NC0071897_owner name change_19990303

+. State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
March 3, 1999
Ms. Cathy Childrey
Mizpah Healthcare, Inc.
P.O. Box 999
Mountain Home, North Carolina 28758
6,74
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: NPDES Permit Modification - Ownership Change
Henderson's Rest Home
Permit NCO071897
Henderson County
Dear Ms. Childrey:
In accordance with your request received February 10, 1999, the Division is forwarding the subject
permit modification. This permit modification changes the ownership of the permitted facility and the permit
expiration date. All other terms and conditions in the original permit remain unchanged and in full effect. This
permit modification is issued under the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the U. S. Environmental Protection Agency dated
December 6, 1983.
Please note that a new fee schedule for NPDES permits took effect on January 1, 1999. As a result of this
new fee schedule, there is no longer a fee required for ownership, changes. The check for $100.00 you submitted
with the modification request is enclosed, along with a document which explains the new fee schedule.
If any parts, measurement frequencies or sampling requirements contained in this permit modification
are unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be a written petition conforming to Chapter 150B of the
North Carolina General Statutes, filed with the Office of Administrative Hearings, Post Office Drawer 27447,
Raleigh, North Carolina 27611-7447. Unless such demand is made, this decision shall be final and binding.
This permit does not affect the legal requirement to obtain other permits which may be required by the
Division of Water Quality, the Division of Land Resources, Coastal Area Management Act, or any other Federal or
Local government permit that may be required. If you have any questions concerning this permit modification,
please contact Charles Weaver at the telephone number or address listed below.
cc: Central Files
Asheville Regional Office, Water Quality Section
NPDES Unit
Point Source Compliance Enforcement Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
Sincerely,
Original Signed By
David A. Goodrich
A. Preston Howard, Jr., P.E.
919 733-5083, extension 511 (fax) 919 733-0719
[e-mail]. state,nc. us

Permit NCO071897
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Mizpah Healthcare, Inc.
is hereby authorized to discharge wastewater from a facility located at
Henderson's Rest Home
602 Brookside Camp Road (NCSR 1528)
north of Hendersonville
Henderson County
to receiving waters designated as an unnamed tributary to Featherstone Creek in the
French Broad 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 March 3, 1999.
This permit and authorization to discharge shall expire at midnight on October 31, 2000.
Signed this day March 3, 1999.
Original Signed By
David A. Goodrich
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO071897
SUPPLEMENT TO PERMIT COVER SHEET
Mizpah Healthcare, Inc. is hereby authorized to:
1. Continue to operate an existing 0.007 MGD wastewater treatment system
consisting of the following components:
■ Bar screen
• Aeration basin
■ Clarifier with sludge return
■ Tertiary sand filter
■ Effluent disinfection
■ Sludge holding tank
The facility is located at Henderson's Rest Home at 602 Brookside Camp Road
north of Hendersonville in Henderson County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Featherstone Creek, classified C waters in the French
Broad River Basin.

