NC0069370_Regional Office Physical File Scan Up To 12/8/2020

Certified Mail # 7015 1520 0003 5463 2763
Return Receipt Requested
February 7, 2017
Greg Penfold, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: NOTICE OF VIOLATION .
Tracking Number: NOV-2017-LV-0097
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Permittee:
A review of the August 2016 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample Limit Reported
Location Parameter Date Value Value Type of Violation
001 Effluent Coliform, Fecal MF, MFC Broth, 8/30/2016 400 600 Daily Maximum Exceeded
44.5 C (31616)
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any,additional violations.
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
828-296-4500

If you have any questions concerning this matter, please contact Janet Cantwell of the Asheville Regional
Office at 828-296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
(. W(�SAA§NUMV IORegionaal20'ff�ice�Enforcem� ent4File
NPDES Compliance/Enforcement Unit - Enforcement File
Trevor C. McMinn/ ORC
G:\WR\WQ\Henderson\Wastewater\Minors\Pine Park Inn 69370\NOV-2017-LV-0097.rtf

Certified Mail # 7014 0510 0000 4466 4309
Return Receipt Requested
November 22, 2016
Greg Penfold, Executive Director .
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: NOTICE OF VIOLATION
Tracking Number: ' NOV-2016-LV-0623
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Permittee:
A review of the June 2016 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample Limit Reported
Location Parameter Date Value Value Type of Violation
001 Effluent BOD, 5-Day (20 Deg. C) - 6/8/2016 45 62 Daily Maximum Exceeded
. Concentration (C0310)
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations.
Please refer to the latest letter titled "Electronic Reporting Requirements" dated March 31, 2016, concerning
registering touse the Division's new a-DMR system for the completion and electronic submittal of monthly
Discharge Monitoring Reports (DMRs).
Your facility will be required to report your Discharge Monitoring Reports electronically by December 21, 2016.
For more information, please visit the eDMR Website at the following address:
http://portal.ncdenr.org/web/wq/admin/bog/ipu/edmr.
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
828-296-4500

If you have any questions concerning this matter, please contact Janet Cantwell of the Asheville Regional
Office at 828-296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
C�:WQS Asheville-Regional'Office Enforcement=File
NPDES Compliance/Enforcement Unit - Enforcement File
Trevor McMinn/ ORC
G:\WR\WQ\Henderson\Wastewater\Minors\Pine Park Inn 693701NOV-2016-LV-0623.rtf

January 14, 2016
Greg Penfold, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
r
SUBJECT:. NOTICE OF VIOLATION
Tracking Number: NOV-2016-LV-0045
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Permittee:
A review of the September 2015 Discharge Monitoring Report (DMR) for the subject facility revealed the
violation(s) indicated below: _
Limit Exceedance Violation(s):
Sample Limit Reported
Location Parameter Date Value Value Type of Violation
001 Effluent Coliform, Fecal MF, M-FC 9/22/2015 400 600 Daily Maximum Exceeded
Broth, 44.5C (31616)
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations.
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
828-296-4500

w
If you have any questions concerning this matter, please contact Janet Cantwell of the Asheville Regional
Office at 828-296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
Cc: WQs_Ashev [1qq egionafFce. lsO. .Enforcement§File
NPDES Compliance/Enforcement Unit - Enforcement File
Trevor McMinn/ ORC
G:\WR\WQ\Henderson\Wastewater\Minors\Pine Park Inn 69370\NOV-2016-LV-0045.rtf

t
L�'�eciY�g
Certified Mail # 7012 1010 0002 1965 6379
Return Receipt Requested
June 22, 2016
Greg Penfold, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: NOTICE OF VIOLATION
Tracking Number: NOV-2016-MV-0062
Permit No. NCO069370
Pine Park Retirement Inn
Henderson County
Dear Permittee:
A review of the February 2016 Discharge Monitoring Report (DMR) for the subject facility revealed the
violation(s) indicated below:
Monitoring Violation(s):
Sample Monitoring
Location Parameter Date Frequency Type of Violation
001 Effluent Nitrogen, Ammonia Total (as N) - 2/29/2016 2 X month Frequency Violation
Concentration (C0610)
Remedial actions, if not already implemented, should be taken to correct any noted problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations.
Please refer to the latest letter titled "Electronic Reporting Requirements" dated March 31, 2016, concerning
registering to use the Division's new a-DMR system for the completion and electronic submittal of monthly
Discharge Monitoring Reports (DMRs).
Your facility will be required to report your Discharge Monitoring Reports electronically by December 21, 2016.
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
�j 828-296-4500

If you have any questions concerning this matter, please contact Janet Cantwell of the Asheville Regional
Office at 828-296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
Cc WQS'=Asheville-Regional--Qffice--- Enforce ment File--�,
NPDES Compliance/Enforcement Unit - Enforcement File
Trevor C. McMinn/ ORC
G;\WR,WQ\Henderson\Wastewater\Minors\Pine Park Inn 64370\NOV-2016-MV-0082.rtf

AAA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 28, 2015
Greg Penfold, Executive Dir.
Pine Park Retirement Inn
2601 Chimney Rock Rd
Hendersonville, NC 28792
Subject: Acknowledgement of Permit Renewal
Permit NCO069370
Henderson County
Dear Permittee:
The NPDES Unit received your permit renewal application on May 28, 2015. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Maureen
Kinney at [phone].
Sincerely,
W re*v Tkzot f &rro�
Wren Thedford
Wastewater Branch
cc: Central Files
■.Asher�tilleReional�Office,
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]/Customer Service: 1-877-623-6748
Internet:: www.ncwater.orm
RECEIVED
Division of Water Resources
JUN - 2 2015
Water Quality Regional Operations
Asheville Regional Office
An Equal OpportunitylAftirmative Action Employer

TREVCO
ENVIRONMENTAL * MAINTENANCE * CONSTRUCTION
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Fax[phone]
5/12/15
Permit Renewal Request
Wren Thedford
RECEIVED/DENROM
MAY 282015
Water Quality
Permitting section
Please find enclosed a permit renewal package for Pine Park Retirement Inn
(NPDES permit # NC0069370). There have been no changes or
modifications to this facility since the issuance of the last permit. We
respectfully request this permit to be renewed. We also hope that you find
this package in order.
If we may be of further assistance please do not hesitate to call or
correspond.
Sincerely,
revor C. McMinn
RECEIVED
Division of Water Resources
JUN - 2 2015
Water Quality Reglonal Operations
Asheville Regional Office

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit WC0069370
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 Brookdale
Facility Name Pine Park Retirement Inn
Mailing Address 2601 Chimney Rock Rd RECEIVED/DENR/DWR
City Hendersonville
State / Zip Code NC 28792 5
Telephone Number [phone] Water Quality.
Permitfinn c inn
Fax Number [phone]
e-mail Address Ar�AWX AV
2. Location of facility producing discharge:
Check here if same address as above X
Street Address or State Road
City
State / Zip Code
County
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Brookdale
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
2601 Chimney Rock Rd
Hendersonville
NC
[phone]

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater( check all that apply).
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: Retire. Inn
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Retirement Inn / Assisted living
Number of persons served: 120
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1 only
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving streams) (NNW applicants. Provide a map showing the exact location of each
outfau).
Clear Creek
S. Frequency of Discharge: ® Continuous
If intermittent:
Days per week discharge occurs:
9. Describe the treatment system
See attached Sheet:
❑ Intermittent
Duration:

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5112115
Point Source Branch
Surface Water Protection Section
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
Pine Park Retirement Inn
NPDES No. NC0069370
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following
individuals for all permit applications, discharge monitoring reports, and other
information relating to the operations at Pine Park Retirement Linn as required by all
applicable federal, state, and local environmental agencies specifically with the
requirements for signatory authority as specified in 15A NCAC 2B.0506.
Name Title
Trevor C. McMinn Operator In Responsible Charge
If you have any questions regarding this letter, please feel free to contact me at 828-692-
1911.
Sincerely ,
1,4
Greg Penfold
Executive Director
cc: WnAm so 9- Regional Office, Surface Water Protection Section
Technical Assistance and Certification Unit

fig
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
General information:
Facility System Name: Pine Park Retirement Inn
Responsible Entity: Brookdale
Person in Charge: Ed Craven
Applicable Permit: NPDES # NC0069370
Description of treatment process:
The 0.025 MGD extended aeration facility consists of an influent lift station, bar screen, flow recorder,
aeration basin, clarifier, effluent pump station, and an aerated sludge holding basin. A dechlor tablet feeder
was installed in 2011 to comply with chlorine limits to take effect on 6/1/2012.
This facility is located at Pine Park Retirement Inn at 2601 Chimney Rock Rd in Henderson County
Sludge Management:
This facility builds sludge rapidly, due to the highly loaded moderate influent flow. As the need for sludge
removal becomes apparent it will be wasted to the digester where it will be stored and thickened for cost
effective hauling. As the flow increases at this facility it may become necessary to increase the frequency in
hauling. Sludge removal will be by truck by Mike's Septic, 1828 253 2612) a local pump truck contractor.
He will haul the sludge to disposal at the Town of Brevard or the MSD waste treatment facility. All
associated costs of this hauling will be paid by Pine Park Retirement Inn. Removal and management of this
sludge will be done in a timely manner and in the best interests of facility operation and the environment.
Operator in responsible charge:
Trevor C. McMinn
Date:5/12/15

a`
North Carolina Department of Enviroram.enta Q:ual'ifi Pat McCrory f `' �,
`-� J erVaa
Governor Division of Wafer Resources Se, reta'
November 3, 2015 DEC
Mr. Greg Penfold
Brookdale Hendersonville East water C?uali
2601 ChimneyRock Rd regional Operations
Asheville_ r
Hendersonville, NC 28792 Reg'onai O;irce
Subject: Issuance oFDES�Permiti.C.QQ69370s' r
Pine Park Retirement Inn WWTP
Henderson County
Class WW-2
Dear Mr. Penfold:
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).
This final permit includes no major changes from the draft permit sent to you on July 15,
2015.
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 any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles Weaver at telephone number (919) 807-
6391. �.
/.- -- - - - - - - - - --- -- - - - - - .- - - -- - - - -
Sincer ly,
S. Jay Zimmerman, Direct
Division of Water Resources
cc: Ce tra1F' es
IL h vWMr
. R1e R, gional dice
NPDE5 IInit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / http://portal.ncdenr.org/web/wq
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/101/6 Post Consumer Paper

Permit NCO069370
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
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,
Brookdale Hendersonville East
is hereby authorized to discharge wastewater from a facility located at the
Pine Park Retirement Inn WWTP
2601 Chimney Rock Road
SE of Oak Hill
Henderson County
to receiving waters designated as Clear Creek in the French Broad River Basin in accordance with effluent
limits, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective December 1, 2015.
This_permit,and authorizationto -discharge- shall -expire. -at midnight on —November 30-2020.------ -- ` ---
Signed this day November 3, 208.
S. J*7immerman, P.G., Director
Division of Water Resources
By Authority of the Environmental Management Commission
Pagel of 8

Permit NC0069370
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.
Brookdale Hendersonville East is hereby authorized to:
1. Continue to operate an existing 0.025 MGD extended aeration wastewater treatment system with the
following components:
♦ Influent lift station
♦ Bar Screen
♦ Aeration basin
♦ Clarifier
♦ Tablet Chlorinator '
♦ Tablet Dechlorination-
♦ Chlorine contact chamber
Sludge digester
♦ Effluent pump station
♦ Effluent Flow Recorder
♦ Activated sludge holding basin
This facility is located at the, Pine Park Retirement Inn (2601 Chimney Rock Rd, Hendersonville) in
Henderson County.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis.
[see A. (3)]. After receiving an Authorization to Construct _permit_-om_the_Division, construct -and- - - - - - -
operate the components necessary for a 0.035 MGD wastewater treatment facility.
3. Discharge from said treatment works at the location specified on the attached map into Clear Creek,
currently classified C waters in sub -basin 04-03-02 of the French Broad River Basin.
Page 2 of 8

PART I Permit NCO069370
A. (1) EFFLUENT LIMITS AND MONITORING REQUIREMENTS - [0'.025 MGD]
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning on the effective date of the permit and lasting until expansion above
0.025 MGD, or permit expiration, the permittee is authorized to discharge treated wastewater from
outfall 001. Such discharges shall be limited and monitored' by the permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIlVIIaTS
�� IVIONIT�URING REQUIREMENTS
Parameter Code
.Dail
>' Measurement„ ''Sample Sample� .:
:Average,,
:, ;Frequency - ' ,: , Type Localion2
Flow3
-,
50050
0.025 MGD
Continuous
Recorder
Influent or
Effluent
BOD, 5-Day (20 Deg. C)
C0310
30.0 mg/L
45.0 mg/L,
Weekly
Grab
Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Nitrogen, Ammonia Total (as N)
C0610
L200/100ml
2 / month
Grab
Effluent
Fecal Coliform [geometric mean]
31616
400/100 ml
Weekly
Grab
Effluent
Chlorine, Total Residual (TRC)4
50060
28pg1L
2/week
Grab
Effluent
Temperature, °Centigrade - 00010
Weekly
Grab
Effluent
pH - 60400
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Fecal Coliform [geometric mean]
31616 -
T
Weekly
Grab -
Upstream &
— I
- IDownstream
Footnotes:
I. No later ,than 270 days from the effective date of this permit, begin submitting discharge monitoring
reports electronically using NC DWR's eDNII2 application system [see A. (4).
2.__Upstream:__100_feet. above, dischar-ge-location; Downstream: 300 feet -below discharge ocation.
.3. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis [see. A. (3)].
4. TRC limit and monitoring requirements apply only if chlorine compounds are used as a means of disinfection. The
Division shall consider all effluent TRC values reported below 50 µg/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 µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
Page 3 of 8

Permit NCO069370
A. (2)- EFFLUENT LIMITS AND MONITORING REQUIREMENTS - [0.035 MGD]
[15A NCAC 02B .0400 et seq., 02B .0500 et seq.]
During the period beginning upon expansion above 0.025 MGD and lasting until permit expiration, the
permittee is authorized to discharge treated wastewater from outfall 001. Such discharges shall be
limited and monitored' by the permittee as specified below:
EFFLUENT
EFFLUENT LWH1 S
,MONITORING REQUIREMENTS
CHARACTERISTICS
Dady
jMeasuremenf.
, Sample
Sample,
Parameter Code
Fee
-Ma&mum
,; 66 'uenc
T" e
Loeat one
Flow
Continuous
Recorder
Influent or
50050
Effluent
BOD, 5-Day (20 Deg. C) -Summer
10.0 mg/L
15.0 mg/L
Weekly
Composite
Effluent
C0310
BOD, 5-Day (20 Deg. C) -Winter*
20.0 mg/L
30.0 mg/L
Weekly
Composite
Effluent
C0310
Total Suspended Solids - C0530
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
Nitrogen, Ammonia Total (as N) - C061.0
(April 1- October 31)
2.0 mg/L
10.0 mg/L
Weekly
Composite
Effluent
Nitrogen, Ammonia Total (as N) - C0610
4.0 mg/L
20.0 mg/L
Weekly
Composite
Effluent
(November 1- March 31)
Dissolved Oxygen - 00300
Weekly
Grab
Effluent
Fecal Coliform [geometric mean]
31616
200/100 ml
400/100 ml
Weekly
Grab
Effluent
Chlorine, Total Residual (TRC)3
50060
28 pg/L
2 /week
Grab
Effluent
Temperature, °Centigrade - 00010
Daily
Grab
Effluent
pH 00400
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Temperature, °Centigrade - 00010
Weekly
Grab
Upstream &
Downstream
-Dissolved-Oxygen - 00300-- - - -- - - --- - -- -
_ -- .-- _ __-._
-- -- _ _. -_ —. _
----Weekly--'--
__.-Grab - -
,_Upstream_&__ _
Downstream
Footnotes:
1. No later than 270 days from the effective date of this permit, begin submitting discharge monitoring
reports electronically using NC DWR's eDMIt application system. See Special Condition A.(4.).
2. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
3. TRC limit and monitoring requirements apply only if chlorine compounds are used as a means of disinfection. The
Division shall consider all effluent TRC values reported below 50 µg/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 µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OT HER THAN TRACE AMOUNTS.
Page 4 of 8

Permit NCO069370
A. (3) ENGINEERING ALTERNATIVES ANALYSIS REQUIREMENT
[G. S. 143-215.1(b)]
Prior to expansion to 0.035 MGD, the permittee shall submit a detailed analysis of all available means to
dispose of this facility's wastewater. This Engineering Alternatives Analysis (EAA) shall be prepared in
compliance with the Division's guidance document for EAAs.
If no EAA is submitted, the Division may reopen and modify this permit to increase monitoring
frequencies or change effluent limits as necessary to protect the receiving stream.
Submit one con of the EAA to the following address:
NCDEQ / DWR / Asheville Regional Office .
Attention: Landon Davidson, Supervisor, Water Quality Regional Operations Section
2090 U. S. Hwy 70 .
Swannanoa, NC 28778
and
Submit the original and one copy of the EAA to the following address:.
Dr. Sergei Chernikov
NCDEQ / DWR / NPDES
1617 Mail Service Center`
Raleigh, NC 27699-1617
A. (4) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
[G.S. 143-215.1(b)]
Proposed federal regulations require electronic submittal of all discharge monitoring reports.(DMRs)
and specify that, if a state does not establish a system to receive such submittals, then permittees must
submit DMRs electronically to the Environmental Protection Agency (EPA).
_.__NOTE:.--T-his-special. condition -supplements- or supersedes the following sections within Part II of this
permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting (Supersedes Section D (2) and Section E (5) (a)1
Beginning no later than 270 days from the effective date of this permit the permittee shall begin
reporting discharge monitoring data electronically using the NC DWR's Electronic Discharge Monitoring
Report (eDMR) internet application.
Page 5 of 8

Permit NC0069370
Monitoring results obtained during the previous month(s) shall be summarized for each month and
submitted electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring
data and submit DMRs electronically using the internet. Until such time that the state's eDMR application
is compliant with EPA's Cross -Media Electronic Reporting Regulation (CROMERR), permittees will be
required to submit all discharge monitoring data to the state electronically using eDMR and will be
required to complete the eDMR submission by printing, signing, and submitting one signed original and a
copy of the computer printed eDMR to the following address:
NC DEQ / DWR / Information Processing Unit
ATTENTION: Central Files / eDMR
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility
being physically located in an area where less than 10 percent of the households have broadband access,
then a temporary waiver from the NPDES electronic reporting requirements may be granted and discharge
monitoring data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved
by the Director. Duplicate signed copies shall be submitted to the mailing address above.
Requests for temporary waivers from the NPDES electronic reporting requirements must be
submitted in writing to the -Division for written approval at least sixty (60) days prior to the date the
facility would be required under this permit to begin using eDMR. Temporary waivers shall be valid for
twelve (12) months and shall thereupon expire. At such time, DMRs shall be submitted electronically to
the Division unless the permittee re -applies for and is granted a new temporary waiver by the Division.
Information on eDMR and application for a temporary waiver from the NPDES electronic reporting
requirements is found on the following web page:
l'ittp://poital.nedenr.org/web/wg./adi-nin/bog/ipu/edilir
Regardless of the submission method, the first DMR is due on the last day of the month following the
issuance of the permit or in the case of a new facility, on the last day of the month following the
commencement of discharge.
2. Signatory Requirements [Supplements Section B. (11) (ib) and supersedes Section B (11) (d)l
- -- - All eDMRs submitted to the -permit -issuing- authority -shall be signed by a person described i-n Part II,
Section B. (I 1.)(a) or by a duly authorized representative of that person as described in Part II, Section B.
(I 1.)(b). A person, and not a position, must be delegated signatory authority for eDMR reporting
purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user
account and login credentials to access the eDMR system. For more information on North Carolina's
eDMR system, registering for eDMR and obtaining an eDMR user account, please visit the following web
page:
http://portal.nedenr. org/web/wq/admu-i/bo g/ipu/edmr
Page 6 of S

Permit NC0069370
Certification. Any person submitting an electronic DMR using the state's eDMR system shall make
the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL
BE ACCEPTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible forgathering the information,
the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the
possibility of fines and imprisonment for knowing violations. "
I Records Retention [Supplements Section D. (6)1
The.permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions.
These records or copies shall be maintained for a period of at least 3 years from the date of the report.
This period maybe extended by request of the Director at anytime [40 CFR 122.41 ].
Page 7 of 8

l
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) DISCHARGE �f,. •i �� C_`
}W {') lspbse. )ant �'_ POINT001 fig' i`� • �ti �,.� ^�
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� r3!� m ._S�t;�f�nl � \ \ � ` )._ s` �� L. ,ti i _` '`l�• - i �� - — 1-4� - ! i n(f��/ / \. � j' U - \ __, .
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l' , �N\:, fr.• ( II �� =>
Br®®kdala Hendersonville Easy Facility
Pine Park Retirement Inn Location X
County: Henderson Stream Class: C (not to scale)
Receiving Stream: Clear Creek Sub -Basin: 04-03-02
Latitude: 35° 21' 28" USGS Quad: Hendersonville, N.C.
Longitude: 86°26'02" HUC#: 0enders5 NORTHNPDES Permit N00069370
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NPDES Permit Standard Conditions
Page 1 of 18
PART II
STANDARD CONDITIONS FOR NPDES PERMITS
Section A. Definitions
2/Month
Samples are collected twice per month with at least ten calendar days between sampling events. These samples shall be
representative of the wastewater discharged during the sample period.
3/Week
Samples are collected three times per week on three separate calendar days. These samples shall be representative of
the wastewater discharged during the sample period.
Act or "the Act"
The Federal Water Pollution Control Act, also known as the Clean Water Act (CWA), as amended, 33 USC 1251, et.
seq.
Annual Average
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar year.; In the case of fecal
coliform, the geometric mean of such discharges.
Arithmetic Mean
The summation of the individual values divided by the number of individual values. I
Bypass
The known diversion of waste streams from any portion of a treatment facility including the collection system, which is
not a designed or established or operating mode for the facility.
Calendar Day
The period from midnight of one day until midnight of the next day. However, for purposes of this permit, any
consecutive 24-hour period that reasonably represents the calendar day may be used for sampling.
Calendar Week
The period from Sunday through the following Saturday.
Calendar Quarter
One of the following distinct periods: January through March, April through June, July through September, and
October through December.
Composite Sample
A sample collected over a 24-hour period by'continuous sampling or combining grab samples of at least 100 mL in.
such a manner as to result in a total sample representative of the wastewater discharge during the sample period. The
Director may designate the most appropriate method (specific number and size of aliquots necessary, the time interval
between grab samples, etc.) on a case -by -case basis. Samples may be collected manually or automatically. Composite
samples may be obtained by the following methods:
(1) Continuous: a single, continuous sample collected over a 24-hour period proportional to the rate of flow.
(2) Constant time/variable volume: a series of grab samples collected at equal time intervals over a 24 hour period
of discharge and combined proportional to the rate of flow measured at the time of individual sample
collection, or
(3) Variable time/constant volume: a series of grab samples of equal volume collected over a 24 hour period with
the time intervals between samples determined by a preset number of gallons passing the sampling point. Flow
measurement between sample intervals shall be determined by use of a flow recorder and totalizer, and the
preset gallon interval between sample collection fixed at greater than 1/24 of the expected total daily flow at
the treatment system, or
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NPDES Permit Standard Conditions
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(4) Constant time/constant volume: a series of grab samples of equal volume collected over a 24-hour period at a
constant time interval. Use of this method requires prior approval by the Director. This method may only be
used in situations where effluent flow rates vary less than 15 percent. The following restrictions also apply:
➢ Influent and effluent grab samples shall be of equal size and of no less than 100 milliliters
➢ Influent samples shall not be collected more than once per hour.
➢ Permittees with wastewater treatment systems whose detention time < 24 hours shall collect effluent grab
samples at intervals of no greater than 20 minutes apart during any 24-hour period.
➢ Permittees with wastewater treatment systems whose detention time exceeds 24 hours shall collect effluent
grab samples at least every six hours; there must be a minimum of four samples during a 24-hour sampling
period.
Continuous flow measurement
Flow monitoring that occurs without interruption throughout the operating hours of the facility. Flow shall be
monitored continually except for the infrequent times when there may be no flow or for infrequent maintenance
activities on the flow device.
Daily Discharge
The discharge of a pollutant measured during a calendar day or any 24-hour period that reasonably represents the
calendar day for purposes of sampling. For pollutants measured in units of mass, the "daily discharge" is calculated as
the total mass of the pollutant discharged over the day. For pollutants expressed in other units of measurement, the
"daily discharge" is calculated as the average measurement of the pollutant over the day. (40 CFR 122.2; see also
"Composite Sample," above.)
Daily Maximum
The highest "daily discharge" during the calendar month.
Daily Sampling
Parameters requiring daily sampling shall be sampled 5 out of every 7 days per week unless otherwise specified in the
permit. Sampling shall be conducted on weekdays except where holidays or other disruptions of normal operations
prevent weekday sampling. If sampling is required for all seven days of the week for any permitparameter(s), that
requirement will be so noted on the Effluent Limitations and Monitoring Page(s).
DWR or "the Division"
The Division of Water Resources, Department of Environment and Natural Resources.
Effluent
Wastewater discharged following all treatment processes from a water pollution control facility or other point source
whether treated or untreated.
EMC
The North Carolina Environmental Management Commission
EPA
The United States Environmental Protection Agency
Facilijy Closure
Cessation of all activities that require coverage under this NPDES permit. Completion of facility closure will allow this
permit to be rescinded.
Geometric Mean
The Nth root of the product of the individual values where N = the number of individual values. For purposes of
calculating the geometric mean, values of "0" (or "< [detection level]") shall be considered = 1.
Grab Sample
Individual samples of at least 100 mL collected over a period of time not exceeding 15 minutes. Grab samples can be
collected manually. Grab samples must be representative of the discharge (or the receiving stream, for instream
samples).
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Hazardous Substance
Any substance designated under 40 CFR Part 116 pursuant to Section 311 of the CWA.
Instantaneous flow measurement
The flow measured during the minimum time required for the flow measuring device or method to produce a result in
that instance. To the extent practical, instantaneous flow measurements coincide with the collection of any grab
samples required for the same sampling period so that together the samples and flow are representative of the discharge
during that sampling period.
Monthly Average (concentration limit)
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar month. In the case of fecal
coliform or other bacterial parameters or indicators, the geometric mean of such discharges.
Permit Issuing Authority
The Director of the Division of Water Resources.
Quarterly Average (concentration limit)
The arithmetic mean of all samples taken over a calendar quarter.
Severe property damage
Substantial physical damage to property, damage to the treatment facilities which causes them to become inoperable, or
substantial and permanent loss of natural resources which can reasonably be expected to occur in the absence of a
bypass. Severe property damage excludes economic loss caused by delays in production.
Toxic Pollutant:
Any pollutant listed as toxic under Section 307(a)(1) of the CWA.
Upset
An incident beyond the reasonable control of the Permittee causing unintentional and temporary noncompliance with
permit effluent limitations and/or monitoring requirements. An upset does not include noncompliance caused by
operational error, improperly designed treatment facilities, inadequate treatment facilities, lack of preventive
maintenance, or careless or improper operation.
Weekly Average (concentration limit)
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar week. In the case of fecal
coliform or other bacterial parameters or indicators, the geometric mean of such discharges.
Section B. General Conditions
1. Duty to Comply_
The Permittee must comply with all conditions of this permit. Any permit noncompliance constitutes a violation of
the CWA and is grounds for enforcement action; for permit termination, revocation and reissuance, or
modification; or denial of a permit renewal application [40 CFR 122.411.
a. The Permittee shall comply with effluent standards or prohibitions established under section 307(a) of the
CWA for toxic pollutants and with standards for sewage sludge use or disposal established under section
405(d) of the CWA within the time provided in the regulations that establish these standards or prohibitions or
standards for sewage sludge use or disposal, even if the permit has not yet been modified to incorporate the
requirement.
b. The CWA provides that any person who violates section[s] 301, 302, 306, 307, 308, 318 or 405 of the Act, or
any permit condition or limitation implementing any such sections in a permit issued under section 402, or any
requirement imposed in a pretreatment program approved under sections 402(a)(3) or 402(b)(8) of the Act, is
subject to a civil penalty not to exceed $37,500 per day for each violation. [33 USC 1319(d) and 40 CFR
122.41(a)(2)]
c. The CWA provides that any person who negligently violates sections 301, 302, 306, 307, 308, 318, or 405 of
the Act, or any condition or limitation implementing any of such sections in a permit issued under section 402
of the Act, or any requirement imposed in a pretreatment program approved under section 402(a)(3) or
402(b)(8) of the Act, is subject to criminal penalties of $2,500 to $25,000 per day of violation, or
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imprisonment of not more than 1 year, or both. In the case of a second or subsequent conviction for a negligent
violation, a person shall be subject to criminal penalties of not more than $50,000 per day of violation, or by
imprisonment of not more than 2 years, or both. [33 USC 1319(c)(1) and 40 CFR 122.41(a)(2)]
d. Any person who knowingly violates such sections, or such conditions or limitations is subject to criminal
penalties of $5,000 to $50,000 per day of violation, or imprisonment for not more than 3 years, or both. In the
case of a second or subsequent conviction for a knowing violation, a person shall be subject to criminal
penalties of not more than $100,000 per day of violation, or imprisonment of not more than 6 years, or both.
[33 USC 1319(c)(2) and 40 CFR 122.41(a)(2)]
e. Any person who knowingly violates section 301, 302, 303, 306, 307, 308, 318 or 405 of the Act, or any permit
condition or limitation implementing any of such sections in a permit issued under section 402 of the Act, and
who knows at that time that he thereby places another person in imminent danger of death or serious bodily
injury, shall, upon conviction, be subject to a fine of not more than $250,000 or imprisonment of not more than
15 years, or both. In the case of a second or subsequent conviction for a knowing endangerment violation, a
person shall be subject to a fine of not more than $500,000 or by imprisonment of not more than 30 years, or
both. An organization, as defined in section 309(c)(3)(B)(iii) of the CWA, shall, upon conviction of violating
the imminent danger provision, be subject to a fine of not more than $1,000,000 and can be fined up to
$2,000,000 for second or subsequent convictions. [40 CFR 122.41(a)(2)]
f. Under state law, a civil penalty of not more than $25,000 per violation may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of a permit. [North
Carolina General Statutes § 143-215.6A]
g. Any person may be assessed an administrative penalty by the Administrator for violating section 301, 302,
306, 307, 308, 318 or 405 of this Act, or any permit condition or limitation implementing any of such sections
in a permit issued under section 402 of this Act. Administrative penalties for Class I violations are not to
exceed $16,000 per violation, with the maximum amount of any Class I penalty assessed not to exceed
$37,500. Penalties for Class II violations are not to exceed $16,000 per day for each day during which the
violation continues, with the maximum amount of any Class II penalty not to exceed $177,500. [33 USC
1319(g)(2) and 40 CFR 122.41(a)(3)]
2. Duty to Mitigate
The Permittee shall take all reasonable steps to minimize or prevent any discharge or sludge use or disposal in
violation of this permit with a reasonable likelihood of adversely affecting human health or the environment [40
CFR 122.41(d)].
3. Civil and Criminal Liability
Except as provided in permit conditions on 'Bypassing" (Part H.C.4), "Upsets" (Part II.C.5) and "Power Failures"
(Part H.C.7), nothing in this permit shall be construed to relieve the Permittee from any responsibilities, liabilities,
or penalties for noncompliance pursuant to NCGS 143-215.3, 143-215.6 or Section 309 of the Federal Act, 33 USC
1319. Furthermore, the Permittee is responsible for consequential damages, such as fish kills, even though the
responsibility for effective compliance may be temporarily suspended.
4. Oil and Hazardous Substance Liability
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve the Permittee
from any responsibilities, liabilities, or penalties to which the Permittee is or may be subject to under NCGS 143-
215.75 et seq. or Section 311 of the Federal Act, 33 USG 1321. Furthermore, the Permittee is responsible for
consequential damages, such as fish kills, even though the responsibility for effective compliance may be
temporarily suspended.
5. Property Rights
The issuance of this permit does not convey any property rights in either real or personal property, or any exclusive
privileges, nor does it authorize any injury to private property or any invasion of personal rights, nor any
infringement of Federal, State or local laws or regulations [40 CFR 122.41(g)].
6. Onshore or Offshore Construction
This permit does not authorize or approve the construction of any onshore or offshore physical structures or
facilities or the undertaking of any work in any navigable waters.
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7. Severability
The provisions of this permit are severable. If any provision of this permit, or the application of any provision of
this permit to any circumstances, is held invalid, the application of such provision to other circumstances, and the
remainder of this permit, shall not be affected thereby [NCGS 15013-23].
8. Duty to Provide Information
The Permittee shall furnish to the Permit Issuing Authority, within a reasonable time, any information which the
Permit Issuing Authority may request to determine whether cause exists for modifying, revoking and reissuing, or
terminating this permit or to determine compliance with this permit. The Permittee shall also furnish to the Permit
Issuing Authority upon request, copies of records required by this permit [40 CFR 122.41(h)].
9. Du to Reapply
If the Permittee wishes to continue an activity regulated by this permit after the expiration date of this permit, the
Permittee must apply for and obtain a new permit [40 CFR 122.41(b)].
10. Expiration of Permit
The Permittee is not authorized to discharge after the expiration date. In order to receive automatic authorization to
discharge beyond the expiration date, the Permittee shall submit such information, forms, and fees as are required
by the agency authorized to issue permits no later than 180 days prior to the expiration date unless permission for a
later date has been granted by the Director. (The Director shall not grant permission for applications to be
submitted later than the expiration date of the existing permit.) [40 CFR 122.21(d)] Any Permittee that has not
requested renewal at least 180 days prior to expiration, or any Permittee that does not have a permit after the
expiration and has not requested renewal at least 180 days prior to expiration, will subject the Permittee to
enforcement procedures as provided in NCGS 143-215.6 and 33 USC 1251 et. seq.
11. Signatory Requirements
All applications, reports, or information submitted.to.the Perm ti Issuing Authority shall be signed aiid certified [40
CFR 122.41(k)].
a. All permit applications shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this Section, a responsible
corporate officer means: (a) a president, secretary, treasurer or vice president of the corporation in charge
of a principal business function, or any other person who performs similar policy or decision making
functions for the corporation, or (b) the manager of one or more manufacturing, production, or operating
facilities, provided, the,manager is authorized to make management decisions which govern the operation
of the regulated facility including having the explicit or implicit duty of making major capital investment
recommendations, and initiating and directing other comprehensive measures to assure long term
environmental compliance with environmental laws and regulations; the manager can ensure that the
necessary systems are established or actions taken to gather complete and accurate information for permit
application requirements; and where authority to sign documents has been assigned or delegated to the
manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, State, Federal, or other public agency: by either a principal executive officer or
ranking elected official [40 .CFR 122.22].
b. All reports required by the permit and other information requested by the Permit Issuing Authority shall be
signed by a person described in paragraph a. above or by a duly authorized representative of that person. A
person is a duly authorized representative only if:
(1) The authorization is made in writing by a person described above;
(2) The authorization specified either an individual or a position having responsibility for the overall operation
of the regulated facility or activity, such as the position of plant manager, operator of a well or well field,
superintendent, a position of equivalent responsibility, or an individual or position having ,overall
responsibility for environmental matters for the company. (A duly authorized representative may thus be
either a named individual or any individual occupying a named position.); and
(3) The written authorization is submitted to the Permit Issuing rAuthority [40 CFR 122.221
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c. Changes to authorization: If an authorization under paragraph (b) of this section is no longer accurate because
a different individual or position has responsibility for the overall operation of the facility, a new authorization
satisfying the requirements of paragraph (b) of this section must be submitted to the Director prior to or
together with any reports, information, or applications to be signed by an authorized representative [40 CFR
122.22]
d. Certification. Any person signing a document under paragraphs a. or b. of this section shall make the following
certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL BE ACCEPTED:
7 certify, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and
evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations. "
12. Permit Actions
This permit may be modified, revoked and reissued, or terminated for cause. The filing of a request by the
Permittee for a permit modification, revocation and reissuance, or termination, or a notification of planned changes
or anticipated noncompliance does not stay any permit condition [40 CFR 122.41(Q.
13. Permit Modification Revocation and Reissuance, or Termination
The issuance of this permit does not prohibit the permit issuing authority from reopening and modifying the permit,
revoking and reissuing the permit, or terminating the permit as allowed by the laws, rules, and regulations
contained in Title 40, Code of Federal Regulations, Parts 122 and 123; Title 15A of the North Carolina
Administrative Code, Subchapter 02H .0100; and North Carolina General Statute 143.215.1 et. al.
14. Annual Administering and Compliance Monitoring Fee Requirements
The Permittee must pay the annual administering and compliance monitoring fee within thirty days after being
billed by the Division. Failure to pay the fee in a timely manner in accordance with 15A NCAC 02H .0105(b)(2)
may cause this Division to initiate action to revoke the permit.
Section C. Operation and Maintenance of Pollution Controls
1. Certified Operator
Owners of classified water pollution control systems must designate operators, certified by the Water Pollution
Control System Operators Certification Commission (WPCSOCC), of the appropriate type and grade for the
system, and, for each classification must [T15A NCAC 08G .0201]:
a. designate one Operator In Responsible Charge (ORC) who possesses a valid certificate of the type and grade at
least equivalent to the type and grade of the system;
b. designate one or more Back-up Operator(s) in Responsible Charge (Back-up ORCs) who possesses a valid
certificate of the type of the system and no more than one grade less than the grade of the system, with the
exception of no backup operator in responsible charge is required for systems whose minimum visitation
requirements are twice per year; and
c. submit a signed completed "Water Pollution Control System Operator Designation Form" to the Commission
(or to the local health department for owners of subsurface systems) countersigned by the designated certified
operators, designating the Operator in Responsible Charge (ORC) and the Back-up Operator in Responsible
Charge (Back-up ORC):
(1) 60 calendar days prior to wastewater or residuals being introduced into a new system; or
(2) within 120 calendar days following:
➢ receiving notification of a change in the classification of the system requiring the designation of a new
Operator in Responsible Charge (ORC) and Back-up Operator in Responsible Charge (Back-up ORC)
of the proper type and grade; or
➢ a vacancy in the position of Operator in Responsible Charge (ORC) or Back-up Operator in
Responsible Charge (Back-up ORC).
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(3) within seven calendar days of vacancies in both ORC and Back-up ORC positions replacing or designating
at least one of the responsibilities.
The ORC of each Class I facility (or the Back-up ORC, when acting as surrogate for the ORC) must:
➢ Visit the facility as often as is necessary to insure proper operation of the treatment system; the treatment
facility must be visited at least weekly
➢ Comply with all other conditions of 15A NCAC 08G .0204.
The ORC of each Class H, III and IV facility (or the Back-up ORC, when acting as surrogate for the ORC) must:
➢ Visit the facility as often as is necessary to insure proper operation of the treatment system; the treatment
facility must be visited at least five days per week, excluding holidays
➢ Properly manage and document daily operation and maintenance of the facility
➢ Comply with all other conditions of 15ANCAC 08G .0204.
2. Proper Operation and Maintenance
The Permittee shall at all times properly operate and maintain all facilities and systems of treatment and control
(and related appurtenances) which are installed or used by the Permittee to achieve compliance with the conditions
of this permit. Proper operation and maintenance also includes adequate laboratory controls and appropriate quality
assurance procedures. This provision requires the Permittee to install and operate backup or auxiliary facilities only
when necessary to achieve compliance with the conditions of the permit [40 CFR 122.41(e)].
NOTE: Properly and officially designated operators are fully responsible for all proper operation and maintenance
of the facility, and all documentation required thereof, whether acting as a contract operator [subcontractor] or a
member of the Permittee's staff.
3. Need to Halt or Reduce not a Defense
It shall not be a defense for a Perxnittee in an enforcemefifktiori that it would have been necessary to halt or
reduce the permitted. activity in order to maintain compliance with the condition of this permit [40 CFR 122.41(c)].
4. Bypassing of Treatment Facilities
a. Bypass not exceeding limitations [40 CFR 122.41(m)(2)]
The Permittee may allow any bypass to occur which does not cause effluent limitations to be exceeded, but
only if it also is for essential maintenance to assure efficient operation. These bypasses are not subject to the
provisions of Paragraphs b. and c. of this section.
b. Notice [40 CFR 122.41(m)(3)]
(1) Anticipated bypass. If the Permittee knows in advance of the need for a bypass, it shall submit prior notice,
if possible at least ten days before the date of the bypass; including an evaluation of the anticipated quality
and effect of the bypass.
(2) Unanticipated bypass. The Permittee shall submit notice of an unanticipated bypass as required in Part
II.E.6. (24-hour notice).
c. Prohibition of Bypass
(1) Bypass from the treatment facility is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for bypass, unless:
(A) Bypass was unavoidable to prevent loss of life, personal injury or severe property damage;
(B) There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities,
retention of untreated wastes or maintenance during normal periods of equipment downtime. This
condition is not satisfied if adequate backup equipment should have been installed in the exercise of
reasonable engineering judgment to prevent a bypass which occurred during normal periods of
equipment downtime or preventive maintenance; and
(C) The Permittee submitted notices as required under Paragraph b. of this section.
(2) Bypass from the collection system is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for a bypass as provided in any current or future system -wide collection system
permit associated with the treatment facility.
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(3) The Permit Issuing Authority may approve an anticipated bypass, after considering its adverse effects, if
the Permit Issuing Authority determines that it will meet the three conditions listed above in Paragraph c.
(1) of this section.
5. Upsets
a. Effect of an upset [40 CFR 122.41(n)(2)]: An upset constitutes an affirmative defense to an action brought for
noncompliance with such technology based permit effluent limitations if the requirements of paragraph b. of
this condition are met. No determination made during administrative review of claims that noncompliance was
caused by upset, and before an action for noncompliance, is final administrative action subject to judicial
review.
b. Conditions necessary for a demonstration of upset: Any Permittee who wishes to establish the affirmative
defense of upset shall demonstrate, through properly signed, contemporaneous operating logs, or other relevant
evidence that:
(1) An upset occurred and that the Permittee can identify the cause(s) of the upset;
(2) The Permittee facility was at the time being properly operated; and
(3) The Permittee submitted notice of the upset as required in Part II.E.6.(b) of this permit.
(4) The Permittee complied with any remedial measures required under Part lI.13.2. of this permit.
c. Burden of proof [40 CFR 122.41(n)(4)1: The Permittee seeking to establish the occurrence of an upset has
. the burden of proof in any enforcement proceeding.
6. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or control of wastewaters
shall be utilized/disposed of in accordance with NCGS 143-215.1 and in a manner such as to prevent any pollutant
from such materials from entering waters of the State or navigable waters of the United States except as permitted
by the Commission. The Permittee shall comply with all applicable state and Federal regulations governing the
disposal of sewage sludge, including 40 CFR 503, Standards for the Use and Disposal of Sewage Sludge; 40 CFR
Part 258, Criteria For Municipal Solid Waste Landfills; and 15A NCAC Subchapter 2T, Waste Not Discharged To
Surface Waters. The Permittee shall notify the Permit Issuing Authority of any significant change in its sludge use
or disposal practices.
7. Power Failures
The Permittee is responsible for maintaining adequate safeguards (as required by 15A NCAC 02H .0124) to
prevent the discharge of untreated or inadequately treated wastes during electrical power failures either by means
of alternate power sources, standby generators or retention of inadequately treated effluent.
Section D. Monitoring and Records
1. Representative Sampling
Samples collected and measurements taken, as required herein, shall be representative of the permitted discharge.
Samples collected at a frequency less than daily shall be taken on a day and time that is representative of the
discharge for the period the sample represents. All samples shall be taken at the monitoring points specified in this
permit and, unless otherwise specified, before the effluent joins or is diluted by any other wastestream, body of
water, or substance. Monitoring points shall not be changed without notification to and the approval of the Permit
Issuing Authority [40 CFR 122.41(j)].
2. Reporting
Monitoring results obtained during the previous month(s) shall be summarized for each month and reported on a
monthly Discharge Monitoring Report (DMR) Form (MR 1, 1. 1, 2, 3) or alternative forms approved by the
Director, postmarked no.later than the last calendar day of the month following the completed reporting period.
The first DMR is due on the last day of the month following the issuance of the permit or in the case of a new
facility, on the last day of the month following the commencement of discharge. Duplicate signed copies of these,
and all other reports required herein, shall be submitted to the following address:
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NC DENR / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Flow Measurements
Appropriate flow measurement devices and methods consistent with accepted scientific practices shall be selected
and used to ensure the accuracy and reliability of measurements of the volume of monitored discharges. The
devices shall be installed, calibrated and maintained to ensure that the accuracy of the measurements is consistent
with the accepted capability of that type of device. Devices selected shall be capable of measuring flows with a
maximum deviation of less than 10% from the true discharge rates throughout the range of expected discharge
volumes. Flow measurement devices shall be accurately calibrated at a minimum of once per year and maintained
to ensure that the accuracy of the measurements is consistent with the accepted capability of that type of device.
The Director shall approve the flow measurement device and monitoring location prior to installation.
Once -through condenser cooling water flow monitored by pump logs, or pump hour meters as specified in Part I of
this permit and based on the manufacturer's pump curves shall not be subject to this requirement.
4. Test Procedures
Laboratories used for sample analysis must be certified by the Division. Permittees should contact the Division's
Laboratory Certification Section (919 733-3908 or http://portal.ncdenr.org/web/wq/lab/cert) for information
regarding laboratory certifications.
Facilities whose personnel are conducting testing of field -certified parameters only must hold the appropriate field
parameter laboratory certifications.
Test procedures for the analysis of pollutants shall conform to the EMC regulations (published pursuant to NCGS
143-215.63 et. seq.), the Water and Air Quality Reporting Acts, and to regulations published pursuant to Section
304(g), 33 USC 1314,,of the CWA (as amended), and 40 CFR 136; or in the case of sludge use or disposal,
approved under 40 CFR 136, unless otherwise specified in 40 CFR 503, unless other test procedures have been
specified in this permif`[40 CFR 122.41].
To meet the intent of the monitoring required by this permit, all test procedures must produce minimum detection
and reporting levels that are below the permit discharge requirements and all data generated must be reported down
to the minimum detection or lower reporting level of the procedure. If no approved methods are determined
capable of achieving minimum detection and reporting levels below pen -nit discharge requirements, then the most
sensitive (method with the lowest possible detection and reporting level) approved method must be used.
5. Penalties for Tampering
The CWA provides that any person who falsifies, tampers with, or knowingly renders inaccurate, any monitoring
device or method required to be maintained under this permit shall, upon conviction, be punished by a fine of not
more than $10,000 per violation, or by imprisonment for not more than two years per violation, or by both. If a
conviction of a person is for a violation committed after a first conviction of such person under this paragraph,
punishment is a fine of not more than $20,000 per day of violation, or by imprisonment of not more than 4 years,
or both [40 CFR 122.41].
6. Records Retention
Except for records of monitoring information required by this permit related to the Permittee's sewage sludge use
and disposal activities, which shall be retained for a period of at least five years (or longer as required by 40 CFR
503), the Permittee shall retain records of all monitoring information, including:
➢ all calibration and maintenance records
➢ all original strip chart recordings for continuous monitoring instrumentation
➢ copies of all reports required by this permit
➢ copies of all data used to complete the application for this permit
These records or copies shall be maintained for a period of at least 3 years from the date of the sample,
measurement, report or application. This period may be extended by request of the Director at any time [40 CFR
122.41].
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7. Recording Results
For each measurement or sample taken pursuant to the requirements of this permit, the Permittee shall record the
following information [40 CFR 122.41]:
a. The date, exact place, and time of sampling or measurements;
b. The individual(s) who performed the sampling or measurements;
c. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.
8. Inspection and Entry
The Permittee shall allow the Director, or an authorized representative (including an authorized contractor acting as
a representative of the Director), upon the presentation of credentials and other documents as may be required by
law, to;
a. Enter, at reasonable times, upon the Permittee's premises where a regulated facility or activity is located or
conducted, or where records must be kept under the conditions of this permit;
b. Have access to and copy, at reasonable times, any records that must be kept under the conditions of this permit,
c. Inspect at reasonable times any facilities, equipment (including monitoring and control equipment), practices,
or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring permit compliance or as otherwise
authorized by the CWA, any substances or parameters at any location [40 CFR 122.41(i)].
Section E Reporting Requirements
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms and conditions of this permit. The discharge of
any pollutant identified in this permit more frequently than or at a level in excess of that authorized shall constitute .
a violation of the permit.
2. Planned Changes
The Permittee shall give notice to the Director as soon as possible of any planned physical alterations or additions
to the permitted facility [40 CFR 122.41(1)]. Notice is required only when:
a. The alteration or addition to a permitted facility may meet one of the criteria for new sources at 40 CFR
122.29(b); or
b. The alteration or addition could significantly change the nature or increase the quantity of pollutants
discharged. This notification applies to pollutants subject neither to effluent limitations in the permit, nor to
notification requirements under 40 CFR 122.42(a)(1); or
c. The alteration or addition results in a significant change in the Permittee's sludge use or disposal practices, and
such alteration, addition or change may justify the application of permit conditions that are different from or
absent in the existing permit, including notification of additional use or disposal sites not reported during the
permit application process or not reported pursuant to an approved land application plan.
3. Anticipated Noncompliance
The Permittee shall give advance notice to the Director of any planned changes to the permitted facility or other
activities that might result in noncompliance with the permit [40 CFR 122.41(1)(2)].
4. Transfers
This permit is not transferable to any person without prior written notice to and approval from the Director in
accordance with 40 CFR 122.61. The Director may condition approval in accordance with NCGS 143-215.1, in
particular NCGS 143-215.1(b)(4)b.2., and may require modification or revocation and reissuance of the permit, or
a minor modification, to identify the new permittee and incorporate such other requirements as may be necessary
under the CWA [40 CFR 122.41(1)(3), 122.611 or state statute.
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5. Monitoring Reports
Monitoring results shall be reported at the intervals specified elsewhere in this permit [40 CFR 122.41(1)(4)].
a. Monitoring results must be reported on a Discharge Monitoring Report (DMR) (See Part II.D.2) or forms
provided by the Director for reporting results of monitoring of sludge use or disposal practices.
b. If the Permittee monitors any pollutant more frequently than required by this permit using test procedures
approved under 40 CFR Part 136 and at a sampling location specified in this permit or other appropriate
instrument governing the discharge, the results of such monitoring shall be included in the calculation and
reporting of the data submitted on the DMR.
6. Twenty-four Hour Reporting
a. The Pen- ittee shall report to the Director or the appropriate Regional Office any noncompliance that
potentially threatens public health or the environment. Any information shall be provided orally within 24
hours from ,the time the Permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the Permittee becomes aware of the circumstances. The written submission
shall contain a description of the noncompliance, and its cause; the period of noncompliance, including exact
dates and times, and if the noncompliance has not been corrected, the anticipated time it is expected to
continue; and steps taken or planned to reduce, eliminate; and prevent reoccurrence of the noncompliance [40
CFR 122.41(l)(6)].
b. The Director may waive the written report on a case -by -case basis for reports under this section if the oral
report has been received within 24 hours.
c. Occurrences outside normal business hours may also be reported to the Division's Emergency Response
personnel at [phone], [phone] or [phone].
7. Other Noncompliance
The Permittee shall report all instances of noncompliance notyeported under Part II.E.5 and 6. of this permit at the
time monitoring reports are submitted. The reports shall contain the information listed in Part II.E.6. of this permit
[40 CFR 122.41(l)(7)].
8. Other Information
Where the Permittee-becomes aware that it failed to submit any relevant facts in a permit application, or submitted
incorrect information in a permit application or in any report to the Director, it shall promptly submit such facts or
information [40 CFR 122.41(l)(8)].
9. Noncompliance Notification
The Permittee shall report by telephone to either the central office or the appropriate regional office of the Division
as soon as possible, but in no case more than 24 hours or on the next working day following the occurrence or first
knowledge of the occurrence of any of the following:
a. Any occurrence at the water pollution control facility which results in the discharge of significant amounts of
wastes which are abnormal in quantity or characteristic, such as the dumping of the contents of a sludge
digester; the known passage of a slug of hazardous substance through the facility; or any other unusual
circumstances.
b. Any process unit failure, due to known or unknown reasons, that render the facility incapable of adequate
wastewater treatment such as mechanical or electrical failures of pumps, aerators, compressors, etc.
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass without treatment of all
or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report within 5 days following first
knowledge of the occurrence. Also see reporting requirements for municipalities in Part IV.C.2.c. of this permit,
10. Availability of Reports
Except for data determined to be confidential under NCGS 143-215.3 (a)(2) or Section 308 of the Federal Act, 33
USC 1318, all reports prepared in accordance with the terms shall be available for public inspection at the offices
of the Division. As required by the Act, effluent data shall not be considered confidential. Knowingly making any
false statement on any such report may result in the imposition of criminal penalties as provided for in NCGS 143-
215. 1 (b)(2) or in Section 309 of the Federal Act.
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11. Penalties for Falsification of Reports
The CWA provides that any person who knowingly makes any false statement, representation, or certification in
any record or other document submitted or required to be maintained under this permit, including monitoring
reports or reports of compliance or noncompliance shall, upon conviction, be punished by a fine of not more than
$25,000 per violation, or by imprisonment for not more than two years per violation, or by both [40 CFR 122.41].
12. Annual Performance Reports
Permittees who own or operate facilities that primarily collect or treat municipal or domestic wastewater and have
an average annual flow greater than 200,000 gallons per day shall provide an annual report to the Permit Issuing
Authority and to the users/customers served by the Permittee (NCGS 143-215.1C). The report shall summarize the
performance of the collection or treatment system, as well as the extent to which the facility was compliant with
applicable Federal or State laws, regulations and rules pertaining to water quality. The report shall be provided no
later than sixty days after the end of the calendar or fiscal year, depending upon which annual period is used for
evaluation.
The report shall be sent to:
NC DENR / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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PART III
OTHER REQUIREMENTS
Section A. Construction
a. The Permittee shall not commence construction of wastewater treatment facilities, nor add to the plant's treatment
capacity, nor change the treatment process(es) utilized at the treatment plant unless (1) the Division has issued an
Authorization to Construct (AtC) permit or (2) the Permittee is exempted from such AtC permit requirements
under Item b. of this Section.
b. In accordance with NCGS 143-215.1(a5) [SL 2011-3941, no permit shall be required to enter into a contract for the
construction, installation, or alteration of any treatment work or disposal system or to construct, install, or alter any
treatment works or disposal system within the State when the system's or work's principle function is to conduct,
treat, equalize, neutralize, stabilize, recycle, or dispose of industrial waste or sewage from an industrial facility and
the discharge of the industrial waste or sewage is authorized under a permit issued for the discharge of the
industrial waste or sewage into the waters of the State. Notwithstanding the above, the permit issued for the
discharge may be modified if required by federal regulation.
c. Issuance of an AtC will not occur until Final Plans and Specifications for the proposed construction have been
submitted by the Permittee and approved by the Division.
Section B. Groundwater Monitoring
The Permittee shall, upon written notice from the Director, conduct groundwater monitoring as may be required to
determine the compliance of this NPDES permitted facility with the current groundwater standards.
Section C: Changes in Discharges of Toxic Substances
The Permittee shall notify the Permit Issuing Authority as soon as it knows or has reason to believe (40 CFR 122.42):
a. That any activity has occurred or will occur which would result in the discharge, on a routine or frequent basis, of
any toxic pollutant which is not limited in the permit, if that discharge will exceed the highest of the following
"notification levels";
(1) One hundred micrograms per liter (100 µg/L);
(2) Two hundred micrograms per liter (200 µg/L) for acrolein and acrylonitrile; five hundred micrograms per liter
(500 µg/L) for 2,4-dinitrophenol and for 2-methyl-4,6-dinitrophenol; and one milligram per liter (1 mg/L) for
antimony;
(3) Five times the maximum concentration value reported for that pollutant in the permit application.
b. That any activity has occurred or will occur which would result in any discharge, on anon -routine or infrequent
basis, of a toxic pollutant which is not limited in .the permit, if that discharge will exceed the highest of the
following "notification levels';
(1) Five hundred micrograms per liter (500 µg/L);
(2) One milligram per liter (1 mg/L) for antimony;
(3) Ten times the maximum concentration value reported for that pollutant in the permit application.
Section D. Facility Closure Requirements
The Permittee must notify the Division at least 90 days prior to the closure of any wastewater treatment system covered
by this permit. The Division may require specific measures during deactivation of the system to prevent adverse
impacts to waters of the State. This permit cannot be rescinded while any activities requiring this permit continue at the
permitted facility.
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PART IV
SPECIAL CONDITIONS FOR MUNICIPAL FACILITIES
Section A. Definitions
In addition to the definitions in Part H of this permit, the following definitions apply to municipal facilities:
Indirect Discharge or Industrial User
Any non -domestic source that discharges wastewater containing pollutants into a POTW regulated under section
307(b), (c) or (d) of the CWA. [40 CFR 403.3 (i) and 0) and 15A NCAC 02H .0903(b)(11)]
Interference
Inhibition or disruption of the POTW treatment processes; operations; or its sludge process, use, or disposal which
causes or contributes to a violation of any requirement of the Permittee's (or any satellite POTW's if different from the
Permittee) NPDES, collection system, or non -discharge permit or prevents sewage sludge use or disposal in
compliance with specified applicable State and Federal statutes, regulations, or permits. [I 5A NCAC 02H
.0903(b)(14)]
Pass Through
A discharge which exits the POTW into waters of the State in quantities or concentrations which, alone or with
discharges from other sources, causes a violation, including an increase in the magnitude or duration of a violation, of
the Permittee's (or any satellite POTW's, if different from the Permittee) NPDES, collection system, or non -discharge
permit. [15A NCAC 02H .0903(b)(23)]
Publicly Owned Treatment Works (POTW)
A treatment works as defined by Section 212 of the CWA, which is owned by a State or local government organization.
This definition includes any devices and systems used in the storage, treatment, recycling and reclamation of municipal
sewage or industrial wastes of a liquid nature. It also includes the collection system, as defined in 15A NCAC 2T
.0402, only if it conveys wastewater to a POTW treatment plant. The term also means the local government
organization, or municipality, as defined in section 502(4) of the CWA, which has jurisdiction over indirect discharges
to and the discharges from such a treatment works. In this context, the organization may be the owner of the POTW
treatment plant or the owner of the collection system into which an indirect discharger discharges. This second type of
POTW maybe referred to as a "satellite POTW organization." [15A NCAC 02H .0903(b)(26)]
"Significant Industrial User" or "SLU"
An Industrial User that discharges wastewater into a publicly owned treatment works and that [15A NCAC 02H
.0903(b)(33)1:
1. Discharges an average of 25,000 gallons per day or more of process wastewater to the POTW (excluding sanitary,
noncontact cooling and boiler blowdown wastewaters); or
2. Contributes process wastewater which makes up five percent or more of the NPDES or non -discharge permitted
flow limit or organic capacity of the POTW treatment plant. In this context, organic capacity refers to BOD, TSS
and ammonia; or
3. Is subject to categorical standards under 40 CFR Part 403.6 and 40 CFR Parts 405-471; or
4. Is designated as such by the Permittee on the basis that the Industrial User has a reasonable potential for adversely
affecting the POTW's operation or for violating any pretreatment standard or requirement, or the POTW's effluent
limitations and conditions in its NPDES or non -discharge permit, or to limit the POTW's sludge disposal options;
5. Subject to approval under 15A NCAC 02H .0907(b), the Permittee may determine that an Industrial User meeting
the criteria in paragraphs 1 or 2 of this definition above has no reasonable potential for adversely affecting the
POTW's operation or for violating any pretreatment standard or requirement, the POTW's effluent limitations and
conditions in its NPDES or non -discharge permit, or to limit the POTW's sludge disposal options, and thus is not a
Significant Industrial User (SILT); or
6. Subject to approval under 15A NCAC 02H ..0907(b), the Permittee may determine that an Industrial User meeting
the criteria in paragraph 3 of this definition above meets the requirements of 40 CFR Part 403.3(v)(2) and thus is a
non -significant categorical Industrial User.
Section B. Publicly Owned Treatment Works (POTWs)
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All POTWs must provide adequate notice to the Director of the following [40 CFR 122.42(b)]:
1. Any new introduction of pollutants into the POTW from an indirect discharger, regardless of the means of
transport, which would be subject to section 301 or 306 of CWA if it were directly discharging those pollutants;
and
2. Any substantial change in the volume or character of pollutants being introduced by an indirect discharger as
influent to that POTW at the time of issuance of the permit.
3. For purposes of this paragraph, adequate notice shall include information on (1) the quality and quantity of effluent
introduced into the POTW, and (2) any anticipated impact that may result from the change of the quantity or
quality of effluent to be discharged from the POTW.
Section C. Municipal Control of Pollutants from Industrial Users.
1. Effluent limitations are listed in Part I of this permit. Other pollutants attributable to inputs from Industrial Users
discharging to the POTW may be present in the Permittee's discharge. At such time as sufficient information
becomes available to establish limitations for such pollutants, this permit may be revised to specify effluent
limitations for any or all of such other pollutants in accordance with best practicable technology or water quality
standards.
2. Prohibited Discharges
a. The Permittee shall develop and enforce their Pretreatment Program to implement the prohibition against the
introduction of pollutants or discharges into the waste treatment system or waste collection system which
cause or contribute to Pass Through or Interference as defined in 15A NCAC 02H .0900 and 40 CFR 403. [40
CFR 403.5(a)(1)]
b. The Permittee shall develop and enforce their Pretreatment Program to implement the prohibitions against the
introduction of the following wastes in the waste treatment or waste collection system [40 CFR 403.5(b)]:
(1) Pollutants which create a fire or explosion hazard in the POTW, including, but not limited to,
wastestreams with a closed cup flashpoint of less than 140 degrees Fahrenheit or 60 degrees Centigrade
using the test methods specified in 40 CFR 261.21;
(2) Pollutants which cause corrosive structural damage to the POTW, but in no case discharges with pH lower
than 5.0, unless the works is specifically designed to accommodate such discharges;
(3) Solid or viscous pollutants in amounts which cause obstruction to the flow in the POTW resulting in
Interference;
(4) Any pollutant, including oxygen demanding pollutants (BOD, etc.) released in a Discharge at a flow rate
and/or pollutant concentration which will cause Interference with the POTW;
(5) Heat in amounts which will inhibit biological activity in the POTW resulting in Interference, but in no
case heat in such quantities that the temperature at the POTW Treatment Plant exceeds 40°C (104°F)
unless the Division, upon request of the POTW, approves alternate temperature limits;
(6) Petroleum oil, non -biodegradable cutting oil, or products of mineral oil origin in amounts that will cause
Interference or Pass Through;
(7) Pollutants which result in the presence of toxic gases, vapors, or fumes within the POTW in a quantity that
may cause acute worker health and safety problems; or
(8) Any trucked or hauled pollutants, except at discharge points designated by the POTW.
c. The Permittee shall investigate the source ,of all discharges into the POTW, including slug loads and other
unusual discharges, which have the potential to adversely impact the Permittee's Pretreatment Program and/or
the operation of the POTW.
The Permittee shall report such discharges into the POTW to the Director or the appropriate Regional Office.
Any information shall be provided orally within 24 hours from the time the Permittee became aware of the
circumstances. A written submission shall also be provided within 5 days of the time the Permittee becomes
aware of the circumstances. The written submission shall contain a description of the discharge; the
investigation into possible sources; the period of the discharge, including exact dates and times; if the
discharge has not ceased, the anticipated time it is expected to continue; and steps taken or planned to reduce,
eliminate, and prevent reoccurrence of the noncompliance,
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3. With regard to the effluent requirements listed in Part I of this permit, it may be necessary for the Permittee to
supplement the requirements of the Federal Pretreatment Standards (40 CFR, Part 403) to ensure compliance by
the Permittee with all applicable effluent limitations. Such actions by the Permittee may be necessary regarding
some or all of the industries discharging to the municipal system.
4. The Permittee shall require any Industrial User (IU) discharging to the POTW to meet Federal Pretreatment
Standards developed under Section 307(b) of the Act as amended (which includes categorical standards and
specific local limits, best management practices and narrative requirements). Prior to accepting wastewater from
any Significant Industrial User (SIU), the Permittee shall either develop and submit to the Division a new
Pretreatment Program or, as necessary, a modification of an existing Pretreatment Program, for approval as
required under section D below as well as 15A NCAC 02H .0907(a) and (b). [40 CFR 122.440)(2)]
5. This permit shall be modified, or alternatively, revoked and reissued, to incorporate or modify an approved POTW
Pretreatment Program or to include a compliance schedule for the development of a POTW Pretreatment Program
as required under Section 402 (b)(8) of the CWA and implementing regulations or by the requirements of the
approved State pretreatment program, as appropriate.
Section D. Pretreatment Programs
Under authority of sections 307 (b) and (c) and 402(b)(8) of the CWA and implementing regulations 40 CFR 403,
North Carolina General Statute 143-215.3(14) and implementing regulations 15A NCAC 02H .0900, and in accordance
with the approved pretreatment program, all provisions and regulations contained and referenced in the pretreatment
program submittal are an enforceable part of this permit. [40 CFR 122.440)(2)]
The Permittee shall operate its approved pretreatment program in accordance with Section 402(b)(8) of the CWA, 40
CFR 403, 15A NCAC 02H .0900, and the legal authorities, policies, procedures, and financial provisions contained in
its pretreatment program submission and Division approved modifications thereof. Such operation shall include but is
not limited to the implementation of the following conditions and requirements. Terms not defined in Part II or Part IV
of this permit are as defined in 15A NCAC 02H .0903 and 40 CFR 403.3.
1. Sewer Use Ordinance (SUO)
The Permittee shall maintain adequate legal authority to implement its approved pretreatment program. [15A
NCAC 02H .0903(b)(32), .0905 and .0906(b)(1); 40 CFR 403.8(f)(1) and 403.9(b)(1) and (2)]
2. Industrial Waste Survey (IWS)
The Permittee shall implement an IWS consisting of the survey of users of the POTW collection system or
treatment plant, as required by 40 CFR 403.8(f)(2)(i-iii) and 15A NCAC 02H .0905 [also 40 CFR 122.440)(1)],
including identification of all Industrial Users that may have an impact on the POTW and the character and amount
of pollutants contributed to the POTW by these Industrial Users and identification of those Industrial Users
meeting the definition of SIU. Where the Permittee accepts wastewater from one or more satellite POTWs, the
IWS for the Permittee shall address all satellite POTW services areas, unless the pretreatment program in those
satellite service areas is administered by a separate Permittee with an approved Pretreatment Program. The
Permittee shall submit a summary of its IWS activities to the Division at least once every five years, and as
required by the Division. The IWS submission shall include a summary of any investigations conducted under
paragraph C.2.c. of this Part. [15A NCAC 02H .0903(b)(13), .0905 and .0906(b)(2); 40 CFR 403.8(f)(2) and 403.91
3. Monitoring Plan
The Permittee shall implement a Division -approved Monitoring Plan for the collection of facility specific data to
be used in a wastewater treatment plant Headworks Analysis (HWA) for the development of specific pretreatment
local limits. Effluent data from the Plan shall be reported on the DMRs (as required by Parts II.D and H.E.5.). [15A
NCAC 02H .0903(b)(16), .0906(b)(3) and .0905]
4. Headworks Analysis (HWA) and Local Limits
The Permittee shall obtain Division approval of a HWA at least once every five years, and as required by the
Division. Within 180 days of the effective date of this permit (or any subsequent permit modification) the
Permittee shall submit to the Division a written technical evaluation of the need to revise local limits (i.e., an
updated HWA or documentation of why one is not needed) [40 CFR 122.44]. The Permittee shall develop, in
accordance with 40 CFR 403.5(c) and 15A NCAC 02H .0909, specific Local Limits to implement the prohibitions
listed in 40 CFR 403.5(a) and (b) and 15A NCAC 02H .0909. Pursuant to 40 CFR 403.5, local limits are
Version 1110912011.1

