NC0071897_permit issuance_20051114

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
November 14, 2005
Ms. Cathy Childrey
Mizpah Healthcare, Inc.
PO Box 1796
Southern Pines, North Carolina 28388
Subject: Issuance of NPDES Permit NCO071897
Henderson's Assisted Living WWT'P
Henderson County
Dear Ms. Childrey:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued 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 May 9, 1994 (or as subsequently amended).
This final permit includes no major changes from the draft permit sent to you on September 14,
2005. This permit includes a TRC limit that will take effect on June 1, 2007. If you wish to install
dechlorination equipment, the Division has promulgated a simplified approval process for such projects.
Guidance for approval of dechlorination projects may be viewed online at
http://viww.nccgl.net/news/ATCoverview.htn-A.
. If any parts, measurement frequencies or sampling requirements contained in this permit 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 in the form of a written petition, conforming to Chapter
150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings (6714 Mail
Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this decision shall be final
and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Quality or permits
required by the Division of Land Resources, the Coastal Area Management Act or any other Federal or Local
governmental permit that may be required. If you have any questions concerning this permit, please contact
Karen Rust at telephone number [phone], extension 361.
Sincerely,
V 4-.:
Alan W. Klimek, P.E.
cc: Central Files
Asheville Regional Office/Surface Water Protection Section
NPDES Files
NorthCarolina
Xaturallrr
N. C. Division of Water Quality 1611 Mail. Service Center Raleigh, North Carolina 27699-1617 Phone: [phone] Customer Service
Internet. httpJ/h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 Fax: [phone]
An Equal Opportunity/Affirmative Action Employer

PermitNCO071897
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 the
Henderson's Assisted Living WWTP
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 December 1, 2005.
This permit and authorization to discharge shall expire at midnight on November 30, 2010.
Signed this day November 14, 2005.
kirlr ; Alan W. Klimek, P. E., Din9ctor
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO071897
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 0.007 MGD wastewater treatment system with
the following components:
♦ Bar screen
♦ 9100 gallon aeration basin
♦ 40 square foot clarifier with sludge return
♦ 1140 gallon sludge holding tank
♦ Dual tertiary sand filter
♦ Chlorine contact tank
♦ Post aeration facilities
The facility is located at Henderson's Assisted Living 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. (I.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - FINAL
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
Average
Weekly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample Location'
(Parameter Codes)
Flow
0.007 MGD
Weekly
Instantaneous
Influent or Effluent
50050
BOD, 5-day (20T)
5.0 mg/L
7.5 mg/L
Weekly
Grab
Effluent
(April 1- October 31)
00310
BOD, 5-day (20°C)
10.0 mg/L
15.0 mg/L
Weekly
Grab
Effluent
(November 1- March 31)
00310
Total Suspended Residue
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
00530
NH3 as N
2.0 mg/L
10.0 mg/L
Weekly
Grab
Effluent
(April 1- October 31)
00610
NH3 as N
4.0 mg/L
20.0 mg/L
Weekly
Grab
Effluent
(November 1- March 31)
00610
Dissolved Oxygen2
Weekly
Grab
Effluent,
(00300)
Upstream &
Downstream
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
2/Month
Grab
Effluent
31616
Total Residual Chlorine3
17 µg/L
Weekly
Grab
Effluent
50060
Temperature (2C)
Weekly
Grab
Effluent,
(00010)
Upstream &
Downstream
pH4
Weekly
Grab
Effluent
00400
Footnotes:
1. 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/L.
3. The limit for total residual chlorine will take effect June 1, 2007, only if chlorine is used.
4. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or visible foam in other than trace amounts..

WC NOTICE,.
.`
ATE OF:N-M •
IRONMENTAL
GNAOEMENT", r
...r.aamYl; .
AFFIDAVIT OF PUBLICATION
BUNCOMBE COUNTY
SS.
NORTH CAROLINA
Before the undersigned, a Notary Public of said
County and State, duly commissioned, qualified and
authorized by law to administer oaths, personally
appeared Darryl Rhymes, who, being first duly
sworn, deposes and says: that he is the Legal
Billing Clerk of The Asheville Citizen -Times,
engaged in publication of a newspaper known as
The Asheville Citizen -Times, published, issued,
and entered as second class mail in the City of
Asheville, in said County and State; that he is
authorized to make this affidavit and sworn
statement; that the notice or other legal
advertisement, a true copy of which is attached
hereto, was published in The Asheville Citizen-,
Times on the following date: September 17, 2005
paper in which said notice, paper, document or legal
advertisement were published were, at the time of
each and every publication, a newspaper meeting all
of the requirements and qualifications of Section 1-
597 of the General Statues of North Carolina and
was a qualified newspaper within the meaning of
Section 1-597 of the General Statues of North
Carolina.
Signed this 19th, Septemb r 2005
Signature oirperso ng affidavi
Sworn to and subscribed before me the 19th day of
September 2005
PYE
(Notary Pdbfic) W -1 -
My Commission expires the 3rd day c o,
2008,"''•.,.Con tRF GD;a�'•

