NC0083933_Regional Office Historical File Pre 2016

RUDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 6, 2015
Aqua North Carolina Inc.
Attn: Thomas J. Roberts, President and CEO
202 Mackenan Drive
Cary, NC 27511
Subject: Compliance Evaluation Inspection
Permittee: Aqua North Carolina Inc.
.Facility: Salem Quarters Wastewater Treatment Plant
NPDES Permit #: NCO083933
Forsyth County
Dear Mr. Roberts:
Donald R. van der Vaart
Secretary .
Ron' Boone of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the
Division) conducted a compliance evaluation inspection (CEI) of the Salem Quarters Wastewater Treatment.
Plant (WWTP) on April 2, 2015. The assistance and cooperation of Sam Pegram was greatly appreciated. An
inspection checklist is attached for your records and inspection findings are summarized below.
General Information
. The WWTP.is located inside the Salem Quarters subdivision in Winston Salem; Forsyth County, NC,
at approximately coordinates 36.191667N, 80.109722W. The permit authorizes Aqua `North Carolina Inc. to
operate this 0.06 MGD WWTP, which consists of a bar screen, a flow splitter box, an equalization basin,, dual
aeration basins, dual clarifiers, a sand filter, an ultraviolet disinfection system, backup chlorination, contact and
dechlorination system, a sludge holding tank, and standby power, and discharge the treated effluent via outfall
001 into an unnamed tributary (UT) to Belews Creek, this section of which is currently classified as Class C
waters in the Roanoke River basin.
Site Review
Mr. Pegram has done an excellent job operating and maintaining the plant. The plant is in good
condition. Mr. Boone noted no discrepancies.
450 West Hanes Mill Road, Suite #300, Winston-Salem, North Carolina 27105
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity1 Affirmative Action Employer— Made in part by recycled paper

Documentation Review
All documentation was reviewed. No discrepancies were found. Mr. Pegram has done an excellent
job of documenting the operation and maintenance of the plant as required by the permit. This includes
operations and visitation logs, discharge monitoring reports and laboratory and field laboratory records, chains
of custody, etc.
Mr. Boone noted no concerns during his inspection. If you have any questions regarding the
inspection or this letter, please call him or me at [phone]. Thank you for your cooperation in this
matter.
Sincerely,
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
1. BIMS Inspection Report
CC:
entral Files
NPDES Unit

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approvalexpires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type
Inspector Fac Type
1 IN 1 2 15 I 3 I NCO083933 I11 121 15/04/02 I17 18 t i t
19 t s I 201 I
211IIIII IIIIIII11II IIIIIII 11IIIII IIIIIIIIIII
f6
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA -------Reserved------
--
67
�71itJ73 J74 75 1 1 1 1 J_U80
70 LJ 72
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)
10:00AM 15/04/02
12/05/01
Salem Quarters WWTP
9999 Rangecrest Rd
Exit Time/Date
Permit Expiration Date
Winston Salem NC 27103
11:00AM 15/04/02
17/02/28
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
-Samuel E. Pegram/ORC/704-489-9404/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Laurie Ison,4163 Sinclair St Denver NC 28037/Western Area Manager/704-489-9404/
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 C WSRO WQ//336-771-4967/
//s—
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers
Date
4
tl
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
31 NCO083933 I1 121 15/04/02 17 18 1 C 1
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

9 Permit: NCO083933 Owner`- Facility: Salem Quarters WWTP
Inspection Date: 04/02/2015 Inspection Type: Compliance Evaluation
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new
application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment: None
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: None
Laboratory
Are field parameters performed by certified personnel or laboratory?
Are all other parameters(excluding field parameters) performed by a certified lab?
Yes No NA NE
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Yes No NA NE
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Yes No NA NE
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Page# 3

Permit: NCO083933 Owner -Facility: Salem Quarters WWTP
Inspection Date: 04/02/2015 Inspection Type: Compliance Evaluation
Laboratory
Yes No NA NE
# Is the facility using a contract lab?
0
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
0
❑
❑
❑
Celsius)?
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑
❑
❑
Incubator (BOD) set to 20.0 degrees Celsius +/_ 1.0 degrees?
❑
❑
❑
Comment: None
Influent Sampling
Yes No NA NE
# Is composite sampling flow proportional?
0
❑
❑
❑
Is sample collected above side streams?
M
❑
❑
❑
Is proper volume collected?
N
❑
❑
❑
Is the tubing clean?
M
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
M
❑
❑
❑
Celsius)?
J
Is sampling performed according to the permit?
❑
❑
❑
Comment: None
Effluent Sampling
Yes No NA NE
Is composite sampling flow proportional?
❑
❑
❑
Is sample collected below all treatment units?
0
❑
❑
❑
Is proper volume collected?
N
❑
❑
❑
Is the tubing clean?
❑
❑
❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees
0
❑
❑
❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type
❑
❑
❑
representative)?
Comment: None
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and ❑ ❑ ❑
sampling location)?
Comment: None
Bar Screens Yes No NA NE
Type of bar screen
Page# 4

Permit: NCO083933 Owner -Facility: Salem Quarters WWTP
Inspection Date: 04/02/2015 Inspection Type: Compliance Evaluation
Bar Screens Yes No NA NE
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment: None
Equalization Basins
Is the basin aerated?
Is the basin free of bypass lines or structures to the natural environment?
Is the basin free of excessive grease?
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Are audible and visual alarms operable?
# Is basin size/volume adequate?
Comment: None
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam.the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/I)
Comment: None
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
❑ ❑ ❑
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■ ❑ ❑ ❑
❑ ❑ ❑
Yes No NA NE
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■ ❑ ❑ ❑
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Yes No NA NE
Ext. Air
Diffused
❑ ❑ ❑
❑ ❑ N ❑
■ ❑ ❑ ❑
■ ❑ ❑ ❑
E ❑ ❑ ❑
❑ ❑ ❑ ■
❑ ❑ ❑ ■
Yes No NA NE
■ ❑ ❑ ❑
Page# 5

Permit: NC0083933
Inspection Date: 04/02/2015
Owner - Facility: Salem Quarters VWVrP
Inspection Type: Compliance Evaluation
Secondary Clarifier
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately %4 of the sidewall depth)
Comment: None
Pumps-RASMAS
Are pumps in place?
Are pumps operational?
Are there adequate spare parts and supplies on site?
Comment: None
Flow Measurement - Effluent
# Is flow meter used for reporting?
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: None
Disinfection - UV
Are extra UV bulbs available on site?
Are UV bulbs clean?
Is UV intensity adequate?
Is transmittance at or above designed level?
Is there a backup system on site?
Is effluent clear and free of solids?
Comment: None
Yes No NA NE
❑ ❑ ® ❑
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Page# 6

p Permit: NCO083933 Owner - Facility: Salem Quarters WNlrP
Inspection Date: 04/02/2015 Inspection Type: Compliance Evaluation
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: None
Aerobic Digester
Is the capacity adequate?
Is the mixing adequate?
Is the site free of excessive foaming in the tank?
# Is the odor acceptable?
# Is tankage available for properly waste sludge?
Comment: None
Operations & Maintenance
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: None
Yes No NA NE
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Yes No NA NE
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Page# 7

NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
May 30, 2014
Thomas J. Roberts, President
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: NOTICE OF DEFICIENCY
NOD-2014-LV-0046
Permit No. NCO083933
Salem Quarters WWTP
Forsyth County
Dear Mr Roberts:
John E. Skvarla, III
Secretary
A review of Salem Quarters WWTP's monitoring report for February 2014 showed the following
deficiencies:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total (as N) -
02/28/14
7.1 mg/1
7.46 mg/1
Monthly
Concentration
Average
Exceeded
Remedial actions should be taken to correct the cause(s) of these deficiencies. Unresolved deficiencies may
lead to the issuance of a Notice of Violation and/or assessments of civil penalties by the Division of Water
Resources of up to $25,000.00 per day for each violation. Any efforts undertaken to bring the facility back
into compliance are not an admission of culpability. Your response, the degree and extent of harm to the
environment, and the duration and gravity of the deficiency(ies) will be considered in any future actions
undertaken.
If you should have any questions, please do not hesitate to contact Ron Boone at [phone].
cc: SWP — Central Files
N FSUS FM-
Sincerely,
W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NC DENR
585 Waughtown St., Winston-Salem, NC 27107
Phone: [phone] Internet: www.ncdenr.gov
An Equal Opportunity IAffirmative Action Employer— Made in part by recycled paper

Facility: Sle--� 4-- "1 41
Parameter
AN3
DMR Review Record
Permit No.: 3 9 3 3 Pipe No.: 10 Z-It Month/Year: 2 2c,1
Monthly Average Violations
Permit Limit DMR Value % Over Limit Action
Weekly/Daily Violations
Date Parameter
Permit Limit Limit Type DMR Value
% Over Limit Action
Monitoring
Frequency Violations
Date Parameter
Permit Frequency
Values Reported
# of Violations Action
Other Violations/Staff Remarks:
bpi
(Supervisor Remarks:' ;y
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Completed by:
Assistant Regional
Supervisor Sign Off:
Regional Supervisor Sign
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Date: S .2 R 1 /
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EFFLUENT PR ,,
NPDES PERMIT NO. NC 0083933 DISCHARGE NO. 001 MONTH February YEAR 2014
FACILITY NAME Salem Quarters WWTP CLASS II COUNTY Forsyth
CERTIFIED LABORATORIES Water Tech Labs, Inc CERTIFICATION NO.
(List additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (ORC) Samuel E. Pegram GRADE II CERTIFICATION NO 11008
PERSON(S) COLLECTING SAMPLES Operators ORC PHONE [phone] ext 57232
CHECK BOX IF ORC HAS CHANGED = NO J>LOW / DISCHARGE FROM SITE
Mail ORIGINAL and ONE C0:I?,N"t0:RECEIV
ATTN: CENTRAL FILES r F_f N.C. Dept. o ENR
DIVISION OF WATER QUALIT ., 4 (SIGNATURE OF OPERATOR IN RESPON BLE CHARGE)
1617 MAIL SERVICE CENTER ' �� o '�� ` BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS !1 a 1'; ,D
RALEIGH, NC 27699-1617 -i WINSTON-Si ,LEM ACCURATE AND COMPLETE TO THE BEST OF MY KNJP 5 EDGY. 20%
REGIONAL O 'FICE
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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
oncompliant
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 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. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Tom Roberts
Perm e (Please print o�r tom)
Signature of Permitee*** Date
(Required unless submitted electronically)
202 MacKenan Court Cary NC 27511 919-467-8712 2/28/17
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 [phone], 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. j
** 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 the state per
15ANCAC213.0506 (b) (2) (D).

E5EARCh ANA1YTiCA1
LAbORATORIES, INC.
Analytical/Process Consultations
RE: Salem Quarters
Non -Compliance February 2014
NH- 3N
During the entire month of February !Multiple problems were experienced with the
blowers that provide air to operate the plant. Problems include: Check valve malfunction
and weak breakers that were tripping out under normal amp load. Maintenance personnel
have since replaced the check valve and installed new breakers. The plant has since been
operating much better. The exceedances for Ammonia for the Month of February was
approximately 1.5% dthe monthly limit.
Neal McDuffie, Back lip ORC
Research & Analytical Laboratories, Inc
P.O. Box 473 • 106 Short Street a Kernersville, North Carolina 27284 ^ 336-996-2841 • Fax [phone]
www.randalabs.com

Water Pollution Control System Operator Designation Form
WPCSOCC
NCAC 15A 8G .0201
Permittee Owner/Officer Name: AcPuA NC TOM 40,6ER S
Mailing Address: e1 o a MAC K£-NAN cei4 R r
City: CARP State: ,UC Zip: 2 7-f/ / - Phone #: (9 /9) V46 r% - 97 / a
Email address: " A-M C o(a 41-e �• /(frgQug a fie/' t e 9 cc:'� M
Signature: dlc�.-e 14CC�/�«.� Date: 312 7,1
................. ... ................................................................................................................... I.........
Facility Name: SA t. rr M 0N,49 naS Permit #: AJC00931733
SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Facility Type/Grade:
Biological WWTP_ Surface Irrigation
Physical/Chemical Land Application
Collection System
Operator in Responsible Charge (ORC)
Print Full Name: ROI& r edAd Mf
Certificate Type / Grade Number:
&J. 4u.
8 Work Phone #:
( 33C�)
//
Signature: ~ �D '�
/7�
' J-�
Date:
—
X
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
....................... .......................................................................................................... :...............
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: 54M484 s-, 106�76,,PA141
Certificate Type / Grade / Number; G✓ 4J. �%J -/ /60 9 Work Phone #: (336) A / ,I--- 'ell 33
Signature:. �,v A',iG�✓%t?ii7t Date: 3 ^ �' 1! ) /J
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities. of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission,"
...................................................................................................................................................
Alail, fax or entail the WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 Fax: [phone]
original to: Email: eertadmin a.nedenr.tz
Mail or firy a copy to lite Asheville
appropriate Regional Office: 2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax; 252.946.9215
Phone: 252.946,6481
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr
Wilmington 29405-2845
Fax: [phone]
Phone: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
585 Waughtown St
Winston-Salem 27107
Fax; 336.771.4631
Phone: [phone]
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]
Revised 02-2013

Facility Name: .SAI-f''t Qg,44rE,eS Permit #: AlCoo83933
.................................................................................................................................... I............
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: DA9PEZ-L f-16ANM Q
Certii". /Yyke / Grade / Number: W.. W q ` ?(j.Z 7 Work Phone #: (3-3(-) 3 Co 02 - / o ye
Date: !� -- -ar�:j,
"I certify that f agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission,"
................................................. ......... ............................................................................... I ......
.
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: _ PgrE DF44 I.,u G-
Certificate Type / Grade / Number: 0J-(-cl. _Zr 99%�/�i`l Work Phone #: (336,-) 3 6.2 — .2009
Signature: (/ Z4_,� /_ _/,,_ �/ _ _ Date: c3, 2A -
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission"
.................... ........... .................... ...................... ............................................................ I..........
Back -Up Operator in Responsible Charge (BU ORC)
Print Ful[ Name: M/CNAFL 6TR1CKI-AN&
Certificate Type / Grade / Number: LU. uJ. 1- 0 2 Work Phone #: (33( ) I.3 & - O 11 8
Signature:YA L(, Date: w� a 14
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the WaterPollution Control System Operators Certification Commission."
.................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number: Work Phone #:
Signature:
Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Revised 02-2013

Water Pollution Control System Operator Designation Form
WPCSOCC
NCAC 15A 8G .0201
Permittee Owner/Officer Name:-_AQ,44 N C -roM 'q0BE'Rr5
Mailing Address: ozo z MAc K FIVAN co,4 ? f
City: CRA 1✓ State: NC Zip: 275'11 - Phone #: (91 8'7 / 9,
Email address C&MCdokA le / a4u a aMq
Signature: Date: 3 /.1 '> ��41
........................ .........................................................................................................................
Facility Name; W£L L £SL £Y P44CS Permit #: Aje 0e)8e(g09
SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Facility Type/Grade:
Biological WWTP
Physical/Chemical
Collection System
i� Surface Irrigation
Land Application
.................................................................................................................. I............................,
Operator in Responsible Charge (ORC)
Print Full Name: SAM u L GRAM
Certificate Type / Grade / NGumber, W.W. /Oo$ Work Phone #: (336) 2 tS- q13.3
Signature: ` Date: 3 �r�'%?'%% q,
"I certify that I agree to my designatiorras the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
.................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: g oe sR T 4A RKst<
Certificate Type / Grade / Number: &J. W. rl 19 V Work Phone #: 6) 3 1?0 - 3 ? 9
Signature: ?i`-7" �v`--. - - Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 080.0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
...................................................................................................................................................
Mall;. tax or email the NVPCSOCC, 1618 Mail Service Center, Raleigh, INC 27699-1618 Fax: 919.807,6492
original to: Email: certadrriin anncdenr.eov
Mall or fkv a copy to the Asheville
appropriate Regional Office: 2090 US Hwy 70
Swannanoa 28778
Fax., 828,299,7043
Phone: [phone]
1ashington
943 Washington Sq Mall
Washington 27889
Fax: 252,946,9215
Phone: 252,946,6481
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: [phone]
Phone: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
585 WaughtoN%% St
Winston-Salem 27107
Fax: [phone]
Phone: 336.771,5000
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:919,791.4200
Revised 02-2013

