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Home My WebLink AboutNC0055212_Regional Office Historical File Pre 2016�m NC®ENR North Carolina Department of Environment and Natural Resources Pat McCrory Donald R. van der Vaart Governor Secretary June 11, 2015 Auman's Mobile Home Park, LLC Attn: Barbara N. Auman, Owner 3910-2 North Main Street High Point, NC 27265-1217 Subject: Compliance Evaluation Inspection Permittee: Auman's Mobile Home Park, LLC Facility: Auman's Mobile Home Park Wastewater Treatment Plant NPDES Permit #: NCO055212 Forsyth County Dear Ms. Auman: Ron Boone, of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the Division) conducted a compliance evaluation inspection (CEI) of the Auman's Mobile Home Park Wastewater Treatment Plant (WWTP) on June 2, 2015. Your assistance and cooperation was greatly appreciated. An inspection checklist is attached for your records and inspection, findings are surpmarized below. General Information The mobile home park is located at 3910-2 North Main Street, in High Point, Forsyth County, NC. The WWTP is located on the north side of the mobile home park (MHP) at coordinates 36.018002°N, - 80.051194°W. Although in Forsyth County, the park/plant are actually located at a High Point address. The permit authorizes you to operate this 0.016 MGD WWTP, which consists of three 3,000 gallon septic .tanks with 1,000 gallon pump tanks, a 6,000 gallon gravity fed septic tank, a 2,000 gallon detention tank, dual surface sand filters, a 4,000 gallon final tank with alternating pumps, an ultraviolet disinfection system, and a backup chlorine disinfection system with dechlorination. The permit authorizes you to discharge the treated effluent from the" WWTP via outfall 001 to Rich Fork Creek, which is currently classified as Class C waters and is located in the Yadkin Pee -Dee River basin. Site Review The entire plant was very well maintained and in good condition. Mr. Boone noted no problems or discrepancies. Documentation Review 450 West Hanes Mill Road, Suite #300, Winston-Salem, North Carolina 27105 Phone: 336-776-98001 Internet: www.ncdenr.gov An Equal Opportunity 1 Affirmative Action Employer — Made in part by recycled paper All documentation was reviewed and no discrepancies were found. You have done an excellent job documenting the operation and maintenance of the plant as required by the permit; this includes operations and visitation logs, discharge monitoring reports, laboratory and field laboratory records, chains of custody, sludge pumping records, etc. If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at (336) 776-9800. Thank you for your cooperation in this matter. Sincerely, J 7 W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality. Attachments: BIMS Inspection Report CC: aIrSQ sWP Central Files NPDES Unit United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 Water Compliance Inspection' Report Approval expires 6-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 IN 1 2 15 1 3 I NCO055212 I11 12 15/06/02 17 18 L C J 19 I G I 201 I 21III1II IIIIII11111IIIIIII1IIIIII IIIIIIIIIII r6 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---- -Reserved----- 67 70 71 I I 72 L �, � 73 I I 174 75I III I I I I80 LJ I I Section B: Facility Data Name and Location of Facility Inspected (For Industrial Use discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and NPDES permit Number) 10:OOAM 15/06/02 14/05/01 Auman's Mobile Home Park WWTP 3910-2 N Main St Exit Time/Date Permit Expiration Date High Point NC 272651217 11:OOAM 15/06/02 19/04/30 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Barbara N Auman/ORC/919-883-3910/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Barbara N Auman,3910-2 N Main St High Point NC 2726512171/336-883-3910/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Ron Boone WSRO WQ//336-776-9690/ % fi Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date .w:; J SC•`,{J 3` n ,l✓�-: f 0 �/:$� Oft,%r , ''t� 4 .a., .�P�' �l �✓ ,2 Y °'Y`a— .A' _ 1n� -T-J i .^� ..' A^ .: 1 : .zjz:. .=s' ^. ��vY',,fw r;up,.. ":.3- .. �:i f ?��2�y..^r,.', Ss _ •€e1, �>:, �, 7 EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page# i NPDES yr/mo/day Inspection Type 31 NCO055212 I11 12 15/06/02 17 18 JCJ Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) Please refer to the attached inspection summary letter. 1 Page# 2 0 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 06/02/2015 Inspection Type: Compliance Evaluation Permit Yes No NA NE (If the present permit expires in 6 months or less). Has the permittee submitted a new ❑ ❑ E ❑ application? Is the facility as described in the permit? 0 ❑ ❑ ❑ # Are there any special conditions for the permit? ❑ ❑ ❑ Is access to the plant site restricted to the general public? N ❑ ❑ _ ❑ Is the inspector granted access to all areas for inspection? N ❑ ❑ ❑ Comment: None Record Keeping Yes No NA NE Are records kept and maintained as required by the permit? N ❑ ❑ ❑ Is all required information readily available, complete and current? 0 ❑ ❑ ❑ Are all records maintained for 3 years (lab. reg. required 5 years)? 0 ❑ ❑ ❑ Are analytical results consistent with data reported on DMRs? ■ ❑ ❑ ❑ Is the chain -of -custody complete? 0 ❑ ❑ ❑ Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses Transported COCs Are DMRs complete: do they include all permit parameters? 0 ❑ ❑ ❑ Has the facility submitted its annual compliance report to users and DWQ? ❑ ❑ 0 ❑ (If the facility is = or> 5 MGD permitted flow) Do they operate 2417 with a certified operator ❑ 0 ❑ ❑ on each shift? Is the ORC visitation log available and current? E ❑ ❑ ❑ 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? ❑ ❑ 0 ❑ Comment: None Laboratory Yes No NA NE Are field parameters performed by certified personnel or laboratory? S ❑ ❑ ❑ Are all other parameters(excluding field parameters) performed by a certified lab? 0 ❑ ❑ ❑ Page# 3 u Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 06/02/2015 Inspection Type: Compliance Evaluation Laboratory Yes No NA NE # Is the facility using a contract lab? 0 ❑ ❑ ❑ # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ ❑ ❑ Celsius)? Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees? ❑ ❑ ❑ Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees? ❑ ❑ ❑ Comment: None Effluent Samplinq Yes No NA NE Is composite sampling flow proportional? ❑ ❑ 0 ❑ Is sample collected below all treatment units? E ❑ ❑ ❑ Is proper volume collected? 0 ❑ ❑ ❑ Is the tubing clean? ❑ ❑ 0 ❑ # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ ❑ ❑ E Celsius)? Is the facility sampling performed as required by the permit (frequency, sampling type ❑ ❑ ❑ representative)? Comment: None Upstream / Downstream Sampling Yes No NA NE Is the facility sampling performed as required by the permit (frequency, sampling type, and E ❑ ❑ ❑ sampling location)? Comment: None Flow Measurement - Influent Yes 'No NA NE # Is flow meter used for reporting? 0 ❑ ❑ ❑ Is flow meter calibrated annually? ❑ ❑ ❑ Is the flow meter operational? N ❑ ❑ ❑ (If units are separated) Does the chart recorder match the flow meter? ❑ ❑ N ❑ Comment: Facility uses city water meter for flow readings Septic Tank Yes No NA NE (If pumps are used) Is an audible and visual alarm operational? ❑ E ❑ ❑ Is septic tank pumped on a schedule? 0 ❑ ❑ ❑ Are pumps or syphons operating properly? ❑ ❑ ❑ Page# 4 Permit: NCO055212 Owner -Facility: Auman's Mobile Home Park WWTP Inspection Date: 06/02/2015 Inspection Type: Compliance Evaluation Septic Tank Yes No NA NE Are high and low water alarms operating properly? ❑ ❑ 0 ❑ Comment: None Sand Filters (Low rate) Yes No NA NE (If pumps are used) Is an audible and visible alarm Present and operational? ❑ ❑ N ❑ Is the distribution box level and watertight? ❑ ❑ ❑ Is sand filter free of ponding? E ❑ ❑ ❑ Is the sand filter effluent re -circulated at a valid ratio? ❑ ❑ ❑ # Is the sand filter surface free of algae or excessive vegetation? 0 ❑ ❑ ❑ # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) N ❑ ❑ ❑ Comment: None Disinfection - UV Yes No NA NE Are extra UV bulbs available on site? 0 ❑ ❑ ❑ Are UV bulbs clean? 0 ❑ ❑ ❑ Is UV intensity adequate? 0 ❑ ❑ ❑ Is transmittance at or above designed level? 0 ❑ ❑ ❑ Is there a backup system on site? 0 ❑ ❑ ❑ Is effluent clear and free of solids? 0 ❑ ❑ ❑ Comment: None Effluent Pipe Yes No NA NE Is right of way to the outfall properly maintained? ❑ ❑ ❑ Are the receiving water free of foam other than trace amounts and other debris? E ❑ ❑ ❑ If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ 0 ❑ Comment: None Operations & Maintenance Yes No NA NE Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ . ❑ Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ E ❑ ❑ Solids, pH, DO, Sludge Judge, and other that are applicable? Comment: None Page# 5 RECEIVED AN.C. Dept of ENR ®� MAR 17 2015 RNLFNCDENR REGIONAL OF E North Carolina Department of Environment and Natural Resources Pat McCrory Donald R. van der Vaart Governor Secretary March 13, 2015 CERTIFIED MAIL ITEM.7010 2780 0003 4825 6649 - RETURN RECEIPT REQUESTED Mrs. Barbara N. Auman Auman's Mobile Home Park LLC 3910-2 N Main St High Point, NC 27265 Subject: Notice of Deficiency Failure to Submit Electronic Discharge Monitoring Reports (eDMRs) Auman's Mobile Home Park WWTP NPDES Permit NCO055212 Forsyth County Dear Permittee: Per the terms of your NPDES permit, you were required to register for and begin using the Division of Water Resources' electronic Discharge Monitoring Report (eDMR) system by 1/26/2015. Our records indicate that as of the date of this letter, the subject facility has not submitted any data using the eDMR system. Failure to register and begin submitting reports electronically is a violation of the terms of your permit, subjecting you to a possible Notice of Violation and/or the assessment of civil penalties. In order to reduce the risk of receiving additional enforcement action, you must complete your registration within 30 days of receipt of this notice. The Division has prepared a website devoted to all aspects of eDMR, including registration for its use, obtaining an eDMR user account, and answers to frequently asked questions. You are encouraged to visit the website at: http://Portal.nedenr.org/web/wq/admin/bog/ipu/edmr. Should you have further questions regarding eDMR after reviewing the website's content, or have need of further assistance, you should contact the appropriate Division staff member as listed under the "Contact Us" section of the website. Thank you for your cooperation in this matter. Sinc ely, S. Jay Zimmerman, D'-or Division of Water Resources cc: NPDES File Central Files !9ttb-ntea Regiona-l-Office 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Phone: 919-807-630011nternet: www.ncwaterquality.org An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper A r41 A NC®ENR North Carolina Department of Environment and Natural Resources Pat McCrory Governor June 13, 2014 Auman's Mobile Home Park, LLC Attn: Barbara N. Auman, Owner 3910-2 North Main Street High Point, NC 27265-1217 Subject: Compliance Evaluation Inspection Permittee: Auman's Mobile Home Park, LLC Facility: Auman's Mobile Home Park Wastewater Treatment Plant NPDES Permit #: NCO055212 Forsyth County Dear Ms. Auman: John E. Skvarla, III Secretary Ron Boone, of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the Division) conducted a compliance evaluation inspection (CEI) of the Auman's Mobile Home Park Wastewater Treatment Plant (WWTP) on June 12, 2014. Your assistance and cooperation was greatly appreciated. An inspection checklist is attached for your records and inspection findings are summarized below. General Information The mobile home park is located at 3910-2 North Main Street, in High Point, Forsyth County, NC. The WWTP is located on the north side of the mobile home park (MHP) at coordinates 36.0180020N, - 80.051194°W. Although in Forsyth County, the park/plant are actually located at a High Point address. The permit authorizes you to operate this 0.016 MGD WWTP, which consists of three 3,000 gallon septic tanks with 1,000 gallon pump tanks, a 6,000 gallon gravity fed septic tank, a 2,000 gallon detention tank, dual surface sand filters, a 4,000 gallon final tank with alternating pumps, an ultraviolet disinfection system, and a backup chlorine disinfection system with dechlorination. The permit authorizes you to discharge the treated effluent from the WWTP via outfall 001 to Rich Fork Creek, which is currently classified as Class C waters and is located in the Yadkin Pee -Dee River basin. Site Review The entire plant was very well maintained and in good condition. Mr. Boone noted no problems or discrepancies. Documentation Review 585 Waughtown Street, Winston-Salem, North Carolina 27107 Phone: 336-771-50001 Internet: www.ncdenr.gov An Equal Opportunity V Affirmative Action Employer— Made in part by recycled paper All documentation was reviewed and no discrepancies were found. You have done an excellent job documenting the operation, and maintenance of the plant as required by the permit; this includes operations and visitation logs, discharge monitoring reports, laboratory and field laboratory records, chains of custody, etc. If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at (336) 771-5000. Thank you for your cooperation in this matter. Sincerely, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality Attachments: BIMS Inspection Report CC: 1� R,Caa r-�;' ,�`'�P Central Files NPDES Unit United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 Water Compliance Inspection Report. Approval expires8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 IN I 2 15 1 3 I NCO055212 I11 12 14/06/12 17 18 i CJ 19 I G I 201 I 21IIII I I I I I III I I I I I I I I I I I I I I I I I I I I I I III I I I I I t66 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ----Reserve 67 70 I_j 71 I I 72 I N I 73I I 174 75I III I I I I80 LJ L I 1 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) 01:00PM 14/06/12 14/05/01 Auman's Mobile Home Park WWTP 3910-2 N Main St Exit Time/Date Permit Expiration Date High Point NC 272651217 02:00PM 14/06/12 19/04/30 Name(s) of Onsite Representabve(s)/Tities(s)/Phone and Fax Number(s) Other Facility Data Gerard B Einig/O RC/910-883-391 0/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Barbara N Auman,3910-2 N Main St High Point NC 272651217//336-883-3910/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspectors) Agency/Office/Phone and Fax Numbers Date Ron Boone — WSRO WQ//336-771-4967/ , Signature Management Q A Reviewer Agencyy/�Offic�e//Phone and Fax Numbers Date %ooff ! EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page# NPDES yr/mo/day Inspection Type 1 31 NCO055212 I11 12 14/06/12 17 18 l C l Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) Page# 1 Permit: NCO055212 Owner - Facility: Human's Mobile Home Park WWfP Inspection Date: 06/12/2014 Inspection Type: Compliance Evaluation Permit Yes No Na Ne ❑ El • El (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? ❑ 0 11 ❑ # Are there any special conditions for the permit? N ❑ Is access to the plant site restricted to the general public? El Is the inspector granted access to all areas for inspection? Comment: None Record Keeping Yes No Na Ne 0 El ❑ ❑ Are records kept and maintained as required by the permit? 