NC0071897_permit issuance_20101213

NCQENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 13, 2010
Ms. Cathey Childrey, President/CEO
Mizpah Healthcare, Inc. ..
PO Box 1029
Marion, North Carolina 28752-1029
Subject: Issuance of NPDES Permit No. NCO071897
Henderson's Assisted Living WWTP
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 October 15, 2007 (or as subsequently amended).
The following modifications in the October 13, 2010 draft permit remain in the final permit:
• "Total Suspended Residue" has been changed to "Total Suspended Solids"
• Footnote #3 has been modified to include the following additional Total Residual Chlorine Language: "The facility
shall report all effluent TRC values reported by a NC certified laboratory including field certified. However, effluent
values below 50 ug/I will be treated as zero for compliance purposes."
• Footnote # 4 has been deleted.
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 Bob Guerra at telephone number [phone] or email at (bob.QuerraCcDncdenr.gov).
Sincerely,
�ColeenH. Sullins
Enclosure: NPDES Permit NCO071897
cc: NPDES Unit
Central files
Asheville Regional Office / Surface Water Protection (Ro er.edwards ncdenr. ov) (ecopy)
1617 Mail Service Center, Raleigh. North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] k FAX: [phone] Customer Service:1-877-623-6748
Internet: http://portal.ncdenr.orgtweb/wq/home
An Equal Opportunity 1 Affirmative Action Employer
One
NorthCarolina
AaturgCCff

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 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
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 January 01, 2011.
This permit and authorization to discharge shall expire at midnight on November 30, 2015.
Signed this day December 13, 2010.
�r Coleen H. Sullins, Director
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 superseded and, as of this issuance, any previously issued permit describing this
treatment facility or 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 described herein.
Mizpah Healthcare, Inc. is hereby authorized to:
1. Continue to operate an existing 0.007 MGD extended aeration wastewater treatment
plant consisting of the following treatment components:
♦ Bar screen
♦ 9,100 gallon - aeration basin
♦ Dual air blowers providing diffused air
♦ 1,535 gallon rectangular Clarifier with skimmer and sludge returns
♦ 1,400 gallon aerobic digestor
• Dual tertiary sand filter
♦ Tablet chlorinator
• 185 gallon baffled chlorine contact chamber
♦ Tablet dechlorinator
♦ 60 gallon post aeration tank
2. This facility is at the Henderson's Assisted Living facility, located at 602 Brookside
Camp Road in Henderson County.
3. 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.

Mizpah Healthcare, Inc. Facility
Henderson's Assisted Living WWTP Location
Latitude: 32° 22' 45" N State Grid: Fruitland not to scale
Longitude: 82° 28' 15" W Permitted Flow: 0.007 MGD
Receiving Stream: UT to Featherstone Creek Stream Class: C NPDES Permit No. NCO071897
Drainage Basin: French Broad River Basin Sub -Basin: 04-03-02 06010105 North I I Henderson County

Permit N00071897
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:
EFFLUENT MONITORING REQUIREMENTS
CHARACTERISTICS
Monthly
Daily
Measurement
-
Sample Type
Sample
Average
Maximum
Frequency
Location'
50050 - Flow
0.007 MGD
Weekly
Instantaneous '=
Influent or
Effluent
00310 - BOD, 5-day (20°C)
(April 1 — October 31)
5.0 mg/L
7.5 mg/L
Weekly
Grab
Effluent
00310 - BOD, 5-day (20°C)
(November 1 — March 31)
10.0 mg/L
15.0 mg/L
Weekly
Grab
Effluent
00530 - Total Suspended
Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
00610 - NH3 as N
(April 1 — October 31)
2.0 mg/L
10.0 mg/L
Weekly
Grab
Effluent
00610 - NH3 as N
(November 1 — March 31)
4.0 mg/L
20..0 mg/L
Weekly
Grab
Effluent
00300 - Dissolved Oxygen Effluent,
Weekly Grab Upstream &
Downstream
50060 - a otal Residual
Chlorine 17 µg/L Weekly I Grab Effluent
00010 - Temperature (°C) + I Weekly I Grab I Upstream &
00400 - pH 6.0 — 9.0 s.u. Weekly Grab Effluent
31616 - Fecal Coliform 200/100 ml 400/100 ml 2/Month Grab Effluent
(geometric mean)
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 Division shall consider all effluent TRC values reported below 50 ug/L to be in compliance with the
permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina
certified laboratory (including field certified), even if these values fall below 50 ug/L.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
1

