NC0074110_Permit issuance_20110512

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
May 12, 2011
Cathy Childrey, President/ CEO
Mizpah Healthcare, Inc.
P.O. Box 1029
Marion, North Carolina 28752-1029
Dee Freeman
Secretary
Subject: Issuance of Permit NCO074110
NPDES, Class 2
Mountain View Assisted Living WWTP
238 Brookside Camp Road
Henderson County
Dear Ms. Childrey:
The Division of Water Quality (the Division) hereby issues the attached NPDES permit for the
subject facility. We issue this permit pursuant to 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 October 15, 2007, or as subsequently amended.
The Division understands that you have made no significant alterations to your wastewater treatment
facilities during the previous permit cycle. Based on your renewal application received May 20, 2010, we
have therefore made only minimal changes to your permit by updating your facility map, treatment -
component description, and adding parameter codes to the effluent monitoring page. We have also added a
footnote regarding Total Residual Chlorine [see Section, A. (L)].
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable, you have the right to an adjudicatory hearing, upon written request submitted within
thirty (30) days after receiving this letter. Your request must take the form of a written petition
conforming to Chapter 150B of the North Carolina General Statutes, and you must file it with the
office of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714.
Unless such a demand is made, this permit shall be final and binding.
This permit is not transferable except after notifying the Division of Water Quality. The Division
may require permit modification, or revocation and re -issuance. Please note that this permit does
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27644
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
Nne
orthCarolina
Naturally
An Equal Opportunity 1 Affirmative Action Employer

not affect your legal obligation to obtain other permits required by the Division of Water Quality,
the Division of Land Resources, the Coastal Area Management Act, -or other federal or local
governments.
If you have questions, or if we can further assist you, please contact Joe Corporon at
[ioe.cpMoron _ncdenr.gov] or call [phone].
ectfully,
�G
Coleen H. Sullins
o�oF wArF9p�
Enclosure: NPDES Permit NCO074110 (FINAL)
hc: Central Files
NPDES Program Files
ARO/SWPS, Attn: Roger Edwards, Supervisor
ec: CG&L Attn: Kim Colson
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NOrthCarolina
Internet: www.ncwaterquality.org //�
An Equal Opportunity 1 Affirmative Action Employer Naturally

;Permit NCO074110
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
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Mizpah Healthcare, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Mountain View Assisted Living WWTP
238 Brookside Camp Road
North of Balfour
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 June 1, 2011.
This permit and authorization to discharge shall expire at midnight on November 30, 2015.
Signed this day May 12, 2011.
— _ _,V., - C �� �
Con H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO074110
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
Mizpah Healthcare, Inc.
is hereby authorized to:
1. continue to operate an existing 0.005 MGD wastewater treatment system consisting of:
• extended aeration basin with gravity flow to
• 5000-gallon treatment system with grease trap and bar screen
• clarifier
• sludge holding basin
• dual blowers
• tertiary filter
• tablet -feed chlorinator
• chlorine -contact chamber
• tablet dechlorinator
• post aeration tank
• effluent discharge line
located at the Mountain View Assisted Living WWTP, 238 Brookside Camp Road Hendersonville,
Henderson County, and
2. discharge from said treatment works, at the location specified on the attached map, into an
unnamed tributary (UT) to Featherstone Creek [Stream Segment 6-55-12], a waterbody currently
classified C within subbasin 04-03-02 of the French Broad River Basin.

Mizpah Healthcare, Inc.
Mountain View Assisted Living WWTP
Latitude: 35° 22' 55" N Longitude: 82° 28' 05" W
State Grid / USGS Quad: F 9 NW /Fruitland, NC Stream Class: C
Drainage Basin: French Broad River Basin Sub -Basin: 04-03-02
Receiving Stream: UT to Featherstone Creek [seg. 6-55-12] Huc: 06010105
Facility
Location
(not to scale)
North. NPDES Permit NCO074110
1 Henderson County