0 El ❑ ❑ Is all required information readily available, complete and current? Are all records maintained for 3 years (lab. reg. required 5 years)? 0 ❑ ❑ ❑ Are analytical results consistent with data. reported on DMRs? . 0 El El 0 Is the chain -of -custody complete? Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration • Dates of analysis Name of person performing analyses ■ Transported COCs Are DMRs complete; do they include all permit parameters? Has the facility submitted its annual compliance report to users and DWQ? ❑ ❑ 0 ❑ (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? ❑ Is the ORC visitation log available'and current? 0 ❑ El - Is the ORC certified at grade equal to or higher than the facility classification? N ❑ ❑ Is the backup operator certified at one grade less or greater than the facility classification? Is a copy of the current NPDES permit available on site? Facility has copy of previous year's Annual Report on file for review? Comment: None Laboratory Yes No Na Ne Page# 3 Permit: NCO055212 Owner -Facility: Auman's Mobile Home Park WWTP Inspection Date: 06/12/2014 Inspection Type: Compliance Evaluation Laboratory Yes No Na Ne Are field parameters performed by certified personnel or laboratory? El 0 Are all other parameters(excluding field parameters) performed by a certified lab? N EJ El ❑ # Is the facility using a contract lab? E El ❑ El # Is proper tem erature set for sam I t k t t 1 h El El El 0 p p e s orage ( Up a ess t an or equal to 6.0 degrees Celsius)? Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees? ❑ 0 Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees? El El EJ 0 Comment: None Effluent Sampling . Yes No Na Ne Is composite sampling flow proportional? El 1:1 0 El Is sample collected below all treatment units? N ❑ El El Is proper volume collected? 0 ❑ El Is the tubing clean? ❑ 0 El # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ 0 Celsius)? Is the facility sampling performed as required by the permit (frequency, sampling type 0 El El El representative)? Comment: None Upstream / Downstream Sampling Yes No Na Ne Is the facility sampling performed as required by the permit (frequency, sampling type, and El ❑ sampling location)? Comment: Flow Measurement - Influent Yes No Na Ne # Is flow meter used for reporting? N El ❑ Is flow meter calibrated annually? ❑ El El E Is the flow meter operational? ❑ ❑ (If units are separated) Does the chart recorder match the flow meter? ❑ ❑ E El Comment: City water meter used Septic Tank Yes No Na Ne 0 El (If pumps are used) Is an audible and visual alarm operational? Is septic tank pumped on a schedule? ❑ Are ors syphons operating 0 Elpumps yp p g properly? Page# 4 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP . S Inspection Date: 06/12/2014 Inspection Type: Compliance Evaluation Septic Tank Yes No Na Ne ❑ Are high and low water alarms operating properly? Comment: None Sand Filters (Lowy rate) Yes No Na Ne El El M R (If pumps are used) Is an audible and visible alarm Present and operational? Is the distribution box level and watertight? Is sand filter free of ponding? Is the sand filter effluent re -circulated at a valid ratio? # Is the sand filter surface free of algae or excessive vegetation?, El El N ❑ # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) Comment: None Disinfection - UV Yes No Na Ne E El ❑ El Are extra UV bulbs available on site? ■ ❑ El ❑ Are UV bulbs clean? 1:1 El Is UV intensity adequate? Is transmittance at or above designed level? E El Is there a backup system on site? El Is effluent clear and free of solids? Comment: None Effluent Pipe Yes No Na Ne ■ ❑ El 0 Is right of way to the outfall properly maintained? N ❑ ❑ 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: None Operations & Maintenance Yes No Na Ne Is the plant generally clean with acceptable housekeeping? El EI Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ® ❑ Solids, pH, DO, Sludge Judge, and other that are applicable? Comment: None Page# 5 Permit: NC0055212 Inspection Date: 06/12/2014 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Type: Compliance Evaluation Page# A 47® NCDENR North Carolina Department of Environment and Pat McCrory Governor November 19, 2013 Attn: Barbara N. Auman Auman Mobile Home Park LLC 3910-2 North Main St. High Point, NC 27265 Subject: Receipt of permit renewal application NPDES Permit NCO055212 Forsyth County Dear Mrs. Auman, N.CRDIED ept. Of E N R NOV 2 1 2013 REGIONALS L , Natural Resources John E. Skvarla, III Secretary The NPDES Unit received your permit renewal application on October 28t", 2013. This permit renewal has been assigned Bob Sledge (919-807-6398) who will contact you if any additional information is required to complete your permit renewal. Due to current backlog, you should continue to operate under terms of your current permit, until a new permit is issued. -if you have any questions, please contact the assigned permit writer. Sincerely, Jeff Poupart Point Source Branch Program Supervisor IV Cc: Central Files 171m1' i Salern _LTi" a_ Cs3ffice NPDES Unit 1601 Mail Service Center, Raleigh, North Carolina 27699-1601 One Phone: 919-707-86001 Internet: www.ncdenr.gov NorthCarolina An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper Naftwl`ff •r October 24, 2013 Barbara N. Auman Auman Mobile Home Park LLC 3910-2 North Main St. High Point, NC 27265 t Mr. Charles H. Weaver, Jr. NCDENR/Water Quality/Point Source Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Subject: Renewal Permit Request Auman Mobile Home Park LLC WWTP NPDES Permit NCO055212 Forsyth County Dear Mr. Charles H. Weaver, Jr. 0 C T 2.8 2013 DENR-WATER QUALITY POINT SOURCE BRANCH N.C. Dept oEDNR ` NOV 2 1 2013 WNSTON-SALEM REGIONAL OFFICE This is a cover letter requesting renewal of the permit #0055212 for Auman Mobile Home Park LLC, WWTP, Forsyth County. The current permit expires April 30, 2014. Our sludge management plan is contracted by a license septic tank service company, Jetco, Inc., to pump and dispose of our sludge from our septic tanks. This is done on a regular basis, once a year or more often when needed. Thank you for your consideration in the permit renewal. Sincerely, Barbara N. Auman Permittee and ORC For Auman Mobile Home Park LLC 1 NPDES APPLICATION - FORM D For -privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD Mail the complete application to: N. C. DENR / Division of Water Resources / NPDES Program 1617 Mail Service Center, Raleigh, NC 27699-1617 kPDES Permit COO If you are completing this form in computer use the TAB key or the up - down arrows to move from one field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type. 1. Contact Information: Owner Name Facility Name •tea �� A�� , Mailing Address�cuyd city% ' - State / Zip Code ly C Telephone Number (3 3 �) S3 ; 3 G% / �• - l �1L# ( 3 �:G� %}- y a . Fax Number (3�L) �' D - 3 S 1 l e-mail Address 2. Location of facility producing discharge: Check here if same address as above Street Address or State Road City State / Zip Code County 3. Operator Information: Name of the firm, public organization or other entity that operates the facility. (Note that this is not referring to the Operator in Responsible Charge or OPQ Name � 42 ZV i= ✓�_S l v ;1 i Mailing Address City State / Zip Code Telephone Number ( ) Fax Number ( ) e-mail Address 1 of 3 Form-D 9/2013 d NPDES APPLICATION - FORM D For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD 4. Description of wastewater: Facility Generating Wastewater(check all that apply): Industrial ❑ Number of Employees Commercial ❑ Number of Employees Residential [2-*-' Number of Homes School ❑ Number of Students/Staff Other ❑ Explain: r *7ry ��-C?z, /� Ni L� 064Y, r,4 / -5 S"sPAc6a- Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,. restaurants, etc.): /YI Mi 1-6- A/44A.<k Number of persons served: J. 00 - t v - �L SB 5. Type of collection system Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer) 6. Outfall Information: Number of separate discharge points 1 Outfall Identification number(s) /�y 1 Is the outfall equipped with a diffuser? ❑ Yes240 7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each outfall): IT/ �h l�a� K C 8. Frequency of Discharge: ❑ Continuous O-"Intermittent If intermittent: Days per week discharge occurs: `i Duration: "Z G /ham . 3 5"y,ar._. t-WC, h 9. Describe the treatment system List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and phosphorus. If the space provided is not suffrcient, attach the description of the treatment system in a separate sheet of paper. S rI aLTEA - 3 LL,®lv�u��L`ItLdt1/1 tANkS 1 TYc. �414W;< f2 4 v a'T y ,�+ J a 0 o Al. °t zt eJOI '--PA-' l K f" -,c o � Al. r6 1Lkh,4 ��„ K t ��/ J_ 4L7-'!F,4 /j a i � ivo` %3 u '�"z � �-nI �7 ��l �.p t� E � ao I- 0 I'd e-a i 7a Sbf._�"s ��7"�v�v�s , s �;.v2.2. W,47Z_4 Y 57, L /9 m1d wi-Y' !a,,4LIFO N Arf;1:''p�llr kL710A - V.",L e: fL;9 6 4 j'L d hU I a Lly 'e'h ec 3 �b� C7 •� rcti f-t�;Q�C b� �fi13 Z.ep,iVt'i1-0,2 �. 1Joo®�AL �2��n17JOrJ ��N4C 2 of 3 j_ d e --no rji, % 4/Zx 0- K Form-D 9/2013 01 NPDES APPLICATION - FORM D For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD 10. Flow Information: Treatment Plant Design. flow 0 d 6 MGD Annual Average daily flow MGD (for the previous 3 years) Maximum daily flow , 00 3,:" MGD (for the previous 3 years) 11. Is this facility located "on Indian country? ❑ Yes No 12. Effluent Data NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum and monthly average. If only one analysis is reported, report as daily maximum. RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over - �ho-rvyct �Fi rrrnnthc inr tnnrnm PtPr.0 l7�Y7 Pnr%lI 7» unu7 nPrffi t_ Mf/rw- nthPr nnrain.PtPrs '7VI 4". Parameter yLrd -"•E Daily Maximum Monthly Average Units of Measurement Biochemical Oxygen Demand (BODs) Fecal Coliform Total Suspended Solids Temperature (Summer) ` Temperature (Winter) pH 13. List all permits, construction approvals and/or applications: Type Permit Number Type Hazardous Waste (RCRA) NESHAPS (CAA) UIC (SDWA) Ocean Dumping (MPRSA) NPDES Dredge or fill (Section 404 or CWA) PSD (CAA) Non -attainment program (CAA) 14. APPLICANT CERTIFICATION Other Permit Number I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief such information is true, complete, and accurate. - 10 Printed name of Person Title ,� of Applicant Date North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.) 3 of 3 Form-D 9/2013 �l. !T / l _ - - '•°4J.� --� -- _- '.1 ° , { y 11i ;'.��' �( '� ,(-`'� ,\ J _ ' P f 11 _ ,, i`�,'. •\s� .�_ /' � t ?• ,\,' I � - r \ - jet,' .- - \ � .I , ', T \ '' I, �, '\• ` .' — � I . —sr / _. m'r , ':ice, ' — 1 /i r f , - / I �\t, f — ye �`i•:.'y^-"'et;`~'_i!�� '!TIF'/i d .�'r I nj rr�• `•rm,-,o-�''•_ ..�1�;"'' �„ j�;•�i �'`ti j` ,� r,�� r--L r� i ,� i •.` - fi ��1 i' . r^ • � ' •-.j1-, 1} S: .t'.'.i a�t.:�.• '" ''y,r �rti:1 1 ,%!('4.1 ,�'':. - _ :�, i' .ik''. �1' -}.-,fir,+'° �-.r.y-».�w�-�. I, �,i m �.�'S " �.(,• •1 f,�;k �� //� rj�/_ r ...�j�'; ti ►r�., Locafim -47 ' '.; `• � �.` l �✓ . 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' •� +,.d,� rY.� •� . ` 1 , ,{% � �-�. i. .�( +, j i �1,r' }, �(� m - i'l,• � � a�i 1 t� i► :.Yr � f, R� '�•., .` '� I _ -`1 � ! j.�•.,\• ,. r` -f� , ,��, •fi . , .�-��3!-�`�l� r ��• i•�+ ~',,4i3 ''.�' � :f ��,..-� : � _- _~�`\i r--�'�r,�,��r�.'1,�4/ `?�' , -- •q.:'n;..., t.r/ 1 eys_ 9 �`% f ff - ±P` (� \ __ � .i _ +��: y• y: f./ �_ el .• _� r''. '4 (��''— j .�,''!t', 4.1 i- �.-.t...�- 1�0 Ali f,2 .lj '�i ✓ ` i � %• � J �' r `/: = to • •� i', .",•'•'�;-s / ` ' i ?