From: Frazier, Wanda
Sent: Monday, October 25, 2010 2:29 PM
To: 'Bob Guerra'
Cc: Edwards, Roger
Subject: NCO071897 draft permit renewal Henderson's Assisted Living - Hend. Co.
Hi Bob,
Everything looks good. Attached are the three most recent inspection reports and facility info cover page .
Here's what I would suggest.
Supplement to permit cover page: (see attachment)
Continue to operate 0.007 MGD (0.060 MGD after A to C) extended aeration package
plant consisting of: bar screen; 9100 gallon aeration basin with dual blowers
providing diffused air;, 1535 gallon (40 sq ft) dual-hoppered rectangular
clarifier with skimmer and sludge returns; 1400 gallon aerobic digestor; (not
in use: dual 3 sq. ft. tertiary sand filter); tablet chlorinator; 185 gallon
baffled chlorine contact chamber; tablet dechlorinator; and 60 gallon post
aeration tank;
effluent weir; and 360 linear feet of 2-inch diameter gravity pipe to outfall.
I feel that everything else in the attached documents is accurate.
ARO recommends renewal of this permit.
Let me know if you have questions or comments.
Thanks,
Wanda
Wanda Frazier
Email: [e-mail]
North Carolina Department of
Environment and Natural Resources
Asheville Regional Office
Division of Water Quality
Surface Water Protection Section
2090 US 70 Highway
Swannanoa, NC 28778
Switchboard: 828-296-4500 x 4662
2

NCDENR/DWQ/NPDES
32002513
Notification of Intent to Issue a NPDES Wastewater
Permit
$173.57
CERTIFICATION OF PUBLICATION
October 19, 2010
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 -dews, 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:
10/16/10
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 19th day of October, 2010.
(Signed)
Sworn to arr subscribed before me, this 19th day of
October, 2010.
C Y-a_, l /, Notary Public
Deborah H. Owen
My Commission Expires March 1, 2011
Times -News
PUB LJC'. ,JTICE
North Carolina
Environmental
Management
Commission/
NPDES Unit
1617 Mall.Service
Center:
27699-i$17+
140t' ice of Intent to
Issue aNPDES
Wastewater Permit
The North_":_
orth_" . Carolina
Environmental Man-
agement2Commission
proposes to;, issue : a
NPDES wastewater dis-
charge',, permit : to" the
person(s) listed below.
L$
Written' comments re-
gardi .. g ttie proposed
permit: will be accepted
until 30 days after the
publish date ofthis no-
tice.. The. Director of the
NC, Division of'Water
Water
Quality (DWQ) may hold
a public hearing should
there be . a significant,
e degree of public. inter-
-est. Please mail' com-
ments and/or informa-
tion requests.to DWQ at
the above address. In-
terested, persons may
visit the DWQ at 512 M
"Salisbury" Street, Ra-
leigh', NC to review in-
formation ° on file,-. Addi-
tional , information:, on
NPDES permits -and this
notice. may lie fourid`on
our : , webste: , httoJ/
portal. ncdenr. org/web/
w�c /swp/ps/nodes/calen
dar,' or by .calling (919)
807-6304.
A PARR OF
The Ne%vYorkThnes
Company
Brookside Village Con-
dominiums' requested
renewal. of permit
NC00833n for Brook-
side WWTP in Hender-
,,son County;' this: permit-
t$d discharge is treated
domestic -wastewater to
Featherstone•. -Creek,
French Broad River
Mizpah Healthcare, Inc.
requested renewal" of
permit NCO071897 for
Henderson1s Assisted
Living . in - Henderson
County; this permitted
discharge is' treated
domestic wastewater to
UT to ­�- Featherstone'
Creek,`,< French.' 13,road
River: Basin:
10/16
N000059090
First Copy — No Charge
Additional Copies - $15 each
1717 Four Seasons Blvd. • Hendersonville, NC 28792
P. O. Box 490 • Hendersonville, NC 28793
828/692-0505 + FAX [phone] a 828/693-5581
www.hendersonvillenews.com