Permit NCO074110
A. (l .) 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:
EFFLUENT
LIMITS
MONITORING REQUIREMENTS'
CHARACTERISTICS
Monthly
Daily
Measurement
Sample
Sample
[Parameter Codes]
Average
Maximum
Frequency
Type
Location I
Flow
[50050
0.005 MGD
Continuous
Recording
I or E
Temperature (°C)
Daily
Grab
E
[00010]
Total Residual Chlorine 2
28 gg/L 2
2/Week
Grab
E
50060]
BOD, 5-day (20°C) [Apr01-Oct31 ]
5.0 mg/L
7.5 mg/L
Weekly
Composite
E
[C0310
BOD, 5-day (20°C) [NovO1-Mar31]
10.0 mg/L
15.0 mg/L
Weekly
Composite
E
C0310]
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
E
C0530]
NH3 as N [Apr01-Oct31 ]
2.0 mg/L
10.0 mg/L
Weekly
Composite
E
00610
NH3 as N [NovOI-Mar31]
4.0 mg/L
20.0 mg/L
Weekly
Composite
E
00610]
Dissolved Oxygen
Not < 6.0
mg/L
Weekly
Grab
E
[00300]
Fecal Coliform (geometric mean)
200/100 ml
4001100 ml
Weekly
Grab
E
[31616
pH
Not < 6.0 nor > 9.0
Weekly
Grab
E
[00400]
standard units
Dissolved Oxygen
Weekly
Grab
U & D
[003001
Fecal Coliform (geometric mean)
Weekly
Grab
U & D
31616
Temperature (°C)
Weekly
Grab
U & D
[00010]
Footnotes:
1. E = Effluent; I = Influent; U = Upstream 50 feet above the discharge point; D= Downstream 50 feet from the
discharge point. 0
2. Total Residual Chlorine (TRC) - The Division shall consider all effluent TRC values reported below 50µg/L to be
compliant with this permit. However, the Permittee shall continue to record and submit all values reported by a
North Carolina -certified laboratory (including field certified), even if these values fall below 50µg/L.
Condition: The Permittee shall discharge no floating solids or foam.

Corporon, Joe
From:
Hennessy, John
Sent:
Wednesday, May 11, 2011 12:28 PM
To:
Corporon, Joe
Subject:
FW: NC0074110 Mtn. View Assisted
From: Haynes, Keith
Sent: Wednesday, May 11, 2011 11:01 AM
To: Hennessy, John
Cc: Edwards, Roger
Subject: NC0074110 Mtn. View Assisted
We don't have any specific requests for the permit renewal at this time. They have not reported any violations since
May 2010. Several of the violations prior to that were chlorine that were BPJd. Only seven enforcement cases since
1998, even though three were in 2010. Thanks.
Keith Haynes - Keith. [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Surface Water Protection
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the NC Public Records Law and may be
disclosed to third parties.

NCDENR/DWQ/NPDES
32002513
Notification of Intent to Issue a NPDES Wastewater
Permit
$200.37
CERTIFICATION OF PUBLICATION
March 22, 2011
1, Jan Sullivan, affirming the following under the penalties of
perjury state:
I am employed by Times -News, a subsidiary of the New York
Times Company. Times -News, a daily newspaper of general
circulation printed and published in the city of Hendersonville,
county of Henderson, and state of North Carolina. I hereby
certify that the advertisement annexed hereto was published in
the editions of The Times -News on the following date or dates:
03/ 19/11
And that the said newspaper in which such notice, paper,.
document, or legal advertisement was published was, at the time
of each and every publication, a newspaper meeting all of the
requirements and qualifications of Section 1-597 of the General
Statutes of North Carolina and was a qualified newspaper within
the meaning of Section 1-597 of the General Statutes of North
Carolina.
This 22nd day of March, 2011.
(Signed) IUc���
Sworn to an(Vsubscribed before me, this 22nd day of
March, 2011.
\IQ.CX12�✓lr I� • C1�ur� Notary Public
Deborah H. Owen
Times -News
A PART OF
The NewYorkThes
Company
PUBLIC NOTICE
City of Heide'rsonville
[305 Williams ' Street,
9 North Carolina'I
Hendersonville, NC.
Environmental
287921 has requested
Management.
renewal., of, permit
Commission%
NCQ042277 for its WTP
NPDES Unit
-in Henderson County;
1617 Mail Service;.
this permitted discharge
Center `:.,.- .
is treated filter -back.,.
Raleigh; NC
wash wastewater to
27699-1617
Brandy Branch, French
=6 I
of
No#ice Intent to
Broad River Basin.
Issue a-NPDES
WaStetirater. Permit
Leonard Schroader
applied to , renew
The North. Carolina
Environmental Man-
NPDES permit NC ;
0075647 for Hidden,,
agement ` 'Commission
.,.
Gap MHP; 'Hender�ort,:'
County; discharging to
prpposesf to issue a
NPDES, wastewater dis-»
-
UT of Devils F `
t.
French_-- Broad'.. F�ixe�
:.charge` permit. to the
person(s) listed belbw.
�� -
Basin.
.Written: comments' re-
Mizpah Healthcare Inc.,-.-
applied to renew permit
garding the proposed
permit, will, be;, accepted-
number
WV 110,
until. 30. days after the
View
Mountain View WWTP,
Brookside Camp Road,
publish, date ,of ,this, no-
tire. ,The Director of the
Henderson County, dis-
NC< Division .of. Water
Quality (DWQ) mayhold
charging to UT of
Featherstgne Creek,
a public hearing should
French Broad River Ba-
there be a significant
sin.,
degree of public inter.-
Veolia Water North
est- Please mail com-
America applied to re-
ments andTor informs '-
tiorr requests to.DWQ at -,
new NPDES
NCO073741 for.
permit
Moun-
the..above:,,address: 1n7
tain Valley- Subdivision
terested persons may I
WWTP, ` ' Henderson
visit the DWQ at 512 N:
County; discharging to
Salisbury Ra-
the,.:French_Broad River. -:
.Street,
Ieigh,,,NC'to review in �r Curerjtlr, total residual
formation` on fife:. Adds ::
6h (5 ne is water quali#y,
,
tional information ' on
NPDES permits and tf> §h
r
-' `
" notice may be found on
(y�J�•�`
our website:
b9k. -Qrtal.ncdenrort#.A. it N000063728
taab/wc/swp/ds/nodes/ .-
cadendar;�-aw -b-r jcallht w 1
(919) 80T BSi4
O Noto( P County
�endecson 1eS= 1717 Four Seasons Blvd. • Hendersonville, NC 28792
, My C;0MM ssto � bxP _ P. O. Box 490 • Hendersonville, NC 28793
p3ip112° O�\��\ 828/692-0505 • FAX [phone] • 828/693-5581
%,;yO�TH �� \,�� www.hendersonvillenews.com

