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Home My WebLink AboutNC0056791_Regional Office Historical File Pre 2016N.C.Dept. of ENR JAN 2 3 2015 �® ®EN L_lRe ston-5alemNC Tonal Office North Carolina Department of Environment and Natural Resources Pat McCrory Donald van der Vaart Governor Secretary January 5, 2015 Mr. Norris Z. Clayton Hugh Creed Associates, Inc. P.O. Box 9623 Greensboro, NC 27429-9623 Subject: Rescission of NPDES Permit N00056791 Horizons Residential Care Center WWTP Forsyth County Dear Mr. Clayton: The Division has reviewed your permit rescission request received on December 5, 2014. The Division has no objection to your request. Therefore, NPDES permit NCO056791 is rescinded, effective immediately. If in the future your organization wishes to discharge wastewater to the State' s surface waters, it must first apply for and receive a new NPDES permit. If you have any questions concerning this matter, please contact Charles H. Weaver at (919) 807-6391 or via e-mail [charies.weaver@ncdenr.gov]. agincely, �homas A. Reede Director Division of Water Resources cc: Central Files Winsto%i S`a�le Regional OLii e / Ron IV S IIni " Teresa Revis / Budget 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604 Phone: 919 807-6300 / FAX 919 807-6489 / Internet: www.ncwaterquality.org An Equal Opportunity/Affirmative Action Employer- 501/6 Recycled/10% Post Consumer Paper HOR IONS Residential -Care Center 100 Horizdns Lane Rural Hall, NC 27045 • (336) 767-2411 Pax (336) 661=2185 April 4, 2014 Wastewater Branch Water Quality Permitting Section Division of Water Resources. 1617 Mail Service Center Raleigh, NC 27699-1617 Subject:. Delegation of Signature Authority Horizons Residential Care Center WWTP NPDES Number NCO056791 To Whom It May Concern: By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all permit applications, discharge monitoring reports, and other information relating to the . operations at Horizons Residential Care Center WWTP required by all applicable federal, state, and, local environmental agencies specifically with the requirements for. signatory authority as specified in 15A NCAC 2B:0506. James M. Cheshire President/CEO Research & Analytical Laboratories, Inc. If you have any questions regarding this letter, please feel free to contact James Cheshire at 336- 996-2841. Sincerely, David Adams President/CEO Horizons Residential Care Center cc: Winston-Salem Regional Office, Water Quality Permitting Section www.HorizonsCenter.org iai�'-u o gl. P MCDENR Borth Carolina Department of Environment and Natural Resources Division. of Water Resources Water Quality Regional Operations Pat MCC rory Thomas A. Reeder Governor Director November 14, 2013 Horizons Residential Care Center Attn: T. David Adams, President and CEO 100 Horizons Lane Rural Hall, NC 27045 SUBJECT: Compliance Evaluation Inspection Horizons Residential Care Center Wastewater Treatment Plant NPDES Permit: NCO056791 Forsyth County Dear Mr. Adams: John E. Skvarla, III Secretary Ron Boone of the Winston Salem Regional Office (WSRO) of the North Carolina Division of Water Resources (DWR or the Division) conducted a compliance evaluation inspection of the Horizions Residential Care Center's wastewater treatment plant on November 13, 2013. The assistance and cooperation of Cliff Cain, Operator in Responsible Charge (ORC), was greatly appreciated. An inspection report is attached for your records and the inspection findings are summarized below. The Horizions Residential Care Center's wastewater treatment plant is located near 100 Horizons Lane in Rural Hall, Forsyth County, North Carolina, at approximate coordinates 36.227984° West, 80.229992° North, Horizon's Residential Care Center is authorized to operate this 0.015 million -gallon -per -day (MGD) wastewater treatment plant, which consists of a septic tank, a dosing tank with two alternating pumps, dual alternating surface sand filters, a recirculation manhole and pump, tablet chlorination, tablet dechlorination, post aeration, and an effluent pump station with force main, and discharge treated effluent from outfall 001 of said treatment works, which is located approximately 0.75 miles west of the treatment works at approximate coordinates 36.2278950 West, 80.243738' North, to Buffalo Creek, which is currently classified as Class C waters and is located in the Roanoke River Basin. SITE REVIEW Mr. Boone reviewed the entire plant with Mr. Cain. The only discrepancy noted was that three of the spray heads on the northern filter appeared to have frozen over because the dosing pump was on and these three heads were not spraying. However, two of the three must have thawed by the time Mr. Boone departed because they had begun spraying. Please keep a close eye on this situation. Steps may need to be taken to address freezing spray heads through the winter. Apparently however, this has not been a problem (causing violations) in the past. North Carolina Division of Water Resources, 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.ncwaterquality.org An Equal Opportunity, 1 Affirmative Action Employer Horizons Residential Care Center Attn: T. David Adams, President and CEO Compliance Evaluation Inspection Horizons Residential Care Center Wastewater Treatment Plant NPDES Permit: NCO056791 Page 2 of 2,11114113 Mr. Boone noted no further discrepancies. The entire plant was well kept and fully operational. Mr. Cain has done a good job operating the plant. DOCUMENTATION REVIEW Mr. Cain had all required documentation for the inspection and everything was complete and current. Mr. Boone found no discrepancies or violations. Mr. Cain has done an excellent job of documenting his operation and maintenance of the plant. Please keep up the excellent work in ensuring the Horizions Residential Care Center's wastewater treatment plant is properly operated and maintained and meeting all the terms and conditions of the permit. Please remember that violations of the permit are subject to enforcement actions not to exceed $25,000 per day, per violation. - If you have any questions regarding the inspection or this letter, please do not hesitate to contact Mr. Boone or me at 336-771-5000. Thank you for your cooperation in this matter. Sincerely, W. Corey Basinger Regional Supervisor Water Quality Regional Operations Division of Water Resources Attachments: CC: 1. BIMS Inspection Report Central Files NPDES Unit R&A Labs Attn: Cliff Cain, Operator in Responsible Charge 106 Short Street P.O. Box 473 Kernersville, NC 27284 United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 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 N I 2 15 I 11 NCO056791 111 121 13/11/13 117 181 C I 19I S I 20III Remarks 2111111111111111111111111111111111.1111111111111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------------------- ------- Reserved ---- —--------- _----- 67I 169 701 I 71 I I 72I N I 73I I 174 751 I I I I I Li 80 W Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and NPDES permit Number) Horizons Residential Care Center 09:30 AM 13/11/13 12/03/01 Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 11:00 AM 13/11/13 17/02/28 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Clifford Curtis Cain/ORC/336-996-2841/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted T David Adams,100 Horizons Ln Rural Hall NC 27045//336-767-2411/3366612185 No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Ron Boone WSRO WQ//336-771-4967/ L& Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date 0 EPA Form 3560-3 Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 3I NCO056791 I11 12I 13/11/13 17 181 C1 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 4 Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 11/13/2013 Inspection Type: Compliance Evaluation Permit Yes No NA NE (If the present permit expires in 6 months or less). Has the permittee submitted a new application? n n ■ n Is the facility as described in the permit? ■ 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: None 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 Cl 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? ■ o n n. Has the facility submitted its annual compliance report to users and DWQ? n n ■ n (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? n ■ n ❑ 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 Is a copy of the current NPDES permit available on site? ■ o n n Facility has copy of previous year's Annual Report on file for review? 0.0 ■ n Comment: NONE Laboratory Yes No NA NE Are field parameters performed by certified personnel or laboratory? ■ n n n Page # 3 a Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 11/13/2013 Inspection Type: Compliance Evaluation Laboratory Yes No NA NE Are all other parameters(excluding field parameters) performed by a certified lab? ■ n n n # Is the facility using a contract lab? ■ n n n # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n ■ Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees? ❑ n ❑ ■ Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees? n n n ■ Comment: NONE Effluent Sampling Yes No NA NE Is composite sampling flow proportional? n Cl ■ n Is sample collected below all treatment units? ■ n n n Is proper volume collected? ■ n n n Is the tubing clean? n n ■ o # 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: NONE Flow Measurement - Influent Yes No NA NE # Is flow meter used for reporting? ■ n n n Is flow meter calibrated annually? n n n ■ Is the flow meter operational? ■ n n n (If units are separated) Does the chart recorder match the flow meter? n n ■ n Comment: City water meter used for flow data. Septic Tank Yes No NA NE (If pumps are used) Is an audible and visual alarm operational? Cl ■ , n n Is septic tank pumped on a schedule? ■ n n n Are pumps or syphons operating properly? ■ n n n Are high and low water alarms operating properly? ■ n n n Comment: There are no alarms on the septic tank but there are audible and visual alarms on the dosing tank that are operational. 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 ■ Page # 4 q Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 11/13/2013 Inspection Type: Compliance Evaluation Sand Filters (Low rate) Yes No NA NE Is sand filter free of ponding? ■ ❑ ❑ ❑ Is the sand filter effluent re -circulated at a valid ratio? ■ ❑ ❑ ❑ . # Is the sand filter surface free of algae or excessive vegetation? ❑ ❑ ❑ # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) ®❑ ❑ ❑ Comment: New filter walls have been constructed since the last inspection. Pump Station - Influent Yes No NA NE Is the pump wet well free of bypass lines or structures? ■ ❑ ❑ ❑ Is the wet well free of excessive grease? ❑ Cl ❑ ■ Are all pumps present? ■ ❑ ❑ ❑ Are all pumps operable? ■ ❑ ❑ ❑ Are float controls operable? ■ ❑ ❑ ❑ Is SCADA telemetry available and operational? ❑ ■ ❑ ❑ Is audible and visual alarm available and operational? ■ ❑ ❑ ❑ Comment: This is the dosing tank.' Are tablet chlorinators operational? ■ ❑ ❑ ❑ Are the tablets the proper size and type? ■ ❑ ❑ ❑ Number of tubes in use? 3 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: NONE Type of system ? Tablet Is the feed ratio proportional to chlorine amount (1 to 1)? ■ ❑ ❑ ❑ Is storage appropriate for cylinders? ■ ❑ ❑ ❑ # Is de -chlorination substance stored away from chlorine containers? ■ ❑ ❑ ❑ Are the tablets the proper size and type? ■ ❑ ❑ ❑ Comment: NONE Are tablet de -chlorinators operational? ■ ❑ ❑ ❑ Page # 5 M Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 11/13/2013 Inspection Type: Compliance Evaluation De -chlorination Yes No NA NE Number of tubes in use? 3 Comment: NONE Pump Station - Effluent Yes No NA NE Is the pump wet well free of bypass lines or structures? ® n n n Are all pumps present? s n n n Are all pumps operable? ® n n o Are float controls operable? ® o n n Is SCADA telemetry available and operational? n ® n n Is audible and visual alarm available and operational? ■ n n n Comment: NONE 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. Cl If effluent (diffuser pipes are required) are they operating properly? n n ■ n Comment: NONE Standby Power Yes No NA NE Is automatically activated standby power available? n n ® n Is the generator tested by interrupting primary power source? n n o Is the generator tested under load? n n ■ n Was generator tested & operational during the inspection? n n s n Do the generator(s) have adequate capacity to operate the entire wastewater site? n ❑ ■ Is there an emergency agreement with a fuel vendor for extended run on back-up power? n n ■ o Is the generator fuel level monitored? n o ® o Comment: No standby power available 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 ■ Cl n n Judge, and other that are applicable? Comment: None Page # 6 United States Environmental Protection Agency Form Approved. Washington, D.C. 20460 EPA OMB No. 2040-0057 Water ance 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 INI 2 15 I 31 NCO056791 111 121 13/11/13 117 181 C I 19I S I 20II Remarks 211111111111IIIIII IIIIIIII IIIIIIII IIIIIIII11111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----------- -------------- Reserved —--------- ---------- 67 I 169 701 I 711 I 721 N I 73I 174 751 I I I I I I 180 WI Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and NPDES permit Number) 09:30 AM 13/11/13 12/03/01 Horizons Residential Care Center Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 11:00 AM 13/11/13 17/02/28 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Clifford Curtis Cain/ORC/336-996-2841/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted T David Adams,100 Horizons Ln Rural Hall NC 27045H336-767-2411/3366612185 No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit ■ Flow Measurement ■ Operations & Maintenance ■ Records/Reports Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Ron Boone WSRO WQ//336-771-4967/ Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type NCO056791 I11 12I 13/11/13 117 18I d Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) Page # 2 I? Permit: NCO056791 Inspection Date: 11/13/2013 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation (If the present permit expires in 6 months or less). Has the permittee submitted a new application? Is the facility as described in the permit? # Are there any special conditions for the permit? Is access to the plant site restricted to the general public? Is the inspector granted access to all areas for inspection? Comment: Record Keeping Are records kept and maintained as required by the permit? Is all required information readily available, complete and current? Are all records maintained for 3 years (lab. reg. required 5 years)? Are analytical results consistent with data reported on DMRs? Is the chain -of -custody complete? Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses Transported COCs Are DMRs complete: do they include all permit parameters? Has the facility submitted its annual compliance report to users and DWQ? (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? Is the ORC visitation log available and current? Is the ORC certified at grade equal to or higher than the facility classification? Is the backup operator certified at one grade less or greater than the facility classification? Is a copy of the current NPDES permit available on site? Facility has copy of previous year's Annual Report on file for review? Comment: Laboratory Are field parameters performed by certified personnel or laboratory? Yes No NA NE Yes No NA NE nnnn n n n n nnnn n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n Yes No NA NE nnnn Page # 3 Permit: NCO056791 Inspection Date: 11/13/2013 Owner - Facility: Horizons Residential Care Center 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: Effluent Sampling Is composite sampling flow proportional? Is sample collected below all treatment units? Is proper volume collected? Is the tubing clean? # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? Is the facility sampling performed as required by the permit (frequency, sampling type representative)? Comment: Flow Measurement - Influent # Is flow meter used for reporting? ;� ! j(. �_ r iA Is flow meter calibrated annually? Is the flow meter operational? (If units are separated) Does the chart recorder match the flow meter? Comment: Septic Tank j (If pumps are used) Is an audible and visual alarm operational? Is septic tank pumped on a schedule? / 7 Are pumps or syphons operating properly? Are high and low water alarms operating properly? Comment: Sand Filters (Low rate) (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? Yes No NA NE nnnn nnnn nnnn nnnn nnnn Yes No NA NE nnnn nnnn nnnn nnnn nnnn n n n n Yes No NA NE Yes No NA NE Rf1nnn Idnnn Wnnn rv�nnn Yes No NA NE Page # 4 4 Permit: NC0056791 Inspection Date: 11/13/2013 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Sand Filters (Low rate) Is the sand filter effluent re -circulated at a valid ratio? r3 +b # Is the sand filter surface free of algae or excessive vegetation? # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) Comment: d4tf fft L. Pump Station - Influent Is the pump wet well free of bypass lines or structures? Is the wet well free of excessive grease? Are all pumps present? Are all pumps operable? Are float controls operable? Is SCADA telemetry available and operational? Is audible and visual alarm available and operational? Comment: 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: 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? Comment: Are the tablets the proper size and type? Are tablet de -chlorinators operational? Number of tubes in use? Yes No NA NE Yes No NA NE nnn r�innn nnn i�innn ran n n nr-nn �nn Yes No NA NE Frnnn I,`nnn I(nnn lalnnn Kin nn Yes No NA NE rpt'nnn nnr,-'n r•�nnn d.nnn r;'n n n a Page # 5 u Permit: NCO056791 Inspection Date: 11/13/2013 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation De -chlorination Yes No NA NE Comment: Pump Station - Effluent Yes No NA NE Is the pump wet well free of bypass lines or structures? ran n n Are all pumps present? Wn n n Are all pumps operable? ran n n Are float controls operable? r�' n n n Is SCADA telemetry available and operational? ri raKn n Is audible and visual alarm available and operational? I7 n n n Comment: Effluent Pipe Yes No NA NE Is right of way to the ouffall properly maintained? n n n n Are the receiving water free of foam other than trace amounts and other debris? n n n n If effluent (diffuser pipes are required) are they operating properly? n n n n Comment: Standby Power Yes No NA NE Is automatically activated standby power available? Is the generator tested by interrupting primary power source? n r i n rn Is the generator tested under load? n n n Was generator tested & operational during the inspection? n M n n Do the generator(s) have adequate capacity to operate the entire wastewater site? n 17 n n Is there an emergency agreement with a fuel vendor for extended run on back-up power? n n n Is the generator fuel level monitored? n - n n Comment: 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 P� n ❑ ❑ Judge, and other that are applicable? Comment: Page # 6 1. Ifffo WASTEWATER SYSTEM P ERFORIVRANC E A' NTT`�TUAIL REPORT ORT 2011 Generral Information Facility Name: Horizons Residential Care Center Responsible Entity: David Adams Contact Person: Clifford Cain Applicable Permit (s): NPDES Permit No:T: 'QO 56791 Description of collection system or process: K NR 012 mce The system consists of a 0.010 million gallon per day (MGD) wastewater treatment plant With the following components: septic/dosing tank with dual alternating' pumps, dual alternating surface sandfilters, recirculating manhole in pump, recirculation sprinkler pump tank, tablet chlorination, chlorine contact basin, tablet dechlorination, post aeration, & effluent pump station with force main conveying the discharge into Buffalo Creek Summary of system performance for calendar year 2011: January 2011 Exceeded permit limits for Fecal Coliform daily max February 2011 Compliant with effluent limitations Larch 2011 Compliant with effluent limitations April 2011 Compliant with effluent limitations May 2011 Compliant with effluent limitations Dune 2011 Compliant with effluent limitations .Duly 2011 Compliant with effluent limitations August 2011 Compliant with effluent limitations September 2011 Exceeded permit limits for Fecal Coliform daily max October 2011 Compliant with effluent limitations November 2011 Compliant with effluent limitations December 2011 Compliant with effluent limitations MAR `r5,r u` - M. 1140fifleafl®n Annual notice posted in facility. Eve Cerrhnricata®n I certify under penalty of law that this report is complete and accurate to the best of my knowledge. Clifford Cain Responsible Person Field Services Manager Title Research & Analytical Laboratories, Inc. )Entity January 24, 2012 Hate _� NCDENR North Carolina Department of Environment and Natural Resources Beverly Eaves Perdue Governor Mr. T. David Adams, President & CEO Horizons Residential Care Center 100 Horizons Lane Rural Hall, NC 27045 Division of Water Quality Coleen H. Sullins Director December 7, 2011 Subject: b aftPDSP$e mitC0.4561 Horizons Residential Care Center WWTP Facility Class WW-1 Forsyth County Dear Mr. Adams: Dee Freeman Secretary 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 minimal changes from the terms of your current permit. The most significant change is noted below: • A footnote has been added regarding the reporting and compliance determination of Total Residual Chlorine values. 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 February 2012, with an effective date of March 1, 2012. If you have any questions or comments concerning this draft permit, call me at (919) 807-6398, or contact me via e-mail at bob.sledge@ncdenr.gov. Sincerely, Bob Sledge Compliance & Expedited Permits Unit cc: NPDES Files Central Files ec: Winston-Salem Regional Office/Surface Water Protection Section TACU 1617 Mail Service Center, Raleigh,.North Carolina 27699-1617 One�1, 1� Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 NOl UlCO1111a Phone: 919-807-6300 FAX: org 807-64921 Customer Service: 1 877 623 6748 ��N�� Internet: www.ncwaterquality.org L An Equal Opportunity \ Affirmative Action Employer Permit NCO056791 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY PERMIT TO DISCHARGE WASTEWATER UNDER THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, the Horizons Residential Care Center is hereby authorized to discharge wastewater from a facility located at the Horizons Residential Care Center WWTP 100 Horizons Lane East of Rural Hall Forsyth County to receiving waters designated as Buffalo Creek in the Roanoke River Basin in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof. This permit shall become effective This permit and authorization to discharge shall expire at midnight on February 28, 2017. Signed this day DRAFT Coleen H. Sullins, Director Division of Water Quality. By Authority of the Environmental Management Commission Permit NC0056791 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. The Horizons Residential Care Center is hereby authorized to: Continue to operate an existing 0.015 MGD wastewater treatment system with the following components: ♦ Septic/Dosing tank with alternating pumps ♦ Dual alternating surface sandfilters ♦ Recirculation manhole and pump ♦ Recirculation sprinkler pump tank ♦ Tablet chlorination ♦ Tablet dechlorination ♦ Post aeration ♦ Effluent pump station and force main The facility is located east of Rural Hall, at 100 Horizons Lane, in Forsyth County. 2. Discharge from said treatment works at the location specified on the attached map into Buffalo Creek, classified C waters in the Roanoke River Basin. Permit NCO056791 A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - DRAFT During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below: EFFLUENT CHARACTERISTICS Parameter Code LIMITS MONITORING REQUIREMENTS Monthly Ayera a Daily Maximum Measurement Frequency Sample Type Sample Location Flow 50050 0.015 MGD Weekly Instantaneous Influent or Effluent BOD, 5-day (20°C) C0310 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent Total Suspended Residue C0530 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent ( as N April 1—October 31 C0610 A 16.0 mg/L 35.0 mg/L 2/Month Grab Effluent NH3 as N November 1 — March 31) C0610 2/Month Grab Effluent Fecal Coliform (geometric mean) 31616 200/100 ml 400/100 ml 2/Month _ Grab Effluent Total Residual Chlorines 50060 28 µg/L Weekly Grab Effluent Temperature (°C) 00010 Weekly Grab Effluent pH2 O0400 2/Month Grab Effluent Footnotes: 1. The Division shall consider all effluent TRC values reported below 50 µg/L to be in compliance with the permit. However, the Pennittee 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. 2. 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 visible foam in other than trace amounts "A4 NC EN forth (_'airolina Department of Environmelnl and Nictu al. Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary December 13, 2011 Thomas E. Byrd Horizons Residential Care Center 100 Horizons Ln Rural Hall, NC 27045 Subject: NOTICE OF VIOLATION NOV-2011-LV-0619 Permit No. NCO056791 Horizons Residential Care Center Forsyth County Dear Mr Byrd: A review of Horizons Residential Care Center's monitoring report for September 2011 showed the following violations: Parameter Date Limit Value Reported Value Violation Type Coliform, Fecal MF, M-FC 09/21/11 400 #/100ml 600 #/100ml Daily Maximum Broth,44.5 C Exceeded Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem. Please be aware that violations of your NPDES permit could result in enforcement action by the Division of Water Quality for this and any additional violations of State law. If you should have any questions, please do not hesitate to contact Ron Boone at (336)771-4967. Sincerely, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality cc: SWP — Central Files WSRO Files North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St, Winston-Salem, North Carolina 27107 Phone: 336-771-5000 \ FAX: 336-771-4630 \ Customer Service: 1-877-623-6748 Internet: vrmnv.ncvaterquality.org Nne orthCarolina Natffrally An Equal Oppc,tunity \ Affirmative Action Employer Cover Sheet from Staff Member to Regional Supervisor DMR Review Record Facility: i'2,5P7fSr Permit/PipeNo.: 6b7VDo/ Month/Year Monthly Average .Violations Parameter Permit Limit DMR Value % Over Limit Weekly/Daily Violations Date Parameter Permit LimitfIv e DMR Value %Over Limit Monitoring Frequency Violations Date Parameter Permit Frequencv Values Reported # of Violations Other Violations LV Completed by: Reaional Water Quality Supervisor Signoff: %Jb-Q Date: A Date: �Z -Dv G %�t NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director October 17, 2011 Horizons Residential Care Center Attn: Thomas E. Byrd, Executive Director 100 Horizons Lane Rural Hall, NC 27045 Subject: Compliance Evaluation Inspection Permittee: Horizons Residential Care Center Facility: Horizons Residential Care Center Wastewater Treatment Plant NPDES Permit #: NCO056791 Forsyth County Dear Mr. Byrd: Dee Freeman Secretary Mr. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ or the Division) conducted a compliance evaluation inspection (CEI) of the subject facility on October 12, 2011. Clifford Cain's assistance and cooperation during the inspection was greatly appreciated. An inspection checklist is attached for your records and inspection findings are summarized below. General Information The wastewater treatment plant (WWTP) is located just north of Horizons Lane in Rural Hall, Forsyth County, NC, at approximate coordinates 36.2279940,-80.2300720. The permit authorizes Horizons to operate this 0.015 MGD WWTP, which consists of a septic tank, a dosing tank with alternating pumps, dual alternating surface sand filters, a recirculation pump tank, tablet chlorination, tablet dechlorination, and an effluent pump station and force main. It is noted that the plant description in the, permit needs to be updated to match what is currently actually on the ground at the plant. Horizons is further authorized to discharge the treated effluent from this WWTP via outfall 001, which is located at approximate coordinates 36.228108°,-80.246731 °, into Buffalo Creek, which is currently classified as Class C waters in the Roanoke River Basin. Site Review The plant itself appears to be in fair,condition. Everything is currently operational and the plant is meeting effluent limitations the majority of the time. However, it is noted that the plant is getting quite old and is dilapidated in some areas. The concrete walls for the filters are beginning to deteriorate. The distribution pipes for the filters appear to be sound and well supported but their supports are somewhat makeshift and the distribution of the pump tank effluent over the southern filter seems considerably weaker than that for the northern filter; one of the pumps may need to be examined and repaired or replaced. The recirculation pump and piping system seems to have been somewhat haphazardly installed, although it appears to be doing its job, the piping is not well supported inside the tank. The audible alarm on the dosing tank needs to be replaced as. it is not very loud and can probably not be heard from very far away. Finally, the effluent pumps tank's visual alarm works but it North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 Phone: 336-771-50001 FAX: 336-771-46301 Customer Service:1-877-623-6748 Internet: www.ncwaterquality.org An Equal Opportunity 1 Affirmative Action Employer One NorthCarolina Natura!!,ff Horizons Residential Care Center Attn: Thomas E. Byrd, Executive Director Compliance Evaluation Inspection NC0056791, Horizons Residential Care Center WWTP Page 2 of 2, October 17, 2011 does not have an audible alarm. Please install an audible alarm on the effluent pump tank's alarm system. It is lastly noted that the plant has no backup power supply source. Documentation Review All documentation was reviewed. Mr. Cain has done a good job producing and keeping the records needed on file. Discharge monitoring reports and field and non -field laboratory records were compared and no discrepancies were found. Mr. Cain uses field discharge monitoring report sheets for his visitation log and an operations log book in which he annotates his daily operational and maintenance activities. The flow for the plant is obtained daily from the facility's water usage meter. The only thing missing from the inspection were septic tank sludge pumping records. Mr. Cain had some from 2011 available during the inspection but nothing further. Please provide copies of your septic tank pumping records for at least the past three years. Mr. Cain said he could arrange for that. Mr. Boone noted no other problems or concerns during his inspection. If you have any questions regarding the inspection or this letter, please call him or me at (336) 771-5000. Thank you for your cooperation in this matter. Sincerely, W. Corey Basinger Water Quality Regional Supervisor Winston-Salem Region Division of Water Quality Attachments: BIMS Inspection Report CC: QVMS�R0O�S1tJ,1lP� Central Files NPDES Unit R&A Labs Attn: Cliff Cain 106 Short Street Kernersville, NC 27284 f United States Environmental Protection Agency Form Approved. E ^ n Washington, D.C. 20460 r/� OMB No. 2040-0057 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 `n I 2 I s I 31 NCO056791 111 121 11/10/12 117 18I C I 19I S I 20! I J L! J Remarks 21111111111111111111111111111111111111111111111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ------------------------ Reserved -------- ------- 67 I 169 70 U. 71 U 72 I N S 73 � 74 75I 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) Horizons Residential Care Center 09:00 AM 11/10/12 11/06/01 Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 11:00 AM 11/10/12 12/02129 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Thomas E Byrd,100 Horizons Ln Rural Hall NC 27045//336-767-2411/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary) -(See attachment summary) , Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Ron Boone WSRO WQ//336-771-4967/ 12—C I� Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date j_ WSAO - 51,11P 2-2/r V .r EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 3I NCO056791 111 12, 11/10/12 117 18I d 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 •r Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 10/12/2011 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 Cl # 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. 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 0- Are all records maintained for 3 years (lab. reg. required 5 years)? ■ ❑ n n Are analytical results consistent with data reported on DMRs? ■ n n n Is the chain -of -custody complete? ■ n n n Dates, times and location of sampling ■ Name of individual performing the sampling ■ Results of analysis and calibration ■ Dates of analysis ■ Name of person performing analyses Transported COCs ■ Are DMRs complete: do they include all permit parameters? ■ n ❑ n Has the facility submitted its annual compliance report to users and DWQ? n ri ■ n (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? n ■ n n Is the ORC visitation log available and current? ■ ❑ n n Is the ORC certified at grade equal to or higher than the facility classification? ■ n n n Is the backup operator certified at one grade less or greater than the facility classification? ■ n n n Is a copy of the current NPDES permit available on site? ■ n n n Facility has copy of previous year's Annual Report on file for review? ❑ ■ n Comment: Please refer to the attached inspection summary letter. Laboratory Yes No NA NE Are field parameters performed by certified personnel or laboratory? ■ n n n Page # 3 Permit: NCO056791 Owner -,Facility: Horizons Residential Care Center Inspection Date: 10/12/2011 Inspection Type: Compliance Evaluation Laboratory Yes No NA NE Are all other parameters(excluding field parameters) performed by a certified lab? ■ n n n # Is the facility using a contract lab? ■ n n n # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n ■ Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees? n n n ■ Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees? Cl Cl n ■ Comment: Please refer to the attached inspection summary letter. Effluent Sampling Yes No NA NE Is composite sampling flow proportional? n n ■ n Is sample collected below all treatment units? ■ n Cl n Is proper volume collected? ■ n n 171 Is the tubing clean? n n ■ Cl # 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. Flow Measurement - Influent Yes No NA NE # Is flow meter used for reporting? ■ n n n Is flow meter calibrated annually? n n n ■ Is the flow meter operational? ■ n n n (If units are separated) Does the chart recorder match the flow meter? n n ■ Cl Comment: Flow is taken daily from the facility's water usage meter. Septic Tank w Yes No NA NE (If pumps are used) Is an audible and visual alarm operational? ■ n n n Is septic tank pumped on a schedule? ■ n 171 ❑ Are pumps or syphons operating properly? ■ n n n Are high and low water alarms operating properly? ■ n n n Comment: The audible alarm heeds to be replaced. It is not loud enough. Sand Filters (Low rate) Yes No NA NE (If pumps are used) Is an audible and visible alarm Present and operational? ■ n Cl n Is the distribution box level and watertight? n n ■ n Is sand filter free of ponding? ■ n n n Page # 4 Permit: NC0056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 10/12/2011 Inspection Type:, Compliance Evaluation Sand Filters (Low rate) Yes No NA NE Is the sand filter effluent re -circulated at a valid ratio? ❑ ❑ ❑ ■ # Is the sand filter surface free of algae or excessive vegetation? ■ ❑ ❑ ❑ # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) ❑ ❑ ❑ ■ Comment: Effluent is recirculated but the ratio is unknown. Treatment appears to be effective at current recirc ratio. Disinfection -Tablet Yes No NA NE Are tablet chlorinators operational? ■ ❑ ❑ ❑ Are the tablets the proper size and type? ■ ❑ ❑ ❑ . Number of tubes in use? 3 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: 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)? ❑ ❑ ❑ ■ Is storage appropriate for cylinders? ■ ❑ ❑ ❑ # Is de -chlorination substance stored away from chlorine containers? ■ ❑ ❑ ❑ Are the tablets the proper size and type? ■ ❑ ❑ Cl Comment: Please refer to the attached inspection summary letter. Are tablet de -chlorinators operational? ■ ❑ ❑ ❑ Number of tubes in use? 2 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? ■ ❑ ❑ ❑ Are all pumps present? ■ ❑ ❑ ❑ Are all pumps operable? ■ ❑ ❑ ❑ Are float controls operable? ■ ❑ Q ❑ Is SCADA telemetry available and operational? ❑ ■ ❑ ❑ Is audible and visual alarm available and operational? ■ ❑ ❑ ❑ Page # 5 Permit: NCO056791 Owner -Facility: Horizons Residential Care Center Inspection Date: 10/12/2011 Inspection Type: Compliance Evaluation Pump Station - Effluent Yes No NA NE Comment: There is no audible alarm. One should be installed. 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? If effluent (diffuser pipes are required) are they operating properly? Comment: Please refer to the attached inspection summary letter. Standby Power Is automatically activated standby power available? Is the generator tested by interrupting primary power source? Is the generator tested under load? Was generator tested & operational during the inspection? Do the generator(s) have adequate capacity to operate the entire wastewater site? Is there an emergency agreement with a fuel vendor for extended run on back-up power? Is the generator fuel level monitored? ■nnn nn■n n■00 nn■n nn■n nn■n nn■n nn■n nn■n 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 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: Plant is getting quite old and somewhat dilapidated. Concrete walls around filters are beginning to deteriorate. Distribution piping seemed to be well supported and restrained but they have somewhat makeshift supports. Also distribution spray of pump tank effluent over southern bed seems somewhat weak. A new pump may be needed. Page # 6 .Inc,, 4 iJ{i Muma Roan Wfnst6h-Safarn, NC 2710$ n W. ETATE, Z1P J i �QW.9COI E ptvU �a am r wt-" .."d,1 -; ref &"b � :. _ 10, L D N �. Sl - I � .2 C 1 7 0 9 1=m BY � " IM6 Fide RETUAiVEO r-WM MUST P-EACCOMPA•IIED BY TH19 BFOEIPT. y U Qharkkyou 9 �zr-arb7nhai2.aa� ' 1 Sprinkle, Inc. 4900 Murray Road i ostor -Salem, NC 271.'06 (T.-L 6r AOiLn BY (,7F �i f ADDHESS cav'sr"F-ZP PHOtlC- CASH t"Joxx PA10 OLr 1APICH.RETUV PAWORPOGQIWT � r - ,4 f .. I _ RECI:IVEO-t<Y TOTAL ` ALL UMAS AND FTr'7UFRMEYCOO®S Fe1JSi0Cf3Ct.Wd1gIjEO GfV T 125 RECon. - Form2oezr«�d,.�san�n ;2-- 6�() -sy Ly owes's TIT, —Siiiic5p-, ckz� JAIFAL Spr"onkfe, RnC. 4WO MUM Road Wlhston-Salem. NC P-7106 (336) 924-SS77 e. X �7 kof qNaakYou Spirink8e, Inc.. 4900 Murray Road yVirlaton-Salem, NC 27106 1) M ,LoLf,AVV ljg) FIFyoFiNeD C,0.0D*-tIUFtT EM. AVLI-"tl--Nlru — .— 1— -- qria#k.9bu ct AAL CARE 4011! pomw ;)LACRIDIPIC 6 rivaLati On . 4900 Murray Road WinWoll-Salem; No 971D3 (338) 924-Q677 LO N m all CD LD IT) 91 LO cz Lf') CD I AND RE-f CAOC CD N !RIrF41IbqGQa3Bq CD —i - ----- — TI&I'lCyou Sprinkle, Me. 4900 Mur(ay Road Wlfisfoa-Saforn, NC 27106 (3�6` 924-6677 f /L 4 xm f7l"k PUONE 7, 6, ,VHABGE 'T 34m. idnham PAODMACMUIA-F DEMnIPTIOR V.9rF- AFAOrFfi- I r, BY TOTAC.Ut TIA, c2u?E- C-PIN, (3316) 66 (Airtm. P-M.w.. ""fik-map Noun, L U."LCE P I c U P. On Unt, CaTIEd In - IS: DAII 'jz 10/17/2011 08:45 336-9960326 R & A LABORATORIES PAGE 01/04 RESEARCh & ANA[yTICAI bbORATORiES, INC. Aria�r[ir.N;Prxe5, C:nn$UI�aUnrl.^, Date: From: To: Comments: FACSIMILE MESSAGE 19-I/ Research & Analytical ,Laboratories, Inc. Telephone (336) 996-2841 Fax (336) 996-0326 Wages to Follow: Mailing Address: PO Box. 473 Kern.ersvi.l.le, NC 27285 Shipping Address: 106 Short Street Kernersvi.11.e, NC 27284 Pn A— all v ins .i—, c-- ab Iln..n. ..: - K -..a ram...:__ n-r 1. — --.. NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary September 6, 2011 RECEIVED— N.C. Deat. of ENR T DAVID ADAMS _ SEP 0 8 2011 PRESIDENT AND CEO l 'nston-Salem HORIZONS RESIDENTIAL CARE CENTER Regional Oft7ce 100 HORIZONS LANE RURAL HALL NC 27045 Subject: Receipt of permit renewal application NPDES Permit NCO056791 Horizons Residential Care Center Forsyth County Dear Mr. Adams: The NPDES Unit received your permit renewal application on September 2, 2011. A member of the NPDES Unit will review your application. They will contact you if additional information is required to complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing permit expires. If you have any additional questions concerning renewal of the subject permit, please contact John Hennessy at (919) 807-6377. Sincerely, Dina Sprinkle Point Source Branch cc: CENTRAL FILES Vilins,trSm�Iti3a1� �O'if3 /Surface Water Protection NPDES Unit 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One Phone: 919-807-6300 \ FAX: 919-807-6492 \ Customer Service: 1-877-623-6748 NorthCarolina Internet: www.ncwaterquality.org -� �9�� ` An Equal Opportunity', Affirmative Action Employer � �/ ajf� HORIZONS RESIDENTIAL CARE CENTER 1.00 Horizons Lane ❖ Rural Hall, NC 27045 Phone: (336) 767-241 1 Fax: (336) 661-2185 ❖ www August 10, 2011 Mrs. Dina Sprinkle NCDENR / DWQ/ Point Source Branch 1617 Mail Service Center Raleigh, NC 27699-1617 Dear Mrs. Sprinkle, Please find enclosed the required items for renewal of our permit for the operation of our privately . owned wastewater treatment center. This letter is our official request for renewal of the permit NCO056791 which is scheduled to expire on February 29; 2012. Since the issuance of the current permit, there have been no substantive changes in the facility which impact the wastewater treatment facility. The sludge generated by this system is removed by a licensed septic company which pumps the sludge from the holding tank on a regular schedule, and more often if needed. Sincerely T. David Adams President & CEO !1 751 0 W R-- P SEP 2 2611 L�� ..;� DEN-1-i�1'��; EF% QUALIFY POINT SOURCE BPANCH Horizons Residential Care Center is a private nonprofit organi.Zation zvhicl) provides, nrith utmost dignit l and re pect, compassionate care and gualit , services appropriate to the needs of individuals with developmental disabilities and their families. 