Value Month Day Year Parameter Sample UoM Cell Type Subbasin
Monthly TSS = 7.412 mg/l
Monthly Flows = 0.001 MGD
Summer monthly NH3= 0.950 mg1l
Winter Monthly NH3=1.037 mg/I
,"O(&7Z]yia6*►'BOD=3.86 mg/l
Winter BOD=4.608 r lL
N00071897 Henderson's Assisted Living 1/12006 0.002 1 2006 Fbw Instantane, mgd CAMONAVG U-03-02
NC0071897 Henderson's Assisted Living 2/1/2006 0.002 2 2006 Fbw Instantane mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 31I2006 0.002 3 2006 Fbw Instamane, mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 4112006 0.001 4 2006 Fbw Instantaw mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 5/1/2006 0.003 5 2006 Fbw Inst-tare, mgd CAMONAVG 04-03-02
NGN71897 Henderson's Assisted Living 6/12006 0.001 8 2006 Fbw Instantar mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 7/12006 0.002 7 2006 Fbw Instantana mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 8/1/2006 0.002 8 2006 Fbw Instamane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 9112006 0.002 9 2006 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 10/12oD6 0.002 10 2006 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 11/1/2006 0-002 11 2006 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 12A2006 0.002 12 2006 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 1/1/2007 0.002 1 2007 Fbw Instarnane, mgd CAMONAVG 04-03.02
NCO071897 Henderson's Assisted Living 2/1/2007 0.001 2 2007 Fbw Instantane, mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 3112007 0.001 3 2007 Fbw Instantane mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 4/12007 0.002 4 2007 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Herderson's Assisted Living 611=7 0.002 5 2007 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 6112007 0.001 6 2007 Fbw Instantane mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 7/12007 0.001 7 2007 Fbw Instamarfe, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 8/1/2007 0.002 8 2007 Fbw IrmUntam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 9/12007 0.002 9 2007 Fbw Instamare mgd CAMONAVG 04-03-02
NCOL71897 Henderson's Assisted Living 10/12007 0.002 10 2007 Fbw - Instandane mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 11/12007 0.001 11 2007 Fbw 8rslanano mgd CAMONAVG 04-03-02
NCO071897 Hendersons Assisted Living 12112007 0.001 12 2007 Fbw Instantarfe, mgd CAMONAVG 04-03-02
NCO071897 Henderson' Assisted Living 1/12008 0.001 1 2008 Fbw Instamane mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 211/2008 0.001 2 2008 Fbw Instarnane mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 3/12008 0.001 3 2008 Fbw Instardane+ mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 4112008 0.001 4 2008 Fbw Instant n mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 511/2008 0.001 5 2008 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson Assisted Living 6112008 0.001 6 2008 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 7112008 0.001 7 2008 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 8/1/2008 0.000 8 2008 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 9/12008 0.000 9 2008 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 10/12008 0.000 10 2008 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson'sAssisted Living 11/1/2008 0.000 11 2008 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 1211/2008 0.000 12 2008 Fbw Instantane, mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 1112009 0.000 1 2009 Fbw Instamane mgd CAMONAVG 04-03-02
N00071897 Henderson's Assisted Living 2I72009 0.000 2 2009 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 3/12009 0.001 3 2009 Fbw Instantane mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 4112009 0.001 4 2009 Fbw Insamanne, mgd CAMONAVG 04-03-02
NCO071897 Herderson's Assisted Living 5/1/2009 0.001 5 2009 Fbw Irnstamarn mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 6112009 0.001 6 2009 Fbw Instamane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 7/12009 0.003 7 2009 Fbw Instantane mgd CAMONAVG 04-03-02
N00071897 Henderson's Assisted Living 8112009 0.002 8 2009 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 9112009 0.001 9 2009 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 10/12009 0.001 10 2009 Fbw Instantane' mgd CAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 11112009 0.003 11 2009 Fbw Instantam mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 12112009 0.003 12 2009 Fbw Instantane, mgd CAMONAVG 04-03-02
NCO071897 Henderson' Assisted LMng 1/12010 0.002 1 2010 Fbw Instamane, mgd CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 2112010 0.003 2 2010 Fbw Instantane, mgd CAMONAVG 04-03-02
N00071897 Henderson's Assisted Living 3/12010 0.002 3 2010 Fbw Instantane mgd CAMONAVG 04-03-02
0.072
51.000
Monthly Flows = 0.001 MGD 0.001
NCO071897 Henderson's Assisted Living 1/1/2006 4.400 1 2006 TSS Grab mg/l CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 2/12006 8.050 2 2006 TSS Grab mg/l CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 3/12006 3.425 3 2006 TSS Grab mg/l CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 4/1/2006 4.300 4 2006 TSS Grab mg/I CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 5/12006 4.840 5 2006 TSS Grab mgA CAMONAVG 04-03-02
NCO071897 Herderson's Assisted Living 6/12006 4.850 6 2006 TSS Grab moll GAMONAVG 04-03-02
NC0071897 Henderson's Assisted Living 7/1/2006 7.575 7 2006 TSS Grab mg/l CAMONAVG 04-03-02
NCO071897 Hendersors Assisted Living 8/12006 3.600 8 2006 TSS Grab mg0 CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 9/1/2006 5.775 9 2006 TSS Grab mg/l CAMONAVG 04-03.02
NCO071897 Henderson'sAssisted Living 10/12006 4.560 10 2006 TSS Grab mg/l CAMONAVG 04-03-02
NCO071897 Henderson's Assisted Living 11/12006. 5.525 11 2006 TSS Grab mgll CAMONAVG 04-03-02