FacilityName: t),F4I-£5GX P De, 4CE Permit#: NC00gY 0I?
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: PARRE6 YbI&If
Certificate Ty rade / Number: W. Gy ` ?(3-2 r% Work Phone #: (33(') 3 (o A 1 o q8
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: ?£TF AE44 I N 6
Certificate Type / Grade / Number: W—til -ZL U 517 Work Phone #: C33C�,-) 3 6.2 - :Zoo S
Signature: . 9�L `1���, " Date: 1-,-5 3
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: MICNfl£G STRICITZAt/D
Certificate Type / Grade / uTber: (..tJ. uJ. -T- 4 Q(o z Work Phone #: 336 .33 9,2 - 011 8
Signature: r i�aDate: U of/Q O i
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
.................................................................................................................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number:
Signature:
Work Phone #:
Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
.... .......................... ................................. I ................ ............................................................. I ............................
Revised 02-2013

4,J&;A_
WNW
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 25, 2014
Aqua North Carolina Inc.
Attn: Thomas J. Roberts, President and CEO
202 Mackenan Drive
Cary, NC 27511
Subject: Compliance Evaluation Inspection
Permittee: Aqua North Carolina Inc.
Facility: Salem Quarters Wastewater Treatment Plant
NPDES Permit#: NCO083933
Forsyth County
Dear Mr. Roberts:
John E. Skvarla, III
Secretary
Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Resources (DWR or the
Division) conducted a compliance evaluation. inspection (CEI) of the Salem Quarters Wastewater Treatment
Plant (WWTP) on April 22, 2014. The assistance and cooperation of Robert Barker, Operator in Responsible
Charge (ORC), was greatly appreciated. An inspection checklist is attached for your records and inspection
findings are summarized below.
General Information
The WWTP is located inside the Salem Quarters subdivision in Winston Salem, Forsyth County, NC,
at approximately coordinates 36.191667N, 80.109722W. The permit authorizes Aqua North Carolina Inc, to
operate this 0.06 MGD WWTP, which consists of a bar screen, a flow splitter box, an equalization basin, dual
aeration basins, dual clarifiers, a sand filter, an ultraviolet disinfection system, backup chlorination, contact and
dechlorination system, a sludge holding tank, and standby power, and discharge the treated effluent via outfall
001 into an unnamed tributary (UT) to Belews Creek, this. section of which is currently classified as Class C
waters in the Roanoke River basin.
Site Review
Mr. Barker has done an excellent job operating and maintaining the plant. The plant is in very good
condition and is being operated exceedingly well. Mr. Boone noted no discrepancies.
585 Waughtown Street, Winston-Salem, North Carolina 27107
Phone: [phone] Internet: www,ncdenr.gov
An Equal Opportunity1 Affirmative Action Employer— Made in part by recycled paper

Documentation Review
All documentation was reviewed. No discrepancies were found. Mr. Barker has done an excellent job
of documenting the operation and maintenance of the plant as required by the permit. This includes
operations and visitation logs, discharge monitoring reports and laboratory and field laboratory records, chains
of custody, etc.
Mr. Boone noted no concerns during his inspection. If you have any questions regarding the
inspection or this letter, please call him or me at [phone]. Thank you for your cooperation in this
matter.
Sincerely,
v� W. Corey Basinger
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. BIMS Inspection Report
CC: 'US'Ft'�'N�
Central Files
NPDES Unit

United States Environmental Protection Agency
Form Approved.
E p nl�/-0 Washington, D.C. 20460
OMB No. 2040-0067
Water Campfiancp 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 N I 2 15 I 31 NCO083933 111 121 14/04/22 117 181 C I 19I S I 201 I
Remarks
211111 I.I II II II 1111 II 111111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --------------------------- Reserved ----------------------
67 I 169 701 I 711 I 72 L N I. 73 LJJ 74 751 I I I I I Li 80
�—
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)
Salem Quarters WWTP
09:00 AM 14/04/22
12/05/01
Exit Time/Date
Permit Expiration Date
9999 Rangecrest Rd
Winston Salem NC 27103
11:00 AM 14/04/22
17/02/28
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
///
Robert M Barker/ORC/336-382-3989/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Laurie Ison,4163 Sinclair St Denver NC 28037/Western Area Manager/704-489-9404/ 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/
2&� 41Z S//,(
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
I` Lc�Seu/ Pto (a /3 77J - �'�'�
� ilk
v
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

Permit: NC0083933 Owner - Facility:
Inspection Date: 04/22/2014 Inspection Type:
Salem Quarters WWTP
Compliance Evaluation
Secondary Clarifier
Yes
No
NA NE
Is the site free of excessive floating sludge?
■
n
n n
Is the drive unit operational?
n
n
■ n
Is the return rate acceptable (low turbulence)?
■
n
n n
Is the overflow clear of excessive solids/pin floc?
■
❑
❑ n
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
n
n
n ■
Comment: None
Pumps-RAS-WAS
Yes
No
NA NE
Are pumps in place?
■
❑
n n
Are pumps operational?
■
n
n n
Are there adequate spare parts and supplies on site?
■
n
n n
Comment: None
Filtration (High Rate Tertiary)
Yes
No
NA NE
Type of operation:
Up
flow
Is the filter media present?
■
n
n n
Is the filter surface free of clogging?
■
n
n n
Is the filter free of growth?
■
n
n n
Is the air scour operational?
n
n
n ■
Is the scouring acceptable?
n
n
n ■
Is the clear well free of excessive solids and filter media?
■
❑
❑ ❑
Comment: None
Disinfection - UV
Yes No
NA NE
Are extra UV bulbs available on site?
■
n
n n
Are UV bulbs clean?
■
❑
n n
Is UV intensity adequate?
■
n
n n
Is transmittance at or above designed level?
■
n
n n
Is there a backup system on site?
■
n
n ❑
Is effluent clear and free of solids?
■
n
n n
Comment: None
Effluent Pipe
Yes No
NA. NE
Is right of way to the outfall properly maintained?
■
❑
Page # 6

Permit: NCO083933
Inspection Date: 04/22/2014
Owner - Facility: Salem Quarters WWTP
Inspection Type: Compliance Evaluation
Are the receiving water free of foam other than trace amounts and other debris?
■
n n n
If effluent (diffuser pipes are required) are they operating properly?
n
n
■ ❑
Comment: None
Aerobic Digester
Yes
No
NA NE
Is the capacity adequate?
■
n
n n
Is the mixing adequate?
■
n
n n
Is the site free of excessive foaming in the tank?
■
n
n n
# Is the odor acceptable?
■
n
❑ ❑
# Is tankage available for properly waste sludge?
■
n
n n
Comment: None
Standby Power
Yes No
NA NE
Is automatically activated standby power available?
■
n
n
Is the generator tested by interrupting primary power source?
■
n
n n
Is the generator tested under load?
■
n
❑ n
Was generator tested & operational during the inspection?
■
n
n o
Do the generator(s) have adequate capacity to operate the entire wastewater site?
■
n
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 In
Comment: None
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 0—
Judge, and other that are applicable?
Comment: None
Page # 7

WASTEWATER TREATMENT PLANT INSPECTION CHECKLIST
EMAIL TO: AT
NAME EMAIL
OR
FAX TO: AT
NAME FAX #
FACILITY NAME: sat �-doof- NPDES #: �C 6c� t 3 93 3
PERMIT EFFECTIVE DATES, FROM: TO: o2/Zf 41-7
INSPECTION DATE: */22//`oe INSPECTIOFNTIME: Q460 - /XbS
PLEASE HAVE THE FOLLOWING RECORDS AVAILABLE FOR REVIEW ON THE ABOVE INSPECTION DATE.
1 DMRs DATES FROM: ! 1 ! 3 TO: ! Z 3/ Lq
2 LAB DATA (SAME AS DN4R DATES):
3 LABORATORIES USED FOR ANALYSIS & THEIR CERTIFICATION #s: �, )g Jrgy —r e
4 CHAIN OF CUSTODY FORMS: ✓
5 DAILY OPERATOR'S LOG & ORC VISITATION LOG:
6 MAINTENANCE LOG:
7 COMPLETE COPY OF CURRENT NPDES PERMIT:
8 FLOW METER CALIBRATION RECORDS, IF APPLICABLE: Fu l4 "' d
9 FLOWCHARTS, IF APPLICABLE:
10 PROCESS CONTROL DATA, INCLUDING FIELD PARAMETERS TESTED AND EQUIPMENT CALIBRATIONS:
11 FIELD PARAMETER CERTIFICATION, IF APPLICABLE:
12 CURRENT SLUDGE/RESIDUALS PERMIT, IF APPLICABLE: ✓
13 SLUDGE/RESIDUALS HAULING RECORDS:
14 SLUDGE/RESIDUALS ANNUAL REPORT: /1! A
15 CURRENT PERM ITTEE/ORC/BACKUP ORC INFORMATION ✓
16 GENERATOR INSPECTION/UNDER LOAD CHECK RECORDS
17 SPILL RESPONSE PLAN (CURRENT EMERGENCY CONTACTS/PHONE NUMBERS): d
18 STATUS OF SOC OR MORATORIUM ISSUANCE, IF APPLICABLE V JA
19 WASTEWATER ANNUAL REPORT (FISCAL OR CALENDAR YEAR), IF APPLICABLE:
20 COPY OF LAST INSPECTION BY THE DIVISION: ✓
21 VISUAL INSPECTION OF TREATMENT UNITS, INCLUDING COMPOSITE SAMLERS/STREAM MONITOR LOCATIONS
22 STREAM ACCESSIBLE FOR INSPECTION (AT EFFLUENT DISCHARGE PIPE): D, s M'cu c-rh 5e-"Vx,1
23 5 R Y0 4)
24 NOTES:i�-
25 WWTP NPDES RECORDS ARE TO BE KEPT FOR 3 YEARS
26 LAB AND SLUDGE RECORDS ARE TO BE KEPT FOR 5 YEARS
27
28 QUESTIONS CALL INSPECTOR: RON BOONE AT 336-771-4967, OR
29 FAX [phone], OR
30 EMAIL AT [e-mail]
NOTES:

� oil
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. Skvarla, III
Governor Director Secretary
May 7, 2013
Aqua North Carolina Inc.
Attn: Thomas J. Roberts, President and CEO
202 Mackenan Drive
Cary, NC 27511
Subject: Compliance Evaluation Inspection
Permittee: Aqua North Carolina Inc.
Facility: Salem Quarters Wastewater Treatment Plant
NPDES Permit #: NCO083933
Forsyth County
Dear Mr. Roberts:
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 Salem Quarters Wastewater
Treatment Plant (WWTP) on May 2, 2013. The assistance and cooperation of Mr. George Gatewood,
Operator in Responsible Charge (ORC), was greatly appreciated. An inspection checklist is attached for
your records and inspection findings are summarized below.
General Information
The WWTP is located inside the Salem Quarters subdivision in Winston Salem, Forsyth County,
NC, at approximately coordinates 36.191667N, 80.109722W. The permit authorizes Aqua North Carolina
Inc. to operate this 0.06 MGD WWTP, which consists of a bar screen, a flow splitter box, an equalization
basin, dual aeration basins, dual clarifiers, a sand filter, an ultraviolet disinfection system, backup
chlorination, contact and dechlorination system, a sludge holding tank, and standby power, and discharge
the treated effluent via outfall 001 into an unnamed tributary (LT) to Belews Creek, this section of which is
currently classified as Class C waters in the Roanoke River basin.
Site Review
Mr. Gatewood has done an excellent job operating and maintaining the plant. The plant is in very
good condition and is being operated exceedingly well. Mr. Boone noted no discrepancies.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service;1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
One
Xwrklrally

Aqua NC Inc.
Attn: Thomas J. Roberts, President and CEO
Compliance Evaluation Inspection
Salem Quarters WWTP, NC0083933
May 6, 2013, Page 2 of 2
Documentation Review
All documentation was reviewed. No discrepancies were, found. Mr. Gatewood has done an
excellent job of documenting the operation and maintenance of the plant as required by the permit. This
includes operations and visitation logs, discharge monitoring reports and laboratory and field laboratory
records, chains of custody, etc.
Mr. Boone noted no concerns during his inspection. If you have any questions regarding the
inspection or this letter, please call him or me at [phone]. 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: VWS O SWPza
Central Files
NPDES Unit

' United States Environmental Protection Agency
Form Approved.
✓ EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type . Inspector Fac Type
1 INI 2 15 I 31 NCO083933 111 121 13/05/02 117
181 C I 19101 20I
Remarks
2111111111111111111111111111111111111111111.1111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
--------------------------- Reserved ----------------------
67I 169 701 I 711 I 721 NJ
73I I 174 751 I I I I I1-1 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)
Salem Quarters WWTP
08:00 AM 13/05/02
12/05/01
Exit Time/Date
Permit Expiration Date
9999 Rangecrest Rd
Winston Salem NC 27103
09:00 AM 13/05/02
17/02/28
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
George Richard Gatewood/ORC/336-215-1048/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Laurie Ison,4163 Sinclair St Denver NC 28037/Western Area Manager// 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 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
Ron Boone WSRO WQ//336-771-4967/
�j
Signature o Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
i�'� ,i' :9 ,..�+ '.F it �/'3'
a' D
p� /%�
r'"*'9 v ram'
-
9
-
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3 NC0083933 111 12I 13/05/02 117 18I CI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
Page # 2

Permit: NC0083933
Inspection Date: 05/02/2013
Owner - Facility: Salem Quarters WWTP
Inspection Type: Compliance Evaluation
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment: Please refer to the attached inspection summary letter.
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: Please refer to the attached inspection summary letter.
.Laboratory
Are field parameters performed by certified personnel or laboratory?
Yes No NA NE
Yes No NA NE
■ n n n
■nnn
■nnn
■ n n n
■nnn
■
Yes No NA NE
■nnn
Page # 3

Permit: NCO083933 Owner - Facility: Salem Quarters WWTP
Inspection Date: 05/02/2013 Inspection p p 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?
n
n
n
Comment: Please refer to the attached inspection summary letter..
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
®n
n
n
Is sample collected below all treatment units?
®
n
n
n
Is proper volume collected?
®
n
n
n
Is the tubing clean? ® n n n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? n n n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ® n n n
Comment: Please refer to the attached inspection summary letter.
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ® n n n
Comment: Please refer to the attached inspection summary letter.
Bar Screens
Type of bar screen
a.Manual
b.Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment: Please refer to the attached inspection summary letter.
Equalization Basins
Is the basin aerated?
Is the basin free of bypass lines or structures to the natural environment?
Is the basin free of excessive grease?
Yes No NA NE
n
Yes No NA NE

Permit: NCO083933
Inspection Date: 05/02/2013
Owner - Facility: Salem Quarters WWTP
Inspection Type: Compliance Evaluation
(Equalization Basins
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Are audible and visual alarms operable?
# Is basin size/volume adequate?
Comment: Please refer to the attached inspection summary letter.
Aeration Basins
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for -the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment: Please refer to the attached inspection summary letter.
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately'/ of the sidewall depth)
Yes No NA NE
■ n n n
■nnn
■ n n n
■nnn
■nnn
Yes No NA NE
Ext. Air
Diffused
■nnn
nn■n
■nnn
■nnn
■nnn
n n n ■
nnn■
Yes No NA NE
Page # 5

Permit: NC0083933 Owner - Facility: Salem Quarters WWTP
Inspection Date: 05/02/2013 Inspection Type: Compliance Evaluation
Secondary Clarifier
Comment: Please refer to the attached inspection summary letter.
Pumps-RAAS-WAS
Are pumps in place?
Are pumps operational?
Are there adequate spare parts and supplies on site?
Comment: Please refer to the attached inspection summary letter.
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: Please refer to the attached inspection summary letter.
Flow Measurement - Effluent
# Is flow meter used for reporting?
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: Please refer to the attached inspection summary letter.
Disinfection - UV
Are extra UV bulbs available on site?
Are UV bulbs clean?
Is UV intensity adequate?
Is transmittance at or above designed level?
Is there a backup system on site?
Is effluent clear and free of solids?
Comment: Please refer to the attached inspection summary letter.
Effluent Pipe
Is right of way to the outfall properly maintained?
Yes No NA NE
Yes No NA NE
®nnn
®nnn
®nnn
Yes No NA NE
mmon
®nnn
®nnn
00013
nnnn
nnnn
Yes No NA NE
Yes No NA NE
®nnn
®nnn
®nnn
®nnn
®nnn
®nnn
Yes No NA NE
® n n n
Page # 6

