NC0046809_Regional Office Historical File Pre 2016

v'
Mickey, Mike
From:
David Merritt <[e-mail]>
Sent:
Thursday, September 03, 2015 10:33 AM
To:
Mickey, Mike
Cc:
'Marc W. Nault'; 'Darrell Pentecostal'
Subject:
RE: Cornerstone Conf Ctr.
Attachments:
07011596-Cornerstone Conf Center.pdf
Hi Mike, please review the attachment.
This was done, late in June, so the results weren't ready until July.... It was just overlooked
We'll get an amended report in
David Merritt
Vice President
Meritech, Inc.,
336-317-5938: Cell
336-342-4748: Office
[e-mail]
www.meritech-labs.com
642 Tamco Rd.
Reidsville, NC 27320
From: Mickey, Mike [mailto:[e-mail]]
Sent: Thursday, September 03, 2015 8:31 AM
To: david.merrittCameritech-labs.com
Subject: Cornerstone Conf Ctr.
David — Please see attached letter for June 2015 monitoring omissions. Mike.
[e-mail]
NC DENR Winston-Salem Regional Office
Division of Water Resources — Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [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.
1

a'
Client:
Sample ID:
Meritech Inc Work Order #
Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
Cornerstone Conf. Center
Effluent Grab
07011596
Date Sample Rcvd: 7/1/2015
Parameters
Results
I
Limits
F m /L
Analysis Date
Analyst
Initial & Date Rec.
MBAs
1M
-7/
.
1 7/a
Oil and Grease HEM
C i,
7 &
1
1 6-1 %/
:i
DATE WORKSHEET TURNED IN: 7/C0
INITIALS:
REPORT IS NOT TYPED FOR THE CLIENT
Cornerstone Conference Center -Limits

3-241033 Chain of Custody Record (CCQ
NPDES#:
Client: �: _�� Phone.
Fax:
Email:
Project:
P.O.#:
Attention: Turn Around Time"
'RUSH work needs prior approval.
How would you like your report sent?
Circle all that apply: Email (preferred), Fax, Mail Std 10 da sj 3 • S Da s za-as Hrx
• M E R ITEC w INC.
1Address:
ENVIRONMENTAL LABORATORIES
642 Tam coRd. Phone: [phone]
Reidsville NC 27320 Fax: [phone]
Email: [e-mail]
www, m e rite c h-i a bS . co m
Sample Location and/or ID #
..Sampling Dates & TimesLab
Person Taking Sample (Sign/Print):
L
Use:.Only
Start
End
Comp?
Grab?
#of
Cont.
`Test(s) Required
On ice?,
e / No
pH OK?
CI OK?
Date
Time
Date
Time
-
l
Z
7emperature.Uporr
Re ' tt
Method of
Shipment:
"" Dechlorination
(<O,S ppm) of Ammonia, Cyanide, Phenol and TKN samples
must be done in the field prior to preservation. •••
Comments:
lJug
Compositor #: .
#
[! UPS
Fed Ex
Are t se results for r gu ' o rposes? Yes No i
Report results in: mg/L ( mg/kg Q; ug/L
�!Hand Delivery
Relinquished b : me:
�15
_ . "
Received by: Date: 'rme:
0:`: Other
Relinquished by: Date: rime:
Received by: Date: 'Time:
Relinquished by: Date: Time:
R by b: r Dat

North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
September 1, 2015
Mr. Darrell Gaines
Western N.C. Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF DEFICIENCY (NOD-2015-MV-0102)
Cornerstone Conference and Resource Center WWTP
Permit No. NCO046809
Guilford County
Dear Mr. Gaines:
Donald van der Vaart
Secretary
A review of the June 2015 Discharge Monitoring Report (DMR) revealed the following monitoring violations:
Parameter
Date
Permit Frequency
Values Deported
# of Violations
Oil & Grease
June 2015
Monthly
0
1
MBAS
June 2015
Monthly
0
1
If this violation is due to a transcription error, and certifiable data are available, we ask that you please submit an
amended DMR(s) to the Division of Water Resources. Send two copies of the amended report to:
Attn: Central Files
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Thank you for your attention to this matter. Remedial actions should be taken to correct the cause of this violation.
Unresolved violations may lead to the issuance of a Notice of Violation and/or assessments of civil penalties. If you
have any questions or require any additional information, please contact Mike Mickey at [phone].
Sincerely,
Sherri V. Knight, P.E.
Assistant Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
cc: David Merritt ([e-mail])
Central Files
1S'RO
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwateraualitV.ore
An Equal Opportunity \ Affirmative Action Employer — Made in part by recycled paper

r DMR ReAe iRbc.oVd
tY� �Oc�Si� q
hacili �� Permit No.: `a0 \ Pipe No; MonthlYear:
Monthly Average Violations
Parameter-� :i��"�V� ermit Limit DMR Value %Over Limit Action
'hekl /Dail Violations
Date Parameter Permit Limit Limit T DMR Value % Over Limit Action
Monitoring Frequency Violations
Date Parameter Permit Frequency Valuerrss� Rworted # of Violations Action
Other Violations/Staff Rem\arks:
VA
a VVx
Supervisor Remarks: N. o
Completed by:
Assistant Regional `
Supervisor Sign Off:
—
Regional Supervisor Sign
Off:
Date:
Date: 9111
Date:

i
EFFLUENT
G
NPDES PERMIT NO. (V-0 � g paDISCHARGE NO.00 MONTH LJid ", YEA,Rr �
FACILITY NAME i3El�'9 CLASS _ COUNTYl mid'
CERTIFIED LABORATORY (1) CERTIFICATION NO.� C
(list additional laboratories on the backside/page 2 of this form) U is,
OPERATOR IN RESPONSIBLE CHARGE (ORC) C, W • d9�Y�va�� GRADE . CERTIFICATION NO.---���
PERSON(S) COLLECTING SAMPLES C. W - ij k- k ORC PHONE &J ` $ 5
CHECK BOX IF ORC HAS CHANGED NO FP /DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
r3 1
DWQ Form MR-1 (11/04)

Mickey, Mike
From:
Jones, Diann
Sent:
Monday, July 13, 2015 1:25 PM
To:
Mickey, Mike; Scott, Michele
Subject:
RE: NCO046809 - Cornerstone Conference Center WWTP
It's done.
From:, Mickey, Mike
Sent: Monday, July 13, 2015 1:19 PM
To: Scott, Michele; Jones, Diann .
Subject:. NCO046809 - Cornerstone Conference Center WWTP
Michelle or Diann —There is a fecal coliform violation in BIMS that is incorrectly attributed to the December 2014 DMR
for Cornerstone (see below). The December DMR states "No Discharge" for the entire month and has no fecal data. As
best as I can determine, it appears that the January 2015 DMR was incorrectly entered as the December report and also
entered for January as the data is identical. Can you check on this and then amend the December BIMS data if
necessary? I have attached both reports. Thanks, Mike.
Limit Violations Monitoring Violations Reporting Violations Other Violations
Permit: INC0046,809 Details... SOC: AD: . Dpf. ils... Monitoring_Report: t2-201
-Facility: Oornerstone Conference -and Rescur Details... Region: Winston-Salerrt 'County: - Guilfort
Owner. estern NC Conference Center r0aintain... Incident .Gietails.:. Inspect. Dt C
Facility Reported As: � 0 Non -Compliant 0 Not Reported ®Is signed ReportType: E
*Outf.. *Location "Parameter -Date *Description SOC Limit _ *Calcu... Unit Over A,c
�D01 Effluent lColiform, Fec... IlZI1612014 D JDarly Maximum ... El 1400 600 #fl00 ml 150
[e-mail]
NC DENR Winston-Salem Regional Office
Division of Water Resources —Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [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.
1

� AA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
May 13, 2015
Mr. Darrell Gaines
Western N.C. Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
SUBJECT: Compliance Sampling Inspection
Cornerstone Conference Ministry Center WWTP
NPDES Permit No. NCO046809
Guilford County
Dear Mr. Gaines:
Donald van der Vaart
Secretary
On April 30, 2015, Mike Mickey of this office met with Patrick Merritt and Mark Nault to perform a
Compliance Sampling Inspection on the wastewater treatment system serving the Cornerstone Conference
Ministry Center. The inspection findings are detailed below and an inspection checklist is attached.
I. Permit
The NPDES permit expires next on April 30, 2016. At renewal, the permit will require that the monthly
Discharge Monitoring Reports (DMRs) be submitted electronically per new EPA rules.
H. Self -Monitoring Program
The DMRs were reviewed for the period April 2014 through March 2015 (see data summary attached).
The facility was found to be compliant with the final NPDES effluent limits for the above period except for a
fecal coliform daily maximum violation that occurred on January 16, 2015. This violation was previously
addressed in correspondence from this office. With regards to the permit monitoring requirements, it was
noted that all sampling was performed per the frequencies specified in the permit.
One recordkeeping issue involved the late submittal of the October 2014 DMR as referenced in the March
31, 2015. Notice of Violation letter from our Raleigh office. The DMR was finally received in our Central
Office on April 24, 2015.
Grab samples of the effluent were collected during the inspection. The sample results from the Division of
Water Resource's laboratory are shown in the attached data summary. The BOD, TSS and fecal coliform
values were found to be compliant with the daily maximum limits in the permit.
III. Flow Measurement
The permit requires instantaneous flow reporting for the effluent. No flow was reported to have occurred
from the treatment system for the months of April, May, August, September, October, November, December
and February.
IV. Sludge Handling and Disposal
No solids were removed from the digester in calendar years 2013 and 2014.
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwaterguality.org
An Equal Opportunity\Affirmative Action Employer —Made in part by recycled paper

Mr. Darrell Gaines
Page 2
May 13, 2015
V. Operations and Maintenance
No problems or concerns were noted with the operation and maintenance of the system.
VI. Facility Site Review
The existing 0.02 MGD treatment system consists of the following: splitter box (not used); dual in -ground
0.01 MGD package plants (only one package plant unit is utilized due to low influent flows) with bar
screens; aeration basins; clarifiers; tertiary filters (inoperable); non -aerated sludge holding; a tablet
chlorinator with contact tank followed by a single tablet dechlorinator unit. It was noted that samples were
collected from the contact chamber which is prior to the dechlor unit due to the small amount of flow from
the facility. If possible, samples of the effluent should be collected after all final treatment.
VII. Records/Reports
A comparison of the March 2015 monitoring report with the corresponding laboratory data sheets from
Meritech found that all values were transcribed onto the DMR correctly.
VM. Effluent/Receiving Waters
The system discharges into an unnamed tributary to Benaja Creek, class "WS-V; NSW" waters in the Cape
Fear River Basin. The outfall was buried in the stream bank and could not be located.
Should you have any questions concerning this report, please contact Mike Mickey or me at (336)
776-9800.
Sincerely,
Sherri V. Knight, PE
Assistant Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
cc: David Merritt (via email: [e-mail])
Central Files
Sm

Permit: NCO046809 Owner - Facility: Cornerstone Conference and Resource Center
Inspection Date: 04/30/2015 Inspection Type: Compliance Sampling
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
❑
❑
0
❑
application?
Is the facility as described in the permit?
M
❑
❑
❑
# Are there any special conditions for the permit?
❑
M
❑
❑
Is access to the plant site restricted to the general public?
0
❑
❑
❑
Is the inspector granted access to all areas for inspection?
0
❑
❑
❑
Comment: A review of the monthly Discharge Monitoring Reports (DMRs) for the period April 2014
through March 2015 found the Cornerstone Conference Ministry Center WWTP to be
compliant with effluent limits The permit expires next on April 30, 2016.
Grab samples were collected of the effluent during the inspection The BOD TSS and fecal
coliform results were found to be compliant with the daily maximum limits in the permit.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ 0 ❑ ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: The existing 0.02 MGD treatment system consists of the following: splitter box (not used
bar screen dual in -ground package plants (only one side of the package plant is utilized due
to low influent flows) consisting of aeration basin clarifier, tertiary filters (not operable),
non -aerated sludge holding tank tablet chlorinator and contact tank followed by a single
tablet dechlorinator unit.
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?
Yes No NA NE
■ ❑ ❑ ❑
■ ❑ ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
• ❑ ❑ ❑
■
■
❑
❑
❑
❑
❑
M
❑
Page# 3

Permit: NCO046809 Owner - Facility: Cornerstone Conference and Resource Centel
Inspection Date: 04/30/2015 Inspection Type: Compliance Sampling
Record Keeping
Yes No NA NE
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
❑
❑
0
❑
on each shift?
Is the ORC visitation log available and current?
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
E
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
0
❑
❑
❑
Is a copy of the current NPDES permit available on site?
0
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
❑
❑
0
❑
Comment: A comparison of the March 2015 DMR with the laboratory data sheets and operator's
records found that the data was correctly transcribed onto the monitoring form.
Bar Screens
Yes No NA NE
Type of bar screen
a.Manual
b.Mechanical
❑
Are the bars adequately screening debris?
E
❑
❑
❑
Is the screen free of excessive debris?
N
❑
❑
❑
Is disposal of screening in compliance?
0
❑
❑
❑
Is the unit in good condition?
E
❑
❑
❑
Comment: Small bar screen located at head of aeration basin.
Aeration Basins
Yes No NA NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
0 ❑
❑
❑
Are surface aerators and mixers operational?
❑ ❑
0
❑
Are the diffusers operational?
❑
❑
❑
Is the foam the proper color for the treatment process?
0 ❑
❑
❑
Does the foam cover less than 25% of the basin's surface?
0 ❑
❑
❑
Is the DO level acceptable?
❑ ❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
❑ ❑
❑
Comment: Single aeration basin in use.
Secondary Clarifier Yes No NA NE
Is the clarifier free of black and odorous wastewater? 0 ❑ ❑ ❑
Page# 4

Permit: NCO046809 Owner - Facility:
Inspection Date: 04/30/2015 Inspection Type:
Cornerstone Conference and Resource Centel
Compliance Sampling
Secondary Clarifier
Yes No NA NE
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
0
❑
Are weirs level?
0
❑
❑
❑
Is the site free of weir blockage?
M
❑
❑
❑
Is the site free of evidence of short-circuiting?
0
❑
❑
❑
Is scum removal'adequate?
0
❑
❑
❑
Is the site free of excessive floating sludge?
❑
❑
❑
Is the drive unit operational?'
❑
❑
E
❑
Is the return rate acceptable (low turbulence)?
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
0
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately Y of the sidewall depth)
❑
❑
❑
Comment: Rectangular clarifier with single weir trough.
Aerobic Digester
Yes No NA NE
Is the capacity adequate?
0
❑
❑
❑
Is the mixing adequate?
M
❑
El.,
❑
Is the site free of excessive foaming in the tank?
0
❑
❑
❑
# Is the odor acceptable? -
A
❑
❑
❑
# Is tankage available for properly waste sludge?
0
❑
❑
❑
Comment: No solids were removed from the system in 2013 and 2014.
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
M
0
❑
❑
Are the tablets the proper size and type?
M
❑
❑
❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
0
❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
0
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
0
❑
❑
❑
Comment: Single chlorinator unit.
Flow Measurement - Effluent
Yes No NA NE
# Is flow meter used for reporting?
❑
0
❑
❑
Is flow meter calibrated annually?
❑
❑
M
❑
Is the flow meter operational?
❑
❑
0
❑
Page# 5

Permit: NC0046809 Owner - Facility: Cornerstone Conference and Resource Center
Inspection Date: 04130/2015 Inspection Type: Compliance Sampling
Flow Measurement - Effluent Yes No NA NE
(If units are separated) Does the chart recorder match the flow meter? ❑ ❑ M ❑
Comment: The permit requires an instantaneous flow measurement using. Effluent flow is estimated.
De -chlorination Yes No NA NE
Type of system ? Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)? ❑ ❑ 0 ❑
Is storage appropriate for cylinders? ❑ ❑ M ❑
# Is de -chlorination substance stored away from chlorine containers? ❑ ❑ M ❑
Comment:
Are the tablets the proper size and type?
Are tablet de -chlorinators operational?
Number of tubes in use?
Comment: Single dechlor unit.
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: The pipe outlet at the stream is buried and could not be located.
■ ❑ ❑ ❑
■ ❑ ❑ ❑
74
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ M ❑
❑ ❑ ■ ❑
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and M ❑ ❑ ❑
sampling location)?
Comment: The upstream and downstream samples were collected by the operator during the
inspection.
Page# 6

Sample Results and
Self -Monitoring Data Summary .
Cornerstone Conference Ministry Center WWTP
NPDES Permit No. NCO046809
April 2014 — March 2016
Parameters
Monthly Avg.
Permit Limits
Monthly Avg. Limit
Violations per DMR
Daily Maximum
Permit Limits
Sample
Results*
Daily Max. Limit
Violations per DMR
Flow (MGD)
0.02
None
-
Not sampled
NA
BOD (mg/1)
30.0
None
45.0
3.4
None
TSS (mg/1)
- 30.0
None
45.0
6.4
None
NH3-N (mg/1)
-
NA
-
0.04
NA
Fecal (#/100 ml)
200
None
400
1
600 on 1/1.6/15
T. Chlorine (ug/1)
-
NA
28.0*
Not sampled
None
T. Phos. (mg/L).
-
NA
-
3.5
NA
Chronic Toxicity
P/F @ 31 %
None
-
Not sampled
NA
pH (S.U)
-
NA
(6.0 — 9.0) range
Not sampled
None
* Samples collected 4130/15.
** TRC values reported below 50 ug/L are considered compliant.

North Carolina Division of Water Resources
Water Sample Collection &Submittal Form
Central Laboratory (Water Sciences Section)
Visit ID j .�
•(optional i"
Tagl ,• ^
ID 6H
Lab Use
----------------se
laboratory' -
Sample Number:
Only:
-----==-=----
I n
(�
Location Description:
( '
CorkA��, ���� �N.� v�N
` `
Location Code:l
Date Received:
I 50,16
County:
(�
I ( \ Or\l
l�
Collector.
�\, �
kN, \ `
Priority:
Water Matrix:
Location Type:
Time Received:,
DWR Region:.
(based an county)
I W�
DWRO�ce:
(oragericynome/
I
❑Ambient
❑ Routine
Compliance
❑ COC
❑ Emergency
❑CIA
❑ Surface
El Ground
'Waste
❑ Blank
❑ Solution
❑River/Stream [—]Lake
❑Estuary ❑Canal
❑Stormwater
❑Monitoring Well ❑Water Supply
,y
IJtffluent ❑Influent
❑Field Blank
❑Trip Blank
❑Filter Blank
❑ Other:
Received By:
River Basin:
p'i
Date:
I—
J
Delivery Method:
StatNe`C'courier
❑Hand Delivery
[]Other:
(�
Notes: p a\ n �_\OC
Time:
�t
` 1 �C'�
chlorinated DDe-chlorinated in Field
Sninpliirg f ,LrGrab
Method:
Composite
❑Other:
Temperature ('C)
onArrival:•
p p
Uv�
Dissolved analysis: Enter"OIS"
❑ Filtered in Field in check -boxes for parameters
Sample'Depth:-;I
Collector's Comments:
Microbiology Parameters:
MBAS (surfactants) mg/L
Metals Parameters:
Tin (Sri) µg/L
Acidity, as GaCO3, to pH 4.5/8.3 mg/L
Oil and Grease, HEM, Total Recoverable mg/L
Aluminum (AI) µg/L
Titanium (Ti) µg/L
Alkalinity, as CaCO3, to pH 4.5/8.3 mg/L
Phenols, Total Recoverable µg/L
Antimony (5b) Ng/L
Vanadium (V) µg/L
BOD: Biochemical Oxygen Demand, 5-day 75,%mg/L
Residue: Total (Total Solids) mg/L
Arsenic (As) µg/L
Zinc (Zn) µg/L
cBOD: Carbonaceous BOO, 5-da mg/L
Residue: Volatile/Fixed, Total mg/L
Barium (Ba) µg/L
Coliform: Fecal MF /100m1
Residue: Suspended (Suspended Solids) a mg/L
Beryllium (Be) µg/L
Boron (B), Total µg/L
Coliform: Total Mr /100ml
Residue: Volatile/Fixed, Suspended mg/L
Cadmium (Cd) µg/L
Mercury 1631, low-level ng/L
Coliform: Tube Fecal /100ml
TDS - Total Dissolved Solids mg/L
Calcium (Ca) mg/L.
Coliform: Tube Total /100ml
Silica mg/L
Chromium (Cr), Total Ng/L
Organics Parameters:
Specific Conductance, at 25 °C umhos/cm
Sulfide mg/L
Cobalt (Co) Ng/L
Acid Herbicides
TOC - Total Organic Carbon mg/L
Tannin & Lignin mg/L
Copper (Cu) Ng/L
Organochlorine Pesticides
Turbidity NTU
Iron (Fe) µg/L
Organonitrogen Pesticides
Other Parameters:
Lead (Pb) pg/L
Organophosphorus Pesticides
Wet Chemistry Parameters:
pH S.U.
Lithium (Li) µg/L
PCBs (polychlorinated biphenyls)
Bromide mg/L
Hardness, Total as CaCO3 - by titration mg/L
Magnesium (Mg) mg/L.
Chloride mg/L
Manganese (Mn) Ng/L
Semi -Volatile Organics (BNAs)
Fluoride mg/L
Mercury (Hg) µg/L
TPH Diesel Range
Sulfate mg/L
Nutrients Parameters:
Molybdenum (Mo) Ng/L
Chlorophyll a Ng/L
Ammonia as N (NH3-N) O mg/L
Nickel (Ni) ug/L
Volatile Organics (VOA)
Color: ADMI C.U.
Nitrate -Nitrite as N (NO3+NO2-N) mg/L
Potassium (K) mg/L
Color: Platinum Cobalt C.U.
Total Kjeldahl Nitrogen as N (TKN) mg/L
Selenium (Se) Ng/L
TPH Gasoline Range
COD: Chemical Oxygen Demand mg/L
Total Phosphorus as P (TP) ti mg/L
Silver (Ag) Ng/L
Cyanide, Total mg/L
Nitrite as N (NO2-N) mg/L
Sodium (Na) mg/L
Biological: - i
Formaldehyde mg/L
Nitrate as N (NO3-N calculated) mg/L
Strontium (Sr) pg/L
Phytoplankton / Algae
Hexavalent Chromium (Cr6+) mg/L
Orthophosphate as P (PO4) mg/L
Thallium (TI) µg/L
LAB COMMENTS:
I Field Parameters(optionol):I Water Temp (°C): I PH (s.u.): ; I I Dissolved Oxygen (ppm): I I , Conductivity (Nmhbs/cm): I I Salinity (pp•t): "
Revision:

Mickey, Mike
From: Overman, Max
Sent: Monday, May 04, 2015 10:15 AM
To: Mickey, Mike
Cc: Green, Cindy
Subject: Sample AC18800 - Nutrients
Attachments: AC18800.pdf
Hi Mike,
We received an effluent sample on 5/01/2015 that you collected on 4/30/2015; the lab sample number is
AC18800 and the field sheet is attached.
I analyzed the sample for NH3 and TP as requested, and wanted to share some information with you.
As you noted on the field sheet, the sample was chlorinated and the samples received at the lab had a very
strong odor of chlorine. Due to the chlorine, it was necessary to de -chlorinate a portion of sample that had not
been acid -preserved in the field. So I took a portion of sample from the bottle submitted for TSS. With that
sample portion, I first used chlorine test strips to determine the concentration, which the strips indicated was —2
ppm. Then I added sodium thiosulfate to remove the chlorine, and then 25% sulfuric acid to adjust pH to <2.
For NH3 analysis, I analyzed the de -chlorinated sample above, plus the acid -preserved sample that you had
submitted for NH3. Based on sample spikes, the chlorine in the acid -preserved sample did affect analysis. So
the reported value for NH3 is from the de -chlorinated sample (which had acceptable spike recovery).
Since the reported result for NH3 is from a sample portion that was not acid -preserved in the field, the result is
being qualified with J6. This is simply to note the fact, and does not invalidate the result. I was able to complete
de -chlorination and analysis less than 27 hours from the time of collection, so I feel that the NH3 result is
certainly valid.
This does not affect Total Phosphorus, as chlorine is not an issue and the analysis was from the acid -preserved
sample that you submitted.
I know that this is probably more than you need to know, but thought it was worth explaining. I appreciate the
information that you included on the field sheet — it was very helpful in determining how to proceed for
analysis.
If you have any questions, please let me know.
Thank you,
Max
Max Overman
Chemist
North Carolina Division of Water Resources
Water Sciences Section -Nutrients Group
4405 Reedy Creek Road, Raleigh, NC 27607
MSC f623

Telephone: [phone], ext. 227
Fax: [phone]
E-maiL correspondence to and from this address is subject to the North CaroLina Public
Records Law and may be disclosed to third parties unless the content is exempt by statute or
other regulation.
2

;mot'
�s.
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
April 15, 2015
Mr. Darrell Gaines
Western N.C. Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION (#NOV-2015-LV-0244)
Permit No. NCO046809
Cornerstone Conference and Resource Center WWTP
Guilford County
Dear Mr. Gaines:
Donald van der Vaart
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for January
2015 showed the following violation:
Parameter
bate
Limit Value
Reported Value
Limit Type
Fecal Coliform
1/16/2015
400 #/100ml
600 #/100ml
Daily Maximum Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please be aware that violations of your NPDES permit could result in enforcement action by
the Division of Water Resources for this and any additional violations of State law.
If you have any questions or require any additional information, please contact Mike Mickey at (336)
776-9697.
Sincerely,
V Sherri V. Knight, PE
! Assistant Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
cc:, David Merritt (via email: [e-mail])
DWQ Central Files
WSRO
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone] \ Internet: www.ncwatercivality.org
An Equal Opportunity \ Affirmative Action Employer — Made in part by recycled paper

f DMR Review Record
Permit IVo.: l E � Pipe No.: MonthNear: `Jki 15,
Monthly Average Violations
Parameter \\`� _ �� Permit Limi DMR Value % Over Limit Action
klv a- Violations
Date
P�Aar(rameter
Permit Limit Limit Type DMR Value
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DIVISION OF WATER QUALITY 7 . ^ (SIGNATURE 01 OPERATOR IN SPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER . 3 r,.� i 1 pa E S BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
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RECEIVED
IN.C.Dept. of ENR
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North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
March 31, 2015
CERTIFIED MAIL Item 7010 2780 0003 4825 6786 - RETURN RECEIPT REQUESTED
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NOV-2015-LR-0029
Permit NCO046809
Guilford County •
Dear Permittee:
This is to inform you that the Division has not received the monthly discharge monitoring report
(DMR) from the Cornerstone Conference and Resource Center for October 2014.
This is in violation of Part II D. (2) of your NPDES permit, as well as 15A NCAC 2B.0506 (a),
which requires the submittal of DMRs no later than thirty calendar days following the reporting
period. You will be considered noncompliant with your NPDES permit until the report is
submitted.
To prevent the assessment of civil penalties, please submit the missing report to Charles Weaver
of my staff at the address listed below within fifteen (15) days of your receipt of this notice.
PLEASE NOTE: this letter provides notice that this office will recommend the assessment of civil
penalties if future reports are not received within the required time frame during the next twelve
(12) reporting months. Timely submittal of DMRs is essential to the efficient operation of the
NPDES program. We appreciate your assistance in this matter. If you have any questions about
this letter or discharge monitoring reports, please contact Mr. Weaver at the telephone number or
e-mail address listed below.
;ncer y,
Jay Zimmerman, Di�ctoir
Division of Water Resources
cc: Central File __
G j,,.__st���alem�!1�eg�onalQU.fhce-1��k�llllickey
NPDES file's
1617 Mail Service Center, Raleigh, North Carolina 27699-1617512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://por al,ncdenr.org/web/wq/swp/ps/npdes
An Equal Opportunity/Affirmative Action Employer- 501/6 Recycledl101/o Post Consumer Paper

