NC0044199_Regional Office Physical File Scan Up To 1/14/2021

Y
October 19, 2006
Ms. Robyn Blanco
LSAA, Inc. dba Sam's Mart
6407 Idlewild Road. Suite 204
Charlotte, North Carolina 28212
Y Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Subject: NPDES PERVHT ISSUANCE
Permit Number NCO044199 .
Sam's Mart #45
Haywood County
Dear Ms. Blanco
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 May 9,
1994 (or as subsequently amended). The following changes have been incorporated into this final
permit: '
➢ Your expiration date for this permit has been changed to January 31, 2011.
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 permit shall be final and binding.
Please take notice that 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 Carolyn Bryant of my staff at [phone], extension
363.
Sincerely,
t� Alan W. Klimek, PIE.
cc: Central Files i
NPDES Unit Files
A��s'heuille Regional Office,Sur, ace Water Protection rOCT 006 01
ECTION
AL OFFICE
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1617 - TELEPHONE [phone]/FAX [phone]
-VISIT US ON THE WEB AT http://h2o.enr.state.nc.us/NPDES

w
Permit NCO044199
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act, as amended,
LSAA, Inc. dba Sam's Mart
is hereby authorized to discharge wastewater ffom a facility located at
r Sam's Mart #45
NC Highway 209, off I-40
North of Waynesville
Haywood County
to receiving waters designated as the Pigeon River in the French Broad River basin in accordance with
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective December 1, 2006.
This permit and authorization to discharge shall expire at midnight on January 31, 2011.
Signed this day October 19, 2006.
�t
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO044199
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.
LSAA Inc. dba Sam's Mart. is hereby authorized to:
1. Continue to, operate an existing 0.015 MGD wastewater treatment facility with the
following components:
♦ Two modular grease inteceptor units
♦; Aeration basin
♦ Clarifier with sludge return
The facility is located at LSAA Inc. dba Sam's Mart"#45, at NC Highway 269 off I-
40, north of Waynesville, Haywood County.,
2. Discharge from said treatment works at the location specified on the attached map
-into the Pigeon River, which is classified Class C waters in the French Broad River
basin.

Dbdmge Locaflan
: .. Facility Information
Latitude:
&34'01" Sub -Basin- 04-OM5
Longitude:
82'57'23"
QuadNarne
Clyde
Steam Class:
C
Receiving Sham
pigeon River

M
Permit NC0044199
V
A. (1..) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on December 1, 2006 and lasting until expiration, the
Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
EFFLUENT -
;;- LIMITS F
Y 1 MONITORING REQUIREMENTS s;
CHARACTERISTICS
u 4
{9
Monthly Average
Daly Maximum
Measurement
Sample Type
Sample
Frequency .
Location
Flow
0.015 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5 day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
NH3 as N
2/Month
Grab
Effluent
Temperature (°C)
Weekly
Grab
Effluent
pH
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2.) FECAL COLIFORM CONDITION
In the event that violations of the North Carolina water quality standards for fecal coliform
occur .as a result of this discharge, disinfection will immediately be required and the permit
amended to establish a coliform effluent limitation.