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 27.699-1617 ..,NPDES, Termit NC00 . If you are completing this form in computer use the TAB key or the up — down arrows to moue 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: Horizons Residential Care Center Owner Name c/o T. David Adams, President & CEO Facility Name Horizons Residential Care Center Mailing Address 100 Horizons Lane Czt✓'_ Rural Ha7fi State / Zip Code North Carolina 27045 Telephone Number (336) 767-2411 Fax Number J 336 ) 661-2185 e-mail Address Davida@horizonscenter.org 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 ORC) Name Horizons Residential Care Center Mailing Address 100 Horizons Lane City Rural Hall State / Zip Code North Carolina 27045 Telephone Number (336) 767-2411 Fax Number ( 336 ) 661-2185 Na.a --0 a...� SEP 2 2011 I 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 Generating Wastewater (check all that apply): Industrial ❑ Number of Employees Commercial ❑ Number of Employees Residential ❑ Number of Homes School ❑ Number of Students/Staff Other ® Explain: Residential Center�or Disabled Chi 1 dren 30 Children & 113 Staff Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers, restaurants, etc.): The source of wastewater is from a Residential Center serving 30 disabled children and an Administrative Office building. Population served: 30 Disabled Children & 113 Staff/day S. Type of collection system M Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer) 6. Outfall Information: Number of separate discharge points 1 Outfall Identification number(s) 001 Is the outfall equipped with a diffuser? ❑ Yes ® No 7. Name of receiving stream(s) (Provide a map shouiing the exact location of each outfall): Buffalo Creek 8. Frequency of Discharge: ® Continuous If intermittent: Days per week discharge occurs: ❑ Intermittent Duration: 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. See attached. 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 .015 MGD Annual Average daily flow .0036 MGD (for the.previous 3.years) Maximum daily flow 0043 MGD (for the previous 3 years), . 11. Is this facility located on Indian country? ❑ .Yes ® No 12. Effluent Data Pro uide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum and monthly average. If only one analysis is reported, report as daily maximum. Parameter Daily Maximum Monthly Average Units of Measurement Biochemical Oxygen Demand (BODs) 7.23 5.20 -mg/1 Fecal Coliform Total Suspended Solids < 1 6.67 0 3.39 # 100 m 1 MCI1 Temperature (Summer) 23 21 O C Temperature (Winter) 8 6.4 ° C pH 6.63 6.3-- SU 13. List all permits, construction approvals and/or applications: Type Permit Number Type Hazardous Waste (RCRA) NESHAPS (CAA) UIC (SDWA) Ocean Dumping (MPRSA) NPDES NCO056791 Dredge or fill (Section 404 or CWA) PSD (CAA) Other Non -attainment program (CAA) 14. APPLICANT CERTIFICATION 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. T. David Adams President & CEO Printed name of Person Signing Title Signature of Applicant 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 05/08 :JAL - 4'v .�-- � - �� `�4� ,�• . _ ',._. P �'. �� r� �� '�� "�-�•, �i �f r � o � - • � /� .r � 5 LLtd � ��•' ,* �..J, i� r�� \v`i1' cl\! l `.�: t f�_-} �y, � .` / '� � . �,�� U. II �r�:f� �.9V . �"' -cam f �•� .-' 'ti d `�� •� � J'��• ��\��, 4� {� 4 Si�iS"�v ��t �+�^'�•�"1 i (t Nc'•- ire r�'��-•/`-% / p r j '1'r' •'±i--- % .41-61 {� : �y�� !�g'� ., I �, fir• �,�'( N � � � ✓ --�� - / � ) ¢'t off. �C � � ti � �? '� ._� - 1`'� ��' � \ � `\fit t� � � �1f �`f./ '-rf �� rt• '��+�� tj ty � : •--�'�-� �3 � na��}� =✓ y\i�`,��%.,` �i'' -� f ;•`II�Y� t y��J� `i 1��'_ \ i ♦0 . :-7+%. J `.y^�J� it . �\ \ : i gn IOutfall 001 At f _ ! it (��`�'� v ~ jet L/' fQ/r•(r��t�\ -\ r {fi{r `},J�'j � j/�%� t >\�jj �J+/�ri� ' t��i � ,. `->J �_i— �i (f (f �}}7� •lY• � �� IIJ i� t !!�} /�.` �/�{�� V� l ��, �1�/'� � ^,�i � i[(1�```--�.'it•('r�\�7�� /6\�S (�' ��_� . � 1 /fl�� i , , r i` E� ki �t.�'L��r/��"_2� �� `� r -i�\ � `�� ( �� ✓vim �� crt'l �j�:� •( } � � �� } �. � � I - ` � ,-•{ `off �;` � � � � , r� r • �� /�/�,r N¢c,';` Jlrr`iltltL;ti`�-,� Latitude: 36° 13'49" Stream Class: C Longitude: 80° 13'55" Subbasin: 030201 Quad # C18NW Receiving Stream: Buffalo Creek Facflity Location NCO056791 - Horizons Residential Care Center Forsyth County w NCDENR North Carolina Department of Environment and Natural Resources Beverly Eaves Perdue Governor Mr. Thomas E. Byrd Horizons Residential Care Center 100 Horizons Ln Rural Hall, NC 27045 Dear Permittee: Division of Water Quality Coleen H. Sullins Dee Freeman Director Secretary RECEIVED August 2, 2011 N.C. Dept. of ENR FAUG� 15 2011 Winston-Salem Regional Office Subject: Renewal Notice NPDES Permit NC0056791. Horizons Residential Care Center Forsyth County Your NPDES permit expires on February 29, 2012. 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 September 2, 2011. 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 February 29, 2012, the current permit must be renewed. Discharge of wastewater without a valid permit would violate North Carolina General Statute 143-215.1; unpermitted discharges of wastewater may be assessed civil penalties of up to $25,000 per day. If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact me at the telephone number or address listed below. Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must submit with the permit renewal application. If you have any questions, please contact me at the telephone number or e-mail address listed below. Sincerely, Charles H. Weaver, Jr. NPDES Unit cc: Central Files W}nstonSaleii%R''e'gional-;Ofiice;Surfac_e sWaier,:Pote_ctiori�= NPDES File 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One 512 North Salisbury Street, Raleigh, North Carolina 27604 NofthCarohna Phone: 919 807-6391 / FAX 919 807-6495 / charles.weaver@ncdenr.gov Nahmally An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper NPDES PERMIT NQ0056791 HORIZONS RESIDENTIAL CARE CENTER FORSYTH COUNTY The following items are REQUIRED for all renewal packages: ➢ A cover letter requesting renewal of the permit and documenting any changes at the facility since issuance of the last permit. Submit one signed original and two copies. ➢ The completed application form (copy attached), signed by the permittee or an Authorized Representative. Submit one signed original and two copies. ➢ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares the renewal package, written. documentation must be provided showing the authority delegated to any such Authorized Representative (see Part II.B.11.b of the existing NPDES permit). ➢ A narrative description of the sludge management plan for the facility. Describe how sludge (or other solids) generated during wastewater treatment are handled and disposed. If your facility has no such plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed original and two copies. The following items must be submitted by 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: Mrs. Dina Sprinkle NC DENR / DWQ / Point Source Branch 1617 Mail Service Center Raleigh, NC 27699-1617 kvo AID "'O� yrv, MCDENR North Carolina Department of Environment and Natural Resources Beverly Eaves Perdue Governor Division of Water Quality Coleen H. Sullins Director April 29, 2011 T DAVID ADAMS PRESIDENT AND CEO HORIZONS RESIDENTIAL CARE CENTER 100 HORIZONS LANE RURAL HALL NC 27045 Subject: Acknowledgement of Permit Modification Request for NCO056791 Horizons Residential Care Center Horizons Residential Care Center Forsyth County Dear Mr. Adams: Dee Freeman Secretary FMAY IVED . of ENR 5 2011 -Salem Office The Division of Water Quality acknowledges receipt of your permit modification request and has assigned it to a reviewer. The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in providing a timely and complete response to any additional information requests. Please note at this time, processing permit applications can take as long as 60 — 90 days after receipt of a complete application. If you have any questions, please contact Maureen Scardina at 919-807-6388, or via email at maureen.scardina@ncdenr.gov. If the reviewer is unavailable, you may leave a message, and they will respond promptly. PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT. Sincerely, Dina Sprinkle Cc: Central Files Winston!!S--a1em Regional Office Surface Water Protection Section Permit application file NCO056791 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 Phone: 9IM07-63001 FAX: 919-807-64921 Customer Service: 1-877-623-6748 Internet: www rlmaterquality.org Nne ot hCaroi1n NatmWAY An Equal Opportunity \ Affirmative Action Employer David Adams President & CEO r + as HORIZONS RESIDENTIAL CARE CENTER 100 Horizons Lane IAL, CARE ,ENTER Rural Hall, NC 27045 Phone:336-767-2411 all, NC 27045 Fax: 336-661-2185 www.horizonscenter.org E-mail:Davida@horizonscenter.org c, (336) 661-2185 4- www.horizonscenter.org i 9 April 26, 2011 Mr. Charles Weaver Division of Water Quality Surface Water Protection Section — NPDES 1617 Mail Service Center Raleigh, NC 27699-1617 Dear Mr. Weaver, It has come to my attention that we are providing a twice -per -week monitoring for Total Chlorine Residual (TRC) while, as a grade I treatment facility, we are only required to have our operator visit and provide reports weekly. Therefore, in compliance with our classification as a Grade I treatment facility, I request that the twice -per -week monitoring requirement for TRC be modified to a once -per -week requirement in accordance with our classification. This change will result in a financial savings for Horizons, a local, non-profit agency which can benefit from any savings in our expenses. I appreciation your attention to this important matter and look forward to hearing from you regarding this change. Sincerely, T. David Adams President & CEO Hori.Zons Residential Care Center is a private, non profit organisation which provides, with utmost dignity and respect, compassionate care and quality services appropriate to the neeal ,of individuals with developmental disabilities and their families. 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 20, 2011 Horizons Residential Care Center Attn: David Adams 100 Horizons Lane Rural Hall, NC 27045 Subject: Total Residual Chlorine Monitoring Permittee: Horizons Residential Care Center Facility: Horizons Residential Care Center NPDES Permit #: NCO056791 Forsyth County Dear Mr. Adams: It has recently come to our attention that your NPDES wastewater discharge permit has a twice -per -week monitoring requirement for Total Chlorine Residual (TRC), yet is classified as a grade I treatment facility, which only requires weekly visitation by the Operator in Responsible Charge (ORC). This somewhat contradictory set of circumstances forces Horizons to pay their contract operator to come to the plant twice per week just to test the TRC level in the effluent, despite the fact that the grade of the facility only requires them to visit the plant once per week. As I am completely unaware of the amount your contract operator charges for such services, I could only guess at how much reducing his visits to once per week would save Horizons, but I would feel comfortable in saying it would likely ;result in a significant savings._ This situation can be easily rectified by your requesting a modification to the permit to reduce the TRC monitoring requirement from twice per week to once per week: To do so, please send an official letter to the . attention of Mr. Charles Weaver at the following address: Division of Water Quality Surface Water Protection Section — NPDES Attn: Charles Weaver 1617 Mail Service Center Raleigh, NC 27699-1617 If you have any questions whatsoever or wish to discuss this situation in great detail please do not hesitate to contact me at 336-771-4963 or corey.basinger(a�ncdenr.gov, or Ron Boone at 336-771-4967 or ron.boone(a)ncdenr.gov. Thank you for your attention to this matter. Sincerely, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality CC: WSRO - SWP Central Files NPDES Unit 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.ncwaterquallty.org NaturallY Nne orthCarolina An Equal Opportunity 1 Affirmative Action Employer lb hr C4J NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director April 18-5 2011 Thomas E. Byrd Horizons Residential Care Center 100 Horizons Ln Rural Hall, NC 27045 Subject: NOTICE OF VIOLATION NOV-2011-LV-0135 Permit No. NC0056791 Horizons Residential Care Center Forsyth County Dear Mr Byrd: Dee Freeman Secretary A review of Horizons Residential Care Center's monitoring report for January 2011 showed the following violations: Parameter Date Limit Value Reported Value Limit Type Coliform, Fecal MF, M-FC 01/14/11 400 #/100ml 880 #/100m1 Daily Broth,44.5C Maximum Exceeded Remedial actions, if not already implemented, should be taken to correct the above noncompliance problem. Please be aware that violations of your NPDES permit could result in enforcement action by the Division of Water Quality for this and any additional violations of State law. If you should have any questions, please do not hesitate to contact Ron Boone at (336)771-4967. Sincerely, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality cc: S_WE=Central Files WSRO i e 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.ncwaterquality.org One NorthCarolina An Equal Opportunity1 Affirmative Action Employer ov-zv - LY-6 I I b� Cover Sheet from - Staff Member to Regional Supervisor DNIR Review Record Facility: Wrr zz„ r 165', Permit/Pipe No.: 676-71/ c ` ° Month/Year / t Monthly Average Violations Parameter Permit Limit DMR Value % Over Limit Weekly/Daily Violations Date Parameter Permit L rr it/Tvpe DMR Value % Over Limit 11AX Monitoring Frequency Violations Date Parameter Permit Frequency Values