� S •' ��.. . �'+ i 1 I •t ��I•},' , '',� i � C � b„ , i ;•��•`r i • 1 �.` i 1•e', �Auman's Mobile Home Park - NCO055212 (Mobile Home Park - NCO055212 I USGS Quad Name: Kernersville Lat.: 36001'05" Receiving Stream: Rich Fork Creek Long.: 80003'00" Stream Class: C Subbasin: Yadkin -Pee Dee - 030707 Facility • Location =rth Not to SCALE September 27, 2013 Barbara N. Auman Auman's Mobile Home Park LLC 3910-2 N Main St High Point, NC 27265-1217 N.C.pept. of ENR - - OCT 0 8 2013 Winston-Salem Regional Office Subject: Renewal Notice NPDES Permit NCO055212 Auman's Mobile Home Park WWTP Forsyth County Dear Permittee: Your NPDES permit expires on April 30, 2014. Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105 (e)) regulations state that permit renewal applications must be filed at least 180 days prior to expiration of the current permit. If you have already mailed your renewal application, you may disregard this notice. Your renewal package must be sent to the Division postmarked no later than November 1, 2013. If any wastewater discharge will occur after April 30, 2014, the current permit must be renewed. Failure to submit a renewal application by the deadline would deny the subject facility the automatic permit extension granted by NCGS 150B. If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact me at the telephone number or address listed below. Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must submit with the permit renewal application. If you have any questions, please contact me at the telephone number or e-mail address listed below. Sincerely, Charles H. Weaver, Jr. NPDES Unit cc: Central Files eWi�n,st�n� .s � m ~-gleraal:f�f�ic�i;Sur ace , aver- rbte�E`ia"�n� , NPDES File 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604 Phone: 919 807-6391 / FAX 919 807-6489 / charles.weaver@ncdenr.gov I An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper NPDES Permit NCO055212 Auman's Mobile Home Park WWTP Forsyth County The following items are REQUIRED for all renewal packages: ➢ A cover letter requesting renewal of the permit and documenting any changes at the facility since issuance of the last permit. Submit one signed original and two copies. ➢ The, completed application form (copy attached), signed by the permittee or an Authorized Representative. Submit one signed original and two copies. ➢ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares the renewal package, written documentation must be provided showing the authority delegated to any such Authorized Representative (see Part II.B.11.b of the existing NPDES permit). ➢ A narrative description facility. Describe how wastewater treatment are has no such plan (or the solids) , explain this ir two copies. of the sludge management plan for the sludge (or other solids) generated during handled and disposed. If your facility permitted facility does not generate any writing. Submit one signed original and The following items must be submitted by any Municipal or Industrial facilities discharging process wastewater: Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal Regulations, Part 122) and ALL Municipal facilities with a permitted flow >! 1.0 MGD must submit a Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21. The above requirement does NOT apply to privately owned facilities treating 100% domestic wastewater, or facilities which discharge non -process wastewater (cooling water, filter backwash, etc.) Send the completed renewal package to: Charles H. Weaver NC DENR / DWR / NPDES Program 1617 Mail Service Center Raleigh, NC 27699-1617 A4 q North Carolina Department of Environment and Natural Resources Division of Water Quality Pat McCrory Charles Wakild, P. E. John E. Skvarla, III Governor Director Secretary May 20, 2013 Auman's Mobile Home Park, LLC Attn: Barbara N. Auman, Owner 3910-2 North Main Street High Point, NC 27265-1217 Subject: Compliance Evaluation Inspection Permittee: Auman's Mobile Home Park, LLC Facility: Auman's Mobile Home Park Wastewater Treatment Plant NPDES Permit #: NCO055212 Forsyth County Dear Ms. Auman: Mr. Ron Boone of the Winston-Salem Regional Office of Ithe NC Division of Water Quality (DWQ or the Division) conducted a compliance evaluation inspection (CEI) of the Auman's Mobile Home Park Wastewater Treatment Plant (WWTP) on May 16, 2013. Your assistance and cooperation was greatly appreciated. An inspection checklist is attached for your records and inspection findings are summarized below. General Information The mobile home park is located at 3910-2 North Main Street, in High Point, Forsyth County, NC. The WWTP is located on the north side of the mobile home park (MHP) at coordinates 36.018002°N, - 80.051194°W. Although in Forsyth County, the park/plant are actually located at a High Point address. The permit authorizes you to operate this 0.016 MGD WWTP, which consists of three 3,000 gallon septic tanks with 1,000 gallon pump tanks, a 6,000 gallon gravity fed septic tank, a 2,000 gallon detention tank, dual surface sand filters, a 4,000 gallon final tank with alternating pumps, an ultraviolet disinfection system, and a backup chlorine disinfection system with dechlorination. The permit authorizes you to discharge the treated effluent from the WWTP via outfall 001 to Rich Fork Creek, which is currently classified as Class C waters and is located in the Yadkin Pee -Dee River basin. Site Review The entire plant was very well maintained and in good condition. Mr. Boone noted no problems or discrepancies. North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 Phone: 336-771-50001 FAX: 336-77146301 Customer Service;1-877-623-6748 Internet: www.nGwaterquality.org An Equal Opportunity 1 Affirmative Action Employer One NofthCarohna Auman's MHP LLC, Attn: Ms, Barbara Auman, Owner Compliance Evaluation Inspection Auman's Mobile Home Park Wastewater Treatment Plant, NCO055212 May 20, 2013, Page 2 of 2 Documentation Review All documentation was reviewed and no discrepancies were found. You have done an excellent job documenting the operation and maintenance of the plant as required by the permit; this includes operations and visitation logs, discharge monitoring reports, laboratory and field laboratory records, chains of custody, etc. Mr. Boone reports that your plant is easily the best operated sand filter system he has seen to date. Your continued diligence to properly operate and maintain the plant is greatly appreciated! If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at (336) 771-5000. Thank you for your cooperation in this matter. Sincerely, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality Attachments: BIMS Inspection Report cc: t� A Central Files NPDES Unit United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 H OMB No. 2040-0057 Water Gnmplianre Insliprtmon Report Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day I Inspection Type Inspector Fac Type 1 INI 2 15 I 31 NCO055212 ill 121 13/05/14 117 181 C I 19I S I 20IU 1- Remarks 211 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 LL I I I I I I I I I I I I I I I I I I I I II16 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------ ------------------- Reserved---------------- 67I 169 701 I 71 IU 721 NJ 73I —u I 174 751 I I I I I I 180 r 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) Auman's Mobile Home Park WWTP 09:00 AM 13/05/14 09/07/01 Exit Time/Date Permit Expiration Date 3910-2 N Main St High Point NC 272651217 10:00 AM 13/05/14 14/04/30 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Barbara N Auman/ORC/919-883-3910/ I Name, Address of Responsible Official/Title/Phone and Fax Number Barbara N Auman,3910-2 N Main St High Point NC 272651217//336-883-3910/ Contacted No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations &I Maintenance Records/Reports Self -Monitoring Program ■ Facility Site Review Effluent/Reciiving 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/Phoni and Fax Numbers Date Ron Boone WSRO WQ#336-771-4967/ �� f,?/z I Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date EPA Form 356.0-3 (Rev 9-94) Previous editions are obsolete. Page # 1 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 05/14/2013 Inspection Type: Compliance Evaluation Laboratory Are all other parameters(excluding field parameters) performed by a certified lab? # Is the facility using a contract lab? # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees? Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees? Comment: Please refer to the attached inspection summary letter. Effluent Sampling Is composite sampling flow proportional? Is sample collected below all treatment units? Is proper volume collected? Is the tubing clean? # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? Yes No NA NE Yes No NA NE n000 ®nnn ®nnn nn■n nnn® Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ® n n n Comment: Please refer to the attached inspection summary letter. Upstream / Downstream Sampling Yes No NA NE Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? S n n n Comment: Please -refer to the attached inspection summary letter. Flow Measurement - influent # Is flow meter used for reporting? Is flow meter calibrated annually? Is the flow meter operational? (If units are separated) Does the chart recorder match the flow meter? Comment: Flow readings taken from city/county water meter. Septic Tank (If pumps are used) Is an audible and visual alarm operational? Is septic tank pumped on a schedule? Are pumps or syphons operating properly? Are high and low water alarms operating properly? Comment: There are no alarms. According to operator, if pumps fail, it will flow by • gravity to the filters and will not overflow the tank. Yes No NA NE Yes No NA NE nn®n Page # 4 C 1 Permit: NC0055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 05/1412013 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? Is sand filter free of ponding? ■ n n n Is the sand filter effluent re -circulated at a valid ratio? ❑ n ® n # Is the sand filter surface free of algae or excessive vegetation? ® n n n # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) n n ® n Comment: Filters are non -recirculating and are in excellent condition. Disinfection - UV Are extra UV bulbs available on site? Are UV bulbs clean? Is UV intensity adequate? Is transmittance at or above designed level? Is there a backup system on site? Is effluent clear and free of solids? Comment: Please refer to the attached inspection summary letter. Disinfection -Tablet Are tablet chlorinators operational? Are the tablets the proper size and type? Number of tubes in use? Is the level of chlorine residual acceptable? Is the contact chamber free of growth, or sludge buildup? Is there chlorine residual prior to de -chlorination? Comment: Chlorine/dechlor! nation system is backup only for UV system. Not in operation at time of inspection. Please refer to the attached inspection summary letter. De -chlorination Type of system ? Is the feed ratio proportional to chlorine amount (1 to 1)? Is storage appropriate for cylinders? # Is de -chlorination substance stored away from chlorine containers? Are the tablets the proper size and type? Yes No NA NE ®nnn Yes No NA NE ■nnn ®nnn 0 nn®n n n n nnn® Yes No NA NE Tablet Mnnn nnnn ®nnn ® n n n v Page # 5 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 05/14/2013 Inspection Type: Compliance Evaluation De -chlorination. Yes No NA NE Comment: Please refer to the attached inspection summary letter. Are tablet de -chlorinators operational? ®n n D Number of tubes in use? 0 Comment: Chlorine/dechlorination system is backup only for UV system. Not in operation at time of inspection. Please refer to the attached inspection summary letter 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? ❑ 0 Comment: Please refer to the attached inspection summary letter. Operations & Maintenance Yes No NA NE y Is the plant generally clean with acceptable housekeeping? ® 0 0 0 Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge W 0 fl Cl Judge, and other that are applicable? Comment: Plant is in outstanding condition. Please refer to the attached inspection summary letter. Page # 6 ADMAN MOBILE HOME PARK LLC 3910 N. Main St. High Point, NC 27265 336-883-3910 Performance Annual Report I. General Information: Facility/System Name: Responsible Entity: Person in Charge/Contact: Auman Mobile Home Park LLC Auman Mobile Home Park LLC Barbara N. Auman 3910-2 N. Main St. High Point, NC 27265 336-883-3910 NC #0055212 Applicable Permit(-N- Description of Collection System Treatment Process: Septic tanks, sand filter and ultraviolet disinfection system with one discharge into Rich Fork creek, In Forsyth County. II. Performance: 1.Text Summary of System Performance for Calendar Year 2010. For the year 2010 this system has operated in good standing with the State of NC. No violations occurred in 2010. 2. Text Summary of Collection System Year 2010: Violations- 2 on paperwork, not properly documented in log book 3. Corrections- paperwork now being documented in log book RECEIVED N.C. Deot. of FN' MAR 172011 III.. Notification: This report sent to NC Division of Water Quality, Raleigh, NC and hand delivered to each residence at Auman Mobile Home Park on February 28, 2011. IV. Certification: I certify under penalty of law that this report is complete and accurate to the best of my knowledge. I further certify that this report has been made available to the ,ma...e= it .vM-t-o.iu.vo�ffLh:a.