Permit: NCO083933
`inspection Date: 05/02/2013
Owner - Facility: Salem Quarters WWTP
Inspection Type: Compliance Evaluation
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: Please refer to the attached inspection summary letter.
Aerobic Digester
Is the capacity adequate?
Is the mixing adequate?
Is the site free of excessive foaming in the tank?
# Is the odor acceptable?
Yes No NA NE
®nnn
nn®n
Yes No NA NE
# Is tankage available for properly waste sludge?
a
n
n
n
Comment: Please refer to the attached inspection summary letter.
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
w
n
❑
n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH,
DO, Sludge ■
n
In
n
Judge, and other that are applicable?
Comment: Please refer to the attached inspection summary letter.
Standby Power
Yes No
NA
NE
Is automatically activated standby power available?
0
n
n
n
Is the generator tested by interrupting primary power source?
n
n
n
9
Is the generator tested under load?
n
❑
n
■
Was generator tested & operational during the inspection?
n
®
n
n
Do the generator(s) have adequate capacity to operate the entire wastewater site?
■
n
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: Please refer to the attached inspection summary letter.
Page # 7

L
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. Skvarla, III
Governor Director Secretary
April 15, 2013
To: sharon.taylor10_)coldwelIban ker.com
Subject: Letter of Adequacy for: 6785 Rangecrest Road, Belews Creek, 27009
Salem Quarters Subdivision / Aqua NC, Inc.
NPDES Permit # NCO083933 / Collection System Permit # WQCSD0205
Forsyth County
Dear Sharon:
As per your request, this letter serves as notice of adequacy and proper licensing for the
wastewater treatment facility and the collection system serving Salem Quarters Subdivision in
Forsyth County, NC. Currently, Aqua North Carolina, Inc., holds both of the permits noted
above.
The wastewater treatment facility at Salem Quarters Subdivision is properly licensed by
the NC Division of Water Quality under permit number NC0083933. The wastewater facility
was last inspected by this office on January 27, 2011. The wastewater collection system at
Salem Quarters Subdivision is properly licensed by the NC Division of Water Quality under
permit number WQCSD0205. The collection system was last inspected on March 29, 2012.
If you have any questions regarding this letter, please call me at [phone].
cc: WSRO
Winston-Salem Regional Office
585 Waughtown Street Winston-Salem, NC 27107
Phone: [phone] FAX: [phone]
NCDENR Customer Service: 1-877-623-6748
Internet: www.ncwaterouality.mg
Sincerely, ,
a
Michael M. Mickey
Environmental Program Consultant
Surface Water Protection Section
Nne
orthCarolina
Natm ly
An Equal Opportunity 1 Affirmative Action Employer

Mickey, Mike
From: Sharon Taylor [sharon.taylor1 @coldwellbanker.com]
Sent: Monday, April 15, 2013 3:20 PM
To: Mickey, Mike
Subject: Septic System Documents on 6785 Rangecrest Road, Belews Creek, 27009
Again, Thank you Mike for your help.
(�iIPM& 3�
Broker / REALTOR/ CSSB/CNS/CRS/CLAMS/CNBS
336-497 3667
Coldwell Banker, TRIAD REALTORS
EMAIL: sharon.taylor1(ED-coldwellban ker.com
WEBSITE: www.myrealtorsharontaylor.com
FACEBOOK PAGE: facebook.com/sharontaylorrealtor.

AI®
C®R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. Skvarla, III
Governor Director Secretary
January 11, 2013
William S. & Betsy L. Wilson
6807 Salem Quarter Road
Belews Creek, NC 27009
Subject: Letter of Adequacy for 6807 Salem Quarter Road
Salem Quarters Subdivision / Aqua NC, Inc.
NPDES Permit # NCO083933 / Collection System Permit # WQCSD0205
Forsyth County .
Dear Mr. & Mrs. Wilson:
As per your request, this letter serves as notice of adequacy and proper licensing for the
wastewater treatment facility and the collection system serving Salem Quarters Subdivision in
Forsyth County, NC. Currently, Aqua North Carolina, Inc., holds both of the permits noted
above.
The wastewater treatment facility at Salem Quarters Subdivision is properly licensed by
the NC Division of Water Quality under permit number NC0083933. The wastewater facility
was last inspected by this office on January 27, 2011. The wastewater collection system at
Salem Quarters Subdivision is properly licensed . by the NC Division of Water Quality under
permit number WQCSD0205. The collection system was last inspected on March 29, 2012.
If you have any questions regarding this letter, please call me at [phone].
cc: [e-mail]
[e-mail]
WSRO
Winston-Salem Regional Office
585 Waughtown Street Winston-Salem, NC 27107
Phone: [phone] FAX: [phone]
NCDENR Customer Service:1-877-623-6748
Internet: www.neweterguality.org
Sincerely,
Michael M. Mickey
Environmental Program Consultant
Surface Water Protection Section
Watualiff
NorthCa olina
An Equal Opportunity IAffirmative Action Employer

Mickey, Mike
From: Betsy Wilson [[e-mail]]
Sent: Friday, January 11, 2013 1:09 PM
To: Mickey, Mike
Cc: [e-mail]
Subject: Letter of Approval for the Package Treatment Plant in my neighborhood
Homeowners: William S. and Betsy L. Wilson
Address of property: 6807 Salem Quarter Road
Belews Creek, NC 27009
We are requesting that this letter be sent to Dhana Stewart with Wells Fargo Home Mortgage.
Her email address is dhana.stewart(?wells/argo.com; I have copies heron this email as well so
she will know to be expecting this letter.
Thanks you so much for your help and have a great weekend!!
Betsy Wilson
336-716-4390

r,n�"""%1 `� I
icLCLitfi G
C'•d.C.'t7e{?t. os"FIVE �`mZk.. , �' ..
VV41ston-5aIera
i Rj iorlai Ofnr
®A ua North Carolina, Inc. Thomas J. Roberts
202 MacKenan Court President and Chief Operating Officer
Cary, NC 27511
T: 919.653.5770
January 25, 2012 F: 919.460.1788
[e-mail]
www.aquanorthcarolina.com
r
Point Source Branch
Surface Water Protection Section
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Delegation of Signature Authority
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 on the
attached list as required by all applicable federal, state, and local environmental agencies specifically with
the requirements for signatory authority as specified in 15A NCAC 213.0506.
Name
Title
Thomas J. Roberts
President and COO
Jack Lihvarcik
Operations Manager
Robert Ashley
Regional Supervisor
Matthew Costner
Regional Supervisor
Larry Finnicum
Area Manager
Michael Melton
Regional Manager of Compliance
Duane Rimmer
Regional Supervisor
If you have any questions regarding this letter, please feel free to contact me at 919-653-5770.
President and COO
cc: Winston Salem Regional Office, DWQ
Mooresville Regional Office, DWQ
jC.n's Vgo�aC; t.d L' 1!; ls'/ r'i .ew
tjC00if-,?
rr`m ,l�rti�k e-
tj C 0 0 1165Gre�Srat��
NC00G3i=•tr
FavCsa p<ici20-
NC00S�GC'E
Sio��i�3�-pn
An Aqua America Company

Permit No.
Facility
County
NC0028746
Briarwood SD WWTP
Stokes
NC0063720
Forest Ride WWTP
Forsyth
NC0065587
Frye Bride WWTP
Forsyth
NC0078115
Gre stone SD WWTP
Forsyth
NC0050792
Melbille Heights WWTP
Rndl h
NC0067091
Mikkola Downs WWTP
Forsyth
NC0078158
Olde Beau GC WWTP
AI hn
NC0055191
Penman Hei his WWTP
Rndl h
NC0083925
Salem Glen SD WWTP
Dvdsn
' C0083933
Sale ua tiers
Foi yth1W
Dvdsn
NC0083941
Sixing Creek WWTP
NC0084409
Wellesley Place WWTP
Forsyth
NC0034452
Willow Creek WWTP
Dvdsn
NC0088536
Bannertown Hills W#2
Surry
NC0088552
Colonial Wds - W 2
Surr
NC0088552
Colonial Wds-W 1
Surry
NC0088528
Hillcrest SD - Well #3
Surry
NC0088498
Mitchell Bluff - Well #1
Surry
NC0088854
Pine Lks W 2
surry
NC0088633
Reeves Wds W #2
Surry
NC0088617
Snow Hill SD
Surry
NC0088501
Stonin ton SD - Well #1
Fors th
NC0088625
The Hollows SD
Surr
NC0088609
Wind ate SD
Su
NC0065749
Ashe Plantation WWTP '
Mklb
WQ0024694
Bri h s Crk WWI RWUS
Polk
NC0065684
Country Wood WWTP
Union
NC0063860
Harbor Estates WW P
Mklb
NC0063789
Mint Hill Festival WWTP
Mklb
NC0063584
Oxford Glen WWTP
Mklb
NC0073539
Willowbrook SD WWTP
Mklb
NC0072061
Fox Run WTP
Gaston
NC0084468
Keltic Meadows WTP #2
Gaston
NCO086193
Ma lecrest WTP
Gaston
NC0086142
Oakley Park 1
Gaston
NC0086142
Oakley Park 2
Gaston
NC0069035
Southgate WTP
Gaston
NC0075205
Alexander Island WWTP
Iredell
NC0056154
Bridgeport WWTP
Iredell
NC0058742
Country Valley WWTP
Catawba
NC0074772
Diamond Head WWTP
Iredell
NC0074900
Highway 150 WWTP
Iredell
NC0063355
Killian Xroads WWTP
Catawba
NC0062481
Mallard Head MEP
Iredell
NC0028941
Pine Valley SD WWTP
Rowan
NC0060593
Spinnaker Bay WWTP
Catawba
NC0080691
Windemere WWTP
Iredell

NCDMR-
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
Mr. Thomas J. Roberts
Aqua North Carolina, Inc.
202 Mackenan Court
Cary, North Carolina 27511
Dear Mr. Roberts:
Charles Wakild, P.E.
Director
February 1, 2012:
Subject: DRAFT NPDES PERMIT
Permit Number NCO083933
Salem Quarters WWTP — Class WW-2
Forsyth County
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. Your permit is among several in the Roanoke River Basin that the Division has
targeted for expedited renewal.
The following modifications have been made to the draft permit:
• Parameter codes have been added to Sections, A.(1.).
• A Total Residual Chlorine footnote has been updated in Section A.(1.).
Please submit any comments to me no later than thirty (30) days following your receipt of
the draft. Comments should be sent to the address listed at the bottom of this page. If no adverse
comments are received from the public or from you, this permit will likely be issued in mid -
March 2012, with an effective date of May 1, 2012.
If you have any questions or comments concerning this draft permit, please contact me at
(919) 807-638.8 or Maureen. Scardinana,ncdenr. gov.
Sincerely,
Maureen Scardina .
cc: NPDES Unit
ec: Winston-Salem Regional Office, Surface Water Protection Section
Steve Reid, Technical Assistance & Certification Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: http://portal.ncdenr.org/web/wgmome
An Equal Opportunity 1 Affirmative Action Employer
lit V446M7119-
Hna

Permit NC0083933
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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,
Aqua North Carolina, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Salem Quarters WWTP
Belews Creek Road
Walkertown
Forsyth County
to receiving waters designated as an unnamed tributary to Belews 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
, 2012.
This permit and authorization to discharge shall expire at midnight on February 28, 2017.
Signed this day
, 2012.
I ' -:- -to 1
Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

k
Permit NC0083933
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under
the permit conditions, requirements,, terms, and provisions included herein.
Aqua North Carolina, Inc. is hereby authorized to:
1. Continue to operate an existing 0.06 MGD wastewater treatment system with the following
components:
♦ Bar screen
♦ Flow Splitter Box
♦ Equalization basin
♦ Dual aeration basins
♦ Dual clarifiers
♦ Dual sand filters
♦ Ultraviolet disinfection system
♦ Back-up chlorinator, contact basin & dechlorinator
♦ Sludge holding tank
♦ Stand-by power
The facility is located near Walkertown at the Salem Quarters WWTP on Belews Creek Road in
Forsyth County.
2. Discharge from said treatment works at the location specified on the attached map into an unnamed
tributary to Belews Creek, currently classified C waters in sub -basin 03-02-01 of the Roanoke
River Basin.

s
Permit NCO083933
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
LIMITS
MONITORING REQUIREMENTS
CHARACTERISTICS
Monthly
Daily
Measurement
Sample
. Sample
Parameter Code
Average
Maximum
Frequency
Tye
Location'
Flow
0.060 MGD
Continuous
Recording
Influent or
50050
Effluent
BOD, 5-day (20°C)
30.0 mg/I,
45.0 mg/L
Weekly
Composite
Effluent
C0310
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
C0530
NH3 as N —Summer*
2.0 mg/L
10.0 mg/L
Weekly
Composite
Effluent
C0610
NH3 as N — Winter*
7.1 mg/L
35.0 mg/L
Weekly
Composite
Effluent
C0610
Dissolved Oxygen
Daily average > 5.0 mg/L
Weekly
Grab
Effluent
00300
—
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
Effluent
31616
Total Residual Chlorine
28 ug/L
2/Week
Grab
Effluent
50060
Temperature (°C)
Daily
Grab
Effluent
00010
Total Phosphorus
Quarterly
Composite
Effluent
C0665
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Composite
Effluent
C0600
pH
Not < 6.0 nor > 9.0
00400
Standard Units
Weekly
Grab
Effluent
Dissolved Oxygen
Upstream &
00300
Weekly
Grab
Downstream
Temperature (°C)
Weekly
Grab
Upstream &
00010
Downstream
*Summer: April 1 — October 31
*Winter: November 1— March 31
Footnotes:
1. Upstream = at least 100 feet above discharge point; Downstream at NCSR 2009
2. The Division shall consider all effluent TRC values reported below 50 µg/L to be in compliance
with the permit. However, the Permittee shall continue to record and submit all values reported by
a North Carolina certified laboratory (including field certified), even if these values fall below 50
µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS

J % • 1 GO
r c
DISCHARGE �„ '• -J�_ t -
POINT
• Nt J/ / i
'iV�~ 111
/ 950
• 9 . J
158
h
Aqua North Carolina, Inc.
Salem Quarters WWTP
County:
Forsyth Stream Class:
C
Receiving Stream: UT to Belews Creek Sub -Basin:
030201
Latitude:
36' 11' 30" Grid/Quad:
C18NE
Longitude:
800 06' 35" HUC:
03010103
Facility
Location
(not to scale)
NORTH NPDES Permit: NCO083933

ALT -K WA
yki"A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
THOMAS J ROBERTS
PRESIDENT AND COO
AQUA NORTH CAROLINA INC
202 MACKENAN COURT
CARY NC 27511
Dear Mr. Roberts:
Coleen H. Sullins
Director
September 12, 2011
Dee Freeman
Secretary
RFCEIVED
N.c. De:,_. oP E N R
Winston-Salem
Regional 0rf-ice
Subject: Receipt of permit renewal application
NPDES Permit NCO083933
Salem Quarters WWTP
Forsyth County
The NPDES Unit received your permit renewal application on September 6, 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 [phone].
Sincerely,
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
�t n: a ej R-qgaonal C ific 7/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: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org A/I ,
An Equal Opportunity 1 Affirmative Action Employer � 'J�/�7aturall

%. I
NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCO083933
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
AQUA NORTH CAROLINA, INC.
Facility Name
SALEM QUARTERS WWTP
Mailing Address
202 MACKENAN COURT
City
CARY
State / Zip Code
NC 27511
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road BELEWS CREEK ROAD
City BELEWS CREEK
State / Zip Code NORTH CAROLINA / 27009
County FORSYTH
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 AQUA NORTH CAROLINA, INC.
Mailing Address 202 MACKENAN COURT--�._���
�• r
City CARY All
State / Zip Code NORTH CAROLINA 27511 l
f
Telephone Number [phone]
Fax Number [phone] 40-1ta soup„e -
1 of 4 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 177
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
This wastewater system serves residential customers only.
Population served: 450
S. Type of collection system
® Separate. (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
UT to Belews Creek
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: 24 hours
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.
This 0.060 MGD wastewater treatment facility consists of:
• Bar screen
• Flow Splitter Box
® Equalization basin
• Dual aeration basins
• Dual clarifiers
• Dual sand filters
• Ultraviolet disinfection system
• Back-up chlorinator, contact basin and dechlorinator
2 of 4 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Sludge holding tank
Stand-by power
3 of 4 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.060 MGD
Annual Average daily flow 0.021 MGD (for the previous year)
Maximum daily flow 0.027 MGD (for the previous year)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum
and monthly average. If only one analysis is reported, report as daily maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
10.9
2.86
MG/L
Fecal Coliform
85.0
3.2
#/ 100ML
Total Suspended Solids
22.0
5.9
MG/L
Temperature (Summer)
29.8
25.7
'Celsius
Temperature (Winter)
20.4
16.7
° Celsius
pH
7.8
N/A
UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NCO083933
14. APPLICANT CERTIFICATION
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
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.)
4of4
Form-D 05108

Aqua North Carolina, Inc. www.aquaamerica.com
202 MacKenan Court
Cary, NC 27511
SLUDGE MANAGEMENT PLAN
For
Aqua North Carolina, Inc.
No sludge will be treated on any wastewater treatment plant site operated by Aqua
N.C., Western Division
Where practical, sludge removed from a Aqua N.C., Western Division facility will
be transported via a contract hauler to another Aqua N.C., Western Division
facility for the purpose of "seeding" a new or under loaded plant.
Unusable (or "dead") sludge will be removed by a contract hauler and properly
disposed of in accordance with NCGS 143-215.1. Contract haulers used by Aqua
N.C., Western Division will be required to report the quantity of sludge
transported and identify the location of the proposed disposal site if the sludge is
not taken to an existing plant operated by Aqua N.C., Western Division. Aqua
N.C., Western Division has not entered into any agreement to accept sludge into
its facilities from plants not owned by them.
Aqua N.C., Western Division will keep records on the quantity of sludge removed from
each facility, the name of the contract hauler, and the destination of the sludge (whether
used in another plant or disposed of). The information will be kept on file and will be
made available to any regulatory agency having jurisdiction over sludge treatment or
disposal.
Aqua N.C., Western Division includes all of the facilities under the jurisdiction of the
Winston-Salem Regional Office.