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Notice of Finding for Immediate Response
The following finding(s) islare found to be of such a nature that immediate
resolution is required. A corrective action response is to be forwarded to:
DWR Laboratory Certification Branch
1623 Mail Service Center
Raleigh, N.C. 27699 -1623
Parameter and Finding
Total Residual Chlorine — SM 4500 Cl G-2000
Finding: Ta ou-7T � _ usg o .
Requirement: Facilities and equipment. Each laboratory requesting certification must contain or be equipped
with the following: Glassware, chemicals, supplies, and equipment required to perform all analytical
procedures included in their certification. Ref: 15A NCAC 02H .0805 (a) (6) (H).
Requirement: See attached letters dated August 14, 2001 and May 1, 2008 regarding Division equipment
requirements for the analysis of TRC.
Comment: All data reviewed were for facilities that had TRC permit limits. However, a Hach Pocket
Colorimeter II is being used which the attached letters state is only allowed for facilities without a permit limit.
The laboratory indicated that they have a spectrophotometer that meets the requirements that is mainly used
for TRC analyses for toxicity. This meter is capable of being used with a battery in a field setting.
1. Please sign and return this form by Monday June 2, 2014.
2. Please submit a list of facilities (including NPDES permit numbers) that are affected as well as the
approximate time frame of the use of an unapproved meter. This information is due by June 13, 2014.
3. Please submit a current curve verification (using the battery as a power source) of an approved meter
and confirm that it is being used for all facilities. This information is due by June 13, 2014.
Auditor: /� _�( Date:
Lab Name: eritech, Inc. Cert #: 165
By signature I verify that I have read and understand the Finding described above.
Signature of responsible party: Date:
Name of responsible party:
(please print) First MI Last
The corrective action response must be received no later than: Date: Specified Above
A copy of this document must be submitted with the corrective action response letter.
Rev 05/30/2014

o
A Division of Water Technology and Controls, Inc.
June 6n �) —0 14
June
Mr. Jason Smith, Chemist II
NC WWIGW Laboratory Certification
NC DENR/Divi8don of Water Resources— Water Quality Programs Water
Sciences Section
Asbevil-le Regional Office
20:9,'0 O.S. 8ighway, 70
SwannanQa, NC 28778
RE: Response to Notice of Finding for Immediate Response, May 30, 2014.
Dear Mr. Smith:
In response to your request we have implemented the -following steps:
1. Requeftedform was completed,signed; and sent to you via email, on June 2,
.2014'.
Z. The following g isa list of affected,facilities: Crown N414P-(NCO0552-55), Sd7en
/Tietex (NC 00013,48), Stood
Highway- (NC00.60623 )), Quail. Acres (NC005925 1.), Countryside Manor
(NC00735.7 1), and Haw River Park (NC0046019). Non -approved chlorine meters
we ' re used ' ed in these facilities approximately since 2_009.
3. Please see attached cur -rent chlorine curve information from the approved meter.
This meter was calibrated in the field operation mode, using a 12V car power
battery supply. This meter will be used in all.1the facilities listed above beginning
June 9, 2014.
If you have any questions- concerning this matter, please give me, a call.
=1
Sincerely,
V, ns fj � �t_ -
Kris Pawlak
Laboratory Mana-er,
Meritech, Inc.
Ph: 336,342 4748
642 Tamco Road - P.O. Box 27 - Reidsville, NC 273207
[phone] - [phone] Fax

Page 22
#165 Meritech, Inc.
highly contaminated (free product) non-soil/sediments (debris). Any other use of ultrasonic extraction is
considered a "significant modification" of the EPH Method. Ref: MADEP, May 2004, Rev. 1.1, Table 4.
Comment: The laboratory uses a modified version of the soil/sediment extraction process from the MADEP
VPH method, substituting acetone for methanol.
Comment: The complete list of approved EPH extraction procedures for water and soil/sediment samples is
presented in Table 4. Alternative extraction procedures other than those listed are acceptable, provided that
the laboratory can document acceptable matrix- and petroleum product -specific performance. However, use
of an alternative extraction procedure is considered a "significant modification" of the EPH method pursuant
to Section 11.3.1.1 and as such would preclude obtaining "presumptive certainty" status for any analytical
data produced using an alternative EPH extraction procedure. Ref: MADEP, May 2004, Rev. 1.1, Section 9.1.
Comment: Any method modification approval must come from the data receiving agency (i.e., the Division of
Waste Management, UST Section).
cccc. Finding: Units of measure were not documented on the EPH extraction log in the column for fractionation.
Requirement: All laboratories must use printed laboratory bench worksheets that include a space to enter
the signature or initials of the analyst, date of analyses, sample identification, volume of sample analyzed,
value from the measurement system, factor and final value to be reported and each item must be recorded
each time samples are analyzed. Ref: 15A NCAC 2H .0805 (a) (7) (H).
Field Parameters
Comment: The laboratory performs two types of field parameter analyses. They have one certified WWTP operator
that operates Crown MHP (NPDES permit #NC0055255), Burlington Mfg. Services (NPDES permit #NC0001384),
Cornerstone Conference Center (NPDES permit #NC0046809), Stone Highway (NPDES permit #NC0060623), Quail
Acres (NPDES permit #NC0059251), Countryside Manor (NPDES permit #NC0073571), and Haw River Park
(NPDES permit #NC0046019). Other laboratory employees collect river basin samples for the North Carolina
Monitoring Coalition Program. The WWTP operator and Monitoring Coalition samplers use different benchsheets.
The Findings for Field Parameters will individually indicate to which category they apply (i.e., NPDES or Monitoring
Coalition).
comment: igeviapGrawry-wras,-riot, usln �tne..p ooppc-equipments«LQrzil ocaiiKesiauai rive anaiy5sees. i ne Norm
Carolina Administrative Code, 1 A NCAC 2H .0805 (a) (6) (H) states: Facilities and equipment. Each laboratory
requesting certification must contain or be equipped with the following: Glassware, chemicals, supplies, and
equipment required to perform all analytical procedures included in their certification. A Division letter dated August
14, 2001 states: "This letter serves as notification to facilities with effluent permit limits for Total Residual Chlorine
(TRC) that effective July 1, 2002, the Division of Water Quality expects these facilities to utilize an instrument or
method that will detect and measure TRC concentrations to levels that are below the permit discharge requirements.
Please note that if a facility has no effluent limit for TRC Oust a monitoring requirement), then use of a hand-held
meter, sometimes described as a pocket colorimeter, and the reporting of <100 pg/L as a TRC value is acceptable.
The Environmental Protection Agency (EPA) and the State have determined that in the interest of overall program
equity, to ensure water quality protection, and to comply with 15A NCAC 2B .0505 (e) (4), the Division will require all
facilities with TRC limits to utilize instruments or methods that will produce detection and reporting levels that are
below the permit discharge requirements for TRC." The laboratory was using a pocket colorimeter at all of the
NPDES permit facilities listed in the above comment and they all have low level TRC limits. It was determined that the
laboratory initially purchased a meter capable of low level TRC analysis, but returned to using the pocket colorimeter
when the meter did not work well. The laboratory has been using the pocket colorimeter since approximately 2009. A
Notice of Finding for Immediate Response (NOFIR) was issued to the laboratory regarding this issue and a copy was
provided to the Winston-Salem Regional Office staff. The laboratory replied to the NOFIR with an acceptable curve
verification on an approved meter and indicated that the approved meter would be put into use beginning June 9,
2014. No further response is necessary for this finding.
Recommendation: The inconsistencies between the benchsheets used by the two field units are the cause of
several of the Field Parameters Findings. Merging the existing benchsheets into one or creating a new benchsheet
(to be used by both units) that will encompass all of the needs for both units is recommended.

aBmORATQ,Rl7 NAME:
ADDRESS:
CERTIFICATE #:
QA"Tc�N-S I TION:
TYPE OF INSPECTION:
AUDITOR(S):
LOCAL PERSON(S) CONTACTED:
INTRODUCTION:
On -Site Inspection Report
eritech C.
P.O. Box 27
Reidsville, NC 27320
165
, -0 '`28; 2 14
Commercial Maintenance
Jason Smith, Jeff Adams, Todd Crawford, Gary Francies, Nick Jones,
Dana Satterwhite, and Tonja Springer
Kris Pawlak, David Merritt, and Ian Bailey
This laboratory was inspected by representatives of the North Carolina Wastewater/Groundwater Laboratory
Certification (NC WW/GW LC) program to verify its compliance with the requirements of 15A NCAC 2H .0800 for the
analysis of environmental samples.
II. GENERAL COMMENTS:
The laboratory was clean and well organized. The facility has all the equipment necessary to perform the analyses.
Analytical data pertinent to each certified analysis was filed in an orderly manner and was readily available for
inspection upon request. Laboratory personnel were accessible to answer questions that arose during the inspection.
Some laboratory documentation was incomplete, inaccurate and additional quality control procedures need to be
implemented. The laboratory must take steps to bring operations into compliance with changes in federal
regulations, particularly 40 CFR Part 136 Methods Update Rules; the most recent was published on May 18, 2012.
Many Standard Operating Procedures (SOPs) were in direct conflict with method and/or regulatory requirements,
did not describe in detail how procedures are performed and personnel were not always following the procedures
as described in the SOPs.
The laboratory is reminded that any time changes are made to laboratory operations; the laboratory must update
the Quality Assurance (QA)/Standard Operating Procedures (SOP) document(s). Any changes made in response
to the Findings, Recommendations or Comments listed in this report must be incorporated to insure the method is
being performed as stated, references to methods are accurate, and the QA and/or SOP document(s) is in
agreement with approved practice and regulatory requirements. In some instances, the laboratory may need to
create a SOP to document how new functions or policy will be implemented. The laboratory must also take steps
to insure that all personnel are aware of the changes made; that they have fully implemented those changes and
steps have been taken (e.g., detailed SOPs and guidance documents, documented training and demonstration of
proficiency with new procedures, etc.) to prevent recurrence of findings.
The requirements associated with Findings A, N, O, P, Q, T, HH, KK, YY, ZZ, LLL, MMM, and HHHH have been
implemented by our program since the last inspection.
III. FINDINGS, REQUIREMENTS, COMMENTS AND RECOMMENDATIONS:
Documentation
Recommendation: The laboratory currently maintains only the most recent SOP revision date. It is recommended
that SOP review dates, in addition to revision dates, be maintained. It is recommended that SOPs include a revision
and review history with relevant dates (e.g., effective, review and revision dates) and a brief description of the
change(s) made.
Recommendation: Copies of each reference method are included in each SOP. However, the introduction section,
which lists the approval year for Standard Methods methods, is not included to verify that the document is actually the
most recently approved version. This means that further research (comparing page numbers and text to the approved

V1A7i ..
- - Michael F. Easley
Governor
William G. Ross, Jr., Secretary
r -4 North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
August 14, 2001
Dear NPDES Permittee:
This letter serves as notification to facilities with effluent permit limits for Total Residual Chlorine (TRC)
that effective July 1, 2002, the Division of Water Quality expects these facilities to utilize an instrument
or method that will detect and measure TRC concentrations to levels that are below the permit discharge
requirements. Please note that if a facility has no effluent limit for TRC (just a monitoring requirement),
then use of a hand-held meter, sometimes described as a pocket colorimeter, and the reporting of <100
ug/L as a TRC value is acceptable. The Environmental Protection Agency (EPA) and the State have
determined that in the interest of overall program equity, to ensure water quality protection, and to
comply with 15A NCAC 2B .0505(e)(4), the Division will require all facilities with TRC limits to utilize
instruments or methods that will produce detection and reporting levels that are below the permit
discharge requirements for TRC.
North Carolina has hundreds of NPDES permitted facilities that are required to limit the amount of TRC
that is discharged from their effluent to the receiving waters of the State. Typically these limits are set at
either 17 or 28 micrograms per liter (ug/L) of wastewater discharged. The EPA has approved two
methods for low-level TRC analyses: the Amperometric Titration Method and the.DPD Colorimetric
Method. The Amperometric Titration Method is a classic chemistry analysis perfonned in a laboratory
setting. Larger facilities with on -site laboratories frequently use this method and achieve reliable, low-
level results of their testing. Many permitted facilities with TRC limits are small and/or have no on -site
laboratory. Because TRC must be analyzed within 15 minutes of sample collection due to its volatile
nature, these facilities are not able to send these samples out for analysis to a commercial lab. They must
rely on a field technique, which will typically utilize the low-level DPD Colorimetric Method. There are
portable instruments available that have the capability of analyzing TRC in the range of 10-15 ug/L.
The Division realizes that changing the method of TRC measurement will not be without difficulty on the
part of the permittees. The permittees will have to evaluate and purchase or otherwise obtain access to
instruments and become both educated and proficient in their use. Please be advised while these
instruments are advertised as portable, permittees may have to prepare special on -site facilities to ensure
their most reliable operation. For these.reasons, permittees will not be required to use the more sensitive
instruments until July 1, 2002,
If you have questions about the contents of this letter, please contact Vanessa Manuel at [phone],
extension 532. The Division of Water Quality thanks you for your cooperation and understanding in this
matter.
Sincerely,
E. Shannon Langley, Supervisor
Point Source Compliance/Enforcement Unit
IGDENR
N. C. Division of Water Quality 1617 Mail Service Center 'Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748

`'OF WAT�c,QW
c
May 1, 2008.
To: NPDES Permittees
Subject: Total Residual Chlorine 50 ug/1 Compliance Level
Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Coleen K Sullins, Director
Division of Water Quality
In a previous letter dated August 14, 2001, the Division of Water Quality (DWQ) notified
NPDES p6rmittees that water/wastewater treatment facilities with Total Residual Chlorine
(TRC) effluent limits would be required to use analytical methods that produce detection levels
below their permit limit by July 1, 2002. [Note: TRC permit limits are typically set between 17
to 28 ug/1 for discharge to freshwater systems, and 13 ug/l for discharge to saltwater systems].
This requirement was based on an Environmental Protection Agency (EPA) audit of the NC
enforcement program. It was also necessary to ensure water quality protection and compliance
with state monitoring regulations [15A NCAC 2110505(e)(4)].
Since that time, DWQ has received several inquiries regarding difficulties with the new
analytical methods, primarily focused on 1) lack of precision with field instrumentation at low
TRC levels for both water and wastewater treatment plants; and 2) manganese interference with
TRC measurement at several water treatment plants. Some facilities have overcome these
problems through various changes, such as: 1) switching dechlorination chemicals; 2) adding a
second dechlorination feed; 3) changing analytical methods; 4) incorporating manganese
correction; 5) switching to LTV disinfection; 6) removing sludge from water treatment plant
settling basins. Also, the DWQ Laboratory Certification staff have provided extensive field
assistance for the new lab methods. Still, some analytical issues remain. In response to the
permittee's concerns, the Division is providing the following changes to its TRC requirements:
❑ TRC Compliance Level Changed to 50 ua/1. DWQ continued discussions with EPA
regarding analytical difficulties with TRC measurements, and in March 2008 received
EPA approval to allow .a 50 ug/1 TRC compliance level. This will not change the
analysis, annual verification of meter performance, or data reporting, but simply how the
reported values will be evaluated by DWQ from a compliance standpoint. Facilities will
still be required to report actual results on their monthly DMR submittals, but for
compliance purposes all TRC values below 50 ug/1 will be treated as zero. For example,
if the facility has a TRC limit of 17 ug/1 and reports a TRC value of 40'ug/1 on the DMR,
this value will be considered compliant under this new policy. This new compliance
level is effective March 1, 2008 (beginning with March 2008 DMR submittals).
DWQ will continue to incorporate TRC effluent limitations into NPDES permits for all
water/wastewater treatment facilities that discharge chlorine -bearing wastestreams to surface
waters. While this new TRC compliance level of 50 ug/1 is effective beginning March 1, 2008, it
will be incorporated into existing NPDES permits with TRC effluent limits upon permit renewal.
At that time, the following TRC footnote language will added to the Effluent Limitations Sheet:
"The facility shall report all effluent TRC values reported by a NC certified laboratory including
field certified. However, effluent values below 50 ug/1 will be treated as zero for compliance
purposes."
Division of Water Quality, Point Source Branch Telephone [phone] Now Cazo}�pa
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 FAX [phone] �j tugo
512 N. Salisbury Street, Raleigh, North Carolina 27604 On the Internet at http://h7o.enrstate.nc.Lw1 . ✓vu /i
An Equal OpportuniWAffinnalive Acton Employer

Page 2 of 2 -
May 1, 2008
TRC 50 ug/l Compliance Memo
DWQ reserves the right to modify this policy in the future as analytical methods evolve. If you
have questions about the content of this letter, please contact Tom Belnick at [phone],
extension 543. If you need assistance with your TRC analytical methodology, please contact
Gary Francies with the DWQ Water Quality Lab at [phone]
Sincerely,
Matt Matthews, Supervisor
Point Source Branch ,

A A19V
NCRA
North Carolina Department of Environment and Natural Resources
Pat McCrory John-E. SI<varla, III
Governor Secretary
April 23, 2014
Mr. Darrell Gaines
Western N.C. Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
SUBJECT: Compliance Evaluation Inspection
Cornerstone Conference Ministry Center WWTP
NPDES Permit No, NCO046809
Guilford County
Dear Mr. Gaines:
On April 17, 2014, Mike Mickey of this office met with you and Mark Nault, ORC, to perform a
Compliance Evaluation Inspection 'on the wastewater treatment system serving the Cornerstone Conference
Ministry Center. The facility was found to be in compliance with the effluent limits of the NPDES permit.
The inspection findings are detailed below and an inspection checklist is attached for your records.
I. Permit
The NPDES permit was issued effective May 1, 2011 and expires on April 30, 2016.
H. Self -Monitoring Program
The monthly self -monitoring reports (DMRs) were reviewed for the period February 2013 through January
2014 (see data summary attached). The facility was found to be compliant with the final NPDES effluent
limits for the above period. With regards to the permit monitoring requirements, it was noted that all
sampling was performed per the frequencies specified in the permit.
One recordkeeping concern involved the late submittal of several monitoring reports. Specifically, the
monthly reports for November 2013, December 2013, January 2014 and February 2014 were not submitted
on time. Please note that the NPDES permit [Part H, Section A(2)] states that the DMRs shall be postmarked
no later than the last calendar day of the month following the completed reporting period (i.e., the February
2014 DMR should be postmarked on or before March 31, 2014). .
Additionally, it was noted that Marc. Nault is signing the back of the DMRs as the Permittee. The permit
[Part If, Section B(11)] requires that the permit holder sign all reports unless a duly authorized representative
has been designated. If you wish for someone to sign for you, please submit a Delegation of Signature
Authority letter for our files (see example attached).
III. Flow Measurement
The permit requires instantaneous flow reporting for the effluent. The ORC uses ajar to catch the discharge
from the chlorinator unit to estimate flow. The reported values ranged from a high of 7,000 gpd to a low of
100 gpd. No flow was reported for the months of May, November and December.
N.C. Division of Water Resources
585 Waughtown Street, Winstion-Salem, NC 27107
Phone: [phone] Internet: www.ncwaterqual4.org
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

Mr. Darrell Gaines
Page 2
April 23, 2014
IV. Sludge Handling and Disposal
No solids were removed from the system in 2013.
V. Operations and Maintenance
The facility appeared to be competently operated and maintained. No problems or concerns were noted.
VI. Facility Site Review
The existing 0.02 MGD treatment system consists of the following: splitter box (not used); dual in -ground
package plants (only the right -side package plant unit is utilized due to low influent flows) with bar screens;
aeration basins; clarifiers; tertiary filters (inoperable); non -aerated sludge holding units; tablet chlorinators
and contact tanks; followed by a single tablet dechlorinator unit.
VH. Records/Reports
A comparison of the January 2014 self -monitoring report with the corresponding operator's log and
laboratory data sheets from Meritech indicated that all values were transcribed onto the DMR correctly.
VIR. Effluent/Receiving Waters
The system discharges into an unnamed tributary to Benaja Creek, class "WS-V; NSW" waters in the Cape
Fear River Basin. The outfall could not be located as it appeared to be buried in the stream bank.
Should you have any questions concerning this report, please contact Mike Mickey or me at (336)
771-5000.
Sincerely,
Sherri V. Knight, PE
Assistant Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
cc: David Merritt (via email: [e-mail])
Central Files
WAS @*�

Data Summary
Cornerstone Conference Ministry. Center WWTP
NPDES Permit No. NCO046809
Self -Monitoring Data Summary
February 2013 - January 2014
Parameters
Monthly Avg.
Permit Limits
Monthly Avg. Limit
Violations per DMR
Daily Maximum
Permit Limits
Daily Max. Limit
Violations per DMR
Flow (MGD)
0.02
None
-
NA
BOD (mg/1)
30.0
None
45.0
None
TSS (mg/1)
30.0
None
45.0
None
NH37N (mg/1)
-
NA
-
NA
Fecal (#/100 ml)
.200
None
400
None .
T. Chlorine (ug/I)
-
NA
28.0*
None
Chronic Toxicity
P/F @ 31%
None
-
NA
pH (S. U.)
-
NA..
(6.0 — 9.0) range
None
* TRC values reported below 50 ug/L are considered compliant.
Late Monitorinq Reports:
Month
DMR Date Due
Date Received
Days Late
November 2013
12/31/13
01/21/14
21
December 2013
01/31/14
02/24/14
24
January 2014 .
02/28/14
03/24/14
24
February 2014
03/31/14
Not received to date
23 +

Permit: NCO046809 Owner - Facility: Cornerstone Conference and Resource Center WWT
Inspection Date: 04/17/2014 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? W ❑ ❑ ❑
# 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: The Cornerstone Conference Ministry Center wastewater treatment system
was found to be compliant with the final NPDES effluent permit limits for the review
period February 2013.through January 2014. The current permit expires on April 30,
2016.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ -❑
Does the facility analyze process control parameters, for ex: NILSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑
Judge, and other that are applicable?
Comment: The existing 0.02 MGD treatment system consists of the following: splitter
box (not used), bar screen, dual in -ground package plants (only one package plant unit
is utilized due to low influent flows) consisting of areation basins, clarifiers, tertiary filters
(not operable), non -aerated sludge holding tanks, tablet chlorinators and contact tanks,
followed by a single tablet dechlorinator unit.
Record Keeping
Yes No
NA NE
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?
❑ ❑
■ ❑
Page # 3

Permit: NCO046809 Owner - Facility: Cornerstone Conference and Resource Center WWT
Inspection Date: 04/17/2014 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No NA
NE
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
Q ■
Is the ORC visitation log available and current?
■
0 Q
0
Is the ORC certified at grade equal to or higher than the facility classification?
■
❑ ❑
Q
Is the backup operator certified at one grade less or greater than the facility classification?
■
Q Q
Q
r
Is a copy of the current NPDES permit available on site?
■
Q ❑
Cl
Facility has copy of previous year's Annual Report on file for review?
Q
0 ■
Q
Comment: A comparison of the January 2014 DMR with the certified laboratory data
sheets and operator's records showed that the data was accurately transcribed onto the
monitoring report.
One recordkeeping problem that was noted involves the late submittal of the monthly
monitoring reports. The November 2013, December 2013, January 2014 and February
2014 DMRs were each submitted over three weeks late. Please make sure that these
reports are mailed to Raleigh on time.
Bar Screens
Yes
No NA
NE
Type of bar screen
a.Manual
■
b.Mechanical
n
Are the bars adequately screening debris?
■
Q ❑
I]
Is the screen free of excessive debris?
■
n ■
n
Is disposal of screening in compliance?
■
O ❑
11
Is the unit in good condition?
■
C1 0
0
Comment: A small bar screen is located at the head of the aeration basin.
Aeration Basins
Yes
No NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n 11
n
Are surface aerators and mixers operational?
n
n ■
❑
Are the diffusers operational?
■
n n
n
Is the foam the proper color for the treatment process?
■
n Cl
Does the foam cover less than 25% of the basin's surface?
■
n n
El
Page # 4

Permit: NCO046809 Owner- Facility: Cornerstone Conference and Resource Center WWT
Inspection Date: 04/17/2014 Inspection Type: Compliance Evaluation
A. — CA. d--;n- - - V.. Mn NA NF
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment: Only one aeration basin of the dual train system needs to be operated due
to the minimal amount of influent flow generated, by the conference center. The
operator adds dog food and soda ash over the winter to maintain the organisms in the
aeration basin.
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 ''/o of the sidewall depth)
Comment: One rectangular clarifier with a single weir trough is operated.
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: Very little sludge is generated and no solids were removed in 2013. The
digester is at the head of the package plant and receives the return flow from the
clarifier.
Disinfection -Tablet
Are tablet chlorinators operational?
❑ ❑ ❑ ■
❑ ❑ ❑ ■
Yes No NA NE
■ ❑ ❑ ❑
Page # 5

Permit: NCO046809
Inspection Date: 04/17/2014
Owner -Facility: Cornerstone Conference and Resource Center WWT
Inspection Type: Compliance Evaluation
Disinfection -Tablet
Yes
No
NA NE
Are the tablets the proper size and type?
■
n
n n
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
■
n
n ❑
Is the contact chamber free of growth, or sludge• buildup?
■
❑
❑ ❑
Is there chlorine residual prior to de -chlorination?
❑
❑
❑ ■
Comment: One chlorinator is used and is followed by the contact tank.
De -chlorination
Yes
No
NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
n
n
■ n
Is storage appropriate for cylinders?
n
n
■ n
# Is de -chlorination substance stored away from chlorine containers?
n
n
■ n
Are the tablets the proper size and type?
■
n
n n
Comment: The dechlorinator was added to the system in 2007 and follows the
right -side package plant.
Are tablet de -chlorinators operational?
■
❑
❑ ❑
Number of tubes in use?
2
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
❑
■
❑
❑
Is flow meter calibrated annually?
❑
❑
■
❑
Is the flow meter operational?
n
n
■
n
(If units are separated) Does the chart recorder match the flow meter?
n
❑
■
❑
Comment: The permit only requires instantaneous flow measurement.
The ORC uses
a jar to catch flow out of the chlorinator to estimate flow.
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
■
❑
❑
❑
Are the receiving water free. of foam other than trace amounts and other debris?
■
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
n
n
■
■
Comment: The effluent pipe appeared to be buried at the stream, and therefore the
exact location of the discharge could not be determined.
Page # 6

Permit: NC0046809
Inspection Date: 04/17/2014
Owner - Facility: Cornerstone Conference and Resource Center WWT
Inspection Type: Compliance Evaluation
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ® 0 ❑ Q
Comment: The upstream and downstream samples are being collected per the permit.
Page # 7

<Date>
Mr. Charles Weaver
NPDES Compliance Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
<Facility Name>
NPDES No. NC
Dear Mr. Weaver:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for
all permit applications, discharge monitoring. reports, and other information relating to the
operations at <Facility Name> 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
If you have any questions regarding this letter, please feel free to contact me at <Phone Number>.
Sincerely,
<Facility Officers Name>
<Facility Officers T'itle>
cc: Winston-Salem Regional Office (Atlas: Mike Mickey, NCDENR, 585 Waughtown St, Winston-Salem, NC 27107)