- «aa.a-a.il.ay..'�s 06 4. aj lLy4' t=l� 1.V.V1J3i—UC—n "„G �L:IA�D=UUa V�f its' availability. Responsible Person Title:. Owner, ORC Entity: Auman Mobile Home Park, LLC cc: File & Auman Mobile Home Park LLC Residents Date M" ` 2091 VIN N_ Wi 1111 NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary February 3rd, 2011 Auman's Mobile Home Park, LLC Attn: Barbara N. Auman, Owner 3910-2 North Main Street High Point, NC 27265-1217 Subject: Compliance Evaluation Inspection Permittee: Auman's Mobile Home Park, LLC Facility: Auman's Mobile Home Park Wastewater Treatment Plant NPDES Permit #: NCO055212 Forsyth County Dear Ms. Auman: Mr. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ or the Division) conducted a compliance evaluation inspection (CEI� of the Auman's Mobile Home Park Wastewater Treatment Plant (WWTP) on January 27' , 2011. Your assistance and cooperation, as Operator in Responsible Charge (ORC) of the WWTP, as well as that of Mr. Gerard Einig, Backup ORC, was greatly appreciated. An inspection checklist is attached for your records and inspection findings are summarized below. General Information The mobile home park is located at 3910-2 North Main Street, in High Point, Forsyth County, NC. The WWTP is located on the north side of the mobile home park (MHP) at coordinates 36.018002°N,-80.0511940W. Although in Forsyth County, the park/plant are actually located at a High Point address. The permit authorizes you to operate this 0.016 MGD WWTP, which consists of three 3,000 gallon septic tanks with 1,000 gallon pump tanks, a 6,000 gallon gravity fed septic tank, a 2,000 gallon detention tank, dual surface sand filters, a 4,000 gallon final tank with alternating pumps, an ultraviolet disinfection system, and a backup chlorine disinfection system with dechlorination. The permit authorizes you to discharge the treated effluent from the WWTP into Rich Fork Creek via outfall 001. Rich Fork Creek is currently classified as Class C waters and is located in the Yadkin Pee Dee River basin. Site Review The entire plant was very well maintained and in good condition. Mr. Boone noted no problems or discrepancies. North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One Phone: 336-771-50001 FAX: 336-77146301 Customer Service:1-877-623-6748 NorthCarolina Internet: www,ncwaterquality,org Awwrall ' An Equal Opportunity 1 Affirmative Action Employer d ` `7✓1 Auman's Mobile Home Park, LLC Attn: Barbara N. Auman, Owner Compliance Evaluation Inspection NC0055212, Auman's MHP WWTP Page 2 of 2, February 3rd, 2011 Documentation Review All documentation was reviewed. No discrepancies were found. You have done an excellent job of documenting the operation and maintenance of the plant as required by the permit. This includes your operations and visitation logs, discharge monitoring reports and laboratory and field laboratory records, chains of custody, etc. Your continued diligence to properly operate and. maintain the plant is greatly appreciated. If you have any questions regarding the inspection or this letter, please call Mr. Boone or me at (336) 771-5000. Thank you for your cooperation in this matter. Sincerely, �1 W. Corey -Basinger Interim Regional Supervisor Surface Water Protection Section Attachments: 1. BIMS Inspection Report CC: �lP Central Files NPDES Unit United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 Water Compliance Inspection Report Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 I NI 2 151 31 N00055212 111 121 11/01/27 117 181 CI 191 SI 201 Remarks 21111111111111111111111111111111111111111111111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ------------------Reserved ---------- ---- 67 I 169 701 I 711 I 721 NJ 73 L_U 74 751 I I I I I I 180 Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and NPDES permit Number) 09/07/01 12:00 PM 11/01/27 Auman's Mobile Home Park WWTP Exit Time/Date Permit Expiration Date 3910-2 N Main St High Point NC 272651217 01:30 PM 11/01/27 14/04/30 Name(s) of Onsite Rep resentative(s)(Titles(s)/Phone and Fax Number(s) Other Facility Data Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Barbara N Auman,3910-2 N Main St High Point NC 272651217//336-883-391�. 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 Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Ron Boone WSRO WQ//704-663-1699 Ext.2202/ 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 W NPDES NCO055212 yr/mo/day 11 12I 11/01/27 Inspection Type 17 18ICI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) Please refer to the attached inspection summary letter. Page # 2 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park VVWTP Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation Permit Yes No NA NE (If the present permit expires in 6 months or less). Has the permittee submitted a new application? n n ■ n Is the facility as described in the permit? ■ n n n # Are there any special conditions for the permit? n ■ n n Is access to the plant site restricted to the general public? ■ n n n Is the inspector granted access to all areas for inspection? ® n n n Comment: Please refer to the attached inspection summary letter. Effluent Sampling Yes No NA NE Is composite sampling flow proportional? ❑ n ■ n Is sample collected below all treatment units? ■ n n n Is proper volume collected? ■ n n n Is the tubing clean? n n ■ # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n ❑ n ■ Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ n n n Comment: Please refer to the attached inspection summary letter. Upstream / Downstream Sampling Yes No NA NE Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ n n n Comment: Please refer to the attached inspection summary letter. Record Keeping Yes No NA NE Are records kept and maintained as required by the permit? ■ n n n Is all required information readily available, complete and current? ■ n n n Are all records maintained for 3 years (lab. reg. required 5 years)? ■ n n n Are analytical results consistent with data reported on DMRs? ■ n n n Is the chain -of -custody complete? ■ n n n Dates, times and location of sampling ■ Name of individual performing the sampling ■ Results of analysis and calibration ■ Dates of analysis ■ Name of person performing analyses ■ Transported COCs ■ Are DMRs complete: do they include all permit parameters? ■ n ❑ ❑ Page # 3 V Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation Record Keeping Yes No NA NE 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 ■ n n 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? ■ ❑ ❑ ❑ Is a copy of the current NPDES permit available on site? ■ n n n Facility has copy of previous year's Annual Report on file for review? n ❑ ■ n Comment: Please refer to the attached inspection summary letter. Flow Measurement - Influent Yes No NA NE # Is flow meter used for reporting? ■ ❑ n ❑ Is flow meter calibrated annually? n n n ■ Is the flow meter operational? ■ ❑ ❑ ❑ (If units are separated) Does the chart recorder match the flow meter? ❑ ❑ ■ ❑ Comment: Flow readings taken from city/county water meter. 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? ■ ❑ ❑ ❑ Are pumps or syphons operating properly? ■ n n n Are high and low water alarms operating properly? ■ n n n Comment: Tanks actually a part of the collection system. Pump Station - Influent Yes No NA NE Is the pump wet well free of bypass lines or structures? ■ ❑ n ❑ Is the wet well free of excessive grease? ■ n n n Are all pumps present? ■ n n n Are all pumps operable? ■ n n n Are float controls operable? ❑ n ❑ ■ Is SCADA telemetry available and operational? ❑ ■ n n Is audible and visual alarm available and operational? n n n ■ Comment: Please refer to the attached inspection summary letter. Sand Filters (Low rate) Yes No NA NE Page # 4 Permit: NC0055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation Sand Filters (Low rate) Yes No NA NE (If pumps are used) Is an audible and visible alarm Present and operational? ■ n n n Is the distribution box level and watertight? ■ n n n Is sand filter free of ponding? ■ n n n Is the sand filter effluent re -circulated at a valid ratio? n ■ n n # Is the sand filter surface free of algae or excessive vegetation? ■ n n n # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) n ■ n n Comment: Please refer to the attached inspection summary letter. Pump Station - Effluent Yes No NA NE Is the pump wet well free of bypass lines or structures? ■ n n o Are all pumps present? ■ n n n Are all pumps operable? ■ n n n Are float controls operable? n n n ■ Is SCADA telemetry available and operational? n ■ n n Is audible and visual alarm available and operational? n n n ■ Comment: Please refer to the attached inspection summary letter. Disinfection - UV Yes No NA NE Are extra UV bulbs available on site? ■ n ❑ n Are UV bulbs clean? ■ n n n Is UV intensity adequate? ■ n n n Is transmittance at or above designed level? ■ n n n Is there a backup system on site? ■ n n n Is effluent clear and free of solids? ■ n n n Comment: Please refer to the attached inspection summary letter. De -chlorination Yes No NA NE Type of system ? Tablet Is the feed ratio proportional to chlorine amount (1 to 1)? n n n ■ Is storage appropriate for cylinders? n n ■ n # Is de -chlorination substance stored away from chlorine containers? ■ n n n Are the tablets the proper size and type? n n n ■ Page # 5 Permit: NCO055212 Inspection Date: 01/27/2011 Owner - Facility: Auman's Mobile Home Park VWVfP Inspection Type: Compliance Evaluation Comment: Backup system only. Please refer to the attached inspection summary letter. Are tablet de -chlorinators operational? ■ n n n Number of tubes in use? 0 Comment: Backup system only. Please refer to the attached inspection summary letter. Effluent Pipe Yes No NA NE Is right of way to the outfall properly maintained? ■ ❑ ❑ 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? ❑ ❑ ❑ ❑ Comment: Please refer to the attached inspection summary letter. Operations & Maintenance Yes No NA NE Is the plant generally clean with acceptable housekeeping? ■ n n n Does the facility analyze process control parameters, for ex' MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑ Judge, and other that are applicable? Comment: Please refer to the attached inspection summary letter. Page # 6 AA e°. NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director February 8, 2010 Ms. Barbara N. Auman Auman's Mobile Home Park, LLC. 3910-2 North Main Street High Point, NC 27265-1217 Subject: NOTICE OF VIOLATION NPDES Permit No. NCO055212 Auman's Mobile Home Park WWTP Forsyth County Dear Ms. Auman: Dee Freeman Secretary A review of the Auman Mobile Home Park WWTP monitoring report for November 2009 showed the following violation: Parameter Date Limit Value Reported Value Limit Type Fecal Coliform 11/12/09 400 #/100ml 1,060 #/100m1 Daily Maximum Exceeded Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem. Please be aware that violations of your NPDES permit could result in enforcement action by the Division of Water Quality for this and any additional violations of State law. If you should have any questions, please do not hesitate to contact Mike Mickey at (336)771-5000. Sincerely, Steve W. Tedder Water Quality Regional Supervisor Winston-Salem Region Division of Water Quality cc: Central Files - SWP North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 Phone: 336-771-50001 FAX: 336-77IA6301 Customer Service:1-877-623-6748 Internet wvvw.ncwaterquality.org Nne ®rthCarolina An Equal Opportunity l Affirmative Action Employer Cover Sheet from Staff Member to Regional Supervisor DMR Review Record Facility: �u.�� Pem-it/Pipe No.: \WIVO �-��. Month/Year �®� Mont \Avera,-,,e Violations Parameter Permit LimDl\� R Value % Over Limit Date Date Nly ail Violations Parameter Permit Li nit/Tvpe DMR Value % Over Limit vu,A V�jo Monit%'ngc,equency Violations Parameter Pre uencv Values Reported # of Violations Violations Completed by: Regional Water Quality J Supervisor Signoff: Date: Date: .7 5L i3�3 /05 i i 35� E F F UlkNT NPDES PERMIT DISCHARGE NO. a v ( MONTH 4/K FACILITY NAMEm : w� CLASS . COUNTY OPERATOR IN RESPONSIBLE CHARGE (ORQaf ,.,i�f� I '_ GRADE E- PHONE ..3 jG AF9 -3 9�o CERTIFIED LABORATORIES (1),VC- 5 L-Ai eif 4 ,, Tic>,: -,- (2) CHECK BOX IF ORC HAS CHANGED ® PERSON(S) COLLECTING SAMPLES%�i%h'/;%�•4 il/ ��%,lo�/l2i Mail ORIGINAL and ONE COPY to: / 6- h?IUD /J, r i,,viG - i3 ATTN: CENTRAL FILES x _ �� Ct�: G— 1% DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) f DATE 1617 NIAIL SERVICE CENTER BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. 11 I 111 1 11 11 I1,1 II I II. I 11 1 ® 11 II 11,11 11 „ ®®__ BELOWNAME AND uNrrs MMMMEM MOM �M�mm ® m_______________ fo =��®® Mom_______________ DWQ form MR-] (OIi00) "` a Facility Status: (Please -check one of the following) All monitoring data and sampling frequencies meet permit requirements El Compliant All monitoring data and sampling frequencies do NOT meet permit requirements F��71 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, un er penalty of law, at 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." Permitte11e (Please print or type) ,Ty Signature of Permittee** Date (Required) 1. raGs . 336 Jd 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 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 (919) 733-5083 or by visiting the Water Quality Section's web site at h2o.e.nr.