13.9/100mis.
I hope this information is helpful in response to your request. If you have questions or
require additional information, please advise.
Sincerely,
Head MHP
Hubert Head
Cc: Gary Stainback

/ ,t
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
February 25, 2005
CERTIFIED MAIL 7002 0860 0000 7978 3546
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
A review of Head Mobile Home Park's monitoring report for November 2004 showed the
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
11/30/04
400 #/100ml
2,200 4/100ml
Daily
Broth,44.5C
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this .and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600 .
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
wSRO-_-_ 1
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) i 336-771-4630 (Fax)
I
I

LFNW
JAN 12 2005
ie;nStan•Salern
Regional Office
EFFLUENT f
NPDES PERMIT NO: N00057223 DISCHARGE NO: 001 COUNTY: FORS""—""� CLASS: TP r�, 04
FACILITY NAME: HEAD TRAILER PARK V W�� } _
MONTH: NOVEMBER YEAR:
OPERATOR IN RESPONSIBLE CHARGE (ORC):Gary Stalnbad('. . - GRNDE:LV<. , PHONE: [phone] j ,-
CERTIFIED LABORATORY: ' j*ro"ArialVtitxl Laboratories .. �` S: .b ,
PERSON(s)CO IN>;SAMP
rnrFcrc Ht OCK IF ORC HAS CHANGED C I l r"
(SIG E OP RESP NSIBLE CHARGE. DAl
Mall orlylnal and one copy to: ' a, l ��
ATT: Central Files BY THIS SIGNATU , I ERTIFY THAT THIS REPORT IS
Division of water Quality ACCURATE AND C M TO THE BEST OF MY KNOWLEDGE
1617 Mall Service Center
Raleigh, NC 27699-1617
REPLICA DEM FORM MR-1 (12t93)
NOTE: A numerical vWw of zero (one for Fecal Coll(onns) was used for calculation on those
numbers reported as 9ess than' (').

Facility 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
a
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. ,
Lx ceoc�
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my iaqui0,,
-of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations:"
Hubert Head
Permittee (Please print or type)
Signature of Permittee** Date
(Required)
Head Mobile Home Park 336-724-5911 33 2004
Permittee Address Phone Number Permit FV. Dat
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
0009S Conductivity
00300 Dissolved Oxygen
00310 BOD5
00340 COD
00406 pH
00530 Total Suspended
Residue
00545 Settleable Matter
PARAMETER CODES
00556 Oil & Grease
00951 Total Fluoride
00600 Total Nitrogen
01002 Total Arsenic
00610 Ammonia Nitrogen
00625 Total Kjeldhal
01027 Cadmiurin
Nitrogen
00630 Nitrates/Nitrites
01032 Hexavalent Chromium
01034 Chromium
00665
Total,Ph6sphorous
00720
Cyanide
00745
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
01037 Total Cobalt
01042 Copper
01045 Iron
01051 Lemd
01062 Molybdenum
01067 Nickel
01077 Silver
0.1092 Zinc
01105 Aluminum
01147 Total Selenium
31616 Fecal Coliform
32730 Total Phenolics
34235 Benzene
34491 Toluene
38260 MBAS
39516 PCBs
5W50 Flow
50060 Total
Residual
Chlorine
71990 FormaU
71900 Mercury
91551 Xylene
Parameter Code assistance may obtained by calling the Point Source CompliancdEnforcement Unit at [phone] or by visit
the Water Quality Section's web siteat h2o.enr.state.nc.us/wqs and linking to the UniCs information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15Ai1bk$E'i �6204.
** If signed by other than the permittee, delegation of signatory authority must be'op file with!the°state per 15A NCAC 2B .050
(2) (D).

NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: So ft. Upstream of discharge point
** UPSTREAM **
D 2400
A CLOCK
T 1 TIME I TEMP I D.O. I pH I B20ODC51 COD I G.MEAN F-COLI
E
WINE
mm
mat-MEE
MWS
MEE
mm
Emsm
mm
EMEW
®m
1 30 1 918 1 16.0
NOTE: A mffwicW vakm of zero (ore for Fecal Colgonns) was used for calculation on those
mffbam reported as "less than"(<).
001 MONTH: NOVEMBER
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of dischame point
95
** DOWNSTREAM **
I 20CI G.MEAN
2T41M0O
CLOCK E I TEMP I D.O. I pH BOD-5 COD I F-COLI
1 932
8 1 16.0
mg
YEAR: .7-
2003

' 1.
N®Y-zooS-
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: OF -A'> ✓ Re Permit/Pipe No.: N600SrTZZ3 Month/Year NOy Zoe y
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl (Daily iolations
Date Parameter Permit Limitrrype DMR Value % Over Limit
11713 oy 'FeCAL GE)U'F. 9 D O
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:0-i5,c>k Date:
Regional Water Quality
Supervisor Signoff: Date:
ti�

December 6, 2005
Mr. Steve Tedder, Supervisor
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
R,c
;.c Der
DEC 15 2004
Regional Office
I am writing in response to your November 19, 2004 Notice of Violation for a Daily
Maximum Fecal Coliform Permit exceedence at Head Mobile Home Park during August,
2004.
The August, 2004 Fecal Coliform excursion occurred on August 3, 2004 with a value of
854/100mis exceeding the daily maximum limit of 400/100mis. The effluent total
residual chlorine concentration for that day was 1.9 mg/l.
The subsequent Fecal Coliform samples collected during August were all compliant.
These results were:
Sample Date Fecal Coliform
#/1( 00MI)
08/10/04
< 1.0
08/17/04
< 1.0
08/24/04
< 1.0
08/31 /04
1.0
The August Fecal Coliform monthly average was 3.9/100 mis, which was compliant with
the monthly average limit of 200/100 mis.
The cause of the excursion is unknown. Potential causes were contamination of the
sample or adverse affects of recent rain.
The chlorine contact chamber is routinely checked for a buildup of solids and continued
care will be implemented in regards to proper sample collection, storage and transfer to
avoid contamination.
I hope this information is helpful to your request.
Sincerely,
ffedd- MH_P€ _
Hubert Head
Cc: Gary Stainback

o f W A7.FR Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
r Alan W. Klimek, P.E. Director
Division of Water Quality
November 19, 2004
CERTIFIED MAIL 7002 0860 0000 7978 3317
RETURN RECEIPT REQUESTED
Mr. Hubert Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston Salem, NC 27103
Subject: NOTICE OF VIOLATION
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Dear Mr. Head:
A review of Head Mobile Home Park's monitoring report for August 2004 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Fecal Coliform
8/3/2004
400/100 ml
854/100 ml
Daily
Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working days of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
OXMAoft
585 Waughtown St Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4603 (Fax)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 14PA-D A+t 5 Permit/PipeNo.: NC oOS?ZZ3 Month/Year 4yy
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limitll'vpe DMR Value % Over Limit
Or-3-0L1 J p-p-Ur L COLA 4j00 iao f-WL
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date: Y
Regional Water Quality
Supervisor Signoff: Date: 6
��v
r
/!/0 � Z0 a f - LY - oSk.3

s,
NPIDES PERMIT NO: NC005722 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWT
OPERATOR IN RESPONSIBLE CHARGE (ORC): Gary Stainbac
CERTIFIED LABORATORY: (1)Hydro Analytical Laboratories
arr
BLnrK iF nRC HAS H ED
Mail original and one copy to:
ATT: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699.1617
REPLICA OEM FORM MR-1 (12/93)
NOTE: A numerical value or zero (one for Fecal Coliforms) was used for calculation on those
numbers reported as 'less than"
EFFLUENT
001 c 601 0 R S YT, H
CLASS: I
MONTH: AUGUST YEAR: 2663
, r(N
GRADE: LV PHONE: 33B 766'0270;1
1 A
PERSON(s) COLLECTI G )SAES: inback
(SIGNAT646FOP TOR IN RESPONSIBLE CHARGE) DATE
BY THIS SIGNATU I CERTIFY THAT THIS REPORT IS
ACCURATE AND CO PLETE TO THE BEST OF MY KNOWLEDGE

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements zr
- -- - - - - -- - - - - -- - - -- - - - Compliant --
All monitoring data and sampling frequencies do NOT meet permit requirements F-1
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 submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
//U 64 /4ea)
Permittee (Please print or type)
Signature of PermittZ24Z �_-_ �? 8! - 0 Cf
ee** Date
(Required)
Bailey's Trailer Pa.rk 336-724-5911 May 31, 2004
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
01067
Nickel
50060 Total
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
01077
Silver
Residual
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
01092
Zinc
Chlorine
00082
Color (ADMI)
00625
Total Kjeldhal
01027
Cadmium
01105
Aluminum
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01147
Total Selenium
71880 Formaldehyde
00300
Dissolved Oxygen
01034
Chromium
31616
Fecal Coliform
71900 Mercury
00310
BOD5
00665
Total Phosphorous
32730
Total Phenolics
81551 Xylene
00340
COD
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00400
pH
00745
Total Sulfide
01042
Copper
34481
Toluene
00530
Total Suspended
00927
Total Magnesium
01045
Iron
39260
MBAS
Residue
00929
Total Sodium
01051
Lead
39516
PCBs
00545
Settleable Matter
00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the
Point
Source Compliance/Enforcement
Unit at [phone]
or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/wqs and linking to the Unit's
information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC' 86 A204:'
** 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)-

r 4 ,
NPDES NO: NCO057223 DISCHARGE NO:
FACILITY NAME: HEAD TRAILER PARK WWTP
STREAM: Little Creek
LOCATION: 50 ft. Upstream of discharge point
** UPSTREAM **
D � 2400
A CLOCK 20 C G.MEAN
COD
T TIME � TEMP � D.O. � H BOD-5 F-COLI
E
Room
m
m��m
Immm
m--=
on
sm
on
ME
WE
sm
IBM=
ME
m��=
ME
Im
�mm
NOTE: A numerical value of wm (one for Fecal Odiforms) was used for calculation on those
numbers reported as 'law than" (<)
001 MONTH: AUGUST
COUNTY: FORSYTH
STREAM: Little Creek
LOCATION: 0.1 Miles downstream of discharge point
** DOWNSTREAM
YEAR: 2003
1 00010 1 00300100400 1 003101 00340 1 31616 1 95
2400 1
CLOCK � 20C � � G.MEAN
TIME � TEMP � D.O. � pH BOD-5 COD F-COLI � CONDUCTIVIT]
4.0
1 930 1 21.0 1 2.8 1 1 1 1 1 1 1