NPDES Permit Standard Conditions
Page 17 of 18
enforceable PretreatmentStandards as defined by 40 CFR 403.3(1). [15A NCAC 02H .0903(b)(10), .0905, and
:0906(b)(4)]
5. Industrial User Pretreatment Permits (!UP) & Allocation Tables'
In accordance with NCGS' 143-215.1, the Permittee shall issue to all Significant Industrial Users, permits for
operation of pretreatment equipment and discharge to the Permittee's collection system or treatment works: These
permits shall contain limitations, sampling protocols, reporting requirements, appropriate standard and special
conditions; and compliance schedules as necessary for the installation of treatment and control technologies to
assure that their wastewater discharge will meet all applicable pretreatment standards and requirements. The
Permittee all maintain a current Allocation Table (AT) which summarizes the results of the 14WA and the limits
from all 1UPs. Permitted IUP loadings for each parameter cannot exceed the treatment capacity of the POTW' as
determined by the HWA. [15A NCAC 0211.0906(b)(6), .0909, .0916,, and .0917; 40 CFR 403.5, 403.8(f)(1)(iii);
NCGS 143-215.67(a)]
6. Authorization to Construct (AtC)
'The Permittee shall ensure that an Authorization to Construct permit (AtC) is issued to all' applicable Industrial
Users for the construction or modification of any pretreatment facility. Prior to the issuance of an AtC, the
proposed pretreat =, nt facility, and treatment process must be evaluated for its capacity to comply with all
Industrial User Pretreatment Permit (IUP) limitations. [15A NCAC 02H .0906(b)(7) and .0905; NCGS 143-
215.1(a)(8)'],
7. POTW Inspection & Monitoring of their IUs
The Permittee shall conduct inspection, surveillance, and monitoring; activities as described in its Division
approved pretreatment program in order to determine, independent of information supplied by Industrial Users,
compliance with applicable pretreatment standards. [15A NCAC 02H>0908(e); 40 CFR 403.8(f)(2)(v)]', The;
Permittee must:
a. Inspect all Significant Industrial Users (SIUs) at least once per calendar year;
b. Sample all Significant Industrial Users (SIUs) at least once per calendar year for all S'IU permit -limited
parameters including flow except as allowed under 15A NCAC .0908(e);, and
c. At least once per year, document an evaluation of any non -significant categorical Industrial User for
compliance with the requirements in 40 CFR 403.3(v)(2), and either continue or revoke the designation as non-
significant.
8. IU Self Monitoringand nd Reporting
The Permittee shall require all Industrial Users to comply with the applicable monitoring, and reporting;
requirements outlined in the Division -approved pretreatment program, the industry's;pretreatment permit, or in 15A
NCAC 02H .0908. [15A NCAC 02H .0906(b)(5) and .0905; 40 CFR 403.8(f)(1)(v) and (2)(iii); 40 CFR
122.440)(2) and 40 CFR 403.1:2]
9. Enforcement Response Plan (ERP),
The Permittee shall enforce and obtain appropriate remedies for violations of all pretreatment standards,
promulgated pursuant to section 307(b) and (c) of the CWA (40 CFR,405 et. ,seq.), prohibitive discharge standards
as set forth in 40 CFR 403.5 and 15A NCAC 02H .0909, specific local limitations, and other pretreatment
requirements. All remedies,, enforcement actions and other, shall be consistent with the Enforcement Response
Plan (ERP) approved by the Division. [15A NCAC 02F1.0903(b)(7)„ 0906('b)(8) and .0905; 40 CFR 403:8(f)(5)],
10. Pretreatment Annual Reports (PAR)
The Perm ttee, shall report to the Division in accordance with 15A NCAC 0214.0908: In lieu of submitting annual
reports, Modified Pretreatment Programs developed under 15A NCAC 02H .0904 (b) may be required to submit a
partial annual report or to meet with Division personnel periodically to discuss enforcement of pretreatment
requirements and other pretreatment implementation issues.
For all other active pretreatment programs, the. Permittee shall submit two copies of a Pretreatment Annual Report
(PAR) describing, its pretreatment activities over the previous calendar year to the Division at the following
address:
Version 1`110912011.1

NPDES Permit Standard Conditions
Page 18 of 18
NC DENR / Division of Water Resources_/ Water Quality Permitting Section
Pretreatment, Emergency Response, and Collection Systems (PERCS) Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
These reports shall be submitted by March 1 of each year and shall contain the following:
a. Narrative.
A narrative summary detailing actions taken, or proposed, by the Permittee to, correct significant non-
compliance and to ensure compliance with pretreatment requirements;.
b. Pretreatment Program Surmnary (PPS)
A pretreatment program summary (PPS) on forms or in a format provided by the Division;
c. Significant Non -Compliance. Report (SNCR)
A list of Industrial Users (IUs) in significant noncompliance (SNC) with pretreatment requirements, and the
nature .qf the violations on forms or in a format provided by the Division;
d. Industrial Data. Summary Forms (IDSF)
Monitoring data from samples collected by both the POTW and the Significant Industrial Users (SIUs). These
analytical results must be reported on Industrial Data Summary Forms (IDSF) or on other forms or in a format
provided by the Division;,
e. Other Information
Copics of the POTW's allocation table, new or modified enforcement compliance schedules, public notice of
IUs in SNC, a summaryof data or other information related to significant noncompliance determinations for
lUs that are not considered'SIUs, and any other information, upon request, which in the opinion of the Director
is needed to determine compliance with .the pretreatment implementation requirements of this permit;,
11. Public Notice
The Permittee shall publish annually a list of Industrial Users (IUs) that were in significant noncompliance (SNC)
as defined in the Permittee's Division -approved Sewer Use Ordinance with applicable pretreatment requirements
and standards during the previous twelve month period. This list shall be published within four months of the
applicable twelve-month period. [15A NCAC 02H .0903(b)(34), .0908(b)(5) and .0905 and 40 CFR
403.8(f)(2)(viii)]
12. Record Keeping
The Permittee shall retain for a minimum of three years records of monitoring activities and results, along with
support information includinggeneral records, water quality records,,and records of industrial impact on the
POTW and shall retain all other Pretreatment Program records as required by 15A NCAC 02H .0908(f). [I 5A
NCAC 02H .0908(f); 40 CFR 403.12(o)]
13. Pretreatment Program Resources
The Permittee shall maintain adequate funding, and qualified personnel to accomplish the objectives of its approved
pretreatment program. and retain a written description of those current levels of inspection. [I 5A NCAC 02H
.0906(b)(9) and (10) and .0905; 40 CFR 403.8(f)(3), 403.9(b)(3)]I
14. Modification to Pretreatment Programs
Modifications to the approved pretreatment program including but not limited to local limits modifications; POTW
monitoring of their Significant, Industrial Users (SIUs),, and Monitoring Plan modifications, shall be considered a
permit modification and shall be governed by 40 CFR 4.03.18, 15 NCAC 02H .0114.and 15A NCAC 02H .090T.
Version 1410912011.1

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 14, 2010
Mr. Edward Y. Gaven, Jr.
Executive Director
Emeritus Corporation
2601 US Highway 64 East
Hendersonville, North Carolina 28792
Subject: NPDES PERMIT ISSUANCE
Permit Number NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Mr. Gaven:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached final 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).
If any parts, measurement frequencies or sampling, requirements contained in. this pen -nit 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 permit
shall be final and binding.
Please note that a Fecal Coliform limit was added to protect the instream Fecal Coliform standard
and that it will go into effect July 1, 2012.
This permit is not transferable. 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, Coastal Area Management Act, or any other Federal or Local governmental permits which may
be required.
If you have any questions or need additional information, please do not hesitate to contact Maureen
Scardina of my staff at (919)-$07=6388: - -
Sincerely,
y ., '�� ma's" ', u t•r°. :ar r
cc: Central Files
NPDES Unit Files
As'he dle1 na al fJffi'ce, SLrface Water Prgtectzo%
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone] \ Customer Service: 1 877-623-6748
Internet: http:llpopi ncdehr,org/weblwglhome
An Equal Opportunity \ Affirmative Acton Employer
ulhns
t1AIV 6 2011
{14
WATER QUALITQ�Cr{O .
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V.
Permit NCO069370
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,
Emeritus Corporation
(dba: Pine Park Retirement Inn)
is hereby authorized to discharge wastewater from a facility located at the
Pine Park Retirement Inn
2601 Chimney Rock Road
Southeast of Oak Hill
Henderson County
to receiving waters designated as Clear Creek in the French Broad River Basin in accordance with
effluent limits, monitoring requirements, and other conditions set forth in Parts I, H, III and IV hereof..
This permit shall become effective January 1, 2011.
This permit and authorization to discharge shall expire at' midnight on November 30, 2015.
Signed this day December 14, 2010.
Coleen H. Sullins, Director
p('Division of Water Quality
By Authority of the Environmental Management Commission

_ 'Permit NCO069370
SUPPLEMENT TO PERMIT COVER,SHEET
`All previous NPDES permits issued to4 this facility, whether, for operation or discharge are hereby
revoked. As of,this,p-6 nit 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.
Emeritus Corporation (dba: Pine Park Retirement Inn) is hereby authorized'to:
`1. Continue to operate an, existing 0.025 MGD extended aeration wastewater treatment system with
the following components:
♦ Influent lift station
♦ Bar Screen
Aeration basin
Clarifier
♦ Tablet. Chlorinator
` . ♦ Chlorine contact chamber
♦ Sludge digester
' ♦ Effluent pump" station
♦ 'Effluent Flow Recorder
♦ Activated sludge holding basin
The facility is located at Pine Park Retirement Inn at 2601 Chimney Rock Road in Hendersonville
in Henderson County;
2. Prior to expansion to 0.035 MGD, the permittee shall submit an. Engineering Alternatives Analysis.
[See Spection Condition A.(3.)]. After receiving an Authorization to Construct permit from the
Division of Water Quality, construct and operate the components necessary for a 0.035 MGD
wastewater treatment facility; and
I. Discharge from said treatment works at the location specified on the attached map into Clear
Creek, currently classified C waters in sub -basin 04-03-02 in the French Broad River Basin.

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Emeritus Corporation
Facilityh�4
Pine Park Retirement inn:x
�.,k.
Location
County: Henderson Stream Class: C
(not to scales
Receiving Stream: Clear Creek Sub -Basin: 04-03-02
Latitude: 35' 21' 28" Grid/Quad: 'F9SW/Hendersonville
'""Toneitude: "'`86°26'&2 -.'''''Htc 06010105
NORTH
NPDESPermit: NC0069370

9 Permit NC006 370
A: (1) EFFLUENT LIMITS AND MONITORING REQUIREMENTS
During 'the period beginning. on January 1, 2011 and lasting until expansion above 0.025 MGD, or
November 30, 2015, the permittee is authorized to discharge treated wastewater from outfall 001. Such
discharges shall be limited and monitored by the permittee as specified below:
EFFLUENT CHARACTERISTICS,
EFFLUENT LIMITS
MONITORING REQUIREMENTS
Monthly
Daily
Measurement
Sample
Sample
ParameterDescnptaon' PCSCode Y
':
" Mazimum
Frequency
#
"
1
Location
:.. , _ :: •
; ;.Average ..
;
.. . ..
TYPe ..
;
Flown
Influent or
0.025 MGD
Continuous
Recorder
Effluent
50050
BOD, 5'-Day (20 Deg. C)
'
30.0 mg/L
45.0 mg/L .
Weekly
Grab
Effluent
00310
Solids, Total Suspended
-M.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
00530•
Nitrogen, Ammonia Total (as
2 / month
Grab
Effluent
00610.
3
_Coliform, Fecal
200/106 nil
400/100 m1 '
Weekly
Grab
Effluent
' 31616
4
Chlorine, Total Residual
28 µg/L.
2 / week
Grab
Effluent
M060
Temperature, Water Deg. Centigrade -
Weekly
-Grab
Effluent
00010.
pH
Not < 6.0 nor > 9.0
Weekly
Grab
Effluent
00400
Standard Units
Colifonn, Fecal
Upstream &
Weekly
Grab
31616'
Downstream
Footnotes:
1'. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis. [See
Special Condition A.(3.)].
3. This limit will take effect July 1, '2012 (18-months after the permit effective date), while monitoring is
required beginning on the permit effective date.
4. ° This'limit applies if'chlorine compounds are used- as -a means of disinfection. The Division shall consider
- - all effluent TRC values reported below 50 µg/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 µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS'OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

m Permit NCO069370
A. (2.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS
During the period beginning upon expansion above 0.025 MGD and lasting .until November 30, 2015,
the permittee is authorized to discharge treated wastewater from outfall 001. Such discharges shall be
limited and monitored by the'permittee as specified below:
EFFLUENT 1
EFFLUENT LIMITS.
MONITORING REQUIREMENTS
0A TERISTICS
. i
Monthly
Daily
Measurement
Sample
mple Sa
Parameter Desci- tion "Pode
`am
Ff_,­,;TyPMF
ocationl
.
Flow
Influent or
0.035 MGD
Continuous
Recorder
50050
Effluent
BOD; 5-Day (20 Deg. C) - Summer*
10.0 mg/L
15.0 mg/L
Weekly
Composite
Effluent
00310
BOD, 5-Day (20 Deg. C) - Winter*
20.0 mg/L
30.0 ing/L
Weekly'
Composite
Effluent
00310
Solids, Total Suspended
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
00530
Nitrogen, Ammonia Total (as N) —Summer*
2.0 mg/L
10.0 mg/L
Weekly
Composite
Effluent.
00610
Nitrogen, Ammonia Total (as N) — Winter*
4.0 mg/L
20.0 mg/L
Weekly
Composite
Effluent
00610
DO, Oxygen, Dissolved
Weekly
Grab
Effluent
00300
Fecal Colifonn
200/100 ml
400/1'00 ml
Weekly
Grab
Effluent
3161.6
.
Chlorine, Total Residual3
28 µg/L
2 / week
Grab
Effluent
50060
Temperature, Water Deg. Centigrade
Daily
Grab
Effluent
00010
pH
Not < 6.0 nor > 9.0
00400
Standard Units
Weekly
Grab
Effluent
Temperature, Water Deg. Centigrade
Upstream &
Weekly
Grab
00010
Downstream
DO, Oxygen, Dissolved
Weekly
Grab
Upstream &
00300
1
1 Downstream
*Summer.: April 1 -October 31
Winter: November I - Md?6h 31" �' v
Footnotes•
1. Upstream: 100 feet above discharge location; Downstream: 300 feet below, discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis. [See Special
Condition A.(3.)].
3. This -limit applies if chlorine compounds are used as a means of disinfection. The Division shall consider all
effluent TRC values reported below 50 µg/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 µg/L.
THERE SHALL BE NO DISCHARGE OP FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

Permit NC0069370
A. (3.) ENGINEERING ALTERNATIVES ANALYSIS REQUIREMENT
Prior to expansion to 0.035 MGD, the permittee shall submit a detailed analysis of all available means to
dispose of this facility's wastewater. This Engineering Alternatives Analysis (EAA) shall be prepared in
compliance with the Division's guidance document of EAAs.
If no EAA is submitted, the Division may reopen and modify this permit to increase monitoring frequencies or
change effluent limits. as necessary to protect the receiving stream.
Submit one copy of the EAA to the following address:
NCDENR / DWQ / Asheville Regional Office
Attention: Mr. Roger Edwards, Surface Water Protection Supervisor
2090 U.S. Hwy 70
Swannanoa, NC 28778
and
Submit the original and one copy of the EAA to the following address:
Dr. Sergei Chernikov
NCDENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

PDES Permit Standard Conditions
Page 1 of 18
PART II
STANDARD CONDITIONS FOR NPDES PERMITS.
SectionA. Definitions
2/Month
Samples are collected twice per month with at least ten calendar days between sampling events. These samples shall
be representative of the wastewater discharged during the sample period.
0
/Week
Samples are collected three times per week on three separate calendar days. These samples shall be representative of
the wastewater discharged during the sample period.
Act or "the Act"
The Federal Water Pollution Control Act, also known as the Clean Water Act (CWA), as amended, 33 USC 1251, et.
seq.
Annual Average
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar year. In the case of fecal
coliform, the geometric mean of such discharges.
Arithmetic Mean
The summation of the individual values divided by the number of individual values.
Bwass
The known diversion of waste streams from any portion of a treatment facility including the collection system, which
is not a designed or established or operating mode for the facility.
Calendar Day
The period from midnight of one day until midnight of the next day. However, for purposes of this permit, any
consecutive 24-hour period that reasonably represents the calendar day may be used for sampling.
Calendar Week
The period from Sunday through the following Saturday.
Calendar Quarter
One of the following distinct periods: January through March, April through June, July through September, and
October through December.
Composite Sample
A sample collected over a 24-hour period by continuous sampling or combining grab samples of at least 100 ml in
such a mariner as to result in a total sample representative of the wastewater discharge during the sample period. The
Director may designate the most appropriate method (specific number and size of aliquots necessary, the time
interval between grab samples, etc.) on a case -by -case basis. Samples may be collected manually or automatically.
Composite samples maybe obtained by the following methods:
(1) Continuous: a single, continuous sample collected over a 24-hour period proportional to the rate of flow.
(2) Constant time/variable volume: a series of grab samples collected at equal time intervals over a 24 hour
period of discharge and combined proportional to the rate of flow measured at the time of individual sample
collection, or
(3) variable time/ constant volume: a series of grab samples of equal volume collected over a 24 hour period
with the time intervals between samples determined by a preset number of gallons passing the sampling
point. Flow measurement between sample intervals shall be determined by use of a flow recorder and
Version 512009