NCDO71897
Henderson's Assisted Living
12/1/2006
13.275
12
2006 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
111/2007
24,580
1
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
2/1/2007
5.100
2
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
3/1/2007
9.080
3
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
4/1/2007
8.100
4
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
5/1/2007
10.200
5
2007 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071827
Henderson's Assisted Living
6/1/2007
7.050
6
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7/112007
7.750
7
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
811/2007
8.360
8
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
91112007
5.025
9
2007 TSS
Grab
mg/l
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
10/112007
2.680
10
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
11/1/2007
7.925
11
2007 TSS
Grab
mg/f
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
12/1/2007
2.100
12
2007 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCD071897
Henderson's Assisted Living
1/12008
2.440
1
2008 TSS
Grab
mg/l
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
2/1/2008
10.350
2
2008 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson'sAssisted Living
3/1/2008
7.850
3
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
4I1/2008
14.575
4
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
5/1/2008
17.780
5
2008 TSS
Grab
nigh
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6fi/2008
12.525
6
2008 TSS
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7/1/2008
6,660
7
2008 TSS
Grab
mg/I
CAMONAVC
04-03-02
NCO071897
Henderson's Assisted Livirg
8/12008
1.850
8
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9/1/2008
5.325
9
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
10/112008
3.940
10
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCOG71897
Henderson's Assisted Living
11112008
11.278
11
2008 TSS
Grab
mg/I
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
12/l/2068
10.120
12
2008 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
111/2009
22.700
1
2009 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
2/112009
18.025
2
2009 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
3/1/2009
6.056
3
2009 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
4/1/2009
4.425
4
2009 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Livirm,
511/2009
3.000
5
2009 TSS
Grab
mg/l
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
6/12009
2.580
6
2009 TSS
Grab
mg/I
GAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7/1/2009
3.825
7
2009 TSS
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
8I72009
5.925
8
2009 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9/12009
8.625
9
2009 TSS
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
ioil/2009
4.006
10
2009 TSS
Grab
mg/1
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
11/1/2009
12.775
11
2009 TSS
Grab
mg/l
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
12/1/2009
16.460
12
2009 TSS
Grab
mgA
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
1/1/2010
13.600
1
2010 TSS
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
2/12010
7.125
2
2010 TSS
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
3/12010
3.120
3
2010 TSS
Grab
mgll
CAMONAVG
04-03-02
405.065
51.000
Monthly TSS =
7.412 mg/I
7.412
NCO071897
Henderson's Assisted Living
4/l2009
0.100
4
2009 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
5112009
4.775
5
2009 Ammonia
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6H/2009
0.220
6
2009 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7/1/2009
0.200
7
2009 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
8/1/2009
1.375
8
2009 Ammonia
Grab
mg/1
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9112009
0.200
9
2009 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
10/1/2009
0.440
10
2009 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Hendersonfs Assisted Living
4/1/2006
0.625
4
2006 Ammonia
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
511/2006
0560
5
2006 Ammonia
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
611/2006
0.425
6
2006 Ammonia
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
711/2006
0.400
7
2006 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
8/12006
2.040
8
2006 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9/l2006
0.350
9
2006 Ammonia
Grab
mg/I
CAMONAVG
04.03-02
N00071897
Henderson's Assisted Living
1011/2006
0260
10
2006 Ammonia
Grab
mgA
CAMONAVG
134-03-02
N00071897
Henderson's Assisted Living
4/1/2007
0.725
4
2007 Ammonia
Grab
mg/l
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
511/2007
3.020
5
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6/112007
2.975
6
2007 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7112007
1.743
7
2007 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
8/12007
0.060
8
2007 Ammonia
Grab
mgII
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9112007
0.200
9
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Hendersons Assisted Living
10/1/2007
0.500
10
2007 Ammonia
Grab
mg/1
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
4/1/2008
0,989
4
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
5/12008
3.340
5
2008 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6112008
0.440
6
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
7/l/2008
0.220
7
2008 Ammonia
Grab
mg/I
CAMONAVG 04-03-02
NCO071897
Henderson's Assisted Living
6/12008
0.150
8
2008 Ammonia
Grab
mg/l
CAMONAVG 04-03-02
N00071897
Henderson's Assisted Living
9/1/2OD8
0.100
9
2008 Ammonia
Grab
mg/l
CAMONAVG 04-03-02
NCO071897
Henderson's Assisted Living
10/1/2008
0.160
10
2008 Ammonia
Grab
mgA
CAMONAVG 04-03-02
26.592
28.000