Nf A TF
Michael F. Easley, Governor
0 RpG
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
\�0
CO
Alan W. Klimek, P. E. Director
Division of Water Quality
pColeen
H. Sullins, Deputy Director
Division of Water Quality
September 26, 2003
Mr. Hubert F. Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston-Salem, NC 27103
Subject: Compliance problems
Head MHP
Forsyth County
Dear Mr. Head:
Recently we discussed your plant's problems with the tighter limits that became effective
February 2003. Your plant has had violations for February, April, May and June. We have taken
enforcement several times and will have to continue to do it until your compliance problem can
be resolved.
The subsurface sand filter that you have will not be able to consistently meet the limits and you
will be faced with more enforcement actions until a plant upgrade can be provided or until you
can attach to city sewer. If you can pursue a solution to the plant problems we will work with you
to issue a Special Order by Consent (SOC) that will give some temporary relaxation of the limits.
The SOC will establish a schedule to fix the compliance problem.
You may want to contact the officials with Stratford Crossing (TJL Development, LLC PO Box
846 Clemmons, NC 27012) about an easement to connect to the sewer on their property. Their
engineer, Richard Bennett of Allied Land Surveying (336-765-2377) may also be able to provide
the details on the best way to access the sewer on this site. However, if that is not the approach
taken and it is necessary to connect to the sewer on Little Creek, it appears that it may only
require one land owner easement.
Access to sewer can be initiated at the City of Winston-Salem Records Center (727-2650). If you
have other questions about the city sewer tap you may also want to talk with Mr. Bob Huff, City -
County Utilities Commission (727-8418). Plans for the collection sewer would have to be drawn
to conform to the standards that Winston-Salem requires.
Please begin to evaluate your options and get back in touch with me in a few weeks.. The
application for SOC is attached and if you wish to discuss it, please call Rose Pruitt (771-4608
ext. 275) or me (ext. 262).
SincereI ,
�i_
Steve Mauney
Acting Water Quality Supervisor
Cc: Mr. Bob Huff
WSRO / Central files
WI•
ENR
N. C. Division of Water Quality/Water Quality Section 585 Waughtown Street Winston-Salem, North Carolina 27107 [phone] Customer Service
1-877-623-6748

c�oF W ATFRP
�O v
� r
May 21, 2004
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
CERTIFIED MAIL 7003 0500 0000 2522 4253
RETURN RECEIPT REQUESTED
Hubert F Head
Head Mobile Home Park
2880 S Stratford Rd
Winston Salem NC 27103
Subject: NOTICE OF VIOLATION
Compliance Evaluation Inspection
Head Mobile Home Park
Permit No. NCO057223
Forsyth County
Dear Mr. Head:
Alan W. Klimek, P.E. Director
Division of Water Quality
Enclosed please find a copy of the Inspection Report from the inspection conducted 2004-04-21.
The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem,
Regional Office. The treatment facility was found to be in violation of permit NCO057223 for the
following:
Compliance issues found during the inspection are:
Inspection Area
Compliance Issue
Sludge Handling
Disposal
Tanks need to be pumped
Records/Reports
No spill response plan
Disinfection
Not using proper wastewater chlorine tablets
Please refer to the enclosed Inspection Report for any additional observation and comments.
585 Waughtown Street Winston-Salem, NC 27107 336-771-4600 (Telephone) 336-771-4630 (Fax)
M.

0
Head
Page2
May 21,2004
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within thirty (30) working day of receipt of this letter. You should address
the causes of noncompliance and all actions taken to prevent the recurrence of similar situations.
If you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-4600.
Sincerely,
Steve W Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachment
Cc:
WQ Central Files w/ attachment
WSROw/ attachrnentv

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 u 2 U 31 NCO057223 111. 121 04/04/21 117 18 LJ 19 U 20 U
Remarks
2111111111Jill 1111111111111111111111111111111111166
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --- -- --------------Reserved--------------
67 I 169 70 U 71 U 72 E 73 W 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)
02:00 PM 04/04/21
00/02/01
Head Mobile Home Park
Exit Time/Date
Permit Expiration Date
2880 S. Stratford Rd Lot
Winston Salem NC 27103
03:30 PM 04/04/21
04/05/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Hubert F Head,2880 S Stratford Rd Winston Salem NC 27103//336-768-496R6
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal Pollution Prevention Facility Site Review
Compliance Schedules 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//336-771-4608/336-771-4630
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
12V
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

14
NPDES yr/mo/day Inspection Type
31 NCO057223 111 12 04/04/21 117 18 ICI
1
Section D• Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) ..
Due to continuing problems meeting effluent limits it is recomended that you seek technical assistance from the
technical consultant below. You should also consider hooking up to city sewer if possible.
Sonja Williams - [e-mail]
[e-mail]
North Carolina Dept. of Environment & Natural Resources
Div. of Water Quality
919 N. Main St.
Mooresville, NC 28115
Ph: 704.663.1699 Fax: [phone]
WWTP Consultant