FACT SHEET
FOR COMPLEX -EXPEDITED PERMIT RENEWAL
Basic Information
Permit Writer / Date
Joe R. Cgrporon, L.G. / I IMar2011
Permit Number
NCO074110
Facility
Mizpah Healthcare — I View Assisted
Living, Grade II
Henderson County, Flow = 0005 MGD
Regional Office / Contact
ARO / Roger Edwards
Basin Name/Sub-basin number
French Broad / 04-03-02
Receiving Stream
UT of Featherstone Creels [segment 6-55-12
Stream Classification in Permit/Verified
Cl Yes
Does permit need Daily Max NH3 limits?
No limited summer and winter
Does permit need TRC limits / language?
No / Yes - included TRC footnote
Does permit have toxicity testing?
No
Doespen-nit have Special Conditions?
No
Does permit have instream monitoring?
YES (DO / Temp / Fecal; no change recommended
Is the stream impaired [303(d) listed]?
No
Any obvious compliance concerns?
Yes [facility has long history of exceeding permit limits
for BOD, less for TRC DO and NH3.
Any permit mods since last permit?
No
Current expiration date
November 30, 2010
New expiration date
November 30, 2015
Comments received on Draft Permit?
BIMS Downloads and Review Results:
• BIMS DMR Report Violations (2006-2010) indicate regular non-compliance. Facility has 5-year
history of exceeding permit limits for BOD, less for TRC, DO, and NH3. ARO proceeded to
Notice of Violation and assessed civil penalties 14 times in 4 years — in 2010 alone 9 of 14 violations
proceeded to enforcement (see attached compliance summary).
• TOX data Summary — WET testing not required — no changes recommended.
For renewal: edited facility description (Supplement to Cover Sheet); updated map; added parameter
codes and resorted table by Sample Location [see A. (L)].
f
V T�

NC DENR - DIVISON OF WATER QUALITY
.0304 FRENCH BROAD RIVER BASIN
Name of Stream Description
Class
Class Date Index No.
Bat Fork From source to Johnson C 09/01/74 6-55-8-1
Drainage Ditch
Dunn Creek From source to Bat Fork C 09/01/74 6-55-8-1-1
King Creek [McCabe Pond, From source to Madonna Lake B 04/01/58 6-55-8-1-2-(1)
Jordans Lake, Bonclarken Dam
Lake, Madonna Lake
(Highlands Lake)]
2B .0300
King Creek
From Madonna Lake Dam to
C
09/01/74
6-55-8-1-2-(2)
Bat Fork
Meninger Creek
From source to King Creek
C
09/01/74
6-55-8-1-2-3
Dye Branch
From source to King Creek
C
09/01/74
6-55-8-1-2-4
Devils Fork
From source to Johnson
C
07/01/73
6-55-8-2
Drainage Ditch
Camp Branch
From source to Devils Fork
B
04/01/58
6-55-8-2-1
Britton Creek
From source to Mud Creek
C
09/01/74
6-55-9
Lugana Lake
Entire lake and connecting
C
09/01/74
6-55-9-1
stream to Britton Creek
Clear Creek
From source to Lewis Creek
B;Tr
08/01/98
6-55-11-(1)
Laurel Fork
From source to Clear Creek
C;Tr
07/01/73
6-55-11-2
Bold Branch
From source to Laurel Fork
C;Tr
07/01/73
6-55-11-2-1
Cox Creek
From source to Clear Creek
C;Tr
07/01/73
6-55-11-3
Puncheon Camp Creek
From source to Clear Creek
C;Tr
07/01/73
6-55-11-4
Clear Creek
From Lewis Creek to Mud
C
07/01/73
6-55-11-(5)
Creek
Lewis Creek
From source to Clear Creek
C;Tr
07/01/73
6-55-11-6
Big Branch
From source to Lewis Creek
C;Tr
07/01/73
6-55-11-6-0.5
Byers Creek
From source to Lewis Creek
C;Tr
07/01/73
6-55-11-6-1
Coon Branch
From source to Lewis Creek
C;Tr
07/01/73
6-55-11-6-2
Mill Creek
From source to Clear Creek
C
07/01/73
6-55-11-7
Kyles Creek
From source to Clear Creek
C;Tr
07/01/73
6-55-11-8
Lanning Mill Creek
From source to Kyles Creek
C
09/01/74
6-55-11-8-1
Henderson Creek
From source to,Clear Creek
C;Tr
08/01/84
6-55-11-9
Camp Judaea Lake
Entire lake and connecting
B;Tr
08/01/84
6-55-11-9-1
stream to Henderson Creek
Laurel Branch
From source to Clear Creek
C
07/01/73
6-55-11-10
Harper Creek
From source to Clear Creek
B;Tr
07/01/73
6-55-11-11
Phillips Branch
From source to Clear Creek
C
09/01/74
6-55-11-12
wolfpen Creek
From source to Clear Creek
C
09/01/74
6-55-11-13
Allen Branch
From source to Clear Creek
C
07/01/73
6-55-11-14
Cherry Branch (Lake David)
From source to Clear Creek
C
09/01/74
6-55-11-IS
Featherstone Creek
From source to Mud Creek
C
09/01/74
6-55-12
Byers Creek
From source to Mud Creek
C
09/01/74
6-55-13
Hollaman Lake
Entire lake and connecting
C
04/01/96
6-56 ' V
stream to French Broad River
Cane Creek From source to Ashworth C;Tr 04/01/96 6-57-(1) J `�
Creek s
D�
Spring Mountain Branch
From source to Cane Creek C;Tr
04/01/96
6-57-2
3T� Z
Ellison Branch
Rocky Fork
From source to Cane Creek C;Tr
From to Cane Creek C;Tr
04/01/96
6-57-3
`
source
04/01/96
6-57-4
V
Page 27 of 63
2011-03-05
07:18:30

3/ 11 /2011
IWC Calculations
Mizpah Healcare Inc - Mtn View Assisted Living 1 Assume upstream TRC level = 0
NC0074110 Assume upstream Fecal level = 0
Prepared By: JRC Check Box if WTP Facility ❑
Enter Design Flow (MGD): 0.002 Enter Upstream NH3-N Level (mg/L):
Enter s7Q10(cfs): 0.000
Enter w7Q10 (cfs): 0.040
Total Residual Chlorine
7Q10 (CFS)
DESIGN FLOW (MGD)
DESIGN FLOW (CFS)
STREAM STD (UG/L)
UPS BACKGROUND LEVEL (I
IWC (%)
Allowable Conc. (ug/1)
Fecal Limit
(If DF >331; Monitor)
(If DF <331; Limit)
Dilution Factor (DF)
Ammonia (NH3 as N)
(summer)
0
7Q10 (CFS)
0
0.002
DESIGN FLOW (MGD)
0.002
0.0031
DESIGN FLOW (CFS)
0.0031
17.0
STREAM STD (MG/L)
1.0
0
UPS BACKGROUND LEVEL (1
0.000
100.00
IWC (%)
100.00
17
Allowable Conc. (mg/1)
1.00
Ammonia (NH3 as N)
(winter)
7Q10 (CFS)
0.04
200/100ml
DESIGN FLOW (MGD)
0.002
DESIGN FLOW (CFS)
0.0031
STREAM STD (MG/L)
1.8
1.00
UPS BACKGROUND LEVEL (r
0.000
IWC (%)
7.19
Allowable Conc. (mg/1)
25.03
Daily MAX
35.0 mg/L
3/11/2011