IN rDE S Permit Standard Conditions
Page 2 of 18
totalizer, and the preset gallon interval between sample collection fixed at no greater than 1/ 24 of the
expected total daily flow at the treatment system, or
(4) Constant time/ constant volume: a series of grab samples of equal volume collected over a 24-hour period at
a constant time interval. Use of this method requites prior approval by the Director This method
may only be used in situations where effluent flow rates vary less than 15 percent. The following
restrictions also apply:
➢ Influent and effluent grab samples shall be of equal size and of no less than 100 milliliters
➢ Influent samples shall not be collected more than once per hour.
➢ Permittees with wastewater treatment systems whose detention time < 24 hours shall collect effluent
grab samples at intervals of no greater than 20 minutes apart during any 24-hour period.
➢ Permittees with wastewater treatment systems whose detention time exceeds 24 hours shall collect
effluent grab samples at least every six hours; there must be a minimum of four samples during a 24-hour
sampling period.
Continuous flow measurement
Flow monitoring that occurs without interruption throughout the operating hours of the facility. Flow shall be
monitored continually except for the infrequent times when there may be no flow or for infrequent maintenance
activities on the flow device.
D &Discharge
The discharge of a pollutant measured during a calendar day or any 24-hour period that reasonably represents the
calendar day for purposes of sampling. For pollutants measured in units of mass, the "daily discharge" is calculated as
the total mass of the pollutant discharged over the day. The "daily discharge" concentration comprises the mean
concentration for a 24-hour sampling period as either a composite sample concentration or the arithmetic mean of alll
grab samples collected during that period. (40 CFR 122.2)
D& Maximum
The highest " daily discharge" during the calendar month.
Daily Sampling
Parameters requiring daily sampling shall be sampled 5 out of every 7 days per week unless otherwise specified in the
permit. Sampling shall be conducted on weekdays except where holidays or other disruptions of normal operations
prevent weekday sampling. If sampling is required for all seven days of the week for any permit parameter(s), that
requirement will be so noted on the Effluent Limitations and Monitoring Page(s).
DWQ or "the Division"
The Division of Water Quality, Department of Environment and Natural Resources.
EMC
The North Carolina Environmental Management Commission.
EPA
The United States E nvironmental Protection Agency
Facility Closure
Cessation of all activities that require coverage under this NPDES permit. Completion of facility closure will allow
this permit to be rescinded.
Geometric Mean
The Nth root of the product of the individual values where N = the number of individual values. For purposes of
calculating the geometric mean, values of "0" (or "< [detection level]") shall be considered = 1.
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Grab Sample
Individual samples of at least 100 ml collected over a period of time not exceeding 15 minutes. Grab samples can be
collected manually. Grab samples must be representative of the discharge (or the receiving stream, for instream
samples).
Hazardous Substance
Any substance designated under 40 CFR Part 116 pursuant to Section 311 of the CWA.
Instantaneous flow measurement
A measure of flow taken at the time of sampling, when both the sample and flow will be representative of the total
discharge.
Monthly Average (concentration limit)
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar month. In the case of fecal
coliform, the geometric mean of such discharges.
Permit Issuing Authority
The Director of the Division of Water Quality.
Quarterly Average (concentration limit)
The average of all samples taken over a calendar quarter.
Severe property damage
Substantial physical damage to property, damage to the treatment facilities which causes their to become inoperable,
or substantial and permanent loss of natural resources which can reasonably be expected to occur in the absence of a
bypass. Severe property damage excludes economic loss caused by delays in production.
Toxic Pollutant:
Any pollutant listed as toxic under Section 307(a)(1) of the CWA.
Upset
An incident beyond the reasonable control of the Permittee causing unintentional and temporary noncompliance with
permit effluent limitations and/or monitoring requirements. An upset does not include noncompliance caused by
operational error, improperly designed treatment facilities, inadequate treatment facilities,. lack of preventive
maintenance, or careless or improper operation.
Weekly Average (concentration limit)
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar week. In the case of fecal
coliform, the geometric mean of such discharges.
Sections. Getwml Conditions
1. Duty to Comply
The Permittee must comply with all conditions of this permit. Any permit noncompliance constitutes a violation
of the CWA and is grounds for enforcement action; for permit termination, revocation and reissuance, or
modification; or denial of a permit renewal application [40 CFR 122.411.
a. The Permittee shall comply with effluent standards or prohibitions established under section 307(a) of the
CWA for toxic pollutants and with standards for sewage sludge use or disposal established under section
405(d) of the CWA within the time provided in the regulations that establish these standards or prohibitions
or standards for sewage sludge use or disposal, even if the permit has not yet been modified to incorporate
the requirement.
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b. The CWA provides that any person who violates sections] 301, 302, 306, 307, 308, 318 or 405 of the Act, or
any permit condition or limitation implementing any such sections in a permit issued under section 402, or
any requirement imposed in a pretreatment program approved under sections 402 (a) (3) or 402 (b) (8) of the
Act, is subject to a civil penalty not to exceed. $37,500 per day for each violation. 133 USC 1319 (d) and 40
CFR 122.41 (a) (2)]
c. The CWA provides that any person who nyiflyviolates sections 301, 302, 306, 307, 308, 318, or 405 of the
Act, or any condition or limitation implementing any of such sections in a permit issued under section 402 of
the Act, or any requirement imposed in a pretreatment program approved under section 402(a)(3) or
402(b)(8) of the. Act, is subject to criminal penalties of $2,500 to $25,000 per day of violation, or
imprisonment of not more than 1 year, or both. In the case of a second or subsequent conviction for a
negligent violation, a person shall be subject to criminal penalties of not more than $50,000 per day of
violation, or by imprisonment of not more than 2 years, .or both. 133 USC 1319 (c) (1) and 40 CFR 122.41 (a)
(2)]
d. Any person who kmdrdy violates such sections, or such conditions or limitations is subject to criminal
penalties of $5,000 to $50,000 per day of violation, or imprisonment for not more than 3 years, or both. In
the case of a second or subsequent conviction for a knowing violation, a person shall be subject to criminal
penalties of not more than $100,000 per day of violation, or imprisonment of not more than 6 years, or both.
133 USC 1319 (c) (2) and 40 CFR 122.41 (a) (2)]
e. Any person who knowingly violates section 301, 302, 303, 306, 307, 308, 318 or 405 of the Act, or any permit
condition or limitation implementing any of such sections in a permit issued under section 402 of the Act,
and who knows at that time that he thereby places another person in imminent danger of death or serious
bodily injury, shall, upon conviction, be subject to a fine of not more than $250,000 or imprisonment of not
more than 15 years, or both. In the case of a second or subsequent conviction for a knowing endangerment
violation, a person shall be subject to a fine of not more than $500,000 or by imprisonment of not more than
30 years, or both. An organization, as defined in section 309(c)(3)(BXiii) of the CWA, shall, upon conviction
of violating the imminent danger provision, be subject to a fine of not more than $1,000,000 and can be fined
up to $2,000,000 for second or subsequent convictions. [40 CFR 122.41 (a) (2)]
f. Under state law, a civil penalty of not more than $25,000 per violation may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of a permit. [North
Carolina General Statutes § 143-215.6A]
g. Any person may be assessed an administrative penalty by the Administrator for violating section 301, 302,
306, 307, 308, 318 or 405 of this Act, or any permit condition or limitation implementing any of such
sections in a permit issued under section 402 of this Act. Administrative penalties for Class I violations are
not to exceed $16,000 per violation, with the maximum amount of any Class I penalty assessed not to exceed
$37,500. Penalties for Class II violations are not to exceed $16,000 per day for each day during which the
violation continues, with the maximum amount of any Class II penalty not to exceed $177,500.133 USC 1219
(g) (2) and 40 CFR 122.41 (a) (3)]
2. Duty to Mitigate
The Permittee shall take all reasonable steps to minimize or prevent any discharge or sludge use or disposal in
violation of this permit with a reasonable likelihood of adversely affecting human health or the environment [40
CFR 122.41 (d)].
3. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II. C. 4), "Upsets" (Part II. C. 5) and "Power
Failures" (Part II. C. 7), nothing in this permit shall be construed to relieve the Permittee from any
responsibilities, liabilities, or penalties for noncompliance pursuant to NCGS 143-215.3, 143-215.6 or Section 309
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of the Federal Act, 33 USC 1319. Furthermore, the Permittee is responsible for consequential damages, such as
fish kills, even though the responsibility for effective compliance may be temporarily suspended.
4. Oil and Hazardous Substance Liability
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve the Permittee
from any responsibilities, liabilities, or penalties to which the Permittee is or maybe subject to under NCGS 143-
215.75 et seq. or Section 311 of the Federal Act, 33 USG 1321. Furthermore, the Permittee is responsible for
consequential damages, such as fish kills, even though the responsibility for effective compliance may be
temporarily suspended.
5. Property Rights
The issuance of this permit does not convey any property rights in either real or personal property, or any
exclusive privileges, nor does it authorize any injury to private property or any invasion of personal rights, nor
any infringement of Federal, State or local laws or regulations [40 CFR 122.41(g)].
6. Onshore or Offshore Construction
This permit does not authorize or approve the construction of any onshore or offshore physical structures or
facilities or the undertaking of any work in any navigable waters.
7. Severability
The provisions of this permit are severable. If any provision of this permit, or the application of any provision of
this permit to any circumstances, is held invalid, the application of such provision to other circumstances, and the
remainder of this permit, shall not be affected thereby [NCGS 15013-231.
8. Duty to Provide Information
The Permittee shall furnish to the Permit Issuing Authority, within a reasonable time, any information which the
Permit Issuing Authority may request to determine whether cause exists for modifying, revoking and reissuing, or
terminating this permit or to determine compliance with this permit. The Permittee shall also furnish to the
Permit Issuing Authority upon request, copies of records required by this permit [40 CFR 122.41 (h)].
9. Duty to Reapply
If the Permittee wishes to continue an activity regulated by this permit after the expiration date of this permit, the
Permittee must apply for and obtain a new permit [40 CFR 122.41(b)].
10. Expiration of Permit
The Permittee is not authorized to discharge after the expiration date. In order to receive automatic
authorization to discharge beyond the expiration date, the Permittee shall submit such information, forms, and
fees as are required by the agency authorized to issue permits no later than 180 days prior to the expiration date.
Any Permittee that has not requested renewal at least 180 days prior to expiration, or any Permittee that does not
have a permit after the expiration and has not requested renewal at least 180 days prior to expiration, will subject
the Permittee to enforcement procedures as provided in NCGS 143-215.6 and 33 USC 1251 et. seq.
11. SiatoryRequirements
All applications, reports, or information submitted to the Permit Issuing Authority shall be signed and certified
[40 CFR 122.41 (k)].
a. All pernut applications stall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this Section, a responsible
corporate officer means: (a) a president, secretary, treasurer or vice president of the corporation in
charge of a principal business function, or any other person who performs similar policy or decision
making functions for the corporation, or (b) the manager of one or more manufacturing, production, or
operating facilities, provided, the manager is authorized to make management decisions which govern the
operation of the regulated facility including having the, explicit or implicit duty of making major capital
investment recommendations, and initiating and directing other comprehensive measures to assure long
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term environmental compliance with environmental laws and regulations; the manager can ensure that
the necessary systems are established or actions taken to gather complete and accurate information for
permit application requirements; and where authority to sign docuunents has been assigned or delegated
to the manager in accordance with corporate procedures .
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively, or
(3) For a municipality, State, Federal, or other public agency: by either a principal executive officer or
ranking elected official [40 CFR 122.221.
b. All reports required by the permit and other information requested by the Permit Issuing Authority shall be
signed by a person described in paragraph a. above or by a duly authorized representative of that person. A
person is a duly authorized representative only if:
1. The authorization is made in writing by a person described above,
2. The authorization specified either an individual or a position having responsibility for the overall
operation of the regulated facility or activity, such as the position of plant manager, operator of a well or
well field, superintendent, a position of equivalent responsibility, or an 'individual or position having
overall responsibility for environmental matters for the company. (A duly authorized representative may
thus be either a named individual or any individual occupying a named position.); and
3. The written authorization is submitted to the Permit Issuing Authority [40 CFR 122.221
c. Changes to authorization: If an authorization under paragraph (b) of this section is no longer accurate
because a different individual or position has responsibility for the overall operation of the facility, a new
authorization satisfying the requirements of paragraph (b) of this section must be submitted to the Director
prior to or together with any reports, information, or applications to be signed by an authorized
representative [40 CFR 122.221
d. Certification. Any person signing a document under paragraphs a. or b. of this section shall make the
following certification [40 CFR 122.221. NO OTHER STATEMENTS OF CERTIFICATION WILL BE
ACCEPTED:
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate
the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
12. Permit Actions
This permit may be modified, revoked and reissued, or terminated for cause. The filing of a request by the
Permittee for a permit modification, revocation and reissuance, or termination, or a notification of planned
changes or anticipated noncompliance does not stay any permit condition [40 CFR 122.41 01.
13. Permit Modification, Revocation and Reissuance, or Termination
The issuance of this permit does not prohibit the permit issuing authority from reopening and modifying the
permit, revoking and reissuing the permit, or terminating the permit as allowed by the laws, rules, and regulations
contained in Title 40, Code of Federal Regulations, Parts 122 and 123; Title 15A of the North Carolina
Administrative Code, Subchapter 2H.0100; and North Carolina General Statute 143-215.1 et. al.
14. Annual Administering and Compliance Monitoring Fee Requirements
The Permittee must pay the annual administering and compliance monitoring fee within thirty days after being
billed by the Division. Failure e to pay the fee in a timely manner in accordance with 15A NCAC 21-1.0105 (b) (2)
may cause this Division to initiate action to revoke the permit.
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Section C. Operation and Maintenance of Pollution Controls
Certified Operator
Upon classification of the permitted facility by the Certification Commission, the Permittee shall employ a
certified water pollution control treatment system operator in responsible charge (ORC) of the water pollution
control treatment system. Such operator must hold a certification of the grade equivalent to or greater than the
classification assigned to the water pollution control treatment system by the Certification Commission. The
Permittee must also employ one or more certified Back-up ORCs who possess a currently valid certificate of the
type of the system. Back-up ORCs must possess a grade equal to (or no more than one grade less than) the grade
of the system [15A NCAC 8G.02011.
The ORC of each Class I facility must:
➢ Visit the facility as often as is necessary to insure proper operation of the treatment system; the treatment
facility must be visited at least weekly
➢ Complywith all other conditions of 15A NCAC 8G.0204.
The ORC of each Class II, III and IV facility must:
➢ Visit the facility as often as is necessary to insure proper operation of the treatment system; the treatment
facility must be visited at least five days per week, excluding holidays
➢ Properly manage and document daily operation and maintenance of the facility
➢ Comply with all other conditions of 15A NCAC 8G.0204.
Once the facility is classified, the Permittee shall submit a letter to the Certification Commission designating the
operator in responsible charge:
a. Within 60 calendar days prior to wastewater being introduced into anew system
b. Within 120 calendar days of:
➢ Receiving notification of a change in the classification of the system requiring the designation of a
new ORC and backup ORC
➢ A vacancy in the position of ORC or backup ORC.
2. Proper Operation and Maintenance
The Permittee shall at all times provide the operation and maintenance resources necessary to operate the existing
facilities at optimum efficiency. The Permittee shall at all times properly operate and maintain all facilities and
systems of treatment and control (and related appurtenances) which are installed or used by the Permittee to
achieve compliance with the conditions of this permit. Proper operation and maintenance also includes adequate
laboratory controls and appropriate quality assurance procedures. This provision requires the Permittee to install
and operate backup or auxiliary facilities only when necessary to achieve compliance with the conditions of the
permit [40 CFR 122.41 (e)].
NOTE: Properly and officially designated operators are fully responsible for all proper operation and
maintenance of the facility, and all documentation required thereof, whether acting as a contract operator
[subcontractor] or a member of the Permittee's staff.
3. Need to Halt or Reduce not a Defense
It shall not be a defense for a Permittee in an enforcement action that it would have been necessary to halt or
reduce the permitted activity in order to maintain compliance with the condition of this permit [40 CFR 122.41
(c)].
4. Bypassing of Treatment Facilities
a. Bypass not exceeding limitations [40 CFR 122.41 (m) (2)]
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The Permittee may allow any bypass to occur which does not cause effluent limitations to be exceeded, but
only if it also is for essential maintenance to assure efficient operation. These bypasses are not subject to the
provisions of Paragraphs b. and c. of this section.
b. Notice [40 CFR 122.41(m) (3)]
(1) Anticipated bypass. If the Permittee knows in advance of the need for a bypass, it shall submit prior
notice, if possible at least ten days before the date of the bypass; including an evaluation of the
anticipated quality and effect of the bypass.
(2) Unanticipated bypass. The Permittee shall submit notice of an unanticipated bypass as required in Part
I I . E . 6. (24-hour notice).
c. Prohibition of Bypass
(1) Bypass from the treatment facility is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for bypass, unless:
(A) Bypass was unavoidable to prevent loss of life, personal injury or severe property damage;
(B) There were no feasible alternatives to the bypass, such as the use of auxiliary treatment facilities,
retention of -untreated wastes or maintenance during normal periods of equipment downtime. This
condition is not satisfied if adequate backup equipment should have been installed in the exercise of
reasonable engineering judgment to prevent a bypass which occurred during normal periods of
equipment downtime or preventive maintenance, and
(C) The Permittee submitted notices as required -eider Paragraph b. of this section.
(2) Bypass from the collection system is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for a bypass as provided in any current or future system wide collection system
permit associated with the treatment facility.
(3) The Permit Issuing Authority may approve an anticipated bypass, after considering its adverse effects, if
the Permit Issuing Authority determines that it will meet the three conditions listed above in Paragraph c.
(1) of this section.
5. Upets
a. Effect of an upset [40 CFR 122.41 (n) (2)1: An upset constitutes an affirmative defense to an action
brought for noncompliance with such technology based permit effluent limitations if the requirements of
paragraph b. of this condition are met. No determination made during administrative review of claims that
noncompliance was caused by upset, and before an action for noncompliance, is final administrative action
subject to judicial review.
b. Conditions necessary for a demonstration of upset: Any Permittee who wishes to establish the
affirmative defense of upset shall demonstrate, through properly signed, contemporaneous operating logs, or
other relevant evidence that:
(1) An upset occurred and that the Permittee can identify the cause(s) of the upset;
(2) The P ermittee facility was at the time being properly operated; and
(3) The Permittee submitted notice of the upset as required in Part II. E . 6. (b) of this permit.
(4) The Permittee complied with any remedial measures required under Part II. B. 2. of this permit.
c. Burden of proof [40 CFR 122.41(n) (4)1: The Permittee seeking to establish the occurrence of an upset
has the burden of proof in any enforcement proceeding.
6. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or control of wastewaters
shall be utilized/ disposed of in accordance with N CGS 143-215.1 and in a manner such as to prevent any pollutant
from such materials from entering waters of the State or navigable waters of the United States. The Permittee
shall comply with all existing Federal regulations governing the disposal of sewage sludge. Upon promulgation of
40 CFR Part 503, any permit issued by the Permit Issuing Authority for the utilization/ disposal of sludge may be
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reopened and modified, or revoked and reissued, to incorporate applicable requirements at 40 CFR 503. The
Permittee shall comply with applicable 40 CFR 503 Standards for the Use and Disposal of Sewage Sludge (when
promulgated) within the time provided in the regulation, even if the permit is not modified to incorporate the
requirement. The Permittee shall notify the Permit Issuing Authority of any significant change in its sludge use
or disposal practices.
7. Power Failures
The Permittee is responsible for maintaining adequate safeguards (as required by 15A NCAC 2H.0124) to prevent
the discharge of untreated or inadequately treated wastes during electrical power failures either by means of
alternate power sources, standby generators or retention of inadequately treated effluent.
Section D. Monitoring and Records
Representative Sampling
Samples collected and measurements taken, as required herein, shall be characteristic of the volume and nature of
the permitted discharge. Samples collected at a frequency less than daily shall be taken on a day and time that is
characteristic of the discharge over the entire period the sample represents. All samples shall be taken at the
monitoring points specified in this permit and, unless otherwise specified, before the effluent joins or is diluted
by any other wastestream, body of water, or substance. Monitoring points shall not be changed without
notification to and the approval of the Permit Issuing Authority [40 CFR 122.41(j)].
2. Reporting
Monitoring results obtained during the previous month(s) shall be summarized for each month and reported on a
monthly Discharge Monitoring Report (DMR) Form (MR 1, 1.1, 2, 3) or alternative forms approved by the
Director, postmarked no later than the last calendar day of the month following the completed reporting period.
The first DMR is due on the last day of the month following the issuance of the permit or in the case of a new
facility, on the last day of the month following the commencement of discharge. Duplicate signed copies of
these, and all other reports required herein, shall be submitted to the following address:
NC DENR / Division of Water Quality/ Water Quality Section
ATTENTION: CentralFiles
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
3. Flow Measurements
Appropriate flow measurement devices and methods consistent with accepted scientific practices shall be selected
and used to ensure the accuracy and reliability of measurements of the volume of monitored discharges. The
devices shall be installed, calibrated and maintained to ensure that the accuracy of the measurements is consistent
with the accepted capability of that type of device. Devices selected shall be capable of measuring flows with a
maximum deviation of less than 106 from the true discharge rates throughout the range of expected discharge
volumes. Flow measurement devices shall be accurately calibrated at a minimum of once per year and maintained
to ensure that the accuracy of the measurements is consistent with the accepted capability of that type of device.
The Director shall approve the flow measurement device and monitoring location prior to installation.
Once -through condenser cooling water flow monitored by pump logs, or pump hour meters as specified in Part I
of this permit and based on the manufacturer's pump curves shall not be subject to this requirement.
4. Test Procedures
Laboratories used for sample analysis must be certified by the Division. Permittees should contact the Division's
Laboratory Certification Section (919 733-3908 or http://h2o.enr.state.nc.us/lab/cert.htm) for information
regarding laboratory certifications.
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Personnel conducting testing of field -certified parameters must hold ' the appropriate field parameter
certifications.
Test procedures for the analysis of pollutants shall conform to the EMC regulations (published pursuant to
NCGS 143-215.63 et. seq.), the Water and Air Quality Reporting Acts, and to regulations published pursuant to
Section 304(g), 33 USC 1314, of the CWA (as amended), and 40 CFR 136; or in the case of sludge use or disposal,
approved under 40 CFR 136, Lidless otherwise specified in 40 CFR 503, Lidless other test procedures have been
specified in this permit [40 CFR 122.411.
To meet the intent of the monitoring required by this permit, all test procedures must produce minimum
detection and reporting levels that are below the permit discharge requirements and all data generated must be
reported down to the minimum detection or lower reporting level of the procedure. If no approved methods are
determined capable of achieving minimum detection and reporting levels below permit discharge requirements,
then the most sensitive (method with the lowest possible detection and reporting level) approved method must
be used.
5. Penalties for Tampering
The CWA provides that any person who falsifies, tampers with, or knowingly renders inaccurate, any monitoring
device or method required to be maintained under this permit shall, upon conviction, be punished by a fine of
not more than $10,000 per violation, or by imprisonment for not more than two years per violation, or by both.
If a conviction of a person 'is for a violation committed after a first conviction of such person under this
paragraph, punishment is a fine of not more than $20,000 per day of violation, or by imprisonment of not more
than 4 years, or both [40 CFR 122.411.
6. Records Retention
Except for records of monitoring information required by this permit related to the Permittcc's sewage sludge
use and disposal activities, which shall be retained for a period of at least five years (or longer as required by 40
CFR 503), the Permittee shall retain records of all monitoring information, including:
➢ all calibration and maintenance records
➢ all original strip chart recordings for continuous monitoring instrumentation
➢ copies of all reports required by this permit
➢ copies of all data used to complete the application for this permit
These records or copies shall be maintained for a period of at least 3 years from the date of the sample,
measurement, report or application. This period may be extended by request of the Director at any time [40 CFR
122.411.
7. Recording Results
For each measurement or sample taken pursuant to the requirements of this permit, the Permittee shall record
the following information [40 CFR 122.411:
a. The date, exact place, and time of sampling or measurements;
b." The individual(s) who performed the sampling or measurements;
c. The dates) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.
8. Inspection and Entry
The Permittee shall allow the Director, or an authorized representative (including an authorized contractor acting
as a representative of the Director), upon the presentation of credentials and other documents as may be required
bylaw, to;
a. Enter upon the Permittee's premises where a regulated facility or activity is located or conducted, or where
records must be kept under the conditions of this permit;
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b. Have access to and copy, at reasonable times, any records that must be kept under the conditions of this
permit;
c. Inspect at reasonable times any facilities, equipment (including monitoring and control equipment), practices,
or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring permit compliance or as otherwise
authorized by the CWA, any substances or parameters at any location [40 CFR 122.41(i)].
Section E Reaortut Requi�cments
Change in Discharge
All discharges authorized herein shall be consistent with the terms and conditions of this permit. The discharge
of any pollutant identified in this permit more frequently than or at a level in excess of that authorized shall
constitute a violation of the permit.
2. Planned Changes
The Permittee shall give notice to the Director as soon as possible of any planned physical alterations or
additions to the permitted facility [40 CFR 122.41 Q. Notice is required only when:
a. The alteration or addition to a permitted facility may meet one of the criteria for new sources at 40 CFR
122.29 (b); or
b. The alteration or addition could significantly change the nature or increase the quantity of pollutants
discharged. This notification applies to pollutants subject neither to effluent limitations in the permit, nor to
notification requirements under 40 CFR 122.42 (a) a).
c. The alteration or addition results in a significant change in the Permittee's sludge use or disposal practices,
and such alteration, addition or change may justify the application of permit conditions that are different
from or absent in the existing permit, including notification of additional use or disposal sites not reported
during the permit application process or not reported pursuant to an approved land application plan.
3. Anticipated Noncompliance
The Permittee shall give advance notice to the Director of any planned changes to the permitted facility or other
activities that might result in noncompliance with the permit [40 CFR 122.41(1) (2)].
4. Transfers
This permit is not transferable to any person without approval from the Director. The Director may require
modification or revocation and reissuance of the permit to document the change of ownership. Any such action
may incorporate other requirements as may be necessary under the CWA [40 CFR 122.410) (3)].
5. Monitoring Reports
Monitoring results shall be reported. at the intervals specified elsewhere in this permit [40 CFR 122.410) (4)].
a. Monitoring results must be reported on a Discharge Monitoring Report (DMR) (See Part IL D. 2) or forms
provided by the Director for reporting results of monitoring of sludge use or disposal practices.
b. If the Permittee monitors any pollutant more frequently than required by this permit, the results of such
monitoring shall be included in the calculation and reporting of the data submitted on the DMR.
6. Twenty-four Hour Reporting
a. The Permittee shall report to the Director or the appropriate Regional Office any noncompliance that
potentially threatens public health or the environment. Any information shall be provided orally within 24
hours from the time the Permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the Permittee becomes aware of the circumstances. The written
submission shall contain a description of the noncompliance, and its cause; the period of noncompliance,
including exact dates and times, and if the noncompliance has not been corrected, the anticipated time it is
expected to continue; and steps taken or planned to, reduce, elvninate, and prevent reoccurrence of the
noncompliance [40 CFR 122.410) (6)].
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b. The Director may waive the written report on a case -by -case basis for reports under this section if the oral
report has been received within 24 hours.
c. Occurrences outside normal business hours may also be reported to the Division's Emergency Response
personnel at [phone], [phone] or [phone].
7. Other Noncompliance
The Permittee shall report all instances of noncompliance not reported under Part II. E. 5 and 6. of this permit at
the time monitoring reports are submitted. The reports shall contain the information listed in Part II. E. 6. of
this permit [40 CFR 122.410) (7)].
8. Other Information
Where the Permittee becomes aware that it failed to submit any relevant facts in a permit application, or
submitted incorrect information in a permit application or in any report to the Director, it shall promptly submit
such facts or information [40 CFR 122.41 (1) (8)].
9. N oncompliance Notification
The Permittee shall report by telephone to either the central office or the appropriate regional office of the
Division as soon as possible, but in no case more than 24 hours or on the next, working day following the
occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence at the water pollution control facility which results in the discharge of significant amounts of
wastes which are abnormal in quantity or characteristic, such as the dLunping of the contents of a sludge
digester; the known passage of a slug of hazardous substance through the facility, or any other unusual
circumstances.
b. Any process unit failure, due to known or unknown reasons, that render the facility incapable of adequate
wastewater treatment such as mechanical or electrical failures of pumps, aerators, compressors, etc.
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass without treatment of
all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report within 5 days following first
knowledge of the occurrence.
10. Availability of Reports
Except for data determined to be confidential under NCGS 143-215.3 (aX2) or Section 308 of the Federal Act, 33
USC 1318, all reports prepared in accordance with the terms shall be available for public inspection at the offices
of the Division. As required by the Act, effluent data shall not be considered confidential. Knowingly making
any false statement on any such report may result in the imposition of criminal penalties as provided for in
NCGS 143-215.1(bX2) or in Section 309 of the Federal Act.
11. Penalties for Falsification of Reports
The CWA provides that any person who knowingly makes any false statement, representation, or certification in
any record or other docurnent submittedd or required to be maintained under this permit, including monitoring
reports or reports of compliance or noncompliance shall, upon conviction, be punished by a fine of not more
than $25,000 per violation, or by imprisonment for not more than two years per violation, or by both [40 CFR
122.411.
12. Annual Performance Reports
Permittees who own or operate facilities that collect or treat municipal or domestic waste shall provide an annual
report to the Permit Issuing Authority and to the users/customers served by the Permittee (NCGS 143-215.1C).
The report shall summarize the performance of the collection or treatment system, as well as the extent to which
the facility was compliant with applicable Federal or State laws, regulations and rules pertaining to water quality.
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The report shall be provided no later than sixty days after the end of the calendar or fiscal year, depending upon
which annual period is used for evaluation.
The report shall be sent to:
NC DENR / DWQ / Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
PART III
OTHER REQUIREMENTS
SectionA. Construction
The Permittee shall not cominence construction of wastewater treatment facilities, nor add to the plant's treatment
capacity, nor change the treatment process(es) utilized at the treatment plant unless the Division has issued an
Authorization to Construct WC) permit. Issuance of an AtC will not occur until Final Plans and Specifications for
the proposed construction have been submitted by the Permittee and approved by the Division.
Section B. Gmund water M onitoring
The Permittee shall, upon written notice from the Director, conduct groundwater monitoring as maybe required to
determine the compliance of this NPDES permitted facility with the current groundwater standards.
Section C. Cbang_es in Discha=es of Toxic Substances
The Permittee shall notify the Permit Issuing Authority as soon as it knows or has reason to believe (40 CFR 122.42):
a. That any activity has occurred or will occur which would result in the discharge, on a routine or frequent
basis, of any toxic pollutant which is not limited in the permit, if that discharge will exceed the highest of the
following "notification levels";
0) One hundred micrograms per liter (100 pg/L);
(2) Two hundred micrograms per liter (200 pg/L) for acrolein and acrylonitrile; five hundred micrograms
per liter (500 pg/L) for 2.4-dinitrophenol and for 2-methyl-4.6-dinitrophenol; and one milligram per liter
0 mg/L) for antimony,
(3) Five times the maximum concentration value reported for that pollutant in the permit application.
b. That any activity has occurred or will occur which would resiit in any discharge, on a non -routine or
infrequent basis, of a toxic pollutant which is not limited in the permit, if that discharge will exceed the
highest of the following "notification levels";
(1) Five hundred micrograms per liter (500 pg/L);
(2) One milligram per liter 0 mg/L) for antimony,
(3) Ten times the maximum concentration value reported for that pollutant in the permit application.
SectionD. Evaluation of Wastewater Disc
eAltematives
The Permittee shall evaluate all wastewater disposal alternatives and pursue the most environmentally sound
alternative of the reasonably cost effective alternatives. If the facility is in substantial non-compliance with the terms
and conditions of the NPDE S permit or governing rules, regulations or laws, the Permittee shall submit a report in
such form and detail as required by the Division evaluating these alternatives and a plan of action within 60 days of
notification by the Division.
Section E . F acility Closute Reauiiemetrts
The Permittee must notify the Division at least 90 days prior to the closure of any wastewater treatment system
covered by this permit. The Division may require specific measures during deactivation of the system to prevent
adverse impacts to waters of the State. This permit cannot be rescinded while any activities requiring this permit
continue at the permitted facility.
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PART IV
SPECIAL CONDITIONS FOR MUNICIPAL FACILITIES
SectionA. Definitions
In addition to the definitions in Part II of this permit, the following definitions apply to municipal facilities:
Indirect Discharge or Industrial User
Any non -domestic source that discharges wastewater containing pollutants into a POTW regulated under section
307(b), (c) or (d) of the CWA. [40 CFR 403.3 (b) (i) and (j)]
Interference
Inhibition or disruption of the POTW treatment processes; operations; or its sludge process, use, or disposal which
causes or contributes to a violation of any requirement of the POTWs NPDE S Permit or prevents sewage sludge use
or disposal in compliance with specified applicable State and Federal statutes, regulations, or permits. [15A NCAC
2H.0903 (b) (13)]
Pass Through
A discharge which exits the POTW into waters of the State in quantities or concentrations which, alone or with
discharges from other sources, causes a violation, including an increase in the magnitude or duration of a violation, of
the POTWs NPDE S permit, or of an instream water quality standard. [15A NCAC 21-1.0903 (b) (23)]
Publicly Owned Treatment Works (POTW)
A treatment works as defined by Section 212 of the CWA, owned by a State or local government entity. This
definition includes any devices and systems used in the storage, treatment, recycling and reclamation of municipal
sewage or industrial wastes of a liquid nature. It also includes sewers, pipes, and other conveyances only if they
convey wastewater to a POTW. The term also means the local government entity, or municipality, as defined in
section 502(4) of the CWA, which has jurisdiction over indirect discharges to and the discharges from such a
treatment works. [15A NCAC 2H.0903 (b) (27)]
"Significant Industrial User" or "SIU"
An industrial user that discharges wastewater into a publicly owned treatment works and that [15A NCAC 2H.0903
(b) (34)1:
(a) discharges an average of 25,000 gallons or more per day of process wastewater to the POTW (excluding
sanitary, noncontact cooling and boiler blowdown wastewaters) or;
(b) contributes more than 5 percent of the design flow of the POTW treatment plant or more than 5 percent of
the maximurn allowable headworks loading of the POTW treatment plant for any pollutant of concern, or;
(c) is required to meet a national categorical pretreatment standard, or;
(d) is, regardless of Parts (a), (b), and (c) of this definition, otherwise determined by the POTW, the Division, or
the EPA to have a reasonable potential for adversely affecting the POTWs operation or for violating any
pretreatment standard or requirement or POTWs receiving stream standard, or to limit the POTWs sludge
disposal options.
SectionB. rdnhli lyOwnecl Treatinetrt Works (POTWs)
All POTWs are required to prevent the introduction of pollutants into the POTW which will interfere with the
operation of the POTW, including interference with its use or disposal of municipal sludge, or pass through the
treatment works or otherwise be incompatible with such treatment works. [40 CFR 403.21
All POTWs must provide adequate notice to the Director of the following [40 CFR 122.42 (b)]:
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1. Any new introduction of pollutants into the POTW from an indirect discharger, •including pump and
hauled waste, which would be subject to section 301 or 306 of CWA if it were directly discharging those
pollutants; and
2. Any substantial change in the volume or character of pollutants being introduced by an indirect discharger
as influent to that POTW at the time of issuance of the permit.
3. For purposes of this paragraph, adequate notice shall include information on (1) the quality and quantity of
effluent introduced into the POTW, and (2) any anticipated impact that may result from the change of the
quantity or quality of effluent to be discharged from the POTW.
Section C. Municival Control of Pollutants firnn Industrial Users.
1. Effluent limitations are listed in Part I of this permit. Other pollutants attributable to inputs from industries
using the municipal system may be present in the Permittee's discharge. At such time as sufficient information
becomes available to establish limitations for such pollutants, this permit may be revised to specify effluent
limitations for any or all of such other pollutants in accordance with best practicable technology or water
quality standards.
Prohibited Discharges
a. Under no circumstances shall the Permittee allow introduction of pollutants or discharges into the waste
treatment system or waste collection system which cause or contribute to Pass Through or Interference
as defined in 15A NCAC 2H.0900 and 40 CFR 403. [40 CFR 403.5 (a) (1)]
b. Under no circumstances shall the Permittee allow introduction of the following wastes in the waste
treatment or waste collection system [40 CFR 403.5 (b)]:
1. Pollutants which create a fire or explosion hazard in the POTW, including, but not limited to,
wastestreams with a closed cup flashpoint of less than 140 degrees Fahrenheit or 60 degrees
Centigrade using the test methods specified in 40 CFR 261.21;
2. Pollutants which cause corrosive structural damage to the POTW, but in no case discharges with
pH lower than 5.0, unless the works is specifically designed to accommodate such discharges;
3. Solid or viscous pollutants in amounts which cause obstruction to the flow in the POTW resulting
in Interference,
4. Any pollutant, including oxygen demanding pollutants (BOD, etc.) released in a Discharge at a
flow rate and/or pollutant concentration which will cause Interference with the POTW;
5. Heat in amounts which will may inhibit biological activity in the POTW resulting in Interference,
but in no case heat in such quantities that the temperature at the POTW Treatment Plant exceeds
40°C (1047) unless the Division, upon request of the POTW, approves alternate temperature
limits;
6. Petroleum oil, nonbiodegradable cutting oil, or products of mineral oil origin in amounts that will
cause interference or pass through;
7. Pollutants which result in the presence of toxic gases, vapors, or fumes within the POTW in a
quantity that may cause acute worker health and safety problems;
8. Any trucked or hauled pollutants, except at discharge points designated by the POTW.
C. The Permittee shall investigate the source of all discharges into the VAVTP, including slug loads and
other unusual discharges, which have the potential to adversely impact the permittee's Pretreatment
Program and/or the operation of the WWTP.
The Permittee shall report such discharges into the WWTP to the Director or the appropriate Regional
Office. Any information shall be provided orally within 24 hours from the time the Permittee became
aware of the circumstances. A written submission shall also be provided within 5 days of the time the
Permittee becomes aware of the circumstances. The written submission shall contain a description of
the discharge, the investigation into possible sources; the period of the discharge, including exact dates
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and times; and if the discharge has not ceased, the anticipated time it is expected to continue; and steps
taken or planned to reduce, eliminate, and prevent reoccurrence of the noncompliance,
3. With regard to the effluent requirements listed in Part I of this permit, it may be necessary for the Permittee to
supplement the requirements of the Federal Pretreatment Standards (40 CFR, Part 403) to ensure compliance
by the Permittee with all applicable effluent limitations. Such actions by the Permittee maybe necessary
regarding some or all of the industries discharging to the municipal system.
4. The Permittee shall require any industrial discharger sending its effluent to the permitted system to meet
Federal Pretreatment Standards promulgated in response to Section 307(b) of the Act as amended (which
includes categorical standards and locally derived limits and narrative requirements). Prior to accepting
wastewater from any significant industrial user, the Permittee shall either develop and submit to the Division a
new Pretreatment Program or a modification of an existing Pretreatment Program, for approval as required
under section D below as well as 15A NCAC 2H.0907 (a) and (b). [40 CFR 122.44 (j) (2)]
5. This permit shall be modified, or alternatively, revoked and reissued, to incorporate or modify an approved
POTW Pretreatment Program or to include a compliance schedule for the development of a POTW
Pretreatment Program as required under Section 402 (b) (8) of the CWA and implementing regulations or by
the requirements of the approved State pretreatment program, as appropriate.
Section D. Pretreatment Programs
Under authority of sections 307 (b) and (c) and 402 (b) (8) of the CWA and implementing regulations 40 CFR 403,
North Carolina General Statute 143-215.3 (14) and implementing regulations 15A NCAC 2H.0900, and in accordance
with the approved pretreatment program, all provisions and regulations contained and referenced in the Pretreatment
Program Submittal are an enforceable part of this permit. [40 CFR 122.44 (j) (2)]
The Permittee shall operate its approved pretreatment program in accordance with Section 402 (b) (8) of the CWA,
40 CFR 403, 15A NCAC 2H.0900, and the legal authorities, policies, procedures, and financial provisions contained
in its pretreatment program submission and Division approved modifications thereof. Such operation shall include
but is not limited to the implementation of the following conditions and requirements. Terms not defined in Part II
or Part IV of this permit are as defined in 15A NCAC 2H.0903 and 40 CFR 403.3.
1. Sewer Use Ordinance (SUO)
The Permittee shall maintain adequate legal authority to implement its approved pretreatment program. [15A
NCAC 2H.0905 and .0906; 40 CFR 403.8 (f) (1) and 403.9 (1), (2)]
Industrial Waste Survey (IWS)
The permittee shall implement an IWS consisting of the survey of users of the POTW, as required by 40 CFR
403.8 (f) (2) (i-iii) and 15A NCAC 2H.0905 [also 40 CFR 122.44 (j) (1)], including identification of all industrial
users and the character and amount of pollutants contributed to the POTW by these industrial users and
identification of those industrial users meeting the definition of SIU. The Permittee shall submit a summary of
its IWS activities to the Division at least once every five years, and as required by the Division. The IWS
submission shall include a summary of any investigations conducted under paragraph B, 2, c, of this Part.
3. Monitoring Plan
The Permittee shall implement a Division -approved Monitoring Plan for the collection of facility specific data
to be used in a wastewater treatment plant Headworks Analysis (HWA) for the development of specific
pretreatment local limits. Effluent data from the Plan shall be reported on the DMRs (as required by Part II,
Section D, and Section E.S.). [15A NCAC 2H.0906 (b) (2) and .09051
4. H eadworks Analysis (HWA) and Local Limits
The Permittee shall obtain Division approval of a HWA at least once every five years, and as required by the
Division. Within 180 days of the effective date of this permit (or any subsequent permit modification) the
Permittee shall submit to the Division a written technical evaluation of the need to revise local limits (i.e., an
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. V.
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updated HWA or documentation of why one is not needed) [40 CFR 122.441. The Permittee shall develop, in
accordance with 40 CFR 403.5 (c) and 15A NCAC '2H.0909, specific Local Limits to implement the
prohibitions listed in 40 CFR 403.5 (a) and U and 15A NCAC 2H.0909.
5. Industrial User Pretreatment Permits (IUP) & Allocation Tables
In accordance with NCGS 143-215.1, the Permittee shall issue to all significant industrial users, permits for
operation of pretreatment equipment and discharge to the Permitteds treatment works. These permits shall
contain limitations, sampling protocols, reporting requirements, appropriate standard and special conditions,
and compliance schedules as necessary for the installation of treatment and control technologies to assure that
their wastewater discharge will meet all applicable pretreatment standards and requirements. The Permittee
shall maintain a current Allocation Table (AT) which summarizes the results of the HWA and the limits from
all IUPs. Permitted IUP loadings for each parameter cannot exceed the treatment capacity of the POTW as
determined by the HWA. [15A NCAC 2H.0909, .0916, and .0917; 40 CFR 403.5, 403.8 (f) (1) (iii); NCGS 143-
215.67 (a)]
6. Authorization to Construct (AtC)
The Permittee shall ensure that an Authorization to Construct permit (AtQ is issued to all applicable industrial
users for the constriction or modification of any pretreatment facility. Prior to the issuance of an AtC, the.
proposed pretreatment facility and treatment process must be evaluated for its capacity to comply with all
Industrial User Pretreatment Permit (IUP) limitations. [15A NCAC 2H.0906 (b) (6) and .0905; NCGS 143-
215.1 (a) (8)]
7. POTW Inspection & Monitoring of their SIUs
The Permittee shall conduct inspection,, surveillance, and monitoring activities as described in its Division
approved pretreatment program in order to determine, independent of information supplied by industrial users,,
compliance with applicable pretreatment standards. [15A- NCAC 2H.0908 (d); 40 CFR 403.8 (f) (2) (v)] The
Permittee must:
a. Inspect all SIUs at least once per calendar year; and
b. Sample all SIUs at least twice per calendar year for all permit -limited pollutants, once during the period
from January 1.through June 30 and once during the period from July I through December 31, except
for organic compounds which shall be sampled once per calendar year. For the purposes of this
paragraph, "organic compounds" means the types of compounds listed in 40 CFR '136.3 (a), Tables IC,
ID, and IF, as amended.
8. SIU Self Monitoring and Reporting
The Permittee shall require all industrial users to comply with the applicable monitoring and reporting
requirements outlined in the Division -approved pretreatment program, the industry's pretreatment permit, or
in 15A NCAC 2H.0908. [15A NCAC 2H.0906 (b) (4) and .0905; 40 CFR 403.8 (f) (1) (v) and (2) (iii); 40 CFR
122.44 (j) (2)]
9. Enforcement Response Plan (ERP)
The Permittee shall enforce and obtain appropriate remedies for violations of all pretreatment standards
promulgated pursuant to section 307 (b) and (c) of the CWA (40 CFR 405 et. seq.), prohibitive discharge
standards as set forth in 40 CFR 403.5 and 15A NCAC 2H.0909, andspecific local limitations. All
enforcement actions shall be consistent with the Enforcement Response Plan (E'RP) approved by the Division.
[1.5A NCAC 2H.0906 U (7) and .0905; 40 CFR 403.8 (f) (5)]
10. Pretreatment Annual Reports (PAR)
The Permittee shall report to the Division in accordance with .l5A NCAC 2H.0908. In lieu of submitting
annual reports, Modified Pretreatment Programs developed under 15A NCAC 2H.0904 (b) may required to
submit a partial annual report or to meet with Division personnel periodically to discuss enforcement of
pretreatment requirements and other pretreatment implementation issues.
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iNrDES Permit Standard Conditions '
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For all other active pretreatment programs, the Permittee shall submit two copies of a Pretreatment Annual
Report (PAR) describing its pretreatment activities over the previous twelve months to the Division at the
following address:
NC DENR / DWQ / Pretreatment, Emergency Response, and Collection Systems Unit (PERCS)
1617 Mail Service Center
Raleigh, NC 27699-1617
These reports shall be submitted according to a schedule established by the Director and shall contain the
following:
a.) Narrative
A brief discussion of reasons for, status of, and actions taken for all SIUs in Significant Non Compliance
(SN Q
b.) Pretreatment Program Summary (PPS)
A pretreatment program summary (PPS) on specific forms approved by the Division;
c.) Significant Non -Compliance Report (SNCR)
The nature of the violations and the actions taken or proposed to correct the violations on specific forms
approved by the Division;
d.) Industrial Data Sjm2mary Forms (IDSF)
Monitoring data from samples collected by both the POTW and the SIU. These analytical results must
be reported on Industrial Data Summary Forms (IDSF) or other specific format approved by the
Division;
e.) Other Information
Copies of the POTWs allocation table, new or modified enforcement compliance schedules, public
notice of SIUs in SNC, and any other information, upon request, which in the opinion of the Director is
needed to determine compliance with the pretreatment implementation requirements of this permit;
11. Public Notice
The Permittee shall publish annually a list of SIUs that were in SNC as defined in the Permitteds Division -
approved Sewer Use Ordinance with applicable pretreatment regL&ements and standards during the previous
twelve month period. This list shall be published within four months of the applicable twelve-month period.
[15A NCAC 2H.0903 (b) (35), .0908 (b) (5) and .0905 and 40 CFR 403.8 (f) (2) (vii)]
12. Record Keeping
The Permittee shall retain for a minimum of three years records of monitoring activities and results, along with
support information including general records, water quality records, and records of industrial impact on the
POTW. [15A NCAC 2H.0908 (f); 40 CFR 403.12 (o)]
13. Funding and Financial Report
The Permittee shall maintain adequate funding and staffing levels to accomplish the objectives of its approved
pretreatment program. [15A NCAC 2H.0906 (a) and .0905; 40 CFR 403.8 (f) (3), 403.9 (b) (3)]
14. Modification to Pretreatment Programs
Modifications to the approved pretreatment program including but not limited to local limits modifications,
POTW monitoring of their SIUs, and Monitoring Plan modifications, shall be considered a permit
modification and shall be governed by 15 NCAC 2H.0114 and 15A NCAC 2H.0907.
Version 512009

Facility information
NPDES permit #: NCO069370 Henderson County
Facility name: Emeritus Corporation —
Pine Park Retirement Inn WWTP
WWTP class: II
WWTP type: 0.025 MGD (0.035 MGD after EAA & A to C) Clow ® extended
aeration package plant consisting of: influent lift station
with duplex pumps, dual high water alarms and telemetry;
manual bar screen; 25,000 gallon aeration basin with dual
blowers providing diffused air; 98 sq ft rectangular clarifier
with 6 ft weir, skimmer & sludge returns; 1700 gallon aerobic
digestor; tablet chlorinator (not used — not required to
chlorinate — IWC = < 0.4%); 576 gallon chlorine contact
chamber; (no tablet dechlorinator); 30 degree V-notch weir;
Stevens 61 R flow meter with strip recorder & totalizer; and
effluent pump station.
Note: The effluent outfall pipe is submerged in the middle of the
creek, therefore, sampling is not possible there.
There are NO requirements to chlorinate (IWC = < 0.4%), but
they have a low-level (28, ug/1) TRC limit and twice a week
TRC monitoring requirements in the current permit.
The TRC limit and monitoring requirements, need to be
removed from the permit.
There is no effluent fecal coliform limit. There are weekly
effluent, upstream and downstream fecal coliform
monitoring requirements. The weekly effluent, upstream
and downstream fecal coliform monitoring requirements
need to be removed from the permit.
Annual Average Flow: 0.012 MGD (2007-2010 — 3 year average).
Collection System: There is one building, therefore < 12 connections.
Development: Consists of a retirement inn which serves 120
residents in apartments and assisted living
facilities.
Grease interceptor: The grease trap is pumped every other month.
Sludge Management: Commercial hauler (Mike's Septic Service — 828-
253-2612) to the City of Brevard's WWTP and
MSD's WWTP.

WWTP location:
2601 Chimney Rock Road; (US Hwy 64' East);
southeast of Oak Hill
Responsible official:
Edward Y. Gaven, Jr.
Responsible "'s title:
Executive Director
Official's location:
2601 Chimney Rock Road;
Hendersonville, NC 28792-9185
Mailing address:
2601 Chimney Rock Road;
Hendersonville, NC 28792-9185
Phone numbers
828-692-1911
Ed Gaven - Executive Director
828-696-3713
" — fax (email: Pine [e-mail])
Mark Lyons — Facilities Services Director
828-691-7191
Trevor C. McMinn, back-up ORC
" — (h): TRECVO; 2020 Howard Gap Road;
Hendersonville, NC 28792
828-693-4338
Mark Jones, ORC — Jones Environmental
828-273-0760 cell
" - (h): 45 Pleasant Court; Flat Rock, NC 28731
828-693-1031
" - fax
Operator information
Certified ORC & grade:
Trevor C. McMinn - Grade II — Cert # 15084
Back-up ORC:
Mark Jones - Grade II Cert # 988527
Permit information
Date issued:
12-1-2005
Expiration date:
11-30-2010
Stream information
Stream & river basin:
Sub -basin:
Quad:
Grid:
Stream classification:
Drainage area sq mi:
Instream Waste Conc.:
Average stream flow:
Summer 7Q10 cfs:
Winter 7Q10 cfs:
30Q2 cfs:
Clear Creek; French Broad River Basin
04-03-02
Hendersonville
F9SW
C
41.2
0.4% at 0.035 MGD
82.4 cfs
13.1
19.7
31.8

Other information
Directions:
The site is located at the intersection of Chimney
Rock Road (US Hwy 64 East) and Howard Gap
Road (NCSR 1006). The WWTP is located 0.1 mile
north of the building. The outfall is located
1700 feet north of the WWTP on Clear Creek.

of Wa rq i)
C•� QG I % I v
> �E-� 1 OCT 1 8 L'-U5
0
Joanne Baker
Emeritus Corporation
2601 US Hwy 64 East
Hendersonville, North Carolina 28792
Dear Ms. Baker:
r
7, 2005
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and NaturalResources
Alan W. Klimek,(P.E ; Di)ector
Drvision ofLWater: Quality
FIST SFCT!0[J
ASHEVILLE REGIC,t4k 0MCE
Subject: Issuance of NPDES Permit NCO069370
Pine Park Retirement Inn,
Henderson County
The Division received your application tor a wastewater discharge permit on April 5, 2005. Division per
have reviewed and approved your application. Accordingly, we are forwarding the attached NPDES discharge
permit. This permit is issued pursuantl 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 2004, .and as subsequently amended. _
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 mus 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 16714. Unless such demand is made, this decision shall be final and
binding.
Please note that this permit is not
modification or revocation and reic
This permit does not affect the legal re(
Division of Water Quality or permits re(
Management Act or any other Federal
If you have any questions concerning t]
733-5083, extension 532.
Attachment
cc: Central --Files _
D_W_Q/_S...P=ARO , !
NPDES File
able except after notice to the Division. The Division may require
of the permit.
uirements to obtain other permits which may be required by the
uired by the Division of Land Resources, the Coastal Area
r Local governmental permit that may be required.
.is permit, please contact Vanessa Manuel at telephone number (919)
Sincerely,
A/
Alan W. Mime,
North Carolina Division of Water Quality 1617 Mail �ervice Center Raleigh, NC 27699-1617
Internet: h2o:enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer — 50% F!ecycled/10% Post Consumer Paper
Nne
6f Carolina
Xtura!!y
Phone [phone]. Customer Service
FAX [phone]

Permit NC0069370 {Y
G
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,
Emeritus Corporation
(dba: Pine Park Retirement Inn)
is hereby authorized to discharge wastewater from a facility located at the
Pine Park Retirement Inn
2601 Highway 64 East
Southeast of Oak Hill
Henderson County
to receiving waters designated as Clear Creek in the French Broad River Basin
in accordance with effluent limits, 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 October 7, 2005.
Ax
-&r: Alan W. Klimek, P.E., Ddector
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0069370
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.
Emeritus Corporation
(dba: Pine Park Retirement Inn)
is hereby authorized to:
1. Continue to operate an existing 0.025 MGD extended aeration wastewater
treatment system with the following components:
♦ Influent lift station
♦ Aeration basin
♦ Clarifier
Chlorine contact chamber with tablet chlorinator
♦ Sludge digester
♦ Flow measurement device
♦ Effluent ;pump station
The facility is located at Pine Park Retirement Inn at 2601 Highway 64 East in
Hendersonville in Henderson County;
2. After receiving an Authorization to Construct permit from the Division of Water
Quality, construct and operate the components necessary for a 0.035 MGD
wastewater treatment facility; and
3. Discharge from said treatment works at the location specified on the attached
map into Clear Creek, classified C waters in the French Broad River Basin.