Permit: NC0057223 Owner - Facility: Head Mobile Home Park - Head Mobile Home Park
Inspection Date: 04/21/04 Inspection Type: Compliance Evaluation
Fffluent Sampling Yes No NA NE
Is the tubing clean? ❑ ❑ 0 ❑
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)? ❑ ❑ ❑ 1
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? 0000
Comment:
UDstr .am / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ❑ ❑ ❑
Comment:
C�omQlian .. Schedules Yes No NA NE
Is there a compliance schedule for this facility? ❑ ❑ ❑ 0
Is the facility compliant with the permit and conditions for the review period? ❑ ❑ ❑
Comment:
Fffl rent Pine
Is right of way to the outfail properly maintained?
Y .c No
❑
NA
❑
NE
❑
Are receiving water free of solids and floatable wastewater materials?
❑
❑
❑
Are the receiving waters free of solids / debris?
❑
❑
❑
Are the receiving waters free of foam other than a trace?
❑
❑
❑
Are the receiving waters free of sludge worms?
❑
❑
❑
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
❑
Comment:

Permit: NCO057223 Owner - Facility: Head Mobile Home Park - Head Mobile Home Park
Inspection Date: 04/21/04 Inspection Type: Compliance Evaluation
`;and Filters (Low ratel Yes No NA NE
Comment:underground
Flow Measurement - Influent
Is flow meter used for reporting?
Yes No
E ❑
NA
❑
NE
❑
Is flow meter calibrated annually?
❑ ❑
0
❑
Is flow meter operating properly?
❑ ❑
N
❑
(If units are separated) Does the chart recorder match the flow meter?
❑ ❑
0
❑
Comment:fresh water meter
Flow Measurement - Effluent
Is flow meter used for reporting?
Yes
❑
No
❑
NA NE
0 ❑
Is flow meter calibrated annually?
❑
❑
so
Is flow meter operating properly?
❑
❑
E ❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
N ❑
Comment:
Record Keeping
Are records kept and maintained as required by the permit?
Yes No
E ❑
NA
❑
NE
❑
Is all required information readily available, complete and current?
0 ❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
E ❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
Are sampling and analysis data adequate and include:
❑
❑
❑
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
❑
Plant records are adequate, available and include
❑ ❑
❑
0
O&M Manual
❑
As built Engineering drawings
❑
Schedules and dates of equipment maintenance and repairs
❑
Are DMRs complete: do they include all permit parameters?
N ❑
❑
❑
Has the facility submitted its annual compliance report to users?
E ❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑ ❑
N
❑
Is the ORC visitation log available and current?
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
❑
❑
❑
Is a copy of the current NPDES permit available on site?
❑
❑
❑
Is the facility description verified as contained in the NPDES permit?
❑
❑
❑
Does the facility analyze process control parameters, for example: MLSS, MCRT, Settleable Solids, DO, Sludge
❑ ❑
❑
Judge, pH, and others that are applicable?
Facility has copy of previous year's Annual Report on file for review?
❑
❑
❑
Comment:No spill response plan
Yes No
NA
NE
Effluent Samplina
Is composite sampling flow proportional?
❑ ❑
■ ❑
Is sample collected below all treatment units?
E ❑
❑
❑
Is proper volume collected?
N 13
0
11

i'
Permit: NC0057223 Owner - Facility: Head Mobile Home Park - Head Mobile Home Park
Inspection Date: 04/21/04 Inspection Type: Compliance Evaluation
Yes
No
NA
NE_
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑
❑
Is the facility as described in the permit?
❑
❑
❑
Are there any special conditions for the permit?
❑ 0
❑
❑
Is access to the plant site restricted to the general public?
❑
❑
❑
Is the inspector granted access to all areas for inspection?
❑
❑
❑
Comment:
Yes
No
NA
NE
Onerations & Maintenance
_ Does the plant have general safety structures in place such as rails around or covers over tanks, pits, or wells?
❑
❑
❑
Is the plant generally clean with acceptable housekeeping?
❑
❑
❑
Comment:
Yes
No
NA
NE
Disinf ..tion
Type of system ?
Are cylinders secured adequately?
❑
❑
❑
Are cylinders protected from direct sunlight?
❑
❑
❑
Is there adequate reserve supply of disinfectant?
❑
❑
❑
Is ventilation equipment operational?
❑ ❑
❑
0
Is ventilation equipment properly located?
❑ ❑
❑
E
Is SCBA equipment available on site?
Cl ❑
❑
0
Is SCBA equipment operational?
Cl ❑
❑
E
Is staff trained is operating SCBA equipment?
Cl ❑
❑
N
Is staff trained in emergency procedures?
❑ ❑
❑
N
Is an evacuation plan in place?
❑ ❑
❑
0
Are tablet chlorinators operational?
❑
❑
❑
Are the tablets the proper size and type?
❑ 0
❑
❑
Number of tubes in use?
(Sodium Hypochlorite) Is pump feed system operational?
❑ Cl
N
❑
Is bulk storage tank containment area adequate? (free of leaks/open drains)
❑ ❑
0
❑
Is the level of chlorine residual acceptable?
0 ❑
❑
❑
Is there adequate detention time
a ❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
N ❑
❑
❑
Comment:Not using proper wastewater chlorine tablets (pool tabs)
Yes
No
NA
NE_
mantic Tank
(If pumps are used) Is an audible and visual alarm operational?
❑ ❑
❑
E
Is septic tank pumped on a schedule?
❑ ❑
❑
0
Is the distribution box level and watertight?
❑ ❑
❑
E
Are pumps or syphons operating properly?
❑ ❑
❑
E
Are high and low water alarms operating properly?
❑ ❑
❑
0
Comment:
Yes
No
NA
NE
Sand Filters (Low rate)
(If pumps are used) Is an audible and visible alarm Present and operational?
❑ ❑
❑
0
Is the distribution box level and watertight?
❑ ❑
❑
N
Is sand filter free of ponding?
❑ ❑
❑
0
Is the sand filter effluent re -circulated at a valid ratio?
❑ ❑
❑
E
Is the sand filter surface free of algae or excessive vegetation?
0 ❑
❑
0 -
I