Reported # of Violations Other Violations �,9 #E— Completed Date: Date: k &� NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Governor Director April 26, 2011 Horizons Residential Care Center Attn: David Adams 100 Horizons Lane Rural Hall, NC 27045 Subject: Total Residual Chlorine Monitoring Permittee: Horizons Residential Care Center Facility: Horizons Residential Care Center NPDES Permit #: NCO056791 Forsyth County Dear Mr. Adams: Dee Freeman Secretary It has recently come to our attention that your NPDES wastewater discharge permit has a twice -per -week monitoring requirement for Total Chlorine Residual (TRC), yet is classified as a grade I treatment facility, which only requires weekly visitation by the Operator in Responsible Charge (ORC). This somewhat contradictory set of circumstances forces Horizons to pay their contract operator to come to the plant twice per week just to test the TRC level in the effluent, despite the fact that the grade of the facility only requires them to visit the plant once per week. As I am completely unaware of the amount your contract operator charges for such services, I could only guess at how much reducing his visits to once per week would save Horizons, but I would feel comfortable in saying it would likely result in a significant savings. This situation can be easily rectified by your requesting a modification to the permit to reduce the TRC monitoring requirement from twice per week to once per week. To do so, please send an official letter to the attention of Mr. Charles Weaver at the following address:. Division of Water Quality Surface Water Protection Section — NPDES Attn: Charles Weaver 1617 Mail Service Center Raleigh, NC 27699-1617 If you have any questions whatsoever or wish to discuss this situation in great detail please do not hesitate to contact me at 336-771-4963 or corey.basingercDncdenr.gov, or Ron Boone at 336-771-4967 or ron.booneCaD_ncdenr.gov. Thank you for your attention to this matter. Sinceelreelly, W. Corey Basinger Surface Water Regional Supervisor Winston-Salem Regional Office Division of Water Quality CC: SRO - S Central Files NPDES Unit 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.ncwaterquality.org An Equal Opportunity 1 Affirmative Action Employer ne NorthCarohna ;Vaturalltf Cover Sheet from Staff Member to Regional Supervisor DMR Review Record Facility:rrri xoh s ��f•d PermitlPipe No.: -SL7 JI Month/Year id Monthly Average Violations Parameter Permit Limit DMR Value % Over Limit Weeldy/Daily Violations Date Parameter Permit Limitll•vne DMR Value % Over Limit Monitoring Frequency Violations Date Parameter Permit Frequencv Values Reported # of Violations r/vv Other Violations Completed by: �Date: Regional Water Quality Supervisor SiQnoff: .� �. Date: L%G'� Q 67gWr Sheet from Staff Member to �L Aj Regional Supervisor DAIR Review �ecord Facility: or(2p ei.ti �/1-:020Ir,& PerrnitlPipe No.: 51-79 / 06/ Month/Year Monthly Average Violations Parameter Permit Limit DMR Value % Over Limit Weekly/Daily Violations Date Parameter Permit LhT igvpe DMR Value % Over Limit Monitoring Frequency Violations Date Parameter Permit Frequency Values Reported # of Violations < Other Violations / Completed by: Regional Water Quality Supervisor SiQnoff: h-7 r Date: Date: Map of Rural Hall, NC by MapQuest http://www.mapquest.com/maps/map.adp?fonntype=address&addtohi... Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the entire map, try clicking the "Printer -Friendly" link at the top of your results page. TI AR AOL C_,7,nPany Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the entire map, try clicking the "Printer -Friendly" link at the top of your results page. All rights reserved. Use Subject to License/Copyright 1 of 2 8/2/2007 8:00 AM Map of Rural Hall, NC by MapQuest http ://www. map quest. com/map s/map. adp?formtyp e=address&addtohi... 0�� Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the E' entire map, try clicking the "Printer -Friendly" link at the top of your results page. 71 t'tiR AOL tonipamy * ovir-mi i- =n tur i iC v a .0^own a.s r r ■ ®.a r s 0 r v w ws a.v m.®m�..1e �.4....^m�..� — - - - ,y Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the entire map, try clicking the "Printer -Friendly" link at the top of your results page. All rights reserved. Use Subject to License/Copyright 1 of 2 8/2/2007 8:02 AM - dAll WASTEWATER SYSTEM PERFORMANCE ANNUAL REPORT 2009 I. General Information Rt crivEI) N.C. pact. of ENR Facility Name: Horizons Residential Care Center APR 2 6 2010 Winston—aemResponsible Entity: David Adams Regionai ofice Contact Person: Clifford Cain - Applicable Permit (s): NPDES Permit N.o gNQ05'G79�1 Description of collection system or process: The system consists of a 0.010 million gallon per day (MGD) wastewater treatment plant With the following components: septic/dosing tank with dual alternating pumps, dual alternating surface sandfilters, recirculating manhole in pump, recirculation sprinkler pump tank, tablet chlorination, chlorine contact basin, .tablet dechlorination, post aeration, & effluent pump station with force main conveying the discharge into Buffalo Creek II. Performance Summary of system performance for calendar year 2009: January 2009 Compliant with effluent limitations February 2009 Compliant with effluent limitations March 2009 Compliant with effluent limitations April 2009 Compliant with effluent limitations May.2009 Compliant with effluent limitations June 2009 Compliant with effluent limitations July 2009 Compliant with effluent limitations August 2009 Compliant with effluent limitations September 2009 Compliant with effluent limitations October 2009 Compliant with effluent limitations November 2009 Compliant with effluent limitations fi,: U � �.• �� d obi I APR % 3 2010 1 December 2009 Exceeded daily maximum fecal coliform III. Notification s Annual notice posted in facility. IV. Certification I certify under penalty of law that this report is complete and accurate to the best of my knowledge. s Clifford Cain - Responsible Person Field Services Manager Title Research & Analvtical Laboratories, Inc. Entity February 18, 2010 Date WASTEWATER SYSTEM PERFORMANCE ANNUAL REPORT 2009 I. General Information Facility Name: Responsible Entity: Contact Person: II. Horizons Residential Care Center David Adams Clifford Cain Applicable Permit (s): NPDES Permit No. NCO056791 Description of collection system or process: The system consists of a 0.010 million gallon per day (MGD) wastewater treatment plant With the following components: septic/dosing tank with dual alternating pumps, dual alternating surface sandfilters, recirculating manhole in pump, recirculation sprinkler pump tank, tablet chlorination, chlorine contact basin, tablet dechlorination, post aeration, & effluent pump station with force main conveying the discharge into Buffalo Creek Summary of system performance for calendar year 2009: January 2009 Compliant with effluent limitations February 2009 Compliant with effluent limitations March 2009 Compliant with effluent limitations April 2009 Compliant with effluent limitations May. 2009 Compliant with effluent limitations June 2009 Compliant with effluent limitations July 2009 Compliant with effluent limitations August 2009 Compliant with effluent limitations September 2009 Compliant with effluent limitations October 2009 Compliant with effluent limitations November 2009 Compliant with effluent limitations December 2009 Exceeded daily maximum fecal coliform M. Notification Annual notice posted in facility. IV. Certification I certify under penalty of law that this report is complete and accurate to the best of my knowledge. Clifford Cain Responsible Person Field Services Manager Title Research & Analytical Laboratories, Inc. Entity February 18, 2010 Date ki Cover Sheet from Staff Member to Regional Supervisor DNIR Review Record Facility: Permit/Pipe No.: �' Month/Year Parameter Date Parameter M Date Parameter Other Violati Average Violations DMR Value P,kly/�Violation Permit Limit/Tvpe OK) % Over Limit s DMR Value % Over Limit %I& ring Frequency Violations Perms re uencv Values Reported # of Violations 0 L Completed by: Date: Regional Water Quality Date: Supervisor Signoff: Date: ��V • EFFLUENT NPDES PERMIT NO. IsiAWOB5.0791 DISCHARGE NO. 001 MONTH_ Deorrn i -- - r.•Y+E�A��R _ �2:0i0�' . FACILITY NAME..oreizons'Res-i`denfia1TCatte7Center CLASS II COUNTY Forsyth a 1 b _ CERTIFIED LABORATORIES R & A Laboratories, Inc. CERTIFICATION NO. 34 :(List additional laboratories on the backside/page 2 of this form) OPERATOR IN RESPONSIBLE CHARGE (ORC) Marc Nault GRADE II CERTIFICATION NO. 9656 `• PERS.ON(S) COLLECTING SAMPLES Operators ORC PHONE 336-996-2841 QHECI{BOX IF ORC;HAS-CHANGED _._ No FLOW /DISCHARGE F'I20M SITE o --- l_:.,_ t--� Mail ORIGINAL and ONE COPYto:-o ATTN: CENTRAL FILES +;'� ` �: '�� X DIVISION OF WATER QUALITY ti (SIGNATUR OF OPERATOR IN R SPONSIBLE CHARGE) DATE 1617 MAIL SERVICE CENTER !BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS �RALEIGH, NC 27699-1617-" " "' — - — ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. 50050 00010 00400 50060 00310 00610 1 00530 31616 1 00300 00600 00665 FLOW a o Enter Parameter Code _ o (~ K �• = o Above Name And Units EFF ET U [-+ w :z u j o U a X o o Below INF E ��®� I�C��iC�7E��1.��1.l�!!•�!!■r�.wa,Q�u�u.�r�i_I� OEM mmm�� 1 11 • ® t:• 1 .1 1 II I 1 � 1 II 1111 I II . 11 .'1 •1 1 ®1 .. Copy DWQ Fonn MR-1 (gl,100) Facility Status: (Please check one of the following) All monitoring data and sampling frequencies meet permit requirements (including weekly averages, if applicable) Compliant All monitoring data and sampling frequencies do NOT meet permit requirements Noncompliant 'I he: uermittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public heai;th or the environment. Any information shall be provided orally within 24 hours frorn the time the permitte became aware of the .circumstances. A written submission shall also be provided within 5 days of the time the permittee becomes aware of the circumstances. If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by Part II.E.6 of the NPDES permit. "I certify, under penalty of law; that this document and all attachments were prepared under my direction or supervision in accordance with a.,system designed to assure that a 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." '1 Jam eshire Authorized Agent) Pe(mittee (Please pri r e 2 Y It, Si re of Permite ** Date equired unless submitted electronically) 100 Horizons Lane Rural Hall- NC 336-767-2411 02/28/12 l'tH{iiitee Address Phone Number Permit Exp. Date ADDITIONAL CERTIFIED LABORATORIES Certified Laboratory. (2) r ,C �tif ionn No. Certified Laboratory (3)AiA±WN0• Certified Laboratory (4) Certifi ation No. Certified Laboratory (5) FEB U 4f,al pion No. Information Processing Unit PARAMETER CODES Dtrvr01/BOG Parameter Code assistance may be obtained by calling the NPDES Unit at at (919) 733-5083, or by visiting the Surface Water Protection Section's web ;.ite at h2o.enr.state.nc.us/wqs and linking to the Unit's information pages. Use only units of measurement designated in the reporting facility's NPDES permit for reporting data. * No Flow / Discharge From Site: Check this box if no discharge occurrs and, as a result, there are no data to be entered for all of the parameters on the DMR for the entire monitoring period. **'ORC On Site? : ORC must visit facility and document visitation of facility as required per 15ANCAC8G.0204. "* Signature of Permittee: If signed by other than the permitte, then the delegation of the signatory authority must be on tie with the state per 15ANCAC2B.0506 (b) (2) (D). RECEIVED , WASTEWATER SYSTEM N.C. Dept. of E"R PERFORMANCE ANNUAL REPCIRTFEB 2 4 2010 2010 Winston-Salem Regional Office I. General Information �� Facility Name: Horizons Residential Care Center 9 ii Responsible Entity: David Adams Fc 2 2010 EB 2 Contact Person: Clifford Cain [ E 'R—!?t'.s�1'E�C. Cs41"I 1. v Pt7ii°JT SiiURG°riil�H Applicable Permit (s): NPDES Pen -nit No;,,N'GO(?