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. �?c * ORC must visit facility and document visitation of facility as required per 15A NCACW 5 04. If signed by other than the pc.rmittce, (lelegsitit)n of signatory :tuf11 ority ill u,� on file INifh the stale per ISA NCAC 2B .0506 (h) (2) (D). ADMAN MOBILE HOME PARK LLC 3910 N. Main St. High Point, NC 27265 336-883-3910 Performance Annual Report I. General Information: VAR - 3 2009 Facility/System Name: Auman Mobile Home Park LL6 E N R -, WADER QUALITY Responsible Entity: Auman Mobile Home Park LL Person in Charge/Contact: Barbara N. Auman POINT SOURCE BRANCH 3910-2 N. Main St. High Point, NC 27265 33 -8° -3910 73 - -. 2 *2D Applicable Permit(s): Description of Collection System Treatment Process: Septic tanks, sand filter and ultraviolet disinfection system with one . discharge into Rich Fork creek, In Forsyth County. II. Performance: Text Summary of System Performance for Calendar Year 2008. For the year 2008 this system has operated in good standing with the State of NC, meeting all permit requirements and was in compliance for the year 2008. List of Violations: No Violations. III. Notification: This report sent to NC Division of Water Quality, Raleigh, NC and hand delivered to each residence at Auman Mobile Home Park on February 26, 2009. IV. Certification: I certify under penalty of law that this report is complete and accurate to the best of my knowledge. I further certify that this report has been made available to the users or customers of the named system and that those users have been notified of its' availability. Responsible Person Title: Owner, ORC Entity: Auman Mobile Home Park, LLC cc: File Auman Mobile Home Park LLC Residents Date bC�CI /Cn N.C. Jett. o' E-NR MAR 0 6 2009 Winston-Salem Regional Office NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen-H. Sullins Governor Director RECEIVED N.C. Dept. of ENR April 8, 2009 APR 0 4 2009 VVi nsto n-Salem Ms. Barbara N. Auman Regional office Auman' s Mobile Home Park, LLC 3910-2 North Main Street High Point, NC 27625 Subject: Draft NPDES Permit Permit Number NCO055212 Auman's Mobile Home Park WWTP Forsyth County Dear Ms. Auman: Dee Freeman Secretary 1 Enclosed with this letter is a copy of the draft permit for your facility. Please review the draft very carefully to ensure thorough understanding of the conditions and requirements it contains. The draft permit contains the following changes from the terms found in your current permit: • The facility description has been updated to note the addition of ultraviolet disinfection. The chlorination and dechlorination facilities are noted as backup systems. • Effluent monitoring for Total Nitrogen and total Phosphorous has been reduced from monthly to quarterly. • Instream monitoring for fecal coliform has been removed from the permit. • A footnote has been added regarding the reporting and compliance determination of Total Residual Chlorine values. Please submit any comments to me no later than thirty days following your receipt of the draft. Comments should be sent to the address listed at the bottom of this page. If no adverse comments are received from the public or from you, this permit will likely be issued in June 2009, with an effective date of July 1, 2009. . If you have any questions or comments concerning this draft permit, call me at (919) 807-6398, or via e-mail at bob. sledge @ ncmail. net. Sincerely, Bob -Sledge Point Source Branch cc: Central Files i�ila ce/Surface Water Protection Section NPDES Files 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 NorthCarolina Phone: 919-807-6300 \ FAX: 919-807-6492 \ Customer Service:1-877-623-6748 Internet: www.ncwaterquality.org An Equal Opportunity \ Affirmative Action Employer Permit NCO055212 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT. AND NATURAL RESOURCES DIVISION OF WATER QUALITY PERMIT TO DISCHARGE WASTEWATER UNDER THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM In compliance with the 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, Auman's Mobile Home Park, LLC is hereby authorized to discharge wastewater from a'facility located at 3910-2 North Main Street High Point, North Carolina Forsyth County to receiving waters designated as Rich Fork 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 April 30, 2014. Signed this day. Coleen H. Sullins, Director Division of Water Quality By Authority of the Environmental Management Commission i Permit NC0055212 SUPPLEMENT TO PERMIT COVER SHEET All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of this permit issuance, any previously issued permit bearing this number is no longer effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements, terms, and provisions included herein. Auman's Mobile Home Park is hereby authorized to: 1. Continue to operate the existing 0.016 MGD wastewater treatment facility consisting of the following components: • Three 3,000-gallon septic tanks with 1,000-gallon pump tanks. • 6,000-gallon gravity fed septic tank • 2,000-gallon detention tank • 4,000-gallon final tank with two alternating pumps • Dual surface sandfilter • Ultraviolet disinfection • Chlorinator and Chlorine contact chamber (as backup disinfection) • Dechlorination (backup) The facility is located at Auman's Mobile Home Park, 3910-2 North Main Street, High Point, in Forsyth County. 2. Discharge treated wastewater from said treatment works at the location specified on the attached map into Rich Fork Creek (via outfall 001); which is classified C waters in the Yadkin -Pee Dee River Basin. -Human's Mobile Home Park - NCO055212 USGS.Quad- Name: Kernersville - Lat.: 36101'05" Receiving Stream: Rich Fork Creek Stream Class: C Lon 80003'00" Subbasin: Yadkin -Pee Dee - 030707 g" Facility Location -a . EEL..— �;7 Not to Scale Forsyth County Permit NCO055212 A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS . Beginning on the effective date of this 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: EFFLUENT "w LIMITS -MONITORING REQUIREMENTS CHARACTERISTICS} `s x ;Monthly Daily Measurement,,~ Sample ' ' S mple x '� ��., A Margum `� erequencp p L .: verage° n1Ty ocatiq Flow 0.016 MGD Weekly Instantaneous I or E BOD, 5-day, 200C 30.0 mg/L 45.0 mg/L 2/Month Grab E Total Suspended Solids 30.0 mg/L 45.0 mg/L 2/Month . Grab E NH3 as N 4.1 mg/L 20.5 mg/L 2/Month Grab E (April 1 - October 31) NH3 as N 14.5 mg/L 35.0 mg/L 2/Month Grab E (November 1 - March 31) Total Residual Chlorine2,3 28.0/rg/L 2/Week Grab E Fecal Coliform 200/100 ml 400/100 ml 2/Month Grab E (geometric mean) Dissolved Oxygen4 Weekly Grab E,U,D Temperature Weekly Grab E,U,D pH5 2/Month Grab E Total Nitrogen (TN) Quarterly Grab E Total Phosphorus (TP) Quarterly Grab E Notes: 1. Sample locations: E- Effluent, U- Upstream of outfall at least 100-feet, D- Downstream of outfall 0.2 miles. 2. TRC monitoring and limit applicable only if chlorine is used for disinfection. 3. The Division shall consider all effluent TRC values reported below 50 µg/L to be in compliance with the permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory (including field certified), even if these values fall below 50 µg/L. 4. The daily average dissolved oxygen effluent concentration shall not be less than 6.0 mg/l. 5. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units. There shall be no discharge of floating solids or foam visible in other than trace amounts. NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary April 28, 2009 Barbara N Aurrian Auman's Mobile Home Park LLC 3910-2 N Main St High Point NC 272651217 SUBJECT:... Compliance Evaluation Inspection Auman's Mobile Home Park WWTP Permit No: NCO055212 Forsyth County, Dear Ms. Auman: Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection conducted on April 22, 2009. The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem Regional Office. The facility was found to be in Compliance with permit NC0055212: Barbara Auman, ORC and Gerard Einig, backup ORC 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 Auman Mobile Home Park WWTP became effective May 1, 2004 and expires on April 2, 2009. The Division has received your renewal application and it is under 'review. The permitted components of the 0.016 MGD wastewater treatment plant include: three 3,000 gallon septic tanks with 1,000 gallon pump tanks, 6,000 gallon gravity fed septic tank, 2,000 gallon detention tank, 4,000 gallon final tank with two alternating pumps, dual surface sand filter, chlorinator, .chlorine contact chamber. An Authorization to Construct was issued by the Division in June 2005 for construction of the following modifications; installation of a new pump tank with two 0.5 HP pumps and two ultraviolet disinfection units. II. Records/Reports A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Auman Mobile Home Park WWTP for the period January 2008 through December 2008 revealed that the facility had no violations. Operations records include all sample analyses and process control tests that are performed. M. Facility Site Review The facility site review indicated that the 0.016 MGD treatment works is consistent with the permitted components. The actual treatment system consists of three 3,000 gallon septic tanks with 1,000 gallon pump tanks, 6,000 gallon gravity fed septic tank, 2,000 gallon detention tank, 4,000 gallon final tank with two alternating pumps, dual surface sand filter, chlorinator, chlorine contact chamber, pump tank with two 0.5 HP pumps and two ultraviolet disinfection units. North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 Phone: 336-771-50001 FAX: 336-771 A6301 Customer Service: 1-877-623-6748 Internet: www.ncwaterquality.org NorthCarohna An Equal Opportunity 1 Affirmative Action Employer IV. Effluent / Receiving Stream The WWTP discharges to Rich Fork Creek, which is a classified 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 Effluent flow is measured with the incoming fresh water meter. VI. Self -Monitoring Program A review of the discharge monitoring reports (DMRs) for the time period of January 2008 through December 2008 demonstrated that the Auman Mobile Home Park WWTP had no effluent violations. VH. Laboratory Field certification for Auman Mobile Home Park was current until.Decenmber 2009, certificate # 5432. Sample analyses are conducted by R & A Labs. The laboratory was not reviewed at the time of the subject inspection. Vffi. Operation and Maintenance Operation and maintenance at the time of the subject inspection were deemed satisfactory. The effluent was clear and free of visible solids. The effluent was clear and free of solids. IX. Sludge Utilization/Disposal . Solids are removed from the WWTP as necessary and were last removed by Jetco on December 10, 2008. X. Sewer Overflow None to report. The Division of Water Quality greatly appreciates your continued oversight at this facility. The Division also encourages you to continue to be proactive in your efforts to maintain compliance. Please refer to the enclosed inspection report for additional observations and comments. If you or your staff have any questions, please call Rose Pruitt at 336-771-5000. Sincerely, Steve W. Tedder Water Quality Regional Supervisor Winston-Salem Regional Office Division of Water Quality cc: Central Files WSRO 0 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 1 I NI 2 I sI 31 NCO055212 111 121 09/04/22 117 181 CI 19I SI 20t— Remarks 21IIIIIIIIIIIIIIIIIIIIIIIIIIII1IIIIIIIIIIIIIIII1J6 Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA------- - -----Reserved---------- 67 I 169 70 I I 711 I 721 NJ 73 L1J 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) 11:00 AM 09/04/22 05/05/01 Auman's Mobile Home Park WWTP Exit Time/Date Permit Expiration Date 3910-2 N Main St High Point NC 272651217 12:00 PM 09/04/22 09/04/30 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data " Barbara N Auman/ORC/919-883-3910/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Barbara N Auman,3910-2 N Main St 'High Point NC 272651217//336-883-39U. Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit N.Flow Measurement Operations & Maintenance 0 Records/Reports Self -Monitoring Program ® Facility Site Review N Effluent/Receiving Waters Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Rose Pruitt WSRO WQ//336-771-5000/ Signature of nagement A Reviewer Agency/Office/Phone and Fax Numbers Date K—Y611J. `{ a Y v f V- EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 1 3I NC0055212 I11 12I 09/04/22 I17 18ICI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) The inspector was met at the facility by the owner/ORC Barbara Auman and backup ORC. At the time of the inspection the facility appeared to be operating efficiently and the effluent was clear with only a trace of foam. The receiving stream appeared free of solids. All records were available and current. Page # 2 Permit: NCO055212 Owner- Facility: Auman's Mobile, Home Park WWTP Inspection Date: 04/22/2009 Inspection Type: Compliance Evaluation Operations & Maintenance Yes No NA ' NE , Is the plant generally clean with acceptable housekeeping? ■ n n n Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ n n n Judge, and other that are applicable?. Comment: Permit Yes No NA NE (If the present permit expires, in 6 months or less). Has the permittee submitted a new application? ■ n ❑ n Is the facility as described in the permit? ■ n n n # Are there any special conditions for the permit? ❑ n ■ n Is access to the plant site restricted to the general public? ■ n n n Is the inspector granted access to all areas for inspection? ■ n n n Comment: Record Keeping Yes No NA NE Are records kept and maintained as required by the permit? ■ Cl n n Is all required information readily available, complete and current? ■ n n ❑ - . Are all records maintained for 3 years (lab. reg. required 5 years)? n n n ■ Are analytical results consistent with data reported on DMRs? ■ n n ❑ Is the chain -of -custody complete? ■ ❑ n . n Dates, times and.location of sampling ■ Name of individual performing the sampling ■ Results of analysis and calibration ■ Dates of analysis ■ Name'of person performing analyses ■ Transported COCs ■ Are DMRs complete: do they include all permit parameters? ■ n n n Has the facility submitted its annual compliance report to users and DWQ? ■ Cl n n (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? n n ■ n Is the ORC visitation log available and current? ■ n n n Is the ORC certified at grade equal to or higher than the facility classification? ■ n n Is the backup operator certified at one grade less or greater than the facility classification? ■ n n n Is a copy of the current NPDES permit available on site? ■ n n n Page # 3 Permit: NC0055212 Owner - Facility: Auman's Mobile Home Park VWVFP Inspection Date: 04/22/2009 Inspection Type: Compliance Evaluation Record Keeping Yes No NA NE Facility has copy of previous year's Annual Report on file for review? ■ ❑ ❑ ❑ Comment: Effluent Pipe Yes No NA NE, Is right of way to the outfall properly maintained? ■ ❑ ❑ ❑ Are the receiving water free of foam other than trace amounts and other debris? ■ ❑ ❑ ❑ If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ ■ ❑ Comment: Flow Measurement- Influent Yes No NA NE # Is flow meter used for reporting? ■ ❑ ❑ ❑ Is flow meter calibrated annually? n ❑ ■ ❑ Is the flow meter operational? n n ❑ ■ (if units are separated) Does the chart recorder match the flow meter? ❑ ❑ ■ ❑ Comment: County fresh water meter used to determine flow Disinfection - UV Yes No NA NE Are extra UV bulbs available on site? ■ ❑ ❑ ❑ Are UV bulbs clean? ■ ❑ ❑ ❑ Is UV intensity adequate? ❑ ❑ ❑ ■ Is transmittance at or above designed level? ❑ ❑ ❑ ■ Is there a backup system on site? ■ ❑ n ❑ Is effluent clear and free of solids? ■ ❑ n n Comment: Sand Filters (Low rate) Yes No NA NE (If pumps are used) Is an audible and visible alarm Present and operational? ❑ ❑ n ■ Is the distribution box level and watertight? n n n ■ Is sand filter free of ponding? ■ ❑ ❑ n Is the sand filter effluent re -circulated at a valid ratio? ❑ n n ■ # Is the sand filter surface free of algae or excessive vegetation? ❑ n ❑ # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) n n n ■ Comment: Septic Tank Yes No NA NE Page # 4 Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 04/22/2009 Inspection Type: Compliance Evaluation Septic Tank Yes No NA NE (If pumps are used) Is an audible and visual alarm operational? n El ■ Is septic tank pumped on a schedule? ■ n n n Are pumps or syphons operating properly? ❑ ❑ n ■ Are high and low water alarms operating properly? n ❑ ❑ ■ Comment: Jetco 12/10/2008 Effluent Sampling Yes No NA NE Is composite sampling flow proportional? ❑ n ■ ❑ Is sample collected below all treatment units? ■ n ❑ ❑ Is proper volume collected? n ❑ ■ n Is the tubing clean? ❑ n ■ n # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? ❑ n ■ [I Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ n n ❑ Comment: Upstream / Downstream Sampling Yes No NA NE Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ n n ❑ Comment: Page # 5 Faxed To: Barbara Auman Fax #: 883-3819 Phone 883-3910 VWIITP Annual Inspection Checklist This information should be available to the inspector at inspection time. Facility: Auman MHP NPDES: NC0055212 Permit Effective Dates: 510112004 to 413012009 Inspection Date: April 22 , 2009 Inspection Time: 11:00 am ',-'1) DMRs (Dates: January 2008 to December 2008 ) ,/2) Lab Data (per DMR dates) .i3) Laboratories used for analysis & certification #'s M-4 Chain of Custody forms (per DMR dates) V 5) Complete copy of current NPDES permit issuance (if applicable) ✓7) ORC and Back-up ORC current certification ,/ 8) Wastewater Annual Report (fiscal or calendar year — if applicable) ,r 9) Daily Operator's log / ORC visitation log --TO) Maintenance log c/1r1) Process control data (which includes field parameters tested and equipment calibrations) V12) Field Parameter certification (if applicable) lfi��f Zj7, L,13) Flow meter calibration records (if applicable) jA)_---[nfttrentand/ore#auent samplers ks ✓17) Spill Response Plan (with current emergency contact numbers) �18) Sludge / Residuals hauling records (if applicable) 3eTGO /g-/g 08 -,19) Plant visual inspection of treatment units t_., 20) 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 (336) 771-5000 Fax: (336) 771-4630 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 ► ,4 May 15, 2008 CERTIFIED MAIL 7007 3020 0000 6279 6979 RETURN RECEIPT REQUESTED Barbara N Auman Auman's Mobile Home Park LLC 3910-2 N Main St High Point NC 272651217 SUBJECT: Compliance Evaluation Inspection Auman's Mobile Home Park WWTP Permit No: NC0055212 Forsyth County Dear Ms. Auman: Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection conducted on May 8, 2008, The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem Regional Office. The facility was found to be in Compliance with permit, NC0055212. Barbara Auman, ORC and Gerard Emig, backup ORC 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 Auman Mobile Home Park WWTP became effective May 1, 2004 and expires on April 2, 2009. The permitted components of the 0.016 MGD wastewater treatment plant include: three 3,000 gallon septic tanks with 1,000 gallon pump tanks, 6,000 gallon gravity fed septic tank, 2,000 gallon detention tank, 4,000 gallon final tank with two alternating pumps. - dual surface sand filter, chlorinator, chlorine contact chamber. An Authorization to Construct was issued by the Division in June 2005 for construction of the following modifications; installation of a new pump tank with two 0.5 HP pumps and two ultraviolet disinfection units. II. Records/Reports A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Auman Mobile Home Park WWTP for the period January 2007 through December 2007 revealed that the facility had no violations. Operations records include all sample analyses and process control tests that are performed. III. Facility Site Review The facility site review indicated that the 0.016 MGD treatment works is consistent with the permitted components. The actual treatment system consists of three 3,000 gallon septic tanks " with 1000 gallon um tanks 6>000 gallon gravity fed septic tank, 2,000 gallon detention tank, NTDEh;� ..,,R.ri wai,nhtnwn street Winston-Salem, NC 27107 Phone (336) 771-5000 Fax (336) 771-4630 Auman MHP Page 2 1 Mai 15, 2008 4,000 gallon final tank with two alternating pumps, dual surface sand filter, chlorinator, chlorine contact chamber, pump tank with two 0.5 HP pumps and two ultraviolet disinfection units. IV. Effluent / Receiving Stream The WWTP discharges to Rich Fork Creek, which is a classified 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 Effluent flow is measured with the incoming fresh water meter. VI. Self -Monitoring Program A review of the discharge monitoring reports (DMRs) for the time period of January 2007 through December 2007 demonstrated that the Auman Mobile Home Park WWTP had no effluent violations. VII. Compliance Schedules No compliance schedules to evaluate. VIII. Laboratory Field certification for Auman Mobile Home Park was current until Decenmber 2008, certificate # 5432. Sample analyses are conducted by R & A 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. The effluent was clear and free of visible solids. The septic tank had been pumped down by a licensed hauler in December of 2005. The effluent was clear and free of solids. X. Sludge Utilization/Disposal Solids are removed from the WWTP as necessary by a licensed contract hauler (Jetco- November 14, 2007) and disposed of properly. XI. Pretreatment Not evaluated during this inspection. No pretreatment program required. XII. Stormwater Not evaluated during this inspection. M XIV. Sewer Overflow None to report. Auman MHP Page 3 May 15, 2008 XV. Pollution Prevention Not evaluated during this inspection. XVI. Multimedia Not evaluated during this inspection. The Division of Water Quality greatly appreciates your continued oversight at this facility. The Division also encourages you to continue to be proactive in your efforts to maintain compliance. Please refer to the enclosed inspection report for additional observations and comments. If you or your staff have any questions, please call Rose Pruitt at 336-771-5000. Sincerely, Steve W. Tedder Water Quality Regional Supervisor Winston-Salem Regional Office Division of Water Quality cc: Central Files OR United States Environmental Protection Agency Form Approved. r E P ^H 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 3I N00055212 111 121 08/05/08 117 181 CI 191 SI 20I II Remarks 211IIIIIIIIIII IIIIIIII I I I I I I I I I I I I I I I I I I I I I I I I II16 Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA --------------------------- Reserved ---------------------- 67 I 169 701 I 711 I 72 I N I 73 I I 174 751 I I I I I I 180 w Section 6: 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) 09:30 AM 08/05/08 05/05/01 Auman's Mobile Home Park WWTP Exit Time/Date Permit Expiration Date 3910-2 N Main St High Point NC 272651217 10:50 AM 08/05/08 09/04/30 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Barbara N Auman/ORC/919-883-3910/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Barbara N Auman,3910-2 N Main St High Point NC 272651217//336-883-391r0/ Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program ® Sludge Handling Disposal ® Facility Site Review Effluent/Receiving Waters Section D: Summary of Finding/Comments (Attach additional sheets of narrative.and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Rose Pruitt WSRO WQ//336-771-5000/ ��''ij� J Y � ✓✓✓��V�LI��r Signature of Manage nt AReview Agency/Office/Phone and Fax Numbers Date �Qf u EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 1 3I NC0055212 I11 12I 08/05/08 117 18ICI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) The inspector was met at the facility by the owner/ORC Barbara Auman and the backup ORC. At the time of the inspection the facility appeared to be operating efficiently and the effluent was clear with only a trace of foam. The receiving stream appeared free of solids. All records were available and current. Page # 2 d Permit: NCO055212 Inspection Date: 05/08/2008 Owner - Facility: Auman's Mobile Home Park VWVfP 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 ❑ Is the facility as described in the permit? ®n # Are there any special conditions for the permit? n n ® ❑ Is access to the plant site restricted to the general public? n ❑ ■ ❑ Is the inspector granted access to all areas for inspection? Comment: Record Keeping Are records kept and maintained as required by the permit? Is all required information readily available, complete and current? Are all records maintained for 3 years (lab. reg. required 5 years)? Are analytical results consistent with data reported on DMRs? Is the chain -of -custody complete? Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses Transported COCs Are DMRs complete: do they include all permit parameters? Has the facility submitted its annual compliance report to users and DWQ? (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? Is the ORC visitation log available and current? Is the ORC certified at grade equal to or higher than the facility classification? Is the backup operator certified at one grade less or greater than the facility classification? Is a copy of the current NPDES permit available on site? ■nnn ®nnn ■nnn ®nnn. ■n.nn ■nnn ■ ■ ■ ■ ■ ®nnn ■nnn nn■n ■nnn ■nnn ®nnn ■nnn Page # 3 Y ` ' e y A. Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 05/08/2008 Inspection Type: Compliance Evaluation Record Keeping Yes No NA NE Facility has copy of previous year's Annual Report on file for review? ® n n n Comment: Effluent Pipe Yes No NA NE Is right of way to the outfall properly maintained? ® n n n Are the receiving water free of foam other than trace amounts and other debris? ® n n n If effluent (diffuser pipes are required), are they operating properly? n n Comment: Flow Measurement - Effluent Yes No NA NE ® n n n # Is flow meter used for reporting? Is flow meter calibrated annually? n n ❑ 0. Is the flow meter operational? n ❑' n (If units are separated) Does the chart recorder match the flow meter? ❑ n ® n Comment: Uses county water meter for flow De -chlorination Yes No NA NE Type of system ? Tablet Is the feed ratio proportional to chlorine amount (1 to 1)? n n ® n Is storage appropriate for cylinders? n n ® n # Is de -chlorination substance stored away from chlorine containers? n n n Are the tablets the proper size and type? n n n ■ Comment: back up only Are tablet de -chlorinators operational? ■ n n n Number of tubes in use? 0 Comment: back up only. 