RECEIVED
N.C. faepl. of ENR
JUN 17 2004
9NinSton-Salem
RegiMal Office
June 14, 2004
Mr. Steve Tedder, Supervisor
NCDENR, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Dear Mr. Tedder,
I am writing in response to the May 21, 2004 Notice of Violation regarding the April 21, 2004
inspection of the Head Mobile Home Park Wastewater Treatment Plant.
As you requested, I am responding to the three compliance issues noted in the May 21, 2004
correspondence. The information is presented subsequently:
1. The inspection noted that the subsurface tanks needed to be pumped. These tanks are
pumped annually. The last pumping event was July, 2003. Following comments from the
recent inspection visit, arrangements have been made to have the tank pumped this month.
Please note that the annual pumping of the tanks have satisfied the operational needs due
to the current loading of the system.
2. The inspector noted that no spill response plan, was in place. The current operating
scheme of this facility is all gravity flow with no pumping incorporated into the unit
processes. The current chemicals used are in solid or tablet form and are not at risk of spill.
In response to this issue, the facility has created a very brief notification procedure that
includes the operators telephone and pager numbers, the septic tank hauler telephone
number, and the Regional Office telephone number including the DWQ emergency number.
These numbers will be maintained by the operator and permittee.
3. The inspection noted that the facility was not using proper wastewater chlorine tablets. The
facility has historically used the tablets evaluated during the April inspection and previous
inspections. The facility had not received any instruction or requirement specifying this
change until the April 21, 2004 inspection.
The Head WWTP will now be using a calcium hypochlorite product (discussed during the
4/04 inspection visit) that is NSF approved and EPA registered as a wastewater disinfectant.

I hope this information is helpful in response to your comments. We appreciate the information
and guidance from your staff.
Sincerely,
Head MHP
, Al,r W-eaj
Hubert Head
Cc: Gary Stainback

r
T
Hubert F. Head .
2880 South Stratford Road
Winston-Salem, North Carolina 27103
Dear Mr. Head:
b3sko
Michael Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
April 14, 2004 N.CRECEIVEp
apt. of ENR
APR 19 2004
Winston-Salem
—=ona! c; f,,
Subject: NPDES Draft Permit
Permit No. NCO057223
Head Mobile Home Park
Forsyth County
Enclosed with this letter is a copy of the draft permit for your facility. Please review the draft
carefully to ensure thorough understanding of the conditions and requirements it contains.
The draft permit contains the following change from your current permit:
➢ A total residual chlorine (IRC) limit has been added to this permit. The limit will take effect
18 months after the effective date of the final permit. See the attached TRC policy memo
for details.
➢ The expiration date for this permit renewal is May 31, 2009.
➢ Daily maximum limits for ammonia have been added based on requirements mandated by
the US Environmental Protection Agency.
➢ Effluent temperature monitoring has been increased to a daily frequency based on the rules
governing treatment plants such as yours.
Submit any comments to me no later than 30 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 are received from the public or
from you, this permit will likely be issued in May with an effective date of July 1, 2004.
If you have any questions or comments concerning this draft permit, contact me at the number listed below.
cc: NPDES Unit
Sincerely,
��" _
David A. Goodrich
NPDES Unit
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone], Ext.517
FAX [phone]
On the Internet at http:/.th2o.enr.state.nc.us/

I
Permit No. NCO057223
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
�= ;1 0TIM
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision 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,
Hubert F. Head
is hereby authorized to discharge wastewater from a facility located at
Head MHP
2880 South Stratford Road
Winston-Salem
Forsyth County
to receiving waters designated as an unnamed tributary to Little Creek 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 May 31, 2009
Signed this day
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

SUPPLEMENT TO PERMIT COVER SHEET
Hubert F. Head
is hereby authorized to:
Permit No. NC0057223
1. Continue to operate an existing 0.0016 MGD wastewater treatment facility consisting of:
a septic tank
• distribution box
• subsurface sand filter
tablet chlorination
contact chamber/post aeration chamber
located at Head Mobile Home Park, 2880 South Stratford Road, Winston Salem, Forsyth
County, and
2. Discharge treated wastewater (via Outfall 001) from said facility into an unnamed tributary to
Little Creek, a Class C water in the Yadkin Pee Dee River Basin, at the location specified on
the attached map.