0.950
Summer monthly NH3= 0.950 mg/I
NC0071897
Henderson's Assisted Living
W112009
0.050
11
2009 Ammonia
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson'. Assisted Living
12/1/2009
0.280
12
2009 Ammonia
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
1112010
0.500
1
2010 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
2/1/2010
0.250
2
2010 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
3/1/2010
0.367
3
2010 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
1/1/2006
0.100
1
2006 Ammonia
Grab
mgll
CAMONAVG
04-03-02
NG0071897
Henderson'. Assisted Living
2/112006
0.225
2
2006 Ammonia
Grab
mg/1
CAMONAVG
04-03-02
NCO071897
Hendersan's Assisted Living
3/1/2006
0.300
3
2006 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
11/1/2006
0.067
11
2006 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
12/l/2006
1.825
12
2006 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
1/1/2007
3.820
1
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
2/1/2007
1.675
2
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
3/1/2007
0.440
3
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Herdeson's Assisted Living
11/1/2007
0.275
11
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
12/1/2007
1.100
12
2007 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
1/12008
0.080
1
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
2J1/2008
1.043
2
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
3/1/2008
1.400
3
2008 Ammonia
Grab
mgA
CAMONAVG
04-03-02
NC0071897
Henderson'. Assisted Living
11/1/2008
3-875
11
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
12/1/2008
3.200
12
2008 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
1/1/2009
1.975
1
2009 Ammonia
Grab
mg/1
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
2M/2009
0.525
2
2009 Ammonia
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
3/112009
0.480
3
2009 Ammonia
Grab
mgll
CAMONAVG
04-03-02
23.852
23.000
Winter Monthly
NH3=1.037 ni
1.037
NC0071897
Henderson's Assisted Living
4/1/2006
"1.725
4
2006 BOD,5
Grab
mgll
CAMONAVG
04-03-02
NC0071897
Hendersons Assisted Living
5112006
1.600
5
2006 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
611/2006
2.500
6
2006 BOD,5
Grab
mg/1
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
711/2006
4.145
7
2006800,5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
8/1/2006
4.160
a
2006 BOD,5
Grab
mg/l
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
911/2006
2.338
9
2006 BCD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson'. Assisted Living
10/1/2006
0.540
10
2006 BOO, 5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
4/1/2007
6.678
4
2007 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
5/12007
6.180
5
2007 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6/1/2007
6.598
6
2007 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NCOC71897
Hendersons Assisted Living
7112007
8.030
7
2007 BCD,5
Grab
mgll
CAMONAVG
04-03-02
NC0071897
Henderson'. Assisted Lrving
8/1/2007
2.600
8
2007 BOD, 5
Grab
mg/I
CAMONAVG
04-G3-02
NC0071897
Henderson's Assisted Living
9112007
4.250
9
2007 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
1011/2007
4.550
10
2007 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
4/12008
5.703
4
2008 BOD,5
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
5/1/2008
13.716
5
2008 BOD, 5
Grab
mgh
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
811/2008
2.718
6
2008 SOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson'. Assisted Living
7/1/2008
2.196
7
2008 SOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
8/12008
0.000
8
2008 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
9/l/2008
2.508
9
2008 BOO, 5
Grab
mg/I
CAMONAVG
04-O -02
NC0071897
Henderson's Assisted Living
10/12008
1.420
10
2008 BCD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
4/1/2009
1.150
4
2009 BOD, 5
Grab
mg/l
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
5/112009
2.975
5
2009 BOO, 5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
6112009
1.416
6
2009 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
HeMerson's Assisted Living
71112009
1.913
7
2009 BOD,5
Grab
mgll
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
8/1/2009
3.945
8
2009 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
9/1/2009
1.855
9
2009 BCD, 5
Grab
mg/I
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
10n2009
1.200
10
2009 BOD, 5
Grab
mg/I
CAMONAVG
04-03-02
97.606
28.000
3.466
Wlntor BOD=3.86 mg/l
NC0071897
Henderson's Assisted Living
1112006
1.040
1
2006 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Hendermn's Assisted Living
2112G06
3.148
2
2006 BOD, 5
Grab
mgll
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
311/2006
2.000
3
2006 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
11/12006
3.855
11
2006 SOD, 5
Grab
mg/1
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
12/1/2006
7.770
12
2006 BOD,5
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted LNing
1/12007
8-970
1
2007 BOD, 5
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
2112007
7.967
2
2007 BOD, 5
Grab
mgA
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
3/1/2007
4.858
3
2007 BOD,5
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
11/1/2007
1.325
11
2007 BOD,5
Grab
mg/I
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
12/12007
2.750
12
2007 BOD, 5
Grab
mg/l
CAMONAVG 04-03-02
NC0071897
Henderson's Assisted Living
1/1/20D8
0-490
1
2008 BOD,5
Grab
mgA
CAMONAVG 04-03-02