Mickey, Mike
From: Mickey, Mike
Sent: Thursday, April 17, 2014 3:52 PM
To: [e-mail]
Subject: FW: DMR signatures for Cornerstone Conf Ctr
Attachments: DMR-Delegation-of-Authority-20100322-DWQ-SWP-NPDES.doc
David —Just FYI on an email send to Darrell Gaines regarding the need for a Delegation of Signature Authority letter for
the DMRs. Mike.
Mike Mickey
Mike. [e-mail]
NC Division of Water Resources
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
From: Mickey, Mike
Sent: Thursday, April 17, 2014 3:49 PM
To: ddc ainesCai)ccrdc.org
Subject: Sewer application
Darrell — Attached is the sewer extension application that would be required to connect more than a single building to
the existing sewer system at the Cornerstone Conference Ministry Center. The application requires several attachments
(FSTE Form, Watershed Classification Form) that the engineer will be familiar with. They can also be found at the
following link: http://portal.ncdenr.org/web/wq/swp/ps/cs/ext
One thing that I forgot to mention to you for the NPDES inspection involves the signing of the monthly self -monitoring
reports (DMRs). Currently Marc Nault is signing the back of the form. The permit [Part II, Section B(11)1 requires that
the permit holder sign all reports unless a duly authorized representative has been designated. I could not find a letter
in our file authorizing Marc or Meritech to sign on your behalf. If you wish for someone to sign for you, please complete
the attached Delegation of Signature Authority form and return it to the address in Raleigh with a copy back to me. If
you wish to sign the forms yourself, Meritech will need to get the forms to you prior to mailing to the State.
Have a good Easter weekend. Thanks, Mike.
Mike Mickey
Mike. [e-mail]
NC Division of Water Resources
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North

Mickey, Mike
From: David Merritt <[e-mail]>
Sent: Friday, January 24, 2014 11:26 AM
To: Mickey, Mike
Subject: RE: ORC Updates Needed.
I'll get it done Mike
David Merritt
Vice President
Meritech, Inc.,
336-317-5936: Cell
336-342-4746: Office
david. merritt(&meritech-labs . com
www.meritech-labs.com
From: Mickey, Mike[mailto:[e-mail]]��
Sent: Friday, January 24, 2014 11:03 AM
To: [e-mail]
Subject: ORC Updates Needed.
David - We are trying to clean up the ORC database to make the new eDMR process go smoothly. Patrick is still listed as
the ORC for Cornerstone and Countryside. Can you submit the attached form with the correct ORC/backup
information? Thanks, Mike.
Cornerstone Conf Ctr- NCO046809
;Designated Operators_
r*Location Class.
-_—._ _ _.._
t3peratorCert
? [Name
Status
,-
*Role
t *Effective Dt
i Expiration Dt
Notiticattoi
VJW-2
M-2111794
Merritt, Patrick A_
Active
ORC
12/29/2003
0/125/2007
WAN-2
WW-21 10569
Merritt, David R.
Active
Backup
01/1512007
0/12512007
Countryside Manor - NCO073571
Designated Operators:
i*Location Class -,
Operator Cert
F Name -
Status
i *Role
*Effective Dt
j Expiration Dt
Notifrcati6
MV-2
WVV-2111794
Merritt, Patrick A.
Active
ORC
1010312002
06/22/2004
VAN-2
MIV-2110569
P,territt, David R.
Active
Backup
10103f2OO2
0612212004
Mike Mickey
[e-mail]
NC Division of Water Resources
585 Waughtown Street
1

Winston-Salem, NC 27107
Phone: [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.
Information from ESET Smart Security, version of virus signature database 9334 (20140124)
The message was checked by ESET Smart Security.
http://www.eset.com
Information from ESET Smart Security, version of virus signature database 9334 (20140124)
The message was checked by ESET Smart Security.
http://www.eset.com

MCDENK
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor. Director .
November 20, 2012
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150,
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO046809.
Cornerstone Conference and Resource Center WWTP
Guilford County.
Dear Mr. Gaines:
Dee Freeman
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for August 2012
showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Fecal Coliform
08/21/12
400 #/100ml
960 #/100m1
Daily Maximum Exceeded
Fecal Colifonn
08/01/12
400 #/100ml
470 #/l00ml
Daily Maximum Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please be aware that violations of your NPDES permit could result in enforcement action by the
'Division of Water Quality for this and any additional violations of State law. .
If you should have any questions, please do not hesitate to contact Mike Mickey at (336)771=5000.
Sincerely,
d
W. Corey Basinger
Regional Water Quality Supervisor
Winston-Salem Region
Surface Water Protection Section
cc: Patrick Merrit (Meritech, Inc., 642 Tamco Road, P.O. Box.27, Reidsville, NC 27320)
Central Files - SWP
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
NofthCarohna
XatarpJAY

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: �oc�2a��G��Q Permit/Pipe No.: �CC��\�vt� Month/Year
Parameter
Average Violations
DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
\r\ �
Moni %rn,,,rFrequency Violations
Date Parameter Frequency Values Reported # of Violations
Other Violations
moo. 1C1t'\ - k��\) vetN\ im,-, �- 'U. os",�sSi��
Completed by: WkD - 1' V•i1 Date:�-
Regional Water Quality I
Supervisor SiQnoff: Date:

RECEIVED
IN-C.dept. of Er%!P 0C T 9 5' 20l2
O�a° v
& a•q EFFLUENT
V II .
yVinston - em
Re 'on O�ricU I
NPDES PERMIT NO. k i; T r —DISCHARGE NO.�)C) { MONTH tUI
FACILITY NAME CYAZW"+V5 CLASS_ COUNTY lu b
CERTIFIED LABORATORY (1) MEP—\TECXA n s. & , CERTIFICATION NO.
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (ORC) nW-C.,Q, PAUC
PERSONS) COLLECTING SAMPLES Mk/kO-,.13Nc.�
CHECK BOX IF ORC HAS CHANGED: '
Mail ORIGINAL and ONE COPY to:b e �. ,
ATTN: CENTRAL FILES 0 I x ° J'
DIVISION OF WATER QUALITY
GRADE —�— CERTIFICATION N0. go
ORCPHONE 3�(-- 341-947 /
A NO FLOW / DISCHARGE FROM SITE
9 - I o)-'�>
1617 MAIL SERVICE CENTER `' BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH. NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLED^QED- _=--�
1 MIN
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DWQ Form MR-1 (11104)

-f
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 meef permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
Q - Nt-jim
Permittee (PIease print or type)
Signature 'of Permitte *** Date
(Required unless submitted electronically)
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory (2) Certification No.
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
Certification No.
Certification No..
Certification No.
PARAMETER CODES - . .
Parameter Code assistance may be obtained by calling the NPDES Unit 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_pemut for -reporting -data . _-_____
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be -on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

A* -
; Aw/
q
C®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
August 13, 2012
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO046809
Cornerstone Conference and Resource Center WWTP
Guilford County
Dear Mr Gaines:
Dee Freeman
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for May 2012
showed the following violations:
Parameter
Date
Limit Value
Reported Value
rLimit Type
Fecal Coliform
5/02/12
400 #/100m1
>600 #/100m1
Daily Maximum Exceeded
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please be aware that violations of your NPDES permit could result in enforcement action by the
Division of Water Quality for this and any additional violations of State law.
If you should have any questions, please do not hesitate to contact Mike Mickey at [phone].
Sincerely,
W. Corey Basinger
Regional Water Quality Supervisor
Surface Water Protection Section
cc: Jim Cheshire (R&A Labs, Inc., 106 Short Street, Kernersville, NC 27284)
Central Files - SWP
I&V49z US6 -
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
No Carolina
Awmally

w- aoa--V� - oAgl
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility- Permit/Pipe No.: Month/Year
nthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Wkl aily Violations
Date Parameter Permit Lin-lit/Type DMR Value % Over Limit
Mon%'n(-y equency Violations
Date Parameter re uencv Values Reported # of Violations
Other Violations
UW
I - C\ Z� -V-
Completed by: tNDate:
Regional Water Quality
Supervisor SiQnoff: '�'�'`d� Date: 20 Z

Sept.
eLRegioflal
�tiFs3l�ti18 2 12 EFFLUENT 10Aton-Salem C> ire_rP� m_
NPDES PERMIT NDISCHARGE NO.C)()_ MONTH ' m It L' `=` `= - YEAR --
FACILITY NAME CLASS_ COUNTY t1 Fz)
CERTIFIED LABORATORY (1) M i P-\-7 C-\ -.1 L , CERTIFICATION NO. J �o
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (ORC) M K-(� Q, VJAUI-1
PERSONS) COLLECTING SAMPLES (`1 P.G ;; t3AQ(-- -
CHECK BOX IF ORC HAS CHANGED',;:-'�
Mail ORIGINAL and ONE C?Ptx!o i ;�
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY ; s 7 } s 0 �, .
1617 MAIL SERVICE CENTER ''1"' E 1 " ' RP',d~ ° E- '
RALEIGH, NC 27699-1617 +��''�ial rso
GRADE ? CERTIFICATION NO. fo5�
ORC PHONE 1-9QZ
NO FLOW I DISCHARGE FROM SITE*
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1 1 I
1 1 1 1
1 1• I I
11, 1
I I I
1 1, I
I I 1
�' '�
1 1 1 1
1 1, 1 1
I I„
�ii►LJ!1'r"'� i �
e
w
I m
INIum��-
IVA
8t�
�
a
DWQ Form MR-1 (11104)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
periiiittee 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 111.6 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
Perm ittee (PIease print or type)
Z,36) --0
Sign of Permittee*** Date
(Required unless submitted electronically)
Permittee Address Phone Number e-mail address Permit Expiration Date
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
ADDITIONAL CERTIFIED LABORATORIES
Certification No.
Certification No.
Certification No..
Certification No.
PARAMETER CODES - - . .
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,' as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
***Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be - on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

Mickey, Mike
From:
Basinger, Corey
Sent:
Monday, March 26, 2012 10:52 AM
To:
Mickey, Mike
Subject:
FW: Pentecostal Holiness Church
Attachments:
1-2012 NC List-AMENDED.pdf
Just FYI
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
Winston-Salem Regional Office
Division of Water Quality
Email: [e-mail]
Phone: [phone]
Fax [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Caw and may be disclosed to
third parties.
From: Meadows, Susan
Sent: Monday, March 26, 2012 10:41 AM
To: Carter, Jenifer
Cc: Basinger, Corey
Subject: Pentecostal Holiness Church
Hi Jenifer,
FYI
For some reason our computer software did not add a Non Compliant test to the Non Compliant List.
Pentecostal Holiness Church (NC0046809) Failed in January.
I have attached an updated list of January 2012 Non-Compliants (all regions).
Susie
Susan Meadows, Environmental Biologist
Aquatic Toxicology Unit
DWQ/Environmental Sciences Section
4401 Reedy Creek Road Raleigh, NC 27607
[e-mail]
t: [phone]
f: (919).743-8517
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.

Facilities Noncompliant with Whole Effluent Toxicity Limits January 2012
March 26, 2012
Reg
Facility
NPDES
Date
County
#
Requirement
ARO
SGL Carbon, LLC
NC0005258/001
1/23/2012
Burke
2
chr lim: 13%
MRO
CMUD-Irwin Creek WWTP
NCO024945/001
1/9/2012
Mecklenburg
1
chr lim: 83%
MRO
CMUD-McDowell Cr. WWTP
NC0036277/001
1/9/2012
Mecklenburg
1
chr lima: 90%
MRO
Dawson International Prop-Albermarle
NCO086487/001
1/9/2012
Stanly
2
chr lim: 90%
MRO
Denver GWR
NCO089001/001
1/24/2012
Catawba
1
Chr Lim: 90%
MRO
Kings Mtn. - Pilot Cr. WWTP
NCO020737/001
1/16/2012
Cleveland
2
chr lim: 33%
RRO
Durham County Triangle WWTP
NCO026051/001
1/9/2012
Durham
2
chr lim: 90%
RRO
NC State University - Lot 86
NCO088129/001
1/23/2012
Wake
9
Chr Lim: 90%
RRO
South Durham WRF
NC0047597/001
1/9/2012
Durham
1
chr lim: 90%
WARO
Hamilton WWTP
NCO044776/001
1/9/2012
Martin
1
Ac P/F Lim: 90% Fthd
WIRO
Burgaw WWTP
NCO021113/001
1/9/2012
Pender
1
chr lim: 90%
WIRO
Lake Waccamaw WWTP
NC0021881/001
1/9/2012
Columbus
2
chr lim: 90%
WSRO
Pentecostal Holiness Church
NCO046809/001
1/31/2012
Guilford
5
chr lim: 31%
# indicates number of targeted events since February 1, 2011

NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, PE
Governor Director
February 17, 2012
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Natural Resources
SUBJECT: Compliance Evaluation Inspection
Cornerstone Conference & Resource Center WWTP
NPDES Permit No. NCO046809
Guilford County
Dear Mr. Gaines:
Dee Freeman
Secretary
On February 15, 2012, Mike Mickey of this office met with Mark Nault, ORC, to perform a
Compliance Evaluation Inspection on the wastewater treatment system serving the Cornerstone
Conference & Resource Center. This type of inspection consists of two basic parts: an in office file
review and an on -site inspection of the treatment facility. The treatment facility was found to be
noncompliant with the effluent limits in the NPDES permit. The attached EPA inspection form notes the
eight (8) areas that were evaluated. The findings and observations are outlined below:
I. Permit
The NPDES permit was recently reissued with an effective date of May 1, 2011.
II. Self -Monitoring Program
The monthly self -monitoring reports (DMR's) were reviewed for the period January 2011 through
December 2011. The facility was found to be noncompliant with final NPDES effluent limits for fecal
coliform and chronic toxicity for the above period (see data summary attached). These violations have
already been addressed by correspondence from this office. In regards to the permit monitoring
requirements, it was also noted that no effluent sampling for dissolved oxygen was reported on the
August DMR. It is our understanding that this was an oversight and a corrected DMR will be
resubmitted. Additionally, please update the name on the DMR's to correctly reflect Cornerstone
Conference Center and not Pentecostal Holiness Church.
III. Flow Measurement
The NPDES permit requires instantaneous flow reporting for the effluent. Reported flows average
approximately 1,000 gpd or less. It is our understanding that on some days the system does not
generate a discharge. If that is the case, please do not sample stagnant water. Simply write `No Flow"
for the specific date on the DMR.
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
NorthCarohna
NGl'hirallbl
An Equal Opportunity \ Affirmative Action Employer

Mr. Darrell Gaines
Page 2
February 17,.2012
IV. Sludge Handling and Disposal
Due to the small volume of wastewater treated, hauling of solids from the aerobic digester is seldom
necessary.
V. Operations and Maintenance
The facility appeared to be competently operated and maintained. No problems or concerns were noted.
VI. Facilitv Site Review
The existing treatment. 0.02 MGD system consists of the following: splitter box., bar screen, dual in
ground package plants (only the right side is utilized due low influent flow) with aeration basins, clarifiers,
tertiary filters (inoperable), sludge holding along with a tablet chlorinator, contact tank, tablet
dechlorinator and effluent discharge pipe.
VII. Records/Reports
A comparison of the December 2011 self -monitoring report with the corresponding laboratory data
sheets showed that all values were transcribed onto the DMR correctly, except for the chronic toxicity
test result for the month. It is our understanding that an amended copy of the December DMR will be
resubmitted.
Vill. Effluent/Receivina Waters
The system discharges into an unnamed tributary to Benaja Creek, class "WS-V NSW' waters in the
Cape Fear River Basin. The outfall could not be located as it appeared to be covered up with sand.
Should you have any questions concerning this report, please contact Mike Mickey or me at (336)
771-5000.
Sincerely,
-,,2,t'6 - /'Lle
W. Corey Basinger
Regional Water Quality Supervisor
Surface Water Protection Section
cc: Patrick Merrit (Meritech, Inc., 642 Tamco Road, P.O. Box 27, Reidsville, NC 27320)
Central Files

V
Cornerstone Conference & Resource Center WWTP
NPDES Permit No. NC0046809
Self -Monitoring Data Summary
January 2011 — December 2011
Parameters
Monthly Avg.
Permit Limits
Monthly Avg. Limit
Violations per DMR
Daily Maximum
Permit Limits
Daily Max. Limit
Violations per DMR
Flow (MGD)
0.02
None
-
NA
BOD (mg/I)
30.0
None
45.0.
None
TSS (mg/1)
30.0
None
45.0
None
NH3-N (mg/1)
-
NA
-
NA
Fecal (#/100 ml)
200
None
400
8/4 & 9/7
T. Chlorine (ug/1)
-
NA
28.0*
None
Chronic Toxicity
P/F @ 31 %
Feb, March, April & Nov.
-
NA
D. Oxygen (mg/L)
-
NA
-
NA
pH (S.U.)
-
None
(6.0 — 9.0) range
None
"TRC values reported below 50 ug/L are considered compliant.
Effluent Violations:
The 640/100 ml fecal coliform value on August 4th violated the 400/100 ml daily maximum fecal coliform limit.
The 1080/100 ml fecal coliform value on September 7th violated the 400/100 ml daily maximum fecal coliform limit.
The February 15th chronic toxicity test violated the 31 % chronic toxicity effluent discharge limitation.
The March 29th chronic test violated the permit effluent limit for chronic toxicity.
The April 26th chronic test violated the permit effluent limit for chronic toxicity.
The November 17th chronic toxicity test violated the 31 % chronic toxicity effluent discharge limitation.
Monitoring violations:
Weekly dissolved oxygen measurements were omitted for the following five weeks in August: 8/1-5, 8/8-12, 8/15-
19, 8/22-26 and 8129-9/2.

United States Environmental Protection Agency
Form Approved.
Washington, D.C. 20460
EPA
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 ICI 3 I NC0046809 111 12I 12/02/15 117 18I C I 191 S I 20I
1
Remarks
21111111111111111111111111111111111111111111111�6
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ------- —---------------- Reserved --------- ---- ------
67 I 169 70131 711 I 721 N I 73 LU 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:45 AM 12/02/15
11/05/01
Cornerstone Conference and Resource Center WWTP
Exit Time/Date
Permit Expiration Date
7545 US Hwy 29 N
Browns Summit NC 27214
12:30 PM 12/02/15
16/04/30
Name(s) of Onsite Representative(s)fTitles(s)/Phone and Fax Number(s)
Other Facility Data
Marc W Nault/ORC/336-341-8971/
Name, Address of Responsible OfficialfTitle/Phone and Fax Number
Contacted
Darrell Gaines,PO Box 150 Browns Summit NC 272140150//336-656-7936/3366567554 Yes
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
Michael M Mickey WSRO WQ//336-771-50001
VA
l A—
Signature f anagejrnentQA Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

0
Permit: NCO046809
Inspection Date: 02/15/2012
Owner -Facility: Cornerstone Conference and Resource Center WWT
Inspection Type: Compliance Evaluation
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? n ❑ ■
Is the facility as described in the permit? ■ n n n
# Are there any special conditions for the permit? n ■ n n
Is access to the plant site restricted to the general public? ■ n n n
Is the inspector granted access to all areas for inspection? ■ n n n
Comment: The NPDES permit was reissued effective May 1, 2011. A reveiw of the
monthly self -monitoring reports for the period January 2011 through December 2011
noted two daily maximum fecal coliform violations that occurred on 8/4 and 9/7. Chronic
toxicity sampling test failures occurred in February, March, April and November. The
three consecutive failures for Feb/March/April resulted in a civil penatly assessment
(TX-2011-0006).
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? n n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge n n n n
Judge, and other that are applicable?
Comment: The existing 0.02 MGD package plant consists of the following: splitter
box, bar screen, dual paralell aeration basins (only one side utilized), dual paralell
clarifiers (only one side utilized), tertiary filters (not operable), aerated sludge holding
tank, tablet chlorinator, contact tank, tablet dechlorinator and effluent discharge pipe.
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)?
■
Cl n n
Are analytical results consistent with data reported on DMRs?
■
n n n
Is the chain -of -custody complete?
■
❑ ❑ Q
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
Page # 3

Permit: NCO046809
Inspection Date: 02/15/2012
Owner - Facility: Cornerstone Conference and Resource Center WWT
Inspection Type: Compliance Evaluation
Record Keeping
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: A review of the DMR's showed the following data omissions:
*August 2011 - No effluent D.O. values were reported. A Notice of Violation letter was
sent. It is our understanding that a corrected DMR is to be resubmitted.
*The chronic toxicity result for December 2011 was omitted from the DMR. The AT-3
form was submitted as required. It is our understanding that a amended copy of the
December DMR is to be resubmitted.
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:
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?
Yes No NA NE
❑ ❑ ■ ❑
nn■n
■nnn
■nnn
■nnn
n n n n
nn■n
Yes No NA NE
n
■
■ n n n
■nnn
■nnn
■nnn
Ext. Air
Diffused
■nnn
nn®n
®nnn
®nnn
■nnn
nnn■
Page # 4

Permit: NCO046809 Owner - Facility: Cornerstone Conference and Resource Center WWT
Inspection Date: 02/15/2012 Inspection Type: Compliance Evaluation
Aeration Basins
Yes No
NA NE
Is the DO level acceptable?(1.0 to 3.0 mg/1)
n
n
n ■
Comment: Only one side of the dual train package plant is utilized due to the minimal
amount of wastewater generated by the conference center.
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?
❑
❑
■ ❑
Are weirs level?
■
n
n n
Is the site free of weir blockage?
■
❑
❑ n
Is the site free of evidence of short-circuiting?
■
n
n
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
■ o
Is the return rate acceptable (low turbulence)?
■
Cl
n n
Is the overflow clear of excessive solids/pin floc?
®
n
n n
Is the sludge blanket level acceptable? (Approximately'/4 of the sidewall depth)
n
n
n ■
Comment:
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?
■
❑
# Is the odor acceptable?
■
n
n n
# Is tankage available for properly waste sludge?
■
❑
❑ Cl
Comment: Little if any sludge is generated.
Disinfection -Tablet
Yes
No
NA NE
Are tablet chlorinators operational?
■
n
n n
Are the tablets the proper size and type?
■
n
n n
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
■
n
n n
Is the contact chamber free of growth, or sludge buildup?
■
n
n n
Is there chlorine residual prior to de -chlorination?
n
n
n ■
Page # 5

Permit: NC0046809 Owner -Facility: Cornerstone Conference and Resource Center WWT
Inspection Date: 02/15/2012 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Comment:
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
Is storage appropriate for cylinders?
# Is de -chlorination substance stored away from chlorine containers?
Comment:
Are the tablets the proper size and type?
Are tablet de -chlorinators operational?
'Number of tubes in use?
Comment:
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: The exact location of the discharge point at the creek could not be located.
It appeared that the end of the pipe had been covered up with sand deposits.
Yes No NA NE
0 0 0 0
■ ❑ ❑
2
Yes No NA NE
Page # 6

®
RC-_i.RIVC13
PLC. Dept of ENK
LI�--
OCT 0 2 2009
NC®ENR
Winston-Salem
North Carolina Department of Environment and Natural ResourcesRegional
office
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Dee Freeman
Governor Director
Secretary
September 25, 2009
Thomas H. McGee
Pentecostal Holiness Church_
PO Box 150 - -
Browns Summit, North Carolina 27214
Subject: Notification of Jordan Lake Nutrient Requirements
NPDES Permit NC0046809
Western NC Conference Center WWTP
Guilford County
Dear Mr. McGee:
Governor Bev Perdue recently signed legislation to complete passage of rules for the Jordan Lake
Nutrient Management Strategy. The Strategy includes a Wastewater Discharge rule (T15A NCAC 02B
.0270) that applies to your wastewater treatment facility. Pursuant to Sub -Item (6)(d) of the rule, I am
writing to notify 'You of the nutrient allocations assigned to your facility.
This letter addresses only certain provisions of the Jordan Lake Wastewater Discharge rule. I encourage
you to familiarize yourself with the remainder of this rule.
Nutrient Allocations. The Wastewater Discharge rule establishes the maximum loads of nitrogen and
phosphorus that can be released from wastewater treatment facilities into the Jordan Lake watershed.
The rule provides that these wasteload allocations are to be divided among the existing facilities in
proportion to (with specific exceptions) their 2001 permitted flows. It also provides that facilities
permitted to discharge 100,000 gpd or more are to receive nitrogen and phosphorus limits equivalent to
their individual allocations.
Your facility has been assigned nitrogen and phosphorus allocations. The allocations are expressed as
annual mass loadings delivered to the lake. Due to foreseeable losses between the discharge point and
the lake, they are also expressed as the equivalent discharge loads at the point of discharge. The
delivered and the corresponding discharge allocations assigned to your facility are as follows:
N00046809
Delivered Allocation
(lb/yr)
Transport
Factor (%)
Discharge Allocation
(lb/yr)
Total Nitrogen
336
46
731
Total Phosphorus
50
41
122
2001 Permitted Flow: 0.02 MGD
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
Intemet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer

Thomas H. McGee
Notification of Jordan Lake Nutrient Requirements
September 25, 2009
Nutrient Limits. Your facility will not receive new nutrient limits at this time. However, any nutrient
limits already in your NPDES permit will remain in effect.
If the facilities permitted for less than 100,000 gpd,.as a group, approach their allocations for nitrogen
or phosphorus, the Division will consider whether nutrient limits are necessary to protect water quality
at that time. In the event that nutrient limits become necessary, the limits would equal your facility's
discharge allocations.
Nutrient TradinZ. The rule provides that, when one utility connects to another, the allocations held by
the closing facility are transferred to the remaining facility. The rule also provides for the trading of
allocations among dischargers within each of the major Jordan subwatersheds. Be sure to consult with
the Divisions NPDES staff before you consider selling allocation: transactions can have profound
implications for your facility and its permit.
If you have any questions regarding these allocations, please contact me at [phone] or at
mike. [e-mail].
cc: Winston=Salem Regional Office
NDPES Files
Central Files
Sincerely,
Coleen H. Sullins
2

Mickey, Mike
From: Giorgino, John
Sent: Wednesday, February 15, 2012 3:31 PM
'To: Mickey, Mike
Subject: RE: Cornerstone Conference Center / NC0046809
Mike, yes. They passed their December test was compliant. Chronic value was >100.
John Giorgino
Environmental Biologist
North Carolina Division of Water Quality
Environmental Sciences Section
Aquatic Toxicology Unit
Mailing Address:
1621 MSC
Raleigh, NC 27699-1621
Office: 919 743-8441
Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Mickey, Mike
Sent: Wednesday, February 15, 2012 3:27 PM
To: Giorgino, John
Subject: RE: Cornerstone Conference Center / NC0046809
One more question. Did Cornerstone submit an AT-3 for a December 2011 test? They didn't put anything on their
December DMR. Thanks, Mike.
Mike Mickey
[e-mail]
NC Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
E-mail correspondence to and from this address maybe subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Giorgino, John
Sent: Tuesday, February 14, 2012 7:43 AM
To: Mickey, Mike
Cc: Moore, Cindy
Subject: RE: Cornerstone Conference Center / NC0046809

Hi Mike. Our unit never received a remission request from the facility. As a matter of fact, I made contact with the
facility on 1/24/12 and told Tommy McGee that we never received payment or a remission request within the 30 day
response window.
He told Cindy Moore that the lab took care of that. We said that we never received the remission request from the
facility or the lab and that they needed to show us some documentation that is was mailed. We also said that the
remission request was the responsibility of the facility, not the lab. They (lab) could not produce any documentation
that it was ever mailed, or copies of the request. Mr. McGee then said that he would go ahead and pay the fine.
I suspect that the fine was paid. I also suspect that some sort of request was mailed down, and we never saw it??
There often is a huge disconnect between our unit and downtown, which is VERY frustrating for us. Please call me or
Cindy for further clarification. Sorry about the mess Mike!
-John
John Giorgino
Environmental Biologist
North Carolina Division of Water Quality
Environmental Sciences Section
Aquatic Toxicology Unit
Mailing Address:
1621 MSC
Raleigh, NC 27699-1621
Office: 919 743-8441
Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Mickey, Mike
Sent: Monday, February 13, 2012 3:07 PM
To: Giorgino, John
Subject: Cornerstone Conference Center / NCO046809
Hi John — I am inspecting the above facility (a.k.a. Pentecostal Holiness Church) on Wednesday. Noticed that they were
assessed back on June 16, 2011 by TX-2011-0006. BIMs has conflicting information as to whether they have paid (see
below). Can you let me know the status? Thanks, Mike.
The summary tab shows nothing paid:
Total Amount Due: 1$3069.26
Total Amount Paid:
Case Closed: i -----�
The Events tab shows payment received & remission requested & OAH petition filed on 7/22/11:

Mickey, Mike
From:
Giorgino, John
Sent:
Tuesday, February 14, 2012 7:43 AM
To:
Mickey, Mike
Cc:
Moore, Cindy
Subject:
RE: Cornerstone Conference Center / NC0046809
Hi Mike. Our unit never received a remission request from the facility. As a matter of fact, I made contact with the
facility on 1/24/12 and told Tommy McGee that we never received payment or a remission request within the 30 day
response window.
He told Cindy Moore that the lab took care of that. We said that we never received the remission request from the
facility or the lab and.that they needed to show us some documentation that is was mailed. We also said that the
remission request was the responsibility of the facility, not the lab. They (lab) could not produce any documentation
that it was ever mailed, or copies of the request. Mr. McGee then said that he would go ahead and pay the fine.
I suspect that the fine was paid. I also suspect that some sort of request was mailed down, and we never saw it??
There often is a huge disconnect between our unit and downtown, which is VERY frustrating for us. Please call me or
Cindy for further clarification. Sorry about the mess Mike!
-John
John Giorgino
Environmental Biologist
North Carolina Division of Water Quality
Environmental Sciences Section
Aquatic Toxicology Unit
Mailing Address:
1621 MSC
Raleigh, NC 27699-1621
Office: 919 743-8441
Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Mickey, Mike
Sent: Monday, February 13, 2012 3:07 PM
To: G!orgino, John
Subject: Cornerstone Conference Center / NC0046809
Hi John — I am inspecting the above facility (a.k.a. Pentecostal Holiness Church) on Wednesday. Noticed that they were
assessed back on June 16, 2011 by TX-2011-0006. BIMs has conflicting information as to whether they have paid (see
below). Can you let me know the status? Thanks, Mike.
The summary tab shows nothing paid:

,� .-- J---- Total Amount Due: 1$3069.26
i
Total Amount Paid:
Case Closed:
{--- -- — — — -- - --- — --_ _ --- — —_
The Events tab shows payment received & remission requested & OAH petition filed on 7/22/11:
Payment received a7i22/2o11 I
Remission request received 07/22f2011
Petition filed at OAH 10 7122/2011
Mike Mickey
[e-mail]
NC Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
E-mail correspondence to and from this address maybe subject to the North
Carolina Public Records Law and may be disclosed to third parties. .