June 2, 2005
To: Mr. Charles Weaver, Jr.
NCDENR/Water Quality/NPDES Unit
From: Cathy Childrey
Henderson's Assisted Living
Mountain View Assisted Living
Re: NPDES Permit Renewal
dn.
y
Ini
1
J U N 7 2005
OENR - WATER QUALITY ;
POINT SOURCE BRANCH u
Today I received a call from Harry James with James and James
Environmental Services to inform me that an inspection had just
been completed at Henderson's Assisted Living by Mr. Roy Davis.
Mr. Davis at that time indicated the NPDES permit renewal had
not been received, to his knowledge, for Henderson's Assisted
Living. I informed Mr. James that Henderson's and Mountain
View's reports were completed and mailed via US Mail Service on
March 21, 2005.
Since the package was sent with the original and two copies as
requested for each facility I feel Mountain View's has not been
received either. Therefore, Mr. James stated I should FedEx
this package tomorrow morning to your attention. The noted
postmarked deadline was June 3, 2005. The f irst package was
sent regular mail- Mr. James advised me in the future to always
use certified mail or FedEx, this I plan to do.
If there are questions please do not hesitate to call me. I have
copied the copy of my package with two additional copies. I have
resigned the signature page- so you would have an original
signature. I also did a second signature page with only today's
date- I wasn't sure if the other would be acceptable. My number

is 910-848-0694. I am leaving to go to a conference meeting so
if there are further questions please feel free to contact Mr.
James at 828-697-0063, he has a copy of package also.
I am very appreciative of Mr. Roy Davis bringing this to our
attention; otherwise we would have been under the impression the
package was received- thanking Mr. Davis in advance.
Sincerely,
Cathy CWildrey
Pre/CEO/ Administrator
Cc: Marry James

N'PDES APPLICATION VOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfallr
UNNAMED TRIBUTARY IN THE FRENCH BROAD RIVER BASIN
10. Is this facility located on Native American lands? (check one)
YES ❑ NO X❑
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.
Person Signing
Title
Date
North Carolina GenWal Statute 143-215.6(bx2) pr+ovideWat. 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 A le, shalt be guilty of a misdemeanor punishable by a fine not to exceed $10,000, or by
imprisonment not to exceed sic months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $10,000 or
imprisonment not more than 5 years, or both for a similar offense.)
Page 3 of 3 Version 12102

James & James Environmental Management, Inc.
814-B Kanugs St., Hendersonville, N. C. 28739
OFFICE: [phone] FAX: [phone]
February 15, 2005
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Maas 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 Henderson's Assisted
Living, NPDES # NC0071897.
Sincerely
Juanita James
James and James Environmental Mgt., Inc.

James & James Environmental Management, Inc.
814-B Kanuga St., Hendersonville, N. C. 28739
OFFICE: [phone] FAX. [phone]
February 15, 2005
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 is pumped by Mike's Septic Tank Service and is permited to be dumped at
Brevard Waste Treatment System and MSD.
Sincerely
Juanita James
James and James Environmental Mgt., Inc.

FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
GDP
Facility Name
Soot SA5aistcd Li V I YZ
Reviewer
SG tUPC—
Basin/Sub-basin
bs OQL—
Receiving Stream
Stream Classification in permit
G
Stream Classification in BIMS
Is the stream impaired (listed on 303(d))?
�d
Is stream monitoring required?
Do they need NH3 limit(s)?
Q
Do they need TRC limit(s)?
Do they have whole -effluent toxicity testing?
Are there special conditions?
Existing Expiration Date
11 3 D b
Proposed Expiration Date
l
Miscellaneous Comments:
If expedited, is this impler per, it
J_.
or a more difficult one?