Permit NCO057223
Part I. Section A
1. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized to discharge from
Outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
EFFLURNLLIMI7AT10NS:
MONITORINGREQUIREMENTS ;
PARAMETER
Monthly
-Weekty
t?aily ::
Maasuremerit
Sample Type
Sample
Avera e .
AVOJragle
Laca3fc�n,.,
Flow (MGD)
0.0016
Weekly
Instantaneous
I or E
5.0 mg/L
7.5 mg/L
Weekly
Grab
E
(April 1 -October 31)
10.0 mg/L
15.0 mg/L
Weekly
Grab
E
(November 1 - March 31)
_
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
2.0 mg/L
10.0 mg/L
Weekly
Grab
E
(April 1 -October 31)
4.0 mg/L 20.0 mg/L
Weekly
Grab
E
(November 1 - March 31)
Dissolved Oxygen
See Footnote 2
Weekly
Grab
E, U, D
Fecal Coliform
200/100 ml
400/100 ml
Weekly
Grab
E
(Geometric Mean)
Total Residual Chlorine
17 ug/L3
2/Week
Grab
E
Temperature —` —
— Monitor & Report - — -
Daily
Grab —
- -E
Temperature
Monitor & Report
Weekly
Grab
U, D
Total Nitrogen
Monitor &Report
Quarterly
Grab
E
(TKN + NO, + Nb,)
Total Phosphorus
Monitor & Report
Quarterly
Grab
E
pH
Between 6.0 and 9.0 Standard Units
Weekly
Grab
E
Notes:
1 E - Effluent, I - Influent, U - Upstream approximately 50 feet above the discharge point, D - Downstream from the
discharge point approximately 0.1 mile.
2 The daily average dissolved oxygen effluent concentration shall not be less than 6.0 mg/L.
3 The limit for total residual chlorine will take effect 18 months after the effective date of the final permit.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

NCDENR
Technical Assistance
WW System Review
NGoa 572Z 3
County: q-ro
Facility: NCav M14 P
System: SV13Su2FAc,f5-
Sys Grade: I
ORC: 124 6fAiNBAa1- Grade
Stream: uT To L-/777.,F cp-eZA:�,
T2,09 i 17`
System Diagram:
DENR Inspector:
Inspection Date:
S 1 aVN
I pR-v 444NA&0MV T7 )
I SAn�v Fi ��--
Comments:
Nar xzg, „,vi s- &oo q pd
30/3o Li M ITS Bob /ts S
WWclass

°.;• - .1
May 3, 2004
5076
Mr. Gary Stainback
Head Mobile Home Park WWTP
140 Linbrook Dr.
Winston-Salem, NC 27106-
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
SUBJECT: Laboratory Certification Maintenance Inspection
Dear Mr. Stainback:
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
RECEIVED
N.C. Dept. of ENR
MAY 0 6 2004
Winston-Salem
Regional Office
Enclosed is a report for the inspection performed on April 28, 2004 by Mr. David
Livingston. Where deficiencies are cited in this report, a response is required as well as for
all lettered comments and/or recommendations. Within thirty days of receipt, please supply
this office with a written item for item description of how these deficiencies, comments
and/or recommendations were corrected. If the deficiencies cited in the enclosed report are
not corrected, enforcement actions will be recommended. For certification maintenance,,
your laboratory must continue to carry out the requirements set forth in 15A NCAC 2H
.0800.
Copies of the checklists completed during the inspection may be requested from this
office. Thank you for your cooperation during the inspection. If you wish to obtain an
electronic copy of this report by email, or if you have questions or need additional
information please contact us at 919-733-3908.
Enclosure
cc: David Livingston
Winston-Salem Regional Office
Sincerely,
Vmes W. Meyer
Laboratory Section
W'A
NCDENRi
N. C. Division of Water Quality Laboratory Section 1623 Mail Service Center Raleigh, North Carolina 27699-1623 [phone]
FAX: [phone]

LABORATORY NAME:
ADDRESS:
CERTIFICATE NO:
DATE OF INSPECTION:
TYPE OF INSPECTION:
EVALUATOR:
LOCAL PERSON(S) CONTACTED
I. INTRODUCTION:
On -Site Inspection Report
Head Mobile Home Park
140 Linbrook Dr.
Winston-Salem, NC 27106
#5076
4/28/04
Field Maintenance
David G. Livingston
Gary Stainback
This laboratory was inspected to verify its compliance with the requirements of 15A NCAC 2H .0800
for the analysis of environmental samples.
II. GENERAL COMMENTS:
The laboratory is spacious and well equipped. All facilities and equipment are well maintained.
Records are well kept and most data looked good. Some further quality control procedures need to
be implemented.
III. DEFICIENCIES, REQUIREMENTS, COMMENTS AND RECOMMENDATIONS:
GENERAL
(A) COMMENT: The laboratory has not checked the meters with Automatic Temperature
Compensation (ATC) against an NIST traceable thermometer.
Note: The laboratory is not using the meters to report temperature.
RECOMMENDATION: It is recommended that the temperature sensor be calibrated annually even
if not being used to report temperature. (Other certified laboratories may provide assistance in
meeting this recommendation.)
RECOMMENDATION: The thermometer should be less than 3°C from the certified reading to be
acceptable.
(B) COMMENT: The laboratory is not recording the time sampled and the time analyzed for their
certified parameters.
REQUIREMENT: The laboratory must record the date and time collected and date and time of
analysis on the laboratory benchsheet. This information is necessary to document that the holding
times were met for each analysis.
Note: If sample time and analysis time are the same document it.