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
January 31, 2012
CERTIFIED MAIL: 7007 0220 00014482 1503
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION: NOV-2012-TX-0006
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Dee Freeman
Secretary
N.C.Dept. ofENR
FEB 63 2012
Winston-Salem
This is to inform you that a review of your toxicity self -monitoring report form for the month of November 2011 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
a -4 0­- 4 "
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: sC-orey.BasinQec/�Wirist: Salem Re��onal;Offioe
Jenifer Carter/ Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
\ Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone]
Internet http://h2o.enr.state.nc.uslesb/
An Equal Opportunity 1 Affirmative Action Employer
NorthCarohna
Xrturall,f

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must provide
written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submittine your toxicity test
results certified mail. return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone]
Internet http:i/h2o.enr.state.nc.us/esb/
NoIlfthCarolina
Natura!!if
An Equal Opportunity 1 Affirmative Action Employer

4
NC®ENR
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
December 21, 2011
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO046809
Cornerstone Conference and Resource Center WWTP
Guilford County
.Dear Mr Gaines:
Resources
Dee Freeman
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for September
2011 showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Fecal Coliform
9/07/11
400 #/100ml
>1,080 #/100m1
Daily Maximum Exceeded
Parameter
Date
Measuring Frequency
# of Violations
Dissolved Oxygen
8/29 — 9/02
Weekly
1
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem. Please note that the above monitoring omission is considered a repeat violation since Notice of
Violation letters were issued by this office for dissolved oxygen omissions in the August 2011 DMR,
dissolved oxygen omissions in the July 2011 DMR, a oil & grease omission in the December 2010 DMR
and for oil & grease and MBAS omissions in the November 2011 DMR. The next monitoring violation
will result in a civil penalty assessment by this office.
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
orthCarolina
,.I aturally
An Equal Opportunity 1 Affirmative Action Employer

December 21, 2011
Page # 2
Im
If you should have any questions, please do not hesitate to contact Mike Mickey at [phone].
Sincerely, e.
W. Corey Basinger
Regional Water Quality Supervisor
Winston-Salem Region
Surface Water Protection Section
cc: Central Files - SWP
al_

Y
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
C S��
Facility PemiitfPipe No.:VLT& MonthY
ear
Parameter
thly Average Violations
DMR Value
Weekly/Daily Violations
% Over Limit
Date Paramet r Pe mvt L'unitlTvpe DMR Value % Over L �mit .
Monitoring Frequency Violations
Date Parameter Permit Fre uencv Values Reported # of Violations
O her Violations
Completed Date:
Comp y•
Regional Water Quality Date: A &2-D I -
Supervisor Signoff: —�
�� 17
PJ

EFFLUENT
rdinstc ,-SaIe:ai j
NPDES PERMIT-N0 _a [1C �CSUq DISCHARGE NO. 60 MONk
FACILITY NAME_pc-�-Ci7�F1(,L�►$ CLASS_ CO[J
CERTIFIED LABORATORY (1) -�1� �It -�'�Y CERTIFICATION N0.
(list additional laboratories on the backside/page 2 of this fo
OPERATOR IN RESPONSIBLE CHARGE (ORC) 'tAg'c, �,y, IyRpli-r- GRADE —J- CERTIFICATI(�
PERSON(S) COLLECTING SAMPLES MAfkG , Wio c—L ORC PHONE ONtNO.�
336' . - Q
CHECK BOX IF ORC HAS CHANGED NO FLOW / DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES 1
l
DIVISION OF WATER QUALITY x'T
(SIGNATURE OF'OPERATO IN R E S P 0 SIBLE f
1617 MAIT SERVICE CENTER
RALEIGH, NC 27699-1617
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ✓� 1 L
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DWQ Form MR-1 (11/04)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements f
(including weekly averages, if applicable) [2 . f
Compliant
All monitoringdata and sampling frequencies do NOT meet permit requirements
El
P g
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permttee 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
Permittee Address
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
Permittee (Please print or type)
Signature of Permittee*** Date
(Required unless submitted electronically)
Phone Number e-mail address Permit Expiration Date
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 [phone] or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

A4
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
December 21, 2011
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO046809
Cornerstone Conference and Resource Center WWTP-
Guilford County
Dear Mr Gaines:
Dee Freeman
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for August 2011
showed the following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Fecal Coliform
8/04/11
400 #/100ml
640 #/100m1
Daily Maximum Exceeded
Parameter
Date
Measuring Frequency
# of Violations
Dissolved Oxygen
8/01— 8/05
Weekly
1
Dissolved Oxygen
8/08 — 8/12
Weekly
1
Dissolved Oxygen 1
8/15 — 8/19
Weekly
1
Dissolved Oxygen
8/22 — 8/26
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.
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
NorthCarolina
�atZlydi,Il f

December 20, 2011
Page #2
If you should have any questions, please do not hesitate to contact Mike Mickey at [phone].
Sincerely,
W. Corey Basinger
Regional Water Quality Supervisor
Winston-Salem Region
Surface Water Protection Section
cc: Central Files - SWP
USAID

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
C ��ta ��\- Permit/Pipe No.: �b�0 Month/Year
Facilityosvas�
Monthly Average Violations
Parameter Permit Limit DMR Value
Weekly/Daily Violations
% Over Limit
Date Par�eter.
Permit Limit/Tvpe DMR Value % OverbLimit
Monitoring Frequency Violations
Date Parameter Permues Re
Permit Freauencv Valported # of Violations
Completed by: � A �'
Date:
Regional Water Quality Date: (etT)� L�
Supervisor Signoff:
�

EFFLUENT
NPDES PERMIT NO. .w4y,4agmu �' n,E- L. '
�' DISCHARGE N0. �L ���. -
.�_ MONTH �;�� . `., � '
M. _..,.._..-b.s
FACILITY NAME Eva ckAooc R CLASSY COUNTY (a-QJLFDZS
CERTIFIED LABORATORY (1) �-'1Ti �a 're:SC
(`' " CERTIFICATION NO.- I (Q 5
(list additional laboratories on the backside/page 2 of this form)
!( tR:,
OPERATOR IN RESPONSIBLE CHARGE (ORC)_'ilaf.[, �9, �iA.L� GRADE CERTIFICATION NO.
PERSON(S) COLLECTING SAMPLES MARL `, ►uAo r-i- ORC PHONE 3yG' . ,Cj 7J,? i
CHECK BOX IF ORC HAS CHANGED NO FLOW / DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to:v
- G
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER ' R (� SI� by I HIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 m 6 1 (ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DWQ Form MR-1 (11/04)

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 pernrit requirements
Noncompliant
The pemuttee 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
pemrittee 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 qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed 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."
/n ARC W IN fqyLT
Permittee (Please print or type)
/ Z) � --3,) - i
Signature 6f Permittee*** Date
(Required unless submitted electronically)
Permittee Address Phone Number e-mail address Permit Expiration 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 [phone] or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

4
NC®ER
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
October 17, 2011
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150.
Browns Summit, NC 27214-0150
Subject: NOTICE OF VIOLATION
NPDES Permit No. NCO046809
Cornerstone Conference and Resource Center WWTP
Guilford County
Dear Mr. Gaines:
Dee Freeman
Secretary
A review of the Cornerstone Conference and Resource Center WWTP monitoring report for July 2011 .
showed the following violations:
Parameter
July Dates
Measuring Frequency
Violations
D.O.
4-8, 11-15, 18-22, 25-29
Weekly
4 (omitted parameter values)
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].
Sincerely,
W. Corey Basinger
Regional Water Quality Supervisor
Surface Water Protection Section
cc: Central Files - SWP
WSR« .
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
Noy-thCarolina
An Equal Opportunity l Affirmative Action Employer

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
f � �
Facility: ���u�c� PernutlPipe No.:
nthly Average Violations
Parameter Per Li ' DMR Value
Date Parameter
kly/Daily Violations
Month/Year 10
it/Tvpe DMR Value
Monitoring Frequency Violations
Date
Parameter
Permit Frequency
Values Reported
%
Ak)
Other Violations
% Over Limit
% Over Limit
# of Violations
1
1
Completed by: Date:
Regional Water Quality
Supervisor Signoff: •%� Date:
s �

MV N.C.
heat. of E N R
EFFLUENT
Wkl�:t-.Jj-,s rn
Ro q i Q; I
NPDES PERMIT NO. W-4ma-Gad-4
DISCHARGE NO. 1001 MONTH
FACILITY NAME CLASS COUNTY GA)JLVQ1Zb
CERTIFIED LABORATORY(l)
CERTIFICATION NO. IGS
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (ORC)_Oftg!L,�,
A fl LT GRADE --.I- CERTIFICATION NO.
PERSON(S) COLLECTING SAMPLES MARE W.
h�ft C—t ORCPHONE '3316 —.9q I —a? 7 1
CHECK BOX IF ORC HAS CHANGED
NO FLOW/ DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
/j
ATTN: CENTRAL FILES
x
DIVISION OF WATER QUALITY
(SIGNATURE OF OPERATOR'P. SIBLE CHARGE) DATE
1617 MAIL. SERVICE CENTER
RALEIGH, NC 27699-1617
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
nt
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
q
6
50050 1 00010 00400 50060 00310 1 00610 00530 31616 1 00300 00600 00665 10u1SRP1k-1,,b1ZA%
FLOW w .4 w
az
ry z ftYR P M OVE
w EFF C., NAME AND I TIET OW
z Q :D
cn INFP
0
-E
0
Cz Z .5.
000 IX
M 0 5
0 L) -�t U
99 0 uv ;D z u
0 Q 9 -A disinfection to
mmmmmmmmmummommumm
Immm
-
A mo
jr4av
-, --)U-V
DWQ Form MR-1 (11/04)

RECEIVED
N.C. Deot. of ENR
NCDENR JUN 2 2 2011
North Carolina Department of Environment and Natural Resources Winston-Salem
Division of Water Quality Reglona off `e
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
,Tune 16, 2011
CERTIFIED MAIL: 7007 1490 0004 5533 5861
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGhee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
SUBJECT: Assessment of Civil Penalty for Violations of NC General Statute 143-215.1(a)(6) and NPDES
Permit No. NCO046809
Western NC Conference Center WWTP
Guilford County
TX-2011-0006
Dear Mr. McGhee:
This letter transmits a Civil Penalty assessment against Western NC Conference Center WWTP in the amount of
$ Ip L q - Z. ( ($ '3,0 o ' civil penalty + $ 9. enforcement costs).
This assessment is based upon the following facts. A review of the facility's toxicity self -monitoring data from April has
been conducted. The review has shown Western NC Conference Center WWTP to be in violation of the 31 % chronic
toxicity effluent discharge limitation found in NPDES Permit No. NC0046809. The facility's toxicity self -monitoring
reports for February through April 20.11 revealed the following effluent toxicity permit limit violations.
February 15,.2011 Fail (chronic P/F))
March 29, 2011 10.96 % (7 day chronic value) Non -Compliant
April 26, 2011 10.96 % (7 day chronic value) Non -Compliant
Based upon the above fact(s), I conclude as a matter of law that Western NC Conference Center WWTP violated the
terms, conditions or requirements of NPDES Permit No. NCO061182 and N.C.G.S. 1,43-215. 1 (a)(6) in the manner and
extent shown above. A civil penalty in accordance with the maximum established by N.C.G.S. 143-215.6A(a)(2), may be
assessed against a person who violates the terms, conditions or requirements of a permit required by N.C.G.S. 143-
215.1(a).
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http://h2o.enr.state.nc.us/esb/
Nne
ofthCarohna
An Equal Opportunity 1 Affirmative Action Employer

Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the Secretary
of the Department of Environment and Natural Resources and the Director of the Division of Water Quality, I, Cindy
Moore, Supervisor, Aquatic Toxicology Unit, hereby make the following civil penalty assessment against Western NC
Conference Center W WTP
$ _ _ `� 6 - For _� of violation(s) of G.S. 143-215.1(a)(6) and NPDES
Permit No. NC0046809, by discharging waste into the waters of the State in
violation of the facility's permit effluent limit for chronic toxicity for
February 15, 2011.
$ a D For —)---of 3 violation(s) of G.S. 143-215.1(a)(6) and NPDES
Permit No. NC0046809, by discharging waste into the waters of the State in
violation of the facility's permit effluent limit for chronic toxicity for March
29, 2011
For of —3-- violation(s) of G.S. 143-215.1(a)(6) and NPDES
Permit No. NC0046809, by discharging waste into the waters of the State in
violation of the facility's permit effluent limit for chronic toxicity for April
26, 2011.
6q,2 � Enforcement costs.
$ ' 0 lV 1 7 b TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact
and Conclusions of Law and the factors set forth at G.S. 143B-282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which The Environmental
Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hftp:/lh2o.enr.state.nc.us/esb/
One
NordiCarolina
An Equal Opportunity 1 Affirmative Action Employer

Within thirty days receipt of this notice, you must do one of the following:
Submit payment of the penalty:
Payment should be made directly to the Department of Environment and Natural Resources (do not include
waiver form). Payment of the penalty will not foreclose enforcement action for any continuing or new
violation(s).
Please submit payment to the attention of:
Point Source Branch
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
'OR
2. Submit a written request for remission or mitigation including a detailed justification for such request.
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained
in the civil penalty assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation
and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why
you believe the civil penalty should be remitted, and submit it to the Division of Water Quality at the address listed
below. In determining whether a remission request will be approved, the following factors shall be considered:
(1) one or more of the civil penalty assessment factors in G.S. 14313-282.1(b) were wrongfully
applied to the detriment of the petitioner;
(2) the violator promptly abated continuing environmental damage resulting from the violation;
(3) the violation was inadvertent or a result of an accident;
(4) the violator had been assessed civil penalties for any previous violations;
(5) payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of the Division of Water Quality will review your evidence and inform you of his decision in
the matter of your remission request. The response will provide details regarding the case status, directions for
payment, and provision for further appeal of the penalty to the Environmental Management Commission's Committee
on Civil Penalty Remissions (Committee). Please be advised that the Committee cannot consider information that
was not part of the original remission request considered by the Director. Therefore, it is very important that you
prepare a complete and thorough statement in support of your request for remission.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http:l/h2o.enr.state.nc.us/esb/
One
NorthCarol.ina
;Vatffrallil
An Equal Opportunity k, Affirmative Action Employer

In order to request remission, you must complete and submit the -enclosed "Request for Remission of Civil Penalties
Waiver of Right to an Administrative Hearing and Stipulation of Facts" form within thirty (30) days of receipt of this
notice. The Division of Water Quality also requests that you complete and submit the enclosed "Justification for
Remission Request." Both forms should be submitted to the following address:
Environmental Sciences Section
Division of Water Quality
1621 Mail Service Center
Raleigh, NC 27699-1621
File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an administrative
hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file the petition with
the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is considered filed when
it is received in the Office of Administrative Hearings during normal office hours. The Office of Administrative Hearings
accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m., except for official state holidays.
The original and one (1) copy of the petition must be filed with the Office of Administrative Hearings. The petition may
be faxed - provided the original and one copy of the document is received in the Office of Administrative Hearings within
five (5) business days following the faxed transmission. The mailing address for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Telephone [phone] Facsimile: [phone]
A copy of the petition must also be served on DENR as follows:
Ms. Mary Penny Thompson, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, NC 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal
date/time received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for
collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations
that occur after the review period of this assessment.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet http://h2o.enr.state.nc.uslesb/
NorthGarolina
NwIlAd if
An Equal Opportunity 1 Affirmative Action Employer

r
Please be advised that any continuing violation(s) may be the subject of a new enforcement action, including an additional
penalty. If you have any questions about this civil penalty assessment, please contact me at 919 743-8442 or Mr. John
Giorgino at 919-743-8441.
I
Date
ATTACHMENTS .,
aft°
Cindy Moore
Supervisor, Aquatic Toxicology Unit
cc:inston-Salem Regional Office w/attachments
Jenifer Carter- Winston-Salem Regional Office w/attachments
Point Source Branch File w/attachments
John Giorgino -Aquatic Toxicology Unit w/attachments
Central Files w/attachments
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] V Customer Service: 1-877-623-6748
Intemet: http://h2o.enr.state.nc.us/esb/
NaftirallY
NorthCarolina
An Equal Opportunity! Affirmative Action Employer

11
STATE OF NORTH CAROLINA
COUNTY OF GUILFORD
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
WESTERN NC CONFERENCE CENTER WWTP
NPDES PERMIT NO. NCO046809
FILE NO
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
TX-2011-0006
Having been assessed civil penalties totaling
forth in the assessment document of the Director of the Division of Water Quality dated
for violation(s) as set
, the undersigned, desiring to seek remission of the civil penalties, does hereby waive the right to an
administrative hearing in the above -stated matter and does stipulate that the facts are as alleged in the
assessment document. The undersigned further understands that all evidence presented in support of remission
of this civil penalty must be submitted to the Director of the Division of Water Quality within 30 days of receipt
of the notice of assessment. No new evidence in support of a remission request will be allowed after 30 days
from the receipt of the notice of assessment.
This the
day of
ADDRESS
TELEPHONE
2011.

JUSTIFICATION FOR REMISSION REQUEST
DWQ Case Number: TX-2011-0006 County: Guilford
Assessed Party: Western NC Conference Center WWTP
Permit No. (if applicable): NC0046809 Amount Assessed: $
Please use this form when requesting remission of this civil penalty. You must also complete the
"Request For Remission Waiver of Right to an Administrative Hearin, and Stipulation of
Facts" form to request remission of this civil penalty. You should attach any documents that
you believe support your request and are necessary for the Director to consider in evaluating
your request for remission. Please be aware that -a request for remission is limited to
consideration of the five factors listed below as they may relate to the reasonableness of the
amount of the civil penalty assessed. Requesting remission is not the proper procedure for
contesting whether the violation(s) occurred or the accuracy of any of the factual statements
contained in the civil penalty assessment document. Pursuant to N.C.G.S. § 143B-282.1(c),
remission of a civil penalty may be granted only when one or more of the following five factors
applies. Please check each factor that you believe applies to your case and provide a detailed
explanation, including copies of supporting documents, as to why the factor applies (attach
additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b)
were wrongfully applied to the detriment of the petitioner (the assessment factors are listed in
the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the
violation (i.e., explain the steps that you took to correct the violation and prevent future
occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain, why the
violation was unavoidable or something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penallyprevent payment for the remaining necessary
remedial actions (i. e., explain how payment of the civil penalty will prevent you from performing
the activities necessary to achieve compliance).
EXPLANATION:

' RECEIVED
�r N.C. Oeot. of ENR 1
NCDENR MAY 3 1 2011
North Carolina Department -of Environment and Natural Resources Winston-Salem
Division of Water Quality _ __ Regional CT ce
Beverly Eaves Perdue
Governor
CERTIFIED MAIL: 7007 1490 0004 5533 5755
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Coleen H. Sullins
Director
May 27, 2011
Subject: NOTICE OF VIOLATION: NOV-201 I-TX-0024
Effluent Toxicity 'Testing
NPDES Permit No. NCO046809
Western NC Conference Center WWTP
Guilford County
Dear Mr. McGee:
Dee Freeman
Secretary
This is to inform you that a review of your toxicity self -monitoring report form for the month of March 2011 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: t, atii ger/ Winston-Salem Regional Office
Jenifer Carter/ Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Il
1
1
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621 One
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607 NorthCarol.ina
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 f� /
Internet: http:llh2o.enr.state.nc.uslesb/ ;Vlatull"lif
An Equal Opportunity 5 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. if you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must provide
written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Intemet: hftp://h2o.enr.state.nc.uslesb/
One
NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer

TAPR
EIVED
t. of ENR
-�=-�-p�� 0 2011
CDM \ n-Salem
North Carolina Department of Environment and Natural Resources Regional office _ -
Beverly Eaves Perdue
Governor
CERTIFIED MAIL: 7007 1490 0004 5533 5656
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Division of Water Quality
Coleen H. Sullins
Director
April 19, 2011
Subject: NOTICE OF VIOLATION: NOV-2011-TX-0015
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Dee Freeman
Secretary
This is to inform you that a review of your toxicity self -monitoring report form for the month of February 2011 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
-Requirements. Please note appropriate mailing addresses for submitting your Discharge • Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
`rAA
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: 'Corey.$asing`erl Winston-Salem Regional Office
Jenifer Carter/ Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service:1-877-623-6748
Internet: http://h2o.enr.state.nc.uslesbl
Nne
orthCarolina
;Vahl all'l�
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
rrr auirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January I -June 30, then you must provide
written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The;_AT form must also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hflp://h2o.enr,state.nc.us/esb/
NonrthCarolina
Natta lly
An Equal Opportunity 1 Affirmative Action Employer

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Dee Freeman., Secretary
Beverly Eaves Perdue, Governor Coleen H. Sullins, Director
20 April 2011
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summit, NC 27214
SUBJECT: Notice of. Violation - Effluent Limitations
NOV-2011-MV-0084
Pentecostal Holiness Church WWTP
-NPDES No. NCO046809
Guilford County
Rev. McGhee:
Review of the self -monitoring report for the month of December 2010 revealed the following
monitoring frequency violation:
Parameter Permit Frequency
Oil/Grease Monthly
MBAS Monthly
Values Reported # of Violations
0 1
0 1
"This is the second consecutive month that the Oil/Grease samples were not collected. Any
future monitoring frequency violations will be subject to civil penalty assessment."
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
cc: Central Files-SWP, WSRO
Guilford County Health Dept WSRO
One 7
Winston-Salem Regional Office NOrthCa ollna
585 Waughtown Street, Winston-Salem, North Carolina 27107 Naturlally
Phone: [phone] Fax: [phone] Internet: www ncwaterauality.ora
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record q
Facility: � r 2.• Permit/Pipe No.: Be)/ Month/Year �
. Go".F— G6PIr "c2
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Tvne DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by:
1 Date:
Regional Water Quality
Supervisor Signoff: �� Date:
l�

Facility Status: (Please check one of the following)
21
All monitoring data and sampling frequencies meet per requirements 'Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ❑
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false. information, including the possibility of fines and imprisonment for knowing violations."
Pente os al Holiness Church
Permittee Pleas print or `ype) I
Signature of Permr ee** Date
(Required)
D.O. Box 150, Brown Summit
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen.
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
00720
Cyanide
00745
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
01037
Total Cobalt
01042
Copper
01045
Iron
01051
Lead
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730 Total Phenolics 81551 Xylene
34235 Benzene
34481 Toluene
38260 MBAS
39516 PCBs
50050 Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state nc.us/wgs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(2) (D)•

NPDES NO. NCO046809 DISCHARGE NO. 001 MONTH
FACILTY NAME Pentecostal Holiness Church COUNT' Guilford
STREAM Unnamed Tributary to Benaja Creek STREAM
LOCATION 100 ft. upstream from the outfall LOCATION
Upstream
00010
00400 1
50060
00300
31818 1
00685
xwEfuowafseoav
O
Z
LU
0
A
-j
�JL
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- ��%
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summit, NC 27214
SUBJECT: Notice of Violation - Effluent Limitations
NOV-2011-MV-0042
Pentecostal Holiness Church WW'TP
NPDES No. NCO046809
Guilford County
Rev. McGhee:
Dee Freeman., Secretary
Coleen H. Sullins, Director
14 February 2011.
Review of the self -monitoring report for the month of November 2010 revealed the following
monitoring frequency violation:
Parameter Permit Frequency Values Reported
Oil/Grease Monthly 0
# of Violations
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection Section
cc: Central Files-SWP, WSRO
Guilford County Health Dept WSRO
Winston-Salem Regional Office One
585 Waughtown Street, Winston-Salem, North Carolina 27107 NorthCarolina
Phone: [phone] Fax: [phone] Internet: www.ncwaterouality.org NatumlIff
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Pounr,'5ra-- ("a.;—Permut/Pipe No.: M'-'zD &9z>2 Month/Year lV5�,,/Z,::214
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekly/Daily Violations
Date Parameter Permit Limit/Type DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
\l o U l /Sri! s1J 5�' N Gz C-0 i
Other Violations
Completed by: Date:
Regional Water Quality ,
Supervisor Signoff: Date: f�1—%3
2v MV.r 05-L,-

a°®
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H, Sullins Dee Freeman
Governor Director Secretary
February 2, 2011
Mr. Darrell Gaines
Western NC Conference Center
P.O. Box 150
Browns Summit, N.C. 27214-0150
Subject: Draft NPDES Permit NCO046809
Cornerstone Conference and Resource Center
Class WW-2
Guilford County
Dear Mr. Gaines:
The Division has reviewed your request [made on behalf of the Permittee] to renew the subject permit.
Please review this draft carefully to ensure your thorough understanding of the information, conditions, and
requirements it contains.
The draft permit includes the following significant changes from the existing permit:
➢ The receiving stream class has changed to WS-V NSW.
➢ The revised total residual chlorine (TRC) compliance level has been added to outfall 001.
i Parameter codes have been added to section A. (1) to simplify DMR data entry.
With this notification, the Division will solicit public comment on this draft permit by publishing a notice in
newspapers having circulation in the general Guilford County area, per EPA requirements. Please provide
your comments, if any, to me no later than 30 days after receiving this draft permit.
Following the 30-day public comment period, the Division will review all pertinent comments and take
appropriate action prior to issuing a final permit. If you have questions concerning the draft, please contact
me at the telephone number or e-mail address listed at the bottom of this page.
Sincerely,
VOW
Charles H. Weaver, Jr.
NPDES Upit
cc: NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www,ncwaterquality.org
charles,weaver@ncdenr,gov
;Vwurally
Nne
orthCarolina
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Permit NCO046809
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
iMMUTIN9
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended, the
Western North Carolina Conference Center
is hereby authorized to discharge wastewater from a facility located at the
Cornerstone Conference and Resource Center WWTP
7545 U. S. Highway 29 North
Browns Summit
Guilford County
to receiving waters designated as an unnamed tributary to Benaja Creek in
subbasin 03-06-01 of the Cape Fear River Basin in accordance with effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV hereof.
This permit shall become effective
This permit and authorization to discharge shall expire at midnight on April 30, 2016.
Signed this day
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0046809
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDLS Permits issued to this facility, whether for operation or discharge are hereby revoked.
As of this permit issuance, any previously issued permit bearing this number is no longer effective.
Therefore, the exclusive authority to operate and discharge from this facility arises under the permit
conditions, requirements, terms, and provisions included herein.
The Western North Carolina Conference Center is hereby authorized to:
1. Continue to operate an existing 0.02 MGD wastewater treat ment facility with the
following components:
♦ Splitter box
♦ Bar screen
♦ Dual parallel aeration tanks
♦ Dual parallel clarifiers
♦ Dual tertiary filters
♦ Chlorine contact chamber with tablet chlorination
♦ Tablet dechlorination
♦ Sludge digester
This facility is located off U.S. Highway 29 North northeast of Browns Summit at
the Cornerstone Conference and Resource Center WWTP in Guilford County.
2. Discharge from said treatment works at the location specified on the attached
map into an unnamed tributary to Benaja Creek, currently classified WS-V NSW
waters in hydrologic unit 03030002 of the Cape Fear River Basin.