NC0071897
Hendermn's Assisted Living
2112008
8.000
2
2008 BOD, 5
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
3/1/2008
3.133
3
2008 BOD, 5
Grab
mg/l
CAMONAVG
04-03-02
N00071897
Henderson's Assisted Living
11/112008
3.217
11
2008 BOD, 5
Grab
mgA
CAMONAVG
04-03-02
NCO071897
Hendenson's Assisted Living
1211/2008
5.346
12
2008 BOD,5
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
1/112009
9.303
1
2009 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
211/2009
5.760
2
2009 BOD,5
Grab
mgll
CAMONAVG
04-03-02
NCO071897
Henderson's Assisted Living
3112009
2.440
3
2009 BOD, 5
Grab
m911
CAMONAVG
04-03-02
NCO071897
Herderson's Assisted Living
11/12009
3.368
11
2009 BOD, 5
Grab
mgA
CAMONAVG
04-03-02
N00071897
Hendenson's Assisted Living
12/1/2009
5.928
12
2009 BOD,5
Grab
mg/I
CAMONAVG
04-03-02
N00071897
Hendermn's Assisted Living
1112010
6.455
1
2010 B00,5
Grab
mg/I
CAMONAVG
04-03-02
NC0071897
Henderson's Assisted Living
2112010
3.075
2
2010 BOD, 5
Grab
mgll
CAMONAVG
04-03-02
NCO071897
HendersarYs Assisted Living
3/112010
5.784
3
2010 BOD, 5
Grab
mgll
CAMONAVG
04-03-02
105.989
23.000
Winter BOD=4.608 mg/L
4.608