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
April 21, 2010
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James
To Whom It May Concern:
This letter is to request the renewal for the waste water treatment facility of Mountain View Assisted
Living, NPDES number NCO074110.
Sincerely
Juanita James
James and James Environmental Mgt., Inc.

James & James Environmental Management, Inc.
r
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
April 21, 2010
Mizpah Healthcare, Inc.
P. O. Box 1029
Marion, N. C. 28752-1029
Ms. Childrey,
Enclosed is the paperwork needed for the permit renewal for Mountain View Assisted Living . You will
need to fill in section 4 the population served. Then sign and date. You need to send the original and 2
copies to the state. Enclosed are the original and 2 copies of the renewal request, sludge removal plan
and map which need to go to the state with the permit renewal.
Once you receive your new permit from the state, would you please send us a copy as the state does not
send us a copy of your permit.
If you have any questions, call our office at 828-697-0063.
Thank you
Juanita Jalrfes
James & James Environmental Mgt., Inc.
j jemi; &be llsouth.net
828-697-0063

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NCO074110
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
MIZPAH HEALTHCARE INC
Facility Name
MOUNTAINVIEW ASSISTED LIVING
Mailing Address
P.O. BOX 1029
City
MARION
State / Zip Code
NORTH CAROLINA 28752-1029
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
2. Location of facility producing discharge: sr-^. ---�;
x a -
Check here if same address as above ❑�„�.�• ,
i
Street Address or State Road BROOKSIDE CAMP ROAD
City HENDERSONVILLE
F; I�t rir
State / Zip Code NORTH CAROLINA 28792
County HENDERSON
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 JAMES & JAMES ENVIRONMENTAL MGT., INC.
Mailing Address P.O. BOX 519
City MOUNTAIN HOME
State / Zip Code NORTH CAROLINA 28758
Telephone Number [phone]
Fax Number [phone]
1 of 4 Form-D 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply).
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
®
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: REST HM
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): C:15TI1� /ICI
REST HOME yyy >)�
Population served: G 7
5. Type of collection system
® Separate (sanitary sewer only)
6. Outfall Information:
Number of separate discharge points
❑ Combined (storm sewer and sanitary sewer)
a
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
FEATHERSTONE CREEK IN FRENCH BROAD RIVER BASIN
S. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacity, 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.
A 0.005 MGD EXTENDED AERATION FACILITY WITH INFLUENT LIFT STATION,
DIGESTER,TERITARY FILTERS AND CHLORINE CONTACT CHAMBER
2 of 4 Form-D 1106

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD.
10. Flow Information:
Treatment Plant Design flow 0.005 MGD
Annual Average daily flow 0.0015 MGD (for the previous 3 years)
Maximum daily flow 0.004 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
El Yes ®No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. Effluent testing data must be based on at least three samples
and must be no more than four and one half years old.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Number of
Samples
FBiochemical Oxygen Demand
13.5
5.2
MG/L
4
Fecal Coliform
11.0
9.6
#/ 100ML
4
Total Suspended Solids
12.5
8.1
MG/L
4
Temperature (Summer)
23.2
20.6
C
22
Temperature (Winter)
9.8
5.9
C
20
pH
7.6
7.3
UNITS
4
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NCO074110 Dredge or fill (Section 404 or CWA)
PSD (CAA) Special Order of Consent (SOC)
Non -attainment program (CAA) 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 kn $ e and i such information is true, complete, and accurate.
Printed name o Signing Title
3 of 4 Form-D 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
Signature of A
to
North Carolina General Statute 143-215.6 (b)(2)Lbltates: 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 knowly 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.)
4 of Form-D 1/06

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
April 21, 2010
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James
To Whom It May Concern:
Sludge from this facility (Mountain View Assisted Living) is pumped by Mike's Septic Tank Service
and is permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
G�
Juanita James
James and James Environmental Mgt., Inc.