4 '
NCDENR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
-January 31st, 2011
Aqua North Carolina Inc.
Attn: Thomas J. Roberts
202 Mackenan Drive
Cary, NC 27511
Subject: Compliance Evaluation Inspection
Permittee: Aqua North Carolina Inc.
Facility: Salem Quarters Wastewater Treatment Plant
NPDES Permit #: NCO083933
Forsyth County
Dear Mr. Roberts:
Resources
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
Salem Quarters Wastewater Treatment Plant (WWTP) on January 27th, 2011. The assistance
and cooperation of Mr. George Gatewood, Operator in Responsible Charge (ORC), was
greatly appreciated. An inspection checklist is attached for your records and inspection
findings are summarized below.
General Information
The WWTP is located inside the Salem Quarters subdivision in Winston Salem, Forsyth
County, NC, at approximately coordinates 36.191667N, 80.109722W. The permit authorizes
Aqua North Carolina Inc. to operate this 0.06 MGD WWTP, which consists of a bar screen, a
flow splitter box, an equalization basin, dual aeration basins, dual clarifiers, dual sand filters,
an ultraviolet disinfection system, a backup chlorination, contact and dechlorination system, a
sludge holding tank, and standby power, and discharge the treated effluent via outfall 001 into
an unnamed tributary (U'T) to Belews Creek, this section of which is currently classified as
Class C waters in the Roanoke River basin.
Site Review
Mr. Gatewood has done an excellent job operating and maintaining the plant. The plant
is in very good condition and is being operated exceedingly well. Mr. Boone noted no
discrepancies.
Documentation Review
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer
Nne
orthCarohna
;VatUrdally

Aqua North Carolina Inc.
Attn: Thomas J. Roberts
Compliance Evaluation Inspection
NC0083933, Salem Quarters WWTP
Page 2 of 2, January 31", 2011
All documentation was reviewed. No discrepancies were found. Mr. Gatewood has
done an excellent job of documenting the operation and maintenance of the plant as required
by the permit. This includes his operations and visitation logs,. his discharge monitoring reports
and laboratory and field laboratory records, chains of custody, etc.
Mr. Boone noted no concerns during his inspection. If you have any questions
regarding the inspection or this letter, please call him or me at [phone]. Thank you for
your cooperation in this matter.
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section
Attachments:
1. BIMS Inspection Report
C C : l� - I^C+3-tS,u P.�
Central Files
NPDES Unit
.ti

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCO083933 111 121 11/01/27 117 181 CI 19I SI 20I I
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA -------------------Reserved----------
67I 169 70I I 711 I 72I N I 73 W 74 711 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)
07/07/01
08:30 AM 11/01/27
Salem Quarters WWTP
Exit Time/Date
Permit Expiration Date
9999 Rangecrest Rd
Winston Salem NC 27103
09:30 AM 11/01/27
12/02/29
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/fitle/Phone and Fax Number
Contacted
Thomas J Roberts,202 Mackenan Dr Cary NC
27511/President/919-467-8712/9194661583 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated) .
Permit N Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program E Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone WSRO WQ//704-663-1699 Ext.2202/
c.yi�38;;),vI
Signature Reviewer Agency/Office/Phone and Fax Numbers Date
;Z,,ementQ
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO083933 I11 12I 11/01/27 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter. Mr. Gatewood is doing an excellent job.
Page # 2

Permit: NCO083933 Owner - Facility: Salem Quarters VWVTP
Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
■
Is the facility as described in the permit?
■
n
n
n
# Are there any special conditions for the permit?
n
®
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector granted access to all areas for inspection?
®❑
❑
n
Comment: Please refer to the attached inspection summary letter.
Record Keeping
Yes No
NA
NE
Are records kept and maintained as required by the permit?
■
n
n
n
Is all required information readily available, complete and current?
■
n
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
n
n
n
Are analytical results consistent with data reported on DMRs?
■
n
n
n
Is the chain -of -custody complete?
■
n
n
n
Dates, times and location of sampling
■
Name of individual performing the sampling
■
Results of analysis and calibration
■
Dates of analysis
■
Name of person performing analyses
■
Transported COCs
■
Are DMRs complete: do they include all permit parameters?
®
n
n
n
Has the facility submitted its annual compliance report to users and DWQ?
n
n
■
El
(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?
■
0
0
EI
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?
❑
❑
■
El
Comment: Please refer to the attached inspection summary letter.
Laboratory
Yes
No
NA NE
Are field parameters performed by certified personnel or laboratory?
■
n
Cl
n
Page # 3

Permit: NCO083933 Owner - Facility: Salem Quarters VWVTP
Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation
Laboratory
Yes
No
NA
NE
Are all other parameters(excluding field parameters) performed by a certified lab?
■
n
❑
Cl
# Is the facility using a contract lab?
■
n
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
■
n
n
n
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
n
n
n
■
Incubator (BOD) set to 20.0 degrees Celsius +/-1.0 degrees?
n
n
n
Comment: Please refer to the attached inspection summary letter.
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
■
n
n
n
Is sample collected below all treatment units?
■
n
n
n
Is proper volume collected?
■
❑
❑
n
Is the tubing clean?
■
❑
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
■
❑
❑
❑
nn
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ - - n-
Comment: Please refer to the attached inspection summary letter.
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ n n n
Comment: Please refer to the attached inspection summary letter.
Bar Screens Yes No NA NE
Type of bar screen
a.Manual
■
b. Mechanical
n
Are the bars adequately screening debris?
■
n
n
n
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
❑
n
n
Is the unit in good condition?
■
n
n
n
Comment: Please refer to the attached inspection summary letter.
Equalization Basins
Yes
No
NA
NE
Is the basin aerated?
■
n
n
n
Is the basin free of bypass lines or structures to the natural environment?
■
n
n
n
Is the basin free of excessive grease?
■
n
00
Page # 4

r
Permit: NCO083933 Owner - Facility: Salem Quarters WWTP
Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation
Equalization Basins
Yes No
NA
NE
Are all pumps present?
■
n
n
n
Are all pumps operable?
■
n
n
n
Are float controls operable?
■
n
n
n
Are audible and visual alarms operable?
■
n
n
n
# Is basin size/volume adequate?
®
n
n
n
Comment: Please refer to the attached inspection summary letter.
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext.
Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
Cl
n
Are surface aerators and mixers operational?
n
n
■
n
Are the diffusers operational?
■
n
n
n
Is the foam the proper color for the treatment process?
■
n
❑
n
Does the foam cover less than 25% of the basin's surface?
■
n
n
n
Is the DO level acceptable? -
n
n
n
■
Is the DO level acceptable?(1.0 to 3.0 mg/I)
n
n
n
■
Comment: Please refer to the attached inspection summary letter.
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
n
n
n
Is the site free of excessive buildup of solids in center well of circular clarifier?
n
n
■
n
Are weirs level?
■
n
n
n
Is the site free of weir blockage?
■
n
n
n
Is the site free of evidence of short-circuiting?
®
n
n
n
Is scum removal adequate?
■
n
n
n
Is the site free of excessive floating sludge?
®
n
n
n
Is the drive unit operational?
n
n
■
n
Is the return rate acceptable (low turbulence)?
■
n
n
n
Is the overflow clear of excessive solids/pin floc?
■
n
n
n
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
■
n
n
n
Page # 5

Permit: NCO083933 Owner - Facility: Salem Quarters VWVrP
Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes No
NA
NE
Comment: Please refer to the attached inspection summary letter.
Pumps-RAS-WAS
Yes No
NA
NE
Are pumps in place?
■ n
n
n
Are pumps operational?
■ n
n
Are there adequate spare parts and supplies on site?
■ n
n
n
Comment: Please refer to the attached inspection summary letter.
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
n
Is sand filter free of ponding?
n n
n
n
Is the sand filter effluent re -circulated at a valid ratio?
n n
n
n
# Is the sand filter surface free of algae or excessive vegetation?
n ❑
# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
❑ ❑
❑
n
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
n
❑
n
Is flow meter calibrated annually?
■
❑
n
Cl
Is the flow meter operational?
■
n
n
n
(If units are separated) Does the chart recorder match the flow meter?
■
n
n
n
Comment: Last calibrated 09102/2010. Isco 4210
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
n
Are the tablets the proper size and type?
❑
n
n
■
Number of tubes in use?
0
Is the level of chlorine residual acceptable?
n
n
■
o
Is the contact chamber free of growth, or sludge buildup?
■
n
n
n
Is there chlorine residual prior to de -chlorination?
n
Cl
■
n
Comment: This is a backup system. UV is primary and was being used at time of
inspection. Please refer to the attached inspection summary letter.
Yes
No
NA
NE
Page # 6

Permit: NC0083933
Inspection Date: 01/27/2011
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
Is storage appropriate for cylinders?
Owner - Facility: Salem Quarters wWTP
Inspection Type: Compliance Evaluation
# Is de -chlorination substance stored away from chlorine containers?
Are the tablets the proper size and type?
Comment: This is a backup system. UV is primary and was being used at time of
inspection. Please refer to the attached inspection summary letter.
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment: This is a backup system. UV is primary and was being used at time of
inspection. Please refer to the attached inspection summary letter.
Disinfection - UV
Are extra UV bulbs available on site?
Are UV bulbs clean?
Is UV intensity adequate?
Is transmittance at or above designed level?
Is there a backup system on site?
Is effluent clear and free of solids?
Comment: UV is primary and was being used at time of inspection. Please refer to the
attached inspection summary letter.
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment: This is a backup system. UV is primary and was being used at time of
inspection. Please refer to the attached inspection summary letter.
Aerobic Digester
Is the capacity adequate?
Is the mixing adequate?
Is the site free of excessive foaming in the tank?
# Is the odor acceptable?
Yes No NA NE
Tablet
0
Yes No NA NE
■nnn
■nnn
■nnn
■nnn
Page # 7

Permit: NCO083933 Owner - Facility: Salem Quarters VWVTP
Inspection Date: 01/27/2011 Inspection Type: Compliance Evaluation
Aerobic Digester Yes No NA NE
# Is tankage available for properly waste sludge? n n 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
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: Please refer to the attached inspection summary letter.
Standby Power Yes
No
NA
NE
Is automatically activated standby power available? ■
n
n
n
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?
Comment: Please refer to the attached inspection summary letter.
Page # 8

Ajo
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
February 3rd, 2011
Brightgreen Home Loans, Inc.
Attn: Kim Jones, Licensed Mortgage Loan Officer NMLS# 104699
8410 Six Forks Rd, Suite 201
Raleigh, NC 27615
Subject: Letter of Adequacy and Proper Licensing
5955 Asheby Drive, Belews Creek, NC 27009
Lot Number 82, Block ID 5221 B Salem Quarter Sec 02
Forsyth County
Dear Ms. Jones:
Dee Freeman
Secretary
As per your request on January 31St, 2010, this letter serves as notice of adequacy and
proper licensing for the wastewater collection, treatment and disposal system that serves the
subject property in the Salem Quarters subdivision in Belews Creek, Forsyth County, NC.
As of the date of this letter, the wastewater collection and treatment/disposal systems
that serve the subject property are in good condition and are well and properly operated by the
current owner, Aqua North Carolina Inc. Additionally, both the wastewater collection and
treatment/disposal systems are properly licensed by the NC Division of Water Quality under
permit numbers WQCSD0205 and NC0083933, respectively.
If you have any questions regarding this letter, please call me at [phone].
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
Nne
orthCarohna
An Equal Opportunity 1 Affirmative Action Employer

JUN/01/2010/TUE 09:20 AM Aqua North C&eo=lina FAX No, 704999409 P, 001/012
¢" :.
'water Pollution Control System Designation Form
WPCSOCC
NCAC 15A.:08G .0201
General Information:
Permittee Owner/Officer Name: ► (/A .vG<
Mailing Address: Y/613
City: a e.v v -ef State: zip: ;? ',?,o 51> -
Telephone Number:
Signature:
Date: ff C
.■■■■■■■■■■■■■■■■■■■■■■rrrYrr■■■■■■rrr■■■■■■■■■■■■■■w■■■■■■■rrr■rr■■■r■■■r■■
Facility Information:
Facility: 5A /—M;:
Permit Number: County: Fagsva
! SUBMIT A SEPARATE FORM FOR EACH TYpIE OF SYSTEM!
Mark XQ Type of fiacilit VALss (1 - 4)
`VV'asthwater plant Z-
Physical/Chemical
Collection System
Class
Spray Irrigation N/A
Land Application N/A
Subsurface N/A
err■■■■■rr■■■■■■■■■■■■r■■■■■■■■■■■•■■rrrr■■■■■■■■■r■■■■■■■■■■■■■■■■■rrrrr■■■
Operator in Responsible Charge:
Print Name: Gc -gpc-? 46-wzyow d Social Security
Certificate Type and Grade: _ jam,/ Lc/ -a- Certificate #: /o G kV
Work Telephone: 3(G ) �?/ j /oH� Signature:
Back -Up Operator in Responsible Charge:
Print Name: -5- 14 a �Z C, A A Social Security # : �� % �����'►1 d i�.
Certificate Tape and Grade: Z UA)TjJ Certificate #:
Work Telephone: Signature- �.
Mail or Fax to: WPCSOCC
1618'Mai1 Service Center
I21eigh, N.C. 27699-1618
Fax: 919/73-3-,1338

JUN/01/2010/TUE 09:20 AM Aqua North Carolina FAX No.7044899409 P.002/012
Water Pollution Control System Designation Form
WPCSOCC
NCAC 1SA:08G .0201
Irr■rYrr■■r■■■■■■■■■■■■■r■�rYrr■■■■■■■■■rr■■wrr••■■■r ■■■■■■■■■■■ww r■r■■r■■■■
AdditoLW Back -Up Operator:
print Name: lie A ° r" 4 )-r Work Phone: Mi - 3 IS 9
WW Cert. GiadelNumber: _�e) 1,0_ Ly ` SI Cert.#: '79�
Signature: 4.0,4 Date:
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Additonal Back -Up Operator:
Piurt Name: . :5-0-% 7�0 A +- % ` Work Phone: I - eo Z - 91 to 2
WW Cert. Cn-ade/Nunmber: W W 'LL SI Cert.#:. ctqD_n Z 2,
Date: 0 S
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Additonal Back -Up Operator:
Prim Name:
WW Cert. Grade/Number:
Signature:
Additonal Back -Up Operator:
Print Name:
WW Cert. Grade/Number:
Signature:
Work Phone:
SI Cert.#:
Date:
Work Phone:
Date:
SI Cert.#:
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Additonal 13ack-Up Operator:
Print Name:
Work Phone: .
WW Cent. Grade/Number: SI Cert.#:
Signature:
Date,
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Performance Annual Report
I. General Information
Facility/System Name:
Responsible Entity: Aqua North Carolina
Person in Charge/Contact: Tom Roberts
Applicable Permit (s):NC 00083933
Description of Collection System or Treatment Process:
FRECEIVED
N.C. Deot. of F
APR 1 6 2010
Winston•5
Regiona! r,
AI'AI? 042010
This 0.060 MGD wastewater treatment facility consists of an influent manual bar
screen flow splitter box equalization basin dual aeration basins dual clarifiers, dual
sand filters UV Disinfection system with back-up chlorinator, contact basin & de -
chlorinator, sludge holding tank and stand-by power.
II. Performance
Text Summary of System Performance for Calendar Year 2009
This plant consistently met discharge permit limits and generally
performed well.
List (by month) any violation of the permit conditions or other environmental regulations.
Monthly lists should include discussion of any environmental impacts and corrective
measures taken to address violations.
January
Compliant
February
Compliant
March
Compliant
- - April,---
Compliant ...
May
Compliant
June
Compliant

July Compliant
August Compliant
October Compliant
November Compliant
December Compliant
III. Notification
Our customers will receive a letter regarding the availability of this report upon request.
These reports will also be available for review with the customer at Aqua's Southern Call
Center.
IV. Certification
I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify that this report has been made available to the users or
customers of the named system and that those users .have been notified of its availability.
A al"G k) 2/26/2010
Responsible Person Date
Title: Regional Compliance Manager
Entity: Aqua North Carolina, Inc.