_56�7;9;1� Description of collection system or process: The system consists of a 0.010 million gallon per day (MGD) wastewater treatment plant With the following components: septic/dosing tank with dual alternating pumps, dual alternating surface sandfilters, recirculating manhole in pump, recirculation sprinkler pump tank, tablet chlorination, chlorine contact basin, tablet dechlorination, post aeration, & effluent pump station with force main conveying the discharge into Buffalo Creek II. Performance Summary of system performance for calendar year 2010: January 2010 Compliant with effluent limitations February 2010 Compliant with effluent limitations March 2010 Compliant with effluent limitations April 2010 Compliant with effluent limitations May 2010 Compliant with effluent limitations June 2010 Compliant with effluent limitations July 2010 Compliant with effluent limitations August 2010 Compliant -with effluent limitations September 2010 Compliant with effluent limitations October 2010 Compliant with effluent limitations November 2010 Compliant with effluent limitations C December 2010 Exceeded daily maximum fecal coliform III. Notification Annual notice posted in facility. IV. Certification I certify under penalty of law that this report is complete and accurate to the best of my knowledge. Clifford Cain Responsible Person Field Services Manager Title Research & Analytical Laboratories, Inc. Entity February 18, 2010 Date A'�Av 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 3, 2010 Mr. Thomas E. Byrd, Executive Dir. Horizons Residential Care Center 100 Horizons Lane Rural Hall, NC 27045 SUBJECT: Compliance Evaluation Inspection Horizons Residential Care Center WWTP NPDES Permit No. NCO056791 Forsyth County Dear Mr. Byrd: On January 29, 2010, Mike Mickey of this office met with Mark Nault and Tommy Bullins to perform a Compliance Evaluation Inspection on the recirculating surface sandfilter wastewater treatment system serving the Horizons Residential Care Center. This type of inspection consists primarily of two parts: an in -office file review and an on -site inspection of the treatment facility. The attached EPA inspection form notes the eight (8) areas that were evaluated. The findings and observations are outlined below: I. Permit The NPDES permit was reissued effective July 1, 2007, and expires next on February 29, 2012. II. Self -Monitoring Program The monthly self -monitoring reports (DMRs) were reviewed for the months of November 2008 through October 2009. The facility was in complete compliance with all NPDES effluent limits for this time period (see data summary attached). In addition, all monitoring was performed per the frequencies specified in the permit. III. Flow Measurement The permit requires that weekly instantaneous flows be reported on the DMR. These flow measurements are obtained from reading the totalizer on the potable water meter. North Carolina Division of Water Quality, Winston-Salem Regional Office Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One Phone: 336-771-50001FAX: 336-771-46301Customer Service: 1-877-623-6748 No thCarolina Internet: www.ncwaterquality.org V An Equal Opportunity 1 Affirmative Action Employer d Mr. Thomas Byrd February 3, 2010 Page 2 IV. Sludge Handling and Disposal Solids were removed from the septic tank in February and November 2009 by Sprinkle Septic Tank Company. V. Operations and Maintenance No concerns were noted with the operation and maintenance of the sandfilter system. Wastewater was being evenly distributed over the filter beds, the sand was replaced in the summer of 2009 and the beds were raked level and free of vegetation and leaves. VI. Facility Site Review The 0.015 MGD recirculating surface sandfilter consists of the following: septic tank, dosinZD g tank with alternating pumps, dual surface sandfilters with spray distribution, recirculation tank with pump, tablet chlorinator, tablet dechlorinator, post aeration tanks and effluent pump station. VII. Records/Reports The ORC records were thorough and complete. VIII. Effluent/Receiving Waters The system discharges into Buffalo Creek, Class "C" waters of the Roanoke River Basin. Sincerely, joptu-mod .^� Steve W. Tedder Water Quality Regional Supervisor cc: Jim Cheshire (R&A Labs, 106 Short Street, Kernersville, NC 27284) Central Files 4' :IZO Horizons Residential Care Center WWTP NPDES Permit No. NC0056791 Self Monitoring Data Summary January 2009 — November 2009 Parameters Monthly Avg. Permit Limit Monthly Avg. Limit Violations per DMR Daily Maximum Permit Limit Daily Max. Limit Violations per DMR Flow (MGD) 0.015 None - NA BOD (mg/1) 30.0 None 45.0 None TSS (mg/1) 30.0 None 45.0 None NH3-N (mg/1) 16.0 None 35.0 None T. Chlorine (ug/1) - NA 28* None Fecal (#/100 ml) 200 None 400 None *(Note: any value below 50 ug/l is considered to be compliant). United States Environmental Protection Agency Form Approved. EPAWashington, D.C. 20460 r 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 1 5I 31 NCO056791 111 121 10/01/29 117 18I CI 19I SI 201 Remarks 211 1 1111111111111111111111111111111111111111111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ---------------------- 67 I 169 70131 711 I 72 I N I 73 I I 174 751 I I I I I Li 80 u� Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and. NPDES permit Number) 08:00 AM 10/01/29 07/07/01 Horizons Residential Care Center Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 08:45 AM 10/01/29 12/02/29 Name(s) of Onsite Representative (s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Johnny Sullins/Maint Sup/336-767-2411 / Marc W Nault/ORC/336-408-8550/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Thomas E Byrd,100 Horizons Ln Rural Hall NC 27045//910-767-2411/ 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 Section D: Summary of Find in /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 Michael M Mickev WSRO WQ//336-771-5000/ ems' \0 LSig4nture 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 Permit: NCO056791 Inspection Date: 01/29/2010 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Operations & Maintenance Yes No NA NE Is the plant generally clean with acceptable housekeeping? ■ Cl. ❑ Cl Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge fl n ■ ❑ Judge, and other that are applicable? Comment: No concerns were noted with the operation and maintenance of the recirculating surface sandfilter system. The facility consists of the following: septic tank, dosing tank with alternating pumps, dual surface sandfilters with spray distribution, recirculation tank with pump, tablet chlorinator, tablet dechlorinator, post aeration tank and effluent pump station. 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 ❑ # 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: The NPDES permit expires next on 2-29-12. For the review period January 2009 through November 2009 the Horizons WWTP was in complete compliance with all NPDES effluent limits and monitoring requirements. Flow Measurement - Influent Yes No NA NE # Is flow meter used for reporting? ■ n n n Is flow meter calibrated annually? ❑ ■ n ❑ Is the flow meter operational? ® n n n (If units are separated) Does the chart recorder match the flow meter? n n Ile n Comment: Flow measurements are obtained from potable water meter readings. Horizons maintenance staff are responsible for reading the 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? ■ n n n Are pumps or syphons operating properly? ® n n n Are high and low water alarms operating properly? ® n n n Comment: The septic tank is separate from the dosing tank. Wastewater from the septic tank flows by gravity to the dosing tank where it is then pumped to the sandfilter beds. Sand Filters (Low rate) Yes No NA NE (If pumps are used) Is an audible and visible alarm Present and operational? ■ n n n Page # 3 Permit: NC0056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 01/29/2010 Inspection Type: Compliance Evaluation Sand Filters (Low rate) Yes No NA NE 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: Wastewater from the dosing tank is alternately pumped to the two surface sandfilters. Spray nozzles distribute the wastewater over the sand beds. Both sandfilters were raked level and free of vegetation/leaves. Disinfection -Tablet Yes No NA NE Are tablet chlorinators operational? ■ n ❑ n Are the tablets the proper size and type? ■ n n n Number of tubes in use? 3 Is the level of chlorine residual acceptable? ■ n n n Is the contact chamber free of growth, or sludge buildup? ®❑ Q n Is there chlorine residual prior to de -chlorination? ■ n n n Comment: Chlorine tablets were present in the three tubes. --- - --. - - V.. Aln Ale KIP 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 ■ # Is de -chlorination substance stored away from chlorine containers? n n ■ a Comment: . Are the tablets the proper size and type? ■ n n n Are tablet de -chlorinators operational? ® n n n Number of tubes in use? 3 Comment: Dechlor tablets are placed in three tubes. Pump Station - Effluent Yes No NA NE Is the pump wet well free of bypass lines or structures? ■ n n n Are all pumps present? ■ n n n Are all pumps operable? ® n n n Page # 4 Permit: NCO056791 Inspection Date: 01/29/2010 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Pump Station - Effluent Are float controls operable? Is SCADA telemetry available and operational? Is audible and visual alarm available and operational? Comment: The effluent is pumped approximately 3,900 feet to Buffalo creek. Record Keeping Are records kept and maintained as required by the permit? Is all required information readily available, complete and current? Are all records maintained for 3 years (lab. reg. required 5 years)? Are analytical results consistent with data reported on DMRs? Is the chain -of -custody complete? Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses Transported COCs Are DMRs complete: do they include all permit parameters? Has the facility submitted its annual compliance report to users and DWQ? (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? Is the ORC visitation log available and current? Is the ORC certified at grade equal to or higher than the facility classification? Is the backup operator certified at one grade less or greater than the facility classification? Is a copy of the current NPDES permit available on site? Facility has copy of previous year's Annual Report on file for review? Comment: The operator records were thorough and complete. ■ n n ❑ ■nnn ■nnn ■ n n n ■ n n n ■ ■ ■ ■ ■ ■ ■nnn nnn■ nn■n ■nnn ■ n n n ■nnn ■nnn ❑n❑■ Page # 5 . .. A 'V sw A NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor IDirector Secretary February 23, 2009 Thomas E Byrd Horizons Residential Care Center 100 Horizons Ln Rural Hall NC 27045 SUBJECT: NOTICE OF DEFICIENCY Compliance Evaluation Inspection Horizons Residential Care Center Horizons Residential Care Center Permit No: NCO056791 Forsyth County Dear Mr. Byrd: Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection conducted on February 11, 2009. The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston-Salem Regional Office. Marc Nault (ORC), and Johnny Bullins maintenance. supervisor 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 Horizons Residential Care Center WWTP became effective July 1, 2007 and expires on February 29, 2012. The permitted components of the 0.015 MGD wastewater treatment plant include: septic/dosing tank with alternating pumps, dual alternating surface sand filters, recirculation manhole and pump, recirculation sprinkler pump tank, tablet chlorination, tablet de -chlorination, post aeration, effluent pump station and effluent force main. II. Records/Reports Operations records include all sample analyses and process control tests that are performed. The ORC's daily logbook was evaluated and found to be satisfactory. DMR's were available for the period requested. A complete copy of the NPDES permit was on site. The daily operator and maintenance logs were on site. Flow meter calibration records and flow charts are not available for this facility as flow is estimated from fresh water meter readings. An annual report for the year 2008 was available at the inspection. Marc Nault is the designated ORC for this facility. III. Facility Site Review The facility site review indicated that the 0.015 MGD treatment works is consistent with the permitted components. The actual treatment system consists of septic/dosing tank with alternating pumps, dual alternating surface sand filters, recirculation manhole and pump, recirculation sprinkler pump tank, tablet chlorination, tablet de -chlorination, post aeration, effluent pump station and force main. 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.ncwaterqualiV.org NorthCarolina An Equal Opportunity l Affirmative Action Employer IV. Effluent / Receiving Stream The WWTP discharges to Buffalo Creek (Class C waters in the Roanoke River Basin). The outfall was accessible and the effluent was clear with only a trace of foam at the time of the inspection. V. Flow Measurement Effluent flow is measured by the fresh water intake meter provided by the county water system. No calibration records are available. 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 Horizons Residential Care Center WWTP had no permit limit violations for 2008. There were four Monitoring Violations for the month of August when no flow measurements were reported on the DMR. VII. Laboratory Sample analyses are conducted by R & A Labs. The laboratory was not reviewed at the time of the subject inspection. VIII. Operation and Maintenance Operation and maintenance appeared to be satisfactory at the time of the inspection. Some, ponding was noted on the surface of the sand filter'bed and the inspector Was informed that a sand change was being planned for the near future. IX. Sludge Utilization/Disposal Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of properly, most recently by Sprinkle Septic on November 18, 2008. X. Sewer Overflow No sewer overflows were reported during the review period. The Division of Water Quality greatly appreciates your continued oversight at this facility. The Division 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: Marc W Nault, ORC; R&A Labs, 106 Short St, Kernersville NC 27284 Central Files VVinsto r-Salem Files" 0 United States Environmental Protection Agency Form Approved. EP /� . Washington, D.C. 20460 �y OMB No. 2040-0057 Water Compliance Inspection Report Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 I NI 2 15I 31 NCO056791 111 121 09/02/11 117 181 Cl 19I SI 20I Remarks 211111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---------- ----------- —Reserved-------------- 67 I 169 701 I 71 I_I 72 I N I 73 L J J 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) 10:00 AM 09/02/11 07/07/01 Horizons Residential Care Center Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 11:15 AM 09/02/11 12/02/29 Name(s) of Onsite Representative (s)/Titl es(s)/Ph one and Fax Number(s) Other Facility Data Marc W Nault/ORC/336-408-8550/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted. Thomas'E Byrd,100 Horizons In Rural Hall'NC 27045//910-767-2411/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit ® Flow Measurement ® Operations & Maintenance N 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 Rose Pruitt WSRO WQ//336-771-5000/ Signature of Managegient Q A[RReevie/wpm% Agency/Office/Phone and Fax Numbers Date �) EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 3I NCO056791 I11 12I 09/02/11 1 17 18ICI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) ORC Marc Nault with R&A Labs was present for the inspection with Johnny Bullins, Maintenance Supervisor for Horizons and Larry. During the file review it was noted that some DMR's were signed by someone other than the ORC. Flow measurements were not reported on the DMR for the month of August 2008. Some ponding was noted in the sand filter bed. The inspector was told that a sand change was due in the imediate future. Page # 2 Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 02/11/2009 Inspection Type: Compliance Evaluation Operations & Maintenance Yes No NA NE Is the plant generally clean with acceptable housekeeping? ® n O n Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge N n n 0- Judge, and other that are applicable? Comment: Permit Yes No NA NE (If the present permit expires in 6 months or less). Has the permittee submitted a new application? n n ® n Is. the facility as described in the permit? ®❑ n n # Are there any special conditions for. the permit? n n 120 Is. access to the plant site restricted to the general public? 