Latitude: 35021'28"
Longitude: 86026'02"
Quad # F9SW (Hendersonville)
Stream Class: C
Subbasin: 04-03-02
Receiving Stream: Clear Creek
NCO0693 70
Emeritus Corporation
Pine Park Retirement Inn
Facility$
Location 9:
Noi"�� NOT TO SCALE

Permit NCO069370
A. (1.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS — FINAL
During the period beginning on December 1, 2005, and lasting until expansion above 0.025
MGD or November 30, 2010, the permittee is authorized to discharge treated wastewater from
outfall 001. Such discharges shall be limited and monitored by the permittee as specified below:
ERI TICS `''
`EFFLUENT,CHARACT S
FLUENT LIMITS ErMONIT®FLING
REQUIREMENTS
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Monthly
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v f Measurements
Sample
AFarameter Deseriptiori -.PCS?Daily
Maximum
Fre uenc
T e '
Location1y
Influent or
Flow, in conduit or thru treatment plant? - 50050
0.025 MGD
Continuous
Recorder
Effluent
BOD, 5-Da 20 Deg. C - 00310
30.0 m L
45.0 m /L
Weekly
Grab
Effluent
Solids, Total Suspended - 00530
30.0 m /L
45.0 m L
Weekly
Grab
Effluent
Nitrogen, Ammonia Total as N - 00610
2 / month
Grab
Effluent
Coliform, Fecal MF, M-FC Broth,44.5C - 31616
Weekly
Grab
Effluent
Chlorine, Total Residual '- 50060
28,u /L
2 / week
Grab
Effluent
Temperature, Water Deg. Centigrade - 00010
Weekly
Grab
Effluent
pH3 - 00400
Weekly
Grab
Effluent
Upstream &
Coliform, Fecal MF, M-FC Broth,44.5C - 31616
Weekly
Grab
Downstream
Footnotes:
1. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis.' {Refer to
special condition A. (3.)1.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shallbe no discharge of floating solids or visible foam in other than trace amounts.

Permit NCO069370
A. (2.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS — FINAL
During the period beginning upon expansion above 0.025 MGD and lasting until November 30,
2010, the permittee is authorized to discharge treated wastewater from outfall 001. Such discharges
shall be limited and monitored by the permittee as specified below:
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EFFLUENT CHARACTERISTICS
EFFLUENT LIMITS,
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Parameter Description , iPCS Code,. „ _ , ,,,y,,
,: average;
Maximum,
Frequency �.. ,
.;_Type,
Locat)on x
Influent or
Flow, in conduit or thru treatment plant2 - 50050
0.035 MGD
Continuous
Recorder
Effluent
BOD, 5-Da 20 Deg. C - 00310 - Summer
10.0 m /L
15.0 m /L
Weekly
Composite
Effluent
BOD, 5-Da 20 Deg. C - 00310 - Winter
20.0 m L
30.0 m /L
Weekly
Composite
Effluent
Solids, Total Suspended = 00530
30.0 m /L
45.0 m /L
Weekly
Composite
Effluent
Nitro en, Ammonia Total as N - 00610 - Summer
2.0 m /L
10.0 m /L
Weekly
Composite'
Effluent
Nitrogen, Ammonia Total as N - 00610 - Winter
4.0 m /L
20.0 m L
Weekly
Composite
Effluent
DO, Oxygen, Dissolved - 00300
Weekly
Grab
Effluent
Coliform, Fecal MF, M-FC Broth,44.5C - 31616
200/100 ml
400/100 ml
Weekly
Grab
Effluent
Chlorine, Total Residual - 50060
28 N /L
2 / week
Grab
Effluent
Temperature, Water Deg. Centigrade - 00010
Daily
Grab
Effluent
pH3 - 00400
Weekly
Grab
Effluent
Upstream &
Temperature, Water Deg. Centigrade - 00010
Weekly
Grab
Downstream
Upstream &
DO, Oxygen, Dissolved - 00300
Weekly
Grab
Downstream
Summer: April 1 - October 31
Winter: November 1 - March 31
Footnotes:
1. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis. (Refer to
special condition A. (3.)).
3. 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.

Permit NCO069370
A. (3.) ENGINEERING ALTERNATIVES ANALYSIS REQUIREMENT
Prior to expansion to 0.035 MGD, the permittee shall submit a detailed analysis of all
available means to dispose of this facility's wastewater. This Engineering Alternatives
Analysis (EAA) shall be prepared in compliance with the Division's guidance document of
EAAs.
If no EAA is submitted, the Division may reopen and modify this permit to , increase
monitoring frequencies —or change— effluent limits as —necessary- to --protect the receiving
stream.

NPDES Permit Requirements
Page 1 of 16
PART II
STANDARD CONDITIONS FOR NPDES PERMITS
Section A. Definitions
2/Month
Samples are collected twice per month with at least ten calendar days between sampling events.
3/Week
Samples are collected three times per week on three separate calendar days.
Act or "the Act"
The Federal Water Pollution Control Act, also known as the Clean Water Act, as amended, 33 USC 1251, et. seq.
Annual Average
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar year. In the case of fecal
coliform, the geometric mean of such discharges.
Arithmetic Mean
The summation of the individual values divided by the number of individual values.
B ass
The known diversion of waste streams from any portion of a treatment facility including the collection system, which
is not a designed or established or operating mode for the facility.
Calendar Dav
The period from midnight of one day until midnight of the next day. However, for purposes of this permit, any
consecutive 24-hour period that reasonably represents the calendar day may be used for sampling.
Calendar Quarter
One of the following distinct periods: January through March, April through June, July through September, and
October through December.
Composite Sample
A sample collected over a 24-hour period by continuous sampling or combining grab samples of at least 100 nil in
such a manner as to result in a total sample representative of the wastewater discharge during the sample period. The
Director may designate the most appropriate method (specific number and size of aliquots necessary, the time
interval between grab samples, etc.) on a case -by -case basis. Samples may be collected manually or automatically.
Composite samples may be obtained by the following methods:
(1) Continuous: a single, continuous sample collected over a 24-hour period proportional to the rate of flow.
(2) Constant time/variable volume: a series of grab samples collected at equal time intervals over a 24 ,hour
period of discharge and combined proportional to the rate of flow measured at the time of individual sample
collection, or
(3) Variable time/constant volume: a series of grab samples of equal volume collected over a 24 hour period
with the ,time intervals between samples determined by a preset number of gallons passing the sampling
point. Flow measurement between sample intervals shall be determined by use of a flow recorder and
totalizer, and the preset gallon interval between sample collection fixed at no greater than 1 /24 of the
expected total daily flow at the treatment system, or
(4) Constant time/constant volume: a series of grab samples of equal volume collected over a 24-hour period at
a constant time interval. This method may only be used in situations where effluent flow rates vary
less than 15 percent. The grab samples shall be taken at intervals of no greater than 20 minutes apart
during any 24-hour period and must be of equal size and of no less than 100 milliliters. Use of this method
requires prior approval by the Director.
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In accordance with (4) above, influent grab samples shall not be collected more than once per hour.
Effluent grab samples shall not be collected more than once per hour except at wastewater treatment systems
having a detention time of greater than 24 hours. In such cases, effluent grab samples may be collected at
intervals evenly spaced over the 24-hour period that are equal in number of hours to the detention time of the
system in number of days. However, the interval between effluent grab samples may not exceed six hours nor
the number of samples less than four during a 24-hour sampling period.
Continuous flow measurement
Flow monitoring that occurs without interruption throughout the operating hours of the facility. Flow shall be
monitored continually except for the infrequent times when there may be no flow or for infrequent maintenance
activities on the flow device.
Dailyy Discharge
The discharge of a pollutant measured during a calendar day or any 24-hour period that reasonably represents the
calendar day for purposes of sampling. For pollutants measured in units of mass, the "daily discharge" is calculated as
the total mass of the pollutant discharged over the day. The "daily discharge" concentration comprises the mean
concentration for a 24-hour sampling period as either a composite sample concentration or the arithmetic mean of all
grab samples collected during that period. (40 CFR 122.3)
Daily Maximum
The highest "daily discharge" during the calendar month.
Da lv Sampling
Parameters requiring daily sampling shall be sampled 5out of every 7 days per week unless otherwise specified in the
permit. The Division expects that sampling shall be conducted on weekdays except where holidays or..other
disruptions of normal operations prevent weekday sampling. If sampling is required for all seven days of the week
for any permit parameter(s), .that requirement will be so noted on the Effluent Limitations and Monitoring Page(s).
DTQ or "the Division"
The Division of Water Quality, Department of Environment and Natural Resources.
EMC
The North Carolina Environmental Management Commission.
Facility Closure
The cessation of wastewater treatment at a permitted facility, or the cessation of all activities that require coverage
under the NPDES. Completion of facility closure will allow this permit to be rescinded.
Geometric Mean
The Nth root of the product of the individual values where N = the number of individual values. For purposes of
calculating the geometric mean, values of "0" (or "< [detection leve]]' shall be considered =1.
Grab Sample
Individual samples of at least 100 ml collected over a period of time not exceeding 15 minutes. Grab samples can be
collected manually. Grab samples must be representative of the discharge (or the receiving stream, for instream
samples).
Hazardous Substance
Any substance designated under 40 CFR Part 116 pursuant to Section 311 of the Clean Water Act.
Instantaneous flow measurement
A measure of flow taken at the time of sampling, when both the sample and flow will be representative of the total
discharge.
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Monthly Averaggg (concentration limitl
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar month. In the case of fecal
coliform, the geometric mean of such discharges.
Permit Issuing Authority
The Director of the Division of Water Quality.
Quarterly Average (concentration limit)
The average of all samples taken over a calendar quarter.
Severe property damage
Substantial physical damage to property, damage to the treatment facilities which causes them to become inoperable,
or substantial and permanent loss of natural resources which can reasonably be expected to occur in the absence of a
bypass. Severe property damage excludes economic loss caused by delays in production.
Toxic Pollutant:
Any pollutant listed as toxic under Section 307(a)0) of the Clean Water Act.
U set
An incident beyond the reasonable control of the Permittee causing unintentional and temporary noncompliance with
permit effluent limitations and/or monitoring requirements. An upset does not include noncompliance caused by
operational . error, improperly_ designed treatment facilities, inadequate treatment facilities, lack of preventive
maintenance, or careless or improper operation.
Weekly Average (concentration limitl
The arithmetic mean of all "daily discharges" of a pollutant measured during the calendar week. In the case of fecal
coliform, the geometric mean of such -discharges.
Section B. General Conditions
1. Duty to Comply
The Permittee must comply with all conditions of this permit. Any permit noncompliance constitutes a violation
of the Clean Water Act and is grounds for enforcement action; for permit termination, revocation and reissuance,
or modification; or denial of a permit renewal application [40 CFR 122.41].
a. The Permittee shall comply with effluent standards or prohibitions established under section 307(a) of the
Clean Water Act for toxic pollutants and with standards for sewage sludge use or disposal established under
section 405(d) of the Clean Water Act within the time provided in the regulations that establish these
standards or prohibitions or standards for sewage sludge use or disposal, even if the permit has not yet been
modified to incorporate the requirement.
b. The Clean Water Act provides that any person who violates section 301, 302, 306, 307, 308, 318 or 405 of the
Act, or any permit condition or limitation implementing any such sections in a permit issued under section
402, or any requirement imposed in a pretreatment program approved under sections 402(a)(3) or 402(b)(8)
of the Act, is subject to a civil penalty not to exceed $25,000 per day for each violation. [40 CFR 122.41 (a)
(2)]
c. The Clean Water Act provides that any person who negligently violates sections 301, 302, 306, 307, 308, 318, or
405 of the Act, or any condition or limitation implementing any of such sections in a permit issued under
section 402 of the Act, or any requirement imposed in a pretreatment program approved under section
402(a)(3) or 402(b)(8) of the Act, is subject to criminal penalties of $2,500 to $25,000 per day of violation, or
imprisonment of not more than 1 year, or both. In the case of a second or subsequent conviction for a
negligent violation, a person shall be subject to criminal penalties of not more than $50,000 per day of
violation, or by imprisonment of not more than 2 years, or both. [40 CFR 122.41 (a) (2)]
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d. Any person who knorvin,gly violates such sections, or such conditions or limitations is subject to criminal
penalties of $5,000 to $50,000 per day of violation, or imprisonment for not more than 3 years, or both. In
the case of a second or subsequent conviction for a knowing violation, a person shall be subject to criminal
penalties of not more than $100,000 per day of violation, or imprisonment of not more than 6 years, or both.
[40 CFR 122.41 (a) (2)]
e. Any person who knowingly violates section 301, 302, 303, 306, 307, 308, 318 or 405 of the Act, or any permit
condition or limitation implementing any of such sections in a permit issued under section 402 of the Act,
and who knows at that time that he thereby place's another person in imminent danger of death or serious
bodily injury, shall, upon conviction, be subject to a fine of not more than $250,000 or imprisonment of not
more than 15 years, or both. In the case of a second or subsequent conviction for a knowing endangerment
violation, a person shall be subject to a fine of not more than $500,000 or by imprisonment of not more than
30 years, or both. An organization, as defined in section 309(c)(3)(B)(iii) of the CWA, shall, upon conviction
of violating the imminent danger provision, be subject to a fine of not more than $1,000,000 and can be fined
up to $2,000,000 for second or subsequent convictions. [40 CFR 122.41 (a) (2)]
f. Under state law, a civil penalty of not more than $25,000 per violation may be assessed against any person
who violates or fails to act in accordance with the terms, conditions, or requirements of a permit. [North
Carolina General Statutes § 143-215.6A]
g. Any person may be assessed an administrative penalty by the Administrator for violating section 361, 302,
306, 307, 308, 318 or 405 of this Act, or any permit condition or limitation implementing any of such
sections in a permit issued under section 402 of this Act. Administrative penalties for Class I violations are
not to exceed $10,000 per violation, with the maximum amount of any Class I penalty assessed not to exceed
$25,000. Penalties for Class II violations are not to exceed $10,000 per day for each- day during which the
violation continues, with the maximum amount of any Class II penalty not to exceed $125,000. [40 CFR
122.41 (a) (3)]
2. Duty to Mitigate
The Permittee shall take all reasonable steps to minimize or prevent any discharge or sludge use or disposal in
violation of this permit which has a reasonable likelihood of adversely affecting human health or the environment
[40 CFR 122.41 (d)].
3. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II. C. 4), "Upsets" (Part II. C. 5) and "Power
Failures" (Part II. C. 7), nothing in this permit shall be construed to relieve the Permittee from any
responsibilities, liabilities, or penalties for noncompliance pursuant to NCGS 143-215.3, 143-215.6 or Section 309
of the Federal Act, 33 USC 1319. Furthermore, the Permittee is responsible for consequential damages, such as
fish kills, even though the responsibility for effective compliance may be temporarily suspended.
4. Oil and Hazardous Substance Liability
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve the Permittee
from any responsibilities, liabilities, or penalties to which the Permittee is or may be subject to under NCGS 143-
215.75 et seq. or Section 311 of the Federal Act, 33 USG 1321. Furthermore, the Permittee is responsible for
consequential damages; such as fish kills, even though the responsibility for effective compliance may be
temporarily suspended.
5. Property Rights
The issuance of this permit does not convey any property rights in either real or personal property, or any
exclusive privileges, nor does it authorize any injury to private property or any invasion. of personal rights, nor
any infringement of Federal, State or local laws or regulations [40 CFR 122.41 (g)].
6. Onshore or Offshore Construction
This permit does not authorize or approve the construction of any onshore or offshore physical structures or
facilities or the undertaking of any work in any navigable waters.
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7. Severabili1y
The provisions of this permit are severable. If any provision of this permit, or the application of any provision of thi:
permit to any circumstances, is held invalid, the application of such provision to other circumstances, and the remaindej
of this permit, shall not be affected thereby [NCGS 150B-23].
8. Duty to Provide Information
The Permittee shall furnish to the Permit Issuing Authority, within a reasonable time, any information which the
Permit Issuing Authority may request to determine whether cause exists for modifying, revoking and reissuing, or
terminating this permit or to determine compliance with this permit. The Permttee shall also furnish to the
Permit Issuing Authority upon request, copies of records required by this permit [40 CFR 122.41 (h)].
9. Duty to Reapply
If the Permittee wishes to continue an activity regulated by this permit after the expiration date of this permit, the
Permittee must apply for and obtain a new permit [40 CFR 122.41 (b)].
10. Expiration of Permit
The Permittee is not authorized to discharge after the expiration date. In order to receive automatic
authorization to discharge beyond the expiration date, the Permittee shall submit such information, forms, and
fees as are required by the agency authorized to issue permits no later than 180 days prior to the expiration date.
Any Permittee that has not requested renewal at least 180 days prior to expiration, or any Permittee that does not
have a permit after the expiration and has not requested renewal at least 180 days prior to expiration, will subject
the Permittee to enforcement procedures as provided in NCGS 143-215.6 and 33 USC 1251 et. seq.
11. Si�atory Requirements
All applications, reports, or'information submitted to the Permit Issuing Authority shall be signed and certified
[40 CFR 122.41 (k)].
a. All permit applications shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this Section, a responsible
corporate officer means: (a) a president, secretary, treasurer or vice president of the corporation in
charge of a principal business function, or any other person who performs similar policy or decision
making functions for the corporation, or (b) the manager of one or more manufacturing, production, or
operating facilities, provided, the manager is authorized to make management decisions which govern the
operation of the regulated facility including having the explicit or implicit duty of making major capital
investment recommendations, and initiating and directing other comprehensive measures to assure long
term environmental compliance with environmental laws and regulations; the manager can ensure that
the necessary systems are established or actions taken to gather complete and accurate information for
permit application requirements; and where authority to sign documents has been assigned or delegated
to the manager in accordance with corporate procedures .
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, State, Federal, . or other public agency: by either a principal executive officer or
ranking elected official [40 CFR 122.22].
b.. All reports required by the permit and other information requested by the Permit Issuing Authority shall be
signed by a person described in paragraph a. above or by a duly authorized representative of that person. A
person is a duly authorized representative only if:
1. The authorization is made in writing by a person described above;
2. The authorization specified either an individual or a position having responsibility for the overall
operation of the regulated facility or activity, such as the position of plant manager, operator of a well or
well field, superintendent, a position of equivalent responsibility,, or an individual or position having
overall responsibility for environmental matters for the company. (A duly authorized representative may
thus be either a named individual or any individual occupying a named position.); and
3. The written authorization is submitted to the Permit Issuing Authority [40 CFR 122.22]
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c. Changes to authorization: If an authorization under paragraph (b) of this section is no longer accurate
because a different individual or position has responsibility for the overall operation of the facility, a new
authorization satisfying the requirements of paragraph (b) of this section must be submitted to the Director
prior to or together with any reports, information, or applications to be signed by an authorized
representative [40 CFR 122.22]
d. Certification. Any person signing a document under paragraphs a. or b. of this section shall make the
following certification [40 CFR 122.22]:
7 certify, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate
the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. 1 am aware that there -are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
12. Permit Actions
This permit may be modified, revoked and reissued, or terminated for cause. The filing of a request by the
Permittee for a permit modification, revocation and reissuance, or termination, or a notification of planned
changes or anticipated noncompliance does not stay any permit condition [40 CFR 122.41
13: Permit Modification. Revocation and Reissuance, or Termination
The issuance of this permit does not prohibit the permit issuing authority from reopening and modifying the
permit, revoking and reissuing the permit, or terminating the permit as allowed by the laws, rules, and regulations
contained in Tide 40, Code of Federal Regulations, Parts 122 and 123; Title- 15A of the North Carolina
Administrative Code, Subchapter 2H .0100; and North Carolina General Statute 143-215.1 et. al.
14. Annual Administering and Compliance Monitoring Fee Requirements
The Permittee must pay the annual administering and compliance monitoring fee within thirty days after being
billed by the Division. Failure to pay the fee in a timely manner in accordance with 15A NCAC 2H.0105 (b) (4)
may cause this Division to initiate action .to revoke the permit.
Section C. Operation and Maintenance of Pollution Controls
1. Certified Operator
Upon classification of the permitted facility by the Certification Commission, the Permittee shall employ a
certified water pollution control treatment system operator in responsible charge (ORC) of the water pollution
control treatment system. Such operator must hold a certification of the grade equivalent to or greater than the
classification assigned to the water pollution control treatment system by the Certification Commission. The
Permittee must also employ one or more certified Back-up.ORCs who possess a currently valid certificate of the
type of the system. Back-up ORCs must possess a grade equal to (or no more than one grade less than) the grade
of the system [15A NCAC 8G.0201].
The ORC of each Class I facility must:
➢ Visit the facility at least weekly
➢ Comply with all other conditions of 15A NCAC 8G.0204.
The ORC of each Class II, III and IV facility must:
➢ Visit the facility at least daily, excluding weekends and holidays
➢ Properly manage and document daily operation and maintenance of the facility
Comply with all other conditions of 15A NCAC 8G.0204.
Once the facility is classified, the Permittee shall submit a letter to the Certification Commission designating the
operator in responsible charge:
a. Within 60 calendar days prior to wastewater being introduced into a new system
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b. Within 120 calendar days of:
➢ Receiving notification of a change in the classification of the system requiring the designation of a
new ORC and back-up ORC
➢ A vacancy in the position of ORC or back-up ORC.
2. Proper Operation and Maintenance. .
The Permittee shall at all times provide the operation .and maintenance resources necessary to operate the existing
facilities at optimum efficiency. The Permittee shall at all times properly operate and maintain all facilities and
systems of treatment and control (and related appurtenances) which are installed or used by the Permittee to
achieve compliance with the conditions of this permit. Proper operation and maintenance also includes adequate
laboratory controls and appropriate quality assurance procedures. This provision requires the Permittee to install
and operate backup or auxiliary facilities only when necessary to achieve compliance with the conditions of the
permit [40 CFR 122.41 (e)].
3. Need to Halt or Reduce not a Defense
It shall not be a defense for a Permittee in an enforcement action that it would have been necessary to halt or
reduce the permitted activity in order to maintain compliance with the condition of this permit [40 CFR 122.41
(c)].
4. BMassing of Treatment Facilities
a. Bypass not exceeding limitations [40 CFR 122.41 (m) (2)]
The Permittee may allow any bypass to occur which does not cause effluent limitations to be exceeded, but
only if it also is for essential maintenance to assure efficient operation. These bypasses are not *Subject to the
provisions of Paragraphs b. and c. of this section.
b. Notice [40 CFR 122.41 (m)' (3)]
(1) Anticipated bypass. If the Permittee knows in advance of .the need for a bypass, it shall submit prior
notice, if possible at least ten days before the date of the bypass; including an evaluation of the
anticipated quality and effect of the bypass.
(2) Unanticipated bypass. The Permittee shall submit notice of an unanticipated bypass as required in Part
II. E. 6. (24-hour notice).
c. Prohibition of Bypass
(1) Bypass from the treatment facility is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for bypass, unless:
(A) Bypass was unavoidable to prevent loss of life, personal injury or severe property damage;
(B) There were no feasible alternatives to the bypass, such as the.use of auxiliary treatment facilities,
retention of untreated wastes or maintenance during normal periods of equipment downtime. This
condition is not satisfied if adequate backup equipment should have been installed in the exercise of
reasonable engineering judgment to prevent a bypass which occurred during normal periods of
equipment downtime or preventive maintenance; and
(C) The Permittee submitted notices as required under Paragraph b. of this section.
(2) Bypass from the collection system is prohibited and the Permit Issuing Authority may take enforcement
action against a Permittee for a bypass as provided in any current or future system -wide collection system
permit associated with the treatment facility.
(3) The Permit Issuing Authority may approve an anticipated bypass, after considering its adverse effects, if
the Permit Issuing Authority determines that it will meet the three conditions listed above in Paragraph c.
0) of this section.
5. upsets
a. Effect of an upset [40 CFR 122.41 (n) (2)1: An upset constitutes an affirmative defense to an action
brought for noncompliance with such technology based permit effluent limitations if the requirements of
paragraph b. of this condition are met. No determination made during administrative review of claims that
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noncompliance was caused by upset, and before an action for noncompliance, is final administrative action
subject to judicial review.
b. Conditions necessary for a demonstration of upset: A Permittee who wishes to establish the
affirmative defense of upset shall demonstrate, through properly signed, contemporaneous operating logs, or
other relevant evidence that:
(1) An upset occurred and that the Permittee can identify the cause(s) of the upset;
(2) The Permittee facility was at the time being properly operated; and
(3) The Permittee submitted notice of the upset as required in Part II. E. 6. (b) (B) of this permit.
(4) The Permittee complied with any remedial measures required under Part II. B. 2. of this permit.
d. Burden of proof [40 CFR 122.41 (n) (4)]: The Permittee seeking to establish the occurrence of an
upset has the burden of proof in any enforcement proceeding.
6. Removed Substances
Solids,, sludges, filter backwash, or other pollutants removed in the course of treatment or control of wastewaters
shall be utilized/disposed of in accordance with NCGS 143-215.1 and in a manner such as to prevent any pollutant
from such materials from entering waters of the State or navigable waters of the United States. The Permittee
shall comply with all existing Federal regulations governing .the disposal of sewage sludge. Upon promulgation of
40 CFR Part 503, any permit issued by the Permit Issuing Authority for the utilization/disposal of sludge may be
reopened and modified, or revoked and reissued, to incorporate applicable requirements at 40 CFR 503. The
Permittee shall comply with applicable 40 CFR 503 Standards for the Use and Disposal of Sewage Sludge (when
promulgated) within the time provided in the regulation, even if the permit is not modified to incorporate the
requirement. The Permittee shall notify. the Permit Issuing Authority of any significant change in its sludge use
or disposal practices.
7. Power Failures
The Permittee is responsible for maintaining adequate safeguards (as required by 15A NCAC 2H.0124 —
Reliability) to prevent the discharge of untreated or inadequately treated wastes during electrical power failures
either by means of alternate power sources, standby generators or retention of inadequately treated effluent.
Section D. Monitoring and Records
Representative Sampling
Samples collected and measurements taken, as required herein, shall be characteristic of the volume and nature of
the permitted discharge. Samples collected at a frequency less than daily shall be taken on a day and time that is
characteristic of the discharge over the entire period the sample represents. All samples shall be taken at the
monitoring points specified in this permit and, unless otherwise specified, before the effluent joins or is diluted
by any other wastestream, body of water, or substance. Monitoring points shall not be changed without
notification to and the approval of the Permit Issuing Authority [40 CFR 122.41 (j)].
2. Reporting
Monitoring results obtained during the previous month(s) shall be summarized for each month and reported on a
monthly Discharge Monitoring Report (DMR) Form (MR 1, 1.1, 2, 3) or alternative forms approved by the
Director, postmarked no later than the 28th day following the completed reporting period.
The first DMR is due on the last day of the month following the issuance of the permit or in the case of a new
facility, on the last day of the month following the commencement of discharge. Duplicate signed copies of
these, and all other reports required herein, shall be submitted to the following address:
NC DENR / Division of Water Quality / Water Quality Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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3. Flow Measurements
Appropriate flow measurement devices and methods consistent with accepted scientific practices shall be selected
and used to ensure the accuracy and reliability of measurements of the volume of monitored discharges. The
devices shall be installed, calibrated and maintained to ensure that the accuracy of the measurements is, consistent
with the accepted capability of that type of device. Devices selected shall be capable of measuring flows with a
maximum deviation of less than 10% from the true discharge rates throughout the range of expected discharge
volumes. Flow measurement devices shall be accurately calibrated at a minimum of once per year and maintained
to ensure that the accuracy of the measurements is consistent with the accepted capability of that type of device.
The Director shall approve the flow measurement device and monitoring location prior to installation.
Once -through condenser cooling water flow monitored by pump logs, or pump hour meters as specified in Part I
of this permit and based on the manufacturer's pump curves shall not be subject to this requirement.
4. Test Procedures
Test procedures for the analysis of pollutants shall conform to the EMC regulations (published pursuant to
NCGS 143-215.63 et. seq.), the Water and Air Quality Reporting Acts, and to regulations published pursuant to
Section 304(g), 33 USC 1314, of the Federal Water Pollution Control Act (as Amended), and 40 CFR 136; or in
the case of sludge use or disposal, approved under 40 CFR 136, unless otherwise specified in 40 CFR 503, unless
other test procedures have been specified in this permit [40 CFR 122.41].
To meet the intent of the monitoring required by this permit, all test procedures must produce minimum
detection and reporting levels that are below the permit discharge requirements and all data generated must be
reported down to the minimum detection or lower reporting level of the procedure. If no approved methods are
determined capable of achieving minimum detection and reporting levels below permit discharge requirements;
then the most sensitive (method with the lowest possible detection and reporting level) approved method must
be used.
Penalties for Tampering
The Clean Water Act provides that any person who falsifies, tampers with, or knowingly renders inaccurate, any
monitoring device or method required to be maintained under this permit shall, upon conviction, be punished by
a fine of not more than $10,000 per violation, or by imprisonment for not more than two years per violation, or
by both. If a conviction of a person is for a violation committed after a first conviction of such person under this
paragraph, punishment is a fine of not more than $20,000 per day of violation, or by imprisonment of not more
than 4 years, or both [40 CFR 122.41].
6. Records Retention
Except for records of monitoring information required by this permit related to the Permittee's sewage sludge
use and disposal activities, which shall be retained for a period of at least five years (or longer as required by 40
CFR 503), the Permittee shall retain records of all monitoring information, including.
➢ all calibration and maintenance records
➢ all original strip chart recordings for continuous monitoring instrumentation
➢ copies of all reports required by this permit _
➢ copies of all data used to complete the application for this permit
These records or copies shall be maintained for a period of at least 3 years from the date of the sample,
measurement, report or application. This period may be. extended by request of the Director at any time [40 CFR
122.41].
7. Recording Results
For each measurement or sample taken pursuant to the requirements of this permit, the Permittee shall record
the following information [40 CFR 122.41]:
a. The date, exact place, and time of sampling or measurements;
b. The individual(s) who performed the sampling or measurements;
c. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
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e. The analytical techniques or methods used; and
f. The results of such analyses.
8. Inspection and EntU
The Permittee shall allow the Director, or an authorized representative (including an authorized contractor acting
as a representative of the Director), upon the presentation of credentials and other documents as may be required
by law, to;
a. Enter upon the Permittee's premises where a regulated facility or activity is located or conducted, or where
records must be kept under the conditions of this permit;
b. Have access to and copy„ at reasonable times, any records that must be kept under the conditions of this
permit;
c., Inspect at reasonable times any facilities, equipment (including monitoring and control equipment), practices,
or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring permit compliance or as otherwise
authorized by the Clean Water Act, any substances or parameters at any location [40 CFR 122.41 (i)].
Section E Reporting Requirements
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms and conditions of this permit. The discharge
of any pollutant identified in this permit more frequently than or at a level in excess of that authorized shall
constitute a violation of the permit.
2. Planned Changes
The Permittee shall give notice to the Director as soon as possible of any planned physical alterations or
additions to the permitted facility [40 CFR 122.410)). Notice is required only when:
a. The alteration or addition to a permitted facility may meet one of the criteria for new sources at 40 CFR
122.29 (b); or
b. The alteration or addition could significantly change the nature or increase the quantity of pollutants
discharged. This notification applies to pollutants subject neither to effluent limitations in the permit, nor to
notification requirements under 40 CFR 122.42 (a) 0).
c. The alteration or addition results in a significant change in the Permittee's sludge use or disposal practices,
and such alternation, addition or change may justify the application of permit conditions that are different
from or absent in the existing permit, including notification of additional use or disposal sites not reported
during the permit application process or not reported pursuant to an approved land application plan.
3. Anticipated Noncompliance
The Permittee shall give advance notice to'the Director of any planned changes to the permitted facility or other
activities that might result in noncompliance with the permit [40 CFR 122.410) (2)].
4. Transfers
This permit is not transferable to any person except after notice to the Director. The Director may require
modification or revocation and reissuance of the permit to document the change of ownership. Any such action
may incorporate other requirements as may be necessary under the Clean Water Act [40 CFR 122.410) (3)].
5. Monitoring Reports
Monitoring results shall be reported at the intervals specified elsewhere in this permit [40 CFR 122.410) (4)].
a. Monitoring results must be reported on a Discharge Monitoring Report (DMR) (See Part II. D. 2) or forms
provided by the Director for reporting results of monitoring of sludge use or disposal practices.
b. If the Permittee monitors any pollutant more frequently than required by this permit, the results of such
monitoring shall be included in the calculation and reporting of the data submitted on the DMR.
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6. Twenty-four I -lour Reporting
a. The Permittee shall report to the Director or the appropriate Regional Office any noncompliance that
potentially threatens public health or the environment. Any information shall be provided orally within 24
hours from the time the Permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the Permittee becomes aware of the circumstances. The written
submission shall contain a description of the noncompliance, and its cause; the period of noncompliance,
including exact dates and times, and if the noncompliance has not been corrected, the anticipated time it is
expected to continue; and steps taken or planned to reduce, eliminate, and prevent reoccurrence of the
noncompliance [40 CFR 122.41 (1) (6)].
b. The Director may waive the written report on a case -by -case basis for reports under this section if the oral
report has been received within 24 hours.
c. Occurrences outside normal business hours may also be reported to the Division's Emergency Response
personnel at [phone], [phone] or [phone].
7. Other Noncompliance
The Permittee shall report all instances of noncompliance not reported -under Part II. E. 5 and 6. of this permit at
the time monitoring reports are submitted. The reports shall contain the information listed in Part II. E. 6. of
this permit [40 CFR 122.410) (7)].
8. Other Information
Where the Permittee becomes aware that it failed to submit any relevant facts in a permit application, or
submitted incorrect information in a permit application or in any report to the Director, it shall promptly submit
such facts or information [40 CFR 122141 0) (8)].
9. Noncompliance Notification
The Permittee shall report by telephone to either the central office or the appropriate regional office of the
Division as soon as possible, but in no case more than 24 hours or on the next working day following the
occurrence or first knowledge of the occurrence of any of the following.
a. Any occurrence at the water pollution control facility which results in the discharge of significant amounts of
wastes which are abnormal in quantity or characteristic, such as the dumping of the contents of a sludge
digester; the known passage of a slug of hazardous substance through the facility; or any other unusual
circumstances.
b. Any process unit failure, due to known or unknown reasons, that render the facility incapable of adequate
wastewater treatment such as mechanical or electrical failures of pumps, aerators, compressors, etc.
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass directly to receiving
waters without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report within 5 days following first
knowledge of the occurrence.
10. Availability of Reports
Except for data determined to be confidential under NCGS 143-215.3 (a)(2) or Section 308 of the Federal Act, 33
USC 1318, all reports prepared in accordance with the terms shall be available for public inspection at the offices
of the Division of Water Quality. As required by the Act, effluent data shall not be considered confidential.
Knowingly making any false statement on any such report may result in the imposition of criminal penalties as
provided for in NCGS 143-215.1(b)(2) or in Section 309 of the Federal Act.
11. Penalties for Falsification of Reports
The Clean Water Act provides that any person who knowingly makes any false statement, representation, or
certification in any record or other document submitted or required to be maintained under this permit, including
monitoring reports or reports of compliance or noncompliance shall, upon conviction, be punished by a fine of
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not more than $25,000 per violation, or by imprisonment for not more than two years per violation, or by both
[40 CFR 122.41].
12. Annual Performance Reports
Permittees who own or operate facilities that collect or treat municipal or domestic waste shall provide an annual
report to the Permit Issuing Authority and to the users/customers served by the Permittee (NCGS 143-215.1C).
The report shall summarize the performance of the collection or treatment system, as well as the extent to which
the facility was compliant with applicable Federal or State laws, regulations and rules,pertaining to water quality.
The report shall be provided no later than sixty days after the end of the calendar or fiscal year, depending upon
which annual period is used for evaluation.
PART III
OTHER REQUIREMENTS
Section A. Construction
The Permittee shall not commence construction of wastewater treatment facilities, nor add to the plant's treatment
capacity, nor change the treatment process(es) utilized at the treatment plant unless the Division has issued an
Authorization to Construct (AtC) permit. Issuance of an AtC will not occur until Final Plans and Specifications for
the proposed construction have been submitted by the Permittee and approved by the Division.
Section B. Groundwater Monitoring
The Permittee shall, upon written notice from the Director of the Division of Water Quality, conduct groundwater
monitoring as may be required to determine the compliance of this NPDES permitted facility with the current
groundwater standards.
Section C. Changes in Discharges of Toxic Substances
The Permittee shall notify the Permit Issuing Authority as soon as it knows or has reason to believe (40 CFR 122.42):
a. That any activity has occurred or will occur which would result in the discharge, on a routine or frequent
basis, of any toxic pollutant which is not limited in the permit, if that discharge will exceed the highest of the
following "notification levels";
0) One hundred micrograms per liter 000 µg/L);
(2) Two hundred micrograms per liter (200 µg/L) for acrolein and acrylonitrile; five hundred micrograms
per liter (500 µg/L) for 2.4-dinitrophenol and for 2-methyl-4.6-dinitrophenol; and one milligram per liter
0 mg/L) for antimony;
(3) Five times the maximum concentration value reported for that pollutant in the permit application.
b. That any activity has occurred or will occur which would result in any discharge, on a non -routine -or
infrequent basis, of a toxic pollutant which is not limited in the permit, if that discharge will exceed the
highest of the following "notification levels";
0) Five hundred micrograms per liter (500 µg/L);
(2) One milligram per liter 0 mg/L) for antimony;
(3) Ten times the maximum concentration value reported for that pollutant in the permit application.
Section D. Evaluation of Wastewater Discharge Alternatives
The Permittee shall evaluate all wastewater disposal alternatives and pursue the most environmentally sound
alternative of the reasonably cost effective alternatives. If the facility is in substantial non-compliance with the terms
and conditions of the NPDES permit or governing rules, regulations or laws, the Permittee shall submit a report in
such form and detail as required by the Division evaluating these alternatives and a plan of action within 60 days of
notification by the Division.
Section E. Facility Closure Requirements
The Permittee must notify the Division at least 90 days prior to the closure of any wastewater treatment system
covered by this permit. The Division may require specific measures during deactivation of the system to prevent
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adverse impacts to waters of the State. This permit cannot be rescinded while any activities requiring this permit
continue at the permitted facility.
PART IV
SPECIAL CONDITIONS FOR MUNCIPAL FACILITIES
Section A Publicly Owned Treatment Works (POTWs)
All POTWs must provide adequate notice to the Director of the following.
1. Any new introduction of pollutants into the POTW from an indirect discharger which would be subject to
section 301 or 306 of CWA if it were directly discharging those pollutants; and
2. Any substantial change in the volume or character of pollutants being introduced by an indirect discharger
as influent to that POTW at the time of issuance of the permit.
3. For purposes of this paragraph, adequate notice shall include information on (1) the quality and quantity of
effluent introduced into ,the POTW, and (2) any anticipated impact of the change on the quantity or quality
of effluent to be discharged from the POTW.
Section B. Municipal Control of Pollutants from Industrial Users.
Effluent limitations are listed in Part I of this permit. Other pollutants attributable to inputs from
industries using the municipal system may be present in the Permittee's discharge. At such time as
sufficient information becomes available to establish limitations for such pollutants, this permit may be
revised to specify effluent limitations for any or all of such other pollutants in accordance with best
practicable technology or water quality standards.
2. Under no circumstances shall the Permittee allow introduction of the following wastes in the waste
treatment system:
a. Pollutants which create a fire or explosion hazard in the POTW, including, but not limited to,
wastestreams with a closed cup flashpoint of less than. 140 degrees. Fahrenheit or 60 degrees
Centigrade using the test methods specified in 40 CFR 261.21;
b. Pollutants which will cause corrosive structural damage to the POTW,. but in no case Discharges
with pH lower than 5.0, unless the works is specifically designed to accommodate such Discharges;
c...- Solid or viscous pollutants in amounts which will cause obstruction to the flow, in the POTW
resulting in Interference;
d. Any pollutant, -including oxygen demanding pollutants (BOD, etc.) released in a Discharge at a flow
rate and/or pollutant concentration which will cause Interference with the POTW;
e. Beat in amounts which will inhibit biological activity in the POTW resulting in Interference, but in
no case heat in such quantities that the temperature at the POTW 'Treatment Plant exceeds 40°C
(104°F) unless the Division, upon request of the POTW, approves alternate temperature limits;
f. Petroleum oil, nonbiodegradable cutting oil, or products of mineral oil origin in amounts that will
cause interference or pass through;
g: Pollutants which result in the presence of toxic gases, vapors, or fumes within the POTW in a
quantity that may cause acute worker health and safety problems;
h. Any trucked or hauled pollutants, except at discharge points designated by the POTW.
3. With regard to the effluent requirements listed in Part I of this permit, it may be necessary for the
Permittee to supplement the requirements of the Federal Pretreatment Standard's (40 CFR, Part 403) to
ensure compliance by the Permittee with all applicable effluent limitations. Such actions by the Permittee
may be necessary regarding some or all of the industries discharging to the municipal system.
4. The Permittee shall require any industrial discharges sending influent to the permitted system to meet
Federal Pretreatment Standards promulgated in response to Section 307(b) of the Act. Prior to accepting
wastewater from any significant industrial user, the Permittee shall either develop and submit to the
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Division a Pretreatment Program for approval per 15A NCAC 2H .0907(a) or modify an existing
Pretreatment Program per 15A NCAC 2H .0907(b).
This permit shall be modified, or alternatively, revoked and reissued, to incorporate or modify an approved
POTW Pretreatment Program or to include a compliance schedule for the development of a POTW
Pretreatment Program as required under Section 402(b)(8) of the Clean Water Act and implementing
regulations or by the requirements of the approved State pretreatment program, as appropriate.
Section C. Pretreatment Programs
Under authority of sections 307(b) and (c) and 402(b) (8) of the Clean Water Act and implementing regulations 40
CFR Part 403, North Carolina General Statute 143-215.3 (14) and implementing regulations 15A NCAC 2H
.0900, and in accordance with the approved pretreatment program, all provisions and regulations contained and
referenced in the Pretreatment Program Submittal are an enforceable part of this permit.
The Permittee shall operate its approved pretreatment program in accordance with Section 402(b)(8) of the Clean
Water Act, the Federal Pretreatment Regulations 40 CFR Part 403, the State Pretreatment Regulations 15A
NCAC 2H .0900, and the legal authorities, policies, procedures, and financial provisions contained in its
pretreatment program submission and Division approved modifications there of. Such operation shall include
but is not limited to the implementation of the following conditions and requirements:
1. Sewer Use Ordinance (SUOZ
The Permittee shall maintain adequate legal authority to implement its approved pretreatment program.
2. Industrial Waste Survey UWS)
The Permittee shall update its Industrial Waste Survey (IWS) to include all users of the sewer collection
system at least once every five years.
3. Monitoring Plan
The Permittee shall implement a Division approved Monitoring Plan for the collection of facility specific
data to be used in a wastewater treatment plant Headworks Analysis (HWA) for the development of
specific pretreatment local limits. Effluent data from the Plan shall be reported on the DMRs (as required
by Part II, Section D, and Section E.5.).
4. Headworks Analysis A) and Local Limits
The Permittee shall obtain Division approval of a Headworks Analysis (HWA) at least once every five
years, and as required by the Division. Within 180 days of the effective date of this permit (or any
subsequent permit modification) the Permittee shall submit to the Division a written technical evaluation
of the need to revise local limits (i.e., an updated HWA or documentation of why one is not needed) [40
CFR 122.42). The Permittee shall develop, in accordance with 40 CFR 403.5(c) and 15A NCAC 2H -.0909,
specific Local Limits to implement the prohibitions listed in 40 CFR 403.5(a) and (b) and 15A NCAC 2H
.0909.
5. Industrial User Pretreatment Permits (IUP) & Allocation Tables
In accordance with NCGS 143-215.1, the Permittee shall issue to all significant industrial users, permits for
operation of pretreatment equipment and discharge to the Permittee's treatment works. These permits
shall contain limitations, sampling protocols, reporting requirements, appropriate standard and special
conditions, and compliance schedules as necessary for the installation of treatment and control
technologies to assure that their wastewater discharge will meet all applicable pretreatment standards and
requirements. The Permittee shall maintain a current Allocation Table (AT) which summarizes the results
of the Headworks Analysis (HWA) and the limits from all Industrial User Pretreatment Permits (IUP).
Permitted IUP loadings for each parameter cannot exceed the treatment capacity of the POTW as
determined by the HWA.
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6. Authorization to Construct (A to C)
The Permittee shall ensure that an Authorization to Construct permit (AtC) is issued to all applicable
industrial users for the construction or modification of any pretreatment facility. Prior to the issuance of
an AtC, the proposed pretreatment facility and treatment process must be evaluated for its capacity to
comply with all Industrial User Pretreatment Permit (IUP) limitations.
POTW Inspection & Monitoring of their SIUs
The Permittee shall conduct inspection, surveillance, and monitoring activities as described in its Division
approved pretreatment program in order to determine, independent of information supplied by industrial
users, compliance with applicable pretreatment standards. The Permittee must:
a. Inspect all Significant Industrial Users (SIUs) at least once per calendar year; and
b. Sample all Significant' Industrial Users (SIUs) at least twice per calendar year for all permit -
limited pollutants, once during the period from January 1 through June 30 and once during the
period from July 1 through December 31, except for organic compounds which shall be sampled
once per calendar year;
8. SIU Self Monitoring and Reporting
The Permittee shall require all industrial users to comply with the applicable monitoring and reporting
requirements outlined in the Division approved pretreatment program, the industry's pretreatment permit,
or in 15A NCAC 2H .0908.
9. Enforcement Response Plan (ERP)
The Permittee shall enforce and obtain appropriate remedies for violations of all pretreatment standards
promulgated pursuant to section 307(b) and (c) of the Clean Water Act (40 CFR 405 et. seq.), prohibitive
discharge standards as set forth in 40 CFR 403.5 and 15A NCAC 2H .0909, and specific local limitations.
All enforcement actions shall be consistent with the Enforcement Response Plan (ERP) approved by the
Division.
10. Pretreatment Annual Reports AR)
The Permittee shall report to the Division in accordance with 15A NCAC 2H .0908. In lieu of submitting
annual reports, Modified Pretreatment Programs developed under 15A NCAC 2H .0904 (b) may be
required to meet with Division personnel periodically to discuss enforcement of pretreatment requirements
and other pretreatment implementation issues.
For all other active pretreatment programs, the Permittee shall submit two copies of a Pretreatment Annual
Report (PAR) describing its pretreatment activities over the previous twelve months to the Division at the
following address:
NC DENR / DWQ / Pretreatment Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
These reports shall be submitted according to a schedule established by the Director and shall contain the
following
a.) Narrative
A brief discussion of reasons for, status of, and actions taken for all Significant Industrial
Users (SIUs) in Significant Non -Compliance (SNC);
b.) Pretreatment Program Summary (PPS),
A pretreatment program summary (PPS) on specific forms approved by the Division;
c.) Significant Non -Compliance Report (SNCR)
The nature of the violations and the actions taken or proposed to correct the violations on
specific forms approved by. the Division;
d.) Industrial Data Summary Forms DSE)
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Monitoring data from samples collected by both the POTW and the Significant Industrial
User (SIU). These analytical results must be reported on Industrial Data Summary Forms
(IDSF) or other specific format approved by the Division;
e.) Other Information
Copies of the POTW's allocation table, new or modified enforcement compliance schedules,
public notice of SIUs in SNC, and any other information, upon request, which in the
opinion of the Director is needed to determine compliance with the pretreatment
implementation requirements of this permit;
11. Public Notice
The Permittee shall publish annually a list of Significant Industrial Users (SIUs) that were in Significant
Non -Compliance (SNC) as defined in the Permittee's Division approved Sewer Use Ordinance with
applicable pretreatment requirements and standards during the previous twelve month period. This list
shall be published within four months of the applicable twelve-month period.
12. Record Keeping
The Permittee shall retain for a minimum of three years records of monitoring activities and results, along
with support information including general records, water quality records, and records of industrial impact
on the POTW.
13. Funding, and Financial Report
The Permittee shall maintain adequate funding and staffing levels to accomplish the objectives of its
approved pretreatment program.
14. Modification to Pretreatment Programs
Modifications to the approved pretreatment program including but not limited to local limits
modifications, POTW monitoring of their Significant Industrial Users (SIUs), and Monitoring Plan
modifications, shall be considered a permit modification and shall be governed by 15 NCA.0 2H .0114 and
15A NCAC 2H.0907..
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Frazier, Wanda
From:
Frazier, Wanda
Sent:
Tuesday, November 16, 2010 5:34 PM
To:
Scardina, Maureen
Cc:
Edwards, Roger
Subject:
RE: NCO069370 Pine Park Retirement Inn
Maureen,
I spoke with Ed Gaven about the changes.
Here are my suggestions for corrections:
On the cover letter and permit: insert 2601 Chimney Rock Road (in the place of 2601 Highway 64 East).
On the Supplement to Permit Cover Sheet:
Item #1. Insert: Tablet Chlorinator and Chlorine Contact Chamber as existing components.
The flow recorder is an effluent flow recorder (if you want to move it down).
"The facility...". (insert 2601 Chimney Rock Road in the place of 2601 Highway 64 East.)
Item #2. "After..." (insert: submitting an EAA and ...) This will match footnote #2 on the permit limits page and Section
A.(3.).
Everything else looks good to me.
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
1