AAIJ
a&
CDR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
November 20, 2009
Mr. Thomas J. Roberts, President & COO
Aqua North Carolina, Inc
202 Mackenan Court
Cary, NC 27511
Subject: NOTICE OF VIOLATION
NPDES Permit No. NC0083933
Salem Quarters WWTP
Forsyth County
Dear Mr Roberts:
Dee Freeman
Secretary
A review of the Salem Quarters WWTP monitoring report for August 2009 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
NH3-N
08/31/09
2 mg/1
2.32 mg/1
Monthly Average Exceeded
Parameter
Date
Measuring Frequency
Violation
NH3-N
8/2-8/6/09
Weekly
1
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please be aware that violations of your NPDES permit could result in enforcement action by the
Division of Water Quality for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Mike Mickey at [phone].
Since y,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
cc: Central Files - S WP
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
One
No thCarohna
,lVatu lZ
An Equal Opportunity 1 Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
yam, DNIR Review Record
Facility: �� Ui�!� ��� Permit/Pipe No.: MZ -�t SS Month/Year ►-`� ����
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Date Parameter
y/Daily Violations
t Limit/ Tvne DMR Value %Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: c ��
Regional Water Quality
Supervisor Siznoff:
<UvLc
Date: A` - o(,
Date: /��- 40 —1191

EFFLUENT ;.
( April 1 through October 31 ) it
1� '
NPDES PERMIT NO.' NCD0� 83933 DISCHARGE NO.: 001 MONTH: AUGUST = YEAR �24709
FACILITY NAM jSaeim °'U rt&S CLASS: II COUNTY: Forsyth OCT 14 2009
OPERATOR IN RESPONSIBLE CHARGE: George Gatewood GRADE: II PHONE: [phone]
CERTIFIED LABORATORIES: (1) Water Tech Labs Inc (2) R&A Labs R
Check box if orc has changed [ ] PERSON(S) COLLECTING SAMPLES: George Gatewood
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES X L d}' �/� r .��
DIVISION OF WATER QUALITY (SIGNATURE OF ORC) DATE Winston 9a,
DENR I
11617 MAIL SERVICE CENTER ACCURATE AND COMPLETE�- nii
TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Ore
on
Site
Flow
[ ] Inf
[XI Eff
Temp.
pH
Res
C12
BOD5
Q
20C
NH3-N
T
S
S
Fecal
Coliform
Geometric
Mean
Dissolvd
oxygen
(DO)
Total
Khejdahi
Nitrogen
Nitrates
Nitrites
Total
Nitrogen
Total
Po4
D
A
T
E
# 1HRS
JHRS
Y/N I
MGD
C
UNITS
u /L
m /L
m /L
m /L
#1100ml
mg1L
m /L
m /L
m /L
m /L
#
1 I
1
1
0.02501
UV
1
2 1
1
1
0.0300
UV
2-
3
06:00
3.00
Y
0.0210
26.2
6.99
UV
/
6.4
3
4
06:00
2.00
Y
0.0290
26.1
UV
`
4
5
06:15
2.00
Y
0.0220
26.3
UV
< 1
5
6
06:15
3.00
Y
0.0170
26.1
UV�
< 2.5
6
7
14:00
1.00
Y
0.0210
26.5
UV3
7
8
0.0220
UV
6
9
0.0240
UV
N2O
9
10
06:00
3.00
Y
0.0230
26.7
7.D1
UV
6.8
10
11
06:00
2.00
Y
0.0250
25.8
UV3.88
11
12
06:10
2.00
Y
0.0230
26.6
UV
< 1
12
13
06:00
3.00
Y
0.0190
25.0
UV
< 2.5
13
14
06:00
3.00
Y
0.0210
24.9
UV
14
15
0.0230
UV
15
16
0.0240
UV
16
17
06:15
3.00
Y
0.0240
24.8
7.00
UV
6.7
17
18
06:00
3.00
Y
0.0240
25.9
UV
18
19
06:10
2.00
Y
0.0230
25.9
UV
< 1
19
20
06:10
1.00
Y
0,0230
25A
UV
< 2.0
< 0.50
20
21
06:00
3.00
Y
0.0190
26.0
UV
< 2.5
21
22
0.0320
UV
22
23
0.0240
UV
23
06:10
3.00
Y
0.0360
25.3
7.00
UV
6.4
24
25
06:00
3.00
Y
0.0230
24.7
UV
< 0.50
25
r24
26
06:00
2.00
Y
0.0210
25.8
UV
< 1
26
27
06:00
1.00
Y
0.0240
25.6
UV
3.2
< 2.5
27
28
06:00
1.00
Y
1 0.0260
26.2
UV
28
29
0.0240
UV
29
30
0.0290
UV
30
31
06:00
1.00
Y
0.0250
25.6
UV
5.40
6.7
31
AVERAGE
0.0241
25.7
UV
2.6
2.6
< 2.5
< 1
6.6
#DIV101
#DN/01
#DIVIO!
#DIVIO!
#
MAXIMUM
0.0360
28.6
7.0
0.0
3.2
5.40
< 2.5
< 1
6.8
0.00
0.00
0.00
0.00
#
MINIMUM
0.0170
24.7
7.0
0.0
< 2.0
< 0.50
< 2.5
< 1
6.4
0.00
0.00
0.00
0.00
#
COMPIGRAB
CONT.
GRAB
GRAB
GRAB
COMP.
COMP.
COMP.
GRAB
GRAB
COMP
COMP
COMP.
COMP.
#
DAILY LIMIT
NA
NA
NA
28
45
10
45
400
N/A
NA
NA
NA
NA
#
QUARTERLY LIMIT
NA
NA
NA
NA
NA
NA
NA
NA
NA
I NA
NA
NA
NA
#
MONTHLY LIMIT
0.06
NA
..<9
NA
30
2
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont.
Daily
Wkly
2MIk
Wkly
Wkly
Wkly
Wkiy
Wkly
Monthly
Monthly
Monthly
Monthly
#
FREQUENCY MET
YES
YES
YES
YES
YES
YES
YES
I YES
YES
NO
NO
NO
NO
#
COMPLIANT
YES
YES
YES
YES
YES
O
I YES
I YES
YES
NO
NO
NO
YES
#
Total Monthly Flow 0.7460 MG [ i N montmy Loaamg 0os.1 s1�J DEM Form MR-1 (12103) 4 Annual TN Mass Loading (lbs./yr)

Permit NCO083933
A. (I.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on July 1, 2007 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
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample Location
Flow
0.060 MGD
Continuous
Recording
Influent or Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
NH3 as N
(April 1— October 31)
2.0 mg/L
10.0 mg/L
Weekly
Composite
Effluent
NH3 as N
(November 1— March 31)
7.1 mg/L
35.0 mg/L
Weekly
Composite
Effluent
Dissolved Oxygen
Weekly
Grab
Effluent,
Upstream &
Downstream
Fecal Coliform (geometric _
mean)
200/100 ml
400/100 ml
Weekly
Grab
Effluent
Total Residual Chlorine
28 ug/L
2/Week
Grab
Effluent
Temperature CC)
Daily
Grab
Effluent
Temperature CC)
Weekly
Grab
Upstream &
Downstream
Total Phosphorus
Quarterly
Composite
Effluent
Total Nitrogen
(NO2+NO3+TKN)
Quarterly
Composite
Effluent
pH
Weekly
Grab
Effluent .
Footnotes:
1. Upstream = at least 100 feet above discharge point; Downstream at NCSR 2009
2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/L
3. Total Residual Chlorine monitoring and limits will only apply if chlorine is used in the treatment
process.
4. 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

Aqua North Carolina, Inc.
202 MacKenan Court
Cary, NC 27511
October 20, 2009
Mr. Steve W. Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston Salem, NC 27107
Dear Mr. Tedder:
t.ECEIVED
fd.r;. OHOL of ENR
j
CT 5 2009
wins.on-Salem I
pe'llor:31 office.
Thomas J. Roberts
President and Chief
Operating Officer
T: 919.653.5770
F: 919.460.1788
[e-mail]
www.aquanorthcarolina.com
Recently three Notice of Violations and Assessment of Civil Penalties were sent to Gary Moseley
with Aqua North Carolina at 4163 Sinclair Street, Denver, NC.
Please be advised that Gary Moseley is no longer with Aqua North Carolina. Please send all
future Notice of Violations, Assessment of Civil Penalties and Compliance Inspections to the attention of:
Thomas J. Roberts, President and COO
Aqua North Carolina, Inc.
202 MacKenan Court
Cary, NC 27511
If you need any further information you may contact me at 919-653-5771.
Sincerely,
Robyn L. Thomas
Executive Assistant to Thomas J. Roberts
An Aqua America Company

A:x U Aw
Aqua North Carolina, Inc.
202 MacKenan Court
Cary, NC 27511
October 20, 2009
Mr. Steve W. Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston Salem, NC 27107
Dear Mr. Tedder:
Oe DL of ENR !
I
OCT 2 5 2009
�-
'M;Iston-Salem
Regional office
Thomas J. Roberts
President and Chief
Operating Officer
T: 919.653.5770
F: 919.460.1788
[e-mail]
www.aquanorthcarolina.com
Recently three Notice of Violations and Assessment of Civil Penalties were sent to Gary Moseley
with Aqua North Carolina at 4163 Sinclair Street, Denver, NC.
Please be advised that Gary Moseley is no longer with Aqua North Carolina. Please send all
future Notice of Violations, Assessment of Civil Penalties and Compliance Inspections to the attention of:
Thomas J. Roberts, President and COO
Aqua North Carolina, Inc.
202 MacKenan Court
Cary, NC 27511
If you need any further information you may contact me at 919-653-5771.
Sincerely,
Robyn L. Thomas
Executive Assistant to Thomas J. Roberts
An Aqua America Company

i Q l A T
dr Incident Report
Report Number: 200902129
Incident Type:
Complaint
On -Site Contact:
Category:
Surface Water
First/Mid/Last Name:
Incident Started:
08/25/2009
Company Name:
County:
Forsyth
- Phone:
City:
Winston Salem
Pager/Mobile Phone:
Farm #:
Responsible Party:
Owner:
Aqua North Carolina Inc
Permit:
NC0083933
Facility:
Salem Quarters WWTP
First Name:
Thomas
Middle Name:
J
Last Name:
Roberts
Address
202 Mackenan Court
City/State/Zip:
Cary NC 27511
Phone:
Material Category: Estimated Qty: UOM
DD:MM:SS Decimal
Latitude:
Longitude:
Location of Incident: Salem Quarters WWTP
Address: 6960 Rangecrest Rd
City/State/Zip Belews Crk NC
Report Created 08/26/09 12:49 PM
Reported By:
First/Mid/Last Name: Kirk Depriest
Company Name:
Address: 6960 Rangecrest Rd
City/State/Zip: Belews Creek NC 27009
Phone:
Pager/Mobile Phone: /
Chemical Name Reportable Qty. lbs. Reportable Qty. kgs.
Position Method:
Position Accuracy:
Position Datum:
27009
Page 1

Cause/Observation:
excessive odor from WWTP
Action Taken:
site visit with Mike Settle Env affairs
Incident Questions:
Did the Material reach the Surface Water? Unknown
Surface Water Name?
Did the Spill result in a Fish Kill? Unknown
If the Spill was from a storage tank indicate type.
Containment? Unknown
Cleanup Complete? Unknown
Water Supply Wells within 1500ft : Unknown
Event Type
Requested Additional Information
Referred to Regional Office - Primary Contact
Report Entered
Inspection or Site Visit Conducted
Directions:
Comments:
No problems noted
Conveyance:
Estimated Number of fish?
(Above Ground or Under Ground)
Groundwater Impacted : Unknown
Event Date Due Date Comment
2009-08-26 12:43:00
2009-08-26 09:30:00 with Mike Settle, no excessive odo
Report Created 08/26/09 12:49 PM Page 2

Report Received
2009-08-26 08:10:00
Incident closed
2009-08-26 12:00:00
Incident Start
2009-08-25 08:10:00
Standard Agencies Notified:
Agency Name Phone
First Name M.I.
Last Name
Contact Date
Other Agencies Notified:
Agency Name Phone
First Name M.I.
Last Name
Contact Date
Forsyth Co Env Affairs [phone] Ext.
Mike
Settle
2009-08-26 08:30:00 AM
Forsyth Co Health Dept [phone] Ext.
Mike
Merrell
2009-08-26 08:10:00 AM
DWQ Information:
Report Taken By:
Report Entered By:
Regional Contact:
Rose Pruitt
Rose Pruitt
Phone:
Date/Time: 2009-08-26 08:10:00 AM
2009-08-26 12:43:00 PM
Referred Via: email
Did DWQ request an additional written report?
If yes, What additional information is needed?
Report Created 08/26/09 12:49 PM Page 3

Pruitt, Rose
From: Pruitt, Rose
Sent: Wednesday, August 26, 2009 11:31 AM
To: 'Merrell II, Michael S-1 '[e-mail]'
Cc: Settle, Mike; Tedder, Steve
Subject: RE: Salem Quarter Complaint About Package Sewer Plant Air Quality Issues
Attachments: Salem Quarter Complaint About Package Sewer Plant Air Quality Issues
Mike,
Mike Settle and I visited the Salem Quarters WWTP today and found it operating properly. The last effluent violation I
have noted for them was in April 2008 for an Ammonia limit. Their only issue noted at the last inspection done in
January 2009 was a broken alarm. They were compliant at their 2008 inspection. I did not note any odor issues today.
This facility is one of the newer ones and is generally well operated.
This wastewater treatment plant is not going anywhere in the foreseeable future, so the homeowner should consult an
attorney if he was told it was temporary. To connect this neighborhood to a Forsyth County WWTP would require the
construction of many pump stations and miles of sewer line to get it back to the Yadkin River Basin where it could
connect to existing gravity flow lines. I am not aware of any plans by Forsyth Co Utilities to install those lines in the
foreseeable future. Without a wastewater treatment plant the entire neighborhood would likely be condemned.
I am also not aware of any additional measures the facility could take to control odors. As I said before I did not note
anything out of the ordinary today. Mr. dePriest's property is located almost directly across the street from the WWTP
and I am sure his close proximity to the plant has some bearing on the odor complaints. During the hot summer months
when folks spend more time outside, the normal smells of a WWTP are certainly going to be more noticeable. Lots in
close proximity to WWTP's are typically in lower demand because of these issues, note that these were among the last
lots developed in the subdivision.
Please have Mr. DePriest call me at the number below if he has any further questions.
*** My email has changed to Rose.Pruitt Ca)ncdenr.eov
Rose Pruitt
NCDENR-DWQ Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
(I� Zo b q 10Zl Z°l