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? ®❑ ❑ 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)? ❑ ❑ ❑ ® ' Are analytical results consistent with data reported on DMRs? ® n n n Is the chain -of -custody complete? Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses M Transported COCs Are DMRs complete: do they include all permit parameters? ❑ ®n n 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? 12 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 Page # 3 Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 02/11/2009 Inspection Type: Compliance Evaluation Record Keeping Yes No NA NE Facility has copy of previous year's Annual Report on file for review? ■ n n n Comment: Failed to monitor flow in August 2008 Effluent Pipe Yes No NA NE Is right of way to the outfall properly maintained?. ■ n n n Are the receiving water free of foam other than trace amounts and other debris? ■ n n n If effluent (diffuser pipes are required) are they operating properly? n n ■ n Comment: Flow Measurement - Effluent Yes No NA NE # Is flow meter used for reporting? ■ n n n Is flow meter calibrated annually? n n ■ ❑ Is the flow meter operational? ❑ ❑ (If units are separated) Does the chart recorder match the flow meter? n n ® ❑ Comment: County fresh water meter used to estimate flow Septic Tank Yes No NA NE (If pumps are used) Is an audible and visual alarm operational? n n ® n Is septic tank pumped on a schedule? ❑ n ® ❑ Are pumps or syphons operating properly? n n ❑ ■ Are high and low water alarms operating properly? ❑ ❑ ® ❑ Comment: Last pumped by Sprinkle 11/18/2009 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 Is the sand filter effluent re -circulated at a valid ratio? n ❑ ❑ # Is the sand filter surface free of algae or excessive vegetation? ®n n n # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) n n n Comment: Some ponding noted at inspection, sand change scheduled for near future Disinfection -Tablet Yes No NA NE Are tablet chlorinators operational? ■ ❑ n ❑ Are the tablets the proper size and type? ® n ❑ n Page # 4 Permit: NCO056791 Inspection Date: 02/11/2009 Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Disinfection -Tablet Yes No NA NE Number of tubes in use? 3 Is the level of chlorine residual acceptable? ❑ ❑ n v Is the contact chamber free of growth, or sludge buildup? ® n n n Is there chlorine residual prior to de -chlorination? n n n Comment: 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 dontainers? ®❑ ❑ n Comment: Are the tablets the proper size and type? n n n Are tablet de -chlorinators operational? M n n n Number of tubes in use? 3 Comment: Pump Station - Effluent Yes No NA • NE Is the pump wet well free of bypass lines or structures? ® n n n Are all pumps present? Are all pumps operable? n Are float controls operable? n n n Is SCADA telemetry available and operational? nn®n Is audible and visual alarm available and operational? n ®n n Comment: Visual alarm only 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 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 ® n Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees? n n ® n Page # 5 i Permit: NCO056791 Inspection Date: 02/11/2009 Laboratory Comment: R & A Labs Effluent Sampling Is composite sampling flow proportional? Is sample collected below all treatment units? Is proper volume collected? Is the tubing clean? Owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Yes No NA NE nn■n nnn■ nn.■n nn■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: Did not measure flow for Aug 2008 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: Page # 6 Feb 11, 2009 011 Ark-01 Feb 11, 2009 016 Feb 11, 2009 012 Feb 11. 2009 017 Feb 11, 2009 013 Feb 11, 2009 018 Feb 11, 2009 014 Feb 11, 2009 015 Faxed To: Jim Cheshire Fax #: 996-0326 Phone 996-2841 WWTP Annual Inspection Checklist This information should be available to the inspector at inspection time. Facility: Horizons NPDES: NC0056791 ;,) G hY�, Permit Effective Dates: 71112007 to 212912012 Inspection Date: 211112009 Inspection Time: 10:00 am 76 ---IT- DMRs (Dates: January 2008 to December 2008 ) 6--2) Lab Data (per DMR dates) Laboratories used for analysis & certification #'s �) Chain of Custody forms (per DMR dates) 115) Complete copy of current NPDES permit f SOC or Moratorium issuance (if applicable) ✓7) ORC and Back-up ORC current certification (Y\U V�, "®.�a. - v8� Wastewater Annual Report (fiscal or calendar year - if applicable) . ,,-9) Daily Operator's log / ORC visitation log ✓f0) Maintenance log -✓11-) Process control data (which includes field parameters tested and equipment calibrations) �) Field Parameter certification (if applicable) L13) Flow meter calibration records (if applic n Dent and/or effluent samplers 1F) Flewcta-rts (if applicable) '1-6--Ge-rreTator Inspection / under load checks - 17) Spill Response Plan (with current emergency contact numbers) --18) Sludge / Residuals hauling records (if applicable) /1 -/:6 -Off ,-A 9) 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 W`� c5 w G, i � a W, �01 I MONITORING REPORT(MR) VIOLATIONS for: Report Date: 02/13/09 Page: 1 of 1 , :. Fermat hc0056791 MRs:Between = 1,-200 and '' 12 2008,; ;i« Re ion::% Violatioii`Categoryc'fljp Fro r`arri Cate o" '0° .r. . U- "S ky;yz 7x w z' x �J} ': �. ,3 .Q ? °+�" f '*"+«u J• S,"o 9S �tai i,t s, r' r• ';gip` i x.. .. ,�. z«. -u .� .j; r 4° >FacliityCounty. t In Mjor t o x t i PERMIT: NCO056791 FACILITY: Horizons Residential Care Center - Horizons Residential COUNTY: Forsyth Care Center REGION: Winston-Salem Monitoring Violation MONITORING OUTFALL / VIOLATION UNIT OF CALCULATED REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE. LIMIT VALUE VIOLATION TYPE VIOLATION ACTION 04 -2008 001 Effluent Chlorine, Total Residual 04/05/08 2 X week ug/I Frequency Violation None 08 -2008 001 Effluent Flow, in conduit or thru 08/09/08 Weekly mgd Frequency Violation None treatment plant 0 -2008 001 Effluent Flow, in conduit or thru 08/16/08 Weekly mgd Frequency Violation None treatment plant 08 OS -2008 001 Effluent Flow, in conduit or thru 08/23/08 Weekly mgd Frequency Violation None treatment plant 8 -2008 001 Effluent Flow, in conduit or thru 08/30/08 Weekly mgd Frequency Violation None treatment plant 44. 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 June 27, 2008 CERTIFIED MAIL 7008 0150 0002 8342 1412 RETURN RECEIPT REQUESTED Thomas E. Byrd Horizons Residential Care Ctr 100 Horizons Ln Rural Hall NC 27045 Subject: Compliance Evaluation Inspection Horizons Residential Care Ctr Permit No. NCO056791 Forsyth County Dear Mr Byrd: Enclosed please find a copy of the Inspection Report from the inspection conducted June 26, 2008. The Compliance Evaluation Inspection was conducted by Rose Pruitt of the Winston- Salem Regional Office, also present was Marc Stokes with DWQ Technical Assistance. Clifford Cain and Marc Nault (ORC) with R&A Labs were also present for the inspection. The inspection consisted of two parts: an on -site inspection of the treatment facility and a file review. The treatment facility was found to be in compliance of permit NC0056791. I. Permit The NPDES permit for the Horizons Residential Care Center WWTP became effective July 1, 2007 and expires on February 29, 2012. The permitted components of the 0.015 MGD wastewater treatment plant include: septic/dosing tank with alternating pumps, dual alternating surface sand filters, recirculation manhole and pump, recirculation sprinkler pump tank, tablet chlorination, tablet de -chlorination, post aeration, effluent pump station and effluent force main. II. Records/Reports A review of the laboratory reports and Discharge Monitoring Reports (DMRs) for the Horizons Residential Care Center WWTP for the period January 2007 through December 2007 revealed that the facility had one violation. That violation was for daily maximum exceeded fecal coliform violations in November, a Notice of Violation was issued for this violation. Operation records include all sample analyses and process control tests that are performed. 585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax) Horizons Page 2 June 27, 2008 III. Facility Site Review The facility site review indicated that the 0.015 MGD treatment works is consistent with the permitted components. The actual treatment system consists of septic/dosing tank with alternating pumps, dual alternating surface sand filters, recirculation manhole and pump, recirculation sprinkler pump tank, tablet chlorination, tablet de -chlorination, post aeration, effluent pump station and force main. IV. Effluent / Receiving Stream The WWTP discharges to Buffalo Creek (Class C waters in the Roanoke River Basin). The outfall was accessible and the effluent was clear with only a trace of foam at the time of the inspection. V. Flow Measurement Effluent flow is measured with the incoming fresh water meter maintained by Forsyth County water department. VI. Self -Monitoring Program Operation records included all sample analyses and process control tests that are performed. VII. Compliance Schedules No compliance schedules to evaluate. VIII. Laboratory All of the sample analyses are conducted by R&A Labs. The laboratory was not reviewed at the time of the subject inspection. However, the laboratory certification document was on -site. IX. Operation and Maintenance Operation and maintenance at the time of the subject inspection appeared to be satisfactory. X. Sludge Utilization/Disposal The septic system was last pumped out by Sprinkle, Inc on 10/31/2007. XI. Pretreatment Not evaluated during this inspection. No pretreatment program required. .rr Horizons Page 3 June 27, 2008 XII. Stormwater Not evaluated during this inspection. XIV. Sewer Overflow None to report. XV. Pollution Prevention Not evaluated during this inspection. XVI. Multimedia Not evaluated during this inspection. Please refer to the enclosed Inspection Report for any additional observations and comments. The Division of Water Quality greatly appreciates your continued oversight at this facility. The Division also encourages you to continue to be proactive in your efforts to maintain compliance. Please refer to the enclosed inspection report for additional observations- and comments. If you or your staff have any questions, please call Rose Pruitt at 336-771-5000. Sincerely, Steve W Tedder Water Quality Regional Supervisor Winston-Salem Region Division of Water Quality Attachments Cc: Clifford Cain, R&A Labs, 106 Short St, Kernersville NC 27284 Marc Nault, ORC, R&A Labs, 106 Short St, Kemersville NC 27284 Central Files uJABIBa®,-lb Marc Stokes, Technical Assistance United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 Water Compliance Inspection Report Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 I NI 2 15I 11 NCO056791 111 121 08/06/26 117 18I CI 19I SI 201 II Remarks 2,111111111111111111111111111111111111111111111116 Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA--------------------------- Reserved ---------------------- 67 I 169 70I I 711 I 721 NJ 73 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) 10:50 AM 08/06/26 07/07/01 Horizons Residential Care Center Exit Time/Date Permit Expiration Date 2835 Mem Industrial School Rd Rural Hall NC 27045 11:25 AM 08/06/26 12/02/29 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Marc W Nault/ORC/336-408-8550/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Thomas E Byrd,100 Horizons Ln Rural Hall NC 27045//910-767-2411/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit ® Flow Measurement Operations & Maintenance ® Records/Reports 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 Marc Stokes WSRO WQ//336-771-5000/ Rose Pruitt WSRO WQ//336-771-5000/ Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date 6" EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page # 1 NPDES yr/mo/day Inspection Type 3I NC0056791 I11 12I 08/06/26 I17 181 CI Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) The inspector and Marc Stokes, Technical Assistance, were met at the facility by Marc Naught, ORC and Clifford Cain with R&A Labs. At the time of the inspection the facility appeared to be operating properly. The efflent was clear and had only a trace of foam. Records for the facility were complete and available at the inspection. Page # 2 J " Permit: NCO056791 Inspection Date: 06/26/2008 Owner - Facility: Horizons Residential Care Center 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 o ■ o ■ n n n Is the facility as described in the permit? # Are there any special conditions for the permit? n n ■ n Is access to the plant site restricted to the general public? n n ■ ❑ Is the inspector granted access to all areas for inspection? ■ ❑ n n Comment: locks on all covers 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 ❑ ❑ Are all records maintained for 3 years (lab. reg. required 5 years)? ® n ❑ n Are analytical results consistent with data reported on DMRs? ®n 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? ® n n n (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? n n ® n Is the ORC visitation log available and current? ® n n n Is the ORC certified at grade equal to or higher than the facility classification? ® n n n Is the backup operator certified at one grade less or greater than the facility classification? ® n n n Is a copy of the current NPDES permit available on site? n n n Page # 3 ._"r, Permit: NCO056791 Inspection Date: 06/26/2008 owner - Facility: Horizons Residential Care Center Inspection Type: Compliance Evaluation Record Keeping Facility has copy of previous year's Annual Report on file for review? Comment: Effluent Pipe Is right of way to the outfall properly maintained? Are the receiving water free of foam other than trace amounts and other debris? If effluent (diffuser pipes are required) are they operating properly? Comment: 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: Sprinkle Septic last hauled 10/31/2007 Sand Filters (Low rate) (If pumps are used) Is an audible and visible alarm Present and operational? Is the distribution box level and watertight? . Is sand filter free of ponding? Is the sand filter effluent re -circulated at a valid ratio? # Is the sand filter surface free of algae or excessive vegetation? # Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1) Comment: Disinfection -Tablet 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: De -chlorination ®nnn Page # 4 Permit: NCO056791 Owner - Facility: Horizons Residential Care Center Inspection Date: 06/26/2008 Inspection Type: Compliance Evaluation 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? Comment: Are the tablets the proper size and type? Are tablet de -chlorinators operational? Number of tubes in use? Comment: Pump Station -Effluent Is the pump wet well free of.bypass lines or structures? Are all pumps present? Are all pumps operable? Are float controls operable? Is SCADA telemetry available and operational? Is audible and visual alarm available and operational? Comment: visual only Yes No NA NE Tablet Page # 5 v Faxed To: Jim Cheshire / Marc Nault ORC Fax #: 996-0326 Phone 996-2841 WWTP Annual Inspection Checklist This information should be available to the inspector at inspection time. Facility: Horizons Residential Care NPDES: NCO056791 Permit Effective Dates: 71112007 to 212912012 1 0 : <5 0 Inspection Date: June 26, 2008 Inspection Time: 11:00 am �I) DMRs (Dates: January 2007 to December 2007 ) ,-1-2) Lab Data (per DMR dates) ,3) Laboratories used for analysis & certification #'s C-4A- -4) Chain of Custody forms (per DMR dates) .