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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.
. 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 periodfrom midnight of one day until midnight of the neat 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
October through December.
March, April through June, July through September, and
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 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.
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. 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 for conventional and other non -toxicant parameters.
NOTE: Permittees may not submit a "daily average' calculation for determining compliance with permit limits for
toxicants. See the relevant Federal effluent guideline[s] for the appropriate calculation interval.
Da4 Sg=Eng
Parameters requiring daily sampling shall be sampled 5 out 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).
DWQ 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 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).
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 Average (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 Emitl
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)(1) of the Clean Water Act.
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 Emitl
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 knowing 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 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)(1) 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 $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. Sever_ ability
The provisions of this pernut 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 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 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 Reapyly
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 and33 USC 1251 et. seq.
11. Sj=atogy 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 122.221:
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 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 perrimit 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 Title 40, Code of Federal Regulations, Parts 122 and 123; Title 15A of the North Carolina
Administrative Code, Subchapter 214 .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) (2)
may cause this Division to initiate action to revoke the permit.
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.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 vacancyin 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. . 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
H. 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.
(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
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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) 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)]: 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
L . 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: 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.
5. 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 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;
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 122.41 (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).
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 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 122.41 (1) (3)].
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, 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 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, 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 Divi' ion'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 122.41 (1) (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. 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
Penn-,Littees 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 planes 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";
(i) One hundred micrograms per liter (l00 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 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 µg/L);
(2) One milligram per liter (l 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.
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.
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. 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;
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 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 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).
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 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 21-1 .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 (SUOI
The Permittee shall maintain adequate legal authority to implement its approved pretreatment program.
2. Industrial Waste Survey IW� Sl
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 ajTA) 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 122.44]. 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 allPP) & 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 Q
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.
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. 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. SILT Self Monitoring and Reps
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 ZH .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 (PARS
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 (PPSI
A pretreatment program summary (PPS) on specific forms approved by the Division;
c.) Significant Non -Compliance Report (�jN=
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 (SF1
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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 NCAC 2H .0114 and
15A NCAC 2H .0907.
Version 6/20/2003

Frazier, Wanda
From: Frazier, Wanda
Sent: Monday, November29, 2010 12:26 PM
To: Weaver, Charles
Cc: Edwards, Roger; Pugh; James L.
Subject: NCO044199 Sam's Mart DRAFT permit renewal
Attachments: NCO044199 a cover page 2010.doc; NCO044199 Sams
Mart #45 DRAFT permit 2010.doc; NCO044199 Sams Mart
#95 box 2010.doc; NCO044199 Sams Mart map 2010.ppt;
NCO044199 Sams Mart #95 expedited fact sheet
2010.doc
Hi Charles,
Here are my comments for the permit renewal for NCO04419 Sam's'Mart #45.
Attached is the most recent facility cover page.
Here's what I would suggest for the draft permit:
Supplement to permit cover page: (see attachment)
Continue to operate:
0.015 MGD extended aeration package plant consisting of:- 2 modular grease interceptor units;
influent.lift station; manual bar screen; aeration basin with dual blowers providing diffused
air; clarifier with skimmer and sludge returns.
Everything else looks good.
ARO recommends renewal of this permit.
Thanks,
Wanda
Wanda^Frazier
Email: Wanda.Frazier(@ncdenr.gov-
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.
-----Original Message -----
From: Weaver, Charles
Sent: Wednesday, November 03, 2010 10:51 AM
To: Frazier, Wanda; Pugh, James L.
Subject: DRAFT permit renewal for NCO044199
Importance: High
This is a class WW-2 facility in Haywood County.
This draft will got o Notice on 11/10/2010. Please send me any comments by 11/29/2010.
Thanks,
CHW
Messages sent to or from this address are subject to the North Carolina Public Records Law.
2

FACT S EET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles H. Weaver — 11/2/20 10
Permit Number
NCO044199
Facility Name
Sam's Mart #45WWTP
Basin Name/Sub-basin number
French Broad / 04-03-05
Receiving Stream
Pigeon River
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
N/A
Does permit need TRC limits/language?
N/A
Does permit have toxicity testing?
No
Does ermif have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No
Any permit mods since lastpermit?
No
New expiration date
1/31/2016
Comments received on Draft Permit?
Most Commonly Used Expedited Language:
• 3.03(d) language for Draft/Final Cover Letters: "Please note that the receiving stream
is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with permitted effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"The facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values below 50 µg/1 will be treated as zero
for compliance purposes."