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? F1 n n ■ Are pumps or syphons operating properly? n n n ■ Are high and low water alarms operating properly? ® n n n Comment: last pumped by Jetco 11/14/07 Sand Filters (Low rate) Yes No NA NE Page # 4 s Permit: NCO055212 Owner - Facility: Auman's Mobile Home Park WWTP Inspection Date: 05/08/2008 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? ®n n n Is sand filter free of ponding? ®❑ n n Is the sand filter effluent re -circulated at a valid ratio? n n n # Is the sand filter surface free of algae or excessive vegetation? ®n n n # Is the sand .filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) n n n Comment: 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 # Is the facility using a contract lab? ■ n n # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n 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 ® n Comment: R&A Disinfection -Tablet Yes No NA NE ■ n n n Are tablet chlorinators operational? Are the tablets the proper size and type? n n n ■ Number of tubes in use? 0 n n ■ ❑ Is the level of chlorine residual acceptable? Is the contact chamber free of growth, or sludge buildup? ❑ n ■ n Is there chlorine residual prior to de -chlorination? n n ■ n Comment: backup only Effluent Sampling Yes No NA NE Is composite sampling flow proportional? n n n ■ Is sample collected below all treatment units? ■ n n n Is proper volume collected? n n n ■ n n ■ n Is the tubing clean? # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n ■ n Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ n n n Page # 5 k n Permit: NCO055212 Inspection Date: 05/08/2008 Owner - Facility: Auman's Mobile Home Park WWfP Inspection Type: Compliance Evaluation Effluent Sampling Comment: Yes No NA NE Upstream / Downstream Sampling Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ®Q ❑ Comment: 0 Page # 6 ` Y Compliance Inspection Report Permit: WQCSD0198 Effective: 03/01/00 Expiration: Owner: Auman's Mobile Home Park LLC SOC: Effective: Expiration: Facility: Auman's MHP Collection System County: Forsyth Region: Winston-Salem Contact Person: Barbara N Auman Title: Phone: 336-883-3910 Directions to Facility: System Classifications: PrimaryORC: , Secondary ORC(s): On -Site Representative(s): Related Permits: Inspection Date: 05/08/2008 Entry Time: 09:30 AM Primary Inspector: Rose Pruitt Secondary Inspector(s): Certification: Exit Time: 10:50 AM Phone: Phone: 336-771-5000 Reason for Inspection: Routine Inspection Type: Compliance Evaluation Permit Inspection Type: Deemed permitted collection system management and operation Facility Status: ❑ Compliant ■ Not Compliant . Question Areas: Miscellaneous Questions Operation & Maint Reqmts Records ■ Monitoring & Rpting Regmts Inspections Pump Station Lines (See attachment summary) Page: 1 Permit: WQCSD0198 Owner - Facility: Auman's Mobile Home Park LLC Inspection Date: 05/08/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine Inspection Summary: Page: 2 Permit: VVQCSDO198 Owner - Facility: Auman's Mobile Home Park LLC Inspection Date: 05/08/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine Inspections Yes No NA NE Are maintenance records for sewer lines available? ■ ❑ 0 Are records available that document pump station inspections? ■ 0 Are SCADA or telemetry equipped pump stations inspected at least once a week? ❑ ❑ ■ Are non-SCADA/telemetry equipped pump stations inspected every day? ❑ fl ■ Are records available that document citizen complaints? n n ■ n # Do you have a system to conduct an annual observation •of entire system? ■ # Has there been an observation of remote areas in the last year? n n ■ n Are records available that document inspections of high -priority lines? n n ■ n Has there been visual inspections of high -priority lines in last six months? ❑ ❑ ■ Comment: Operation & Maintenance Requirements Yes No NA NE Are all log books available? ■ ❑ ❑ Does supervisor review all log books on a regular basis? ■ ❑ ❑ n Does the supervisor have plans to address documented short-term problem areas? n n ■ n What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas? daily Are maintenance records for equipment available? ■ n n n Is a schedule maintained for testing emergency/standby equipment? ■ n n n What is the schedule for testing emergency/standby equipment? weekly Do pump station logs include Inside and outside cleaning and debris removal? ■ n n n Inspecting and exercising all valves? ■ Inspecting and lubricating pumps and other equipment? ❑ ❑ ■ ❑. Inspecting alarms, telemetry and auxiliary equipment? n n ■ n Is there at least one spare pump for each pump station w/o pump reliability? ■ n n n Are maintenance records for right-of-ways available? ■ n n n Are right-of-ways currently accessible in the event of an emergency? ■ n n n Are system cleaning records available? ■ ❑ ❑ Has at least 10% of system been cleaned annually? ■ n n n Page: 3 Permit: WQCSDO198 Owner - Facility: Auman's Mobile Home Park LLC Inspection Date: 05/08/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine What areas are scheduled for cleaning in the next 12 months? 52-64, 53-65 Is a Spill Response Action Plan available? ®❑ fl ❑ Does the plan include: 24-hour contact numbers ■ n n n Response time ❑ ❑ ■ ❑ Equipment list and spare parts inventory n n ■ n Access to cleaning equipment ■ ❑ fl Access to construction crews, contractors, and/or engineers n n ■ n Source of emergency funds nn■n Site sanitation and cleanup materials ■ 0 ❑ ❑ Post-overflow/spill assessment ■ ❑ ❑ Q Is a Spill Response Action Plan available for all personnel? ■ n n n Is the spare parts inventory adequate? ■ n n n a Comment: Records Yes No NA NE Are adequate records of all SSOs, spills and complaints available? ❑ ❑ ■ Are records of SSOs that are under the reportable threshold available? 0 0 ■ Do spill records indicate repeated overflows (2 or more in 12 months) at same location? n n ■ n If yes, is there a corrective action plan? ❑ ❑ ■ Is a map of the system available? ■ n n n Does the map include: Pipe sizes ■ n n n Pipe materials ® ❑ ❑ ❑ Pipe location ■ Flow direction ■ Approximate pipe age ■ n n n Number of service taps ■ n n n Pump stations and capacity ■ n n n If no, what percent'is complete? Page: 4 Permit: WQCSD0198 Owner - Facility: Auman's Mobile Home Park LLC Inspection Date: 05/08/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine List any modifications and extensions that need to be added to the map # Does the permittee have a copy of their permit? Comment: Monitoring and Reporting Requirements Are copies of required press releases and distribution lists available? Are public notices and proof of publication available? # Is an annual report being prepared in accordance with G.S. 143-215.1 C? # Is permittee compliant with all compliance schedules in the permits? If no, which one(s)? Comment: grease education material nn■n Page: 5 Permit: VVQCS00190 Owner - Facility: Tim Horner Inspection Date: 10/17/2007 Inspection Type: Compliance Evaluation Reason for Visit: Routine Inspections Yes No NA NE Are maintenance records for sewer lines available?Vf n n n Are records available that document pump station inspections? n n n n nZ Are SCADA or telemetry equipped pump stations inspected at least once a week? Are non-SCADA/telemetry equipped pump stations inspected every day? n n n Are records available that document citizen complaints? n — �I n # Do you have a syslcm to corulucl an annual observation of entire ,.;yster i? # Has there been an observation of remote areas in the last year? n ❑ x n Are records available that document inspections of high -priority lines? ❑ n n Has there been visual inspections of high -priority lines in last six months? n n f1J L rl Comment: Operation & Maintenance Requirements Yesrn No NA NE n f] n Are all log books available? Does supervisor review all log books on a regular basis? Does the supervisor have plans to address documented short-term problem areas? ❑ n What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas? At L� Are maintenance records for equipment available? �( n n n Is a schedule maintained for testing emergency/standby equipment? t n n What is the schedule for testing emergency/standby equipment? Do pump station logs include: Inside and.outside cleaning and debris removal? n n n n' n Inspecting and exercising all valves? Inspecting and lubricating pumps and other equipment? n n Inspecting alarms, telemetry and auxiliary equipment? n n r n Is there at least one spare pump for each pump station w/o pump reliability? ❑ n n Are maintenance records for right-of-ways available? ❑ ❑ n Are right-of-ways currently accessible in the event of an emergency? (,� n n n Are system cleaning records available? n n n Has at least 10% of system been cleaned annually?I Page: 3 Permit: WQCSDO190 Owner - Facility: Tim Horner Inspection Date: 10/17/2007 Inspection Type: Compliance Evaluation Reason for Visit: Routine What areas are scheduled for cleaning in the next 12 months?� (� 7 �� J �G-12 Is a Spill Response Action Plan available? n n n Does the plan include: 24-hour contact numbers n n n Response time n n 't n Equipment list and spare parts inventory n n n Access to cleaning equipment f l n M 17-1 Access to construction crews, contractors, and/or engineers n n / n Source of emergency funds n n n Site sanitation and cleanup materials Post-overflow/spill assessment n n n Is a Spill Response Action Plan available for all personnel? I I n n n Is the spare parts inventory adequate? n n n Comment: Records Yes No NA NE Are adequate records of all SSOs, spills and complaints available? n n Are records of SSOs that are under the reportable threshold available? n n n Do spill records indicate repeated overflows (2 or more in 12 months) at same location? n n n If yes, is there a corrective action plan? n n n Is a map of the system available? fZl' n n n Does the map include: Pipe sizes �1 n n n Pipe materials n n n Pipe locationI n n n Flow direction n n Approximate pipe age Number of service taps ❑ n ❑ Pump stations and capacity I�I n n n J If no, what percent is complete? Page: 4 Permit: WQCSD0190 Owner - Facility: Tim Horner Inspection Date: 10117/2007 Inspection Type: Compliance Evaluation Reason for Visit: Routine List any modifications and extensions that need to be added to the map # Does4be-permsi i� par atom- '[ram Comment - Monitoring Monitoring and Reporting Requirements Are copies of required press releases and distribution lists available? Are public notices and proof of publication available? ft Is an annual report being prepared in accordance with G.S. 143-215.1 C? # Is permittee compliant with all compliance schedules in the permits? If no, which one(s)? Comment: Pump Station Pump station type Are pump station logs available? Is it accessible in all weather conditions? # Is general housekeeping acceptable? Are all pumps present? Are all pumps operable? Are wet wells free of excessive debris? Are upstream manholes free of excessive debris/signs of overflow? Are floats/controls for pumps/alarms operable? Is "auto polling" feature/SCADA present? Is "auto polling" feature/SCADA operational? Is simple telemetry present? Is simple telemetry operational? Are audio and visual alarms present? Are audio and visual alarms operable? Is the Pump station inspected as required? Are backflow devices in place? nnnn �l'nnn �nnn nnn nnnn r�i'nnn n n X, nnY1n nn,�in nnnn nn�in nn+n nnnn nri�n nnnn nnn nnPn Page: 5 v Permit: VVQCSD0190 Owner - Facility: Tim Horner Inspection Date: 10/1712007 Inspection Type: Compliance Evaluation Reason for Visit: Routine yAre n n backflow devices operable?'❑ Are air relief valves in place? n n n nnrn Are air relief valves operable? n n n # Is an emergency generator available? n n n Can the emergency 9enerator run the pumps? Is the pump station equipped for quick hook-up? n n n Is the generator operable? ❑ n n # Is fuel in tank and sufficient? . n n n Is the generator inspected according to their schedule? Is a 24-hour notification sign posted? n ❑ ❑ n Does it include: Instructions for notification? Pump station identifier? Emergency phone number Is public access limited? Is pump station free of overflow piping? Is the pump station free of signs of overflow? Are run times comparable for multiple pumps? Comment. - Is Education Program for grease established and documented? What educational tools are used? (Reg. says distribute info.twice/year) kvl6r Is system free of known points of bypass? V_, 2 If no, describe type of bypass and location. Z n n n nnfLin �I.nnn nn�in �!nnn nnn G Faxed To: Barbara Auman Fax #: 883-3811 Phone 883-3910 WWTP Annual Inspection Checklist This information should be available to the inspector at inspection time. Facility: Auman MHP NPDES: NC0055212 Permit Effective Dates: 510112004 to 413012009 Inspection Date: Thurs May 8, 2008 Inspection Time: O"00 am ,'1) DMRs (Dates: January 2007 to December 2007 ) 1,2) Lab Data (per DMR dates) .i3) Laboratories used for analysis & certification #'s �4) Chain of Custody forms (per DMR dates) ✓5) Complete copy of current NPDES permit atus of SOC or Moratorium issuance (if applicable) 0/7) ORC and Back-up ORC current certification v/8) Wastewater Annual Report (fiscal or calendar year - if applicable) ti9) Daily Operator's log / ORC visitation log v-10) Maintenance log ,/11) Process control data (which includes field parameters tested and equipment calibrations) ,�,,12) Field Parameter certification (if applicable)°532 ✓13) Flow meter calibration records (if applicable) 14) Influent and/or effluent samplers 4.5-)--Fb harts (if applicable) ►/ 1:6) -_ Generator Inspection / under load checks .