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
April 20, 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 Henderson's Rest Home,
NPDES number NC0071897.
Sincerely
64 t6-
Juanita J es
James and James Environmental Mgt., Inc.

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 C00?1897
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 HENDERSON'S ASSISTED LIVING
Mailing Address P. O. BOX 1029
City MARION
State / Zip Code NORTH CAROLINA 28752-1029
Telephone Number [phone]
Fax Number (828-652-1619) E -� _ :�"; ; # �y
e-mail Addressc,N. h....._.,_K....,� .. _ ..Ul
MAY 14 2010 1
2. Location of facility producing discharge:
Check here if same address as above ❑ DE
PUNT
Street Address or State Road 602 BROOKSIDE CAMP ROAD
City HENDERSONVILLE
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.):1 /iv7n/� ��
REST HOME 6 imdo f �
Population served:
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
FEATHERSTONE CREEK IN THE 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.
AN EXISTING 0.007 MGD FACILITY WITH BAR SCREE, 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.
2 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
10. Flow Information:
Treatment Plant Design flow 0.007 MGD
Annual Average daily flow 0.0029 MGD (for the previous 3 years)
Maximum daily flow 0.006 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. 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
Biochemical Oxygen Demand
(BOD5)
5.4
3.1
MG/L
4
Fecal Coliform
12.2
10.1
#/ 100ML
4
Total Suspended Solids
12.4
7.1
MG/L
4
Temperature (Summer)
27.1
23.4
C
5
Temperature (Winter)
12.7
9.0
C
4
pH
7.8
7.1
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 NCO071897 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 I dge and -belief such information is true, complete, and accurate.
Printed name
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) 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 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 4 Form-D 1/06

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
April 20, 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 (Henderson's Rest Home) is pumped by Mike's Septic Tank Service and is
permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
JuUtta James
James and James Environmental Mgt., Inc.

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full 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
Permit Writer/Date
Bob Guerra / 10-13-2010
Permit Number
NCO071897
Facility Name
Henderson's Assisted Living WWTP
Basin Name/Sub-basin number
French Broad — 04-03-02
Receiving Stream
UT to Featherstone Creek
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
No
Does permit need TRC limits/language?
Yes - New language added to footnote
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes - Data review = No Significant Impacts
Is the stream impaired (on 303(d) list)? For
whatparameter?
No
Any obvious compliance concerns?
Attach BIMS Report; discuss with Region
Any permit mods since lastpermit?
No
Current expiration date
11-30-2010
New expiration date
11-30-2015
Comments received on Draft Permit?
Yes No If Yes, discuss response with
Supervisor
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream
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 permitted 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 ug/1 will be treated as zero
for compliance purposes."
BIMS Compliance Download: Queries>Reports>Violations>Monitor Report Violations>Limit
Violations for Past 3 Years
Reminder: Permits that are not subject to expedited renewal include the following: 1) Major
Facility (municipal/industrial); 2) Minor Municipals with pretreatment program; 3)
Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS, etc); 4)
Limits based on reasonable potential analysis (metals, GW remediation organics); 5)
Permitted flow > 0.5 MGD (requires full Fact Sheet); 6) permits determined by Supervisor to be
outside expedited process.
Note: This sheet is located on NPDES Server/CurrentVersions/Expedited Fact Sheet May2010