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Haytham Kasem
Sam's Mart, Inc.
7935 Council Pl, Suite 200
Matthews, N.C. 28105
Dear Ms. Kasem:
The Division has revi(
ensure your thorough
The draft permit incl
Division of Water Quality
Coleen H. Sullins
Director
November 10, 2010
Subject: Draft NPDES Permit NCOO44199
Sam's Mart #45 WWTP
Class WW-2
Haywood County
Dee Freeman
Secretary
your request to renew the subject permit. Please review this draft carefully to
rstanding of the information, conditions, and requirements it contains.
no significant changes from the existing permit:
With this notification, the ivision will solicit public comment on this draft permit by publishing a notice in
newspapers having circulation in the general Haywood County area, per EPA requirements. Please
provide your commentr,, if any, to me -no later than 30 days after -receiving this draft permit.
Following the 30-day put
appropriate action prior 1
me at the telephone num.
cc: NPDES Unit
1617 Mail Service Center, Raleigh,)
512 North Salisbury Street, Raleigh,
Phone: [phone] / FAX 919 8(
[e-mail]
.c comment period, the Division will review all pertinent comments and take
issuing a final permit. If you have questions concerning the draft, please contact
3r or e-mail address listed at the bottom of this page.
orth Carolina 27699-1617
Vorth Carolina 27604
-6495 / Internet: www.ncwaterquality,org
Sincerely,
Charles H. Weaver, Jr.-
NPDES Unit
Nne
orthCarohna
A119turody
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Permit NCO044199
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act, as amended,
LSAA, Inc. dba Sam's Mart
is hereby authorized to discharge wastewater from a facility located at
Sam's Mart #45
3360 Crab Tree Rd @ NC Highway 209
Waynesville
Haywood County
to receiving waters designated as the Pigeon River in subbasin 04-03-05 of the French Broad River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III and rV hereof.
This permit shall become effective
This permit and authorization to discharge shall expire at midnight on January 31, 2016.
Signed this day
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO044199
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.
LSAA Inc. dba Sam's Mart is hereby authorized to:
1. Continue to operate an existing 0.015 MGD wastewater treatment facility that
includes the following components:
♦ Two modular grease interceptor units
♦ Aeration basin
♦ Clarifier with sludge return
The facility is located at Sam's Mart #45, on Crab Tree Rd at NC Highway 209
north of Waynesville in Haywood County.
2. Discharge from said treatment works at the location specified on the attached map
into the Pigeon River, currently classified C waters in hydrologic unit 06010106 of
the French Broad River Basin.

Permit NCO044199
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until
expiration, the Permittee is authorized to discharge,from outfall 001. Such discharges shall
be limited and monitored by the Permittee as specified below: .
. PARAMETER.'.'
LIMITS
MONITORING REQUIREMENTS
[PCS Code]
Monthly Average
Daily Maximum
Measurement
Sample Type
Sample
Frequency
Location
Flow
0.015 MGD
Weekly
Instantaneous
Influent or
[500501
Effluent
BOD, 5 day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
C0310
Total, Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
C0530
NH3 as N
2/Month
Grab
Effluent
C0610
Temperature (°C)
Weekly
Grab
Effluent
00010
pH
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
00400
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2) FECAL COLIFORM CONDITION
In the event that violations of the North Carolina water quality standards for fecal coliform
occur as a result of this discharge, disinfection will immediately be required and the permit
re -opened to include a fecal coliform effluent limit.

i
Uffa I —I
oj
a
�= Discharge Location «�
l,\ II y
is
41,
nzal
i
r
\ f, O cJ
ts
�• �-%tic. L---r-a,.r---�, `^: ' _ � �-�j�
N 0044199 - a m's Mart -#�5l Facility
35034'O1" Sub -Basin: 04-03-05
,ude:
82057'23" River Basin: French Broad
[lame:
Clyde Hydrologic Unit: 06010106
a Class:
C
ing Stream: Pigeon River
Location
Haywood County
Map not to scale

Beverly Eaves Perdu
Governor
A=w
NEE R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
e �-��•--w� ..,,. ,ee reeman
Director f Secretary . .
July 30, 2010
HAYTHAM KASEM
MAINTENANCE AND ENVIRONMENTAL MANAGER
LSAA INC DBA SAM'S MART
7935 COUNCIL PLACE
SUITE 200
MATTHEWS NC 28105
Dear Mr. Kasem:
(i
AUG - 3 2010
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
Subject: Receipt of permit renewal application
NPDES Permit NCO044199
Sam's Mart #45
Haywood County
The NPDES Unit received your permit renewal application on July 28, 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 Charles
Weaver at [phone].
Sincerely,
Dina -Sprinkle
Point Source Branch
cc: CENTRAL FILES
AslevineRegional®fic/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone]A FAX: [phone] \ Customer Service:1-877-623-6748 N&Marollna
Internet: www.ncwatercluality.org
An Equal Opportunity \ Affirmative Action Employer t d