Permit NCO071897
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS — SUMMER
(April 1 — October 31)
During the period beginning on the effective date of the permit and lasting until expiration, the
Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored
by the Permittee as specified below:
EFFLUENT ,
CHARACTERISTICS
LIMITS
MONITORING REQUIREMENTS ,". A -
Monthly
Average.
Daily
Maximum:
Measurement
Frequency
Sample Type
` Sample Locationl
Flow
0.007 MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5 day 20°C
5.0 m /I
7.5 m /I
2/MontW'
Grab
Effluent
Total Suspended Solids
30.0 m /l
45.0 m /l
2/ Ent
Grab
Effluent
NH3 as N
2.0 m /I
Month
Grab
Effluent
Dissolved Oxygen2
Weekly
Grab
Effluent, Upstream & Downstream
Fecal Coliform eometric mean
200/100 ml
400/100 ml
2/Month
L Grab
Effluent
Total Residual Chlorine
-2Aw-AVV
Grab
Effluent
Temperature °C
Weekly
Grab
Effluent, Upstream & Downstream
H3
Weekly
Grab
Effluent
Footnotes:
1. Sample Locations: Upstream = at Brookside Camp Road; Downstream = at mouth of tributary.
2. The daily average dissolved oxygen effluent concentration shall not be less than 6.0 mg/1.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units and shall be
monitored weekly at the effluent by grab sample
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS — WINTER
(November 1 — March 31)
During the period beginning on the effective date of the permit and lasting until expiration, the
Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored
by the Permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIMITS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Fre ueuc
Sample Type
` Sample Location!'
Flow
0.007 MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5 day 20°C
10.0 m /l
15.0 m /l
2/Mon
Grab
Effluent
Total Suspended Solids
30.0 m /I
45.0 m /I
2/ nth
Grab
Effluent
NH3 as N
4.0 m /I
Aonth
Grab
Effluent
Dissolved Oxygen2
Weekly
Grab
Effluent, Upstream & Downstream
Fecal Coliform(geometric mean
200/100 ml
400/100 ml
2/Month
Grab
Effluent
Total Residual Chlorine
@.
Grab
Effluent
Temperature °C
Weekly
Grab
Effluent, Upstream & Downstream
H3
Weekly
Grab
Effluent
Footnotes:
I. Sample Locations: Upstream = at Brookside Camp Road; Downstream = at mouth of tributary.
2. The daily average dissolved oxygen effluent concentration shall not be less than 6.0 mg/1.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units and shall be
monitored weekly at the effluent by grab sample
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NCO071897
A. (3.) ENGINEERING REPORT REQUIREMENT
Removal of the discharge will be required by the Division if a more environmentally sound alternative is
available.
An engineering report evaluating connection to the City of Hendersonville sewer system is due to the
Division no later than May 4, 2000, along with the permit renewal application. Upon review of the
results of the engineering report, the Division may reopen and modify this NPDES permit to require
removal of the discharge, a modified treatment system and / or revised effluent limitations within a
specified time schedule.

�31 - 27/1993 15: 57 4 PAGE 02
le State of North Carolina
Department of Environment,
Health and Natural Resources 4
Division of Environmental Management
James B., H Governor I -IL
D
Jonathan
rt 8Howes, SaGr®tet
A. Freston Howard, Jr., P.E., Director
a, J 4.: 1� • • \ � . RK; i •
1. Pemat holders name: �.m.�` R y o
2. Perivit's signing official's name and tint , _ — -
(Person kegally responsible for pextnit)
3. Malting address: City.
State' �_/ —Zip Cock: Pisosse:
1, Ibis request for a name change is a result of.
,_,.,__a. Change in ownership of properlykompany
__--b. Narne change only
_c. Oilier (please
2. New owner's name (name to be put on
New owner's or slgr ,S official's n m4
Mailing address- — -City' 1 tl
State -- Zip Code` ,`A6 Tr IWA: (Sae I !`1 -a - �

01/27!1999 15: 57 4 - I-- . _... . -
PAGE 03
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF
ENVIRONMENTAL. MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS
LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
RE, QUIRII3 rl7EMS:
1. This d:mnvleted application
2. PraCessing fee of S 100.00 (Checks tts be made payable to DEHNR)
3. If an ownership change, legal docwnentatiou of the transfer of ownership (such as a contract, deed,
articles of incorporation)
I=:ER'rTFICATION MM BE COMPLETED AND SIGNED BY BOTH THE CURRENT
PERMIT HOLDER AND THE NEW APPLICANT IN THE CASE OF CHANGE OF
OWNERSHIP. FOR NAME CHANCE ONLY, COMPLETE AND SIGN THE
APPLICANT'S" CERTIFICATION.
Current Perrnittee's Certification-,
1, A\� S-2 r` MA--�4 / _. attest that this application for namelownersWp change has been
reviewed and is accurate and oznpreie to the best of my knowledge. I understand that if all required parts
of this application are not completed and that If all required supporting information and attachments ate not
included, thisrapplication package Will be returned as ix=mplete.
Signature• Dom•
Applicant's Certification:
I, A < < ., � � c _ram - attest that this application for a name/ownership change has been
cv
reviewed and is A:rate and corn ete to the best of my knowledge, I understand that if all required pare
of this appt cation not #x mpleted grid that if all required supporting information and attachments are not
included, this a is kag1-1 w ttarnW as incomplete,
Signa e• Hatt'
-7-
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION
AND MATERIALS. SHOULD BE SENT TO THE FOLLOWING ADDRESS:
North Carollat Division of Environmental Mat:agement
Water Quality Srctlon
Permits and Engirteerirtg Emit
P.O. Box 2953$
Raleigh, North Carolina 27626-0535
Telephone: [phone]
Fax; `[phone]