-5) Complete copy of current NPDES permit —Sta-tas of SOC or Moratorium issuance (if applicable) r �6RC and Back-up ORC current certificationU��-t .✓8) Wastewater Annual Report (fiscal or calendar year - if applicable) ✓9) Daily Operator's log / ORC visitation log ✓fO) Maintenance log _ 1) Process control data (which includes field parameters tested and equipment calibrations) ✓t2) Field Parameter certification (if applicable) ✓ 1.3) Flow meter calibration records (if applicable) IA*—inffuent and/or effluent samplers 1 Few charts (if applicable) 164---Generator Inspection / under load checks L-17) Spill Response Plan (with current emergency contact numbers) .--18) Sludge / Residuals hauling records (if applicable) 5 Pp)iAlV-)L:(// /0/-3/107 ✓t9) 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 41 Winston-Salem Regional Office (336) 771-5000 Fax: (336) 771-4630 Please have the ORC present at the inspection. MONITORING REPORT(MR) VIOLATIONS for: Report Date: 03/06/08 Page: 1 of 1 Permit: nc0056791 MRs Between: 1-2007 -and 1`2 2007 Region: % Vidlation Category: °lo Program Category: %-x.. I Facility Name:°lo Param Name -, County: °lo _- Subbasin:°°Jo Violation Action: . . Major Minor'.`%, u PERMIT: NCO056791 FACILITY: Horizons Residential Care Center - Horizons Residential COUNTY: Forsyth REGION: Winston-Salem Care Center Limit Violation MONITORING OUTFALL / LOCATION PARAMETER VIOLATION FREQUENCY UNIT OF LIMIT CALCULATED VIOLATION TYPE VIOLATION ACTION REPORT PPI DATE MEASURE VALUE 11 -2007 001 Effluent Coliform, Fecal MF, M-FC 11/13/07 2 X month #/loom[ 400 8,400 Daily Maximum Exceeded Proceed to NOV Broth,44.5C 05 -2007 001 Effluent pH 05/01/07 2 X month su 6 5.95 Daily Minimum Not Reached No Action, BPJ Monitoring Violation MONITORING OUTFALL / LOCATION PARAMETER VIOLATION FREQUENCY UNIT OF LIMIT CALCULATED VIOLATION TYPE VIOLATION ACTION REPORT PPI DATE MEASURE VALUE 09 -2007 001 Effluent Chlorine, Total Residual 09/22/07 2 X week ug/I Frequency Violation None 12 -2007 001 Effluent Chlorine, Total Residual 12/01/07 2 X week ug/I Frequency Violation None 12 -2007 001 Effluent Chlorine, Total Residual 12/29/07 2 X week ug/1 Frequency Violation None HORIZONS RESIDENTIAL CARE CENTER 100 Horizons Lane ❖ Rural Hall, NC 27045 Phone: (336) 767-241 1 ❖ Fax: (336) 661-21 S5 4- February 26, 2008 Mr. Steve W. Tedder Water Quality Regional Supervisor 585 Waughtown Street Winston-Salem, NC 27107 Dear Mr. Tedder, www.h737 R 00 Regional I am in receipt of your "notice of violation" dated February 21, 2008, concerning a violation on November 13, 2007. The licensed operator of our wastewater treatment facility is Mr. Mark Nault with Research & Analytical Labs. Upon discovering this abnormal reading on November 13, Mr. Nault immediately cleaned the chlorine unit and added additional chlorine tablets. All readings since November 13 have fallen within the acceptable parameters, and so we are confident that this has corrected the problem. Please contact me, or Mr. Nault (336-996-2841), should you have further questions. Sincerely, f T. David Adams President & CEO Hon.Zons Residential Care Center is a private, non profit organization which provides, with utmost dignity and respect, compassionate care and quality services appropriate to the needs of individuals with developmental disabilities and theirfamilies. O�O� WA �9QG 0 N', 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 February 21, 2008 CERTIFIED MAIL 70071490 0004 9565 0665 RETURN RECEIPT REQUESTED Thomas E Byrd Horizons Residential Care Center 100 Horizons Ln Rural Hall NC 27045 Subject: NOTICE OF VIOLATION Permit No. NCO056701 Horizons Residential Care Center Forsyth County Dear Mr Byrd: A review of Horizons Residential Care Center's monitoring report for November 2007 showed the following violations: Parameter Date Limit Value Reported Value Limit Type Coliform, Fecal MF, M-FC 11/13/07 400 #/100m1 8,400 #/100ml Daily Broth,44.5 C Maximum Exceeded Remedial actions should be taken to correct this problem. The Division of Water Quality may pursue enforcement action for this and any additional violations of State law. To prevent further action, carefully review these violations and deficiencies and respond in writing to this office within 30 working day of receipt of this letter. You should address the causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If you should have any questions, please do not hesitate to contact Rose Pruitt at 336-771-5000. Sincerely, Steve W. Tedder Water Quality Regional Supervisor Winston-Salem Region Division of Water Quality Cc: Central Files —SWP 585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax) Z-0-0 �V, Of/ I Cover Sheet from Staff Member to Regional Supervisor DMR Review Record Facility: /` 1)00NG **0 Permit/Pipe No.: NG0p5&%91 Month/Year /V oy 292 O `7 Monthly Average Violations Parameter Permit Limit DMR Value % Over Limit Weekl /Daily olations Date Parameter Permit Limit/Tvpe 'DMR Value % Over Limit IZVS-07 1'�teJfA©& o o 9 yh Y00 2 0 ©0 0 Date Parameter Other Violations Completed by: f-� Regional Water Quality Supervisor Signoff: Monitoring Frequency Violations Permit Frequency Values Reported # of Violations Date: - ; r � , 0 k Date: 0�' K0ON|TOFU0GREPORT(K0R)NOLATONSfoc nvnm�oum pono umo ouoomo : 1ov1 Facility Name: % County: Major Minor: 'lq PERK8|T:NCOO58791 FACILITY: Horizons Residential Care Center ' Horizons Residential COUNTY: Forsyth REGION: Winston-Salem Care Center Limit Violation MONITORING OUTFALL/ LOCATION PARAMETER VIOLATION FREQUENCY UNIT OF LIMIT CALCULATED VIOLATION TYPE VIOLATION ACTION xsponr pp/ uArs msxuoas VALUE Os'conr 001 Effluent pH 05/0107 2Xmonth vu s 5.95 Daily Minimum Not Reached moAction, opJ Monitoring Violation MONITORING OUTFALL/ LOCATION PARAMETER VIOLATION FREQUENCY UNIT OF LIMIT CALCULATED VIOLATION TYPE VIOLATION ACTION Rsponr pp/ oArs MEASURE' VALUE 09'2007 001 Effluent Chlorine, Total Residual 0912207 2Xweek ug/| Frequency Violation None EFFLUENT 10A NPDES PERMIT NO. NC 0056791 DISCHARGE NO. 001 MONTH November FEVEW'" 29078 FACILITY NAME Horizons Residential Care Center CLASS II COUNTYWFor,AhL CERTIFIED LABORATORIES R & A Laboratories, Inc. CERTIFICATION NO. 34 (List additional laboratories on the backside/page 2 of this form �. OPERATOR IN RESPONSIBLE CHARGE (ORC) Marc ult GRADE II CERTIFICATION NO. 9656 PERSON(S) COLLECTING SAMPLES Operators ORC PHONE 336-996-2841 CHECK BOX IF ORC HAS CHANGED f = l t NO FLOW / DISCHARGE FROM SITE * 0 Mail ORIGINAL and ONE COPY to: _ ATTN: CENTRAL FILES FEB 6 0 208 1 DIVISION OF WATER QUALITY Prins on•salem(SIGN T[I OF OPERATOR IN RESPONSIBLE CHARGE) DA 1617 MAIL SERVICE CENTER L Regi l QffictBy THIS mnATURE, I CERTIFY THAT THIS REPORT IS FEB^ RALF.IGH_ NC 27699-1617 naACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. EB - 6 2008 d A 8 N g a E O F C d Q Cl. 0 a• o ai 0 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 FLOWy y j °' H c o b C4 U rq � en °, 8 d o cn `� F $ u w d > A e u z F o o F Enter Parameter Code Above Name And Units Below EFF..= W ►'' A Weekly Weekly 2/Month 2/Week 2/Month 2/Month 2/Month 2/Month N/A HRS HRS v/B/N MGD SU /I m /I mg/1 m /I #loohn, m /I mg/1 m /1 1", 1343 0 30 _ Y , r< 0.0040' „' 17:0='° ° .6:Sfi <10.0;, . <2:00...<O:I00 `<5.0 ,2'" 2 0.0031 3 ;,.. , 0.0031 " ,,,, „� 4 0.0031 g 0.0029 6 0715 0.30 Y 0.0034 No Discharge 7 0.0034''`= 8 0.0027 9 " .13254:30 °Y0:0034 " 1sIoDischarge';>, w . 10 0.0034 w ". 0.0034; '' 12 0.0026 13 :1430: '0:50 Y ""'0.0034-r 12: ;6.48 :<10.0', 4.63,'� "'0:440 14 0.0028 15 0.0031 , 16 0605 0.40 Y 0.0033 No Discharge d, Y: 18 0.0033 19 -060 •0: 0 'Y `- ";; 0.0030 , . „ No DiseIiarge`'°° ; <, 20 0.0034 21 �0635` -_0: 0` °'Y �, , 0.0024 "" _ NowDiscliatgeti 22 0.0024 Z3. •, 0.0030" r. . 24 0.0031 25 . 00:0030., 26 0626 0.30 Y 0.0028 No Discharge ' 27 0.0034 28 0.0030 29 0.0026 30 31 ,..,<, ... . AVERAGE 0.0031 14.5 0 2.32 0.220 0 130 1GIAXI1v[UM , o.00ao 17.0 =0.A40 . �5:0 8400 MINIMUM 0.0024 12.0 6.48 <10.0 <2.00 <0.100 <5.0 2 CQmp.10 /EGrab,(G)" "I - G G G G G'^° ��` G G . Monthly Limit 0.015 =>6<9 28.0 30.0 16.OS 30.0 200.0 N/A Copy DWQ Form MR-1 (01/00) Facility Status: (Please check one'of the following) All monitoring data and sampling frequencies meet permit requirements (including weekly averages, if applicable) Compliant All monitoring data and sampling frequencies do NOT meet permit requirements Noncompliant The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the permitte became aware of the circumstances. A written submission shall also be provided within 5 days of the time the permittee becomes aware of the circumstances. If thefacility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by Part II.E.6 of the NPDES permit. "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that a 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." James M. Cheshire (Authorized Agent) Pe ittee (Peasqont or typ ) 44trf, 49-0 Sign tore of Permitee*** Date (Required unless submitted electronically) 100 Horizons Lane, Rural Hall NC 336-767-2411 02/28/07 Permittee Address Phone Number Permit Exp. Date Certified Laboratory (2) Certified Laboratory (3) Certified Laboratory (4) Certified Laboratory (5) ADDITIONAL CERTIFIED LABORATORIES PARAMETER CODES Certification No. Certification No. Certification No. Certification No. Parameter Code assistance may be obtained by calling the NPDES Unit at at (919) 733-5083, or by visiting the Surface Water Protection Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages. Use only units of measurement designated in the reporting facility's NPDES permit for reporting data. * No Flow / Discharge From Site: Check this box if no discharge occurrs and, as a result, there are no data to be entered for all of the parameters on the DMR for the entire monitoring period. ** ORC On Site? : ORC must visit facility and document visitation of facility as required per 15ANCAC8G.0204. *** Signature of Permittee: If signed by other than the permitte, then the delegation of the signatory authority must be on file with t, state per 15ANCAC213.0506 (b) (2) (D). G _ ■ Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. X ` El Agent ■ Print your name and address on the reverse "k) � ❑ Addresse so that we can return the card to you. B. Received by (Printed Nai e Date of Deliver ■ Attach this card to the back of the mailpiece, r �! or on the front if space permits. D. Is delivery address di ere` fr item 1?NCI W 1. Article Addressed to: b — If YES, enter delivery �' r ss elo�w� i N1 Thomas E. Byrd Horizons Residential Care Center 100 Horizons Lane Rural Hall, NC 27045 3. S,ervice Type Certified Mail Express Mail RRegistered Return Receipt for Merchandisf ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2 is i` i i' i�)1� j, �� i it 70% 149d b0�4 9565 �665 Ma � PS Form,3811, February2004; Domestic Return Receipt _ 7 l _ > ,(Q� 102595-02-M-154 l• UNITED STATE$--1 ,,Q TRitE' `'�i''i:. Y�1'•Y�'_?�' a;{��kihrCy._�Ii, n?:•+_yi..�f�ts. • � t.�Y. ��^��yy,,, 1, G• f. ... J. � filr§1�t-�f�'ss��il fii..4c?i Pt3rAi�t;l0: G-10 4 NCDENR-Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 r Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. Print your name and address on the reverse so that we can return the card to you. Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: A. Signature ❑ Agent ❑ Addressee Received by (Printed Na ) C. Date of Delive `CCS. D. Is delivery address different from ' em 1? ❑ Yes If YES, enter delivery address elow: ❑ No Thomas Byrd I Horizons Residential Care Center 100 Horizons Lane 3. rvice Type Rural Hall NC 27045 j Certified Mail ❑ Express Mail r 11 P Registered Return Receipt for Merchandise -- ❑ Insured Mail 6C.O.D. 4. Restricted Delivery? (Extra Fee) 7008 0150 0002 8342 1412 n 3811, February 2004 Domestic Return Receipt r-7 ❑ Yes 102595-02-M-154( UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • NCDENR- Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 ii?�!llii!{'ri!i�il!!i�!!ii4?1?!lilt 11?!!ilifi!li!Ilill�i?lii�f