4
sums LSDAt mart
, jjj
July 26, 2010
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Point Source Branch
1617 Mail service Center
Raleigh, NC 27699-1617
1- J
Attention: Mrs. Dina Sprinkle
Reference: Renewal Notice
NPDES Perrui*L160-04*199V
Sam's Mart #45
3360 Crab Tree Road at NC Hwy 209
Waynesville, Haywood County, NC 28785
Dear Mrs. Sprinkle:
AUG - 3 2010
i
J
WAITER QUALITY SECTION
ASHr-VILLE REGIONAL OFFICE
This letter is a request to renew the NPDES Permit (Pen -nit #NC0044199) for the waste
treatment facility located' at Sam's Mart #45.
Sincerely,
-&a'eharn Kasem
Maintenance & Environmental manager
7935 Council,Place, Suite 200
Matthews, NC 28105
Phone [phone] - Fax [phone]

,.IDES 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 Quality / NPDES Unit
1617 Mail. Service Center, Raleigh, NC 27699-1617
NPDES Permit INCOO 4`j' $ 9
If you are completing this form in computer use the TAB kerb 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 LSA A . Lye_ J Lai &W6A&f
Facility Name say-;.'
Mailing Address -19 31 C 0 A 1A CA L P I A-,e- 20-o
City (vl a t-LL eiz -5
State / Zip Code VQ Ce 2 0-5-
Telephone Number T)" .) 7- 9-4 Zc.F
Fax Number (- 701f) j 7 — Pf 3 'I_
e-mail Address
4 Co wi
2. Location of facility producing discharge:
Check here if same address as_above ❑
Street Address .or State Road
33 6 o Crak ..B rep: ' .acs
City dm ►L'-e s'/; II'e
State /Zip Code N G I-SZ- 7 94
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 J ayA e s �� l4ae s &W. M!) �. Vl
Mailing Address Q D A in X, _S;r1 9
city -Qn t'f-
*� s up
State /Zip Code L Z� ST
Telephone Number 6 3 J U L 2 8 2010
Fax Number DEAR-vtr/AT1=p ns Cai F.-V
1 of 3 Form-D 05108

r_ 1
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:
Describe the sources) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
se�v�ce sf��`on
Population served:
S. •Type of collection system
0 Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s) OT
Is the outfall equipped with a diffuser? ❑ Yes jr''No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfali):
S. Frequency of Discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration: _
i. Describe she 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.
o., 42�e-k ��j Witt,
a- w o YYAo A0&-v- rest i rote c-r in
CA
2 of 3 Form-D 05/08

-DES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow •Q 1 ^MGD
Annual Average daily flow 0 bo \ � MGD (for the previous 3 years)
Maximum daily flow 0 .(3 MGD (for the: -previous 3-years) .
11. Is this facility located on Indian country?
❑ Yes 0 No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliforrn, 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 maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
Ltj _ Z
(o , S
1 L
Fecal Coliform
Total Suspended Solids
Temperature (Summer)
23 , S
Z Z - f
Temperature (Winter)
pH
7-1
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES VVC 66 �t Dredge or fill (Section 404 or CWA)
Tr
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Printed 19ame of Person Signing
Applicant
Title
- Z (. 10
Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or 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.)
3 of 3 1 Form-D 05/08

C
James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
July 20, 2010
N. C: Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617 _
Regarding All Waste Water Facilities Operated by James & James
To Whom It May Concern:
Sludge from this facility (Sam's Mart #45) is pumped by Mike's Septic Tank Service and is permitted to
be dmnped at Brevard Waste Treatment System. and MSD.
Sincerely
Ju James
James and James Environmental Mgt., Inc.