Page 2
Head MHP
(C) COMMENT: One of the laboratory's benchsheets did not contain all of the necessary labeling
information. No units of measure are associated with some of the data values listed on the
benchsheet.
REQUIREMENT: The laboratory must review all benchsheets and log books to make sure that each
entry is marked with a unit of measure. Every number recorded on a benchsheet or logbook must
have an appropriate unit assigned to it.
DISSOLVED OXYGEN
(D) COMMENT: The laboratory is calibrating the DO meter but not documenting the calibration.
REQUIREMENT: The laboratory must document that the Dissolved Oxygen meter is properly
calibrated each analysis day.
TOTAL RESIDUAL CHLORINE
(E) COMMENT: The laboratory analyzed three "gel type" check standards each day that Residual
Chlorine analysis was performed but did not document this process.
REQUIREMENT: When a five standard curve is used, the laboratory must verify the calibration curve
each analysis day. To do this, the laboratory must analyze a blank to zero the instrument and a check
standard each day that samples are analyzed. Document the known value of the check standard and
the actual reading of the check. standard:
RECOMMENDATION: Check standard at the mid -range or high concentration and should be within
10% of the known value.
IV. PAPER TRAIL INVESTIGATION:
This consisted of comparing data with the values obtained on laboratory bench worksheets.
V. CONCLUSIONS:
Correcting the above cited comments and implementing the requirements/recommendations will
help this lab to produce quality data and meet certification requirements. Please respond to the
lettered comments.
Report prepared by: David G. Livingston Date: 4/29/04

Re: Head'M11P NC0057223
Subject: Re: Head MHP NCO057223
From: Steve Tedder <[e-mail]>
Date: Tue, 27 Jan 2004 08:36:55 -0500
To: [e-mail]
OK If they had come in and talked to us about a resolution to their situation I might have given them
ssome credit at the remission conference next week. As it is, I'll recommend denial of their request
for remission.
On 1/26/2004 8:19 PM, rose.pruitt(a)ncmail.net wrote:
Neither Mr Head nor Mr Wilkerson called back. The rest of the Head file
is on my desk next to the in box if you need it, I think Mr Wilkersoon's
number is on a note stuck on the outside of the folder. If you need anything
else call me at home 852-9088, I'll be here waiting for the big thaw Tuesday.
-- Original Message --
Date: Mon, 26 Jan 2004 12:08:06 -0500
From: Steve Tedder <Steve. Tedder@ncmail. net>
To: [e-mail]
Subject: Head MHP NCO057223
Did Mr. Head or Dennis Wilkerson ever get back to you about setting up a
meeting to try and resolve their situation with SOC till they get tied
on somewhere?
Steve Tedder
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone] ext 259
FAX: [phone]
Steve Tedder
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone] ext 259
FAX: [phone]
1 of 1 1/28/2004 1:26 PN

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Head MHK
28.$0-S- Stratford Road
U�i�ston Salem NC 27103
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7003 0500 0000 2522 4253
3S Form 3811, August 2001. Domestic Return ec 102595-01-M-25c

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NC DEN R2glonal Offl�
Water Qu i y vection- —�
585 Waughtown Street
Winston-Salem NC 27107-2241
r3'3 IIf1FIlfFll!ilIIII}11 I31iI[l1311III I�1lIIIIl�iI13I3i I7II7IlIfI

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Winston-Salem, NC 27103
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NCD NR
RECEIVED
N.C. Dept. of ENR
Division of Water Qua it37 NOV 2 3 2004
585 Waugh.town Street
Winston-Salem, NC 2710Winston-Salem
% Regional Office
r,s I1111111.1 k.11 II!!Ii!I!�iilSl!SII��l ISliil�Il!flS 9�l�!!li!I�

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Head Mobile Home Park
-288o South Stratford Rd.
Winston-Salem, NC 27103
08
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7002 0860 0000�'7978 •3546 41'a? .. /vOV
PS Form;381 1i, August 20011 ; i i i Domestic Return Receipt 102595-02•M-15,
t ii itti t t I tl.l: Ilii f: i 11t1

UNITED STATES POSTAL SERVICE
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NCDENR
RCLA
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 2710'
RECEIVED
N.0 Den of E`lR
MAR 0 2 2005
Winstcn•Salam
Regional CrffiCa
i� 9 1lil1IIlallllllllllli1SllllillIIIlillllllfill IIII IIII IIII III II

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1. Article Addressed to:
Mr. Hubert Head
Head Mobile Home Park
288o South Stratford Road
Winston-Salem, NC 271L03
7002 24.10.. -0005 9361 9966
'S Form 3811, August 2001
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2 i A " ressee
r
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Domestic Return Receipt
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102595-01-M-250E

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RECEIVED
Roc_,e
Pcul'v� N.C. Dept. of ENR
Division of Water Quality OCT 2 '2 2004
585 Waughtown Street Winston-Salem
Winston-Salem, NC 27107 Regional Office

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Mr. Hubert Head
Head Mobile Home Park
2880 South Stratford Rd.
Winston-Salem, NC 27103
j� 7GO2 •086T aoao '79'7`8' 3
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RECEIVED
DE N.C. Deot. of ENR
Division of. Water Quality R09io°,; o rCe
585 Waughtown Street
Winston-Salem, NC 2'7107
1 � iatia�:aaaitaa�iiittt�attliciti;;�t��ataftit{t�aa�ta�ait:iat��

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FED 23
Hubert.F. Head Winston-sale,l
Regional ofnc
Head'Mobile Home Park
2880 S. Stratford Road
Winston-Salem, NC 27103
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7005 2570 0001 4673 8845
IS Form 3811 Febrijary 2004 1 1 1 1 Domestic Re4urn Receipt
102595-02-M•154

UNITED STATES RBST'AEc `EFV�� I�Icc�Il�ic�F�i�'c c , i'I,t„t't�:
First -Class M911`
Postage & Fees Paid
USPS
Permit No. G-10
XCOEX -Water Quality
,qttn: a�e Ae t r
585 Waughtown Street
Winston Salem, XC 27107