Switchboard: 828-296-4500 x 4662
Direct line: 828-296-4662
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
From: Scardina, Maureen
Sent: Tuesday, November 16, 2010 2:31 PM
To: Frazier, Wanda
Subject: RE: NCO069370 Pine Park Retirement Inn
Wanda,
I've attached a revised draft that includes a fecal limit.
Thank you for the information provided below. We've been reviewing their fecal data (please see attached). Jeff is
inclined to add a fecal limit given their numbers. The facility upstream from them has limits as well.
This one has been confusing. All indications are they don't chlorinate yet they report TRC on their DMRs. If they were
chlorinating their fecal numbers would likely not be so high.
At this point we should probably keep the TRC limit in the permit should they install disinfection and opt for chlorine.
Please have another look at this draft and let me know if you have any concerns or recommendations. Once we get this
one ironed out I will resend the amended draft to the permittee for review/comment.
Thanks Wanda,
Maureen
From: Frazier, Wanda
Sent: Tuesday, November 16, 2010 11:13 AM
To: Scardina, Maureen
Cc: Edwards, Roger
Subject: NCO069370 Pine Park Retirement Inn
Hi Maureen,
I just got back from vacation today and got your email.
The reason they don't chlorinate is because of the extremely low instream waste
concentration (0.4%).
The effluent outfall pipe is submerged in the middle of the creek, therefore,
sampling is not possible there.
2

There are NO requirements to chlorinate (IWC = < 0.4%), but they have a low
level (28 ug/1) TRC limit and twice a week TRC monitoring requirements in the
current permit. --The TRC limit -and monitoring requirements, need to be removed
from the permit.
There is no effluent fecal coliform limit. There are weekly effluent, upstream and
downstream fecal coliform monitoring requirements. The weekly effluent,
upstream and downstream fecal coliform monitoring requirements need to be
removed from the permit.
Thanks,
Wanda
Here's their facilitv info:
Stream information
Stream & river basin:
Sub -basin:
Quad:
Grid:
Stream classification:
Drainage area sq mi:
Instream Waste Conc.:
Average stream flow:
Summer 7Q10 cfs:
Winter 7Q10 cfs:
30Q2 cfs:
Facilitv information
Clear Creek; French Broad River Basin
04-03-02
Hendersonville
F9SW
C
41.2
0.4% at 0.035 MGD
82.4 cfs
13.1
19.7
31.8
NPDES permit#: NCO069370 Henderson County
Facility name: Emeritus -Corporation —
Pine Park Retirement Inn WWTP
WWTP class: II
WWTP type: 0.025 MGD (0.035 MGD after EAA & A to C) Clow ® extended
aeration package plant consisting of: influent lift station with
duplex pumps, dual high water alarms and telemetry; manual
bar screen; 25,000 gallon aeration basin with dual blowers
providing diffused air; 98 sq ft rectangular clarifier with 6 ft weir,
skimmer & sludge returns; 1700 gallon aerobic digestor; tablet
chlorinator (not used — not required to chlorinate — IWC = <
0.4%); 576 gallon chlorine contact chamber; (no tablet
i1

dechlorinator); 30 degree V-notch weir; Stevens 61 R flow meter
with strip recorder & totalizer; and effluent pump station.
Annual Average Flow: 0.012 MGD (2007-2010 — 3 year average).
Collection System: There is one building, therefore < 12 connections.
Development: Consists of a retirement inn which serves 120
residents in apartments and assisted living
facilities.
Grease interceptor: The grease trap is pumped every other month.
Sludge Management: Commercial hauler (Mike's Septic Service — 828-253-
2612) to the City of Brevard's WWTP and
MSD's WWTP.
WWTP location:
2601 Chimney Rock Road; (US Hwy 64 East);
southeast of Oak Hill
Responsible official:
Edward Y. Gaven, Jr.
Responsible "'s title:
Executive Director
Official's location:
2601 Chimney Rock Road;
Hendersonville, NC 28792-9185
Mailing address:
2601 Chimney Rock Road;
Hendersonville, NC 28792-9185
Phone numbers
828-692-1911
Ed Gaven - Executive Director
828-696-3713
" —fax (email: Pine [e-mail])
Mark Lyons — Facilities Services Director
828-691-7191
Trevor C. McMinn, back-up ORC
" — (h): TRECVO; 2020 Howard Gap Road;
Hendersonville, NC 28792
828-693-4338
Mark Jones, ORC — Jones Environmental
828-273-0760 cell
" - (h): 45 Pleasant Court; Flat Rock, NC 28731
828-693-1031
" -fax
Operator information
Certified ORC & grade: Trevor C. McMinn - Grade II — Cert # 15084
Back-up ORC: Mark Jones - Grade II Cert # 988527
Permit information
Date issued: 12-1-2005
Expiration date: 11-30-2010
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
Direct line: 828-296-4662
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
From: Scardina, Maureen
Sent: Monday, November 01, 2010 9:29 AM
To: Frazier, Wanda
Subject: NC0069370 Pine Park Retirement Inn
Wanda,
Can you help me with this? This one got to the final stages of issuance and Jeff wanted to know why there are no fecal
limits/disinfection. Is there a reason this was not put into this permit? The file I have doesn't show any
documentation/rationale.
Maureen
�� ��atart Scari�n� ;r
gyp ` �StcDE fhgQ
tiaiireen scar in ndden,.�P
#aar�tSourc� Bt�rrch
itialh, tC 29 J o
Email correspondence to and from this address may be subject to
the North Carolina Public Recordslaw and may be disclosed to third parties.
5

Lam)
MCDENR
North Carolina Department of Environment and Natural Resources
r Beverly Eaves Perdue
Governor
Mr. Edward Y. Gaven, Jr.
Executive Director
Emeritus Corporation
2601 US Highway 64 East
Hendersonville, North Carolina 28792
Dear Mr. Gaven:
Division of Water Quality
Coleen H. Sullins
Director
,2010
Dee Freeman
Secretary
Subject: DRAFT NPDES PERMIT - AMENDED
Permit Number NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Enclosed with this letter is an amended draft permit for review. Please review the changes made to
this draft very carefully; see Section A.(1.) Effluent Limits and Monitoring. A Fecal Coliform limit was
added to protect the instream Fecal Coliform standard. The instream self monitoring data reported over the
last permit cycle indicates numbers that exceed the standand. This limit will go into effect June 1, 2012 per
15A NCAC 02B .0211(3)(e):
"Organisms of the Coliform group: Fecal Coliforms shall not exceed a geometric mean of 200/100
ml based upon at least five consecutive samples examined during any 30-day period, not exceed
4001100 ml in more than 20 percent of the samples examined during such period. "
In order to comply with this limit waste water dischargers should install some form of
disinfection; chlorination/dechlorination or ultraviolet disinfection. If there are no existing
disinfection component(s) then you will need to get an Authorization to Construct (ATC) from the
Division's Construction Grants & Loan Section (CG&L). Here is a link to CG&L's forms and
applications: littp://portal.nedenr.org/web/wq/cgls/permit/Ups. Please keep in mind that your limit
goes into effect 18-months from the effective date of your permit (June 1, 2010) and it will take some
time to attain an ATC, then construct. If you have questions or need assistance please contact CG&L
at 19 733-6900. For your reference, .I have included with this amended draft pen -nit a copy of the
echlorination ystem Minimum Design Criteria.
This permit will likely be finalized and issued in late November; with an effective date of
January 1, 2011. If you have any questions or comments concerning this draft permit, please contact
me at [phone] or Maureen. Scardina cnr,ncdenr.gov.
Sincerely,
Maureen Scardina
cc: NPDES Unit
ec: Asheville Regional Office
Technical Assistance & Certification Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: http://portal.ncdenr.org/web/Wgihome
One ,
NorthCarolina
An Equal Opportunity \ Affirmative .Action Employer

Permit N00069370
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,
Emeritus Corporation
(dba: Pine Park Retirement Inn)
is hereby authorized to discharge wastewater from a facility located at the
Pine Park Retirement Inn
2601 i h 64 Eas CLl.1 m n e- ! �&ck ZOal (
Southeast of Oak Hill
Henderson County
to receiving waters designated as Clear Creek in the French Broad River Basin in accordance with
effluent limits, monitoring requirements, and other conditions set forth in Parts I,11, III and IV hereof.
This permit shall become effective . , 2010.
This permit and authorization to discharge shall expire at midnight on November 30, 2015.
Signed this day , 2010.
DRAFT
Coleen H. Sullins, Director'
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO069370
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.
Emeritus Corporation (dba: Pine Park Retirement Inn) is hereby authorized to:
1. Continue to operate an existing 0.025 MGD extended aeration wastewater treatment system with
the following components:
♦ Influent lift station
♦ Bar Screen
♦ Flow Recorder
♦ Aeration basin
♦ Clarifier
♦ Sludge digester —F
♦ Effluent pump station
♦ Activated sludge holding basin
The facility is located at Pine Park Retirement Inn at 2601 Highway 64 Eas in Hendersonville in
Henderson County; a-mne Dock Logo(
2. After receiving an Authorization to Construct permit from the Division of Water Quality, construct
and operate the components necessary for a 0.035 MGD wastewater treatment facility; and
3. Discharge from said treatment works at the location specified on the attached map into Clear
Creek, currently classified C waters in sub -basin 04-03-02 in the French Broad River Basin.

Permit NCO069370
A. (L) EFFLUENT LIMITS AND MONITORING REQUIREMENTS - DRAFT
During the period beginning on January 1, 2011 and lasting until expansion above 0.025 MGD, or
November 30, 2015, the permittee is authorized to discharge treated wastewater from outfall 001. Such
discharges shall be limited and monitored by the permittee as specified below:
EF]JiLUENTCDARACTEVIST)1CS
dFLUENTIIiYIITS
l ONI1{ORING][2EQULREMENTSA°
. .
:a fi `9 e
Fe
n
Month➢y
Daily
Measurement
Sample °
' ' Sample
Pma neter� sera Lion PC ebd' -
aAveage
ai
xonum
.,
Freq ►t enc
` �
Y pe
1
tia
oda n
u t
,�Ia
Flow2
Influent or
0.025 MGD
Continuous
Recorder
Effluent
50050
BOD, 5-Day (20 Deg. C)
30.0 mg/I,
45.0 mg/L
Weekly
Grab
Effluent
00310
Solids, Total Suspended
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
00530
Nitrogen, Ammonia Total (as N)
2 /month
Grab
Effluent
00610
Coliform, Fecal
200/100 ml
400/100 ml
Weekly
Grab
Effluent
31616
Chlorine, Total Residual
28 µg/L
2 /week
Grab
Effluent
50060
Temperature, Water Deg. Centigrade -
00010
Weekly
Grab
Effluent
pH
Not < 6.0 nor > 9.0
Weekly
Grab
Effluent
00400
Standard Units
Coliform, Fecal
WeeklyGrab
Upstream &
31616
Downstream
Footnotes:
1. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis. [See
Special Condition A.(3.)].
3. This limit will take effect June 1, 2011 (18-months after the permit effective date), while monitoring is
required beginning on the permit effective date.
4. This limit only applies if chlorine compounds are used as a means of disinfection. The Division shall
consider all effluent TRC values reported below 50 µg/1 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 µg/l.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

Permit NC0069370
A. (2.) EFFLUENT LIMITS AND MONITORING REQUIREMENTS
During the period beginning upon expansion above 0.025 MGD and lasting until November 30, 2015,
the permittee is authorized to discharge treated wastewater from outfall 001. Such discharges shall be
limited and monitored by the permittee as specified below:
EFFEUEi CFYAI2AGTERISTACS'FLU]EN'I'
T1[M�[TS
MCINITORIN RE0TIIREN[N7S, `
`
Monlily
I?aaly"
Measureme�at`
Sample;anple
l'araffieter aDescri 1PCS,Coiie '`
Av+eia 'e
a,
Jlirc'`uenc`
a
.,
=ii'Iaxiffirr
Flow
Influent or
0.035 MGD
Continuous
Recorder
Effluent
50050
BOD, 5-Day (20 Deg. C) - Summer
10.0 mg/L
15.0 mg/L
Weekly
Composite
Effluent
00310
BOD, 5-Day (20 Deg. C) - Winter
20.0 mg/L
30.0 mg/L
Weekly
Composite
Effluent
00310
Solids, Total Suspended
30.0 mg/L
45.0 mg/L
Weekly
Composite
Effluent
00530
Nitrogen, Ammonia Total (as N) - Summer
2.0 mg/L
10.0 mg/L,
Weekly
Composite
Effluent
00610
Nitrogen, Ammonia Total (as N) - Winter
4.0 mg/L
20.0 mg/L
Weekly
Composite
Effluent
00610
DO, Oxygen, Dissolved
Weekly
Grab
Effluent
00300
Fecal Coliform
200/100 ml
400/100 ml
Weekly
Grab
Effluent
31616
Chlorine, Total Residual
28 µg/L,
2 / week
Grab
Effluent
50060
Temperature, Water Deg. Centigrade
Daily
Grab
Effluent
00010
pH
Not < 6.0 nor > 9.0
Weekly
Grab
Effluent
00400
Standard Units
Temperature, Water Deg. Centigrade
Weekly
Grab
Upstream &
00010
Downstream
DO, Oxygen, Dissolved
Weekly
Grab
Upstream &
00300
Downstream
Summer: April 1 - October 31
Winter: November 1 - March 31
Footnotes:
1. Upstream: 100 feet above discharge location; Downstream: 300 feet below discharge location.
2. Prior to expansion to 0.035 MGD, the permittee shall submit an Engineering Alternatives Analysis. [See Special
Condition A.(3.)].
3. This limit only applies if chlorine compounds are used as a means of disinfection. The Division shall consider all
effluent TRC values reported below 50 µg/1 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 µg/l.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

Permit NC0069370
A. (3.) ENGINEERING ALTERNATIVES ANALYSIS REQUIREMENT
Prior to expansion to 0.035 MGD, the permittee shall submit a detailed analysis of all available means to
dispose of this facility's wastewater. This Engineering Alternatives Analysis (EAA) shall be prepared in
compliance with the Division's guidance document of EAAs.
If no EAA is submitted, the Division may reopen and modify this permit to increase monitoring frequencies or
change effluent limits as necessary to protect the receiving stream.
Submit one copy of the EAA to the following address:
NCDENR / DWQ / Asheville Regional Office
Attention: Mr. Roger Edwards, Surface Water Protection Supervisor
2090 U.S. Hwy 70
Swannanoa, NC 28778
and
Submit the original and one copy of the EAA to the following address:
Dr. Sergei Chernikov
NCDENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

M
11-2- '40
ME
ME-1
DISCHARGE
POINT1001
v
res
_201? wev
" 11111T Miffil
- -t-v, 11
Emeritus Corporation Facility
Pine Park Retirement Inn Location
County: Henderson Stream Class: C (not to scale)
Receiving Stream: Clear Creek Sub -Basin: 04-03-02
Latitude: 35' 21' 28" Grid/Quad: F95W/Hendersonville
Longitude: 86o 26' 02" HUC M 06010105 NORTH NPIDES Permit: NCO069370

Dechlorination System Minimum Design Criteria
Adopted April 18, 2003
Introduction
The Triennial Review Committee's move to adopt a fresh water standard for total
residual chlorine (TRC) is driving the implementation of TRC effluent limitations for
facilities that use chlorine or a chlorine derivative for disinfection. Such a limit may
necessitate the use of a dechlorinating agent such as sulfur dioxide or a sulfite
derivative. The relatively simple nature of dechlorination affords the Division the
opportunity to develop a fast -track permitting strategy for approval of such systems.
The minimum design criteria outlined herein are meant to provide the regulated
community and their engineers the information necessary to ensure proper system
design and rapid project turn -around.
Applicability
This criteria document applies to the design of sulfur dioxide and sulfite derivative
systems. Facilities proposing to employ. an alternate means for dechlorination, such as
activated carbon, are .required -to follow the standard authorization to construct (ATC)
permitting process.
Design Criteria
1.0 Dosage Rates
The following dosage rates are to be used for the design of dechlorination systems.
These dosage rates constitute the stoichiometric requirement plus a 10% margin, of
safety'.
ZEN
Sulfur Dioxide 1.0 mom/ L S02 _per m 1 C12 removed _
Sodium Bisulfite ! 1.6 mg/L NaHS_03 per mg/L C12 removed
Sodium Metabisulfite 1.5 mg/L Na2S205 per mg/L Cl2 removed
2.0 Duality Requirements
Designs shall include dual feed systems to insure compliance with residual
chlorination limitations in the event the primary (if one is designated) system fails.
3.0 Feed Systems
3.1 Suter Dioxide
i Recommended Standards for Wastewater Facilities; Great Lakes -Upper Mississippi River
Board of State and Provincial Public Health and Environmental Managers; page 100-7, 1997
Edition.

Dechlorination System Minimum Design Criteria
Gaseous sulfur dioxide feed systems shall employ vacuum pumps and carbon steel or
stainless steel piping. For aqueous solutions, PVC, PE, CPVC, or rubber tubing are
acceptable piping alternatives.
3.2 Sulfite Derivatives
Feed systems for both sodium bisulfite and sodium metabisulfite solutions shall
employ positive displacement pumps and stainless steel piping.
4.0 Mixing
Proper turbulent 'mixing should be provided such that the dechlorinating agent is
completely mixed within 20 seconds of application. Designs shall provide no less than
30 seconds detention time for mixing.2
5.0 Chemical Storage
The dechlorinating agent storage area must route solution spills or leakage to a
containment area. Chlorine and sulfur dioxide are to be stored separately in well -
ventilated areas.
6.0 Effluent Quality
Dechlorination consumes alkalinity and exerts an oxygen demand. As such, proper
consideration. must be given: to effluent pH and dissolved oxygen to ensure that both
parameters are within acceptable ranges at the point of discharge.
2 Recommended Standards for Wastewater Facilities; Great Lakes -Upper Mississippi River
Board of State and Provincial Public Health and Environmental Managers; page 100-8, 1997
Edition.
Version 4.18.2003
Page 2 of 2

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins .,
Governor Director r
EDWARD Y GAVEN JR
EXECUTIVE DIRECTOR
EMERITUS CORPORATION
2601 US HIGHWAY 64 EAST
HENDERSONVILLE NC 28792
Dear Mr Gaven:
i
May 13, 2010 S;.
s
l0
Dee Freeman
Secretary
.�.R
Subject: Receipt of permit renewal application
NPDES' Permit NCO069370
Pine Park Retirement Inn
Henderson County
s
F
The NPDES Unit received your permit renewal application on May 12, 2010. A member of the NPDES
Unit will review your application. They will contact you if additional information is required to complete your
permit renewal. You should expect to receive a draft permit approximately 30-45 days before your existing permit
expires.
If you have any additional questions concerning renewal of the subject permit, please contact Maureen
Scardina at [phone].
Sincerely, .
Dina Sprinkle
Point Source Branch
cc: CENTRAL FILES
Ashwill Regionalt@ffice/Surface Water Protection
NPDES Unit
Trevor C. McMinn, TREVCO, 2020 Howard Gap Road, Hendersonville, NC 28792
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] \ FAX: 91 M07-6492 \ Customer Service: 1-877-623-6748 NorthCarol.l.na
Internet: wmu.ncwaterquality.org �m ,
An Equal Opportunity, Affirmative Action EmployerVVaty

THE"C"0 _
E-NIVIRONTME TAL i LA-R,; 'ENF 1`SCE ` COIN'STPLCTICNI
------------------
2020 Howard Gap Road
1Ierdersoiiyille, .C.287` 2)
Phone (828'691- 7 t 91
l:ax [phone]
4/28/10
Permit Renewal Request
Mrs. Dina. Sprinkle
D�-�
7 I
E
Y 14 2010
QUALITY SECTION
A.SHEVILLE REGIOP,1,gL. OFFICE
Please find enclosed a permit renewal package for Pine Park Retirement Inn (NPDES
permit # NC0069370). There have been no changes or modifications to this facility since
the issuance of the last permit. We respectfully request this permit to be renewed. We
also hope that you find this package in order_
i
If we may be of further assistance please do not hesitate to call or correspond.
Sincerely,
Trevor C. McMinn

*MPDES APPLICATION - FORMI wastewaters <1.0 MGD
For privately awned treatment systems treating 100% domestic
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit WC-00693
T 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 Informatiow.
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
`e-mail Address
Emeritus Corporation
tk
k.
Pine Park Retirement Inn
2601 US Highway 64 East
V MAY 1 4
Hendersonville
NC 28792 Qi iij ITY RECTION
[phone] 2ft2LL—GIONAL
Tice
[phone]
A/ F- PA R LRp E A4 E- IL iTVS 0 IV
i
2. Location of facility Producing discharge:
Check here if same address as above
Street Address or State Road
City
State / Zip Code
1 County
3. Operator Information:
MAY 12 2010
Lnp gn 0-7-777i—j
POINT &3JRCL 3RANCH
1 Name of the finr4 public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charg
e or ORC)
vo�- e Name Emeritus Corporation,/ 10) Al 6�7' IOAP, AZ —rr
Mailing Address E-!f RaQ
!Z&6 I CW I MAJ e- k
city
i
Ne%� State / Zip Code 2'Z
A)
V' Telephone Number 7- X`
Fax Number 6 921-3
A -X^

ONPDES APPLICATION - FORM
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
14. Description of wastewater.
Facility Generating Wastewater(check all that applyft
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: Retire. Inn
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Retirement Inn / Assisted Living
I Population served: 2 O
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer).
i 6. Outfall Information:
Number of separate discharge points 1 only
OuthM Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (Provide a map shounng the exact location of each outfallt
t Clear Creek
i S. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
See attached Sheet

k
APDES APPLICATION - FORK L
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
C
10. Flow Information:
Treatment Plant Design flow 0.025 MGD
Annual Average daily flow 0.012. MGD (for the previous 3 years)
Maximum daily flow 0.024 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. If more than one analysis is reported, report daily maximum
and monthly average. If only one analysis is reported, report as daily maadmum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
4.8
3.0
Mg/L
Fecal Coliform — y'jp l ir,.
12500
4592
#/ 100 ML
Total Suspended Solids
17.9
8.5
Mg/L
Temperature (Summer)
26
22
Degrees C
Temperature (Winter)
5
3
Degrees C
pH
17.2
6.4
Standard Units
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NFDES Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
Permit Number
14. APPLICANT CERTIFICATION
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.
r v
G �. T . J �IL•'
Printed name of Person Signin Title
Signature of
`S /10//0
Date
North Carolina General Statue 143-215.6 (b)�9iates: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other docume t files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article.. or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article; shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)

f
J
i
TREVCO
?�2 eiC)lPc1?i[i�d............ ._......... _........... _.__.................................. ............ ................................................................ ......... _.........
f Hendersonville, N.C. 28792
Phone [phone]
Fax [phone]
Apri128, 2010
Signatory Authority / Authorized Representative
3
For the purpose of signing monthly D.M.R_s and permit renewal (Signatory authority on file per
15ANCAC 8A_0202(b)(5)(B) with DEM Central files) for the Pine Park Retirement Inn:
NPDES#NC0069370 evidenced by the signatures below.
Authorized signature:
Trevor McMinn
Operator in Responsible Charge
Pine Park Retirement Inn
Title: E `D
Print ..,� Sign: ( l7 ✓ �% 1 J�iQ
Date:

2020 Howard Gap Road
Hendersonville, ?N1.C. 28792
Phone [phone]
Fax(828`,696-8971
Sludge Management and Treatment Description
Mr. Mark Lyons:
Trevco and Operator in Responsible Charge, Trevor McMinn (cert#15084) are providing this report to
assist with your permit renewal.
General information:
Facility System Name: Pine Park Retirement Home
Responsible Entity: Emeritas Corporation
Person in Charge: Mark Lyons
Applicable Permit: NPDES # NCO069370
Description of treatment process:
The 0.025 MGD extended aeration facility consists of an influent lift station, bar screen, flow recorder,
aeration basin, clarifier, sludge digester, effluent pump station, and an aerated sludge holding basin.
This facility is located at Pine Park Retirement Inn at 2601 US 64 East in Henderson County.
Sludge Management:
This facility builds sludge rapidly, due to the highly loaded moderate influent flow (averages 12,000
gallons per day). As the need for sludge removal becomes apparent it will be wasted to the digester where it
will be stored and thickened for cost effective hauling. As the flow increases at this facility it may become
necessary to increase the frequency in hauling. Sludge removal will be by truck by Mike's Septic,
{828-253-2612) a local pump truck contractor. He will haul the sludge to disposal at the Town of Brevard
or the MSD waste treatment facility. All associated costs of this hauling will be paid by Pine Park
Retirement Inn. Removal and management of this sludge will be done in a timely manner and in the best
interests of facility operation and the environment. 6 loads of sludge have been removed in 2009.
Notification: This report will be delivered to Pine Park Retirement Inn to the attention of Mr. Mark
Lyons and to Mrs. Dina Sprinkle NCDENR DWQ Point Source Branch in Raleigh, NC.
Conclusion: The Pine Park waste treatment facility is well designed for the existing flow and is a pleasure
to operate. Everyone involved at the Pine Park Retirement Inn should be commended for the care and
management of this facility and the environment.
Certification: I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify that this report has been made available to the users or customers of the named
system and that those users have been notified of its availability_
Operator in responsible charge:
Trevor C. McMinn
,/ w ( /V
Owner, Trevco

LO1
........................................................................................................................................................................................
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Pax(828)696-8971
June 25, 2003
Signatory Authority / Authorized Representative
For the purpose of signing monthly D,M.1t.s (Signatory authority on file per 15ANCAC
8A.0202(b)(5)(l3)'cwith DEM Central files) for the Pine nark Retirement inn: NPDFS#NC0069370
evidenced by the signatures below_
Authorized signature:
Trevor44 C. M �4
Operator in Responsible Charge
Da
A 4rizing Permlitee
NZ
Z9 3Jbd
ZI0AMU TL689698Z8 EZ:9T E00Z/9T/TT

SOC PRIORITY PROJECT:
IF YES, SOC NUMBER
TO: PERMITS AND ENGINEERING UNIT
WATER QUALITY SECTION
ATTENTION: Susan Robson
DATE: March 22, 1995
NPDES STAFF REPORT AND RECOMMENDATION
COUNTY Henderson
PERMIT NUMBER NCO069370
PART I - GENERAL INFORMATION
1. Facility and Address: Pine Park Retirement Inn
2601 Hwy 64 East (Hwy 64 & Howard Gap Rd)
P. O. Box 207
Hendersonville, N. C. 28793
2. Date of Investigation: March 21, 1995
3. Report Prepared By: Paul White
4. Persons Contacted and Telephone Number: George F. Bond, Jr.
704-692-1911
5. Directions to Site: The site is located at the intersection of
Highway 64 East and Howard Gap Road (SR 1006). The WWTP is
located 0.1 mile north of the building. The outfall is located
approximately 1700 feet north of the WWTP on Clear Creek.
6. Discharge Point(s), List for all discharge points:
Latitude: 350 21' 26" Longitude: 820 25' 55"
Attach a USGS map extract and indicate treatment facility site and
discharge point on map.
U.S.G.S. Quad No. F9SW U.S.G.S. Quad Name Hendersonville
7. Site size and expansion area consistent with application?
X Yes No If No, explain:
Page 1

8. Topography (relationship to flood plain included): The WWTP is
located on the west slope near the top of a ridge. Slopes 150.
Not in flood plain.
9. Location of nearest dwelling: >200 feet
10. Receiving stream or affected surface waters: Clear Creek
a. Classification: C
b. River Basin and Subbasin No.: French Broad 040302
C. Describe receiving stream features and pertinent downstream
uses: Rural and agricultural drainage. Fish and wildlife
propagation, fishing, hunting, agriculture.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater to be permitted 0.035 MGD (Ultimate
Design Capacity)
b. What is the current permitted capacity of the Wastewater
Treatment facility? 0.035 mgd
c. Actual treatment capacity of the current facility (current
design capacity 0.025 mgd
d. Date(s) and construction activities allowed by previous
Authorizations to Construct issued in the previous two years:
none
e. Please provide a description of existing or substantially
constructed wastewater treatment facilities: Existing
facilities consist of an extended aeration plant with
influent lift station, bar screen, 25,000 gal aeration basin,
dual blowers, a 98 sq. ft. clarifier with a 6 ft. effluent
weir, a 1700 gal. sludge holding basin, a 576 gal. chlorine
contact chamber, a tablet chlorinator, a 30 degree V-notch
weir, a flow meter with indicator, chart recorder, and
totalizer, and effluent pump station.
f. Please provide a description of proposed wastewater treatment
facilities: n/a
g. Possible toxic impacts to surface waters: Chlorine, ammonia,
chemicals used in cleaning.
h. Pretreatment Program (POTWs only): n/a
in development approved
should be required not needed
2. Residuals handling and utilization/disposal scheme: Contract
hauler.
Page 2

a. If residuals are being land applied, please specify DEM
Permit Number
Residuals Contractor
Telephone Number
b. Residuals stabilization: PSRP PFRP OTHER
c. Landfill:
d. Other disposal/utilization scheme (Specify):
3. Treatment plant classification (attach completed rating sheet): II
4. SIC Codes(s): 8361
Wastewater Code(s) of actual wastewater, not particular facilities
i.e., non -contact cooling water discharge from a metal plating
company would be 14, not 56.
Primary 11 Secondary
Main Treatment Unit Code: 0607
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds
or are any public monies involved. (municipals only)? no
2. Special monitoring or limitations (including toxicity) requests:
none
3. Important SOC, JOC, or Compliance Schedule dates: (Please
indicate) none
Date
Submission of Plans and Specifications
Begin Construction
Complete Construction
4. Alternative Analysis Evaluation: Has the facility evaluated all
of the non -discharge options available. Please provide regional
perspective for each option evaluated.
Spray Irrigation: Probably not feasible.
Page 3

REVISED PAGE 4 tVGod 6q3 70
Connection to Regional Sewer System: The gravity sewer line
serving North Henderson High School has been permitted to
Henderson County Utilities (Mud Creek Water and Sewer District) as
of February 20, 1995. This sewer line extends down Highway 64 to
the vicinity of Pine Park Retirement Inn.
Subsurface: Not an option.
Other disposal options:
5. Other Special Items:
PART IV - EVALUATION AND RECOMMENDATIONS
This revised page 4 is submitted as a modification to the
original staff report dated March 22, 1995, which stated that the
sewer line was 2000 feet away.
The above mentioned sewer line is within approximately 600
feet of the property of Pine Park Retirement Inn. However, it
appears that private easements would still have to be obtained in
order to connect to this line, unless the sewer line was extended
north up Howard Gap Road by the County. Pine Park Retirement Inn
should ultimately connect to this sewer line.
The permit was modified September 27, 1993 to include two
effluent limits pages, for 0.025 mgd and 0.035 mgd. It is
recommended that the permit be reissued with the appropriate
language concerning connection to a regional sewer system when
available. The continuous flow monitoring requirement should
remain in the permit since it is a current requirement at both
flows and the permittee has installed this equipment.
pa'ay x0j",
Signature of Report Preparer
a er Quality Regional Supervisor
��
Date/
Page 4

PERMIT NO.: NCO069370
�ESWAS'TE LOAD ALLOCATION
ECEN
Water QuaRY tion
PERMITTF,E NAME: American Retirement Association
FACILITY NAME:
Pine Park Retirement InnMAK
Facility Status: Existing
Permit Status: Renewal
Major
Pipe No.: 001
Minor
Design Capacity: 0.035 MGD
Domestic (% of Flow): 100 %
Industrial (% of Flow):
Comments:
RECEIVING STREAM: Clear Creek
mheville REgi
Asheville, N01
Class: C-Trout
Sub -Basin: 04-03-02
Reference USGS Quad: F9SW (please attach)
County: 'Henderson
Regional Office: Asheville Regional Office
Previous Exp. Date: 4/30/92 Treatment Plant Class: 1
Classification changes within three miles:
No change within three miles.
Requested by: Mack Wiggins Date: 12/11/91
Prepared by: Q Date: z z S 9 L
Reviewed Date:
l3S
, �S
Modeler
Date Rec.
#
-S KJO d
. Lz� n
2Drai
nage Area (miL) 4/, z Avg. Streamflow (cfs):
Offs
7 10 (cfs) l3, t Winter 7Q10 (cfs) 1p. 7 30Q2 (cfs)
arfticity, Limits: IWC I % Acute/Chronic
Instream Monitoring:
Parameters lc� o�,✓
Upstream Y Location /°b
Downstream Location5jp. 4.
Effluent.
Characteristics
Summer
Winter
BOD5 (mg/1)
30
D.O. (mg/1)
rye
TSS (mg/1)
36
F. Col. (/ 100 ml)
m&,,
pH (SU)
Ate,
A*tva- G4.A., r a.,.s-
4. -7a-l--
�J

9P
L11
Facility Name:
NPDES No.:
Type of Waste:
Facility Status:
Permit Status:
Receiving Stream:
Stream Classification:
Subbasin:
County:
Regional Office:
Requestor:
Date of Request:
Topo Quad:
Ll
FACT SHEET FOR WASTELOAD ALLOCATION
Pine Park Retirement Inn
NCO069370
Domestic - 100%
Existing
Renewal
Clear Creek
C Trout
040302
Henderson
Asheville
Wiggins
12/17/91
F9SW
Request # 6663
Stream Characteristic:
USGS #
Date:
Drainage Area (mi2):
Summer 7Q10 (cfs):
Winter 7Q10 (cfs):
Average Flow (cfs):
30Q2 (efs):
IWC (%):
F F D 10 1 .2
-Asheville Regional
Asbevig% North Carotin
41.2
13.1
19.7
82.4
31.8
0.4
Wasteload Allocation Summary
(approach taken, correspondence with region, EPA, etc.)
Facility requesting renewal of existing permit. Per new dilution ratio, facility needs fecal coliform
limit. Recommend effluent monitoring, upstream and downstream monitoring of fecal coliform.
Special /Schedule Requirements and additional comments from Reviewers:
/2�6�,4/ �� GO.v iA'�._ �/rl�i9� L,pivt7 iT.o.✓ �iL �yi �✓/ "" G
Recommended by: Date: 1/24/92
Reviewed by
Instream Assessment
Regional Su00
Permits & Engineeri
Date: 7 02
Date:` Z
ng: Date:
RETURN TO TECHNICAL SERVICES BY:
MAR 0 5 1992
FEB 9 19°2

•
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Existing Limits:
Wasteflow (MGD):
BOD5 (mg/1):
NH3N (mg/1):
DO (mg/1):
TSS (mg/1):
Fecal Col. (/100 ml):
pH (SU):
Residual Chlorine (µg/l):
Oil & Grease (mg/1):
TP (mg/1):
TN (mg/1):
Recommended Limits:
Wasteflow (MGM
BOD5 (mg/1):
NH3N (mg/1):
DO (mg/l):
TSS (mg/1):
Fecal Col. (/100 ml):
pH (SU):
Residual Chlorine (4g/1):
Oil & Grease (mg/1):
TP (mg/1):
TN (mg/1):
CONVENTIONAL PARAMETERS
Monthly Average
Summer Winter
0.035
30
nr
nr
30
nr
nr
Monthly Average
Summer Winter
0.035
30
monitor
nr
30
monitor
nr
Limits Changes Due To:,
Change in 7Q10 data
Change in stream classification
Relocation of discharge
Change in wasteflow
Other (onsite toxicity study, interaction, etc
Instream data
New regulations/standards/procedures
New facility information
WQ or EL
WQ
WQ
WQ
WQ
Parameter(s) Affected ,
Fecal Coliform
X Parameter(s) are water quality limited. For some parameters, the available load capacity of
the immediate receiving water will be consumed. This may affect future water quality based
effluent limitations for additional dischargers within this portion of the watershed.
No parameters are water quality limited, but this discharge may affect future allocations.

•
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.:p
INSTREAM MONITORING REQUIREMENTS
Upstream Location: 100 ft. upstream of discharger
Downstream Location: 300 ft. downstream of discharger
Parameters: Fecal Coliform
Special instream monitoring locations or monitoring frequencies:
MISCELLANEOUS INFORMATION & SPECIAL CONDITIONS
Adgquacy of Existing Treatment
Has the facility demo trated the ability to meet the proposed new limits with existing treatment
facilities? Yes No
If no, which parameters cannot be met?
Would a "phasing in" of the new limits be appropriate? Yes No
If yes, please provide a schedule (and basis for that schedule) with the regional
office recommendations:
If no, why not?
Special Instructions or Conditions
Wasteload sent to EPA? (Major) (Y or N)
(If yes, then attach schematic, toxics spreadsheet, copy of model, or, if not modeled, then old
assumptions that were made, and description of how it fits into basinwide plan)
Additional Information attached? (Y or N) If yes, explain with attachments.

RECEIVED
A U G 17 )MI
PERMITS & ENGINEERING
TECHNICAL SPECIFICATIONS
for
WASTEWATER COLLECTION/TREATMENT FACILITIES
to serve
PINE PARK RETIREMENT INN
HENDERSON COUNTY, NORTH CAROLINA
Prepared By
WILLIAM G. LAPSLEY & ASSOCIATES, P.A.
CONSULTING ENGINEERS
HENDERSONVILLE, NORTH CAROLINA
o`ooeo�eae0000r�io � ��(� �1v �a^"
- I �i NUTS & ENGINEERING
1� f

SECTION 06230
DIVISION 6 WASTEWATER TREATMENT PLANT -
WASTEWATER TREATMENT SYSTEM PACKAGE TYPE (STEEL)
A. DESCRIPTION OF WORK
The work covered under this section shall consist of
furnishing all materials, labor, equipment, and services
necessary for the installation of a complete factory
built (prefabricated) wastewater treatment plant. The
plant shall be complete and ready for operation in
accordance with the drawings and specifications stated
in this section.
The treatment plant shall be of the activated sludge
type, specifically known as "Extended Aeration" designed
for treating gallons per day of
PPM - BOD5 domestic sewage.
B. TANK CONSTRUCTION
The principal component of the treatment plant shall be
its steel tank within which the wastewater treatment
process is to take place.
The tank shall be 1/4-inch steel plate joined by arc
welding with fillets of adequate section for the joint
involved. Walls shall be continuous and watertight and
shall be supported by structural members where required.
The Contractor shall provide necessary field assembly
including welding when required. For cathodic
protection, magnesium anodes shall be
furnished. Anodes are to be buried by the Contractor
and securely -connected to the tank walls by heavy copper
wire in good electrical contact thereto. A poured
concrete foundation slab shall be provided by Contractor
in the field for anchoring the steel tank.
The inside and outside surfaces of the tank shall have
all rust, mill scale, flux fumes, oxides, grease and oil
removed by commerical sandblasting. Immediately after
sandblasting, one coat of Bakelite Chromate Primer, and
one coat of green enamel shall be applied to all
surfaces. The green enamel is made from a combination
of alkyd resin and chlorinated rubber and the
combination of these two coats gives the preparation
outstanding water resistance and high durability. The
primer coat shall be equivalent to #69409 and the finish
coat equivalent to #67323 as -manufactured by the Perry &
Derrick Company, Incorporated, Cincinnati, Ohio.