Permit NC0046809
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
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:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[PCS Code]
Monthly
Daily
Measurement
Sample Type
Sample Locations
Average
Maximum
Frequency
Flow
0.02 MGD
Weekly
Instantaneous
Influent or Effluent
[50050]
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
[C0310
Total Suspended Solids
30.0 mg/L
45,0 mg/L
Weekly
Grab
Effluent
[C0530
NH3 as N
2/Month
Grab
Effluent
C0610]
Dissolved Oxygen
Weekly
Grab
Effluent,
00300
U & D
Fecal Coliform (geometric mean)
200 / 100 ml
400 / 100 ml
Weekly
Grab
Effluent
31616
Fecal Coliform (geometric mean)
Weekly
Grab
U & %
31616]
Total Residual Chlorine2
28 µg/L
I eek7
Grab
Effluent
150060]
Temperature (°C)
Weekly
Grab
Effluent,
00010]
U & D
Oil and Grease
Monthly
Grab
Effluent
[00556]
MBAS
Monthly
Grab
Effluent
38260
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Grab
Effluent
C0600]
Total Phosphorus
Quarterly
Grab
Effluent
C06651
pH
00400
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Chronic Toxicity3
Quarterly
Grab
Effluent
[TGP3B
Footnotes:
1. U: at least 100 feet upstream from the outfall. D: at least 100 feet downstream from the outfall.
2. The Permittee shall report all effluent TRC values reported by a NC -certified laboratory [including
field -certified]. Effluent values below 50 µg/L will be treated as zero for compliance purposes.
3. Chronic Toxicity (Ceriodaphnia) P/F at 31%: February, May, August & November (see A. (2.)).
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NCO046809
A. (2) CHRONIC TOXICITY PERMIT LIMIT (Quarterly)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to
Ceriodaphnia dlebia at an effluent concentration of 31%
Tlie permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the "North
Carolina Cefiodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent versions or
"North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or
subsequent versions. The tests will be performed during the 7yonlbs of February, May, August & November. Effluent
sampling for this testing shall be performed at the NPDES permitted final effluent discharge below all treatment
processes.
If the test procedure performed as the first test.of any single quarter results in a failure or ChV below the permit
limit, then multiple -concentration testing shall be performed at a minimum, in each of the two following months as
described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998)
or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the highest
concentration having no detectable impairment of reproduction or survival and the lowest concentration that does
have a detectable impairment of reproduction or survival. The definition of "detectable impairment," collection
methods, exposure regimes, and further statistical methods are specified in the "North Carolina Phase II Chronic
Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions,
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge
Monitoring Form (MR-1) for the months in which tests were performed, using the parameter code TGP3B for the
pass/fail results and TI-IP3B for the Chronic Value. Additionally, DWQ Form AT-3 (original) is to be sent to the
following address:
NC DENR / DWQ / Environmental Sciences Branch
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic ToxicityTest Forms shall be filed with the Environmental Sciences Branch no later than 30
days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all
concentration/response data, and be certified by laboratory supeivisor and ORC or approved designate signature.
Total residual chlorine of the effluent toxicity, sample must be measured and reported if chlorine is employed for
disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required, the
permittee will complete the information located at the top of the aquatic toxicity (AT) test form indicating the
facility name, permit number, pipe number, county, and the month/year of the report with the notation of "No
Flow" in the comment area of the form. The report shall be submitted to the Environmental Sciences Branch at the
address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required, monitoring will be
required during the following month.
Should any test data from this monitoring requirement or tests performed by the North Carolina Division of Water
Qualit, indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include
alternate monitoring requirements or limits.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism
survival, minimum control organism reproduction,' and appropriate environmental controls, shall constitute an
invalid test and will require immediate follow-up testing to be completed no later than the last day of the month
following the month of the initial monitoring.

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
frill Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Perm it Writer/Date
Charles 1-1. Weaver — 1 /27/201 1
Permit Number
NC0046809
Facility Name
Western NC Conference Center WWTP
Basin Name/Sub-basin number
Cape Fear / 03-06-01
Receiving Stream
An unnamed tributary to Benaja Creek
Stream Classification in Permit
WS-V NSW
Does permit need Daily Maximum NH3 limits?
N/A
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
Yes .
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No
Any permit mods since lastpermit?
No
New expiration date
4/30/2016
Comments received on Draft Permit?
Most Commonly Used Expedited Language:
0 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is,a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".
® TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"The facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values below 50 µg/l will be treated as zero
for compliance purposes."

NCO046809
Cornerstone Conference and Resource Center WWTP Facility
Location
Latitude: 36' 13' 45" N USGS Quad: Brownsville, N.C.
Lonaitude: 79° 41' 29" W Permitted Flow: 0.02 MGD
Hydrologic Unit: 03030002 Stream Class: WS-V NSW (�//1 Guilford County
Receiving Stream: UT Benaja Creek Sub -Basin: 03-06-01 "3Offid Map not to scale

8
North Carolina Department of Environment and Natural Resou
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
November 3, 2010
DARRELL GAINES
OFFICE MANAGER
CORNERSTONE CONFERENCE AND RESOURCE CENTER
PO BOY 150
BROWNS SUMMIT NC 27214
Dear Mr. Gaines:
v(tk(C IVED
N.C. D ot. of Er F
n 8 2010
Winston -Sale,
Regional Office
Dee Freeman
Secretary
Subject: Receipt of permit renewal application
NPDES Permit NCO046809
Western NC Conference Center WWTP
Guilford County
The NPDES Unit received your permit renewal application on October 29, 2010. 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 Jeff Poupart at
[phone].
Sincerely,
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
mains oi. _`aaleraa Rre&1�4ff/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] \ FAX: 91 M07-6492 \ Customer Service:1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer
NorthCarolina
atur ff

jt on,, e:r�tone
ay_ Con erence and ,esouYce: Center
International Pentecostal Holiness Church
October 28, 2010
N.C. DENR/Division of Water Quality
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Mailing Address:
PO Box 150
Browns Summit, NC 27214
"Eareipping l br ExceIle nce JrF Iffiris r)-v
Enclosed you will find our request for renewal of our NPDES wastewater discharge permit. The
only addition to the Waste Water Treatment Plant since issuance of the last permit was a tablet
dechlorinator installed after the chlorine contact chamber. If you have any other questions
concerning this please feel free to call me at 336-656-7936 ext 121 or you may email me at
dgaineskccrdc.org.
Blessings,
Darrell Gaines
Office Manager
L Cl 2, Z010
TY
D�ivF2-sF�°i'€' D�1nNs N
7545 Highway 29
Browns Summit, NC 27214
Phone [phone] - Fax [phone]

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 0600 4 b Q q
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 W-04.c, n N OV-4, LVD Coy4yw u C y.�
Facility Name WtALV^ Afar-d-, (' ��, l;yv_ z� �u �3. v /G'i►►�l�
Mailing Address Po ISO x
City �Y'0 % . -q S �a. .,► •-!-
State / Zip Code N(- a -I - l �i
Telephone Number (33 6) u - u -- '1 GI '3 to
Fax Number ow :.LO`"-le 95'5 '!I.
e-mail Address 66 � � L reC C , G rg
2. Location of facility producing discharge:
Check here if same address as above 5'
Street Address or State Road 9 S Li-� LA-5 H W U
City P"" wr' , Vern,+-► + -4 t
State / Zip Code
County
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name �S �(,uV1 Na%;;�
Mailing Address p.D 6 ox 1 �-
city
State / Zip Code
Telephone Number
Fax Number (3i (0) (t,S io- ')5 •S Li
187
OCT
1 of 3 - ._. _... a __k.._.. +w�h i 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
E
Commercial
Residential
❑
School
❑
Other
❑
Number of Employees
Number of Employees
Number of Homes
Number of Students/Staff
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): �� �I'L11--
\ (C'4t Q"(,Z CeAe_(
Population served:,-4�-�+-)
S. Type of collection system
Separate (sanitary sewer only)
6. Outfall Information:
❑ Combined (storm sewer and sanitary sewer)
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes L^ No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall).
Ueek
8. Frequency of Discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
6p� h �_t ' &0X
Gina- 1trS 51U���
2 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0 , ® OL MGD
Annual Average daily flow 0 000 9 - MGD (for the previous 3 years)
Maximum daily flow 0 o 0 1 O MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes .K 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)
3 Qj ,-7
M0> I lL
Fecal Coliform --
6CD
c
C 0 0
Total Suspended Solids
L
Temperature (Summer)
. -]
_43t a
a C_
Temperature (Winter)
1J
)
® C.
pH
6
su
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NESHAPS (CAA)
Ocean Dumping (MPRSA)
jV L DOL4 � 6 09 Dredge or fill (Section 404 or CWA)
Other
14. APPLICANT CERTIFICATION
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
u
Printed name of Person Signing
of Applicant
Title
Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3 of 3 Form-D 05/08

i
Western NC Conference Center
Pentecostal Holiness Church WWTP
Latitude: 360 13' 45" N State Grid: Brownsville
Loneitude: 79° 4l' 29" W Permitted Flow: 0.02 MGD
Receivina Stream: UT Benaja Creek Draina¢e Basin: Cape Fear River Basin
Stream Class: C-NSW Sub -Basin: 03-06-01
Facility
Location
not to scale
NPDES Permit No. NCO046809
North I Guilford County

:ucornmt.one
���.. Con f erence� ands �;esource Center
International Pentecostal Holiness Church
MEMO
October 28, 2010
To: N.C. DENR/Division of Water Quality
NPDES Unit
From: Darrell Gaines, Office Manager
RE: Sludge Management Plan
Mailing Address:
PO Box '150
Browns Summit, NC 27214
"Equipping For Excellence In Ifinistrn,
Sludge is wasted into the digestor by the operator as needed. Once the digestor has reached its
capacity the operator calls a septic hauling company (currently Billingsly Septic in Reidsville,
NC), to remove and dispose of the waste sludge. The amount of sludge removed is recorded and
the billing and receipts for the hauling are kept in the main office.
Blessings,
Darrell Gaines
Office Manager
7545 Highway 29
Browns Summit, NC 27214
Phone [phone] o Fax [phone]

AIL.
NCDENR
North Carolina Department of Environment and Natural
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
October26, 2010
CERTIFIED MAIL: 7002 3150 0003 7052 3835
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal I-[oliness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Resource
RECEIVED
N 17. nnnt. of Eh'
OCT 2 9 2010
Pa^
Dee Freeman
Secretary
This is to inform you that a review ofyour toxicity self -monitoring report form for the month of August 2010 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
rc
j
1
Cindy A. Moore I'
CGSupervisor, Aquatic Toxicology Unit
cc: S�tevc-, ^ er/ inston-Salem Regional Office
J ntfer Carter/ Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607.
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http:/lh2o.enr.state.nc.uslesb/
One
Nort%Carohna
atul'allill
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
_reequirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requitement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg..January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January I -June 30, then you must provide
written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form mustaalso be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
,Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hap://h2o.enr.state.nc.us/esb/
One
NorthCarol.ina
Naturally
An Eoua! Opportunity'+Affirmative Action Employer

All
MCDENR
North Carolina Department of Environment and
Beverly Eaves Perdue
Governor
CERTIFIED MAIL: 7002 3150 0003 7052 3743
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent "Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Division of Water Quality
Coleen H. Sullins
Director
September 29, 2010
Natural Resources
RECEIVED
N.C. Deot.of F^1,
OCT 0 4 2010
1'dinsicn�,,,
Region'): C -
Dee Freeman
Secretary
This is to inform you that a review ofyour toxicity self -monitoring report form for the month of.luly 2010 indicates a violation of' the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting aToxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Alonitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
GA f III �
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: Ste od r ins, n-Salem Regional Office
niferyCarter/ nston-Salem Regional Office
AA�ti 5cology Unit
.entral Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road. Raleigh. North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http:dh2o.enr.state.nc.usles1b/
One
NorthCarolina
Naturallff
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in vour NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
.John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual ree uirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, .January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must provide
written notification to the Environmental Sciences Section by .tune 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top ofthe AT form indicating the facility name, permit number. pipe number. county and the month/year of the subject report.
You should also write "Ni o Plow-- on the AT form. sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor. ?Pr
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Avail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh. North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http://h2o.enr.state.nc.us/esb/
One
NorthCarol.ina
autrally
An Equal Opportunity'. Affirmative Action Employer

Beverly Eaves Perdue
Governor
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
September 23, 2010
RECEIVED
CERTIFIED MAIL RETURN 7009-1680-0002-2464-7804 N.C. Deot. or c1 11
RECEIPT REQUESTED SEP 2 7 2010
Winston-s_ ,
Mr. Thomas H. McGee Reaicnal 04`•ce
Pentecostal Holiness Church --
P.O. Box 150
Browns Summit, North Carolina 27214
Dear Mr. McGee:
Dee Freeman
Secretary
Subject: NOTICE OF VIOLATION
Western NC Conference Center WWTP
NPDES Permit NCO046809
Guilford County
NOV-2010-LR-0062
This is to inform you that the Division of Water Quality did not received your monthly monitoring report
for June 2010 until August 24. Also, the July 2010 report was not received until September 20, 2010.
This is in violation of Part II, condition D(2) of the NPDES permit, as well as 15A NCAC 2B .506(a),
which requires the submittal of Discharge Monitoring Reports no later than the last calendar day
followingthe he reporting -period. Failure to submit reports as required will subject the violator to the
assessment of a civil penalty of up to $25,000 per violation.
Additionally, this letter provides notice that this office will recommend the assessment of civil penalties if
future reports are not received within the required time frame during the next twelve (12) reporting
months. The Division must take these steps because timely submittal of discharge monitoring reports is
essential to the efficient operation of our water quality programs. We appreciate your assistance in this
matter. If you have any questions about this letter or discharge monitoring reports, please contact me at
919-807-6388.
Sincerely,
Maureen Scardina
cc: Maureen Scardina, NPDES Unit
✓D- WQ Winston-Salem Regional Office Supervisor, Surface Water Protection
Central Files
-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 NofthCarolina
Internet: http://portal.ncdenr.org/web/wq/home Aah rallY
An Equal Opportunity 1 Affirmafive Action Employer 6 `L

NorthCarolina-•. of • and Natul
Beverly Eaves Perdue
Governor
CERTIFIED MAIL: 7006 2760 0001 9282 0839
RETURN RECEIPT REQUESTED
Mr. Thomas 1-1. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
flit `.�NC0,04�,
:zsternaN:Ct.Con�fec`enc_e`RC;enter �W W�!1_�1
Guilford County
Dear Mr. McGee:
Division of Water Quality
Coleen H, Sullins
Director
July 23, 2010
r"
JUL L 9 LUIU .I
'Winstcn-Salem
Resources Rc'icnei ° 1Ce
Dee Freeman
Secretary
This is to inform you that a review of your toxicity self -monitoring report form for the month of May 2010 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identity the causative agents of effluent toxicity.
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DAr/Rs) and Aquatic Toxicity (AT)
Test Farms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
r �eW
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: S evee±7ed�der/ Winston-Salem Regional Office
Jenifer Carter/ Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http://h2o.enr.state.nc.us/esb/
One
NortllCarolina
N%turallil
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
.John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, .June, September, and December, then toxicity testing must
be conducted during these months).
➢ Ifyour NPDES Permit specifies episodic monitoring and your facility does nothave a discharge from January 1-.June 30, then you must provide
written notification to the Environmental Sciences Section by .tune 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT f6i3ritrriust also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road. Raleigh. North Carolina 27607
Phone: [phone] FAX: [phone] i Customer Service: 1.877-623-6748
internet. http11h2o.enr state.nauslesbr
One
NorthCarolina
Crtlmally
An EqUal+Cropor:unify' Atiirmatnro.4c;or: Erncoyer

foo
NCDEHR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
CERTIFIED MAIL: 7006 2760 0001 9282 0839
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit- North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Division of Water Quality
Coleen H. Sullins
Director
July 23, 2010
K zc,cl�,co
ir D- _f F'dr'•
'A"nston -5aIe-
Regional 0-ice
Dee Freeman
Secretary
This is to inform you that a review of your toxicity self -monitoring report form for the month of May 2010 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity.
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: St e Tedder/ Winsto -Salem Regional Office
?Jei6ri@a�r/ Wi on -Salem Regional Office ��y r�t�
Aquatic To,' ogy Unit II
Cen Iles
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http://h2o.enr.state.nc.us/esb/
One
NordiCarol..ina
Naftillrallil
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
.John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The oermittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh. NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must he submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, .tune, September, and December, then toxicity testing must
be conducted.during these months).
➢ Ifyour NPDES Permit specifies episodic monitoring and your facility does not have a discharge from .January 1-June 30, then you must provide
written notification to the Environmental Sciences Section by .tune 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor. ,
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road. Raleigh. North Carolina 27607
Phone. [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http:iih2o.enr.siate.nc.usfesbf
NorthCarolina
%till°ally
Au. Equa! 0DOOrt nfly ` ;tiirrigtive ActiCf t mployer

A*
CDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
18 June 2010
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summit, NC 27214
SUBJECT: Notice of Violation - Effluent Limitations
NOV-2010-LV-0217
Pentecostal Holiness Church WWTP
NPDES No. NCO046809
Guilford County
Rev. McGhee:
Dee Freeman
Secretary
Review of the self -monitoring report for the month of March 2010 revealed the following daily
maximum effluent limit violations:
Date Parameter Permit Limit Reported Value Units
3/9 Fecal Coliform 400 480 #/100mL
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Supervisor
cc: Central Files-SW,�W�S{" O
Guilford County Health Dept WSRO
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughlown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www ricwaterquality.org
An -qua[ Oppo;lunity, 1 Affirmative Action Employer
One
NorthCarolina
,.Yat lrallly

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record Al
Facility: SQL Permit/Pipe No.: Month/1'ear PP���
Monthly Average Violations
Parameter Permit Limit DMR Value % Over Limit
Weekl aily ,olations
Date Parameter Permit Limit/Tvpe DMR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequency Values Reported # of Violations
Other Violations
Completed by: Date:
Regional Water Quality
Supervisor Signoff: Date: (0

RECEIVED f
4
t
N.C. Deot. of ENR
EFFL ENT J U N 0 12010
NPDES PERMIT NO. NC 0 0 4 6 8 0 9
FACILITY NAME Pentecostal
MONTH A ch 'a.OIo
DISCHARGE NO. 001 winst11 o
OPERATOR IN RESPONSIBLE CHARGE
Holiness Church
(ORC)Pa tri ck M _rri ttASSGRADEIOI� PHONE [phone]
CERTIFIED LABORATORIES(1) Meritech
CHECK BOX IF ORC HAS CHANGED
Inc (2)
® PER
OLLE TING SAMPLES Patrick N ritt
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
II 11
DIVISION OF WATER QUALITY
X
1617 MAIL SERVICE CENTER
(SIGNATURE O OPER OR IN RESPONSIBLE CHARGE) DATE
RALEIGH, NC 27699-1617
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS MAY 2010
ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWi.Fnr.F
DWQ Form MR-1 (01/00)

0
Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for.improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Pe tec stal Holiness Church
Permittee (Pease print or type)
'-I�auIto
Signna e of mittee** Date
(Required)
D.O. Box 150, Brown Summit, NC 27214 [phone]
Permittee Address Phone Number Permit Exp. Date
PARAAMTER CODES
00010
Temperature
00556
Oil & Grease
00951
Total Fluoride
01067
Nickel
50060 Total
00076
Turbidity
00600
Total Nitrogen
01002
Total Arsenic
01077
Silver
Residual
00080
Color (Pt -Co)
00610
Ammonia Nitrogen
01092
Zinc
Chlorine
00082
Color (ADMI)
00625
Total Kjeldhal
01027
Cadmium
01105
Aluminum
Nitrogen
00095
Conductivity
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01147
Total Selenium
71880 Formaldehyde
00300
Dissolved Oxygen.
01034
Chromium
31616
Fecal Coliform
71900 Mercury
00310
BOD5
00665
Total Phosphorous
32730
Total Phenolics
81551 Xylene
00340
COD
00720
Cyanide
01037
Total Cobalt
34235
Benzene
00400
pH
00745
Total Sulfide
01042
Copper
34481
Toluene
00530
Total Suspended "
00927
Total Magnesium
01045
Iron
38260
MBAS
Residue
00929
Total Sodium
01051
Lead
39516
PCBs
00545
Settleable Matter .00940
Total Chloride
01062
Molybdenum
50050
Flow
Parameter Code assistance
may obtained by calling the
Point
Source Compliance/Enforcement
Unit at [phone]
or by visiting
the Water Quality Section's
web site
at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
w",
=k ORC must visit facility and document visitation of facility as required per 15A NCAC�% .0
** If signed by other than the permittee, delegation of signatory authority must be oa file with�the state -per 15A NCAC 2B .0506 (b)
(2) (D).

I '2)0/ 0
NPDES NO. NCO046809 DISCHARGE NO. 001 MONTH YEAR 200•".
FACILTY NAME Pentecostal Holiness Church COUNT Guilford
STREAM Unnamed Tributary to Benaja Creek
LOCATION 100 ft. upstream from the outfall
Upstream
OF-571-MEEME
DEM Form MR-3 (12/93)
STREAM Unnamed tributary to Benaja Creek
LOCATION . 100 ft., downstream
Downstream
00010
00400
50M
00300
31616
00665
1
W
0:
W zOC
2.1
tu
O
0
1
2
W
0
U) �
U
IL
2 0
0
U) 0
'L 0
ul
I.-
MRS
'C
UNITS
UG/L
MG/L
#/IOOML
wNioYcm
P"
jj
3
1 1�O11'1,"'
K"
03ol
9
'7.co
)15
"j.
1390
13
Wo14
15
17
Cj
$
q
21
7--
,22
23
24
21
9"
m
77-
27
29
io
31
CA
AVERAGE
66
'R17
MAXIMUM
I
MINIMUM
v

0 1 110111.