O(C W A%RpG Michael F. Easley, Governor
William G. Ross ,r.; Secretary
rNorth Carolina Department of Envux mnent and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
April 29, 2005
Adnan Jazairi 5r? l 5 ai f
6407 Idlewild Rd., S-204
Charlotte, North Carolina 28212
Subject: NPDES Permit Modification
Permit NCO044199
�— Thomas Drolen
fotmedy(Citgo Truck Stop ���f1�57-u4 71019)
Haywood County
�--? � �Ct ►'1G% �un�� y �#�G3�
Dear Mr. Jazairi:
Division personnel have reviewed and approved your request to transfer ownership of the subject permit,
received on April 27, 2005. This permit modification documents the change in ownership.
Please find enclosed the revised permit. All other terms and conditions contained in the original permit remain
unchanged and in full effect This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and, the U.S. Environmental
Protection Agency.
If you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
733-5083, extension 363.
cc: Central Files
---------------- --------- --
�A"sheville Regional 01�ce, Water Quality Section ;
NPDES Unit File
Sincerely,
Y-2 &&�
4a6nW.-
Klimek, P.E.
D
APR 2 9 2005
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
Nor[hCarolina
)Vatura!!y
North Carolina. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Intemet: h2o.encstaie.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]

ft
0 Permit NC0044199 ,
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-Z15.1, other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act, as amended,
LSAA, Inc. dba Sam's Mart
is hereby authorized to discharge wastewater from a facility located at the
LSAA, Inc. dba Sani's Mart #45
At NC Highway 209 off I-40
North of Waynesville
Haywood County
to receiving waters designated as the Pigeon River in the French Broad River basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I,
II, III and IV hereof:
This permit shall become effective April 29, 2005.
This permit and authorization to discharge shall expire at midnight on November 30, 2006.
Signed this day April 29, 2005.
fW
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

•
Permit NCO044199
SUPPLEMENT TO PERMIT COVER SHEET
LSAA Inc. dba Sam's Mart is hereby authorized to:
L. -,Continue to operate an existing 0.015 MGD wastewater treatment facility with the
following components: _...._
♦ Two modular grease inteceptor units
Aeration basin
♦ Clarifier with sludge return -
The facility is located at LSAA Inc. dba Sam's Mart #45, at NC Highway 209 off I-
40,. north of Waynesville, Haywood County.
2. Discharge from said treatment works at the location specified- on the attached- map
into the Pigeon River which is classified, Class: C waters in the French Broad River.
basin."

•
•
Permit NCO044199
A;., (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS — FINAL
During the period beginning on the effective date of the permit and lasting; until
expiration, the Permittee is authorized to discharge from outfall 001. Such discharges shall
be limited and monitored by the Permittee as specified below:
fFlyEiVTI#E%9
C AMACTEItIS'C10S
.. __ �. :.
MONii�1NGEiO(REMENTS .
Ahon�ily
. ;,t�►" . e.:;
`Weekly
_Arfera e,
Daly
`Maximum _
MeasuretnenE
,'f= u
Samffie'�pe
SatrNpfe location
Flow
0.015MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5 day (20°C)
30.0 mglL
45.0 mg/L.
Weekly
Grab
Effluent
Total Suspended Residue
30.0 mg&
45.0 n4L
weekly
Grab
Effluent
NH3 as N
Month
Grab
Effluent
Temperature (°C)
we"
Grab
Effluent
PHI
Weekly
Grab
Effluent
Footnotes-
1. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units and
shall be monitored weekly at the effluent by grab sample
There shall be no discharge of floating solids or visible foam in other than trace amounts:
A. (2.) FECAL COLIFORM CONDITION'
In the event that violations of the fecal coliform requirements of the North Carolina water
quality standards occur as a result of this discharge, disinfection will immediately be -
required and the permit amended to establish a coliform effluent limitation.