C. AERATION CHAMBER
The aeration chamber shall be of sufficient capacity to
provide a minimum 24 hour period of retention. The tank
shall be filleted on each side, at the bottom to prevent
sludge accumulation, and at the top to enhance rotation
of tank contents and prevent scum and froth accumulation.
The aeration chamber shall be constructed with air
diffusers placed longitudinally along one side of the
chamber so as to, in conjunction with the flow control
baffles, enhance the spiral rotation of chamber contents.
The proportion of chamber width to depth, in direction
of rotation, shall not exceed 1.33 to 1 and shall be in
such proportion that the velocity of rotation so
promoted shall be sufficient to scour the chamber's
bottom and prevent sludge filleting, as well as to
prevent the escape to the surface of miniscule air
diffusion bubbles and by so causing their entrapment to
provide maximum oxygenation efficiency.
D. AIR DIFFUSION'SYSTEM
Diffuser air shall be supplied by two (2) positive
displacement blower(s), (each) of ample size based on
B.O.D. application to provide a minimum of 2100 cubic
feet of air per pound of B.O.D. applied and/or based on
tank cleansing velocities to provide a minimum of one
diffuser for every 6" of aeration tank length. With
this spacing, the air flow per diffuser shall range from
1-1/4 to 3 C.F.M. which gives a minimum air velocity of
40 feet per second through the diffuser orifice. This
minimum air velocity shall be maintained to insure
sufficient velocity for self cleansing. The diffusers
shall be parallel to and near the base of the fillet and
at an elevation which will provide the optimum diffusion
and mixing of the tank contents. The diffuser assembly
shall be easily removed from the tank and shall be
equipped with an air regulating valve permitting
adjustment of the air flow or complete shut-off. It
shall be designed to handle a wide range of air flow,
varying the orifice opening automatically to the air
flow, thus insuring small uniform bubble distribution.
The oxygen transfer capacity.of each diffuser shall be
such that an adequate supply of oxygen will be
maintained in the aeration chamber to meet treatment
requirements of the design sewage load.
E. BLOWER UNITS
There shall be (two) blower/motor unit(s) supplied,
(each) meeting the following specifications The blower
shall have a 24-hour time clock to vary the air supply
in 15 minute intervals and shall deliver C.F.M.
@ 5 psi. The motor drive shall be H.P.►

1750 R.P.M., 230 volt, 1 phase, 60 cycle, motor
with V-belt drive. The blower and motor shall be
mounted on slide rails to maintain proper belt tension,
and enclosed in a weatherproof enclosure. For easy
access'. to the controls, blower and motor, access doors,
equipped with locking device, shall be supplied. For
proper air ventilation, air louvers shall be placed in
the enclosure on the blower and motor chamber side. For
the reduction of the inlet air noise and the filtration
of the inlet air, there shall be supplied an Air -Maze
dry type filter -silencer as manufactured by the
Rockwell, Standard Corporation, or approved equal.
F. CLARIFIER CHAMBER
The clarifier chamber shall be of ample size to provide
a minimum of 4 hoursretention, based upon the average
design flow. The total settling volume shall include
the volume of the upper 1/3 of the sludge hopper. The
bottom of the chamber shall be formed into inverted
pyramidal hopper or hoppers with flat bottom area of
each hopper being not greater than one square foot.
Slope of hopper walls shall not be less than 1.7
vertical to 1.0 horizontal. Settled sludge shall be
returned from the clarifier sludge hopper to the
aeration chamber by the positive sludge return system.
The clarifier effluent shall pass over the edge of an
effluent weir into the effluent trough and thus out of
the chamber. Effluent weir' shall be mounted to permit
easy adjustment for level and height.
G. SLUDGE RETURN SYSTEM.
There shall be installed within the clarifier chamber
one (two) airlift sludge return assembly(ies) meeting
the following specificatons: The airlift pump shall
have a recirculation capacity of 0% to 100E of design
flow. Air line supplying air to the pump shall be
equipped with a needle valve to vary the amount of air
to each pump thus varying the capacity of the airlift
pump. Airlift pump(s) shall be firmly supported and
shall be equipped with a cleanout plug to allow for easy
cleaning and maintenance.
H. SCUM SKIMMING SYSTEM
There shall be (two) airlift skimming device(s), (each)
meeting the following specifications: The skimming
device shall be of the positive airlift pump type,
located in the settling tank to skim and return floating
material to the aeration tank. Air line supplying air
to the skimming device shall be equipped with a needle
valve to regulate the rate of return.

I
J.
K.
FROTH CONTROL SYSTEM
A 230 volt, single phase, 10 G.P.M. froth control
pump shall be provided in the clarifier chamber and
sufficient spray nozzles attached to the discharge line
of the pump to insure control of frothing or foaming in
the aeration chamber. The spray nozzle shall be of the
weighted counterlever type with a flip -open cap for
quick flush cleaning of the nozzles 1/2" diameter
orifice. Spray nozzles shall produce a sharp spray
pattern along the entire length of aeration tank. A
hose bib shall be furnished between the discharge side
of the pump and spray nozzle shut-off valve to provide
wash-up water when required.
SERVICE WALKWAY
Galvanized open grip safety grating panels shall be
provided for walkways to service the plant equipment.
The grating panel shall be 18" maximum in width and
constructed of 14 gauge galvanized sheet metal formed,
perforated, and extruded so as to permit maximum open
area. The maximum weight of each panel shall not exceed
55 pounds and each panel shall have a safe uniform load
carrying capacity of 50 pounds/sq. feet without
excessive deflection.
INLET BAR SCREEN
A bar screen shall be provided, within the aeration
chamber at the influent port to remove any unusually
large solids from the incoming raw sewage. The bar
screen shall be fabricated from one-half inch diameter
bars spaced one inch apart and arranged as shown on the
drawings.
The bars shall be sloped to permit easy cleaning of
accumulated debris. A drying deck shall be furnished
for drying this debris. The bar screen shall have the
same protective coating as specified for the steel tank.
M. CHLORINE CONTACT TANK
The chlorine contact tank shall have a capacity of
2,400 gallons based on 40 minutes retention time
for the design flow rate. The tank shall be constructed
as an integral part of the wastewater treatment plant.
The tank shall have the same structural requirements as
the plant and the same protective coatings.
Sufficient flow baffles shall be supplied to assure
proper mixing of the chlorine solution with the plant
effluent.

N. CHLORINATION EQUIPMENT
To provide for chlorination of the sewage treatment
plant effluent, a hypochlorination unit shall be
supplied. This will include a solution feed pump of the
positive displacement type designed for feeding sodium
or calcium hypochlorite or similar solution. The unit
shall be acid and alkali resistant and all parts which
come in contact with the pumped solution shall be
chemically resistant plastic or synthetic rubber.
A bracket mounting for the hypochlorinator shall be
included. One unit space heater of adequate capacity to
maintain temperature above freezing shall be supplied.
The unit heater shall be complete with integral
thermostatic control. All wiring and electrical devices
required inside the housing shall be installed complete.
Conduit and wiring between power source and
hypochlorinator housing shall be provided by the
Contractor. All electrical equipment and control
devices shall be designed for 230 volt -service.
The housing shall be designed for easy mounting on the
top of the plant near the inlet of the chlorine contact
tank using bolts furnished with the housing.
O. CONTROLS
The necessary controls for each blower motor and
associated plant equipment shall be housed within the
Nema 3R blower cabinet. The control section shall be
accessible by removing the front -cover. The blower,
motor and pulley section of the blower housing shall be
isolated by the removable control subpanel. Across the
line, magnetic starters with overload protection shall
be supplied for blower motor and spray pump. Hand off
auto switches shall be supplied with the automatic
circuit interlocked to run the spray clock. Duplex or
stand-by blower panels shall be preprogrammed to
alternate automatically. Individual off -on switches are
provided when associated plant equipment is supplied.
All electric equipment and circuitry shall be protected
by a properly sized circuit breaker.
P. START-UP SERVICE
At the time the sewage treatment plant is filled with
water or sewage, power connections are completed, and
all equipment is approved for service, the Contractor
shall provide the services of a representative of the
manufacturer who shall instruct the Owner's
representative in the proper maintenance and operation
of the sewage treatment plant, including instructions in
conducting all required operational tests. The
manufacturer's representative shall turn over to the

Q•
R.
Owner's representative at that time a service manual
outlining, in detail, all operation instructions and
procedures.
GUARANTEE
The manufacturer of the treatment plant shall guarantee
for 15 months from date of shipment, or 12 months from
date of start-up, whichever occurs first, that the
structure and all equipment shall be free from faults in
materials and workmanship. The manufacturer shall
furnish replacement parts for any component proven
defective during the guarantee period.
MANUFACTURER'S QUALIFICATIONS
These specifications describe a factory built wastewater
treatment plant deemed most suitable for the service
anticipated by the Engineer. The treatment plant
furnished by the Contractor shall be the product of a
manufacturer with a minimum of five (5) years experience
in the design and fabrication of wastewater treatment
plant equipment.
For the sake of this contract acceptable manufacturers
are those listed below unless approved otherwise by the
Engineer:
1. Clow Corporation, Florence, Kentucky
2. Pollution Control, Inc., Cincinnati, Ohio
S. COMPENSATION
Payment for furnishing and installation of the equipment
described in this section and as shown on the plans
shall be covered under the contract lump sum price for
Package Type Wastewater Treatment Plant as listed in the
Bid Schedule.

WaterResources
ENVIRONMENTAL QUALITY
PAT MCCRORY
` l 1 Governor
DONALD R. VAN DER VAART
secretory
S. JAY ZIMMERMAN
Director
December 9, 2015
Joy Hougan
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: Compliance Evaluation Inspection
Pine Park Retirement Inn
Permit No: NCO069370
Henderson County
Dear Ms. Hougan:
Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection conducted on
9/241/2015. The facility appeared to be in compliance with permit NC0069370. .
Please refer to the enclosed inspection report for observations and comments. If you or your staff have any.
questions, please call me at 828-296-4500.
Sincerely,
Katherine H. Jimison
Chemist I
Asheville Regional Office
Enc. Inspection Report
cc: Trevor Clyde McMinn, ORC .
MSC 1617-Central Files -Basement
IR's1-e7ril11 1 isles ►
G:\WR\WQ\Henderson\Wastewater\Minors\Pine Park Inn 69370\CEI.Sept2015.Ltr.docx
Water Quality Regional Operations —Asheville Regional Office
2090 U.S. Highway 70, Swannarioa, North Carolina 28778
Phone: 828-296A500 FAX: [phone]
Internet: http://portal.ncdenr.org/web/wq
An Equal Opportunity 1 Affirmative Action Employer

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
- .. _.._ _..__.__._— water-COF pliance Inspection Report __ _
._Approval-expires.e 3]-98._....__.--
Section A: National Data System Coding (i.e:;,PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 IN I 2 15 1 3.119 I g 20I I
� Nc0069370 11 12 15/0 /2a 17' 18 u
u LJ I' �u
r :1 f6
211 1 1 1 I I I I I .1; I-j 1,]
Inspection
Work Days Facility Self -Monitoring Evaluation Rating 61 QA. -Reserved-
67
70 Lj 71 Lj 72. N J � 73 I I 174 751 I I I I I I 180
L_I 1
Section B: Facility Data
Name and Location of Facility -Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
08.'OOAM 15/09/24
11/01/01
Pine Park Retirement Inn
2601 U S Hwy 64 E
Exit Time/Date
permit Expiration Date
Hendersonville NC 28792
09:OOAM 15/09/24
15/11/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
/p
Trevor Clyde McMinn/ORC/828-691-7191/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joy. Hougan,2601 U S Hwy 64 E Hendersonville NC 28792//828-692-1 g11/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated) .
M-Permit - - - -0-FlowMeasuremenY----- Operations &-Maintenance-,M-Facility Site Review- - - -
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
ison AROWQ//828-296-4500/
Signature of Managem t Q Reviewer Agency/Office/Phone and Fax Numbers Date
ti ,
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

Permit: NCO069370 l owner- Facility: Pine Park Retirement inn
.
Inspection Date: 09/24/20.15 Inspection Type: Compliance Evaluation
PernAt
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted anew
0
❑
❑
.❑ ,.
application?
Is the facility as described in the permit?
0
., ❑
❑
. ❑ _•
# Are there any special conditions for the permit? ' ..
❑..
W _
El,
❑
Is. access to the plant site restricted. to the general public?
❑
. ❑
❑
Is the inspector granted access to all areas for inspection?_
0
❑
❑
❑
Comment: Mr. Trevor McMinn assisted in this inspection.
Operations & Maintenance
Yes No NA NE
Is the plant generally clean. with acceptable housekeeping?
❑
. ❑
❑
Does the facility analyze process control parameters, for ex` MLSS, MCRT, Settleable
M
El.
❑
❑
Solid's, pH, DO, Sludge Judge, and other that are applicable?
Comment: Setteable Solids,
Pump Station - Influent
Yes No NA NE
Is the pump wet well free of bypass lines or structures?
0
❑
' ❑
❑
Is the wet well free of excessive grease?
•4,
❑
❑
❑
Are all pumps present?
❑
❑
❑
Are all pumps operable?
0
❑
❑
❑
Are float controls operable?
❑
❑
❑.
Is SCADA telemetry available and operational?
-''
❑
❑
❑
Is audible and visual alarm available and operational?
M,
❑
❑
❑
Comment:
Bar Screens
Yes No NA NE
Type of bar screen
a.Manual.
.
b.Mechanical
❑
Are the bars adequately screening debris?
0
❑
❑
❑
Is the screen free of excessive debris?
0❑
❑
❑ .
Is disposal of screening in compliance?
M,
❑ '
❑
❑ . .
Is the unit in good condition? -
M'
❑
0
❑
Comment:
Page#
I
3

Permit: NCO069370
Owner - Facility: Pine Park Retirement Inn
Inspection Date: 09/24/2016
Inspection Type: Compliance Evaluation
Aeration Basins
Yes No NA NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
O
❑`
❑
❑
Are surface aerator's and mixers operational?
❑
,❑
❑
Are the diffusers operational?
0
❑
❑
❑
Is the foam the proper color for the treatment process?
N
❑
❑
❑
Does the foam cover less than 25% of the basin's surface?
0
❑
❑
❑ .
Is the DO level acceptable?
❑
❑
❑
Is the DO level`acceptable?(1.0 to 3.0 mg/1)
❑
❑
❑
M
Comment:
Secondary Clarifier
Yes No NA NE
Is the clarifier free of black and odorous wastewater?
S
❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
®
❑
Are weirs level?
N
. ❑
❑
❑
Is the site free of weir blockage?
0
❑
❑
❑
Is the site free of evidence of short-circuiting?
■
❑ .
❑
❑
Is scum removal adequate?
■
❑
❑
❑
Is -the site free of excessive floating sludge? -
■
" ❑
-❑
❑-- -
Is the drive unit operational?
❑
❑
!
❑.
Is the: return rate acceptable (low turbulence)?
N
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
E
❑
❑
❑
Is the sludge blanket level acceptable? .(Approximately Y4 of the sidewall depth)
❑
❑
❑
0
Comment:
Disinfection -Tablet
Yes No NA NE
Are tablet chlorinators operational?
0
❑
❑
❑
Are the tablets the proper -size and type?
■
❑
❑
❑
Number of tubes in use?
3
Is the level of chlorine residual acceptable?
❑
❑
❑-
Is the contact chamber free of growth, or sludge buildup?
0
❑
❑
❑
Is there chlorine residual prior to de -chlorination?
❑
❑
❑
Comment:
Page# 4

Permit: NC0069370 Owner- Facility:
Pine Park Retirement Inn
Inspection Date: 09/24/2015 Inspection Type:
Compliance Evaluation
De -chlorination
Yes No NA NE
Type of system ?
Tablet
Is the feed ratio proportional to chlorine amount (1 to 1)?
❑
❑
0
❑
Is storage appropriate for cylinders?
❑.
❑
M.
❑
# Is de=chlorination substance stored away from chlorine containers?
❑
❑
M
❑
Comment:
Are the tablets the proper size and type?
M
❑
❑
❑
Are tablet de -chlorinators operational?
0
❑
❑
❑
Number of tubes in use?
2
Comment:
Pump Station - Effluent
Yes No NA NE
Is the pump wetwell free of bypass lines or structures?
❑
❑
❑
Are all pumps present?
M
❑
❑
❑
Are all pumps operable?
M
❑
❑
❑
Are float controls operable?
M
❑
❑
❑
Is SCADA telemetry available and operational?
❑
❑
0.
❑ "
Is audible and visual alarm available and operational?
M
❑
❑
❑
_ Comment: - - --- -
Page# 5

_A4 7JfA
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Donald R. van der Vaart
July 16, 2015
Ms. Joy Hougan, Executive Director
Emeritus Corp DBA Pine Park
2601 U.S. Highway 64 East
Hendersonville, North Carolina 28792
Subject: NOTICE OF VIOLATION
NOV-2015-LV-0446
Permit No. NCO069370
Pine Park Retirement Inn.WWTP
Henderson County
Dear Ms. Hougan:
Secretary
A review of Pine Park Retirement Inn's WWTP monitoring report for May 2015 showed the
following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-
FC Broth,44.5C
05/19/2015
400.0 #/ 100ml
530.0 #/ 100ml
Daily Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct any problem. Since the
comments section on the reverse of the relevant DMR provided an adequate explanation for the subject
violation, it is not requested that a response be submitted.
The Division of Water Resources may pursue enforcement action for this and any additional violations
of State law. If you should have any questions, please do not hesitate to contact Janet Cantwell or me
at 828/296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations, NCDENR
Asheville Regional Office
c UVQYAsh ievtev t1 Files .
MSC 1617-Central Files -Basement
Trevor C. McMinn/ ORC
G:\WR\WO\Henderson\Wastewater%AinorslPine Park Inn 69370\N0V-2016-LV-0446.d0c
Water Quality Regional Operations — Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, North Carolina 28778
Phone: [phone] Fax: [phone]
Internet: http://portal.ncdenr.org/web/wq
An Equal Opportunity! Affirmative Action Employer

NCDENR,+
North Carolina Department of Environment and Natural Resources L E
Pat McCrory Donald R. van der Vaart
Governor Secretary
March 23, 2015
Ms. Joy Hougan, Executive Director -
Emeritus Corp. DBA Pine Park
2601 U S. Highway 64 East
Hendersonville, North Carolina 28792
Subject: NOTICE OF VIOLATION
NOV-2016-LV-0193
Permit No. NC0069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Ms. Hougan:
A review of Pine Park Retirement Inn's WWTP monitoring report for December 2014 showed the
following violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF,
M-FC Broth,44.5C
12/10/2014
400.00 #/ 100ml
600.00 #/ 100ml
Daily Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct any problem. Since the
comments section on the reverse of the relevant DMR provided an adequate explanation for the subject
violation, it is not requested that a response be submitted.
The Division of Water Resources may pursue enforcement action for this and any additional violations
of State law. If you should have any questions, please do not hesitate to contact Janet Cantwell or me
at 8281296-4500.
Sincerely,
G. Landon'Davidson, P.G., Regional Supervisor
Water Quality Regional Operations, NCDENR
Asheville Regional Office
cc: WQSAsheullle`Ftles ; :,
wmrMSC 1617 Central Files -Basement
Trevor McMinn/ ORC
G;\WR\WQ\Henderson\Wastewater\Minors\Pine Park Inn 69370WOV-2015-LV-0193.doc
Water Quality Regional Operations —Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, North Carolina 28778
.Phone: [phone] Fax: [phone]
Internet: http://portaLnedenr.org/web/wq
An Equal Opportunity/ Affirmative Action Employer

Axa,:.ca M,
.' DE L7,77,g
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ms. Joy Hougan, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Highway 64 East
Hendersonville, North Carolina 28792
Dear Ms. Hougan:
John E. Skvarla, III
Secretary
July 23, 2014
Subject: NOTICE OF !VIOLATION
NOV-2014-MV-0051
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
A review of Pine Park Retirement Inn's WWTP monitoring report for January 2014 showed the
following violation:
Parameter
Date
Measuring Frequency
Violation
Nitrogen, Ammonia Total
(as N) - Concentration
01/31/2014
2 X /month
Failure to Monitor
Remedial actions, if not already implemented, should be taken to correct any problem. Since the
comments section on the reverse of the relevant DMR provided an adequate explanation for the subject
violation, it is not requested that a response be submitted.
The Division of Water Resources may pursue enforcement action for this and any -additional violations
of State law. If you should have any questions, please do not hesitate to contact Janet Cantwell or me
at 828/296-4500.
Sincerely,
t
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations, NCDENR
Asheville Regional Office
cc: VrVQ Ash`euiI Files- FRF-"
MSC 1617-Central Files -Basement
Trevor McMinn/ ORC
G:;'VRWY0\Henderscnt4VasteviaterhlinorslPine Park Inn 69370MV-2014-MV-00.51.doc
Water Quality Regional Operations — Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, North Carolina 28778
Phone: [phone] FAX: [phone]
Internet: http://portal.ncdenr.org/web/wq
An Equal Opportunity/ Affirmative Action Employer

FEB 1 2011
Wormation Processing Unit
DWQIBOG
TREVC®
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Performance Annual Report 2010
Mr. Mark Lyons:
Trevco and Operator in Responsible Charge, Trevor McMinn (cert.#15084) are providing this report once
per year to keep you informed of the performance at this facility.
General information:
Facility System Name: Pine Park Retirement Home
Responsible Entity: Emeritas Corporation
Person in Charge: Mark Lyons
Applicable Permit: NPD)GS #WC0069370—_ i
Description of treatment process:
The 0.025 MGD extended aeration facility consists of an influent lift station, bar screen, flow recorder,
aeration basin, clarifier, effluent pump station, and an aerated sludge holding basin.
This facility is located at Pine Park Retirement Inn at 2601 US 64 East in Henderson County.
Performance:
This Facility had no violations in 2010.
Sludge Management:
This facility builds sludge rapidly, due to the highly loaded moderate influent flow (averages 15,000
gallons per day). As the need for sludge removal becomes apparent it will be wasted to the digester where it
will be stored and thickened for cost effective hauling. As the flow increases at this facility it may become
necessary to increase the frequency in hauling. Sludge removal will be by truck by Mike's Septic, {828-
253-2612} a local pump truck contractor. He will haul the sludge to disposal at the Town of Brevard or the
MSD waste treatment facility. All associated costs of this hauling will be paid by Pine Park Retirement Inn.
Removal and management of this sludge will be done in a timely manner and in the best interests of facility
operation and the environment.
Notification: This report will be delivered to Pine Park Retirement Inn to the attention of Mr. Mark
Lyons.
Conclusion: The Pine Park waste treatment facility is well designed for the existing flow and is a pleasure
to operate. Everyone involved at the Pine Park Retirement Inn should be commended for the care and
management of this facility and the environment.
Certification: I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify that this report has been made available to the users or customers of the named
system and that those users have been notified of its availability.
Operator in responsible charge: Date:1/31/11
Tre r� McMinn
wner, Trevco
D 9 11
F— 8 2011
FEB
s, FEa 0 4 2011
WATER QUALITY SECTION DEN�t-Vv:'.'
ASHEVILLE REGIONAL OFFIC OINT SOUR(,L i3RA
h
0

KI-CA
A7A.
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins �..3� - fDee%Fre'eman Ty.
Governor Director
June 13, 2011 .
Mr. Trevor McMinn
Emeritas Corp DBA Pine Park
2601 Chimney Rock Road
Hendersonville, North Carolina 28792
SUBJECT:
Dear Mr. McMinn:
--- -- - Secretary. r i
1
JUN 1 5 2011.
WATER Q IALITY SECTION I
Amu`l^_� I r Rom:, CivAL OFFICEl L_.-
Authorization to Construct
A to C No. .0693 70A01—
Emeritas/Pine Park
Pine Park Retirement Inn WWTP
Dechlorination Facilities
Henderson County
A fast track application for Authorization to Construct dechlorination facilities was
received on June 13, 2011, by the Division of Water Quality (Division). Authorization is hereby
granted for the construction of modifications to the existing Pine Park Retirement Inn WWTP,
with discharge of wastewater into Clear Creek in the French Broad River Basin.
This authorization results in no increase in design or permitted capacity and is awarded
for the construction of the following specific modifications:
Installation of a dechlorination system utilizing Sodium Sulfite pursuant to the
fast track application received on June 13, 2011, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
This Authorization to Construct is issued in accordance with Part III, Paragraph A of
NPDES Permit No. NCO069370 issued January 1, 2011, and shall be subject to revocation unless
the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No. NC00.69370.
In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those as may
be required by this Division, such as the construction of additional or replacement wastewater
treatment or disposal facilities.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 NorthCaTolina
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org ���u��"1/
An Equal Opportunity IAffirmativeAction Employer vv i/

Mr. Trevor McMinn
June 13, 2011
Page 2
— - - -- The Asheville Regional Office, telephone number-[phone] shall be notified at
least forty-eight (48) hours in advance of operation of the installed facilities so that an on site
inspection can be made. Such notification to the regional supervisor shall be made during the
normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding State
Holidays. ,
Upon completion of construction and prior to operation of these permitted facilities, the
attached Engineer's Certification form must be received from a professional engineer certifying
that the permitted facility has been installed in accordance with the NPDES Permit and this
Authorization to Construct. Mail the Certification to: Construction Grants & Loans,
DWQ/DENR, 1633 Mail Service Center, Raleigh, NC 27699-1633.
Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of the
wastewater treatment facilities. The operator must hold a certificate of the type and grade at least
equivalent to or greater than the classification assigned to the wastewater treatment facilities by
the Certification Commission.
The Permittee must also employ a certified back-up operator of the appropriate type and
grade to comply with the conditions of T15A:8G.0202. The ORC of the facility must visit each
Class I facility at least weekly and each Class II, III and IV facility at least daily, excluding
weekends and holidays, must properly manage the facility, must document daily operation and
maintenance of the facility, and must comply with all other conditions of T15A:8G.0202.
A copy of the approved plans and specifications shall be maintained on file by the
Permittee for the life of the facility.
During the construction of the proposed additions/modifications, the permittee shall
continue to properly maintain and operate the existing wastewater treatment facilities at all times,
and in such a manner, as necessary to comply with the effluent limits specified in the NPDES
Permit.
You are reminded that it is mandatory for the project to be constructed in accordance
with the North Carolina Sedimentation Pollution Control Act, and, when applicable, the North
Carolina Dam Safety Act. In addition, the specifications must clearly state what the contractor's
responsibilities shall be in complying with these Acts.
Prior to entering into any contract(s) for construction, the recipient must have obtained all
applicable permits from the State.
Failure to abide by the requirements contained in this Authorization to Construct may
subject the Permittee to an enforcement action by the Division in accordance with North
Carolina General Statute 143-215.6A to 143-215.6C.

Mr. Trevor McMinn
June 13, 2011
Page 3
_The issuance_ofthis Authorization -to Construct -does -not -preclude the _Permittee-from -.--
complying with any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.
If you have any questions or need additional information, please do not hesitate to contact
Seth Robertson, P.E. at telephone number [phone].
Sincerely,
Coleen H. Sullins
0111"
MM/sr
cc: Jon Laughter, Laughter Austin and Assoc., 131 Fourth Ave. East, Hendersonville,
NC 28792
Henderson County Health Department
Technical Assistance and Certification
Point Source Branch, NPDES Program
Michelle McKay, E.I.
ATC File

Emeritas Corp DBA Pine Park
A To C No. 069370A01
Issued June 13, 2011
Engineer's -Certification
I,
Installation of a dechlorination system utilizing Sodium Sulfite pursuant to the
fast track application received on June 13, 2011, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
I certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Signature
Date
Registration No.
Send to: Construction Grants & Loans
DENR/DWQ
1633 Mail Service Center
Raleigh, NC 27699-1633

I
Emeritas Corp DBA Pine Park
A To C No. 06937OA01
Issued June 13, 2011{
Engineer's Certification.;f��;�l�i,�f'
L�``� 4 �� as a duly registered Professional Engineer in
the State of North Carolina, having been authorized to observe (periodically/weeklylfull time)
the construction of the modifications and improvements to the Pine Park Retirement Inn W WTP,
located on Chimney Rock Road. in Henderson County for Ementas Corp DBA Pine Park, hereby
state that; to the best of my abilities, due care and diligence was used in the observation of the
following constriction:
Installation of a dechlorination system utilizing Sodium Sulfite pursuant to the
fast track application received on June 13, 2011, and in conformity with the
Minimum Design Criteria for Dechlorination Facilities.
i certify that the construction of the above referenced project was observed to be built
within substantial compliance and intent of the approved plans and specifications.
Signature ' � _ Registration N.. -�
Date_Oe> y 2 3ro. 2_ e) 1 1
Send to: Construction Grants & Loans
D04RMWQ
1633 Mail Service Center
Raleigh, NC 27699-1633
FEB 2 0 2013
DWQ/Surface Water Protection Section

AJ4
RCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Joy Hougan, Executive Director
Emeritus Corp / DBA Pine Park
2601 U S Highway 64 East
Hendersonville, North Carolina 28792
Dear Ms. Hougan:
Division of Water Quality
Charles Wakild, P.E.
Director
November 16, 2012
E-7,7 i L E copAY
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0584
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dee.Freeman
Secretary
A review of Pine Park Retirement Inn's monitoring report for August 2012 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
Broth,44.5C
08/07/2012
400 #/100ml
600 #/100ml
Daily Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct any problem. Since the
comments section on the reverse of the relevant DMR provided an adequate explanation for the subject
violation, it is not requested that a response be submitted.
The Division of Water Quality may pursue enforcement action for this and any additional violations of
State law. If you should have any questions, please do not hesitate to contact Janet Cantwell or me at
828/296-4500.
Sincerely,
Chuck Cranford, Regional Supervisor
Surface Water Protection Section
fQ sheviJl. Files
DWQ Central Files
Trevor McMinn/ ORC
S:\SWP\Henderson\Wastewater\Minors\Pine Park Inn 69370\NOV-2012-LV-0584.doc
Noi thCarolina
Aatura!!ff
North Carolina Division of Water Quality. 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone]
Internet: www.newaterguality.org FAX [phone]

Rlnu
A4 -
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Joy Hougan, Executive Director
Emeritus Corp / DBA Pine Park
2601 U S Highway 64 East
Hendersonville, North Carolina 28792
Division of Water Quality
Charles Wakild, P.E.
Director
November 16, 2012
Dee Freeman
Secretary
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0581
Permit No. NC006.9370
Pine Park Retirement Inn WWTP
Henderson County
Dear Ms. Hougan:
A review of Pine Park Retirement Inn's monitoring report for July 2012 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Coliform, Fecal MF, M-FC
Broth,44.5C
07/16/2012
400 #/100m1
600 #/100ml
Daily Maximum
Exceeded
Remedial actions, if not already implemented, should be taken to correct any problem. Since the
comments section on the reverse of the relevant DMR provided an adequate explanation for the subject
violation, it is not requested that a response be :submitted.
The Division of Water Quality may pursue enforcement action for this and any additional violations of
State law. If you should have any questions, please do not hesitate to contact Janet Cantwell or me at
828/296-4500.
Sincerely, `
ti
Chuck Cranford, Regional Supervisor
Surface Water Protection Section
Ash ev-,iale,Fi{es
DWQ Central Files
Trevor McMinn/ ORC
S:\SWP\Henderson\Wastewater\Minors\Pine Park Inn 69370\NOV-2012-LV-0581.doc No�rthCazolina
)Vatura!!y
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone]
Internet: www.ncwaterguality.org FAX [phone]

AS� FILE COPY
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue , Coleen H. Sullins Dee Freeman
Governor
Ms. Joy Hougan, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, North Carolina 28792
Dear Ms. Hougan:
Director
March 30, 2011
Subject: NOTICE OF VIOLATION
NOV-201 1 -MV-0076
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Secretary
A review of Pine Park Retirement Inn's WWTP monitoring report for January 2011 showed the following
violations:
Parameter -
Date
Measuring
Frequency
Violation
Flow, in conduit or thru treatment plant
01/01/2011
Continuous
Failure to Monitor
Flow, in conduit or thru treatment plant
01/02/2011
Continuous
Failure to Monitor
Flow, in conduit or thru treatment plant
01/22/2011
Continuous
Failure to Monitor
Flow, in conduit or thru treatment plant
01/23/2011
Continuous
Failure to Monitor
It was also noted that the Compliance box on the back of the DMR was marked "Compliant" when in fact it should
have been marked "Non -Compliant" with an explanation for the non-compliance. If the above parameter was left off
inadvertently, please send an amended DMR within 10 business days of receipt of this letter to Raleigh at the
address found on the front page of your DMK and also a copy to this office.
Remedial actions should be taken to correct this problem. The Division of Water Quality may pursue enforcement
action for this and any additional violations of State law. If you should have any questions, please do not hesitate to
contact Janet Cantwell at 828/296-4500.
Sincerely,
1
Roger C. Edwards, Regional Supervisor
Surface Water Protection Section
=" .I Files
DWQ Central Files
Trevor McMinn/ ORC
S:ISWPIHendersonlWastewaterlMinorslPine Park Inn 693701NOV-2011-MV-0076.doc
N
_.one Carolina
dvatura!!b
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone] Customer Service
Internet: www.ncwateroualitv.org FAX [phone]

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 15, 2010
Ms. Joy Hougan, Executive Director
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, North Carolina 28792
Subject: NOTICE OF VIOLATION
NOV-2010-MV-0122
Permit No. NCO069370
Pine Park Retirement Inn WWTP
Henderson County
Dear Ms. Hougan:
A review of Pine Park Retirement Inn's WWTP monitoring report for May 2010 showed the
following violation:
Parameter
Date
Measuring
Frequency
Violation
Total Suspended Solids
Week ending: 05/08/2010
Weekly
Failure to Monitor
It was also noted that the Compliance box on the back of the DMR was marked "Compliant" when in
fact it should have been marked "Non -Compliant" with an explanation for the non-compliance. If the above
parameter was left off inadvertently, please send an amended DMR to Raleigh at the address found on
the front page of your DMR.
Remedial actions should be taken to, correct this problem. The Division of Water Quality may pursue
enforcement action for this and any additional violations of State law. If you should have any questions,
please do not hesitate to contact Janet Cantwell at 8281296-4500.
Sincerely,
�Z_
Roger C. Edwards, Regional Supervisor
Surface Water Protection Section
cc: tgfilmo AT evi I'e�F'il'es
DWQ Central Files
Trevor McMinn/ ORC
S:1SWP1Henderson\WastewaterlMinors%Pine Park Inn 693701NOV-2010-MV-0122.doc
NcorthCarolina
Aatwra!!y
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone] Customer Service
Internet: www.ncwateroualitv.org FAX [phone]

r � n. \VI
�. C C, a Y
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
SURFACE WATER PROTECTION SECTION
September 14, 2010
Mr. Ed Gaven,
Executive Director
Emeritus Corporation
2601 US Hwy 64 E
Hendersonville, NC 28792
SUBJECT: Compliance Evaluation Inspection
Pine Park Retirement Inn
Permit No: NCO069370
Henderson County
Dear Mr. Gaven:
Enclosed please find a copy of the Compliance Evaluation Inspection report from the
inspection conducted on August 27, 2010. The facility was found to be in compliance with permit
NC0069370.
Please refer to the enclosed inspection report for additional observations and comments.
If you or your staff should have any questions, please call me at 828-296-4662.
Sincerely,
ra"'rL
Ind ��
Wanda P. Frazier
Enclosure Environmental Specialist
cc: Trevor McMinn, ORC
Central Files
Asp, esilfe0i100
S:\SWP\Henderson\Wastewater\Minors\Pine Park Inn 69370\CE1.8-27-10.doc
SURFACE WATER PROTECTION —ASHEVILLE REGIONAL OFFICE One
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778 oo hCarolina
Phone: [phone] FAX: [phone] \ Customer Service: 1-877-623-6748 Q'tul+Q'li>/
Internet: www.ncwaterguality.org
k^

United States Environmental Protection Agency
Form Approved.
EPA IWashington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 11 NCO069370 111 121 10/08/27 117 181 CI 19I SI 20III
Remarks
21111111111111111111111111 III I I II I IIII I III 11111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA Reserved------
67I 1.0 169 70131 711 I 72I N I 73 LJJ 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:25 AM 10/08/27
05/12/01
Pine Park Retirement Inn
Exit Time/Date
Permit Expiration Date
2601 U S Hwy 64 E
Hendersonville NC 28792
11:15 AM 10/08/27
10/11/30
Name(s) of Onsite Representative(s)ITitles(s)/Phone and Fax Number(s)
Other Facility Data
Trevor Clyde McMinn/ORC/828-691-7191/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joy Hougan,2601 U S Hwy 64 E Hendersonville NC 28792//828-692-1911/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenance 0 Records/Reports Facility Site Review
Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Wanda P Frazier ARo WQ//828-296-4500 Ext.4662/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
9LUX-01
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO069370 I11 12I 10/08/27 117 18ICI
(cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
FACILITY DESCRIPTION:
The Emeritus Corporation — Pine Park Retirement Inn WWTP is a class II facility rated as a 0.025
MGD (0.035 MGD after EAA & A to C) metal Clow 0 extended aeration package plant consisting of:
influent lift station with duplex pumps, dual high water alarms and telemetry; manual bar
screen; 25,000 gallon aeration basin with dual blowers providing diffused air; 98 sq ft
rectangular clarifier with 6 ft weir, skimmer & sludge returns; 1700 gallon aerobic digestor;
tablet chlorinator (not used — not required to chlorinate); 576 gallon chlorine contact chamber;
(no tablet dechlorinator); 30 degree V-notch weir; Stevens 61 R flow meter with strip recorder
and totalizer; and effluent pump station.
Note: The effluent outfall pipe is submerged in the middle of the creek, therefore, sampling is not
possible there.
There are NO requirements to chlorinate (IWC = < 0.4%), but there is a low level (28 ug/1) total
residual chlorine (TRC) limit and twice a week TRC monitoring requirements in the current
permit.
It has been requrested that the total residual chlorine (TRC) limit and monitoring requirements,
be removed from the permit.
There is no effluent fecal coliform limit. There are weekly effluent, upstream and downstream
fecal coliform monitoring requirements.
It has been requested that the weekly effluent, upstream and downstream fecal coliform
monitoring requirements be removed from the permit.
Annual Average Flow: 0.012 MGD (2007-2010 — 3 year average).
Collection System: There is one building, therefore < 12 connections.
Development: Consists of a retirement inn which serves 120 residents in apartments and assisted
living facilities.
Grease interceptor: The grease trap is pumped every other month.
Sludge Management: Commercial hauler (Mike's Septic Service @ 828-253-2612) to the City of
Brevard's WWTP and MSD's WWTP.
PERMIT / INSPECTION / LOG:
A review of the files indicates that the last compliance evaluation inspection was conducted on
3-11-2009 by Janet Cantwell.
The permit expires on 11-30-2010. Your request for permit renewal was received by the Division
on 5-12-10.
Page # 2

Permit: NCO069370
Inspection Date: 08/27/2010
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
The daily operator log was present on -site and had good notation of daily events, process
control and field testing data.
TREATMENT UNITS / PROCESS CONTROL TESTING DATA:
The activated sludge aeration basin process control data was as follows:
Temperature = 24.9 degrees Celsius
pH = 6.0 units
Dissolved Oxygen = 1.64 mg/1
Settleable Solids = 650 ml/I = 65%
EFFLUENT:
The effluent data was as follows:
Dissolved Oxygen = 6.0 mg/I
pH = 6.2 units
Temperature = 24.2 degrees Celsius
Chlorine = < 10 ug/I
FLOW MEASUREMENT:
The flow meter was last calibrated in August 2010 by John Lassiter.
OPERATIONS AND MAINTENANCE / EFFLUENT / SUMMARY:
Mr. Trevor McMinn, ORC, assisted in the inspection and appears to be operating and maintaining
the facility very well.
The effluent was clear and appeared to be in compliance with permit limits.
SYSTEM PERFORMANCE ANNUAL REPORT:
The 2009 System Performance Annual Report was received by the Division on 2-23-2010.
Page # 3

Permit: NCO069370
Inspection Date: 08/27/2010
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Permit Yes NO NA N
(If the present permit expires in 6 months or less). Has the permittee submitted a new application? ■ ❑ n n
Is the facility as described in the permit? ■ n ❑ n
# Are there any special conditions for the permit?
n
■
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector granted access to all areas for inspection?
■
n
n
n
Comment:
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
■
n
n
n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable
Solids, pH, DO, Sludge ■
n
n
n
Judge, and other that are applicable?
Comment:
Pump Station - Influent
Yes
No
NA
NE
Is the pump wet well free of bypass lines or structures?
■
n
n
n
Is the wet well free of excessive grease?
■
0011
Are all pumps present?
■
n
n
n
Are all pumps operable?
■
n
n
n
Are float controls operable?
■
n
n
n
Is SCADA telemetry available and operational?
■
n
n
Cl
Is audible and visual alarm available and operational?
■
n
n
n
Comment:
Bar Screens
Yes
No
NA
NE
Type of bar screen
a.Manual
■
b.Mechanical
Are the bars adequately screening debris?
■
n
n
n
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
n
n
n
Is the unit in good condition?
■
n
n
n
Comment:
Aeration Basins
Yes
No
NA
NE
Page # 4

Permit: NCO069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 08/27/2010 Inspection Type: Compliance Evaluation
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
n
n
Are surface aerators and mixers operational?
❑
❑
■
❑
Are the diffusers operational?
■
n
n
n
Is the foam the proper color for the treatment process?
■
n
n
n
Does the foam cover less than 25% of the basin's surface?
■
n
n
n
Is the DO level acceptable?
■
n
n
n
Is the DO level acceptable?(1.0 to 3.0 mg/1)
■
n
n
n
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
n
n
Cl
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
■
Are weirs level?
■
n
n
n
Is the site free of weir blockage?
■
CI
n
n
Is the site free of evidence of short-circuiting?
■
n
n
n
Is scum removal adequate?
■
n
n
n
Is the site free of excessive floating sludge?
■
n
n
n
Is the drive unit operational?
n
n
■
n
Is the return rate acceptable (low turbulence)?
■
n
n
n
Is the overflow clear of excessive solids/pin floc?
■
n
n
n
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
■
n
n
n
Comment:
Pump Station - Effluent
Yes
No
NA
NE
Is the pump wet well free of bypass lines or structures?
■
n
n
n
Are all pumps present?
■
0
Are all pumps operable?
■
n
n
n
Are float controls operable?
■
n
Cl
n
Is SCADA telemetry available and operational?
■
n
n
n
Page # 5

Permit: NC0069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 08/27/2010 Inspection Type: Compliance Evaluation
Pump Station.- Effluent Yes No NA NE
Is audible and visual alarm available and operational? ■ ❑ ❑ ❑
Comment:
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
Page # 6

T E V V V
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Fax[phone]
Performance Annual Report 2009
U_ L' y L �`
� I L� L� II v .
ID
i ° FES 2 5 2010
WATER QUALITY SECTION
ASHEVILLE REGIONAL O=FICE
Mr. Mark Lyons:
Trevco and Operator in Responsible Charge, Trevor McMinn (cert.#15084) are providing this report once
per year to keep you informed of the performance at this facility.
General information:
Facility System Name: Pine Park Retirement Home
Responsible Entity: Emeritas Corporation
Person in Charge: Mark Lyons
Applicable Permit: NPDE #, N 000 '
Description of treatment process:
The 0.025 MGD extended aeration facility consists of an influent lift station, bar screen, flow recorder,
aeration basin, clarifier, effluent pump station, and an aerated sludge holding basin.
This facility is located at Pine Park Retirement Inn at 2601 US 64 East in Henderson County.
Performance:
This Facility had no violations in 2009.
Sludge Management:
This facility builds sludge rapidly, due to the highly loaded moderate influent flow (averages 11,000
gallons per day). As the need for sludge removal becomes apparent it will be wasted to the digester where it
will be stored and thickened for cost effective hauling. As the flow increases at this facility it may become
necessary to increase the frequency in hauling. Sludge removal will be by truck by Mike's Septic, 1828-
253-2612) a local pump truck contractor. He will haul the sludge to disposal at the Town of Brevard or the
MSD waste treatment facility. All associated costs of this hauling will be paid by Pine Park Retirement Inn.
Removal and management of this sludge will be done in a timely manner and in the best interests of facility
operation and the environment. 6 loads of sludge have been removed in 2009.
Notification: This report will be delivered to Pine Park Retirement Inn to the attention of Mr. Mark
Lyons.
Conclusion: The Pine Park waste treatment facility is well designed for the existing flow and is a
to operate. Everyone involved at the Pine Park Retirement Inn should be commen ® Y�
management of this facility and the environment.
FEB 2 3 2010

Cer if entione I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify that this report has been made available to the users or customers of the named
system and that those users have been notified of its availability.
Operator in responsible charge: Date:2/17/10
Trevor C. McMinn
J
Owner, Trevco

r-
4 ED FlU COPY
P
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
March 13, 2009
Ms. Joy Houogan
Emeritus Corp. DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, North Carolina 28792
SUBJECT: Compliance Sampling Inspection
Pine Park Retirement Inn WWTP
Status: Compliant
Permit No: NCO069370
Henderson County
Dear Ms. Houogan:
Enclosed please find a copy of the Compliance Sampling Inspection form from the
inspection conducted on March 11, 2009. The facility appeared to be in compliance with
permit NC0069370. The kind assistance of Trevor. McMinn/ORC, Mark Lyons and Keith
Young was appreciated. Mr. McMinn is doing a fine job of operating this facility.
Effluent samples were collected during the inspection and have been submitted to
the lab for analysis. Results will be sent separately.
Please refer to the enclosed inspection report for additional observations and
comments. If you or your staff have any questions, please call me at 828-296-4500, Ext.
4667.
Sincerely,
net Cantwell
Environmental Specialist
Enclosure
�c DUVC A-h uille.�Fi,l. s
DWQ Central Files
Trevor McMinn/ ORC w/ attachment
G:\WPDATA\DEMWQ\Henderson\69370 Emeritus Corp\69370-CS1.09.doc
SURFACE WATER PROTECTION — ASHEVILLE REGIONAL OFFICE
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778 One
Phone: [phone]\FAX: [phone]\Customer Service: 1-877-623-6748 NorthCarollii�na
Internet: www.ncwaterguality.org Natumll/

United States Environmental Protection Agency
Form Approved.
E P n Washington, D.C. 20460
i�
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 11 NC0069370 Ill 121 09/03/11 117 181 sI 191 gI 201 I
Remarks
Ill 111111111111111111111IIIIIIIIIIIIIIIIIIIIIII116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA --------------------------- Reserved ----------------------
67I 169 701 I 711 I 72I NI 73I I 174 751 I I I I I I 180
ICI
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
11:40 AM 09/03/11
05/12/01
Pine Park Retirement Inn
Exit Time/Date
Permit Expiration Date
2601 U S Hwy 64 E
Hendersonville NC 28792
12:30 PM 09/03/11
10/11/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Trevor. Clyde McMinn/ORC/828-654-7062/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joy Houogan,2601 U S Hwy 64 E Hendersonville NC 28792//828-692-1911/No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ME Flow Measurement Operations & Maintenance [2 Records/Reports
Self -Monitoring Program M Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Janet Cantwell ARO WQ//828-296-4500 Ext.4667/'
Signature of gem t Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type (cont. ) 1
3I NCO069370 I11 12I 09'/03/11 117 18I S
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Trevor McMinn/ORC, and Mark Lyons and Keith Young, both of Emeritus, assisted.in the inspection of this
facility.
The permit will expire November 30, 2010. Please request a permit renewal 180 days prior to expiration.
The operator stated that two new blowers in the aeration basin have been installed and the plant will be
painted this month.
Audible and visual alarms for the pump station were tested during the inspection and were operable.
The flowmeter was calibrated August 7, 2008.
Trimming shrubbery inside and around the fence was discussed.
The logbook was present on site.
The effluent was clear.
Effluent samples were collected during the inspection and have been submitted to the lab. Results will be
sent separately.
Page # 2