Forsyth County Environmental Health Department > Environmental Health Inspection Sy... Page 1 of 1
Environmental Health Inspection System
Forsyth County Environmental Health Department search for facility ?.,.
Home Assign Complaint
............... .... ........._.....
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Facilities
—_----� i Back to List
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:.............................. ..... ... ....
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Help
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User Info
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Forsythlpenninss
RS Number: 0
Unassigned
Complaints
My Facilty List i
My Complaint List I
Status:
I f t th
Open
Complaint Type:
Facility
Addressi:
Range Crest Road
City:
Belews Creek
State:
NC
Zip Code:
27009
Complaint:
The sewage/wastewater system that services the Salem Quarter housing
division ON Rangecrest Road does not seem to meet air quality standards. As
it is a privately owned wastewater system, they do violate ,0522 CONTROL
AND PROHIBITION OF ODOROUS EMISSIONS of the Forsyth county Air
Quality Control Ordinance. The air quality of surrounding residential properties
is significantly impacted. At times residents have difficulty spending time
outside Of their homes due to the foul smell. Many owners were advised upon
purchase of their properties that the waste water system was temporary. The
d t h d
qua ity o air ue o e sys em as amaging impact on the value and resale
ability of the surrounding homes. The wastewater management system needs
to be moved.
Name: kirk DePriest
ContactMethod: e-mail
Value: [e-mail]
Assign To: _ select User -
Assign Complaint
Copyright <Oc 2005, Forsyth County North Carolina. All Rights Reserved.
hup://fcnet/inspections/AssignComplaint.aspx?id=2088 8/26/2009

Pruitt, Rose
From:
Merrell II, Michael J [[e-mail]]
Sent:
Wednesday, August 26, 2009 8:10 AM
To:
Settle, Michael E; 'Rose. [e-mail]'
Subject:
Salem Quarter Complaint About Package Sewer Plant Air Quality Issues
Attachments:
Untitled. PDF
Rose/Mike:
I have attached a complaint that we received about some air quality issues relating to Salem Quarter Subdivision which I
believe is on belews creek rd. The persons contact info and complaint is included in the attachment.
I appreciate all your help with this matter, let me know if you need anything.
Mike Merrell
Michael J Merrell II IRS
Environmental Health Field Supervisor
Onsite Water Protection
Forsyth Co. Health Department
[phone] Office
[phone] Fax
From: Pennington, Sandra S
Sent: Wednesday, August 26, 2009 8:05 AM
To: Merrell II, Michael J
Subject: Untitled.PDF
NOTE: This is a Forsyth County operated e-mail system. ALL e-Mail communication is subject to be accessed by the news media and the public pursuant to the
Public Records Law of North Carolina.

Print Preview
http: //maps2.co. forsyth.nc.us/geodata%5FO8/printPreview.aspx?Prin...
Forsyth County, NC
PIN
6879-20-2747.00
Current Deed Stamps
$274
Property Address
6960 Rangecrest Rd
Map Number
672890
Block Lot
522113172
Assessment Method
Cost
Additional Lots
W/P
No
Tax Jurisdiction
Forsyth County / Walkertown (Northeast) FD
Land Value
$26,100
Anx
N
Dwelling Value
$110,666
Taxable Owner Name
Depriest, Kirk
Commercial Value
Taxable Owner Name2
Depriest, Kate
Industrial Value
Taxable Owner Address
6960 Rangecrest Rd
Misc Imp Value
Taxable Owner City St Zip
Belews Creek, NC 27009
Total Value
$136,800
Taxable Deed Bk-Pg
2668-981
Acreage
0.36
Taxable Deed Date
6/7/2006
Sq Ft Living Area (Res)
1185
Taxable Deed Stamps
$274
Gross Sq Ft (Cam)
Current Owner Name
Depriest, Kirk
Year Built (Res)
2006
Current Owner Name2
Depriest, Kate
Year Built (Com)
Current Owner Address
6960 Rangecrest Rd
Census Tract
31
Current Owner City St Zip
Belews Creek, NC 27009
Zoning
AG
Current Deed Bk-Pg
2668-981
Last Qualified Sale Price
$137,000
Current Deed Date
6/7/2006
Disclaimer: Forsyth County cannot guarantee the accuracy of this information, and the Map Scale
County hereby disclaims all warranties, including warranties as to the accuracy of this 1 inch = 60 feet
information.
1 of 1 8/26/2009 12:40 PM

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Forsyth County, NC
2902 �
t
r
Fh
. 043AC - .:dry .98AC
1� l
110
PIN
6879-20-4699.00
Current Deed Stamps
Map Number
$84
672890
Property Address
6961 Rangecrest Rd
Block Lot
5221 B000A
Assessment Method
Cost
Additional Lots
WIP
No
Tax Jurisdiction
Forsyth County / Walkertown (Northeast) FD
Land Value
$100
Anx
N
Dwelling Value
Taxable Owner Name
Heater Utilities Inc
Commercial Value
Taxable Owner Name2
Industrial Value
Taxable Owner Address
PO Box 4889
Misc Imp Value
$8,882
Taxable Owner City St Zip
Cary, NC 27519
Total Value
$9,000
Taxable Deed Bk-Pg
1950-779
Acreage
0.98
Taxable Deed Date
6/6/1997
Sq Ft Living Area (Res)
Taxable Deed Stamps
$84
Gross Sq Ft (Com)
Current Owner Name
Heater Utilities Inc
Year Built (Res)
Current Owner Name2
Year Built (Com)
Current Owner Address
PO Box 4889
Census Tract
31
Current Owner City St Zip
Cary, NC 27519
Zoning
AG
Current Deed Bk-Pg
1950-779
Last Qualified Sale Price
Current Deed Date
6/6/1997
Disclaimer: Forsyth County cannot guarantee the accuracy of this information, and the Map Scale
County hereby disclaims all warranties, including warranties as to the accuracy of this 1 inch = 60 feet
information.
1 of 1
8/26/2009 12:37 PM

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Mail SL Fax to: WPC30CC
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Raki=b, N.C. 27699.1618
F'as: 919033.1335

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qP
1.
Performance Annual Report
I. General Information
L i V� a L%ram Ld G L' ^ 1 r
Facility/System Name: Salem Quarters WWTP —UEIN' VV✓t', E T R 0 U A L I I Y
Responsible Entity: Aqua North Carolina POINT SOURCE BRANCH
Person in Charge/Contact: Tom Roberts
Applicable Permit (s) N�C`00$ 33'
Description of Collection System or Treatment Process:
This 0.060 MGD wastewater treatment facility consists of an influent manual bar
screen, flow splitter box, equalization basin, dual aeration basins, dual clarifiers, dual
sand filters, UV Disinfection system with back-up chlorinator, contact basin & de -
chlorinator, sludge holding tank, and stand-by power.
II. Performance
Text Summary of System Performance for Calendar Year 2008
This plant consistently met discharge permit limits and generally
performed well.
List (by month) any violation of the permit conditions or other environmental regulations.
Monthly lists should include discussion of any environmental impacts and corrective
measures taken to address violations.
January Compliant
February Compliant
March Compliant
April The monthly limit for NH3-N was exceeded. All other parameters were in
compliance. The operator had no explanation for this occurrence.
May Compliant
RECEIVED
N.C. Deot. o' ENR
Winston-Sziem
Regional office

r
June Compliant
July Compliant
August Compliant
October Compliant
November Compliant
December Compliant
III. Notification
Our customers will receive a notice on their bills regarding the availability of this report
upon request and a notebook containing every report is located in our Customer Service
office.
IV. Certification
I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify that this report has been made available to the users or
customers of the named system and that those users have been notified of its availability.
I," f q 4aiL 2/28/09
Responsible Person Date
Title: Regional Compliance Manager
Entity: Aqua North Carolina

RECLINED
- 'Yot. of ENR
A O U A w FEB 2 6 2009
-�.
-Salem
�
3,l 0ff1Ca Aqu North Carolina, Inc.
acKenan Court
Cary, NC 27511
February 24, 2009
N.C. Division of Water Quality
Attn: Rose Pruitt
585 Waughtown Street
Winston-Salem, N.C. 27107
Re: Salem Quarters WWTP
Permit No. NCO083933
Thomas J. Roberts
President and Chief
Operating Officer
T: 919.653.5770
F: 919.460.1788
[e-mail]
www.aquanorthcarolina.com
Forsyth -Go
ear Ms. Pruitt -
This letter is in response to the Compliance Evaluation Inspection performed at the referenced
wastewater treatment plant on January 28, 2009. The following addresses the comments of your
letter.
(1) The visual and audible alarm on the equalization basin was not functional during the
inspection. This must be repaired no later than February 20, 2009. Please notify this Office
when the visual alarm is repaired.
Response:
la) The visual and audible alarm on the equalization basin has been repaired and
is functioning correctly.
If you have any questions, please feel free to contact Delbert Likins or Robert Barker at (704)
489-9404, extension 57224.
Sincere ,
Thomas J. Ro erts
President and COO
cc: Michael Melton
Delbert Likins
Robert Barker
An Aqua America Company

MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 5, 2009
Thomas Roberts
Heater Utilities Inc Owned By Aqua NC
202 Mackenan Ct
Cary, NC 27511
Subject: NOTICE OF DEFICIENCY
Compliance Evaluation Inspection
Salem Quarters WWTP
NPDES Permit No. NC0083933
Forsyth County
Dear Mr Roberts:
A Compliance Evaluation Inspection (CEI) was performed on the Salem Quarters wastewater treatment plant on Wednesday, January
28, 2009 by Rose Pruitt and Marc Stokes, Technical Assistance of the Winston-Salem Regional Office. Robert Barker (ORC), Tony
Parker and Delbert Likins with Aqua NC 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 following are the findings from the subject inspection.
I. Permit
The NPDES permit for the Salem Quarters WWTP became effective July 1, 2007 and expires on February 29, 2012. The permitted
components of the 0.06 MGD wastewater treatment plant include: a bar screen, flow splitter box, equalization basin, dual aeration
basins, dual clarifiers, dual sand filters, ultraviolet disinfection system, back up chlorinator, contact basin & dechlorinator, sludge
holding tank, and stand by power.
The facility is located at Belews Creek road in Walkertown, Forsyth County and is authorized to discharge into an Unnamed tributary
to Belews Creek in the Roanoke River Basin.
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 were available at the inspection.
Flow meter calibration was last conducted on July 27, 2008.
A spill response plan was available and emergency contact information was posted on the gate. The inspector called this number
and the answering service did not know how to handle the call. The inspector was forwarded to an automated call center that
has been problematic in the past. Please continue to review proper handling procedures.
An annual report for the year 2007 was available at the inspection. Please remember to submit your annual report for 2008. Annual
reports must be submitted within 60 days of the end of the applicable review period, either a calendar year or fiscal year. As this
facility has previously submitted a calendar year report, your report will be due March 1. Robert Barker is the designated ORC for
this facility.
11I. Facility Site Review f=
The facility site review indicated that the 0.06 MGD treatment works is consistent with the permitted components. The actual
treatment system consists of a bar screen, flow splitter box, equalization basin, dual aeration basins, dual clarifiers, dual sand filters,
ultraviolet disinfection system, back up chlorinator, contact basin & dechlorinator, sludge holding tank, and stand by power.. The
emergency generator is powered by propane and was tested under load.
The following items were noted during the inspection and require your immediate attention:
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St, Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterqual4.org
An Equal Opportunity 1 Affirmative Action Employer
onrt NhCarohiia
Naturally

(1) The visual and audible alarm on the equalization basin was not functional during the inspection. This must be repaired no
later than February 20, 2009. Please notify this Office when the visual and audible alarms are repaired.
IV. Effluent / Receiving Stream
The WWTP discharges to an unnamed tributary to Belews Creek, classified C waters in the Roanoke River Basin. There was no
effluent at the time of the inspection. The receiving stream was free of solids, foam and debris.
V. Flow Measurement
Effluent flow is measured with an Isco 4210 flow meter, which was last calibrated by Horizon on July 27, 2008.
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 Salem Quarters WWTP had one permit limit violations for 2008. This violation has been previously addressed via a Notice of
Violation or Enforcement Action by the Division.
VII. Laboratory
Sample analyses are conducted by Watertech. The laboratory was not reviewed at the time of the subject inspection. However, it
was noted that some chain of custody forms were not properly signed by this lab, this was noted in a previous inspection.
VIII. Operation and Maintenance
Operation and maintenance continue to improve.
IX. Sludge Utilization/Disposal
Solids are removed from the WWTP as necessary by a licensed contract hauler and disposed of properly. Most recently 4,000 gallons
were removed by Forsyth Rooter on December 9, 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 and notes that operations are much
improved from last years inspection. 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: Robert Barker, ORC, 227 Old Covered Bridge Rd, Madison NC 27025
Central Files
� 0

A
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 31 NCO083933 Ill 121 09/01/28 117 18I CI 19I SI 20I I
Remarks
211 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I_LJ 6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 81 QA —----- —-------------- --Reserved ------ ------------
67I 169 701 I 711 I 721 NJ 73I I 174 751 I I I I I I 180
w
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
12:25 PM 09/01/28
07/07/01
Salem Quarters WWTP
Exit Time/Date
Permit Expiration Date
9999 Rangecrest Rd
Winston Salem NC 27103
12:45 PM 09/01/28
12/02/29
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Robert M Barker/ORC/336-613-8428/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Thomas J Roberts,202 Mackenan Ct Cary NC
27511/President/919-467-8712/9194601788 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 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 R iew/er Agency/Office/Phone and Fax Numbers Date
EPA EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3I NC0083933 I11 121
09/01/28 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The inspector and Marc Stokes, Technical Assistance for WSRO were met at the facility by the ORC Robert
Barker, Tony Parker and Delbert Likins with Aquasource.
EQ basin visual and audible alarm did not work during inspection.
Page # 2

Permit: NCO083933
Inspection Date: 01/28/2009
Owner - Facility: Salem Quarters WWTP
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:
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
®
❑
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?
M
n
-n
n
Is all required. information readily available, complete and current?
®
n
n
n
Are all records maintained for 3 years (lab. reg. required 5 years)?
n
n
n
Are analytical results consistent with data reported on DMRs?
®
n
n
n
Is the chain -of -custody complete?
®n
n
n
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
®
n
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

Permit: NCO083933 Owner - Facility: Salem Quarters VWVT'P
Inspection Date: 01/28/2009 Inspection Type: Compliance Evaluation
Record Keeping
Facility has copy of previous year's Annual Report on file for review?
Comment: 2008 annual report due March 1
Some chain of custodies not signed by lab
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: No effluent at time of inspection
Flow Measurement - Effluent
# Is flow meter used for reporting?
Is flow meter'calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: Isco 4210 last calibrated 7/27/2008 by Horizon
I ype or Dar screen
a.Manual
b. Mechanical
Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
Comment:
Equalization Basins
Is the basin aerated?
Is the basin free of bypass lines or structures to the natural environment?
Is the basin free of excessive grease?
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Yes No NA NE
LS91•MM
Yes No NA NE
ennn
■nnn
nn®n
Yes No NA NE
®nnn
®nnn
®nnn
nnn■
n
®nnn
®nnn
®nnn
®nnn
Yes No NA NE
®nnn
®nnn
®nnn
nnn®
nnn®
®nnn
Page # 4

j
Permit: NCO083933 Owner - Facility: Salem Quarters WWTP
Inspection Date: 01/28/2009 Inspection Type: Compliance Evaluation
Equalization Basins
Yes
No
NA NE
Are audible and visual alarms operable?
Cl
®
n
n
# Is basin size/volume adequate?
n
n
n
■
Comment: Audible and visual alarms not working
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
®
n
n
n
Are surface aerators and mixers operational?
ER
n
n
Are the diffusers operational?
®n
n
n
Is the foam the proper color for the treatment process?
®
n
n
n
Does the foam cover less than 25% of the basin's surface?
®n
n
Is the DO level acceptable?
n
❑
n
Is the DO level acceptable?(1.0 to 3.0 mg/I)
nnn®
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
®n
n
n
Is the site free of excessive buildup of solids in center well of circular clarifier?
n
n
®
n
Are weirs level?
®
n
n
n
Is the site free of weir blockage?
®n
❑
n
Is the site free of evidence of short-circuiting?
®n
n
n
Is scum removal adequate?
n
®
n
n
Is the site free of excessive floating sludge?
n
®
_n
n
Is the drive unit operational?
n
n
®
n
Is the return rate acceptable (low turbulence)?
n
n
n
Is the overflow clear of excessive solids/pin floc?
n
®
n
n
Is the sludge blanket level acceptable? (Approximately %< of the sidewall depth)
n
n
n
Ell
Comment: Solids in weir
Disinfection - UV
Yes
No
NA
NE
Are extra UV bulbs available on site?
®
n
n
❑
Are UV bulbs clean?
®
n
n
n
Page
# 5