SATISFACTION: The debt secured by the within Deed of Trust
together with the note(s) secured thereby has been satisfied in full.
This the day of 19
Signed:
Tax Lot No.
Verified by .
by _,
Recording: Time, Book and Page
Parcel Identifier No.
County on the day of
19
Mail after recording to Lax H. Veazey, Attorney, 210 North Main Street, Hendersonville, NC 28792.
This instrument prepared by Lox H. Veazey.
Brief Description for the index #602 Brookside Camp Road
PURCHASE MONEY
NORTH CAROLINA DEED OF TRUST
THIS DEED of TRUST made 15th day of January, 1998, by and between:
GRANTOR
MIZPAH PROPERTIES, LLC,
a North Carolina Limited Liability Company
LEX H. VEAZEY
TRUSTEE
BENEFICIARY
ALFRED MAYO
and wife,
WANDA P. MAYO
Enter in appropriate block for each party: name address, and, if appropriate, character of entity, e.g. corporation or partnership
The designation Grantor, Trustee, and Beneficiary as used herein shall include said parties, their heirs, successors, and assigns, and sha
include singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, That whereas the Grantor is indebted to the Beneficiary in the principal sum of ONE HUNDRED SEVENTY-FIVE THOUSANI
AND NO/100'S Dollars ($175,000.00), as evidenced by a Promissory Note of even date herewith, the terms of which are incorporate(
herein by reference. The final due date for payments of said Promissory Note, if not sooner paid, is JANUARY 15, 2005.
NOW, THEREFORE, as security for said indebtedness, advancements and other sums expended by Beneficiary pursuant to this Deei
of Trust and costs of collection (including attorneys fees as provided in the Promissory Note) and other valuable consideration, the receip
of which is hereby acknowledged, the Grantor has bargained, sold, given and conveyed and does by these presents bargain, sell, give, gran
and convey to said Trustee, his heirs, or successors; and assigns, the parcel(s) of land situated in the City of , HOOPERS CREEI
Township, HENDERSON County, North Carolina, (the "Premises") and more particularly described as follows:
BEGINNING at a point in the center of the intersection of the centerline of Brookside Camp Road (S.R. 1528) with the centerline of Hower(
Gap Road (S.R. 1006) and running thence within the pavement of Brookside Camp Road (S.R. 1528) and continuing along the southen
edge of the pavement of said Brookside Camp Road, North 67 deg. 06 min. 17 sec. East 433.58 feet to an iron pin at the northwest come
of Lot 3 as shown on plat entitled "Property of Jack Henderson and Joan Henderson" recorded in Plat Slide 2013, Henderson Count!
Registry; thence with the western edge of said Lot 3, South 39 deg. 26 min. 04 sec. East 259.03 feet to an iron pin at the southwest come
of said Lot 3 and the southernmost comer of said Lot 3; thence with an edge of Lot 2, the following two (2) courses and distances: Soutl
39 deg. 26 min. 04 sec. East 10 feet to an iron pin and South 39 deg. 26 min. 04 sec. East 35.19 feet to an iron pin; thence continuinc
with said Lot 2, South 63 deg. 12 min. 50 sec. West 35.75 feet to an iron pin at the westernmost corner of Lot 2 as shown on Plat Slid-4
2013 and the northernmost corner of Lot 1 of said subdivision; thence with the northern edge of Lot 1, the following two (2) courses am
distances: South 63 deg. 12 min. 50 sec. West 355.24 feet to an iron pin and South 63 deg. 12 min. 50 sec. West 29.51 feet to a point
in the center of Howard Gap Road (S.R. 1006); thence with the center of Howard Gap Road, the following two (2) courses and distances
North 41 deg. 41 min. 30 sec. West 190.24 feet and North 38 deg. 35 min. 20 sec. West 145.50 feet to the point and place of
BEGINNING, and containing 3.043 acres, more or less, as shown on that survey prepared by J. Glenn Haynes, RLS, entitled "Survey fo!
Mispah Properties, LLC", dated Dec. 3, 1997 and being Job No. B-4440. Being that property recorded in Deed Book 836 at page 229
Henderson County Registry.