{
..
RYA
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summit, NC 27214
Division of Water Quality
Coleen H. Sullins
Director
SUBJECT: Notice of Violation - Effluent Limitations
NOV-2010-LV-0061
Pentecostal Holiness Church WWTP
NPDES No. NCO046809
Guilford County
Rev. McGhee:
Dee Freeman
10 February 2010 Secretary
Review of the self -monitoring report for. the month of November 2009 revealed the following
monthly average and daily maximum effluent limit violations:
Parameter Permit Limit
Total Suspended Solids 30.0
Date Parameter Permit Limit
11/4 Total Suspended Solids 45.0
Reported Value Units
37.0 mg/L
Reported Value Units
67.0 mg/L
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely
Steve W. Tedder
Water Quality Supervisor
cc: Central Files-SWP, WSRO
Guilford County Health Dept WSRO
North Carolina Division of Water Quality, inston-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
011C
NorthCarolina
An Equal Opportunity \Affirmative Action Employer

DMR Review Record
Facility: YF,cicoSiLva2Permit/Pipe No.: //el3b865
Monthly Average Violations
Cover Sheet from
Staff Member to
Regional Supervisor
Month/Year Alb / 2,00 7
Parameter Permit Limit DMR Value % Over Limit
Date
li 4—
Date
Weekly/Daily Violations
Parameter Permit Lin-it/Type DMR Value % Over Limit
Monitoring Frequency Violations
Parameter Permit Frequency Values Reported # of Violations
Violations
Completed by:
J'UwA�t�-
Regional Water Quality
Supervisor SiQnoff:
Date: . 6 6,f, zo /0
Date: „ 2 1
Zero-LV-oo6E

g
EFFL NT
NPDES PERMIT NO. NC 0 0 4 6 8 0 9
DISCHARGE NO. 0 01
MONTH F\ � YEAR
FACILITYNAME Pentecostal
Holiness Church CLASS II COUNTY Guilford
OPERATOR IN RESPONSIBLE CHARGE(ORC)Patrick Merritt
GRADEII PHONE [phone]
CERTIFIED LABORATORIES (1) Meritech Inc. (2)
CHECK BOX IF ORC HAS CHANGED
®
PERSON(S) CO LEC NG SAMPLES Patrick Merritt
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
X i
I1
p
DIVISION OF WATER QUALITY
(SIGNATURE OF O ERA IN RESPONSIBLE CHARGE)" DATES
1617 MAIL SERVICE CENTER
1 r -•'
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS 1
RALEIGH, NC 27699-1617
��
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
JX9-
50050
00010
00400
5 0060
00310
00610
00530
31616
00300
00600
00665
t9
F
v
E
F
cv
FLOW
EFF
W
c4
w W
Q z
A
v
q
z
ENTER PARAMETER CODE ABOVE
W
L
U
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INF ❑
F]
�- ."
U
Ao
z C7
w W
a A
¢zgdO
a w 5_
w z
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NAME AND UNITS BELOW
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F" w�T"
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V)
U u
A
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a.
S2o
N.
❑ MG/L
Cl
HRS
HRS
Y/B/N
MGD
° C
UNITS
.� UG/L
MG/L
MG/L
MG/L
#/100ML
MG/L
MG/L
MG/L
:::.::.:.:.:.......:..............................:........:...........:.:.:..:.:.:.:.:.:.:.::.:.:.:.:.:.:.::.:.:.:.:.:.::::.::.:.:.:.::.:.:.:.:.:.:.::.:.:.:.:.:.:.::.:.:.:.:.:.:.::.:.:.:.:.:.:.:
2
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.:.:..:.:.:.::.:.:..::.:.:.:.:.:.::.:.:.:.::.:......:..:...:.:
.:•::•:...::•
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4
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..................:.:..........................:........:..............:...:.:.:..:.:.:.....:.:..:...:.:...:..........:.:.:.:.
6.1)
7
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o�.....................................................................................................................................................................................:.:.:.:.:.:.:..:.:.:.:.:.:.:.:.:.:.:.:.:.:..:.:.:.:.:.:.:.
14
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16
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18
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y
::::`'�.:::::.::::::::::::::::::::::::::::::::::::::::::::[::::::::::::::........�.............pia............I.........•.......................................................
:.:.:::.:.::.:..:.::::.
C1
Wit............
..............:::.:.:.:.:.:.::.:.:.:.:.:.:.:::.:.:.:.:.:.::.:.:.:.:.:.:.::
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
..:.....................:.:.:.:.:.:.:.
�.{a:.:.::.:.:.:.:.:.:.::.:.:.:.::.:.:
20ato
,`f
I
p.ocl
IS
i.7
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.,
22
24
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.......................................................................:.:.
28
1
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{
30
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AVERA
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�7
I
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::::::0............�s............._.......................,.
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...t...-........5..........-:.::.:.::.:.:.:.:.::.:
,
MINIM
0• (
��
�(�
�a-`O
(Oal
6
Lj
) 14
c
Monthly Limit
02
6-9
3Om
/1
3Omg
_200
6
PI
"=
o
1 O OmL
DWQ Form MR-1 (01/00)
FEB 0 2 .2iJ, '�,3
i
1,ti'inston-S21em
Regional Office

Facility Status: (Please chet;k one of the following)
All monitoring data and sampling frequencies meet permit requirements F-1Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements F-71
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and'a time -table for improvements to be made.
"I certify, under penalty .(if, law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. B ased 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."
Pe ecostal Holiness Church
Permit ee (P ase print or type)
lal n )0 1
Signatuk of ermittee** Date
(Required)
P.O. Box 150, Brown Summit, NC 27214 (336)645_5476
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen.
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
01042
Copper
00927
Total Magnesium
01045
Iron
00929
Total Sodium
01051
Lead
00940
Total Chloride
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147
Total Selenium
71880 Formaldehyde
31616
Fecal Coliform
71900 Mercury
32730
Total Phenolics
81551 Xylene
34235
Benzene
34481
Toluene
38260
MBAS
39516
PCBs
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Bnforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G. 0�04.1-11 u
** If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(2) (D)•

id NPDES; NO. NCO046809 DISCHARGE NO. 001
MONTH *-JJ YEAR 200,f)
FACILTY NAME Pentecostal Holiness Church _COUNT Guilford
STREAM Unnamed Tiibutary to Benaja Creek STREAM
LOCATION 100 ft. upstream from the ouffall LOCATION
Upstream
00010
00400
50000
00300
- 31016
00665
LU
CD
C-4
w z
�1 w
0:11
Z
0
U)
x
Lo
0
0
z
a
w _j
fu
a. w
CL
LU 0
LL
vt U
0
0
0
'1 w
c
0
w
M
0
Q
HRS
*c
UMTS
LIGIL
MGfL
#1100ML
........................ -----
3
v,
5
s
7
9
-gn
_P
4-
NZ,
1517
2"
21
23
27
29
31
'G'4 C)
AVERAGE
MAXIMUMt
MINIMUMft
­­­ t-1
Unnamed tributary to Benaia Creek
100 ftAlownstream
Downstream
00010
00400
1 50060
00300
31616
00665
w
W.
U
W Z
>
W.
I
x
I
(wq
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v
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.j
CL
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U
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pc
w
HRS
-c
LWTS
UG/L
MGfL
#/100ML
ud..k.
21
31
,
M,2
5
T
YIaKgi�
0.
TV
swt
�v
'75
:11
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U01
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AVERAGE
I -)
t
�64
MAXIMUM
�L�__
10
MINIMUM

Q- NI`iF

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves, Perdue Coieen H, Sullins
Governor Director
December 21, 2009
CERTIFIED MAIL:.7006 2760 0001 9282 0488
RETURN RECEIPT REOUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit- North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
RECEIVED
N.C. Dept. of ENR
DEC 3 0 2D�
Winston-Salem
Regional Office
Dee Freeman
Secretary
This is to inform you that a review of your toxicity self -monitoring report form for the month of October 2009 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Monitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely,
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: Steve Tedder/ Winston-Salem Regional Office
EJeTi er �arter�VViton-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hftp://h2o.enr.state.nc.us/esb/
Nne
orthCarolina
aturalCJ
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, .tune, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must provide.
written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623.6748
Intemet: hftp://h2o.enr.state.nc.us/esb/
One
NorthCarolina
atl rally
An Equal Opportunity 1 Affirmative Action Employer

A
RCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
October 22, 2009
CERTIFIED MAIL: 7006 2760 0001 9282 0327
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No. NCO046809
Western NC Conference Center W WTP
Guilford County
Dear Mr. McGee:
Natural Resources
Dee Freeman
Secretary
RECEIVED i
N.C, Dept of ENR
OCT 2 5 2009
Winston-Salem
ReoJonal Cir,e
This is to inform you that a review of your toxicity self -monitoring report form for the month of August 2009 indicates a violation of the
toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity violation(s). Your efforts
may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed to identify the causative agents of effluent toxicity,
isolate the sources of toxicity, evaluate the effectiveness of toxicity control options, and confirm reductions in effluent toxicity. Please be aware that
North Carolina General Statutes provide for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity Monitoring and Reporting
Requirements. Please note appropriate mailing addresses for submitting your Discharge Allonitoring Reports (DMRs) and Aquatic Toxicity (AT)
Test Forms. We encourage you to review this information; if it would be helpful to discuss this situation or possible solutions to resolve effluent
toxicity noncompliance, please contact Mr. John Giorgino with this office at [phone].
Sincerely, P
, 0
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: Steve Tedder/ Winston-Salem Regional Office
iC=rf� Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hfp:/lh2o.erlr.state.nc.us/esb/
NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and reporting
information. Please take time to review this information. The items below do not address or include all the toxicity testing and reporting
requirements contained in your NPDES permit. If you should have any questions about your toxicity testing requirement, please contact Mr.
John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at the same number.
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report forms are
appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period
(eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure of any
single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two multiple
concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be completed will be
accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any single quarterly test, you
may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per the Division's WET enforcement
initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing' -months specified in your NPDES permit are March, June, September, and December, then toxicity testing must
be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must provide
written notification to the Environmental Sciences Section by .tune 30 that a discharge did not occur during the first six months of the calendar
year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental Sciences
Section at [phone] and provide written documentation indicating why the test was invalidated and the date when follow-up testing will
occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information block
located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the subject report.
You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have not
received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must also be
signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity test
results certified mail, return receipt requested to the Environmental Sciences Section.
Environmental Sciences Section
1621 Mail Service Center, Raleigh, North Carolina 27699-1621
Location: 4401 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: hap://h2o.enr.state.nc.us/esb/
One
NorthCarohna
N%ttaully
An Equal Opportunity 1 Affirmative Action Employer

MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
24 July 2009
Rev. Thomas McGhee
Pentecostal Holiness Church
P. O. Box 150
Browns Summit, NC 27214-0150
SUBJECT: Compliance Evaluation Inspection
Pentecostal Holiness Church
Western NC Conference Center WWTP
NPDES Permit No. NCO046809
Guilford County
Dear Rev. McGhee:
A Compliance Evaluation Inspection was performed on the Pentecostal Holiness Church Western NC Conference Center
wastewater treatment facility on July 23, 2009 by Corey Basinger of the Winston-Salem Regional Office. Patrick Merritt,
ORC was present for the subject inspection. The inspection consisted of two parts: an on -site inspection of the treatment
facility and an in -office file review. The following are the findings from the subject inspection.
L Permit
The NPDES permit for the Pentecostal Holiness Church WWTP became effective on May 1, 2006 and expires on April 30,
2011. The permitted wastewater treatment components for the 0.020 MGD facility include a splitter box, bar screen, dual
parallel aeration tanks, dual parallel clarifiers, dual tertiary filters, tablet chlorination, and chlorine contact chamber.
II. Records/Reports
A daily visitation log was available at the site. Information contained in this daily log included field parameter data,
maintenance records, and process control data. The Annual Performance Report was received on May 15, 2009 for
calendar year 2008.
III. Facility Site Review
On the date of inspection, only the right side treatment works was in operation and consisted of a splitter box', bar
screen, aeration tank, secondary clarifier, tablet chlorinator, chlorine contact chamber and dechlorination unit. The
tertiary filter was not in service. The left side treatment works is not being used due to the small amount of flow
tributary to the system.
IV. Effluent & Receiving Waters
The Pentecostal Holiness Church discharges to an unnamed tributary to Benaja Creek (Class C-NSW waters in the Cape
Fear River Basin). On the date of the inspection, the effluent discharge was clear and free of visible solids. The
receiving stream was free of solids, foam and debris.
V. Flow Measurement
Flow is required to be measured instantaneously. Currently flow is measure using the gauge on the chlorinator. The
facility receives very little flow (-1,000 gpd or less). The summer youth camp buildings produce additional flow
during the summer months.
VI. Self -Monitoring Program
A review of the discharge monitoring reports (DMRs) for the time period of January 2008 through April 2009 showed
that the Pentecostal Holiness Church WWTP experienced only one (1) permit effluent limitation violation. This was
handled via previous correspondence from the Division.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone]lCustomer Service:1-877-623-6748 1r
Internet: www.ncwaterquality.org T�Tof hCarolina`��
An Equal Opportunity 1 Affirmative Action Employer bi

VII. Compliance Schedules
No compliance schedule to evaluate.
VIII. Laboratory
All of the samples are taken to a contract lab (Meritech, Inc.) for analysis.
IX. Operations and Maintenance
This facility receives very little flow (-1,000 gpd or less). Currently, only one (1) of the two (2) treatment trains was
being used. Both blowers/motors were operational. The diffusers appeared to be functioning properly. The clarifier
had some minor pin floc.
X. SludjZe Utilization/Disposal
Solids are removed as necessary by a licensed hauler.
XI. Pretreatment, Pollution Prevention, Multimedia
Not applicable for this facility
XII. Stormwater
Not applicable for this facility.
XIII. Sewer Overflow
No sewer overflows were reported during the review period.
XIV. Other
The previous inspection was conducted by Corey Basinger of the Winston-Salem Regional Office on April 9, 2008.
If you should have any questions or concerns regarding this report, please contact this Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Supervisor
Cc: Patrick Merritt, ORC (Meritech, Inc. 642 Tamco Rd, PO Box 27, Reidsville, NC 27320)
Guilford County Health Department
(�entral Piles, QIR

A-0
Form Approved
OMB No.2040-0057
Approval Expires
United States Environmental Protection Agencv. Washington_ D.C.. 20460
8-31-98
Section A: National Data System Coding
Transaction Code NPDES No. Yr/1V1o/Day Inspection Type Inspector FacilityType
N 5 NCO046809 09-07-23 C S 2
Facility Evaluation Rating BI QA ..........Reserved...........
4 N N
Section B: Facility Data
Name and Location of Facility Inspected:
Entry Time:
Permit Effective
1355 hrs.
Date: May 1, 2006
Pentecostal Holiness Church WWTP
Hwy 29 North in Browns Summit, NC (Guilford Co)
Exit Time:
Permit Expiration
1425 hrs.
Date: April 30, 2011
Name(s) of On -Site Representative(s): Title(s): Phone No(s):
Mr. Pat Merritt ORC [phone] cell
Name, Address of Responsible Official:
Title: Conference Superintendent
Rev. Thomas H. McGhee
Pentecostal Holiness Church
Phone No.
Contacted? No
P.O. Box 150
336-656-7936
Browns Summit, NC 27214-0150
Section C: Areas Evaluated During Inspection (check only those areas evaluated)
X Permit X Flow Measurement X Operations/Maintenance _ Sewer Overflow
X Records/Reports X Self -Monitoring Program X Sludge Handling/Disposal _ Pollution revention
X Facility Site Review NA Compliance Schedules NA Pretreatment
X Effluent/Receiving Waters NA Laboratory Stormwater
Section D: Summary of Findings/Comments
See attached letter for further details regarding the subject inspection.
REVIEW PERIOD January 2008 — April 2009
Name(s) and Signature(s) of Inspectors:
Agency/Office/Telephone:
Date:
DWQ / WSRO / [phone]
p 9
Signature of Reviewer:
IL CJ k/1 �
Agency/Office:
DWQ / WSRO / [phone]
Date:
712-�/�

r
Permit: NC0046809 owner - Facility: Western NC Conference Center WWTP
Inspection Date: 07/23/2009 Inspection Type: Compliance Evaluation
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
RM
❑
❑
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge
®
❑
❑
❑
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑
®
❑
Is the facility as described in the permit?
❑
❑
❑
# Are there any special conditions for the permit?
®
❑
[J
❑
Is access to the plant site restricted to the general public?
®❑
❑
❑
Is the inspector granted access to all areas for inspection?
®
❑
❑
❑
Comment:
Record Keeping
Yes
No
NA
NE
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?
❑
❑
®
Cl
Is the ORC visitation log available and current?
in
❑
❑
❑
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?
®
❑
❑
❑
Page # 3

Permit: NC0046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 07/23/2009 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Facility has copy of previous year's Annual Report on file for review?
®n
❑
n
Comment:
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
®
n
n
Are the receiving water free of foam other than trace amounts and other debris?
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
n
n
®f]
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
n
n
■
n
Is flow meter calibrated annually?
❑
❑
■
❑
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
❑
n
®
n
Comment: staff gauge on chlorinator used to report flow
Aerobic Digester
Yes
No
NA
NE
Is the capacity adequate?
■
❑
❑
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?
®
❑
❑
❑
# Is tankage available for properly waste sludge?
®
n
n
n
Comment:
.-. ..
V—
Nn
KIA
AIC
Type of bar screen
a.Manual
b.Mechanical
n
Are the bars adequately screening debris?
■
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
n
n
n
Is the unit in good condition?
®
n
n
n
Comment:
Secondary Clarifier
Yes
No
NA
NE
Page # 4

If
Permit: NCO046809
Inspection Date: 07/23/2009
Owner - Facility: Western NC Conference Center WWTP
Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No
NA
Nt
Is the clarifier free of black and odorous wastewater?
®❑
Cl
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
®
❑
❑
Cl
Are weirs level?
®❑
❑
❑
Is the site free of weir blockage?
®
n
❑
n
Is the site free of evidence of short-circuiting?
®❑
n
n
Is scum removal adequate?
®❑
❑
❑
Is the site free of excessive floating sludge?
®
❑
❑
❑
Is the drive unit operational?
❑
❑
®
❑
Is the return rate acceptable (low turbulence)?
®❑
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
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext.
Air
Type of aeration system
Diffused
Is the basin free of dead spots?
®❑
❑
❑
Are surface aerators and mixers operational?
®❑
n
❑
Are the diffusers operational?
®
❑
❑
❑
Is the foam the proper color for the treatment process?
®
❑
❑
n
Does the foam cover less than 25% of the basin's surface?
®
❑
❑
❑
Is the DO level acceptable?
®
n
❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
®❑
❑
❑
Comment:
Disinfection- Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
®
Cl
Cl
❑
Are the tablets the proper size and type?
®
n
❑
❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
®❑
❑
❑
Is the contact chamber free of growth, or sludge buildup?
®
n
n
n
Page # 5

Y
Permit: NCO046809
Inspection Date: 07/23/2009
Owner - Facility: Western NC Conference Center WWTP
Inspection Type: Compliance Evaluation
Disinfection -Tablet
Yes
No
NA
NE
Is there chlorine residual prior to de -chlorination?
®❑
❑
❑
Comment:
De -chlorination
Yes
No
NA
NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
®❑
n
n
Is storage appropriate for cylinders?
®
n
n
n
# Is de -chlorination substance stored away from chlorine containers?
®
n
n
n
Comment:
Are the tablets the proper size and type?
©❑
n
n
Are tablet de -chlorinators operational?
®❑
❑
❑
Number of tubes in use?
Comment:
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
❑
❑
®
❑
Is sample collected below all treatment units?
le
n
n
n
Is proper volume collected? ®❑ ❑ ❑
Is the tubing clean? ❑ ❑ ® o
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? NO n ❑
Is the facility sampling performed as required by the permit (frequency, sampling type representative)? ■ ❑ ❑ ❑
Comment:
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ® ❑ ❑ ❑
Comment:
Page # 6

r
�10
MERiTECH., INC.
ENVIRONMENTAL LABORATORIES
A Division of Water Technology and Controls, Inc.
May 7, 2009
Dear System Owner,
RFOEIvrrl j
N.0 Deot. of ENR
MAY 15
W;nsmo;aie;r.
Regional Office
Enclosed you will find a copy of the annual performance report for 2008 required each year by
DENR. Please have the responsible parry sign & date the last page of the report, then make you a
copy and mail original to the following address:
System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, N.C. 27699-1617
If you have any questions or need additional information please do not hesitate to call.
Sincerely
Meritech Inc.
David Merritt
Vice President
RECEIVED
MAY 12 2009
DENR - WATER QUALITY
POINT SOURCE BRANCH

r _,
A �MER OT
I ECHINC
- ° ENVIRONMENTAL LABORATORIES.
; r°w A Division of Water Technology and Controls, Inc.
Annual Performance -Report
Pentecostal Holiness Church
January 1, — December 31, 2008
I. General Information
Facility/System Name: Pentecostal Holiness Church
Responsible Entity: Rev. Thomas McGhee PO Box 150 Brown
Summit, N.C. 27214 (336-656-7936)
Person in Charge/Contact: Thomas McGhee
Applicable Permit(s): WWTP NC0046809-
Description of Collection System or Treatment Process:
A Grade II Wastewater treatment plant consisting of an activated sludge basin and a
clarifier treats waste that is collected throughout by a collection system.
II. Performance
Text Summary of System Performance for Year 2008
The system operated with no bypasses or system overflows for this period,
The Following Violation Occurred During 2008.
June, TSS daily violation.
Office: 106-A South Walnut Circle P.O. Box 8808 Greensboro, NC 27419 [phone]
Laboratory: 642 Tamco Road Reidsville, NC 27320 [phone]

III. Notification
A copy of this report will be made available to all system users.
IV. Certification
I certify under penalty of law that this report is complete and accurate to the
best of my knowledge. I further certify that this report has been made
available to the users or customers of the named system and that those users
have been notified of its availability.
Responsible Per n:
Titl .
Date:
Office: 106-A South Walnut Circle P.O. Box 8808 Greensboro, NC 27419 [phone]
Laboratory: 642 Tamco Road Reidsville, NC 27320 [phone]

C&unty: I GUI LFORD
River Basin CAPE FEAR
Report To WSROSP
Collector:
C BASINGER
Region:
WSRO
Sample Matrix:
Surfacewater
Loc. Type:
Effluent
Emergency Yes/No
COC Yes/No
VisitlD
Loc. Descr.: PENTECOSTAL CHURCH
Sample ID:
AB28701
PO Number #
8W2494
Date Received:
04/10/2008
Time Received:
07:65
Labworks LoginlD
MMATHIS
Date Reported:
4/29/08
Report Generated: 04/29/2008
Location ID: WSROSPNLC Collect Date: 04/09/2008 Collect Time:: 10:30 Sample Depth
Sample Qualifiers and Comments
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A -Value reported is the average of two or more determinations N3-Estimated concentration is < PQL and >MDL
B1-Countable membranes with <20 colonies; Estimated NE -No established PQL
B2- Counts from all filters were zero.
63- Countable membranes with more than 60 or 80 colonies; Estimated P-Elevated PQL due to matrix interference and/or sample dilution
B4-Filters have counts of both >60 or 80 and < 20; Estimated Q1-Holding time exceeded prior to receipt at lab.
Q2- Holding time exceeded following receipt by lab
B5-Too many colonies were present; too numerous to count (TNTC) PQL- Practical Quantitation Limit -subject to change due to instrument sensitivity
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated U-Samples analyzed for this compound but not detected
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated X1- Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
IAR
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 1 of 2

Location ID: , WSRDSPNLC
XC (DWQQ Laboratory Section Results
SampleID
Collect Date:
AB28701
04/09/2008
Loc. Descr.: PENTECOSTAL CHURCH
Collect Time::
10:30
Visit ID
CAS # Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
LAB
Sample temperature at receipt by lab
0.7
°C
DSAUNDERS
MMATHIS
Method Reference
4/10108
4/10/08
MIC
BOD, 5-Day in liquid 2.0
24 G5 G6
mg/L
ADEXTER
MOVERMAN
Method Reference APHA5210B
4/10/08
4/21/08
Coliform, MF Fecal in liquid 1
2 B1 Q1
CFU/100ml
PCOTTEN
MOVERMAN
Method Reference APHA9222D-20th
4/10/08
4/21/08
WET
Residue —Suspended in liquid 6.2
19
mg/L
AWILLIAMS.
MOVERMAN
Method Reference APHA2540D-20th
4/11/08
4/21/08
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

DIVISION OF ENVIRONMENTAL MANAGEMENT For Lab Use ONLY W 1-i
COUNTY Gam(/(( r—a-iz EI)i
WATER QUALITY FIELD -LAB FORM (DM1) %
PRIORITY SAMPLE TYPE ^
❑AMBIENT ❑ QA ❑ STREAM EFFLUENT
S
eE COMPLIANCE ❑ CHAIN ❑ LAKE ❑ INFLUENT
OF CUSTODY
❑EMERGENCY ❑ ESTUARY
RIVER BASIN l �'�
FRO MAjpfOi
REPORT TO: ARO FRO MRO RRO WaRO WIR WSR
Other
Otherer
Shipped by: Bus ourie , Staff, Other
_Lab Number•
Date Received: :4 - 10-09 Time:015_
Rec'd by: From: Bus ourie -Hand Del
DATA ENTRY BY: C}(;
DATE REPORTED:
�,�'�_ STATION LOCATION: iCOS%L �ffr2c�o�-
Estimated BOD Renge• 0-SfLs�,S/25-65/40-130 or 300 plus � j//�� �� p
Seed: Yes ❑ No El Chlorinated: Yet No ❑ REMARKS: 1JCQ O 4&,6o
tlon
,ate Begin (yy/mm/dd) Time Begin Date End Time End Depth DM DB DBM
D 8 . o4 1 09 ( 61�6
BOD5 310 rng/I
COD High 340 mg/1
COD Low 335 mg/1
Coliform: MF Fecal 31616 /100m1
Coliform: MF Total 31504 /100ml
Collform; Tube Fecal 31615 /100ml
Coliform: Fecal Strep 31673 /100m1
Residue: Total 500 mg/I
Volatile 505 mg/I
Fixed 510 mg/1
Volatile 535 mg/I
Fixed 540 mg/1
pH 403 units
Acidity to pH 4.5 436 mg/1
Acidity to pH 8.3 435 mg/l
Alkalinity to, pH 8.3 415 mg/I
Alkalinity to pH 4.5 410 mg/I
TOC 680 mg/I
Turbidity 76 NTU
Chloride 940 - mg/I
Chi a: Tri 32217 ug/1
Chi a: Corr 32209 ug/I
Pheophytin a 32213 ug/I
Color: True 80 Pt -Co
Color:(pH ) 83 ADM
Color: pH 7.6 82 ADM
Cyanide 720 mg/l
Fluoride 951 mg/1
Formaldehyde 71880 mg/1
Grease and Oils 556 mg/I
Hardness Total900 mg/I
Specific Cond. 95 uMhos/cm2
MBAS 38260 mg/I
Phenols 32730 ug/I
Sulfate 945 mgA
Sulfide 745 mg/I
A H L
NH3 as N 610 mg/i
TKN as N 625 tn9/1
NO2 Pitts NO3 as N 630 mg/I
P: Total as P 665 tng/1
PO4 as P 70507 mgA
P: Dissolved as P 666 mg/1
Cd-Cadmium 1027 ug/1
Cr-Chromlum:Tota11034 ugA
Cu-Copper 1042 ug/1
Ni-Nickel 1067 ug/I
Pb-Lead 1051 ug/1
Zn-Zinc 1092 ug/I
Ag-Silver 1077 ug/l
AI -Aluminum 1105 ug/I
Be -Beryllium 1012 ug/I
Ca -Calcium 916 mgA
Co -Cobalt 1037 ug/1
Fe -Iron 1045 uoA
Composite Sample T e
T S B C� G GNXX �.
Li -Lithium 1132. ug/l
Mg -Magnesium 927 mg/l
Mn-Manganese 1055 ug/l
Na-Sodium 929 mg/I
Arsenic -Total 1002 ug/I
Se -Selenium 1147 ug/1
Hg-Mercury 71900 ug/1
Organochlorine Pesticides -�
Otganophosphorug Pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg*d)
Phytoplankton
Sampling Point %
Conductance at 25 C
Water Temperature (C)
D.O. mgA
PH
Alkalinity
Acidity
Air Temperature (C)
PH 8.3 pH 4.5
pH 4.5 pH 8.3
2
94
10
300 1.
400 1&
82244 431
82243 182242
20
Salinity %
Precipitlon On/day)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth ft.
Stream Width ft.
480
45
132
36
11351
1350 135
64 14
I10-A-wa 1AMC

Report to: _WSRO_
Lab Number:
Station Location:
ample Type:
Sample Anomaly Report (SAR)
AB28701 Sample ID:
Pentecostal
Church
Effluent
Date collected: 4/9/08
Affected Parameter(s):
BOD
County: Guilford
NCO046809
Region: Winston Salem
Priority: Compliance Collector: C.Basinger
Date received: 4/10/08 Date analyzed: 4/10/08
Analytical Area (check one):
❑ WCH ❑METALS
❑NUT ®MICRO
The following anomalies occurred (check all that apply):
[:]Samples
❑Improper container used
❑VOA vials with headspace
❑Sulfide samples with headspace
❑Samples not received, but listed on fieldsheet
❑Samples received, but not listed on fieldsheet
❑Mislabeled as to tests, preservatives, etc..
❑Holding time expired
[]Prior to receipt in lab
❑After receipt in lab
❑Insufficient quantity for analysis
El Sample exhibits gross non -homogeneity
❑Sample not chemically preserved properly
❑pH out of range (record pH):
❑Improper chemical
❑Residual chlorine present in sample
❑Color interference
❑Heavy emulsion formed during extraction
❑Sample bottle broken in lab - no reportable results
❑VOA ❑SVGA
[-]PEST
®Quality Control
❑Instrument failure — no reportable results
❑Analyst error — no reportable results
❑Surrogates
❑None added
❑Recovery outside acceptance limits
❑Spike recovery
❑None added
❑Recovery outside acceptance limits
❑Failed to meet criteria for precision
❑Internal standards
❑Blank contamination
❑QC data reported outside of controls (e.g., QCS, LCS)
❑Incorrect procedure used
❑SOP intentionally modified with QA and Branch Head
approval
❑Invalid instrument calibration
❑Elevated detection limits due to:
[]Insufficient sample volume
®Other (specify): The calculated seed correction exceeded the range of 0.6 to 1.0 mg/L resulting in a G6 qualifier. The
calculated seed was 1.600
Comments:
Corrective Action:0
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s) on hold until:
®Sample reported with qualification. Data qualification code used:G6
❑Other (explain):
Notification Required? ❑ Yes ❑ No
Person .Contacted: Date:
Form completed by: ela Dexte Date: 4/16/2008
Lead Chemist Review (initial):
(ABIOCHEM V\%
❑ METALS
❑ PEST
❑ VOA
Branch Head Review (initial) 'l �'v
QA/QC Review (init. (JI/d• u,�, YO
)A\Form s\Laborarory\SAR
❑ S VOA
Logged into database by (initial):
10/3/Oldbs