Permit: NCO083933 Owner - Facility: Salem Quarters WVVTP
Inspection Date: 01/28/2009 Inspection Type: Compliance Evaluation
Disinfection - UV
Yes
No
NA
NE
Is UV intensity adequate?
n
n
n
M
Is transmittance at or above designed level?
n
n
n
■
Is there a backup system on site?
n
n
n
Is effluent clear and free of solids?
0
❑
❑
n
Comment:
Standby Power
Yes
No
NA
NE
Is automatically activated standby power available?
e
n
n
n
Is the generator tested by interrupting primary power source?
■
n
n
n
Is the generator tested under load?
®
n
n
n
Was generator tested & operational during the inspection?
®
n
n
n
Do the generator(s) have adequate capacity to operate the entire wastewater site?
®
n
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:
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?
®❑
❑
❑
# Is the facility using a contract lab?
■
❑
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
®
n
n
n
Incubator (Fecal Coliform) set to 44.5 degrees Celsius+/- 0.2 degrees?
❑
❑
®
❑
Incubator (BOD) set to 20.0 degrees Celsius +/- 1.0 degrees?
n
❑
®
❑
Comment: Watertech, Heater
Isco 3710 @ 4
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
❑
❑
❑
Ig
Is sample collected below all treatment units?
®❑
❑
❑
Is proper volume collected?
.❑
❑
❑
Is the tubing clean?
®
n
n
n
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
®
n
n
n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
®
n
n
n
Page # 6

Permit: NCO083933 Owner - Facility: Salem Quarters WWrP
Inspection Date: 01/28/2009 Inspection Type: Compliance Evaluation
Effluent Sampling Yes No NA NE
Comment: Isco 3710 @ 4
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? N ❑ ❑ —
Comment:
Page # 7

Faxed To: Tony Parker for Facility ORC
Fax #: [phone] Phone [phone]
WWTP Annual Inspection Checklist
This information should be available to the inspector at inspection time.
Facility: Salem Quarters NPDES: NC0083933
Permit Effective Dates: July 1, 2007 to Feb 12, 2012
Inspection Date: 01/28/2009 Inspection Time: 1 -�am
�1)
DMRs (Dates: January2008 to December2008 )
✓ 2)
'-`�3)
Lab Data (per DMR dates)
Laboratories used for analysis & certification #'s
-- - 4)
Chain of Custody forms (per DMR dates)
L-5)
Complete copy of current NPDES permit
of SOC or Moratorium issuance (if applicable)
-7)
ORC and Back-up ORC current certification ,
• 8)
Wastewater Annual Report (fiscal or calendar year - if applicable)
-,9)
Daily Operator's log / ORC visitation log ©C/ .
�0)
Maintenance log
•___11)
- ' �u�
Process control ata (which includes field parameters tested and equipment
- --Z�
o
calibrations)
%-- 12)
�-13)
Field Parameter certification
Flow meter calibration records �� �'^ ��Z��� �' %S Cc
4)
Influent and/or effluent samplers 37/0
✓15)
Flow charts (if applicable)
16)
Generator Inspection / under load checks
17)
Spill Response Plan (with current emergency contact nu bers)o�
18)
Sludge / Residuals hauling records (if applicable)
—1I19)
Plant visual inspection of treatment units
L,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
[phone]
Fax: [phone]
1 vv

MONITORING REPORT(MR) VIOLATIONS for:
Report Date: 01/22/09 Page: 1 of 1
nF
Permit no0�}83933, ,h- ; MRs Between 1=200 4 and 12, 2008 L'Regront 9!o Violatoon Category % Program Category
,
,;,� '�- k' . 'i_' t, p.....µ C„�. €,... ^ '..o
a•p ''P
S. Q'„", - x;.or'��°
p
� Facility
<a ;�, �a,',is; E. _- �, 'x�.: .. Q e. {e;p-
PERMIT: NCO083933 FACILITY: Heater Utilities Inc - Salem Quarters WWTP
COUNTY: Forsyth REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL/ VIOLATION UNIT
OF CALCULATED
REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE
LIMIT VALUE VIOLATION TYPE VIOLATION ACTION
04 -2008 001 Effluent Nitrogen, Ammonia Total (as 04/30/08 Weekly
mg/I 2 2.4 Monthly Average Exceeded Proceed to NOV

jan 28-29, 2009 039
jan 28-29, 2009 044
jan 28-29, 2009 040
jan 28-29, 2009 045
jan 28-29, 2009 041
jan 28-29, 2009 046
jan 28-29, 2009 042
jan 28-29, 2009 047
jan 28-29, 2009 043

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI . 2 15I 31 NCO083933 Ill 121 09/04/17 117 181 JI 19I SI 20III
Remarks
21111111111111111111111111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA --Reserved--
67 I 169 701 I 711 I 721 I 73 L1J 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
09:45 AM 09/04/17
07/07/01
Salem Quarters WWTP
Exit Time/Date
Permit Expiration Date
9999 Rangecrest Rd
Winston Salem NC 27103
10.15 AM 09/04/17
12/02/29
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
Thomas J Roberts,202-Mackenan Ct Cary NC Contacted
27511/President/919-467-8712/9194661583 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Effluent/Receiving Waters
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Rose Pruitt WSRO WQ//336-771-5000/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO083933 I11 12I 09/04/17 I17 18IJI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Anonymous complaint caller said he saw sludge & sludge worms in the stream at the effluent pipe. caller
also described what sounded like an operator wasting to the creek the week of April 9. No evidence seen at
the time of the inspection.
Page # 2

01/29/2003 11:18 FAX [phone]& 001/004
North Carolina.
Aqua North Cerollne, Inc, r. 704.489.940&
F: 704-489.9409
Denver, C r63 NCz6037 lr Street www,8quanorthcarolina,com
Den
To:
Frnm! r'
Fox: v Pt�eess:
Phone: Data: "/g�
Re:JCC:
o 120,1
❑ Urgent ❑ For Review O Please Comment ❑ Plosse Reply 0 Please Recycle
An Aqua America Company

01/28/2008 11:19 FAX [phone] [6 002/004
P.2
Performance Annual Report
I. Genera nfor ati n
Facility/System Name: `Salem Quarter
Responsible Entity: Aqua N,C. Inc.
Person in Charge/Contact: TOM ROBERTS
Applicable Permit (s): _ NC0088 93� 3�
Description of Collection Systems or Treatment Process:
This 0,060 MGD wastowiggr IL=ent facility consists of an influent
Gravity collection bar screen,floW,ggualization,dual aeration basins
clarifier, dual tertiM filters and ultra violet disinfection
SludV_da es� tor, chlorination and not aeration.
II. PerfolMoce
Text Summary of System Performance for Calendar Year 2007
This facility has consistently Met discharge 12ermit, imits.Qew Isco
flow meter was installed 2007.

01/29/2009 11:19 FAX [phone]
IA003/004
P.3
List (by month) any violations of permit conditions or other environmental
regulations. Monthly lists should include discussion of any environmental
Impacts and corrective measures taken to address violations:
January
Compliant
February
Compliant
March
Compliant
April
Compliant
May
Compliant
June
Compliant
July
Compliant
August Compliant
September Compliant
October Compliant
November Compliant
December Compliant
Ill. Notifica
Customers received a message on their bills regarding the availability of this
report upon request and a notebook containing every report is located in the
appropriate Customer Service office.

01/29/2008 11:20 FAX [phone].
bR� rMuItLI 3364751094 TO;17044A99409
(6004/004
P.4
IV, Certification,
I certify under penalty of law that this report is complete and accurate to the
best of my knowledge. I further certify that this report has been made
available to the users or customers of the named system and that those users
have been notified of its availability.
Prepared by: Atlantic Utility Inc / Tim Waddell 1-1Y
Responsible Person Date 02-24-2008 °n1 Gber+s
Title: Tom .Roberts
Entity: Aqua North Carolina, Inc.

I
ORC RESIGNATION: Atlantic Utility Inc
Thursday, September 25, 2008
Dear TACU and DWQ/ DENR,
RECEIVED
SEP 2 9 2008
Winston-4._-;;
Regional Office
We are requesting that all of our ORC and Back -Up ORC be removed from
the following WWTP Systems belonging to the Pertnittee Aqua NC Inc.
Timothy J Waddell WW3 #21891
George Gatewood WW2 410.684
Richard Hughes WW3 #12721
Robert White WW2 # 991396
Peter Saulsbury WW4 # 21219
James K Garrett Jr. WWI #991954
P WILLOW CREEK: NCO034452
PENMAN HEIGHTS: NCO055191
�. MELBILLE HEIGHTS: NC0050792
FOREST RIDGE: NCO063720
>� SPRING CREEKS: NCO083941
� SALEM GLEN: NC00839�'S
r FRYE BRIDGE: NCO065587
MIKKOLA DOWNS: NCO067091
/= GRAYSTONE FOREST: NCO078115
CAINSWAY MHP: NCO075027
zQUARTERS N000_ .3933
BRIARWOOD: NCO028746
�' WELLESLEY PLACE: NC 0084409
N

2
Thursday, September 25, 2008
Aqua NC has hired their own operators to ORC their WWTP and Atlantic
Utility Inc will no longer be ORC or Back -Up ORC as of September 19cn
2008: We are releasing all Data: Log Sheets, Lab Sheets, Maintenance Logs,
Chains of Custody, Sludge Hauling Reports and or Manifest, Collection
System Data, Lift Station Monitoring, Pictures, Maps and a List of needed
repairs as pertaining to 2008 Operations by Atlantic Utility Inc.
We will complete a partial DMR for operations up to Friday
September 19th, 2008.

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
July 7, 2008
CERTIFIED MAIL 7008 01500 0002 8342 1443
RETURN RECEIPT REQUESTED
Thomas J Roberts, President
Heater Utilities Inc
202 Mackenan Ct
Cary NC 27511
Subject:. NOTICE OF VIOLATION
Permit No. NCO083933
Salem Quarters WWTP
Forsyth County
Dear Roberts, President:
Coleen H. Sullins Director
Division of Water Quality A
A review of Salem Quarters WWTP's monitoring report for April 2008 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total
04/30/08
2 mg/1
2.4 mg/l
Monthly
(as N)
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
*14
585 Waughtown Street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (Fax)

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: 2A Permit/Pipe No.: NC.00 T3g33Month/Year SP(LI L
U UAAR�rL S ZOO 8-
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
N 1A:aa cc S lv o
m
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency, Values Reported # of Violations
Other Violations
Completed by: Date: 7 O
Regional Water Quality
Supervisor SiQnoff: Date:
PV
����zLV - 03 f �

EFFLUENT
(April1 through October3 )
NPDES PERMIT NO.: NCO0883933 DISCHARGE NO.: 001 MONTH: APRIL YEAR: 2008
FACILITY NAME: Salem Quarters LASS: II COUNT`T9Fe3ssytt�, RECEIVED
OPERATOR IN RESPONSIBLE CHARGE: GEORGE GATE OD GRADE: II PHONE:N336$4dL004_NR
CERTIFIED LABORATORIES: (1) Water Tech L Inc (2) R&A Lab �p I�
Check box if orc has changed [ ] PERSON(S) COLLECTING SAMPLES: GEORGE GATEWOOb u 200s
Mail ORIGINAL and ONE COPY to: �J Winston-Salem
ATTN: CENTRAL FILES X A, /� ��ce �T J/ o� egional Office
DIVISION OF WATER QUALITY (SIGNATURE OF ORC) DATE
DENR BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
1617 MAIL SERVICE CENTER ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
RALEIGH, NC 27699-1617
JUN 1 0 2008
5 2008
50050
00010
00040
50060
00310
00610
00530
31616
00300
00625
00630
00600
00665
D
A
T
E
Opr.
Arrive
Time
2400
clock
Opr.
Time
on
Site
Orc
on
Site
Flow
[ ] Inf
[Xj Eff
Temp.
pH
Res
Cl2
BOD5
tip
20C
NH3-N
T
S
S
Fecal
Colifonn
Geometric
Mean
Dissolvd
Oxygen
(DO)
Total
Khejdahl
Nitrogen
Nitrates
Nitrites
Total
Nitrogen
Total
Poo
D
A
T
E
#
JHRS
JHRS
Y
I MGD
I C
UNITS
u /L
m /L
m /L
m /L
#/100m1
mg/L
m /L
I m /L
m /L
m /L
#
1
13:30
1.50
Y
0.0230
15.6
UV
1
2
8:15
2.00
Y
0.0230
15.6
UV
2.9
4.05
< 2.0
< 1
5.6
0.41
6.01
6.20
2
3
9:00
2.00
Y
0.0150
15.9
UV
3
4
15:00
1.00
Y
0.0330
17.5
UV
-
4
5
N
0.0320
UV
5
61
1
N
1 0.0370
UV
6
7
9:00
2.00
Y
0.01201
16.4
6.88
UV
1
6.2
7
8
9:00
1.00
Y
0.0340
16.6
UV
8
9
10:15
1.00
Y
0.0200
16.6
UV
2.0
< 0.50
7.0
< 1
9
10
9:00
2.00
Y
0.0210
16.9
UV
10
11
13:00
1.00
Y
0.0200
18.6
UV
11
121
1
N
1 0.02801
UV
1
12
13
N
0.0230
UV
13
14
18:00
0.50
B
0.0230
17.0
UV
14
15
14:00
1.00
Y
0.0110
17.5
UV
6.3
15
16
8:15
1.00
Y
0.0230
16.1
6.89
UV
< 2.0
0.94
< 2.0
< 1
16
17
7:00
2.00
Y
0.0150
16.5
UV
1
17
181
11:001
2.00
Y
1 0.02201
17.9
UV
18
19
N
0.0240
UV
19
20
N
0.0270
UV
20
21
9:00
2.00
Y
0.0250
18.6
6.87
UV
6.3
21
22
9:00
2.00
Y
0.0220
19.4
UV
1
22
23
10:15
1.00
Y
0.0210
19.2
UV
2.6
2.75
2.8
< 1
23
24
11:301
2.00
Y
0.0190
20.8
1
UV
24
25
9:001
2.00
Y
0.0170
19.9
UV
25
26
N
0.0220
UV
26
27
N
0.0290
UV
27
28
9:00
2.00
Y
0.0310
20.9
6.80
UV
6.6
28
29
8:00
0.50
B
0.0190
19.8
UV
29
30
10:15
1.00
Y
0.0690
18.4
UV
5.5
4.25
3.5
< 1
30
UV
I
I
I31
AVERAGE
0.0247
17.8
6.66
UV
3.0
" .2.5
3.5
1
6.4
5.6
1 0.41
6.01
1 6.20
#
MAXIMUM
0.0690
20.9
6.89
0.0
5.5
4.25
7.0
1
6.6
5.6
0.41
6.01
6.20
#
MINIMUM
0.0110
15.6
6.80
0.0
< 2.0
< 0.50
< 2.0
< 1
6.2
< 5.6
0.41
6.01
6.20
#
COMP/GRAB
CONT.
GRAB
GRAB
GRAB
COMP.
COMP.
COMP.
GRAB
GRAB
COMP
COMP
COMP.
COMP.
#
DAILY LIMIT
NA
NA
NA
28
45
NA
45
400
N/A
NA
NA
NA
NA
#
QUARTERLY LIMIT
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
#
MONTHLY LIMIT
0.06
NA
>6,<9
NA
30
5
30
200
NA
NA
NA
NA
NA
#
MONITORING FREQUENCY
Cont
Daily
Wkly
21Wk
Wkly
Wkly
Wkly
Wkly
Wkly
Monthly
Monthly
Monthly
Monthly
#
FREQUENCY MET
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
#
COMPLIANT
YES
YES
YES
I YES
I YES
-&E-8-
YES
YES
YES
I YES
YES
YES
I YES
#
Total Monthly Flow 0.7400 MG TN Monthly Loading (Ibs.) 37
DEM Form MR-1 (12103) Annual TN Mass Loading (lbs./yr)