--17) Spill Response Plan (with current emergency contact numbers) P1 18) Sludge / Residuals hauling records (if applicable) /1 /Zf-a -7 -� 19) Plant visual inspection of treatment units 20) '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 (336) 771-5000 Fax: (336) 771-4630 r vV, S COLLECTION SYSTEM INSPECTION CHECKLIST To: Barbara Auman Facility: Auman MHP Fax #: 883-3811 Inspection Date 05/08/2008 Inspection Time: 9 am Please have the following information available for the inspector: 1. Sanitary Sewer Overflows (SSOs) - Number of SSOs in the past 12 months and copies of reports - Copies of public notice for all spills over 15,000 gallons - Copies of press release for all SSOs reaching surface water & over 1,OOO gallons 1 2. Current Collection System Map with the following information: - Approximate age of sewer lines - Line size - Pipe material - Flow direction - Pump stations - Major tap locations of satellite systems - Annual updates - Construction drawings if available - Length of sewers 3. Grease Control Program - Copies of the educational materials that have been distributed 4. High Priority Sewer Lines (i.e. suspended, in channel, or under body of water) - Inspection log that includes: date, inspection method and corrective actions 5. Operation & Maintenance Plan with the following information: - Pump station inspection frequency - Preventative maintenance sched. - Spare parts inventory - Overflow response plan - Schedule to test emergency equip. 6. Pump Station Inspections & Maintenance — show evidence of the following tasks:_ - Removal of interior and exterior debris as needed - Exercising of all valves - Lubrication of pumps & mechanical equipment - Operation of alarms, telemetry, and generator - Pump / power failure contingency' plan posted at pump station Have this information available for inspector: Total # Pump Stations: # Pump Stations with telemetry: # Pump Stations w/out telemetry: # Pump Stations with emergency contact information posted: 7. Right-of-ways and easements maintenance Provide any maintenance logs or maps to show progress 8. Sewer line cleaning (should be performed on 10% of lines per year if any overflows) Provide any maintenance logs or maps to show progress 9. General observation of entire system (should be performed on an annual basis) Provide any maintenance logs or maps to show progress 10. All records should be maintained for 3 years INA 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 August 15, 2008 Barbara N. Auman Auman's Mobile Home Park LLC 3910-2 N Main St High Point, NC 27265-1217 RECEIVED I N.C. Deot. of ENR 11 Winston-Salem Regional Office Subject: Renewal Notice NPDES Permit NCO055212 Auman's Mobile Home Park WWTP Forsyth County Dear Permittee: Your NPDES permit expires on April 30, 2009. Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105 (e)) regulations state that_ permit renewal applications must be filed at least 180 days prior to expiration of the current permit. If you have already mailed your renewal application, you may disregard this notice. Your renewal package must be sent to the Division_ postmarked no later than November 1, 2008. Failure to request renewal by this date may result in a civil penalty assessment. Larger penalties may be assessed depending upon the delinquency of the request. If any wastewater discharge will occur after April 30, 2009, the current permit must be renewed. Discharge of wastewater without a valid permit would violate North Carolina General Statute 143-215.1; unpermitted discharges of wastewater may be assessed civil penalties of up to $25,000 per day. If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact me at the telephone number or address listed below. Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must submit with the permit renewal application. If you have any questions, please contact me at the telephone number or.e-mail address listed below. Sincerely, Charles H. Weaver, Jr. NPDES Unit CentralFiles.D 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One 512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarolina ina Phone: 919 807-6391 / FAX 919 807-6495/.charles.weaver@ncmail.net Amorally An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper NPDES PERMIT NCO055212 ADMAN'S MOBILE HOME PARK WWTP FORSYTH COUNT' The following items are REQUIRED for all renewal packages: ➢ A cover letter requesting renewal of the permit and documenting any changes at the facility since issuanceof the last permit. Submit one signed original and two copies. ➢ The completed application form (copy attached), signed by the permittee or an Authorized Representative. Submit one signed original and two copies. ➢ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares the renewal package, written documentation must be provided showing the authority delegated to any such Authorized Representative (see Part II.B.11.b of the existing NPDES permit). ➢ A narrative description of the sludge management plan for the facility. Describe how sludge (or other solids) generated during wastewater treatment are handled and disposed. If your facility has no such plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed original and two copies. The following items must be submitted by and Municipal or Industrial facilities discharging process wastewater: Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal Regulations, Part 122) and ALL Municipal facilities with a permitted flow ? 1.0 MGD must submit a Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21. The above requirement does NOT apply to privately owned facilities treating 100% domestic wastewater, or facilities which discharge non process wastewater (cooling water, filter backwash, etc.) Send the completed renewal package to: Mrs. Dina Sprinkle NC DENR / DWQ / Point Source Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Michael F. Easley, Governor William G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resources November 13, 2008 BARBARA N ADMAN OWNER AND ORC AUMAN MOBILE HOME PARK LLC 3910-2 NORTH MAIN STREET HIGH POINT NC 27265 Dear Ms. Auman: Coleen H. Sullins, Director Division of Water Quality Rc- cc- IVvP N.C. Dept. of rNR NOY 17 2008 Winston-Salem Regional Office Subject: Receipt of permit renewal application NPDES Permit NCO055212 Auman's Mobile Home Park W VIT Forsyth County The NPDES Unit received your permit renewal application on October 31, 2008. A member of the NPDES Unit will review your application. They will contact you if additional information is required to complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing permit expires. If you have any additionalquestions concerning renewal of the subject permit, please contact Robert Sledge at (919) 807=6398. Sincerely, Dina Sprinkle NPDES Unit cc: CENTRAL FILES tea -S.a�lem Rrepk /Surface Water Protection NPDES Unit Mailing Address Phone (919) 807-6300 Location None hCarolina 1617 Mail Service Center Fax (919) 807-6492 512 N. Salisbury St. WtlfIYMIIdf Raleigh, NC 27699-1617 Raleigh, NC 27604 Internet: www.ncwateraualitv.or¢ Customer Service 1-877-623-6748 An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper M October 28, 2008 Mrs. Dina Sprinkle NCDENR/Water Quality/Point Source Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Subject: Renewal Permit Request Auman Mobile Home Park LLC WWTP NPDES Permit NC0055212 Forsyth County Dear Mrs. Dina Sprinkle, Barbara N. Auman Auman Mobile Home Park LLC 3910-2 North Main Street High Point, NC 27265 4 ` k OCT 3 1 2008 r This is a cover letter requesting renewal of the permit #0055212 for Auman Mobile Home Park LLC, WWTP, Forsyth County. The current Permit expires April 30, 2009. There has been an ultraviolet system installed at the facility since issuance of the last permit. Auman Mobile Home Park LLC operates a system consisting of septic tanks, sand filter ultraviolet disinfection system, with chlorinator and decholorinator unit for back up. Our sludge management plan is contracted by a license septic tank service company, to pump and dispose of our sludge from our septic tanks. This is done on a regular basis; once a year or more often when needed. Thank you for your consideration in the permit renewal. Sincerely; Barbara N. Auman Permittee and ORC For Auman Mobile Home Park LLC NPDES APPLICATION - FORM D For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD Mail the complete application to: N. C. DENR / Division of Water Quality / NPDES Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 NPDES Permit #coo If you are completing this form in computer use the TAB key or the up - down arrows to move from one field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type. 1. Contact Information: Owner Name 16!4AV,04 Facility Name Al'YA&I Mailing Address 39 /D - 1 City7- State / Zip Code N e Telephone Number (334) F9 q Fax Number (330 gg 3 - 3 91/ e-mail Address 2. Location of facility producing discharge: Check here if same address as above [ Street Address or State Road City ate ip o e County is P0!rri :nfil.,i. 3. Operator Information: Name of the firm, public organization or other entity that operates the facility. (Note that this is not referring to the Operator in Responsible Charge or ORC) Name Mailing Address City . State / Zip Code Telephone Number Fax Number -5514mE AS A6'o•V IF 1 of 3 Form-D 05/08 NPDES APPLICATION - FORM D For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD 4. Description of wastewater: Facility Genesatin Wastewater(check all that applyr Industrial ❑ Number of Employees Commercial ❑ Number of Employees Residential ® Number of Homes School ❑ Number of Students/Staff Other ❑ Explain: T7 5T/�AC c s - �u R,qEaTry- SS S'J A a E S oeeylEd) Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers, restaurants, etc.): %ob k Population served: !/1? ao o fio a.So S. Type of collection system (✓�4PnaratP (sanitary sewer only) F1 Combined (storm sewer and sanitary sewer) 6. Outfall Information: Number of separate discharge points i Outfall Identification number(s) Do 1 Is the outfall equipped with a diffuser? ❑ Yes ['Ivo -7. Nacre o receiving s reams wide map showinig ize-exactlucati of each otctfali . l?t c.l ro,4 /f C 4 E EK S. Frequency of Discharge: LJ Continuous [9—Intermirtent If intermittent: Days per week discharge occurs: 7 Duration:�e- 9. Describe the treatment system List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a separate sheet of paper. S�Jn/d `r[TGR—31000964 SYFrle- ia✓ks-i- /Oeogdl-./JuvhrA�q�/ks - 61ao0 S e,147-? e---"I,) k , e Ra v fTY d [�� poo iFL - u p fi4NK �/ a �Tr �e �� 7�':Uq au �yPs ,t, Sf�,vd /=i Zre4 �ED s iZ < 3 o d ivld ed iNfv �D/"%. .5 ecL7t tonJ_s . S �'LvGA 6-AT-e2 A"014 iNs d'wto y ,spo dui ldliVj - a LtLt(�iF �IoLcfi tc.tJt�5 /idvu7`�oo�/, %�i �_ /?"cA 1-:7014k (2AEEk. ch 2 of 3 Form-D 05/08 NPDES APPLICATION - FORM D For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD 10. Flow Information: Treatment Plant Design flow 0/ 4 MGD Annual Average daily flow MGD (for the previous 3 years) Maximum daily flow , oo$.S- MGD (for the previous 3 years) 11. Is this facility located on Indian country? ❑ Yes 9-No 12. Effluent Data _ �rE ,�, -S p,* -T- p Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum and monthly average. If only one analysis is reported, report as daily maximum. Parameter Daily Maximum Monthly IUnits of Average Measurement Biochemical Oxygen Demand (BOD5) Fecal Coliform Total Suspended Solids Temperature (Summer) Temperature (Winter) pH 13. List all permits, construction approvals and/or applications: -- - ---- ------ - - -=-- erm um et Hazardous Waste (RCRA) UIC (SDWA) PSD (CAA) Non -attainment program (CAA) 14. APPLICANT CERTIFICATION NESHAPS (CAA) Ocean Dumping (MPRSA) , _ -; Other OCT 3 1 2008 14ai'MT QUA -LIT I certify that I am familiar with the information contained in the_ap-plicafionjandEt lik best of my knowledge and belief such information is true, complete, and accurate. SW"414 IV 4Uth I -A/ A Printed name of Person Signing Title It -Z" ture of Applicant _ jI_ Date North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.) 3of3 Form-D 05/08 V k k 4 0 A % oil 0 V5, 11-- ZA I If & x" XVI* Y 4, 4%11 I" -'Vh,, 4,1 1/ "1 )dd U'r DLqrliairge t' Locadm Jt f 7i! "Tiff *hot __4*1 171 it V!k �KA'R iN, jb -N X, f 77, f vyu .4 ity, 7; 96) t.x If T I' up 4? jr, J /44 J. ir ' V 7 r, gh Auman's Mobile Home Park - NCO055212 Facility �T Location USGS Quad Name: Kernersville Lat.: 36001'05" Receiving Stream: Rich Fork Creek Long.: 80003 1 001, Stream Class: C Subbasin: Yadkin -Pee Dee - 030707 Not to SCALE ■ Complete items-1, 2, and 3. Also.complgte; ,,:'• A.,Whatu - j item 4 if Restricted Delivery is desired: ■ Print your name and address on the reverse X so that we can return the card to you. B. Received by (Printed Name) ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Barbara Auman Auman's Mobile Home Park 3910-2 North Main Street High Point, NC 27265A217 0 VAgent Date of Deliver. D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. S mice Type Certified Mail Express Mail Registered Retum Receipt for Merchandisi ❑ Insured Mail C.O.D. 4. Restricted Delivery? (Extra Fee) , ❑ Yes 700;7 ;3�2�;(p PP'i6,27fl 69791i t1i1(d 1i P8 Fb�m138111. Febrd&Vb ob4i I I I I !Domestic R6turn Receipt i .n 0 &- 102595-02-M-1& ,,��r�i.��,FiiijS'rrdti UNITED STATES F'65TA1"�RVICE ))l%aUh:1+7543.5{�leJ.1i11�':i:<t%x.�J • Sender: Please print your name, address, and ZIP+4 in this box • NCDENR- Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107