Report to: _WSRO
Sample Anomaly Report (SAR)
Lab Number:
AB28701
Station Location:
Pentecostal
Church
)mple Type:
Effluent
Date collected:
4/9/08
Affected Parameter(s): BOD
Sample ID:
County: Guilford
NCO046809
Region: Winston Salem
Priority: Compliance Collector:
Date received: 4/10/08 Date analyzed:
Analytical Area (check one):
❑ WCH ❑METALS
❑NUT ®MICRO
The following anomalies occurred (check all that apply):
❑Samples
❑Improper container used
❑VOA vials with headspace
❑Sulfide samples with headspace
❑Samples not received, but listed on fieldsheet
❑Samples received, but not listed on fieldsheet
❑Mislabeled as to tests, preservatives, etc.
❑Holding time expired
❑Prior to receipt in lab
❑After receipt in lab
❑Insufficient quantity for analysis
❑Sample exhibits gross non -homogeneity
[]Sample not chemically preserved properly
❑pH out of range (record pH):
❑Improper chemical
❑Residual chlorine present in sample
❑Color interference
❑Heavy emulsion formed during extraction
❑Sample bottle broken in lab - no reportable results
❑Other (specify):
C.Basinger
4/10/08
❑VOA ❑SVGA
❑PEST
ffQuality Control
❑Instrument failure — no reportable results
❑Analyst error — no reportable results
❑Surrogates
❑None added
❑Recovery outside acceptance limits
❑Spike recovery
❑None added
❑Recovery outside acceptance limits
❑Failed to meet criteria for precision
❑Internal standards
❑Blank contamination
®QC data reported outside of controls (e.g., QCS, LCS)
❑Incorrect procedure used
❑SOP intentionally modified with QA and Branch Head
approval
❑Invalid instrument calibration
❑Elevated detection limits due to:
❑Insufficient sample volume
Comments: Both of the two glucose glutamic acid standards were above the acceptable range of 167.5 and 228.8 mg/L at 232 mg/L
and 233 mg/L. The sample was seeded
Corrective Action:Ongoing investigation to determine the cause of high GGA standard results.
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s) on hold until:
®Sample reported with qualification. Data qualification code used:GS
❑Other (explain):
Notification Required? ❑ Yes ❑ No
Person Contacted: Date:
Form completed by:[Angela Dexte a,,4Date: 4/16/2008
Lead Chemist Review (initial):
gBIOCHEM _np
METALS
❑ PEST
❑VOA
Branch Head Review (initial7�^2(^0�
QA/QC Review (init• 1): %
IA\Form Al-abo ratory\SAR
❑ SVOA
Logged into database by (initial):
10/23/Oldbs

Report to: _WSRO
Sample Anomaly Report (SAR)
Lab Number: AB28701
Station Location: Pentecostal
Church
)mple Type: Effluent
Date collected: 4/9/08
Affected Parameter(s): BOD
Sample ID: NCO046809
County: Guilford Region. Winston Salem
Priority: Compliance Collector:
Date received: 4/10/08 Date analyzed:
Analytical Area (check one):
❑ WCH ❑METALS
❑NUT ®MICRO
The following anomalies occurred (check all that apply):
❑ Samples
❑Improper container used
❑VOA vials with headspace
❑Sulfide samples with headspace
❑Samples not received, but listed on fieldsheet
❑Samples received, but not listed on fieldsheet
❑Mislabeled as to tests, preservatives, etc.
❑Holding time expired
❑Prior to receipt in lab
❑After receipt in lab
❑Insufficient quantity for analysis
❑Sample exhibits gross non -homogeneity
❑Sample not chemically preserved properly
❑pH out of range (record pH):
❑Improper chemical
[]Residual chlorine present in sample
❑Color interference
❑Heavy emulsion formed during extraction
❑Sample bottle broken in lab - no reportable results
C.Basinger
4/10/08
❑VOA ❑SVOA
❑PEST
®Quality Control
❑Instrument failure — no reportable results
El Analyst error— no reportable results
❑ Surrogates
❑None added
❑Recovery outside acceptance limits
[]Spike recovery
❑None added
❑Recovery outside acceptance limits
❑Failed to meet criteria for precision
❑Internal standards
❑Blank contamination
❑QC data reported outside of controls (e.g., QCS, LCS)
❑Incorrect procedure used
❑SOP intentionally modified with QA and Branch Head
approval
❑Invalid instrument calibration
❑Elevated detection limits due to:
❑Insufficient sample volume
®Other (specify):The sample contained excess reducing agents. It took 140 drops of bi-iodate to neutralize the sample. The
sample was seeded.
Comments:
Corrective Action:
❑Samples were rejected by DWQ Lab. Authorized by: Date:
❑Accepted and analyzed after notifying the collector or contact person and determining that another sample could not be secured.
❑Sample(s) on hold until:
®Sample reported with qualification. Data qualification code used:
❑Other (explain):
Notification Required? ❑ Yes ❑ No
Person Contacted: Date:
Form completed by: ela Dexte Date: 4/16/2008
Lead Chemist Review (initial):
6BIOCHEM VO
METALS
Branch Head Review (initial): '-q^07
QA/QC Review (initia
•RA\Forms\Labo mtory\SAR
i
❑ PEST
❑VOA
❑SVOA
Logged into database by (initial):
l0/3101dbs

October 27, 2008
CERTIFIED MAIL: 7007 1490 0004 5537 8813
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No: NCO046809
Pentecostal Holiness Church WWTP
Guilford County
Dear Mr. McGee:
Co*
Michael F. Easley, overnor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
RECEIVED
M.C. Deot of ENR
NOV 0 3 2008
MnatonSalem
Regional Office
This is to inform you that a review of your toxicity self -monitoring report form for the month of August 2008
indicates a violation of the toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity
violation(s). Your efforts may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed
to identify the causative agents of effluent toxicity, isolate the sources of toxicity, evaluate the effectiveness of toxicity
control options, and confirm reductions in effluent toxicity. Please be aware that North Carolina General Statutes provide
for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity
Monitoring and Reporting Requirements. Please note appropriate mailing addresses for submitting your Discharge
Monitoring Reports (DMRs) and Aquatic Toxicity (AT) Test Forms. We encourage you to review this information; if it
would be helpful to discuss this situation or possible solutions to resolve effluent toxicity noncompliance, please contact
Mr. John Giorgino or me with this office at [phone].
Sincerely,
4
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc; Steve Tedder/Winston-Salem Regional Office
David Russell/Winston-Salem Regional Office
Jenifer Carter/Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files NorthCarolina
Nawrallil
North Carolina Division of Water Quality 1621 Mail Service Center Raleigh, NC 27699-1621 Phone [phone] Customer Service
Internet: www.esb.enr.state.nc.us 4401 Reedy Creek Rd. Raleigh, NC 27607 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and
reporting information. Please take time to review this information. The items below do not address or include all the toxicity testing
and reporting requirements contained in your NPDES permit. If you should have any questions about your toxicity testing
requirement, please contact Mr. John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at
[phone].
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report
forms are appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Sectiowno later than 30 days after the end of the reporting
period (eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure
of any single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two
multiple concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be
completed will be accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any
single quarterly test, you may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per
the Division's WET enforcement initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the
Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing
must be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must
provide written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months
of the calendar year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental
Sciences Section at [phone] and provide written documentation indicating why the test was invalidated and the date when
follow-up testing will occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information
block located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the
subject report. You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have
not received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must
also be signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity
test results certified mail, return receipt requested to the Environmental Sciences Section.

October 27, 2008
CERTIFIED MAIL: 7007 1490 0004 5537 8813
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No: NCO046809
Pentecostal Holiness Church WWTP
Guilford County
Dear Mr. McGee:
Michael F. ���overnor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
RECEIVED
MC. Deot. of ENR
NOV 0 3 200S
W1njstonSalern
Regional of lice
This is to inform you that a review of your toxicity self -monitoring report form for the month of August 2008
indicates a violation of the toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity
violation(s). Your efforts may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed
to identify the causative agents of effluent toxicity, isolate the sources of toxicity, evaluate the effectiveness of toxicity
control options, and confirm reductions in effluent toxicity. Please be aware that North Carolina General Statutes provide
for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains. important information concerning your Whole Effluent Toxicity
Monitoring and Reporting Requirements. Please note appropriate mailing addresses for submitting your Discharge
Monitoring Reports (DMRs) and Aquatic Toxicity (AT) Test Forms. We encourage you to review this information; if it
would be helpful to discuss this situation or possible solutions to resolve effluent toxicity noncompliance, please contact
Mr. John Giorgino or me with this office at [phone].
Sincerely,
C -4 d
m'q
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: Steve Tedder/Winston-Salem Regional Office
,David Russell/Winston-Salem Regional Office_—
Jenifer Carter/Winston-Salem Regional Office
Aquatic Toxicology Unit
One
Central Files NorthCarolina
Natmally
North Carolina Division of Water Quality 1621 Mail Service Center Raleigh, NC 27699-1621 Phone [phone] Customer Service
Internet: www.esb.enr.state.nc.us 4401 Reedy'Creek Rd. Raleigh, NC 27607 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and
reporting information. Please take time to review this information. The items below do not address or include all the toxicity testing
and reporting requirements contained in your NPDES permit. If you should have any questions about your toxicity testing
requirement, please contact Mr. John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at
[phone].
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report
forms are appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting
period (eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure
of any single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two
multiple concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be
completed will be accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any
single quarterly test, you may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per
the Division's WET enforcement initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the
Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing
must be conducted during these months).
➢ if your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must
provide written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months
of the calendar year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental
Sciences Section at [phone] and provide written documentation indicating why the test was invalidated and the date when
follow-up testing will occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information
block located at the top of the AT form indicating the facility name, permit number, pipe,number, county and the month/year of the
subject report. You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have
not received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must
also be signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity
test results certified mail, return receipt requested to the Environmental Sciences Section.

CERTIFIED MAIL:7007 1490 0004 5537 8813
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentecostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Michael F. EasleyOPMernor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
October 27, 2008
RECEIVED
N.C. Dept of ENR
NOV 0 3 2008
F-
WinAton-Salem
Regional office
Subject: NOTICE OF VIOLATION
Effluent Toxicity Testing
NPDES Permit No: NCO046809
Pentecostal Holiness Church W WTP
Guilford County
Dear Mr. McGee:
This is to inform you that a review of your toxicity self -monitoring report form for the month of August 2008
indicates a violation of the toxicity limitation specified in your NPDES Permit.
You should take whatever remedial actions are necessary to eliminate the conditions causing the effluent toxicity
violation(s). Your efforts may include conducting a Toxicity Reduction Evaluation (TRE), a site -specific study designed
to identify the causative agents of effluent toxicity, isolate the sources of toxicity, evaluate the effectiveness of toxicity
control options, and confirm reductions in effluent toxicity. Please be aware that North Carolina General Statutes provide
for assessment of civil penalties for violations of NPDES permit limitations and requirements.
The reverse side of this Notice contains important information concerning your Whole Effluent Toxicity
Monitoring and Reporting Requirements. Please note appropriate mailing addresses for submitting your Discharge
Monitoring Reports (DMRs) and Aquatic Toxicity (AT) Test Forms. We encourage you to review this information; if it
would be helpful to discuss this situation or possible solutions to resolve effluent toxicity noncompliance, please contact
Mr. John Giorgino or me with this office at [phone].
Sincerely,
.0 -4 d m'
Cindy A. Moore
Supervisor, Aquatic Toxicology Unit
cc: Steve Tedder/Winston-Salem Regional Office
David Russell/Winston-Salem Regional Office
Jenifer Carter/Winston-Salem Regional Office
Aquatic Toxicology Unit
Central Files NorthCarolina
Naturally
North Carolina Division of Water Quality 1621 Mail Service Center Raleigh, NC 27699-1621 Phone [phone] Customer Service
Internet: www.esb.enr.state.nc.us 4401 Reedy Creek Rd. Raleigh, NC 27607 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycledl10% Post Consumer Paper

WHOLE EFFLUENT TOXICITY MONITORING AND REPORTING INFORMATION
➢ The following items are provided in an effort to assist you with identifying critical and sometimes overlooked toxicity testing and
reporting information. Please take time to review this information. The items below do not address or include all the toxicity testing
and reporting requirements contained in your NPDES permit. If you should have any questions about your toxicity testing
requirement, please contact Mr. John Giorgino with the Aquatic Toxicology Unit at [phone] or another Unit representative at
[phone].
➢ The permittee is responsible for ensuring that toxicity testing is conducted according to the permit requirement and that toxicity report
forms are appropriately filed.
➢ The reporting of whole effluent toxicity testing data is a dual requirement. All toxicity test results must be entered (with the appropriate
. parameter code) on your monthly Discharge Monitoring Report which is submitted to:
North Carolina Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
IN ADDITION
Toxicity test data (original "AT" form) must be submitted to the following address:
North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
➢ Toxicity test results shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting
period (eg, January test result is due by the end of February).
➢ Toxicity test condition language contained in your NPDES permit may require use of multiple concentration toxicity testing upon failure
of any single quarterly toxicity test. If the initial pass/fail test fails or if the chronic value is lower than the permit limit, then at least two
multiple concentration toxicity tests (one per month) will be conducted over the following two months. As many analyses as can be
completed will be accepted. If your NPDES permit does not require use of multiple concentration toxicity testing upon failure of any
single quarterly test, you may choose to conduct either single concentration toxicity testing or multiple concentration toxicity testing per
the Division's WET enforcement initiatives effective July 1, 1999. Follow-up multiple concentration toxicity testing will influence the
Division's enforcement response.
➢ Toxicity testing months are specified by the NPDES Permit, except for NPDES Permits which contain episodic toxicity monitoring
requirements (eg, if the testing months specified in your NPDES permit are March, June, September, and December, then toxicity testing
must be conducted during these months).
➢ If your NPDES Permit specifies episodic monitoring and your facility does not have a discharge from January 1-June 30, then you must
provide written notification to the Environmental Sciences Section by June 30 that a discharge did not occur during the first six months
of the calendar year.
➢ If you receive notification from your contract laboratory that a test was invalidated, you should immediately notify the Environmental
Sciences Section at [phone] and provide written documentation indicating why the test was invalidated and the date when
follow-up testing will occur.
➢ If your facility is required to conduct toxicity testing during a month in which no discharge occurs, you should complete the information
block located at the top of the AT form indicating the facility name, permit number, pipe number, county and the month/year of the
subject report. You should also write "No Flow" on the AT form, sign the form and submit following normal procedures.
➢ The Aquatic Toxicity Test forms shall be signed by the facility's Operator in Responsible Charge (ORC) except for facilities which have
not received a facility classification. In these cases, a duly authorized facility representative must sign the AT form. The AT form must
also be signed by the performing lab supervisor.
➢ To determine if your AT test forms were received on time by the Division of Water Quality, you may consider submitting your toxicity
test results certified mail, return receipt requested to the Environmental Sciences Section.

RECEIVED
N.C. Dept. of ENR
0 C T C
ReginnalOmceL -1
(p y—
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
October 1, 2008
CERTIFIED MAIL 7002-0860-0006-5836-2148
RETURN RECEIPT REQUESTED
Mr. Thomas H. McGee
Pentacostal Holiness Church
P.O. Box 150
Browns Summit, North Carolina 27214
Dear Mr. McGee:
Coleen H. Sullins, Director
Division of Water Quality
Subject: NOTICE OF VIOLATION
Western NC Conference Center
NPDES Permit NCO046809
Guilford County
NOV-2008-LR-0066
This is to inform you that the Division of Water Quality has not received your monthly
monitoring report for July 2008. This is in violation of Part II, Condition D(2) of the NPDES permit, as
well as 15A NCAC 2B .506(a), which requires the submittal of Discharge Monitoring Reports no later
than the thirtieth (30t) day following the reporting period. Failure to submit reports as required will
subject the violator to the assessment of a civil penalty of up to $25,000 per violation. You will be
considered noncompliant with the self -monitoring requirements of your NPDES permit until the report
has been submitted.
To prevent further action, please submit said report within fifteen (15) days of receipt of this
notice.
The Division must take these steps because timely submittal of discharge monitoring reports is
essential to the efficient operation of our water quality programs. We appreciate your assistance in this
matter. If you have any questions about this letter or Discharge Monitoring Reports, please contact me at
919-807-6388.
Sincerely,
lla �h C
l� tip.
Ma reen Scardina
cc: Maureen Scardina, NPDES Unit
DWQ-Wi-nsto_n-Sa_le_m Regional Office Supervisor
Central Files
NNorthCarotina
aturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper

Cbr
MERITECH, 1 NC
ENVIRONMENTAL LABORATORIES
j A Division of Water Technology and Controls, Inc.
June 4, 2008
To Whom It May Concern:
RECENT-!
N.C. De'
'JUN 0 5 2000
Winston -Sales
Regional Office
This letter is regarding the notice of. violation for Pentecostal Holiness
Church dated May 6, 2008. The system now has a complete 0 & M plan
and a map of the collection system. Also, grease education materials will
be. handed out each year in January and June.
If you have any questions, please call me at 336-342-4748.
cerely,
Patrick Merritt
ORC
642 Tamco Road • P.O. Box 27 a Reidsville, NC 27320
[phone] • [phone] Fax

I
i
7
r-
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summitt, NC 27214
SUBJECT: Notice of Violation - Effluent Limitations
NOV-2008-LV-0420
Pentecostal Holiness Church WWTP
NPDES No. NCO046809
Guilford County.
Rev. McGhee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
29 August 2008
Coleen H. Sullins, Director
Division of Water Quality
Review of the self -monitoring report for the month of June 2008 revealed the following daily
maximum effluent limit violation:
Date
Parameter
Permit Limit
Reported Value
Units
6/26
Total Suspended Solids
45.0
83.0
mg/L
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Supervisor
cc: Central Files-SWP
`Guilford County Health Dept
AWSR1*7
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Winston-Salem Regional Office Winston-Salem, NC 27107 Fax [phone]
Internet: www.ncwateroudlitv.org
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
N" ❑�en Carolina
A74ma!!y

Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: Permit/Pipe No.: NCOdA,606y Month/Year J Uri= 6g
Monthly Averalge Violations
Parameter Permit Limit DMR Value % Over Limit
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:
Regional Water Quality
Supervisor Signoff:
�v
Date.
Date:
�J6V., g—LV- 6,d-;?�O

r
1
EFFLUENT
NPDES PERMIT NO. NC 0"0 4 6 8 0 9 DISCHARGE NO. 0 01 MONTH J "�-- YEAR aOGg
FACILITY NAME Pentecostal Holiness Church F, CLASS II COUNTY�ild-'
OPERATOR IN RESPONSIBLE CHARGE (ORC)Patri ck Merritt GRADEI I PHONE [phone]
CERTIFIED LABORATORIES (1) Meri tech Inc -
CHECK BOX IF ORC HAS CHANGED g
R CEIV
Mail ORIGINAL and ONE COPY to: N c. oeot. of ENR
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
COLLECTING SAMPLES Patrick Merritt
`7 b4ce
URE, I CERTIFY THAT THIS REPORT IS
COMPLETE TO THE BEST OF MY KNOWLEDGE.
900
DWQ Form MR-1 (01/00)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance,' etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Penfe ostal Holiness Church
Permllee (Please print or type)
k-7 106
Signature of ittee** Date
(Required)
P.O. Box 150, Brown Summit, NC 27214 (336)645_5476
Permittee Address Phone Number Permit Exp. Date
00010
Temperature
00076
Turbidity
00080
Color (Pt -Co)
00082
Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen.
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665
Total Phosphorous
00720
Cyanide
00745
Total Sulfide
00927
Total Magnesium
00929
Total Sodium
00940
Total Chloride
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147
Total Selenium
71880
Formaldehyde
31616
Fecal Coliform
71900
Mercury
32730
Total Phenolics
81551
Xylene
01037
Total Cobalt
34235
Benzene
01042
Copper
34481
Toluene
01045
Iron
38260
MBAS
01051
Lead
39516
PCBs
01062
Molybdenum
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/wqs and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204. so S - 9nV
** If signed by other than the permittee, delegation of signatory authority must be on file with: the- state.per...15A NCAC;2B .0506 (b)
(2) (D)• iw

rA
NPDES NO.
NCO046809 DISCHARGE NO.
001 MONTH
YEAR 2001�)
FACILTY NAME
Pentecostal Holiness Church
—COUNr Guilford
STREAM
Unnamed Tilbutary
to Benaja Creek — STREAM
Unnamed tributary to 13enaia Creek
LOCATION 100 ft upstream from the ouffall
Upstream
milli
vem Form MR-3 (12m)
LOCATION 100 ft.,downstream
Downstream
OBWO
00400
50M
00300
31616
00865
ul
W z
hc
U
> Lu
i
0: W
0
UJ 0
Lu j
0
-J 0
"J
U)
0 Lli
r-
W
0
0
MRS
-C
UMTS
UGfL
MOIL
#1100ML
mnhetfcm
3
5
7
9
11
4,
13
C) Q
15
17
"F
19
7
7--
211
1
1
21 2�
23
24
25
t tt
28
%�
oO
28
29
31
AVERAGE
MAMMUM
1-7.00
41 1
MINIMUM

AUG -5 08

�0F W A TE9Q
� r
Rev. Thomas McGhee
Pentecostal Holiness Church
P. O. Box 150
Browns Summit, NC 27214-0150
SUBJECT: Compliance Evaluation Inspection
Pentecostal Holiness Church
Western NC Conference Center WWTP
NPDES Permit No. NCO046809
Guilford County
Dear Rev. McGhee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
09 April 2008
Coleen H. Sullins, Director
Division of Water Quality
A Compliance Evaluation Inspection was performed on the Pentecostal Holiness Church Western NC Conference Center
wastewater treatment facility on April 9, 2008 by Corey Basinger of the Winston-Salem Regional Office. Patrick Merritt,
ORC was present for the subject inspection. The inspection consisted of two parts: an on -site inspection of the treatment
facility and an in -office file review. The following are the findings from the subject inspection.
I. Permit
The NPDES permit for the Pentecostal Holiness Church WWTP became effective on May 1, 2006 and expires on April 30,
2011. The permitted wastewater treatment components for the 0.020 MGD facility include a splitter box, bar screen, dual
parallel aeration tanks, dual parallel clarifiers, dual tertiary filters, tablet chlorination, and chlorine contact chamber. An
Authorization to Construct (No. 046809A01) was issued October 29, 2007. The professional engineer's certification was
received on January 18, 2008.
II. Records/Reports
A daily visitation log was available at the site. Information contained in this daily log included field parameter data,
maintenance records, and process control data. The Annual Performance Report has not yet been submitted
calendar year 2007. The Annual Performance Report was due by April 1, 2008. Please submit the 2007 Annual
Performance Report immediately..
III. Facility Site Review
On the date of inspection, only the right side treatment works was in operation and consisted of a splitter box, bar
screen, aeration tank, secondary clarifier, tablet chlorinator, chlorine contact chamber and dechlorination unit. The
tertiary filter was not in service. The left side treatment works is not being used due to the small amount of flow
tributary to the system.
IV. Effluent & Receiving Waters
The Pentecostal Holiness Church discharges to an unnamed tributary to Benaja Creek (Class C-NSW waters in the Cape
Fear River Basin). On the date of the inspection, -the minimal effluent discharge was clear and free of visible solids.
The receiving stream was free of solids, foam and debris.
NorthCarolina
Nattirally
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Winston-Salem Regional Office Winston-Salem, NC 27107 Fax [phone]
Internet: www.ncwaterguality.org
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

V. Flow Measurement
Flow is required to be measured instantaneously. Currently flow is measure using the gauge on the chlorinator. The
facility receives very little flow (-1,000 gpd or less). However, the future addition of 4,650 gpd of additional
wastewater from the proposed two (2) summer youth camp buildings should produce enough flow to warrant the
installation of an adequate flow measurement device. The Division will address this issue at the appropriate time.
VI. Self -Monitoring Program
A review of the discharge monitoring reports (DMRs) for the time period of January 2007 through December 2007
showed that the Pentecostal Holiness Church WWTP experienced only one (1) permit effluent limitation violation.
This was handled via previous correspondence from the Division.
VII. Compliance Schedules
No compliance schedule to evaluate.
VIII. Laboratory
All of the samples are taken to a contract lab (Meritech, Inc.) for analysis.
IX. Operations and Maintenance
This facility receives very little flow (-1,000 gpd or less). Currently, only one (1) of the two (2) treatment trains was
being used. Both blowers/motors were operational. The diffusers appeared to be functioning properly. The clarifier
had some minor pin floc.
X. Sludge Utilization/Disposal
Solids are removed as necessary by a licensed hauler.
XI. Pretreatment, Pollution Prevention, Multimedia
Not applicable for this facility
XII. Stormwater
Not applicable for this facility.
XIII. Sewer Overflow
No sewer overflows were reported during the review period. A collection system inspection form was attached to
the previous inspection report (dated May 10, 2007) for you to complete and return to this Office. This Office
has no record of that form being completed and returned. This form was completed during the subject
inspection and you will receive a separate correspondence concerning the findings.
XIV. Other
The previous inspection was conducted by Corey Basinger of the Winston-Salem Regional Office on May 9, 2007.
If you should have any questions or concerns regarding this report, please contact this Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Supervisor
Cc: Patrick Merritt, ORC (Meritech, Inc. 642 Tamco Rd, PO Box 27, Reidsville, NC 27320)
Guilford County Health Department
Central Files, ; - RO

Form Approved
OMB No.2040-0057
Approval Expires
8-31-98
United States Environmental Protection Agenev. Washington. D.C._ 20460
Section A: National Data System Coding
Transaction Code NPDES No. Yr/Mo/Day Inspection Type Inspector FacilityType
N 5 NCO046809 08-04-09 C S 2
Facility Evaluation Rating BI QA ..........Reserved...........
4 N N
Section B: Facility Data
Name and Location of Facility Inspected:
Entry Time:
Permit Effective
102011rs.
Date: May 1, 2006
Pentecostal Holiness Church WWTP
Hwy 29 North in Browns Summit, NC (Guilford Co)
Exit Time:
Permit Expiration
1100 hrs.
I Date: April 30, 2011
Name(s) of On -Site Representative(s): Title(s): Phone No(s):
Mr. Pat Merritt ORC [phone] cell
Name, Address of Responsible Official:
Title: Conference Superintendent
Rev. Thomas H. McGhee
Pentecostal Holiness Church
Phone No.
Contacted? No
P.O. Box 150
336-656-7936
Browns Summit, NC 27214-0150
Section C: Areas Evaluated During Inspection (check only those areas evaluated)
X Permit X Flow Measurement - X Operations/Maintenance _ Sewer Overflow
X Records/Reports X Self -Monitoring Program X Sludge Handling/Disposal _ Pollution revention
X Facility Site Review NA Compliance Schedules NA Pretreatment
X Effluent/Receiving Waters NA Laboratory Stormwater
Section D: Summary of Findings/Comments
See attached letter for further details regarding the subject inspection.
REVIEW PERIOD January 2007 — December 2007
Names and Signatures) of Inspectors:
Agency/Office/Telephone:
Date:
`
DWQ / WSRO / [phone]
Signature of Review
Agency/Office:
Date:
DWQ / WSRO / [phone]
�✓ P ®®

Permit: NCO046809
Inspection Date: 04/09/2008
Owner - Facility: Western NC Conference Center WWTP
Inspection Type: Compliance Sampling
Compliance Schedules
Yes
No
NA
NE
Is there a compliance schedule for this facility?
■
❑
❑
❑
Is the facility compliant with the permit and conditions for the review period?
■
❑
❑
❑
Comment: TRC limit took effect 11/1/2007.
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
■
❑
❑
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
Nr-
(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: TRC limit took effect 11/1/2007.
Record Keeping
Yes
No
NA
NE
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?
■
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 2417 with a certified operator on each shift? ❑ 0 ® ❑
Page # 3