MIAY 29 03

Salem Quarters Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements (X J
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ( J
- Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc, and a time table for improvements to be made.
"I certify, under penalty of few, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information sub-
mitted. Based on my Inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and com-
plete. I am aware that there are significant penalties for submitting false information, including the possibility of fines
and imprisonment for knowing violations."
Pemtittee Address: P.O. Drawer 4869
Cary, N.C. 27519
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00300 Dissolved Oxygen
00310 B O D 5
00340 C O D
00400 pH
00530 T S S
00545 Settleable Solids
00556 Oil and Grease
00600 Total Nitrogen
Permittee (Please print or type) Thomas J Roberts,
President Aqua North Carolina
Inc
Z ?
Signature of P rtnittee"
Date
Z Z
Phone Numb r.
Permit Exp. Date-'
(919)-467-8712
34.0.4ey-08
PARAMETER CODES
-- _--
00510 Ammonia Nitrogen
01032 Hexavalent
00625 Total Kjeldah
Chromium
32730 Total Phenolics
Nitrogen
01034 Chromium
34235 Benzene
00630 Nitrate/Nitrite
01037 Total Cobalt
34481 Toluene
00655 Total Phosporous
01042 Copper
38260 MBAS
00720 Cyanide
01045 Iron
39516 PCBs
00745 Total Sulfide
01051 Lead
50050 Flow
00927 Total Magnesium
01067 Nickel
50060 Total Residual
00929 Total Sodium
01077 Silver
Chlorine
00940 Total Chloride
01092 Zinc
71880 Fornal-
00951 Total Fluoride
01105 Alumimum
dehyde
01002 Total Arsenic
01147 Total Selenium
71900 Mercury
01027 Cadmium
31616 Fecal Coliform
81551 Xylene
Parameter Code assistance may be obtained by calling the Water Quality Compliance Group at [phone] ext 581 or 534
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designed in the reporting — --
facility's permit for reporting data.
` ORC must visit the facility and document visitation of facility as required per 15A NCAC 8A .0202(b)(5)(B)
•' If signed by other than the pernittee, delegation of signatory authority must be on file with the state per
15A NCAC 2B .0506 (b)(2)(D)

AY 29 03

NPDES PERMIT NO: NCO0883933 DISCHARGE NO.: 001 MONTHApnI
FACILITY NAME: SALEM QUARTERS COUNTY: FORSYTH
STREAM:UNAMMED TRIBUTARY LOCATION: @ 100ft upstream
UPSTREAM
YEAR:2008 NPDES PERMIT NO: NC00883933 DISCHARGE NO.: Doi MONTH:ApnI
FACILITY NAME: SALEM QUARTERS COUNTY: FORSYTH
STREAM:UNAMMED TRIBUTARY LOCATION: @ SR2009
DOWNSTREAM
YEAR2008
DEM Farm MR-3 (12193) OEM Form MR-3 (12193)

MY291 08
. - e

MONITORING REPORT(MR) VIOLATIONS for: Report Date: 07/07/08 Page: 1 of 1
"77
,^�.
Permd: ;nc0083933 MRs bet�iVeen:�,,4-2007 . and 3=2008 Region:% Violation Category": %-' ;`Program Categ"ory %'
,.
Facility'Name: % �`�Param Name: %. =County: %. ,'Subbasin:'% ; Violation'Actioh: % l
Major Minor:%
PERMIT: NCO083933 FACILITY: Heater Utilities Inc - Salem Quarters WWTP COUNTY: Forsyth REGION: Winston-Salem
Monitoring Violation
MONITORING OUTFALL /
VIOLATION
UNIT OF
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
04 -2007
001
Effluent
Chlorine, Total Residual
04/07/07
2 X week
ug/I
04 -2007
001
Effluent
Chlorine, Total Residual
04/14/07
2 X week
ug/I
04 -2007
001
Effluent
Chlorine, Total Residual
04/21/07
2 X week
ug/I
04 -2007
001
Effluent
Chlorine, Total Residual
04/28/07
2 X week
ug/I
05 -2007
001
Effluent
Chlorine, Total Residual
05/05/07
2 X week
ug/I
05 -2007
001
Effluent
Chlorine, Total Residual
05/12/07
2 X week
ug/I
05 -2007
001
Effluent
Chlorine, Total Residual
05/19/07
2 X week
ug/1
05 -2007
001
Effluent
Chlorine, Total Residual
05/26/07
2 X week
ug/I
06 -2007
001
Effluent
Chlorine, Total Residual
06/02/07
2 X week
ug/1
06 -2007
001
Effluent
Chlorine, Total Residual
06/09/07
2 X week
ug/I
06 -2007
001
Effluent
Chlorine, Total Residual
06/16/07
2 X week
ug/I
06 -2007
001
Effluent
Chlorine, Total Residual
06/23/07
2 X week
ug/I
08 -2007
001
Effluent
DO, Oxygen, Dissolved
08/18/07
Weekly
mg/I
05 -2007
001
Effluent
Temperature, Water Deg.
05/05/07
5 X week
deg c
Centigrade
07 -2007
001
Effluent
Temperature, Water Deg.
07/21/07
5 X week
deg c
Centigrade
08 -2007
001
Effluent
Temperature, Water Deg.
08/11/07
5 X week
deg c
Centigrade
CALCULATED
LIMIT VALUE
VIOLATION TYPE
VIOLATION ACTION
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency
Violation
None
Frequency Violation None
Frequency Violation None

FW: NOV - Salem Qtrs (no penalty)
Subject: FW: NOV - Salem Qtrs (no penalty)
From: "Parker, Tony R." <[e-mail]>
Date: Wed, 16 Jul 2008 09:25:08 -0400
To: <[e-mail]>
CC: "Perna, Penny L." <[e-mail]>, "Moseley, Gary R."
<[e-mail]>, "Thomas, Robyn L." <[e-mail]>, "Melton,
Michael A." <[e-mail]>, <[e-mail]>
Tim,
The attached non compliance was not indicated on your report and we overlooked this in our review.
Please forward a response or reason for the violation to me and we will submit an amended DMR
indicating that a violation occurred along with the ORC comments. In addition to this please revise future
DMR's with the correct permit limits at the bottom of the DMR itself. The current one shows n/a rather
than the 2.0 and 10.0 summer limit.
Please call if you have questions.
Thanks
Tony
From: Thomas, Robyn L.
Sent: Wednesday, July 16, 2008 9:06 AM
To: Melton, Michael A.; Moseley, Gary R.; Parker, Tony R.
Cc: Roberts, Tom
Subject: NOV - Salem Qtrs (no penalty)
Attached is a NOV for Salem Quarters for violation of ammonia limit in April 08.
Robyn L. Thomas, Executive Assistant
Aqua North Carolina, Inc.
919-653-5771
rlthomasoaquaamerica.com
Content -Description: Salem Qtrs - NOV - April 08.pdf
Salem Qtrs - NOV - April 08.pdf Content -Type: application/octet-stream
Content -Encoding: base64
1 of 1 7/17/2008 11:08 AM

oa0F NlArEA4G
r
,O, Y
CERTIFIED MAIL 7008 01500 0002 8342 1443
RETURN RECEIPT REQUESTED
Thomas J Roberts, President
Heater Utilities Inc
202 Mackerian Ct
Cary NC 27511
Subject: NOTICE OF VIOLATION
Pertnit No. NCO083933
- --• -Salem Quarters WWTP - -
Forsyth County
Dear Roberts, President:
Michael F. Fnley, Gat-u ,
Wi— G. Ras 1r., Secretary
North Carohal Departrrnt nt Fnsiruamrnt and Natur1 Rom' a
[.Mean IL Sullins Di--
Dnisionofwau Quality
July 7, 2008
J(f
C1��©
Og
A review of Salem Quarters WWTP's monitoring report for April 2008 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Nitrogen, Ammonia Total
04/30, 08
2 mg/l
2.4 nig/l
Monthly
(as N)
Average
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
To prevent farther action, carefully review these violations and deficiencies and respond in
writing to this office within 30 working day of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If
you should have any questions, please do not hesitate to contact Rose Pruitt at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Cc: WQ Central Files
WSRO
585 Waughfcvm street Winston-Salem, NC 27107 336-771-5000 (Telephone) 336-771-4630 (rate)

FW: NOV - Salem Qtrs (no penalty)
Subject: FW: NOV - Salem Qtrs (no penalty)
From: "Parker, Tony R." <[e-mail]>
Date: Fri, 18 Jul 2008 14:58:35 -0400
To: "Perna, Penny L." <[e-mail]>, "Melton, Michael A."
<[e-mail]>, "Likins, Delbert H." <[e-mail]>
CC: <[e-mail]>
From: [e-mail][mailto:[e-mail]]
Sent: Friday, July 18, 2008 2:35 PM
To: Parker, Tony R.
Subject: Re: NOV - Salem Qtrs (no penalty)
Tony,
I spoke with George Gatewood about the NOV. The NH3-N violation occured when both blowers went
out. Del ordered new blowers and motors and Chip, George and Chris installed the new parts. We used
a temporary blower motor from Wellesley Place to get air back to process while we waited for the parts
I believed this happened over the weekend so the plant was septic by the time they got one blower
running on Monday.
Sincerely
Tim Waddell
Parker, Tony R. writes:
Tim,
The attached non compliance was not indicated on your report and we
overlooked this in our review. Please forward a response or reason for
the violation to me and we will submit an amended DMR indicating that a
violation occurred along with the ORC comments. In addition to this
please revise future DMR's with the correct permit limits at the bottom
of the DMR itself. The current one shoves n/a rather than the 2.0 and
10.0 summer limit. Please call if you have questions.
Thanks
Tony
From: Thomas, Robyn L. Sent: Wednesday, July 16, 2008 9:06 AM
To: Melton, Michael A.; Moseley, Gary R.; Parker, Tony R.
Cc: Roberts, Tom
Subject: NOV - Salem Qtrs (no penalty)
Attached is a NOV for Salem Quarters for violation of ammonia limit in
April 08. Robyn L. Thomas, Executive Assistant
1 of 2 7/21/2008 10:25 AM

FW: NOV - Salem Qtrs (no penalty)
Aqua North Carolina, Inc.
919-653-5771
[e-mail] <mailto:[e-mail]>
2 of 2 7/21/2008 10:25 AM

e
Atlantic Utility. Inc.
"Company Name: 203 E. Bodenhamer St.
Kernersville. NC 27284
NON -HAZARDOUS
Generator Name: � u�, �v� Generator Location: Bch I ,n-, Lins
Address: 26,;1 lhc�c. Lam Address:_.__
Phone#: PO# - -
of Waste
�K�00 s J Lt13C
[0-es- -
Type Gals.
SOLIDS
SLUDGE a 00
LIQUID
1 hereby certify that the above named material is not hazardous waste as defined by 49 CFR Bari 261 or nay
applicable state law.
Generator Signature: Date:
IeI�T TO..K.T. SPORTER
Contractor's Name: Atlantic Utility Inc. _ Phone # C�/
203 E. Bodenhamer St. Permit C S x
Address: Kernersville, NC 27284 NC
SC Permit #
hereby certify that the above name material was picked up at the generator site listed below and was delivered
without incident to th edestination listed betow.
0
Driver's Signature: lELc,�� Date:
Site Name: ic- �� y 1,.� I Phone # 33 � — 7 6 5-0 S
Address: C�0 �' f �, �° �� .� S Sc­ 1 c- A , -
I hereby certify that th eabove named material has been accepted and to the best of my knowledge the
foregoing is true and accurate.
Authorized Agent: Date:
White- Original -Return to Generator Yellow-Transporter/Destination Pink -Generator's Copy
T39dd 972268V9a 1401�M8 WHI71IM 6_�-:9I 8002-t'0-t70

I
OWN
j 'Atlarrtic Utility Inc. --
Company Name: 203 E. Bodenhamer St.
Kernersville, NC 27284
NON -HAZARDOUS
a: ,
Generator Name: Ao_c<c, i," C ?-,vc Generator Location:...Ec kca,
Address: a C) a Mac kf�G; C�f Address: _ P-�N
5 I Cec(_- L t 1 C�
Phone#: I S - ` 6 % - % L Po#
Description of Waste Type Gals. Fq nde
Lon_J5 V_c�ao- SOLIDS
SLUDGE
LIQUID
I hereby certify that the above named material is not hazardous waste as defined by 49 CFR Part 261 or nay
applicable state law.
Generator Signature: Date:
TRAC--
Contractor°s flame: Atlantic Utility Inc. _ Phone #
Address: ® 203 E. Bodenhamer St. NC Permit # MC-3
Kernersville, NC 27284
SG Permit #
I hereby certify that the above name material was picked up at the generator site listed below and was delivered
without incident to th edestination listed below.
r
Drivers Signature: Jti o , Date:
�I�.$ rd -cK -
Site Name. t t W6 W L J ` _P Phone #
Address: WINC' l lrJ sa%' . /A-/C
i hereby certify that th eabove named material has been accepted and to the best of my knowledge the
foregoing is true 6rnd accurate.
Authorized Agent: Date:
White- Original -Return to Generator `fellow--Transpartw/ oration Pints -Generator's Copy
T3!E�t1cd St£3SaFt-0! 14316UG Wtil"t_JIM 6t7:9T 8002-t7O-t7O

i U-A.
North Carolin.i
July 18, 2008
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: DMR for April 2008
Salem Quarters WWTP— NPDES Permit # NC0083933
RECEIV D
N.C. Oeot. of ENR
JUL 2 2 2008
Winston.Salem
Regional ice
Please accept the enclosed explanation from the ORC for the amended DMR for
the above referenced system for the month of.April, 2008.
Should there be any questions, please do not hesitate to call me at (704) 489-
9404 ext. 232.
Sincerely,
per—
Tony R. Parker
Area Manager
TRP/pp
Enclosure
C: Mks. Rose Pruitt, DWQ, WSRO
Mr. Tim Waddell, Atlantic Utilities, Inc.
4163 Sinclair Street • Denver, NC • 28037 • 704-489-9404

Page 1 of 2
Perna, Penny L.
From: Parker, Tony R.
Sent: Friday, July 18, 2008 2:59 PM
To: Perna, Penny L.; Melton, Michael A.; Likins, Delbert H.
Cc: ([e-mail])
Subject: FW: NOV - Salem Qtrs (no penalty.)
From: [e-mail][mailto:[e-mail]]
Sent: Friday, July 18, 2008 2:35 PM
To: Parker, Tony R.
Subject: Re: NOV - Salem Qtrs (no penalty)
Tony,
I spoke with George Gatewood about the NOV. The NH3-N violation occured when both blowers went
out. Del ordered new blowers and motors and Chip, George and Chris installed the new parts. We used a
temporary blower motor from Wellesley Place to get air back to process while we waited for the parts I
believed this happened over the weekend so the plant was septic by the time they got one blower
running on Monday.
Sincerely
Tim Waddell
Parker, Tony R: writes:
Tim,
The attached non compliance was not indicated on your report and we
overlooked this in our review. Please forward a response or reason for
the violation to me and we will submit an amended DMR indicating that a
violation occurred along with the ORC comments. In addition to this
please revise future DMR's with the correct permit limits at the bottom
of the DMR itself. The current one shows n/a rather than the 2.0 and
10.0 summer limit. Please call if you have questions.
Thanks
Tony
From: Thomas, Robyn L. Sent: Wednesday, July 16, 2008 9:06 AM
To: Melton, Michael A.; Moseley, Gary R.; Parker, Tony R.
Cc: Roberts, Tom
Subject: NOV - Salem Qtrs (no penalty)
Attached is a NOV for Salem Quarters for violation of ammonia limit in
7/18/2008

Page 2 of 2
April 08. Robyn L. Thomas, Executive Assistant
Aqua North Carolina, Inc.
919-653-5771
[e-mail]<mailto:hrlthomasgaaquaamerica.com>
7/18/2008

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Heater Utilities, Inc.
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