Permit: NCO069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 03/11/2009 Inspection Type: Compliance Sampling
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
n
®
n
Is the facility as described in the permit?
t
❑
n
❑
# Are there any special conditions for the permit?
0000
Is access to the plant site restricted to the general public?
00011
Is the inspector granted access to all areas for inspection? ❑ ❑ ❑
Comment: The permit will expire November 30, 2010. Please request a permit
renewal 180 days prior to expiration.
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ® n n n
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ®❑ ❑ ❑
Judge, and other that are applicable?
Comment: The operator stated that two new blowers for the aeration basin have been
installed and the plant will be painted this month.
Record Keeping
Yes
No
NA N
Are records kept and maintained as required by the permit?
®❑
❑ ❑
Is all required information readily available, complete and current?
®
n
n ❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
n
n Ig
Is the chain -of -custody complete?
n
n
n
Dates, times and location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
®❑
❑ ❑
Has the facility submitted its annual compliance report to users and DWQ?
®
n
n ❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
❑
iD ❑
Is the ORC visitation log available and current?
®❑
❑ ❑
Is the ORC certified at grade equal to or higher than the facility classification?
®
n
n n
Is the backup operator certified at one grade less or greater than the facility classification?
®
n
n n
Page # 3

Permit: NCO069370
Inspection Date: 03/11/2009
Record Keeping
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Comment: A copy of the permit will be sent to Trevco.
Logbook and Annual Report were available on site.
Aeration Basins
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Sampling
Mode of operation
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational?
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin's surface?
Is the DO level acceptable?
Is the DO level acceptable?(1.0 to 3.0 mg/1)
Comment: Operator stated that two new blowers have been installed.
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately'/4 of the sidewall depth)
Comment:
Flow Measurement - Effluent
# Is flow meter used for reporting?
Yes No NA NE
nnn
®0.nn
Ext. Air
Fixed
®nnn
nn®n
n n n
®nnn
® n n n
n n n m
nnn®
®nnn
nn®n
® n n n
n n n
® n n n
® n n n
®nnn
nnImn
® n n n
® n n n
nnn®
Yes No NA NE
® n n n
Page # 4

0
Permit: NCO069370
Inspection Date: 03/11/2009
Flow Measurement - Effluent
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Sampling
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: The flowmeter was calibrated August 7, 2008.
Pump Station - Effluent
Is the pump wet well free of bypass lines or structures?
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Is SCADA telemetry available and operational?
Is audible and visual alarm available and operational?
Comment: Audible and visual alarms were tested during the inspection and were
operable.
Yes No NA NE
�nnn
�000
®nnn
Yes No NA NE
mnnn
In❑❑❑
IM ❑ ❑ ❑
M❑❑❑
❑nl3n
Page # 5

N (DZV La6oratoaSection Wesufts
County:
HENDERSON
Sample ID:
AB41821
River Basin
FRB
� bVA � �
�'Qq
PO Number#
ARO
Report To
AROSP
t0� QG
Date Received:
03/11/2009
Collector:
J CANTWELL
a y
Time Received:
16:00
Region:
ARO
v r
Labworks Lo inlD
g
KJIMISON
Sample Matrix:
Wastewater
Date Reported:
5/8/09
Loc. Type:
EFFLUENT
Report Generated:
05/08/2009
Emergency Yes/No
COC Yes/No
VisitlD
Loc. Desc_t , P7NE P.'- K WWTP
Location ID:
NCO069370
Collect Date: 0311112009 Collect Time:: 12:15
Sample Depth
Sample Qualifiers and Comments
WASM
€ EPORT
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A -Value reported is the average of two or more determinations
B1-Countable membranes with <20 colonies; Estimated
B2- Counts from all filters were zero.
B3- Countable membranes with more than 60 or 80 colonies; Estimated
84-Filters have counts of both >60 or 80 and < 20; Estimated
B5-Tao many colonies were present; too numerous to count (TNTC)
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
N1-The component has been tentatively identified based on mass spectral library search and has an estimated value
ARO
N3-Estimated concentration is < PQL and >MDL
NE -No established PQL
P-Elevated PQL due to matrix interference and/or sample dilution
Q1-Holding time exceeded prior to receipt at lab.
Q2- Holding time exceeded following receipt by lab
r Y-..
PQL- Practical Quantifati6VLimit-sutijpci ji3,nfiange due,to instrmuent sensitivity;:
U- Samples analyzed for this compound but not detected ~
X1- Sample not analyzed for ound___
I�
MAY 2 7 2009
WATER QUALITY SECTION
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] ILLE a & 'JL OFFICE

NC DWQQ La6oratory Section Results Sample ID A641821
Location ID� NC0069370 Collect Date: 03/11/2009
Luc. Descr.: PINE PARK WWTP Collect Time:: 12:15
Visit ID
CAS # Analyte Name
PQL Result Qualifier Units
Analyst/Date
Approved By /Date
Sample temperature at receipt by lab
2.6 °C
KJIMISON
SMATHIS
Method Reference
3111109
3/12/09
BOD, 5-Day In liquid
2.0 7.8 mg/L
KJIMISON
CGREEN
Method Reference APHA5210B
3/12109
3/23/09
Residue —Suspended In liquid
6.2 10 mg/L
KJIMISON
CGREEN
Method Reference APHA2540D-20th
3/13109
3/23/09
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

DIVISION OF WATER QUALITY WATER QUALITY FIELD -LAB FORM (DM1)
PRIORITY SAMPLETYPE
' couNTY 0
RIVER BASIN 7/�. ❑ g1ABIENT ❑ STREAM FFLUENT
REPORT TOOFRO MRO RRO WaRO WiRO WSRO TS
AT BM &O,MPLIANCE ❑ LAKE ❑ INFLUENT
Other
Shipped by: Bus. Courier, StaIL Other ❑ EMERGENCY ❑ ESR(S)• (j . ��'�'_ Al f'�,�/��
Estimated BOD Range: 0-5/5-25125-65!40-130 or 100 plus STATION LOCATION.• "" � `^'� Ci�//8'� r T
Seed: Yes❑ No❑ Chlorinated, Yes❑ NOD
REMARKS:
Station r11 Date Begin (yyhnm!dd) Time Begin Date End Time End Depth DM DB DBM
I
BODS 310 mg/L
2
COD High 340 mg/L
Low 335 mgL
orm: MF Fecal 31616 !100ml
onm.NIFTotal31504 iloomi
orm: Tube Fecal 31615 +100ml
;o,
fonn: Fecal Sucp 31673-:100ml
due: Total 500 mg/L
Volatile 505 mg!L
Fixed 510 me IL
due: Suspended 530 ntBL
Volatile 535 mgiL
13
Fixed 540 mg/L
14
PH 403 units
15
16
17
18
19
20
Acidity to pH 45 436 mg, L
Acidity to PH 8.3 435 mgR-
.Alkalinity to pH 8.3 415 mg/L
Alkalinity to pH 4.5 410 me/L
TOC 680 mg/L
Turbidity 76 Nrru
Chloride 940 mg/L
j
Chl a 70953 µ L
I
'
Color: True 80 Pt-00
Color.(pH ) 83 ADMI
Color.pH 7.6 82 ADMI
Cyanid. 720 mg1L
Fluoride 951 mg/L
Formaldehyde 71880 . mg/L
Grease and Oils 556 mg/L
Hardness Total 900 mgtL
Specific Cond. 95
MB.4S 38260 m91
Phenols 32730 pg!L
Sulfate 945 mgiL
Sulfide 745 mg/L
Lab Number:
qt g
Date Received:
Time: (. 60
Rec'd by:
DATA, ENTRY BY:
From: Bus -Courier -Hand Del.
CK:
DATE REPORTED:
/ 3-7 C
A H L I T S B
610 mg/L
625 mg/L
N0.3 asN 630 m&R
E
P 665 mg/L
665 mgiL
P- Dissolved as P 666 mg/L
Cdd:adntiunt 1027 uvL
Cr-Chrotmunt.Total 1034 µg/L
Cu-Copper 1042 P&IL
Ni mckel 1067 µ8/L
Pb-Lead 1051 µg!L
Zn-Zinc 1092 µ8/L
A. -Silver 1077 µt:/L
Al -Aluminum 1105 µgiL
Be -Beryllium 1012 µ8/L
Ca -Calcium 916 mg/L
Co-Cobalt1037 µg/L
Fe -iron 1045 lig/L
ianiple Type
C G GNXX
Sampling Point %
Conductance at 25°C I
Water Temperature °C
D.O. mall
PH
Alkaliniry
Acidity
Air Temperature 'C
H83 pH4.5
H4.5 PH8.3
4
0
300
400
82244 431
32243 82242
20
2
Salinity 9(,a
Precipitation (in/day)
Cloud Cover %
Wind Direction (Deg)
Turbidity Severity
Stream Flmv SeverityT1310
Wind Velocity Mean Stream Depth fl.
Stream Width ft.
80
5
2
6
1351
35 64
4

County: HENDERSON
F
River Basin FRB
Report To AROSP
Collector: J CANTWELL
Region: ARO
Sample Matrix: Wastewater
Loc. Type: EFFLUENT
Emergency Yes/No
COC Yes/No
wArFR¢�
f � y
1E C`I�
APR 1 3 2009
1 VisitlD
WATER QUALITY" SECTION
ASHEVILLE R=:GIONAL OFFICE Loc. Descr.: PINE PARK 69370
Sample ID:
PO Number #
Date Received:
Time Received:
Labworks LoginlD
Date Reported:
Report Generated:
11 Location ID: PINEPARK60370 I Collect Date: 03/11/2009 I Collect Time:: 12:15 1 Sample Depth
Sample Qualifiers and Comments
AB41938
9W1936
03/18/2009
08:15
SMATHIS
4/1 /09
04/01 /2009
'� � _-� In 9 -
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwglab.org under Staff Access
A -Value reported is the average of two or more determinations
N3-Estimated concentration is < PQL and >MDL
B1-Countable membranes with <20 colonies; Estimated NE -No established PQL
62- Counts from all filters were zero.
B3- Countable membranes with more than 60 or 80 colonies; Estimated P-Elevated PQL due to matrix interference and/or sample dilution
Q1-Holding time exceeded prior to receipt at lab.
1134-Filters have counts of both >60 or 80 and < 20; Estimated
Q2- Holding time exceeded following receipt by lab
B5-Too many colonies were present; too numerous to count (TNTC)
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated PQL- Practical Quantitation Limit -subject to change due to instrument sensitivity
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated U- Samples analyzed for this compound but not detected
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
X1-Sample not analyzed for this compound
NI -The component has been tentatively identified based on mass spectral library search and has an estimated value
I AR
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 1 of 2

Sample ID AB41938
ANC 1DWQ Laboratory Section Results
Location ID: PINEPARK69370 Collect Date: 03/11/2009
Loc. jrscr.: PINE PARK 69370 Collect Time:: 12:16
Visit ID
AS # Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
LAB
Sample temperature at receipt by lab 0.9 °C DSAUNDERS SMATHIS
Method Reference 3118/09 3/18/09
NUT
NH3 as N in liquid 0.02 0.33 mg/L as N MAJAYI CGREEN
Method Reference LaclO-107-06-1-J 3/18/09 4/1/09
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

'DIVISION OF WATER QUALITY
WATER QUALITY FIELD -LAB FORM (DMI)
rn
PRIORITY
SAMPLE TYPE
!!
COUNTY
RIVER BASIN ���
❑ AMBIENT
❑ STREAM
FFLUENT
REPORT T0�91`RO I\IRO RRO WaRO WiRO WSRO TS
ATBM
COMPLIANCE
❑ LAKE
❑ INFLUENT
Other
Shipped by: Bus, Courier, Staff, Other
❑ EMERGENCY
❑ ESTUARY
, /
COLLECTOR(S): �
Estimated BOD Range: 0-5/5-25/25-65/40-130 or 100 pluus�L....�
STATION LOCATION:
Seed: Yes ❑ No ❑ Chlorinated: Yes ❑ No ❑
4
Fnr Tah TTc nNLY 1 VV q
C l
Lab Number:P
Date Receive
Time:
Rec'd b :
DATA ENTRY BY:
From: Bus ourier- and Del.
CK:
DATE REPORTED:
/Date Begin (Sy/tmn/dd) Time Begin Date End Time End Depth DM DB DBM Value Type Composite Sample Type
A H L T S B C G GNXX
1
BOD5 310 mg/L
2
COD High 340 mg/L
3
COD Low 335 mg[L
4
Coliform: MF Fecal 31616 /IOOtnI
5
Colifonn: MF Total 31504 /1001111
6
Colifomr: Tube Fecal 31615 /100ml
7
Colifonn: Fecal Strep 31673 /100mI
8
Residue: Total 500 mg/L
9
Volatile 505 mg/L
10
Fixed 510 mg/L
II
Residue: Suspended 530 mg/L
12
Volatile 535 mg/L
13
Fixed 540 mg/L
14
pH 403 units
15
Acidity to pH 45 436 mg/L
16
Acidity to pH 8.3 435 mg/L
17
Alkalinity to pH 8.3 415 mg/L
18
Alkalinity to pH 4.5 410 mg/L
19
TOC 680 mg/L
20
Turbidity 76 NTU
Chloride 940 mg/L
Chi a 70953 µg/L
Color: True 80 Pt -Co
Color:(pH ) 83 ADMI
Color:pH 7.6 82 ADM]
Cyanide 720 mg/L
Fluoride 951 mg/L
Formaldehyde 71880 mg/L
Grease and Oils 556 mg/L
Hardness Total 900 mg/L
Specific Cond. 95
MBAS 38260 mg/L
Phenols 32730 µg/L
Sulfate 945 mg/L
Sulfide 745 mg/L
NH3 as N 610 mg/L
TKN as N 625 mg/L
NO2 plus NO3 as N 630 mg/L
P: Total as P 665 mg/L
PO4 as P 665 mg/L
P: Dissolved as P 666 mg/L
Cd-Cadmium 1027 µg/L
Cr-Chromium Total 1034 µg/L
Cu-Copper 1042 lig/L
Ni-Nickel 1067 µg/L
Pb-Lead 1051 µg/L
Zn-Zinc 1092 µg/L
Ag-Silver 1077 µg/L
Al -Aluminum 1105 µg/L
Be -Beryllium 1012 µg/L
Ca -Calcium 916 mg/L
Co -Cobalt 1037 µg/L
Fe -Iron 1045 µg/L
Li -Lithium 1132 µg/L
Ma Magnesium 927 mg/L
Mn-Manganese 1055 µg/L
Na-Sodium 929 mg/L
Arsenic:Total 1002 µg/L
Se -Selenium 1147 µg/L
Hg-Mercury 71900 µg/L
Organochlorine Pesticides
Organophosphorus Pesticides
Acid Herbicides
Base/Neutral Extractable Organics
Acid Extractable Organics
Purgeabte Organics (VOA bottle req'd)
Phytoplankton
Lab Use Only
Temperature on arrival: n
Sampling Point %
Conductance at 25°C
Water Temperature 'C
D.O. mg/L
pH
Alkalinity
Acidity
Air Temperature 'C
pH 8.3 pH4.5
pH4.5 pH 8.3
2
94
0
300
400
82244 431
2243 82242
20
Salinity %e
Precipitation (in/day)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity
Mean Stream Depth ft.
Stream Width ft.
80
5
2
6
1351
1350
35
64
4

I
County: HENDERSON
Sample ID:
�)ArQQ�
River Basin FRB
d
PO Number #
Report To AROSP
Date Received:
cp
, rp—
Time Received:
Collector: J CANTWELL
Q
Labworks LoginlD
Region: ARO
Date Reported:
Sample Matrix: WASTEWATER
Loc. Type: EFFLUENT
Report Generated:
Emergency Yes/No
COC Yes/No
VisitlD
Loc. Descr.: PINE PARK WWTP
Location ID: NCO069370
Collect Date: 03111/2009
1 Collect Time:: 12:15
Sample Depth
Sample Qualifiers and Comments
AB41821
ARO
03/11/2009
15:00
KJIMISON
3/23/09
03/23/2009
3 1a 5 69
Routine Qualifiers
For a more detailed description of these qualifier codes refer to www.dwqlab.org under Staff Access
A -Value reported is the average of two or more determinations
N3-Estimated concentration is < PQL and >MDL
B1-Countable membranes with <20 colonies; Estimated
NE -No established PQL
B2- Counts from all filters were zero.
P-Elevated PQL due to matrix interference and/or sample dilution
83- Countable membranes with more than 60 or 80 colonies; Estimated
Q1-Holding time exceeded prior to receipt at lab.
B4-Filters have counts of both >60 or 80 and < 20; Estimated
Q2- Holding time exceeded following receipt by lab
B5-Too many colonies were present; too numerous to count (TNTC)
PQL- Practical Quantitation.LiOyiiysubjecttolchange due tainstrumentsensmbvity,.,,,.��.,;
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated �.ise , :f
J3-The sample matrix interfered with the ability to make any accurate determination; Estimated U- Samples analyzed for this compoun2Cut not de#ecfecr
X1- Sample not analyzed for this compound
J6-The lab analysis was from an unpreserved or improperly chemically preserved sample; Estimated
NI -The component has been tentatively identified based on mass spectral library search and has an estimated value ¢ F E C E V E F ?.
� II „ II `j j
ARO
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
MAR 3 1 2009
ASH EVILr'C- AMTIONAL OFFICE

XC IDWQ Laboratory Section Results Sample ID AB41821
Location ID:' NCO069370 Collect Date: 03111/2009
Loc. Descr.: PINE PARK WWTP Collect Time:: 12:15
Visit ID
CAS # Analyte Name PQL Result Qualifier Units Analyst/Date Approved By (Date
Method Reference
3/11/09
3/12/09
BOD, 5-Day In liquid 2.0 7:8
mg/L KJIMISON
CGREEN
Method Reference APHA5210B
3/12109
3/23/09
Residue_Suspended In liquid 6.2 10
mg/L KJIMISON
CGREEN
Method Reference APHA2540D-20th
3/13/09
3/23109
Laboratory Section 1623 Mall Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

0
DIVISION/OF WATER QUALITY WATER QUALITY FIELD -LAB FORM (DM1)
L/dam PRIORITY SAMPLETYPE
COUNTY
RIVER BASIN ��• ❑ AMBIENT ❑ STREAM FFLUENT 0
REPORT TO RO MRO PRO WiiRO WiRO WSRO TS
AT BM PCOMPL[ANCE ❑ LAKE ❑ INFLUENT
Other
Shipped by: Bus, Courier. Sttaaf� OOther ❑EMERGENCY ❑ ESTUA Y,
COLLECTOR(S'): [,f '_
Estimated HOD Range: 0-5/5-25/25-65!40-130 or 100 plus STATIONLOCATION.
Seed: Yes❑No❑ Chlorinated• Yes❑No❑
' REMARKS:
Station 4 4f Date Begin (yylninu'dd) Time Begin Date End Time End Depth DM DS DB\
1
BOD531(1 mg/L
2
1
COD High 340 mg/L
3
COD Low 335 mg/L
4
Coliform: MF Fecal 31616 1100ml
5
Colifonn.NIFTotal31504 !IOOmI
6
Coliform: Tube Fecal :31615 'loom[.
7
Coliform: Fecal Strep . 1673 1100ml
8
Residue: Total 500 mg!L
9
Volatile 505 m,-!L
10
Fixed 510 matL
I 1
Residue: Suspended 530 mg!L
12
Volatile 535 mgiL
13
Fixed 540 mg/L
14
pH 403 units
15
Acidity to pH 4.5 436 nig,'L
16
Acidity to pH 8.3 435 mg/L
17
Alkalinity to pH 8.3 415 mg/L
18
Alkalinity to pH 4.5 410 me/L
19
TOC 680 mg1L
20
Turbidity 76 NI t
Chloride 940 mg/L
Chl a 70953 µg/L
I
I
Color: True 80 Pt -Co
C'olor:(pH ) 83 ADMI
Color:pH 7.6 82 ADMI
Cyanide 720 me/L
Fluoride 951 mg/L
Fonualdehyde 71880 mg/L
Crease and Oils 556 mg/L
Hardness Total 900 mgjL
Specific Cond. 95
MBAS 38260 mg/L
Phenols 32730 µg!L
Sulfate 945 tngiL
Sulfide 745 mg/L
Fnr t a1' r Tc CWT V
Lab Number:
qt !i
Date Received: It
09 Time: l _ 60
Rec'd by:
DATA ENTRY BY:
From: Bus -Courier -Hand Del.
CK:
DATE REPORTED:
C7 -5-7 C'
Value Type
A H L
NH3 as IN 610 mg/L
TKN as N 625 mg/L
NO2 plus NO3 as N 630 mg/L
P: Total as P 665 mg/L
PO4 as P 665 mg/L
P: Dissolved as P 666 mg/I.
Cd-Cadmium 1027 pg/L
Cr-ChrormunitToml 1034 µg/L
Cu-Copper 1042 1r8/L
Ni-Nickel 1067 µg!L
Pb-Lead 1051 pg/L
Zn-Zinc 1092 µ8/L
Ag-Silver 1077 µg/L
AI -Aluminum 1105 µg/L
Be -Beryllium 1012 µMIL
Ca -Calcium 916 mg/L
Co-Cobalt1037 µg/L
Fe-lron 1045 µ
iposite Sample Type
T S B I C G
Li -Lithium 1132 µg!L
Mg -Magnesium 927 mg/L
Mn-Manganese 1055 µu/L
Na-Sodium 929 me!L
"Arsenic:Total 1002 pg!L
Se -Selenium 1147
Hg-Mercury 71900
Organochlonne Pesticides
Organophosphorus Pesticides
'1
Acid Herbicides
Base/Neunal Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle req'd)
Phytoplankion
Lab Use Onlv /
Temperature on arrival: 40
Sam lin Point %
Conductance at 25°C 1
Water Temperature °C
I D.O. me/L
PH
Alkalinity
Acidity
Air Temperature °C
148.3 PH 4.5
pH4.5 PH8.3
2
94
0
300
400
92244 431
32243 82242
0
Salinity %°
Precipitation (in/day)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity Turbidity Severity
Wind Velocity Mean Stream Depth fl.
Stream Width ft.
80
5
2
6
I351 1350
35 64
4

i F W ATF Jam
cha F. Easldvernor
s JA.ASMretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
> r Division of Water Quality
Asheville Regional Office
SURFACE WATER PROTECTION SECTION
November 21, 2006
Ms. Joanne J. Baker
Emeritus Corp. DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: Compliance Evaluation Inspection
Status: Compliant
Emeritus Corp DBA Pine Park
Pine Park Retirement Inn
Permit No: NCO069370
Henderson County
Dear Ms. Baker:
Enclosed please find a copy of the Compliance Evaluation Inspection form from the
inspection conducted on November 14, 2006. The facility was found to be in compliance with
permit NC0069370.
Please refer to the enclosed inspection report for additional observations and comments.
If you or your staff have any questions, please call me at 828-296-4500 extension 4662.
Sincerely,
Wanda P. Frazier
Environmental Specialist
Enclosure
cc: Trevor McMinn, ORC
Central Files
ORMs h�vlfl Fife s
NorthCarolina
N17WIVIl f
2090 U.S. Highway 70, Swannanoa, NC 28778 Telephone: [phone] Fax: [phone] Customer Service 1 877 623-6748

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 2046o
OMB No. 2040-0057
Water Compliance. Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 I51 31 NCO069370 Ill 121 06/11/14 117 18ICI 19ISI 20I
�—
Remarks
21IIIIIIIIIIIIIIIIIIIIIIIIIII111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ------------------------Reserved---------------------
72 —73 L_L 74 751 1 I I I I I 180
711 I
67I 1.0 169 70�l
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
Pine Park Retirement Inn
03:45 PM 06/11/14
05/12/01
Exit.Time/Date
Permit Expiration Date
2601 U s Hwy 64 E
Hendersonville NC 28792
04:30 PM 06/11/14
10/11/30
Name(s) of Onsite Representative (s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Trevor Clyde MCMinn/ORC/828-696-8971/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joanne J Baker,2601 U S Hwy 64 E Hendersonville NC 28792//82B-692-1911/
Yes
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance N Records/Reports Self -Monitoring Program
Facility Site Review Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspectors) Agency/Office/Phone and Fax Numbers Date
Wanda P Frazier ARO WQ//828-296-4500 Ext.4662/
i
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
1
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO069370 I11 12I 06/11/14 I17 181
C
(cont.)
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
A review of the files indicates that the last compliance evaluation inspection was conducted on
09-08-06 by Janet Cantwell.
The permit expires on 11-30-2010, please request a permit renewal 6 months prior to expiration.
The Annual Performance Report has been filed for the year.
The aeration basin process control data was as follows on the day of the inspection.
Temperature = 18.6 degrees Celcius
Dissolved Oxygen = 1.4 mg/I
Tip: The ideal level for dissolved oxygen in the aeration basin is generally 1 to 3 mg/I. Seasonal changes in
temperature or flow require the adjustment of the aeration timer to achieve ideal dissolved oxygen levels.
Settleable solids - 950 ml/I = 95% due to filamentous bacteria
Tip: Using the settleability test, the return sludge pumping rate is usually set so that the flow rate is
approximately equal to the percentage volumes occupied by the settleable solids from the aeration basin
after settling for 30 minutes in a settleometer. For example, a settleability of 30% would generally indicate a
recommended return sludge pumping rate of 30%.
Having the percent settleable solids (i.e. 30%) the same as the percent return sludge pumping rate (i.e.
30%), allows for the solids balance in the plant to be maintained. If the plant cannot handle that return
sludge pumping rate, then wasting is probably recommended.
Because the settleable solids were 95% due to filamentous bacteria, it is not recommended that wasting be
done at this time (see recommendations below).
pH = 7.5 units
The effluent data was as follows on the day of the inspection.
Dissolved Oxygen = 1.6 mg/I
Temperature = 18.3 degrees Celcius
Chlorine = <15 ug/I
pH = 6.6 units
There was evidence of filamentous bacteria in the aeration basin as indicated by foam. Discussions were
held regarding the plant's ability to maintain sufficient aeration basin dissolved oxygen levels and the
adjustment of pH by the addition of lime to increase alkalinity, as well as, chlorination of the return activated
sludge to kill the filamentous bacteria.
Page # 2

t9
Permit: NCO069370 Owner- Facility: Pine Park Retirement Inn
Inspection Date: 11/14/2006 Inspection Type: Compliance Evaluation
Since the last technnical assistance by DWQ, the aeration timers had been adjusted to 45 minutes on and
15 minutes off, to increase DO levels and the routine addition of lime had been implemented to maintain a
higher pH level. These efforts, in addition to chlorination of the return activated sludge have not improved
the filamentous problem.
Two recommended options .remain. The plant could be pumped in an effort to remove filamentous bacteria
and reseeded to restore the plant's inventory of desirable and beneficial bacteria. In addition, the existing
aerated digestor could be temporarily used as a flow equalization basin to allow hydraulic and organic
surges to be fed gradually into the plant, so that proper aeration basin dissolved oxygen levels can be
maintained. These measures should alleviate and prevent the regrowth of filamentous bacteria. The costs
associated with these measures were discussed with the ORC and Mr. Neely.
On -site during the inspection were Trevor McMinn, ORC, Mark Jones, and Carl Neely.
The log book was present on -site and had good notation of daily events.
The effluent appeared to be clear, indicating compliance with permit limits.
This facility appears to be Well operated and maintained. The operator is doing a good job.
Page # 3

a
Permit: NCO069370
Inspection Date: 11/14/2006
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
n
n
■
n
Is the facility as described in the permit?
M
n
n
n
# Are there any special conditions for the permit?
n
®
n
n
Is access to the plant site restricted to the general public?
■
n
n
n
Is the inspector, granted access to all areas for inspection?
M
0
❑
❑
Comment:
Operations $ Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
■
n
00
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■
n
n
n
Judge, and other that are applicable?
Comment:
Page # 4

c
J 24EVeV
OPERATIONS * MAINTENANCE * CONSTRUCTION
..................................................................................................................I.
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Fax [phone]
RESPONSE TO NOV-2006-LV-0485
Mr. Roger Edwards:
,.
OCT 2 7 2006
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
��s gin'.+. ri"y.'::F::<:?!�.::-.+,•�:.^�r.:i=•.r:.,i,n x..s_ti,:,c:�^ -_, :.
art;...- ...:. •:" c.:..,. � s,
----,-, r--may
This response addresses the violation for TSS on 8/2/06 fdr AKFZI a"rk:7Zetirement
kwow
We are currently dealing with a filamentous bacteria in our system. It is causing slow settling
solids coupled with a thick foam on the clarifier. We are currently managing the filamentous
bacteria by wasting them out of the plant and adding alum to floc down the remaining solids.
This has been our management technique since taking over the plant.
Mr. Don Price visited the site as requested on June 28th 2006. Don's expertise was most
appreciated. His recommendations were implemented immediately. Urea is added in small
quantities to make up any Nitrogen deficiencies. The dissolved oxygen was raised. Additional
pumping was implemented to remove foam that was harboring filamentous bacteria. I am feeding
Bicarb to adjust the pH in the aeration basin. Influent BOD's were taken and averaged 305 mg/l
for the month of September.
The Plant has not responded as well as I had hoped to this course of treatment. However I have
seen some positive impact. Please grant us some leniency as we fine tune this new course of
treatment. As the temperature cools and the filamentous are no longer multiplying as they do in
summer, I fully expect to get a handle on the filamentous bacteria. In raising the D.O. I also
inadvertently raised the Return Activated Sludge flows (this tiny plant has two three inch return
lines) this TSS violation is suspected to be a combination of this increase in clarifier flow and the
filamentous slow settling sludge.
Please consider the cost of these additional measures should you have to institute any fines. The
folks at Pine Park have been most agreeable in getting anything I need to meet our compliance.
goals.
If I can answer any questions or be of further assistance please let me know.
Siticerely,
lA, C
Trevor C. McMinn, ORC

ctiiAu�x4i;:1,=vn�i�::s'^.fi,:i,.:rC:3 �i,i.,n.:. ....x . .......
M !? Michael F. Easley, Governor
Villiam G. Ross Jr., Secretary
oifli Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Asheville Regional Office
SURFACE WATER PROTECTION SECTION
OCTOBER 23, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7005 3110 0003 5474 1001
Ms. Joanne J. -Baker
Emeritus Corp.
DBA: Pine Park Retirement Inn
2601 US Hwy 64 E
Hendersonville, NC 28792
Subject: NOTICE OF VIOLATION
NOV-2006-LV-0485
Permit No. NCO069370
Pine Park Retirement Inn
Henderson County
Dear Ms. Baker:
A review of Pine Park Retirement Inn's monitoring report for August 2006 showed the _
following violations:
Parameter
Date
Limit Value
Reported Value
Limit Type,
Total Suspended Solids
08/02/06
45 mg/I
120 mg/I
Daily Maximum
Exceeded
Remedial actions should be taken to correct this problem. The Division of Water Quality may
pursue enforcement action for this and any additional violations of State law.
NorthCarolina
2090 U.S. Highway 70, Swannanoa, N.C._ 28778, 828/296-4500 (Telephone) 828/299-7043(Fax) Customer Service 877-623-6748 IvIatmwilf
i

Ms. Joanne J. Baker
Emeritus Corp.
October 23, 2006
Page 2 of 2
To prevent further action, carefully review these violations and deficiencies and respond in writing
to this office within 10 working days of receipt of this letter. You should address the causes of non-
compliance and all actions taken to prevent the recurrence of similar situations. If you should have
any questions, please do not hesitate to contact Wanda Frazier at 828-296-4500 extension 4662.
The Asheville Regional Office currently has on staff a Wastewater Treatment Consultant to offer
technical assistance to Wastewater Treatment Plants and Collection Systems with operational
concerns. This service is free and non -regulatory to assist in the identification and correction of
operational problems. This service can be utilized for optimization of the operation of WWTP
and/or Collection Systems. Should you have questions about this service, please contact Don
Price at 828-296-4500 extension 4656.
Sincerely,
Roger C. Edwards, Regional Supervisor
Surface Water Protection Section
EnclosVre
cc: Bob Guerra, NPDES Point Source Compliance Enforcement
Wanda Frazier - ARO
l'�uille=FAO=-'facility�f�fe
WQ Central Files

Michael F. Easley, Gover r .
r., ecretary �.
North Carolina Department or --nviron d tur Rurc.
A Klik, Direct , r
y Divisio f e ual '
• lw���jb`i3'?t.';s.y+�WM�P-MB!R7!M!F«!�t.AF�
Asheville Regional Office
SURFACE WATER PROTECTION
September 18, 2006
Joanne J. Baker
Emeritus Corporation, DBA Pine Park
2601 U.S. Hwy.. 64 East
Hendersonville, North Carolina 28792
Dear Ms. Baker:
Enclosed please find a copy of
the follow up inspection conducted on
compliance with Permit # NC0069370.
this facility.
SUBJECT: Follow Up Compliance Evaluation
Inspection
Status: -Compliant
Pine Park Retirement Inn WWTP
Permit No: NCO069370
Henderson County
the Compliance Evaluation Inspection form from
September 8, 2006. The facility appeared to be in
Mr.Trevor McMinn is doing a fine job of operating
Please refer to the enclosed inspection report for additional observations and
comments. If you or your staff have any questions, please call me at 828-296-4500.
Sincerely,
Janet Cantwell
Environmental Technician
Enclosure
cc. WGt_As W evitl_� FIIf_s„w/�attachmerit=
WQ Central Files, w/ attachment
Trevor Clyde McMinn/ORC, w/ attachment
2090 U.S. Highway 70, Swannanoa, NC 28778 Telephone: [phone] Fax: [phone] Customer Service 1 877 623-6748
I� rthCarolina
Xlaturall,ff

United States Environmental Protection Agency
Form Approved.
E n q Washington, D.C. 20460
r/`1
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data. System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI'. 2 I_I 31 NCO069370 I11 121 06/09/08 117 18ICI 19ISI 20 J
Remarks
211IIIIIIIIIIIIII_IIIIIIIIIIIIIIIIIIIII IIII IIII III6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ---- --- ---- —------- —---- Reserved --------- —-------- --
67I 169 70I_I 711 I 72 L N i 73I I 174 751 I I I I I I 180
Iu! I—LJ
Section B: Facility Data
Name and Location of Facility Inspected (For industrial Users discharging to POTW, also include
Entry TimelDate
Permit,Effective Date
POTW name and NPDES permit Number)
Pine Park Retirement Inn
03:05 PM 06/09/08
05/12/01
Exit Time/Date
Permit Expiration Date
2601 U S Hwy 64 E
Hendersonville NC 28792
03:45 PM 06/09/08
10/11/30
Name(s) of Onsite Representative (s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Trevor Clyde McMinn/ORC/828-696-8971/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joanne J Baker,2601 U S Hwy 64 E Hendersonville NC 28792//828-692-19]il/
es
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ■ Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program ■ Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
s
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Janet Cantwell ,« �r ARO WQ//828-296-4500 Ext.4667/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
v -
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3I NCO069370 I11 121
.06/09/08 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Trevor McMinn, ORC, assisted in the inspection of this facility.
The flow meter was calibrated 6/15/06.
Mr. McMinn stated that Don•Price, of our office, has been helping him with technical assistance in some
areas of operations for the plant.
Page # 2

M
Permit: NG0069370
Inspection Date: 09/08/2006
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Permit
Yes
No
NA
NE
(if the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑
■
Is the facility as described in the permit?
■
❑
❑
❑
# Are there any special conditionsfor the permit?
❑
❑
■
❑
Is access to the plant site restricted to the general public?
■
❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
❑
L
❑
Comment:
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
■
❑
n
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge
■
❑
❑
❑
Judge, and other that are applicable?
Comment:
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
❑
❑
❑
Is all required information readily available, complete and current?
■
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
❑
❑
❑
Are analytical results consistent with data reported on DMRs?
❑
❑
❑
■
Is the chain -of -custody complete?'
❑
❑
❑
■
Dates, times and location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
■
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
■
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
' ❑
■
❑
Is the ORC visitation log available and current?
■
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
■
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑
❑
❑
Is a copy of the current NPDES permit available on site?
■
❑
❑
❑
Page # 3

Permit: NCO069370
Inspection Date: 09/08/2006
Owner- Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Facility has copy of previous year's A nual Report on file for review?
■
n
n
n
Comment:
Pump Station--- nfl a
Yes
No
NA
NE
Is the pump t well free of bypass lines or structures?
■
Is the wet well free of excessive grease?
■
❑'
n
Are all pumps present?
■
n
n
n
Are all pumps operable?
■
n
n
n
Are float controls operable?
■
n
n
n
Is SCADA telemetry available and operational?
❑
❑
■
Is audible and visual alarm available and operational?
■
n
n
n
Comment:
Bar Screians
Yes
No
NA
NE
Type of bar screen
a.Manual
f l
b.Mechanical
rl
Are the bars adequately screening debris?
■
n
n
n
Is the screen free of excessive debris?
■
❑
n
n
Is disposal of screening in compliance?
■
❑
❑
Is the unit in good condition?
■
❑
❑
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
n
n
Are surface aerators and mixers operational?
❑
n
■
n
Are the diffusers operational?
■
n
n
n
Is the foam the proper color for the treatment process?
■
n
n
n
Does the foam cover less than 25% of the basin's surface?
■
n
n
n
Is the DO level acceptable?
n
n
n
■
Is the DO level acceptable?(1.0 to 3.0 mg/1)
n
n
n
■
Page # 4

Permit: NCO069370
Inspection Date: 09/08/2006
Owner - Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Aeration Basins
Yes
No
NA
NE
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
■
❑
Are weirs level?
■
❑
❑
❑
Is the site free of weir blockage?
■
❑
❑
❑
Is the site free of evidence of short-circuiting?
■
❑
❑
❑
Is scum removal adequate?
■
❑
Is the site free of excessive floating sludge?
■
❑
❑
❑
Is the drive unit operational?
❑
❑
■
❑
Is the return rate acceptable (low turbulence)?
■
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
■
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
❑
❑
❑
■
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
❑
❑
❑
Is flow meter calibrated annually?
®❑
❑
❑
Is the flow meter operational?
■
❑
❑
❑
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
■
❑
Comment:
The flow meter was calibrated 6/15/06.
Page # 5

W ATFRQ
G
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
F�'H' OPY Alan W. Klimek P.E. Director
Division of Water Quality
Ms. Joanne J. Barker
Pine Park Retirement Inn
2601 U. S. Hwy 64 E
Hendersonville, N.C. 28792
-Dear Ms. Baker
Asheville Regional Office
SURFACE WATER PROTECTION
July 26, 2006
SUBJECT: June 28, 2006
Technical Assistance Inspection
Pine Park Retirement Inn
Permit No: NCO069370
Henderson County
Enclosed please find a copy of the Technical Assistance Inspection form from the
inspection conducted on June 28, 2006. The Technical Assistance Inspection was
conducted by Don Price of the Asheville Regional Office. The facility was found to be in
Compliance with permit NC0069370.
Please refer to the enclosed inspection report for additional observations and
comments. If you or your staff have any questions, please call me at [phone].
Sincerely,
AIK,- PA4_-e_—
Don Price
VW1/TP Consultant
Enclosure
cc: Trevor C. McMinn, ORC
Central=Files_._
�shl:le�l�eg ona�l�Offii�e=F- lgs��`
NorthCarolina
2090 U.S. Highway 70, Swannanoa, NC 28778 Telephone: [phone] Fax: [phone] Customer Service 1 877 623-6748

United States Environmental Protection Agency
Washington, D.C. 20460
EPA
Form Approved.
OMB No. 2040-0057
Water Compliance In ection Re Ort
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 I SI 31 N00069370' 111 121 06/06/28 117 181 DI 191 SI 201 I
Remarks
211
�6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ----------------------Reserved--------------
67I 169 70I 3 I 71 I I 72I N I 73IW I 174 . 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
Entry Time/Date
Permit Effective Date
Pine Park Retirement Inn
09:30 AM 06/06/28
05/12/01
2601 U S Hwy 69 E
Exit Time/Date
Permit Expiration Date
Hendersonville NC 28792
11:00 AM 06/06/28
10[11/30
Name(s) of Onsite Representative (s)/Titles (s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible OfficialfTitle/Phone and Fax Number
ta
Joanne J Baker,2601 U S Hwy 64 E Hendersonville NC 28792//828-692 19
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Flow Measurement ®Operations & Maintenance E Self -Monitoring Program N Facility Site Review
Section D: Summary of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s). Agency/Office/Phone and Fax Numbers Date
Don Price ARO WQ//828-296-4500/ '7 Zoo
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
Roger C Edwards ARO WQ//$28-296-4500/ ?"
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type (cont.) 1
3I NCO069370 I11 12I 06/06/28 I17 18IDI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The ORC, Trevor McMinn's time and assistance in conducting the Technical Assistance is appreciated. The
Technical Assistance was conducted at the request of the ORC in. response to an NOV. The NOV was sent
for violations of the NPDES permit limitation for Total Suspended Residue.
The most probable cause of the violation was probably an accumulation ,of filamentous bacteria. There are
several causes for filamentous bacteria to occur in an Activated Sludge system. These are: 1) low dissolved
oxygen levels in the aeration basin and/or sections of the aeration basin( insufficient oxygen transfer), 2)
insufficient nutrients ( activated sludge systems need a BOD:N:P ratio of 100'5:1), and
3) in some instances low pH of the influent waste stream can create conditions favorable to filamentous
bacteria's growth.
The best way to control filamentous bacteria is to prevent the conditions which promote the growth and
accumulation of the filamentous. This means control the DO levels, the nutrient levels and possibly add lime
or soda ash to the influent as needed. On -site measurements for alkalinity revealed a range of 120-140
mg/L alkalinity on the effluent and a range of 80-120 mg/L on the influent. By these results the system
appears to need some supplemental alkalinity added to the system. This addition will promote nitrification
and should aid in recovery efforts.
Literature information regarding activated sludge systems, proper nutrients, and control of filamentous
bacteria can be found in the Advanced Waste Treatment volume of the Sacremento Manuals. This is a very
good reference to keep available should questions arise regarding operation of the activated sludge
systems.
Page # 2

F1
Permit: NCO069370 Owner- Facility: Pine Park Retirement Inn
Inspection Date: 06/28/2006 Inspection Type: Technical Assistance
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ■ ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■ ❑ ❑ ❑
Judge, and other that are applicable?
Comment:
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
Is the site free of weir blockage?
Is the site free of evidence of short-circuiting?
Is scum removal adequate?
Is the site free of excessive floating sludge?
Is the drive unit operational?
Is the return rate acceptable (low turbulence)?
Is the overflow clear of excessive solids/pin floc?
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
Comment: At the time of the Technical Assistance the ORC had made adjustments to
plant to prevent the sludge blanket from rising and going over the effluent weir. These
adjustments included turning off the air lift scum removal pumps. With this
implementation
the ORC will have to remove scum manually. The secondary clarifier stilling well was
accumulating a high level of scum and needed to be skimmed out and/or pumped out.
Pump Station - Effluent
Is the pump wet well free of bypass lines or structures?
Are all pumps present?
Are all pumps operable?
Are float controls operable?
Is SCADA telemetry available and operational?
Is audible and visual alarm available and operational?
Comment:
Pump Station - Influent
Is the pump wet well free of bypass lines or structures?
Yes No NA NE
■❑❑❑
■❑❑❑
■❑❑❑
■❑❑❑
❑ ■ ❑ ❑
■❑n❑
n❑■❑
■❑❑❑
■❑❑❑
❑ ■ ❑ ❑
Yes No NA NE
Yes No NA NE
■n❑❑
Page # 3

A
Permit: NCO069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 06/28/2006 Inspection Type: Technical Assistance
Pump Station - Influent
Yes
No
NA
NE
Is the wet well free of excessive grease?
■
n
n
n
Are all pumps present?
■
❑
Cl
n
Are all pumps operable?
■
n
n
n
Are float controls operable?
■
n
n
n
Is SCADA telemetry available and operational?
n
n
n
■
Is audible and visual alarm available and operational?
■
n
n
n
Comment:
Type of bar screen
a.Manual
■
b.Mechanical
n
Are the bars adequately screening debris?
n
■
n
n
Is the screen free of excessive debris?
■
n
n
n
Is disposal of screening in compliance?
■
n
n
n
Is the unit in good condition?
n
■
n
n
Comment: The existing Bar Screen consists of bars about 2" to 3" apart, and works
more as a " Bar Rack" rather than a screen. The facility may wish to look into installing
a muffin monster type communitor on the influent pump station if screenings become
an operational issue at the facility.
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
n
n
n
Are surface aerators and mixers operational?
n
n
■
n
Are the diffusers operational?
■
n
n
n
Is the foam the proper color for the treatment process?
■
n
n
n
Does the foam cover less than 25% of the basin's surface?
■
n
n
n
Is the DO level acceptable?
■
❑
❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
■
❑
❑
❑
Page # 4

t
Permit: NCO069370 Owner —Facility: Pine Park Retirement Inn
Inspection Date: 06/28/2006 Inspection Type: Technical Assistance
Aeration Basins Yes No NA NE
Comment: On -site measurements for DO = 1.09 mg/L, Settleabler solids = 900 ml/L,
and onsite measurement for MLSS = 1240 mg/L.
SVI calculation 725, which is very skewed. This appears to be due t.o very young
sludge. ORC indicated he was having difficulty with filamentous bacteria, and to address
this issue, had increased wasting from the system and had been applying chlorine to
the return. ORC also indicated he had changed the diffuser heads with,,a larger head to
improve the oxygen transfer to the areation basin.
De -chlorination
Yes
No
NA
NE
Type of system ?
Is the feed ratio proportional to chlorine amount (1 to 1)?
❑
■
❑
❑
Is storage appropriate for cylinders?
❑
■
❑
❑
# Is de -chlorination substance stored away from chlorine containers?
❑
■
❑
Are the tablets the proper size and type?
❑
■
❑
❑
Comment: At the time of the technical assistance the ORC was not de -chlorinating
and was not required to in the permit.
Are tablet de -chlorinators operational?
❑
■
❑
❑
Number of tubes in use?
Comment: De -chlorination not required at the time of the Technical Assistance, due to
the facility has not increased flow above 25,000 gallons per day.
Disinfection -Tablet
Yes
No
NA
NE
Are tablet chlorinators operational?
■
❑
❑
❑
Are the tablets the proper size and type?
■
❑
❑
❑
Number of tubes in use?
2
Is the level of chlorine residual acceptable? ❑ ❑ ❑ ■
Is the contact chamber free of growth, or sludge buildup? ■ ❑ ❑ ❑
Is there chlorine residual prior to de -chlorination? ■ ❑ ❑ 0
Comment: "
Page # 5
19