�\I
PAT MCCRORY
Govenior
Water Resources
ENVIRONMENTAL QUALITY
Robert M. Rose, Jr, Environmental Manager
Sam's Mart, Inc.
7935 Council Place, Suite 200
Matthews, North Carolina 28105
Dear Mr. Rose:
April 29, 2015
DONALD R. VAN DER VAART
.7ecremry
MMERMAN
r
Division of Water Resources `r
MAY 2 4 2016
Water nuality Regional Operations
Ashevi:•l'e 6 ice
Subject: Review of Permit D
NPDES NCO044199
Sams Mart #45 WWTP
3360 Crabtree Road, Waynesville
Haywood County
The Division of Water Resources (the Division) hereby issues the attached NPDES permit for the
subject facility. We issue this permit pursuant to the requirements of North Carolina General Statute,
143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency dated October 15, 2007, or as subsequently amended.
Changes for Renewal. The Division understands that you have made no, significant changes to your
treatment processes since last renewal. We have therefore made only minimal changes to your permit by
updating your permit format and site map. However, please note that electronic reporting of Discharge
Monitoring Reports (DMRs) is now required.
Implementing Electronic Discharge Monitoring Reports (eDMRs). Please be advised that the Division
has implemented an electronic Discharge Monitoring Report (eDMR) program, in accord with adopted
requirements by the Environmental Protection Agency (EPA). We include updated details to implement
the eDMR program in this permit [see Section A. (2.)].
Effective December 21, 2016, federal regulations require electronic submittal of all DMRs and specify
that, if North Carolina does not establish a program to receive such submittals, Permittees must then
submit eDMRs directly to EPA. For more information on eDMRs, registering for eDMR submittal, and
obtaining an eDMR user account, please visit DWR's webpage:
http://portal.ncdenr.org/web/wq/admin/bog/i Ll/p edmr
For information on EPA's proposed NPDES: Electronic Reporting Rule, please visit EPA's website:
http://www2.epa ov/com liance%roposed-ades-electronic-reporting-rule
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, North Carolina 27699-1611
919 707 9000

Robert M. Rose, Jr
Sam's Mart, Inc.
February 24, 2016
Page 2
If any parts, in frequencies, or sampling requirements contained in this permit are
unacceptable, you have the right to an adjudicatory hearing, upon written request submitted within
thirty (30) days after receiving this letter. Your request must take the form of a written petition
conforming to Chapter 1-50B of the North Carolina General Statutes, and you must file it with the office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless
such a demand is made, this permit shall be final and binding.
This permit is not transferable except after notifying the Division of Water Resources. The Division
may require permit modification, or revocation and re -issuance. Please note that this permit does not
affect your legal obligation to obtain other permits required by the Division of Water Resources, the
Division of Land Resources, the Coastal Area Management Act, or other federal or local governments.
If you have questions, or if we can further assist you, please contact Joe Corporon at
[joe.coi ooron a ncdenr.gov] or call [phone].
pe tfully,
S. Jay Zimmerman, P.G.
Enclosure: NPDES Permit NCO044199 (issuance final)
he: NPDES Program Files
ARO/SWPS, Landon Davidson
Central Files
ec: ARO/SWPS, Landon Davidson
OCU, Maureen Kinney

Permit NCO044199
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES) v
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,
Sam's Mart, Inc.
is hereby authorized to discharge wastewater from a facility located at
Sam's Mart #45
3360 Crab Tree Road @ NC Highway 209, Waynesville
Haywood County
to receiving waters designated as the Pigeon River in subbasin 04-03-05 of the French Broad River
Basin in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, II, III and IV hereof.
This permit shall become effective June 1, 2016.
This permit and authorization to discharge shall expire at midnight on January 31, 2021.
Signed this day April 29, 2016.,._
immerman, P.G. Director
Division of Water resources
By Authority of the Environmental Management Commission
Page I of 5

Permit NCO044199
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.
Sam's Mart, Inc.
is hereby authorized to:
1. continue to operate an existing 0.015 MGD extended -aeration wastewater treatment facility
utilizing;
♦ two (2) modular grease -interceptor units
♦ influent lift station
♦ manual bar screen
♦ aeration basin with dual (2) blowers providing diffused air
♦ clarifier with skimmer and sludge return
these facilities located at Sam's Mart#45, 3360 Crab Tree Road (at NC Highway 209) north of
Waynesville in Haywood County, and
2. discharge from said treatment works via Outfall 001, at the location specified on the attached map,
into the Pigeon River [stream segment 5-(7)], currently classified C waters within subbasin 04-03-05
WC 06010106] of the French Broad River Basin.
Page 2 of 5