Permit: NCO046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 04/09/2008 Inspection Type: Compliance Sampling
Record Keeping
Yes
No
NA
NE
Is the ORC visitation log available and current?
®n
n
n
Is the ORC certified at grade equal to or higher than the facility classification?
®n
n
n
Is the backup operator certified at one grade less or greater than the facility classification?
Is a copy of the current NPDES permit available on site?
®n
n
n
Facility has copy of previous year's Annual Report on file for review?
®n
n
n
Comment: No annual report on file with WSRO as of inspection date.
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
®n
n
n
Are the receiving water free of foam other than trace amounts and other debris?
®
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
n
n
®
n
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE .
# Is flow meter used for reporting?
❑
❑
■
❑
Is flow meter calibrated annually?
❑
❑
®
❑
Is the flow meter operational?
n
n
®
n
(If units are separated) Does the chart recorder match the flow meter?
n
n
®
❑
Comment: staff gauge on chlorinator used to report flow.
Aerobic Digester
Yes
No
NA
NE
Is the capacity adequate?
®
❑
❑
0
Is the mixing adequate?
®
❑
Is the site free of excessive foaming in the tank?
®
n
11
n
# Is the odor acceptable?
n
n
n
# Is tankage available for properly waste sludge?
Comment:
Bar Screens
Yes
No
NA
NE
Type of bar screen
a.Manual
b.Mechanical
n
Are the bars adequately screening debris?
®
n
❑
❑
Is the screen free of excessive debris?
®
n
n
n
Page # 4

Permit: NC0046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 04/09/2008 Inspection Type: Compliance Sampling
Bar Screens
Yes
No
NA
NE
Is disposal of screening in compliance?
■
n
n
n
Is the unit in good condition?
■
❑
❑
❑
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
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
❑
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?
Is the drive unit operational?
■
❑
❑
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
ri
Comment: clarifier was a little cloudy on date of inspection.
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
n
Are the tablets'the proper size and type?
■
n
n
n
Number of tubes in use?
2
Is the level of chlorine residual acceptable?
®n
n
n
Is the contact chamber free of growth, or sludge buildup?
®n
n
n
Is there chlorine residual prior to de -chlorination?
®n
n
n
Comment:
.� ..
Vn
KIn
IJA
KM
Type of system ? Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)? ®❑ ❑
Is storage appropriate for cylinders? ®n n n
# Is de -chlorination substance stored away from chlorine containers? ®n ❑ n
Comment:
Page # 5

Permit: NCO046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 04/09/2008 Inspection Type: Compliance Sampling
De -chlorination
Yes
No
NA
NE
Are the tablets the proper size and type?
®❑
❑
Are tablet de -chlorinators operational?
■
n
n
n
Number of tubes in use?
Comment:
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
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 1.0 to 4.4 degrees Celsius)?
n
n
n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
®n
n
n
Comment:
Upstream / Downstream Sampling
Yes
No
NA
NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)?
®
n
n
n
Comment:
Page # 6

Pentecostal -Holiness -Church-._
�To C No. 046809AOI
Issued October 29, 2007
RECEIVED
N r Dent. of -NR
Y1,r,5.an•Sa1em
Regional offiCe
Engineer's Certification
/ 4 �oej/sa duly registered istered Professional Engineer in
�
the State of North Carolina, having been authorized to observe (periodically/weekly/full time)
the construction of the modifications and improvements to the Western NC Conference Center
WWTP, located on US Hwy 29 North in It uiT1f±Ccruntyfor the Pentecostal Holiness Church,
hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on October 26, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
I certify that the construction
Date /?-Z G/ a Z
�S�1111111
M a of G0
referenced project was observed to be built
Send to: Construction Grants & Loans
DENR/DW Q
1633 Mail Service Center
Raleigh, NC 27699-1633
plans and specifications.
on No. %7G6%'
r f T

e o`,oF warF9QG
3 a _ ikllz —I
Rev. Thomas McGhee
Pentecostal Holiness Church
P. O. Box 150
Browns Summit, NC 27214-0150
SUBJECT: Compliance Evaluation Inspection
Pentecostal Holiness Church
Western NC Conference Center WWTP
NPDES Permit No. NCO046809
Guilford County
Dear Rev. McGhee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
10 May 2007
A Compliance Evaluation Inspection was performed on the Pentecostal Holiness Church Western NC Conference Center
wastewater treatment facility on May 9, 2006 by Corey Basinger of the Winston-Salem Regional Office. Patrick Merritt,
ORC and Rose Pruitt (Environmental Specialist with DWQ) were present for the subject inspection. The inspection
consisted of two parts: an on -site inspection of the treatment facility and an in -office file review. The following are the
findings from the subject inspection.
I. Permit
The NPDES permit for the Pentecostal Holiness Church WWTP became effective on May 1, 2006 and expires on April
30, 2011. The permitted wastewater treatment components for the 0.020 MGD facility include a splitter box, bar screen,
dual parallel aeration tanks, dual parallel clarifiers, dual tertiary filters, tablet chlorination, and chlorine contact
chamber.
II. Records/Reports
A daily visitation log was available at the site. Information contained in this daily log included field parameter data,
maintenance records, and process control data. The Annual Performance Report has not yet been submitted calendar
year 2006. The Annual Performance Report was due by April 1, 2007. You must submit the Annual
Performance Report by June 15, 2007.
III. Facility Site Review
On the date of inspection, only the right side treatment works was in operation and consisted of a splitter box, bar
screen, aeration tank, secondary clarifier, tablet chlorinator, and chlorine contact chamber. The tertiary filter was not in
service. The left side treatment works is not being used due to the small amount of flow tributary to the system.
IV. Effluent & Receiving Waters
The Pentecostal Holiness Church discharges to an unnamed tributary to Benaja Creek (Class C-NSW waters in the Cape
Fear River Basin). On the date of the inspection, the minimal effluent discharge was clear and free of visible solids.
The receiving stream was free of solids, foam and debris.
Nose Carolina
Ntum lly
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Winston-Salem Regional Office Winston-Salem, NC 27107 Fax [phone]
Internet: www.newaterquality.org
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

0
V. Flow Measurement
Flow is required to be measured instantaneously. Currently flow is measure using the gauge on the chlorinator. The
facility receives very little flow (-1,000 gpd or less). However, the future addition of 4,650 gpd of additional
wastewater from the proposed two (2) summer youth camp buildings should produce enough flow to warrant the
installation of an adequate flow measurement device. The Division will address this issue at the appropriate time.
VI..Self-Monitoring Program
A review of the discharge monitoring reports (DMRs) for the time period of January 2006 through December 2006
showed that the Pentecostal Holiness Church WWTP did not have any permit effluent limitation violations.
VII. Compliance Schedules
No compliance schedule to evaluate.
VIII. Laboratory
All of the samples are taken to a contract lab (Meritech, Inc.) for analysis.
IX. Operations and Maintenance
This facility receives very little flow (-1,000 gpd or less). Currently, only one (1) of the two (2) treatment trains was
being used. Both blowers/motors were operational. The diffusers appeared to be functioning properly. The clarifier
had some minor pin floc.
X. Sludge Utilization/Disposal
Solids are removed as necessary by a licensed hauler.
XI. Pretreatment, Pollution Prevention, Multimedia
Not applicable for this facility
XII. Stormwater
Not applicable for this facility.
XIII. Sewer Overflow
No sewer overflows were reported during the review period. A collection system inspection form is attached for you
to complete and return to this Office. Please return to Steve Mauney at the Division of Water Quality, 585
Waughtown Street, Winston-Salem, NC 27107 no later than June 15, 2007.
XIV. Other
The previous inspection was conducted by Corey Basinger of the Winston-Salem Regional Office on March 2, 2006
2005. If you should have any questions or concerns regarding this report, please contact this Office at (336) 771-
5000.
Sincerel ,
Steve W. Tedder
Water Quality Supervisor
Cc: Patrick Merritt, ORC (Meritech, Inc. 642 Tamco Rd, PO Box 27, Reidsville, NC 27320)
Guilford County Health Department
Central Files, WSRO

Form Approved
OMB No.2040-0057
Approval Expires
8-31-98
United States Environmental Protection Aaencv. Washington_ D.C,.. 20460
Section A: National Data System Coding
Transaction Code NPDES No. Yr/Mo/Day Inspection Type Inspector FacilityType
N 5 NCO046809 07-05-09 C S 2
Facility Evaluation Rating BI QA ..........Reserved...........
4 N N
Section B: Facility Data
Name and Location of Facility Inspected:
Entry Time:
Permit Effective
1210 hrs.
Date: May 1, 2006
Pentecostal Holiness Church WWTP
Exit Time:
Permit Expiration
Hwy 29 North in Browns Summit, NC (Guilford Co)
1240 hrs. I
Date: Aril 30, 2011
Name(s) of On -Site Representative(s): Title(s): Phone No(s):
Mr. Pat Merrit ORC [phone] cell
Name, Address of Responsible Official:
Title: Conference Su erintendent
Phone No.
Contacted? No
Rev. Thomas H. McGhee
Pentecostal Holiness Church
P.O. Box 150
336-656-7936
Browns Summit, NC 27214-0150
Section C: Areas Evaluated During Inspection (check only those areas evaluated)
X Permit X Flow Measurement X Operations/Maintenance _ Sewer Overflow
X Records/Reports X Self -Monitoring Program X Sludge Handling/Disposal _ Pollution revention
X Facility Site Review NA Compliance Schedules NA Pretreatment
X Effluent/Receiving Waters NA Laboratory Stormwater
Section D: Summary of Findings/Comments
See attached letter for firrther details regarding the subject inspection.
REVIEW PERIOD January 2006 — December 2006
Name(s) and Si ature(s) of Inspectors:
Agency/Office/Telephone:
Date:
DWQ / WSRO / [phone]
�dl�
Signature of Reviewer:
Agency/Office:
Date:
DWQ / WSRO / [phone]
S�/G_O,

v
Permit: NCO046809
Inspection Date: 05/09/2007
Owner - Facility: Western NC Conference Center WWTP
Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ n ❑ n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ n ❑ 0—
Judge, and other that are applicable?
Comment:
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
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?
■
❑
❑
❑
Comment: new TRC limit to be effective November 1, 2007.
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?
■
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 24R with a certified operator on each shift?
■
n
I]
Is the ORC visitation log available and current?
■
❑
n
n
Is the ORC certified at grade equal to or higher than the facility classification?
■
n
n
n
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑
n
n
Is a copy of the current NPDES permit available on site?
■
n
n
n
Page # 3

r
Permit: NCO046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 05/09/2007 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Facility has copy of previous years Annual Report on file for review?
■
n
n
n
Comment: annual report was due April 1, 2007. Not received by WSRO. Must submit
by June 15, 2007.
Effluent Pipe
Yes
No
NA
NE
Is right of way to the outfall properly maintained?
■
Are the receiving water free of foam other than trace amounts and other debris?
■
n
n
n
If effluent (diffuser pipes are required) are they operating properly?
❑
❑
■
11
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
110
■
Is flow meter calibrated annually?
■
n
011
Is the flow meter operational?
00
■
n
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
■
Comment: staff gauge on chlorinator used to report flow.
Aerobic Digester
Yes
No
NA
NE
Is the capacity adequate?
■
❑
❑
❑
Is the mixing adequate?
■
n
n
n
Is the site free of excessive foaming in the tank?
■
n
n
n
# Is the odor acceptable?
■
❑
❑
❑
# Is tankage available for properly waste sludge?
■
n
n
n
Comment:
Yns
Nn
NA
NF
Type of bar screen
a.Manual
■
b.Mechanical
❑
Are the bars adequately screening debris?
■
n
n n
Is the screen free of excessive debris?
■
n
n n
Is disposal of screening in compliance?
■
n
n n
Is the unit in good condition?
■
❑
Comment:
Page # 4

w
Permit: NCO046809 Owner - Facility: Western NC Conference Center WWTP
Inspection Date: 05/09/2007 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
❑
❑
n
Is the site free of excessive buildup of solids in center well of circular clarifier?
■
n
n
n
Are weirs level?
■
❑
❑
❑
Is the site free of weir blockage?
■
❑
n
n
Is the site free of evidence of short-circuiting?
■
❑
❑
n
Is scum removal adequate?
■
❑
❑
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?
■
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately of the sidewall depth)
■
n
n
n
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
n
n
Are surface aerators and mixers operational?
■
n
Are the diffusers operational?
■
n
n
❑
Is the foam the proper color for the treatment process?
■
n
n
n
Does the foam cover less than 25% of the basin's surface?
■
n
n
n
Is the DO level acceptable?
■
n
n
n
Is the DO level acceptable?(1.0 to 3.0 mg/1)
■
n
n
n
Comment:
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
n
n
n
Are the tablets the proper size and type?
■
1-1
171
Number of tubes in use?
.3
Is the level of chlorine residual acceptable?
■
n
n
n
Is the contact chamber free of growth, or sludge buildup?
■
n
Cl
n
Page # 5

Permit: NCO046809
Inspection Date: 05/09/2007
Disinfection -Tablet
Owner - Facility: Western NC Conference Center WWTP
Inspection Type: Compliance Evaluation
Is there chlorine residual prior to de -chlorination?
■
❑
fl
❑
Comment:
Effluent Sampling
Yes
No
NA
NE
Is composite sampling flow proportional?
❑
❑
■
❑
Is sample collected below all treatment units?
■
Is proper volume collected?
®
❑
❑
❑
Is the tubing clean?
n
n
■
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)?
®
n
n
n
Is the facility sampling performed as required by the permit (frequency, sampling type representative)?
■
n
Q
n
Comment:
Upstream / Downstream Sampling
Yesi No
NA
NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)?
■
Eln
n
Comment:
Page # 6

` 6ystem f A7ecoS7_4
NPDES # CDo 6 d
Inspector �B�5.ti1Gi2 ��•�
COLLECTION SYSTEM INSPECTION FORM
Dates 9 o Time /Z/a -/Z Va
Sanita Sewer Overflows SSOs
How many SSOs were reported to DWQ in the past 12.months?
to report to•DWQ all spills that reach surface- water or greater than 1,000gallons_
-(Required
Were all SSOs over 15,000 gallons reported by public notice? Y❑ N❑
If yes, ask for copies of notices
Were all SSOs that reached surface water & greater than 1,000 gallons reported fw1tha
press release? Y❑ N❑ If yes, ask for copies of releases
Comments:
Is the Collection -S stern Map current? Y❑ N❑ Does it include the following?.
Approximate age of sewer lines? Y❑ N❑ Line size?.Y❑ NO Pipe material?.Y[l N❑
Flow Direction? Y❑.N❑ Pump stations?:Y❑ HE]Major tap locations of satellite
systems? Y❑ N❑ Annual updates? Y❑ N❑ .Construction drawings? Y❑ N❑
.Comments:
Does the have a Grease Control Program? •Y❑ N❑
.system
Has the operator distributed educational material once every 2 years? Y❑. N❑
More fre uentl if SSO's are caused by grease? Y❑ N❑
Comments:
Hi 'h Priority Sewer Lines i.e. sus ended, in channel, or under body of water
Has the operator inspected high -priority sewer lines at least eve 6 months? Y❑ N❑
Has the operator maintained an inspection log? Y❑ N❑
Does it include the following: Dates of.inspections? Y❑ NE] Inspection methods such as
visual observation or cleaning lines andlor right-of-way? Y❑ N❑ Corrective
actions taken orplanned? Y❑ N❑
Comments:

z�
Does the Operation & Maintenance Plan include the following?
Pump station inspection frequency? Y❑ N❑ Spare Parts inventory? Y❑ N❑
Preventative maintenance schedule? Y❑ N❑ Overflow response plan? Y❑ N❑
Schedule to test emergency e ui ment? Y❑ NO
Comments:
Self -Monitorin , Inspections, & Maintenance.
Does the operator perform Pump Station Inspections on a weekly basis if functioning
telemet exists? Y❑ N❑ Or every day if no functional telemetry? Y❑ N❑
Do Pump Station.lnspections include the following maintenance tasks? Remove any
exterior debris as needed? Y❑ N❑ Remove interior debris as needed? Y❑ N❑
Exercise all valves? Y[) N❑ Lubricate pumps? Y❑ N❑ Lubricate any mechanical
equipment?_Y❑ N❑'Check operation of alarms?.Y❑ N❑ Check operation -of
telemetry? Y❑ N❑ Check operation of generator? Y❑ N❑ Is pump failure contingency
Ian osted at pump station? Y❑ N❑
Total # Pump Stations: # Pump Stations with telemetry:
# Pump Stations w/out tel&netry:
# pump Stations without emergency contact information osted
Comments:
Does the operator.adequately maintain Right -'Ways anal Easements? Y❑ N❑ . .
Does the o erator keep a maintenance to j or ma 'to show ro ress? Y❑ N❑
Comments:
Does operator perform Sewer Line Cleaning at rate of 10% of lines per yearTYEI N❑ .
Does the o e.rator ke.ep a maintenance log or map to show progress? Y❑ NEI
Comments:.
Is a general observation of the entire system performed on annual basis? Y❑ NO
Comments:
Are all records maintained for 3 ears? Y❑ N❑
Comments:71

wAr�RP�
r \
r
Rev. Thomas McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summitt, NC 27214
SUBJECT: Notice of Violation - Effluent Limitations
NOV-2007-LV-532
Pentecostal Holiness Church WWTP
NPDES No. NCO046809
Guilford County
Rev. McGhee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
2 November 2007
Coleen H. Sullins, Director
Division of Water Quality
Review of the self -monitoring report for the month of August 2007 revealed the following daily
maximum effluent limit violation:
Date
Parameter
Permit Limit
Reported Value
Units
8/24
Fecal Coliform
400.0
>600
#/100ml
Also, the compliance box on the reverse of the DMR was incorrectly marked as "complaint".
Remedial actions, if not already implemented, should be taken to correct the above noncompliance
problem(s). Please be aware that violations of your NPDES permit could subject you to enforcement
action by the Division with the possible assessment of civil penalties of up to $25,000 per day, per
violation. Should you have any questions, please contact this Office at [phone].
Sincerely,
Steve W. Tedder
Water Quality Supervisor
cc: Central Files-SWP
Noce Carolina
Naturally
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Winston-Salem Regional Office Winston-Salem, NC 27107 Fax [phone]
Internet: www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

IL
Cover Sheet from
Staff Member to
Regional Supervisor
DMR Review Record
Facility: �'�i L Permit/Pipe No.: P D ��Mo Month/Year
CAI
Monthly Average Violations
Parameter Permit Lin -lit D1 IR Value % Over Limit
Weekly Violations
Date Parameter Permit Limit/Tvpe DNIR Value % Over Limit
Monitoring Frequency Violations
Date Parameter Permit Frequencv Values Reported # of Violations
Other Violations
6 6z,-&
Completed by: .( Date:
Regional Water Quality
Supervisor Signoff: Date: /
1 A1 .
&VV � 0 � L V 3 -

EFFLUENT 2007
NPDES PERMIT NO. N C 0 0 4 6 8 0 9 DIS CHARGE NO. 001 MONTH YE -AR 20 7
FACILITY NAME Pentecostal Holiness Church CLASS II COUNTSiZ�f1d
OPERATOR IN RESPONSIBLE CHARGE (ORC)Patrick Merritt GRADEII O jw3�SI� 4748
CERTIFIED LABORATORIES /tom (2)
CHECK BOX IF ORC HAS CHANGED N �� oE�NYERSO .(S) LECTING SAMPLES Patrick Merritt
Mail ORIGINAL and ONE COPY tOUCT Z 3 2007 J �q
ATTN: CENTRAL FILES I X 1 ��
DIVISION OF WATER QUALITY ';:n !cn-Szlem(SIGNA RE'OF OPERA IN RESPONSIBL CHARGE) DATE
1617 MAIL SERVICE CENTER i Rey -n a! 0- T1ceBY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLE 0 ,
50050
00010
00400
50060
00310
00610
00530
31616
00300
00600
6T5
,`e�M } �,a
m
a
FLOW
WW
rz
ENTER PARAMETER CODE ABOVE
o
[= '
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NAME AND UNITS BELOW
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8
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❑
❑ MG/L
HRS
HRS
Y/B/N I
MGD
o C
UNITS
JZ UG/L
MG/L
MG/L
MG/L
#/100ML
MG/1 I
MG/L I
MG/L
MOM
mmmm
Em
�Mm
am=
smmmmsmmm
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11
DWQ Form MR-1 (01/00)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements [71
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements F-1
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time -table for improvements to be made.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry
of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Pent `ce ostal Holiness Church
Permit ee ( ease print or type)
A--��t - 01
Signature of Permittee" Date
(Required)
P.O. Box 150, Brown Summit, NC 27214 (336)645_5476
Permittee Address Phone Number Permit Exp. Date
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00095
Conductivity
00300
Dissolved Oxygen.
00310
BOD5
00340
COD
00400
pH
00530
Total Suspended
Residue
00545
Settleable Matter
PARAMETER CODES
00556
Oil & Grease
00951
Total Fluoride
00600
Total Nitrogen
01002
Total Arsenic
00610
Ammonia Nitrogen
00625
Total Kjeldhal
01027
Cadmium
Nitrogen
00630
Nitrates/Nitrites
01032
Hexavalent Chromium
01034
Chromium
00665 Total Phosphorous
00720
Cyanide
01037
Total Cobalt
00745
Total Sulfide
01042
Copper
00927
Total Magnesium
01045
Iron
00929
Total Sodium
01051
Lead
00940
Total Chloride
01062
Molybdenum
01067
Nickel
01077
Silver
01092
Zinc
01105
Aluminum
50060 Total
Residual
Chlorine
01147
Total Selenium
71880 Formaldehyde
31616
Fecal Coliform
71900 Mercury
32730
Total Phenolics
81551 Xylene
34235
Benzene
34481
Toluene
38260
MBAS
39516
PCBs
50050
Flow
Parameter Code assistance may obtained by calling the Point Source Compliance/Enforcement Unit at [phone] or by visiting
the Water Quality Section's web site at h2o.enr.state.nc.us/was and linking to the Unit's information pages.
Use only units designated in the reporting facility's permit for reporting data.
* ORC must visit facility and document visitation of facility as -required per 15A NCAC 8G .0204.
** If signed by other than the permittee, delegation -,of signatory authority must be on file with the state per 15A NCAC 2B .0506 (b)
(2) (D)•

NPDES NO. NCO046809 DISCHARGE NO. 001 MONTH
FACILTY NAME Pentecostal Holiness Church —COUNr Guilford
STREAM Unnamed Tributary to Benaja Creek — I STREAM
LOCATION 100 ft. upstream from the ouffall LOCATION
Upstream
•
- rum - p-)
PSQ c— YEAR 200-77r
Unnamed tributary to Benaja Creek
100 ft. downstream
Downstream
00010
00400
50060
00300
31616
00665
1
E P-
LU
Y
IK
=) U)
2
C3
LU
LU
1 E'a
U
0
1
In
0
4 M
v
=
LU -i
2
W
0. U3
CL
a
U)
W -1 02
� 0 LU
10
c
5-
0
U) 0
U
W
HRS
'C
UNITS
UGIL
MG/L
0/180ML
u.,h-.,,.
qq-5
ZP.11
lot(.
10
Vmo
13
is
7
20
21
22
n
24-
25
7
j
:w
27
29
3;1
)6-
Do
i;;
y;D
(J.7
A
0�0
6
AVERAGE
kO
? 1
MAXIMUM
igi
I
MINIMUM

6C T-

�F V'VATF
6*1
/ Michael F. Easley, Governor
October 29, 2007
The Honorable Reverend Thomas H. McGhee
Pentecostal Holiness Church
PO Box 150
Browns Summit, North Carolina 27214
Dear Reverend McGhee:
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
RECENED
N.C. Deot. of
yyinston.sale7n
Regional p{f'ce
SUBJECT: Authorization to Construct
A to C No. 046809A01
Pentecostal Holiness Church
Western NC Conference Center WWTP
Dechlorination Facilities
Guilford County
A fast track application for Authorization to. Construct dechlorination facilities was
received on October 26, 2007, by the Division. Authorization is hereby granted for the
construction of modifications to the existing Western NC Conference Center WWTP, with
discharge of treated wastewater effluent into unnamed tributary to Benaja Creek in the Cape Fear
River Basin.
This authorization results in no increase in design or permitted capacity and is awarded
for the construction of the following specific modifications:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on October 26, 2007, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
This Authorization to Construct is issued in accordance with Part III, Paragraph A of
NPDES Permit No. NCO046809 issued April 3, 2006, and shall be subject to revocation unless
the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No. NC0046809.
In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those as may
be required by this Division, such as the construction of additional or replacement wastewater
treatment or disposal facilities.
The Winston-Salem Regional Office, telephone number [phone] shall be notified
at least forty-eight (48) hours in advance of operation of the installed facilities so that an on site
NorthCarolina
Natllrallil
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: www.ncwaterguality.orq 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Reverend McGhee
October 29, 2007
Page 2
inspection can be made. Such notification to the regional supervisor shall be made during the
normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State
Holidays.
Pursuant to 15A NCAC 2H .0140, upon completion of construction and prior to operation
of these permitted facilities, the completed Engineering Certification form attached to this permit
shall be submitted to the address provided on the form.
Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of the
wastewater treatment facilities. The operator must hold a certificate of the type and grade at least
equivalent to or greater than the classification assigned to the wastewater treatment facilities by
the Certification Commission.
The Permittee must also employ a certified back-up operator of the appropriate type and
grade to comply with the conditions of T15A:8G.0202. The ORC of the facility must visit each
Class I facility at least weekly and each Class II, III and IV facility at least daily, excluding
weekends and holidays, must properly manage the facility, must document daily operation and
maintenance of the facility, and must comply with all other conditions of T15A:8G.0202.
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for the life of the facility.
During the construction of the proposed additions/modifications, the permittee shall
continue to properly maintain and operate the existing wastewater treatment facilities at all times,
and in such a manner, as necessary to comply with the effluent limits specified ui the NPDES
Permit.
You are reminded that it is mandatory for the project to be constructed in accordance
with the North Carolina Sedimentation Pollution Control Act, and, when applicable, the North
Carolina Dam Safety Act. In addition, the specifications must clearly state what the contractor's
responsibilities shall be in complying with these Acts.
Prior to entering into any contract(s) for construction, the recipient must have obtained all
applicable permits from the State.
Failure to abide by the requirements contained in this Authorization to Construct may
subject the Permittee to an enforcement action by the Division of Water Quality in accordance
with North Carolina General Statute 143-215.6A to 143-215.6C.
The issuance of this Authorization to Construct does not preclude the Permittee from
complying with any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.

V
Reverend McGhee
October 29, 2007
Page 3
If you have any questions or need additional information, please do not hesitate to contact
Cecil G. Madden, Jr., P.E. at telephone number [phone].
Sincerely,
Cole n H. Sull s
AR/cgm
cc: Gary S. MacConnell, P.E., MacConnell & Associates, P.C., Morrisville
Guilford County Health Department
Technical Assistance and Certification Unit'
Daniel Blaisdell, P.E.
Point Source Branch, NPDES Program
Cecil G. Madden, Jr., P.E.
Anita Reed, E.I.
ATC File

Pentecostal Holiness Church
A To C No. 046809A01
Issued October 29, 2007
Engineer's Certification
I, , as a duly registered Professional Engineer in
the State of North Carolina, having been authorized to observe (periodically/weekly/full time)
the construction of the modifications and improvements to the Western NC Conference Center
WWTP, located on US Hwy 29 North in Guilford County for the Pentecostal Holiness Church,
hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the following construction:
Installation of a dechlorination system utilizing sodium sulfite pursuant to the fast
track application received on October 26, 2007, and in conformity with the
Minimum Design Criteria for Dechlormation Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Signature
Date
Registration No.
Send to: Construction Grants & Loans
DENR/DWQ
1633 Mail Service Center
Raleigh, NC 27699-1633