Cvcv
OPERATIONS * MAINTENANCE * CONSTRUCTION
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone [phone]
Fax [phone]
- A -
Mr. Bcoger Edwards:
This response addresses the violation for required annual calibration for Pine Park, Retirement
t
T
A"' Ttv, fil
actualily ex sicu.
nave contracted with Laboratory instrument Service to pe6brm yearly calibrations from now
DreVe-
nr P—m r, n1f, ,n Ilef mn knnvv.
E D c E
F--
Ll I
JUL, 2 0,2006
ASHEVILLE REGIONAL OFFICE

LaWratol,N 111StI'll lElellt senk -103 Cam shell A%enta: • 56 (864) 4;'_.I8?8
1 Landrum � 3"(
Report of Flow Teter Calibration
Customer: _ Date: / -wi 0 Due:�UMC gco 7
M' r ll+el Sean tr
Stevens - _L GIR - - 149983-94AG Pine park
Primary: 300 v-notch IMaximum: 70 ThGPD
Initial checkout
Totalizer Multiplier: 1
-- - --- Final total %err =
Elapsed time; L
X flow rateStarting total -� CT)x t 000/,CT
I
Calculated total =Indicated total
Flow
-- Measured level ..snits Look -up flow units 1 Indicated flow [units �
0,3S
Service or adjustment performed
AD�i" Te i> im_> a c A —(E p Fl-o t,J..J
)Final checkout
Totalizer 1Vlultiplier: A® _._. %error =
Elapsed time 16D Final total (IT-CT)x100%
x now rate
+ ` 70 ke - --- Starting total! J_a lb 0 CT �
I=Calcuslated total) ����^/ 6/�$y�7®//)� =Indicated total
}Flow
Measured level [units] Look -up flow [units] Indicated #low [units]
a 4 3 ®, crop
Comments/Evaluation
In tolerance as found YES NO In tolerance as left / NO
Technician

r
ATF,�Q Michael F. Easley, Governor
William G. Ross Jr., Secretary
\r� G North Carolina Department of Environment and Natural Resources
� r Alan W. Klimek, P.E. Director
={ Division of Water Quality
Q `C
Asheville Regional. Office
SURFACE WATER PROTECTION.
July 14, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7005 0390 00013553 1091
Joanne J. Baker
Emeritus Corporation DBA Pine Park
2601 U. S. Hwy. 64 East
Hendersonville, North Carolina 28792
Subject: NOTICE, OF VIOLATION
NOV-2006-PC-0296 `
Compliance Evaluation Inspection
Status: Non -Compliant
Pine Park Retirement Inn WWTP
Permit No. NCO069370
Henderson County
Dear Ms. Baker:
Enclosed please find a copy of the Inspection Report from the inspection conducted June 6,
2006. The Compliance Evaluation Inspection was conducted by Janet Cantwell of the Asheville
Regional Office. The treatment facility was found to be in violation of Permit # NCO069370 for the
following:
Inspection Area
Compliance Issue
Flow Meter
Part II, Section C.2. Operation and Maintenance.
Annual calibration of the flow meter is required. The last
calibration was in October 2002.
2090 U.S. Highway 70, Swannanoa, N.C. 28778 'Telephone: [phone] PAX: 828/299-7043 Customer Service: 877/623-6748 NOne
orthCatolina
�aturrr!!y

NCO069370
July 14, 2006
Page Two
Please refer to the enclosed Inspection Report for any additional observations and comments.
To -prevent further action, carefully review these violations and deficiencies and respond in
writing to this office within fifteen (15) working days of receipt of this letter. You should address the
causes of noncompliance and all actions taken to prevent the recurrence of similar situations. If you
should have any questions, please do not hesitate to contact Janet Cantwell at 828/296-4500.
Sincerely,
U
Roger C. Edwards, Regional Supervisor
Surface Water Protection
Attachment
711Lcc -- _ Q Asheville=File; vac/ attachments--_
WQ Central Files w/ attachment
Bob Guerra, Enforcement Files w/ attachment
Trevor McMinn/ORC, w/ attachment

5 , r
United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval expires8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 1 NJ 2 L5I 31 NCO069370 I11 121 06/06/06 117 181CI 19 c1 201 I
J LJ
Remarks
211 I I I I I I I I I I I I I I I _I 1 l l l l l I_ I I I I I I I I I I I 1 l l L I I I I' I I 116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA - -- - - ---- —Reserved------------------
671 169 70I_I 71 L 72 I N I 73 L_Lj 74 751 1 I I I I I 180
L
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10,:50 AM 06/06/06
05/12/01
Pine Park Retirement Inn
Exit Time/Date
Permit Expiration Date
2601 U S Hwy 64 E
Hendersonville NC 28792
11:35 AM 06/06/06
10/11/30
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Trevor Clyde McMinn/ORC/828-696-8971/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Joanne J Baker,2601 U S Hwy 64 E Hendersonville NC 28792//828-692-1911/
Yes
Section C: Areas rEvaluated During Inspection (Check only those areas evaluated)
Permit 0 Flow Measurement Operations & Maintenance N Records/Reports .
Self. -Monitoring Program ■ Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Janet Cantwell ARO wQ//828-296-4500 Ext.4667/ r 711�le �
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type 1
3I NCO069370 I11 121 06/06/06 117 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Trevor McMinn assisted in the inspection of this facility.
The permit became effective December 1, 2005.
The facility is well -operated.
All records and reports were available and complete.
Audible and visual alarms were tested at the time of inspection and were operable.
The flow meter was last calibrated October 2002. Flow meters should be calibrated annually.
Page # 2

Permit: NCO069370
Inspection Date: 06/06/2006
Owner- Facility: Pine Park Retirement Inn
Inspection Type: Compliance Evaluation
Permit
Yes
No
NA
NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
❑
❑
■
❑
Is the facility as described in the permit?
■
❑
❑
❑
# Are there any special conditions for the permit?
❑
■
❑
❑
Is access to the plant site restricted to the general public?
■
❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
❑
❑
❑
Comment:
Permit became effective December 1, 2005
Operations & Maintenance
Yes
No
NA
NE
Is the plant generally clean with acceptable housekeeping?
■
❑
❑
❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ■
❑
❑
❑
Judge, and other that are applicable?
Comment:
The facility is well -operated.
Record Keeping
Yes
No
NA
NE
Are records kept and maintained as required by the permit?
■
❑
❑
❑
Is all required information readily available, complete and current?
■
❑
❑
❑
Are all records maintained for 3 years (lab. reg. required 5 years)?
■
01111
Are analytical results consistent with data reported on DMRs?.
❑
❑
❑
■
Is the chain -of -custody complete?
❑
❑
❑
■
Dates, times and location of sampling
❑
Name of individual performing the sampling
❑
Results of analysis and calibration
❑
Dates of analysis
❑
Name of person performing analyses
❑
Transported COCs
❑
Are DMRs complete: do they include all permit parameters?
■
❑
❑
❑
Has the facility submitted its annual compliance report to users and DWQ?
■
❑
❑
❑
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift?
❑
❑
■
❑
Is the ORC visitation log available and current?
■
❑
❑
❑
Is the ORC certified at grade equal to or higher than the facility classification?
❑
❑
❑
Is the backup operator certified at one grade less or greater than the facility classification?
■
❑
❑
❑
Page # 3

Permit: NC0069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 06/06/2006 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Is a copy of the current NPDES permit available on site?
■
n
❑
❑
Facility has copy of previous year's Annual Report on file for review?
■
❑
❑
❑
Comment:
All records and reports were available and complete.
Pump Station - Influent
Yes
No
NA
NE
Is the pump wet well free of bypass lines or structures?
■
❑
0
❑
Is the wet well free of excessive grease?
■
n
n
n
Are all pumps present?
■
❑
❑
❑
Are all pumps operable?
■
❑
❑
❑
Are float controls operable?
■
❑
❑
❑
Is SCADA telemetry available and operational?
n
n
■
n
Is audible and visual alarm available and operational?
■
❑
❑
❑
Comment:
Audible and visual alarms were tested at the time of inspection and were operable.
Bar Screens
Yes
No
NA
NE
Type of bar screen
a.Manual
❑
b.Mechanical
❑
Are the bars adequately screening debris?
■
❑
❑
❑
Is the screen free of excessive debris?
■
❑
❑
❑
Is disposal of screening in compliance?
■
❑
❑
❑
Is the unit in good condition?
■
n
n
❑
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Type of aeration system
Is the basin free of dead spots?
■
❑
❑
❑
Are surface aerators and mixers operational?
❑
❑
■
❑
Are the diffusers operational?
■
❑
❑
❑
Is the foam the proper color for the treatment process?
■
❑
n
❑
Page # 4

Permit: NCO069370 Owner - Facility: Pine Park Retirement Inn
Inspection Date: 06/06/2006 Inspection Type: Compliance Evaluation
Aeration Basins
Yes
No
NA
NE
Does the foam cover less than 25% of the basin's surface?
■
Cl
❑
❑
Is the DO level acceptable?
■
❑
❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
■
❑
Cl
❑
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
❑
❑
❑
Is the site free of excessive buildup of solids in center well of circular clarifier?
❑
❑
■
❑
Are weirs level?
■
❑
❑
❑
Is the site free of weir blockage?
■
❑
❑
❑
Is the site free of evidence of short-circuiting?
■
❑
❑
❑
Is scum removal adequate?
■
❑
❑
❑
Is the site free of excessive floating sludge?
■
❑
❑
❑
Is the drive unit operational?
❑
❑
■
❑
Is the return rate acceptable (low turbulence)?
■
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
■
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately''/4 of the sidewall depth)
■
❑
Cl
❑
Comment:
Flow Measurement - Effluent
Yes
No
NA
NE
# Is flow meter used for reporting?
■
❑
❑
❑
Is flow meter calibrated annually?
❑
■
❑
❑
Is the flow meter operational?
■
Cl
110
(If units are separated) Does the chart recorder match the flow meter?
❑
❑
■
❑
Comment:
The flow meter was last calibrated October 2002. Flow meters are to be calibrated
annually.
Page # 5

)Irk
OPERATIONS * MAINTENANCE * CONSTRUC ON
............................................................................................. .... ............................................................ ........................................ I ....... I.....................
2020 Howard Gap Road
Hendersonville, N.C. 28792
Phone[phone]
Fax[phone] �G
s f 6 // eases
RESPONSE TO NOV-2006-LV-0268
Mr. Roger Edwards: /
This response addresses the violation for TSS on 4/12/06 for Pine Park Retirement Inn (Permit #
NC0069370).
We are currently dealing with a filamentous bacteria in our system. It is causing slow settling
solids coupled with a thick foam on the clarifier. We are currently managing the filamentous
bacteria by wasting them out of the plant and adding alum to floc down the remaining solids.
This has been our management technique since taking over the plant. The warmer weather
starting in March 2006 has caused a extraordinary growth of these filamentous bacteria. We have
met this growth with steady wasting and hauling at considerable cost to the owner. We have had
no violations for TSS since April. This seems to be working to control these bacteria.
Could you please suggest a feasible solution or offer some tech support in dealing with this
problem? Any help rendered would be greatly appreciated.
Please consider the cost of this additional pumping should you have to institute any fines. The
folks at Pine Park have been most agreeable in getting anything I need to meet our compliance
goals.
If I can answer any questions or be of further assistance please let me know.
mcerely,
Trevor C. McMinn, ORC
J U N 1 9 2006
S 6
V\.',AT',-zR QUnL IT`,' :i -M IC"•I

\NAT�� Michael F. Easley, Governor
William G. Ross Jr., Secretary
O� t' 4t!. ru'6Korth IrolinLWrn f nvironment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
x Asheville Regional Office
SURFACE WATER PROTECTION
June 9, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Joanne J Baker
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville NC 28792
Subject: NOTICE OF VIOLATION
NOV-2006-LV-0268
Permit No. NCO069370
Pine Park Retirement Inn
Henderson County
Dear Baker:
A review of Pine Park Retirement Inn's monitoring report for April 2006 showed the following
violations:
Parameter
Date
Limit Value
Reported Value
Limit Type
Solids, Total Suspended
04/12/06
45 mg/I
80 mg/I
Daily Maximum
Exceeded
Remedial actions should be taken' to correct this problem. The Division of Water Quality may pursue
enforcement action for this and any additional violations of State law. ,
To prevent further action, carefully review these violations and deficiencies and respond in writing to this office
within working day of receipt of this letter. You should address the causes of non-compliance and all actions
taken to prevent the recurrence of similar situations. If you should have any questions, please do not hesitate
to contact Mr. James Reid at 828/296-4500.
Sincerely,
'R
Roger COU. Edwards, Regional Supervisor
Surface Water Protection
Enclosure
cc: WQ Central Files
Compliance Oversight, Danny Smith
None Carolina
2090 U.S. Highway 70, Swannanoa, N.C. 28778 828/296-4500 (Telephone) 828/299-7043(Fax) Customer Service 877-623-6748 Wturui7A;.

IPDES PERMIT NO.
ACILITY NAME
EFF ENT
NC0069370 DISCHARGE NO 001
Pine Park Retirement Inn Class
)PERATOR IN RESPONSIBLE CHARGE (ORC)- Trevor C. 4coinn
:ERTIFIED LABORATORIES(1) Pace Analytical Services In . 2
HECK BOX IF ORC HAS CHANGED I PERSON(S) COLLECTING SAMPI
YEAR
MONTH ti;�Ap['tk;�a'°'!- � 2006
II COUNTY Henderson
GRADE II '.PHONE. [phone]
_ES Trevor McMinn
Mail ORIGINAL and ONE COPY to:
.TT; CENTRAL FILES
,IV. OF WATER QUALITY X
617 MAIL SERVICE CENTER (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
;ALEIGH, NC 27699-1617 BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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•s��
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Certified Mail # 7014 0510 0000 4466 0813
Return Receipt Requested
June 23, 2015
Joy Hougan, Director Executive
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC 28792
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215. 1 (a)(6)
and NPDES Permit No. NCO069370
Emeritus Corp DBA Pine Park
Pine Park Retirement Inn
Case No. LV-2015-0099
Henderson County
Dear Permittee:
Donald R. van der Vaart
Secretary
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $259.26 ($100.00 civil penalty
+ $159.26 enforcement costs) against Emeritus Corp DBA Pine Park.
This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report
(DMR) submitted by Emeritus Corp DBA Pine Park for the month of February 2015. This review has shown the
subject facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES Permit No.
NC0069370. The violations, which occurred in February 2015, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Emeritus Corp DBA Pine Park violated the terms,
conditions or requirements of NPDES Permit No. NCO069370 and G.S. 143-215.1(a)(6) in the manner and extent
shown in Attachment A. In accordance with the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may
be assessed against any person who violates the terms, conditions or requirements of a permit required by G.S.
143-215.1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the
Secretary of the Department of Environment and Natural Resources and the Director of the Division of Water
Resources, I, G. Landon Davidson, Regional Supervisor, Asheville Regional Office hereby make the following civil
penalty assessment against Emeritus Corp DBA Pine Park:
2090 U.S. 70 Highway, Swannanoa, NC 28778
Phone: [phone] \ Internet: www.ncdenr.gov <http://,,v%Nw.ncdeni-.Rov>
An Equal Opportunity,.. Affirntative Action Employer - Made in part by recycled paper

$100.00 1 of the 1 violations of 143-215.1(a)(6) and NPDES Permit No.NC0069370, by discharging
waste water into the waters of the State in violation of the Permit Daily Maximum for FEC
COLI.
0.00 0 of the 1 violations of 143-215.1(a)(6) and NPDES Permit No.NC0069370, by discharging
waste water into the waters of the State in violation of the Permit Daily Maximum for TSS
Conc.
$100.00 TOTAL CIVIL PENALTY
$159.26 Enforcement Costs
$259.26 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact
and Conclusions of Law and the factors set forth at G.S. 14313-282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the Environmental
Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures. -
Within thirty (30) days of receipt of this notice, you must do one of the following:
(1) Submit payment of the penalty, OR
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural Resources (do not
include waiver form). Payment of the penalty will not foreclose further enforcement action for any continuing or
new violation(s). Please submit payment to the attention of: .
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
2

Option 2: Submit a written request for remission or mitigation including a detailed
justification for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained
in the civil penalty assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation
and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why
you believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address listed
below. In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b) was wrongfully
applied to the detriment of the petitioner;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of the Division of Water Resources will review your evidence and inform you of his decision
in the matter of your remission request. The response will provide details regarding the case status, directions for
payment, and provision for further appeal of the penalty to the Environmental Management Commission's Committee
on Civil Penalty Remissions (Committee). Please be advised that the Committee cannot consider information that
was not part of the original remission request considered by the Director. Therefore, it is very important that you
prepare a complete and thorough statement in support of your request for remission.
In order to request remission, you must complete and submit the enclosed "Request for Remission of Civil Penalties,
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form within thirty (30) dvs of receipt of this
notice. The Division of Water Resources also requests that you complete and submit the enclosed "Justification for
Remission Request."
Both forms should be submitted to the following address:
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
3

Option 3: File a petition for an administrative hearing with the Office of Administrative
Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an
administrative hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file
the petition with the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is
considered filed when it is received in the Office of Administrative Hearings during normal office hours. The Office of
Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.,
except for official state holidays. The petition may be filed by facsimile (fax) or electronic mail by an attached file
(with restrictions) - provided the signed original, one (1) copy and a filing fee (if a filing fee is required by NCGS
§150B-23.2) is received in the Office of Administrative Hearings within seven (7) business days following the faxed
or electronic transmission. You should contact the Office of Administrative Hearings with all questions regarding the
filing fee and/or the details of the filing process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Tel: [phone]
Fax: [phone]
One (1) copy of the petition must also be served on DENR as follows:
Mr. Sam M. Hayes, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, North Carolina 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal
date/time received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for
collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations
that occur after the review period of this assessment.
4

If you have any questions, please contact Janet Cantwell with the Division of Water Resources staff of the Asheville
Regional Office at [phone] or via email [e-mail].
Sincerely,
for S. Jay Zimmerman, P.G.
Director, Division of Water Resources, NCDENR
By G. Landon Davidson, Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDENR
ATTACHMENTS
Cc: WQS Asheville Regional Office - Enforcement File (w/attachments)
NPDES Compliance/Enforcement Unit - Enforcement File (w/attachments)
Central Files, Water Quality Section (w/attachments)
5

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV-2015-0099 County: Henderson
Assessed Party: Emeritus Corp DBA Pine Park
Permit No.: NC0069370 Amount Assessed: $259.26
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For
Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of
this civil penalty. You should attach any documents that you believe support your request and are necessary for the
Director to consider in evaluating your request for remission. Please be aware that a request for remission is limited to
consideration of the five factors listed below as they may relate to the reasonableness of the amount of the civil penalty
assessed. Requesting remission is not the proper procedure for contesting whether the violation(s) occurred or the
accuracy of any of the factual statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. §
143B-282.1(c), remission of a civil penalty may be granted only when one or more of the following five factors apply.
Please check each factor that you believe applies to your case and provide a detailed explanation, including copies of
supporting documents, as to why the factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b) were wrongfully applied to
the detriment of the petitioner (the assessment factors are listed in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the violation (i.e., explain the
steps that you took to correct the violation and prevent future occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain why the violation was unavoidable or
something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance).
EXPLANATION:

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF HENDERSON
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
Emeritus Corp DBA Pine Park )
Pine Park Retirement Inn 1
PERMIT NO. NCO069370 1 CASE NO. LV-2015-0099
Having been assessed civil penalties totaling $259.26 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated June 23, 2015, the undersigned, desiring to seek remission of the civil penalty, does
hereby waive the right to an administrative hearing in the above -stated matter and does stipulate that the facts are as
alleged in the assessment document. The undersigned further understands that all evidence presented in support of
remission of this civil penalty must be submitted to the Director of the Division of Water Resources within thirty (30) days
of receipt of the notice of assessment. No new evidence in support of a remission request will be allowed after (30) days
from the receipt of the notice of assessment.
This the
day of , 20
ADDRESS
TELEPHONE
,.SIGNATURE

ATTACHMENT A
Emeritus Corp DBA Pine Park
CASE NUMBER: LV-2015-0099
PERMIT: NCO069370 FACILITY: Pine Park Retirement Inn COUNTY: Henderson REGION: Asheville
Limit Violations
MONITORING OUTFALL /
VIOLATION
UNIT OF
CALCULATED
% OVER
PENALTY
REPORT PPI LOCATION PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE
LIMIT
VIOLATION TYPE
$100.00
2-2015 001 Effluent FEC COLI
2/10/15
Weekly
#/100ml
400 600
50.0
Daily Maximum Exceeded
$0.00
2-2015 001 Effluent TSS - Conc
2/3/15
Weekly
mg/I
45 49
8.9
Daily Maximum Exceeded

EFFLUENT
00
NPDES PERMIT NO. NCO069370 DISCHARGE NO. 001 MONTH February YEAR 2015
FACILITY NAME Pine Park Retirement Inn Class 11 Henderson
OPERATOR IN RESPONSIBLE CHARGE.(OR, Trevor C. McMinn GRADE If PHONE [phone]
CERTIFIED LABORATORIES(1) ETS Inc. 2 Cert #600
CHECK BOX IF ORC HAS CHANGED `PERSON(S) COLLECTING SAMPLES Trevor McMinn
Mail ORIGINAL and ONE COPY to:
ATT; CENTRAL FILES
DIV. OF WATER QUALITY
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
�f �'j C
X / - C. ' ` `4"3/5/2015
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) . DATE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.,=-�_ _ _ _ _. `h er-�� ED
50060
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Facility Status: (Please Check one of the following)
All monitoring data and sampling frequencies meet permit requirements F-1
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirement: X]
Noncompliant
If the facility is noncompliant, Please comment on the corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time table for improvements to be made.
2/3/2015 high TSS reduced D.O. no further occurance.
2110/15 High Fecal Coliforn Pump truck and wash down Chlorine Contact no further occurance.
" I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a systems designer to assure that qualified personnel property gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
_.., infom]ation. submittl dls,xQJbe t� st of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submtting,false information, including the possibility of fines and imprisonment for knowing violations."
Pine Park Retirement Inn
Pernittee (Please pint or type.) g�,
' C. !' 1 /' I .Gnh, 015
Signature of PermittW* Date
64 East, Hendersonville, NC 28792 828-891-6640 11/30/2015
Fermittee Address Phone Number Permit Fes. Date
PARAMETER CODES
00010 Temperature 00556 Oil & Grease 00951 Total Fluoride -' 01067 Nickel " 50060 Total
•00076 Turbidity 00600 Total Nitrogen 01002 Total Arsenic 01077 Silver Residual
00080 Color (Pt -Co) 00610 Ammonia Nitrogen 01092 Zinc Chlorine
00082 Color (ADMI) 00066 Total Igeldhal 01027 Cadmium 01105 Aluminum
Nitrogen
00095 Conductivity .00630 Nitrates/Nitrites 01032 Hexavalent Chromiur 01147 Total selenium 71880 Formaldehyde
00300 Dissolved Oxygen 010$4 Chromium 31616 Fecal Coliform 71900 Mercury
00310 BOD s 00665 Total Phosphorous 32730 Total Phenolics 81551 Xylene
00340 COD 00720 Cyanide 01037 Total Cobalt 34235 Benzene
00400 pH 00745 Total Sulfide 01042 Copper 34481 Toluene
00530 Total Suspended 00927 Total Magnesium 38260 MBAs
Residue 00929 Total Sodium 01045 lion 39516 PCBs
00545 Settleable Matter 00940 Total Chloride 01051 Lead 50050 Flow
Parameter Code assistance may obtained by calling the Water Quality Compliance Group at (919) 7335083, extension 581 or 534.
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting
facility's permit for reporting data
ORC must visit facility and document visitation of facility as required per 15J NCAC 8A .0202 (b) (5) (8).
"' If siged by other than the permitee, delegation of signatory -authority must be on file with.the state per 15A NCAC 2B ;0506 (b).

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (FILE)
Violator: Pine Park Retirement / NCO069370
(February 2015 DMR)
County: Henderson
Case Number: LV-2015-0099
ASSESSMENT FACTORS
As required by G.S. 143-214.6A(c), in determining the amount of the penalty I considered the factors set out in
G.S. 143B-282.1(b), which are:
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
All effluent violations may be detrimental to the receiving stream but may not be
immediately quantified.
2) The duration and gravity of the violation;
One Daily Max Fecal Coliform exceeded the permit limit by 50%.
One Daily Max TSS exceeded the permit limit by 8.8%.
3) The effect on ground or surface water quantity or quality or on air quality;
All effluent violations may be detrimental to the receiving stream but may not be
immediately quantified.
4) The cost of rectifying the damage;
The cost is unknown.
5) The amount of money saved by noncompliance;
The amount of money saved would include the cost of excess solids removal and
additional aeration. It would also include more operating and maintenance time on site
and the cost of additional chemical treatment.
6) Whether the violation was committed willfully or intentionally,
It does not appear to be either.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority; and
There have been no civil penalty enforcements in the twelve months prior to this
violation.
8) The cost to the State of the enforcement procedures.
$159.26.
Date G. Landon Davidson, Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office, NCDENR
06/2312015

_ms
*
b...i.. `
e
North Carolina Department of Environment and Natural Resources
Pat McCrory
Donald R. van der Vaart
Governor
Secretary
Certified Mail # 7014 0510 0000 4466 0813
Return Receipt Requested
June 23, 2015
Joy Hougan, Director Executive
Emeritus Corp DBA Pine Park
2601 U S Hwy 64 E
Hendersonville, NC'28792
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(6)
and NPDES Permit No. NCO069370
Emeritus Corp DBA Pine Park
Pine Park Retirement Inn
Case No. LV-2015-0099
Henderson County
Dear Permittee:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $259.26 ($100.00 civil penalty
+ $159.26 enforcement costs) against Emeritus Corp DBA Pine Park.
This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report
(DMR) submitted by Emeritus Corp DBA Pine Park for the month of February 2015. This review has shown the
subject facility to be in violation of,the discharge limitations and/or monitoring requirements found in NPDES Permit No.
NC0069370. The violations, which occurred in February 2015, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Emeritus Corp DBA Pine Park violated the terms,
conditions or requirements of NPDES Permit No. NCO069370 and G.S. 143-215.1(a)(6) in the manner and extent
shown in Attachment A. In accordance with -the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may
be assessed against any person who violates the terms, conditions or requirements of a permit required by G.S.
143-215.'1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the
Secretary of the Department of Environment and Natural Resources and the Director of the Division of Water
Resources, I, G. Landon Davidson, Regional Supervisor, Asheville Regional Office hereby make the following civil
penalty assessment against Emeritus Corp DBA Pine Park:
2090 U.S. 70 Highway, Swannanoa, NC 28778
Phone: [phone] Internet: wwtiv.ncdenr.gov <hup:/Avww.ncdencgov>
An Equal Opportunity'\. Affirmative Action Employer- Made in put by recycled paper

$100.00 1 of the 1 violations of 143-215.1(a)(6) and NPDES Permit No.NC0069370, by discharging
waste water into the waters of the State in violation of the Permit Daily Maximum for FEC
COLI.
0.00 0 of the 1 violations of 143-215.1(a)(6) and NPDES Permit NO.NC0069370, by discharging
waste water into the waters of the State in violation of the Permit Daily Maximum for TSS -
Conc.
$100.00 TOTAL CIVIL PENALTY
$159.26 Enforcement Costs
$259.26 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact
and Conclusions of Law and the factors set forth at G.S. 14313-282. 1 (b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the Environmental
Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Within thirty (30) days of receipt of this notice, you must do one of the following:
(1) Submit payment of the penalty, OR
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural Resources =(do not
include waiver form). Payment of the penalty will not foreclose further enforcement action for any continuing or
new violation(s). Please submit payment to the attention of-
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina.27699-1617
PA

Option 2: Submit a written request for remission or mitigation including a detailed
justification for such request:
Please be aware that a request f6r remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty. assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained
in the civil penalty assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation
and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why
you believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address listed
below. In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 14313-282.1(b) was wrongfully
applied to the detriment of the petitioner;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of the Division of Water Resources will review your evidence and inform you of his decision
in the matter of your remission request. The response will provide details regarding the case status, directions for
payment, and provision for further appeal of the penalty to the Environmental Management Commission's Committee
on Civil Penalty Remissions (Committee). Please be advised that the Committee cannot consider information that
was not part of the original remission request considered by the Director. Therefore, it is very important that you
prepare a complete and thorough statement in support of your request for remission.
In order to request remission, you must complete and submit the enclosed "Request for Remission of Civil Penalties
Waiver of Right to an Administrative Hearing and Stipulation of Facts" form within thirty (30) days of receipt of this
notice. The Division of Water Resources also requests that you complete and submit the enclosed "Justification for
Remission Request."
Both forms should be submitted to the following address:
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
9

Option 3: File a petition for an administrative hearing with the Office of Administrati
Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an
administrative hearing. You' may obtain the petition form from the Office of Administrative Hearings. You must file
the petition with the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is
considered filed when it is received in the Office of Administrative Hearings during normal office hours. The Office of
Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.,
except for official state holidays. The petition may be filed by facsimile (fax) or electronic mail by an attached file
(with restrictions) - provided the signed original, one (1) copy and a filing fee (if a filing fee is required by NCGS
§150B-23.2) is received in the Office of Administrative Hearings within seven (7) business days following the faxed
or electronic transmission. You should contact the Office of Administrative Hearings with all questions regarding the
filing fee and/or the details of the filing process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Tel: [phone]
Fax: [phone]
One (1)`copy of the petition must also be served on DENR as follows:
Mr. Sam M. Hayes, General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh, North Carolina 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal
date/time received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for
collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations
that occur after the review period of this assessment.
4

any questions, please contact Janet Cantwell with the Division of Water Resources staff of the Asheville
ice at [phone] or via email [e-mail].
Sincerely,
A
for S. Jay Zimmerman, P.G.
Director, Division of Water Resources, NCDENR
By G. Landon Davidson, Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDENR
ATTACHMENTS
Cc WQS ATsl vtl,ORe i no aliOOffee.=nforceinentvFile _ (w/attachments)
NPDES Compliance/Enforcement Unit - Enforcement File (w/attachments)
Central Files, Water Quality Section (w/attachments)
5

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV-2015-0099 County: Henderson
Assessed Party: Emeritus Corp DBA Pine Park
Permit No.: NC0069370 Amount Assessed: $259.26
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For
Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of
this civil penalty. You should attach any documents that you believe support your request and are necessary for the
Director to consider in evaluating your request for remission. Please be aware that a request for remission is limited to
consideration of the five factors listed below as they may relate to the reasonableness of the amount of the civil penalty
assessed. kequesting remission is not the proper procedure for contesting whether the violation(s) occurred or the
accuracy of any of the factual statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. § a:
143B-282.1(c), remission of a civil penalty may be granted only when one or more of the following five factors apply.
Please check each factor that you believe applies to your case and provide a detailed explanation, including copies of
supporting documents, as to why the factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b) were wrongfully applied to
the detriment of the petitioner (the assessment factors are listed in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the violation (i.e., explain the
steps that you took to correct the violation and prevent future occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain why the violation was unavoidable or
something you could notprevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance).
EXPLANATION:

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF HENDERSON
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
Emeritus Corp DBA Pine Park )
Pine Park Retirement Inn 1
PERMIT NO. NCO069370 ) CASE NO. LV-2015-0099
Having been assessed civil penalties totaling $259.26 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated June 23, 20153 the undersigned, desiring to seek remission of the civil penalty, does
hereby waive the right. to an administrative hearing in the above stated matter and does stipulate that the facts are as
alleged in the assessment document. The undersigned further understands that all evidence presented in support of
remission of this civil penalty must be submitted to the Director of the Division of Water Resources within thirty (30) days
of receipt of the notice of assessment. No new evidence in support of a remission request will be allowed after (30) days
from the receipt of the notice of assessment.
This the
day of
20
ADDRESS
TELEPHONE
SIGNATURE

ATTACHMENT A
Emeritus Corp DBA Pine Park
CASE NUMBER: LV-2015-0099
PERMIT: NCO069370 FACILITY: Pine Park Retirement Inn COUNTY: Henderson REGION: Asheville
Limit Violations,
MONITORING OUTFALL / VIOLATION UNIT OF CALCULATED , % OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE
$100.00 2-2015 001 Effluent FEC COLT 2/10/15 Weekly #/l00ml 400 600 50.0 Daily Maximum Exceeded
$0.00 2-2015 001 Effluent TSS - Cone 2/3/15 Weekly mg/I 45 49 8.9 Daily Maximum Exceeded

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (FILE)
Violator: Pine Park Retirement / NCO069370
(February 201.5 DMR)
County: Henderson
Case Number: LV-2015-0099
8 ASSESSMENT FACTORS
As required by G.S. 143-214.6A(c), in determining the amount of the penalty I considered the factors set out in
G.S. 143B-282.1(b), which are:
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
All effluent violations may be detrimental to the receiving stream but may not be
immediately quantified.
2) The duration and gravity of the violation;
One Daily Max Fecal Coliform exceeded the permit limit by 50%.
One Daily Max TSS exceeded the permit limit by 8.8%.
3) The effect on ground or surface water quantity or quality or on air quality;
All effluent violations may be detrimental to the receiving stream but may not be
immediately quantified.
4) The cost of rectifying the damage;
The cost is unknown.
5) The amount of money saved by noncompliance;
The amount of money saved would include the cost of excess solids removal and
additional aeration. It would also include more operating and maintenance time on site
and the cost of additional chemical treatment.
6) Whether the violation was committed willfully or intentionally;
It does not appear to be either.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority; and
There have been no civil penalty enforcements in the twelve months prior to this
violation.
8) The cost to the State of the enforcement procedures.
$159.26.
l
Date G. Landon Davidson, Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office, NCDENR
06/23/2015

EFFLUENT
,,ERMIT NO. NCO069370 DISCHARGE NO. 001 MONTH
UTY NAME Pine Park Retirement Inn Class II
OPERATOR IN RESPONSIBLE CHARGE (OR, Trevor C. McMinn GRADE
CERTIFIED LABORATORIES(1) ETS Inc. 2
CHECK BOX IF ORC HAS CHANGED PERSON(S) COLLECTING SAMPLES
Mail ORIGINAL and ONE COPY to:
ATT; CENTRAL FILES
DIV. OF WATER QUALITY .
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
(FIZ4 4w))
February YEAR 2015
Henderson
II PHONE [phone]
Cert #600
Trevor McMinn
x �/1@�1rOL C. 3/5/2015
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) . DATE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
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Facility Status: (Please Check one of the following)
All monitoring data and sampling frequencies meet permit requirements F-1
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirement: ❑X
Noncompliant
If the facility is noncompliant, Please comment on the corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a time table for improvements to be made.
2/3/2015 high TSS reduced D.O. no further occurance.
2/10115 High Fecal Coliform Pump truck and wash down Chlorine Contact no further occurance.
" I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a systems deli g lied to assure that qualified
Y 9 q personnel properly, gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
bfo0trakRR submitted is, tolge, est.of my knowledge.and belief, true; accurate, and complete_ I am aware that there are significant
penalties,for�sUbmittio9.!aJse information, including the possibility of fines and imprisonment for knowing violations."
Pine Park Retirement Inn
Permittee (Please pint or type:)
015
Signature of. Permitted" Date
,64 East, Hendersonville, NC 28792 828-891--6640 11/30/2015
Permittee Address Phone Number Permit Exp. Date
PARAMETER CODES `
00010 Temperature 00556 Oil & Grease 00951 Total Fluoride ;01067 Nickel' 50060 Total
00076 Turbidity 00600 Total Nitrogen 01002 Total Arsenic 01077 Silver Residual
00080 Color (Pt -Co) 00610 Ammonia Nitrogen 01092 Zinc Chlorine -
00082 Color (ADMI) 00065 Total ICjeldhal 01027 Cadmium 01105 Aluminum
Nitrogen
00095 Conductivity 00630 Nitrates/Ni"es 01032 Hexavalent Chromiurr `01147 Total selenium 71880. Formaldehyde
00300 Dissolved Oxygen 01034 Chromium 31616 Fecal Colfforn 71900 Mercury
00310 BOD s 00665 Total Phosphorous 32730 Total Phenolics 81551 Xylene _
00340 COD 00720 Cyanide 01037 Total Cobalt 34236 Benzene
00400 pH 00745 Total Sulfide 01042 Copper 34481 Toluene
00.530 Total Suspended 00927 Total Magnesium 38260 MBAs
Residue 00929 Total Sodium 01045 Iron „39516 PCBs
00545 Settleable Matter '00940 Total Chloride 01051 Lead '50050 Flow
Parameter Code assistance may obtained by calling the Water Quality Compliance Group at (919) MM083, extension 581 or 534.
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only'units designated in the reporting
facility's permit for reporting data
* ORC must visit facility and document visitation of facility as
dY required per 15J NCAC 8A .0202 (b) (5) (B).
"If siged by other than the-permitee, delegatiorrof signatory -authority must be on file with;the state per 15A NCAC 28 :0506 (b).

NCDEN i
North Carolina Department of Environment and Natural Resources .
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 14, 2015,
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7014 0510.0000 4466 5764:
Ms. Joy Hougan, Executive Director
Emeritus Corp. DBA Pine Park'
Pine Park Retirement Inn
2601 U.S. Hwy 64'East
Hendersonville, North Carolina 28792
Subject: Notice of Violation and
Recommendation for Enforcement
Tracking #: NOV-2015-LV-0314 `
Pine Park`Retiremeiit Inn WWTP
NPDES Permit No. NC0069370
Henderson County
Dear Ms. Hougan:
A review of the February 2015 self -monitoring report.for the subject facility revealed violations of the
following parameters:
U
Date
Outfall
Parameter.
Reported Value
Permit Limit
02/10/2015
001
Fecal
-600 #/ 100ml
400 #/ 100ml
02/03/2015
- 001
TSS
.49 mg/ L
45 mg/ L
A Notice of Violation/ Notice of Recommendation for Enforcement (NOV/ NRE) is being issued for the
noted violation of North Carolina General Statute. (G.S.) 143-215.1 and NPDES Permit No. NC0069370.
Pursuant to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($25,000.00) may be
assessed against any person who violates or fails to act in accordance with the terms, conditions; or
requirements of any permit issued pursuant to G.S. 143-215.1. If you wish to provide additional information
regarding the noted violation, request technical assistance, or discuss overall compliance please respond in
writing within ten (10) days after receipt of this -Notice. Areview of your response will be considered along
with any information provided on the. February. 2015Discharge Monitoring Report. You will then be notified
of any civil _penalties that may be assessed regarding the violations. If no response is received in this Office.
within the 10-day period, a civil penalty assessment may be prepared.
Water Quality Regional Operations —Asheville Regional Office
2090 U.S. Highway 70., Swannanoa, North Carolina 28778
Phone: [phone] FAX: [phone]
Internet: hftp://portal.ncdenr,orglweb/wq
An Equal Opportunity/ Affirmative Action Employer

Ms. Joy Hougan
May 14, 2015 J
Page Two
Remedial actions, if not already implemented, should be taken to correct any problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of
a continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent. You may
contact this office for additional information.
If you have questions concerning this matter, please do not hesitate to contact Janet"Cantwell or
me at 828/296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations, NCDENR
Asheville Regional Office
cWQ_Ashevslle Files
MSC 1617 Centr' Fil s Basement
WQ Enforcement/ NPDES Point Source Branch
GPnrk Inn 593MN04' .NRE-2M-LV-0314.doc

NC®ENR
North Carolina Department of Environment and Natural. Resources
Pat McCrory -,Donald R. van der Vaart
Governor Secretary
May 14, 2015
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7014 0510 0000 4466 5764
Ms. Joy Hougan, Executive Director
Emeritus Corp. DBA Pine Park
Pine Park Retirement Inn
2601 U.S. Hwy 64 East
Hendersonville, North Carolina 28792
Subject: Notice of Violation and .
Recommendation for Enforcement
Tracking #:, NOV-2015-LV-0314
Pine Park Retirement Inn WWTP
NPDES Permit No. NCO069370
Henderson County
Dear Ms. Hougan:
A review of the February 2015 self -monitoring report for the subject facility revealed violations of the
following parameters:
Date
Outfall
Parameter
Reported Value
Permit Limit
02/10/2015
001
Fecal
600 #/ 100ml
400 #/ 100m1
02/03/2015
001
TSS
49 mg/ L
, 45 mg/ L
A Notice of Violation/ Notice of Recommendation for Enforcement (NOV/ NRE) is being issued for the
noted violation of North Carolina General Statute (G.S.) 143-215.1 and NPDES Permit No. NC0069370.
Pursuant to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($25,000.00) may be
assessed against any person who violates or fails to act in accordance with the terms, conditions, or
requirements of any permit issued pursuant to G.S. 143-215.1. If you wish to provide additional information
regarding the noted violation, request technical assistance, or discuss overall compliance please respond in
writing within ten (10) days after receipt of this Notice. A review of your response will be considered along
with any information provided on the February 2015 Discharge Monitoring Report. You will then be notified
of any civil penalties that may be. assessed regarding the violations. If no response is received in this Office
within the 10-day period, a civil penalty assessment may be prepared.
Water Quality Regional Operations — Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, North Carolina 28778
Phone: [phone] FAX: [phone]
Internet: hftp://portal.ncdenr.org/webtwq
An Equal Opportunity/ Affirmative Action Employer

Ms. Joy Hougan
May 14, 2015
Page Two ,
Remedial actions, if not already implemented, should be taken to correct any problems. The Division of
Water Resources may pursue enforcement actions for this and any additional violations. If the violations are of
a continuing nature, not related to operation and/or maintenance problems, and you anticipate remedial
construction activities, then you may wish to consider applying for a Special Order by Consent. You may
contact this office for additional information.
If you have questions concerning this matter, please do not hesitate to contact Janet Cantwell or
me at 828/296-4500.
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations, NCDENR
Asheville Regional Office
cc: WQ Asheville Files
MSC 1617-Central Files -Basement
WQ Enforcement/ NPDES Point Source Branch
G;`:W"R`•.LYQ`klenQerson\l4'astelvaizrs�linor fine Porkllin!i93?6`tNOV-i\RE?Q1-L4'-0314.doc

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2090 U.S. Highway 70, Swannanoa , Nc 281 8
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JOANNE J BAKER.-_ .
EMERITUS CORPORATION
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Water Quality Regional Operations Section .- - ICE �;a--
2090 U.S. Highway70
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Greg Penfold, Executive Director
Emeritus Corp d/b/a Pine Park
2601 US Highway 64 E
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Division of Water Resources
Water Quality Operations Section
2090 U.S. Highway 70 —
Swannanoa, NC 28778-8211
Greg Penfold, Executive Director
Emeritus Cor a Pine Park
2601 US Hig 64 E
HendersonvilIE"C 28792
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Greg Penfold, Executive Director
Emeritus Corp d/b/a Pine Park
2601 US Highway-64-E _
Hendeiso`nville, N'C. �213792
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NCOEO-OWR-WQROS
2090 U.S. HIGHWAY 70
SWANNANOA NC 28778
in this box*

■ Complete items 1, 2, and 3. Also complete
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�'� Division of Water Resources
NC®ENR V Water Quality Regional Operations Section
2090 US. Highway70, Swannanoa, NC 28778
Joy Hougan,_ Executive Director
Emeritus'Corp°DBA Pine Park
2601 U S High"w,ay 64 East
Hendersonville, NC 28792
3, Se�ice Ty pe eCertified Mail® ❑ Priority Mail Express'"
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UNITED STATEV-P S
• nde"r." Please print your name, address,iP
JANET CAN
NCDENR-DIVV
2090 U.S' HIG
SWANNANOA
Fifst-Cfsss Mail
TIIRQstage &-Fees Paid
I .
Permit G-1 0
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71

■ Complete iteriis'tA—and S. Also complete
item 4 it'Restricte&Delivery is desired.
■ Print your name ani# address on the reverse
so that we can return the card to you.
Of
North Carolina Department of
Environment and Natural Resources � different from item 1? ❑ Yes
ery address below: El No
Division of Water Resources
Ater Quality Regional Operations Section
.S.. Highway.70, S�wannanoa, NC 28778
Joy Hoingan, Executivd Director
Emeritus Corp DBA Pine Park
Pine Park Retirement Inn
2601 U S Highway 64 East
Hendersonville, NC 28792
iniriiriiriniiiiiunillnIIII
Se ice Type
Certified Mail® ❑ Priority Mail Express'"
Registered Return Receipt for Merchandise
❑ Insured Mai Collect on Delivery
4. Restricted Delivery? (Extra Fee) ❑ Yes
7014�T 051p 0000 4466 5764o11-ao/ LV -U3/ q
PS Form 3811 ;July 2013. s 's Domestic Return Receipt

UNITED STATES II Fi
t -C
lass Mail
Pst e& Fees Paid
SPS
Permit o.-10 • Sende�lr'roi e-,.>a s-b print your name, address, and /ZIf/ Althis box•
�qzeP
JANET CANTVVELI."'/
NCI)ENR-DWR'WQR,
2090 U.S.HIGHWAY 7ON
SWANNANOA NC 28778"-\ ` OL
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