Permit NCO044199
Part I
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq.; 02B .0500 et seq.]
During the period beginning on the effective date of this permit and'lasting until expiration, the
Permittee is authorized to discharge from Outfall 001. Such discharges shall be limited, monitored, and
reported 1 by the Permittee as specified below:
EFFLUENT .
CHARACTERISTICS.
.. .-Paranzeter-Code]
LIIVI,ITS -
1VIONITOR-WGREQUIREIVIENTS
Monthly
Average.:
Daily.., .
, Maximum
Measurement
.. Frequency
Sample
Type
Sample
Lgeafion'
Flow
50050
0.015 MGD
Weekly
Instantaneous
Influent or
Effluent .
BOD, 5 day (20°C)
C0310
30.0 ing/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Temperature (°C)
00010
Weekly
Grab
Effluent
pH'
00400
Not < 6.0 nor > 9.0 s. u.
Weekly
Grab
Effluent
Ammonia [NH3 as N]
C0610
2/1\4onth
Grab
Effluent
Footnote:
1. Effective December 21, 2016, the permittee shall report discharge monitoring data
electronically using the NCDWR's Electronic Discharge Monitoring Report (eQMR)
internet application [see section A. (3.)].
Condition: The Permittee shall discharge no floating solids or foam.
A. (2.), FECAL COLIFORM CONDITION
[G.S. 143-215.3(a)(2)] and/or [G.S. 143-215.66]
In the event that violations of North Carolina water -quality standards for fecal coliform occur as, a result
of this discharge, disinfection will immediately be required and the" permit re -opened to include a fecal
coliform effluent limit. -
A. (3.) ELECTRONIC REPORTING - DISCHARGE MONITORING REPORTS
[G.S. 143-215.1(b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program
reports and specify that, if a state does not establish a system to receive such submittals, then permittees
must submit monitoring data and reports electronically to the Environmental Protection Agency (EPA).
The final NPDES Electronic Reporting Rule was adopted and became effective on December 21, 2015.
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Permit N00044199
NOTE: This special condition supplements or supersedes the following sections within Part II of this
permit (Standard Conditions for NPDES Permits):
• Section B. (11.)
• Section D. (2.)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reporting Requirements CSupersedes Section D. (2.) and Section E. (5.) (a)l
Effective December 21, 2016, the permittee shall report discharge monitoring data electronically
using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application.
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 DENRY Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
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. See "How to Request a Waiver from Electronic Reporting" section below.
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.
Starting on December 21, 2020, the permittee must -electronically report the following compliance
monitoring data and reports, when applicable:
Sewer Overflow/Bypass Event Reports;
Pretreatment Program Annual Reports; and
Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to Request a
Waiver from Electronic Reporting" section below).
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Permit NCO044199
2. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an
electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to
the Division. Requests for temporary electronic reporting waivers 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 beginsubmitting monitoring data and reports. The duration of a
temporary waiver shall not exceed 5 years and shall thereupon expire. At such time, monitoring data
and reports shall be submitted electronically to the Division unless the permittee re -applies for and is
granted anew temporary electronic reporting waiver by the Division. Approved electronic reporting
waivers are not transferrable. Only permittees with an approved reporting waiver request may
submit monitoring data and reports on paper to the Division for the period that the approved
reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are found on
the following web page:
http://portal.ncdenr. org/web/wq/admin/bo g/ipu/ed=
I Signatory Requirements [Supplements Section B (11) (b) and Supersedes Section B (11) (d)1
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part II,
Section B. (I 1.)(a) or by a duly authorized representative of that person as described in Part 11,
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 eDMRand obtaining an eDMR user account, please visit
the following web page:
http://portal.nedenr.org/web/wq/admin/bog/ipu/edn-ii
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:
U certifi� 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. "
4. Records Retention [Supplements Section D. (6 )l
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
may be extended by request of the Director at any time [40 CFR 122.411.
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Sam's
Mart, Inc.
DrainalZe Basin:
French Broad
Receivin2 Stream:
Pigeon River
Stream Segment:
5-(7)
Stream Class:
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(flows N)
Teod t
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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.
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 no greater than 1/24 of the expected total daily flow at
the treatment system, or
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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 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 permit parameter(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
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.
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 122.41].
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 R 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)].
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. Propegy 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. 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 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 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]. 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 quaked 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 offines 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(f)].
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 11, 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 15A NCAC 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 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)]
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 II.B.2. of this permit.
c. 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 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.nedenr.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 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.
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), 122.61] 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 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 122.41(1)(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. 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 2011-394], 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 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 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. [15A 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 may be referred to as a "satellite POTW organization." [15A NCAC 02H .0903(b)(26)]
"Significant Industrial User" or "SIU"
An Industrial User that discharges wastewater into a publicly owned treatment works and that [15A NCAC 02H
.0903(b)(33)]:
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 (SIU); 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 11 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 403.9]
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 11.1) and II.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
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ES Permit Standard Conditions
Page 17 of 18
enforceable Pretreatment Standards as defined by 40 CFR 403.3(1). [15A NCAC 02H .0903(b)(10), .0905, and
.0906(b)(4)]
5. Industrial User Pretreatment Permits (1UP) & 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 shall maintain a current Allocation Table (AT) which summarizes the results of the HWA and the limits
from all IUDs. Permitted IUP loadings for each parameter cannot exceed the treatment capacity of the POTW as
determined by the HWA. [15A NCAC 02H .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 pretreatment 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 SIU 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. 1U 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 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 403.12]
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. [I5A NCAC 02H .0903 (b)(7),.0906(b)(8) and .0905; 40 CFR 403.8(f)(5)]
10. Pretreatment Annual Reports (PAR)
The Permittee shall report to the Division in accordance with 15A NCAC02H .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 1110912011.1 .