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Hubert F Head
Head Mobile Home Park
2880 S. Stratford Road
Winston-Salem, NC 27103 J
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Agent
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'DEC 3 0 2005
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7005 2570 0001 4673 8791 NDV
,S Form 3811, February}200'4 I - I Domdsiic Return Receipt 102595.02-M-1541

UNITED STATES POSTAL SERVICE
M1 EXR-Water Quality
-9ttno P& d
58.5 Wauglitown Street
Winston ,Salem, j1YC 27107
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Article Addressed to:
Hubert F. Head
Head Mobile Home Park
2880 S. Stratford lad.
Winston-Salem, NC 27103
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Agent
�� I
essee
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Z
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"DEC 22
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'S orm a ruary 21JI)4 Domestic Return Receipt
102595-02-M-1540

UNITED STATES HMMMINI!f!!!111"l!i! l! 1! ii l!!'I!"li!l""First-ClassMa`"il—":
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XCDEX -Water Qugfity
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Winston ,Salem, XC 27107

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Hubert F. ea
Head Mobile Home Park
2880 S. Stratford Road
Winston-Salem, NC 27103
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Form iAugust 200,1 ' ` ' ; "Domestic!.� eturn Receipt
102595.02-M-15

UNITED STATES POSTAL SERVICE rst 1 ss
• .( i:., i :'`:i'��i�Z_: �:t 4 .r� .r} .r">�..i,r<,: �3 7•k .�� .r � i l
USPS
1,. ,,� Pe[!#::fj G-10
• Sender: Please print your name, address, and ZIP+din this box •
NCDENR- Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
r_G f„I,f„f„II

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Mr. Hubert Head
Head Mobile Home Park
2880 S. Stratford Road
Winston-Salem, NC 27103
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X . ❑ Agent
� Q ❑ Addressee
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Llh i Al
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etum Receipt for Merchandisf
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875§81 6405''Iq�.jl 1N'riV
PS Form 3811. February 2004
Domestic Return Receipt
102595-02-M-154

y.a�muw�
UNITED STATES P4§TM.YS,1P_R�VP ' T'I=i..iAD Af E I FU.St= a s
USPS
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NC Dept of Environment & Natural Resources
Division of Water Quality-SWP MIR
585 Waughtown Street O"t"-salem
Winston-Salem, North Carolina 27107 omce
I
ATTN *.
III kill in•i,,;if111a1i,1ii'si1iiitii81 i finnii�9iy�riiri�

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2880 S. Stratford Road
Winston-Salem, NC 27103
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x . f�G/
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7006� 0100 0001�1787�58j�71121
7_C I:— StR11 gnnd nmmaetic Patnm P—int
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NCDENR - Divisions of Water Quality
!.Attn: !eM2
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'Winston-Salem, NC 27107

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Hubert -Head
Head Mobile Home Park
2880 S. Stratford Road
Winston-Salem, NC 27103
A. Signature
X J ❑ Agent
❑ Addressee
B. Received by (Printed Name) C. Date of Deliver)
D. Is delivery address different from item 1 T ❑ Yes
If YES, enter delivery address below: ❑ No
3. S rvice Type
ertified Mail ❑ Express Mail
FRegistered ReturnReceipt for Merchandise
— - - ❑ Insured Mail 9—CC.
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r1-'—i ► �i
7007 OMI D 0001 5586 9394
PS Form 3811. February 2bO4 ' ' ' Domestic Return Receipt i / l „ .6Z102595.02-M-154

UNITED STAT5 LSF
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gtaC rb"&F6 S Paid''
N I-.,
..Mi A©v
• Sender: Please print your name, address, and ZIP+4 in this box •
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MUMMMUM"Hum"Mnlim"UHMMUMIF

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Head -Mobile Home Park
28861S. Stratford Road
Winsiton=Salem, NC 27103
A. Signature
X Agent
1 ❑ Addressee
B. Received by (Printed Name) C. Date of De'
IZ-T
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Certified Mail p Express Mail
�j�`j Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Y9
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PS Form 3811, February 2004 Domestic Return Receipt oZ _ ( L�-6 102595-02-M-1541

UNITED STATE!, .'J?Q "S'
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S
14P
o. G-10
tzt 17"T.
NCDENR-Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
It) If III I I I I I I Jill I I III I I It III I I fit /I I I d I If If It III I I) I) III III

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Prinf your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Dennis F. Wilkinson
2880 S. Stratford Road, #6
Winston-Salem, NC 27103
A Signature
❑ Agent
❑ Addresse
B. Received by (Printed Name) C. Date of Deli er
- .O
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. SS—ery Ice Type
I�Certified Mail ❑ Express Mail
❑ Registered U Return Receipt for Merchandis(
J ❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
6955
PR F:Arm "AR1 i Fchriiani 9nnG 7 i 41 1 1 I'rnmaefic Rofiim P.eOfnf 4— z _ A O .Q�J i no9Q9_nO_ee_1 cn

UNITED STATES POSTAL SERVICE
First -Claw Mail 1
Postage & Fees Paid
USPS
Permit No. G-1 0
Sender: Please print your name, address, and ZIP+4 in this box •
9. Prut t. -4t—
Surface Water Protection Section
N.C. Dept. of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107
I
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