` NPDES Permit Standard Conditions
-- Page 18 of 18
.1
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 Summary (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 of 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
Copies of the POTW's allocation table, new or modified enforcement compliance schedules, public notice of
IUs in SNC, a summary of data or other information related to significant noncompliance determinations for
IUs 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 including general 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). [15A
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. [15A NCAC 02H
.0906(b)(9) and (10) 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 Significant Industrial Users (SIUs), and Monitoring Plan modifications, shall be considered a
permit modification and shall be governed by 40 CFR 403.18, 15 NCAC 02H .0114 and 15A NCAC 02H .0907.
Version 1110912011.1

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 Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCO044199
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 Sam's Mart, Inc.
Facility Name Sam's Mart #45 RECEIVEDMENN R
Mailing Address 7935 Council Pl, Suite 200 AUG - 4 2015
City Matthews
Water Quality
State / Zip Code NC 28105 Permitting Section
Telephone Number 70 q- 9 9 0- 3 G I a
Fax Number _7 0 9 — l.� 0 5 _ 9 6IOL
e-mail Address m �% rG . Grp h-
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 3360 Crab Tree Road @NC Highway 209
City
Waynesville
State / Zip Code NC
County Haywood
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 Sam's Mart, Inc.+tr:;r:,^':r►^Lr�.^.,-.�`f.'ss':�
Mailing Address
7935 Council Pl, Suite 200
City
Matthews
ri Division f Water Resources '
State / Zip Code
NC 28105
yl
Telephone Number
p
7- `t()
Z
I a
Fax Number
.1 jjWater QualitV Regional Operations
e-mail Address
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1 of 3 Form-D 11/12

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 X
Number of Employees
Residential
Number of Homes
School
Number of Students/Staff
Other ❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Restaurant,bathrooms,showers
Number of persons served:
5. Type of collection system
X Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Pigeon River
8. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 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.
A 0.015 MGD extended aeration facility with two modular grease interceptor units,
influent lift station, manual bar screen, aeration basin with dual blowers providing
diffused air, clarifier with skimmer and sludge return
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.015 MGD
Annual Average daily flow .0008 MGD (for the previous 3 years)
Maximum daily flow 0.0028 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X No
12. Effluent Data
NEW APPLICANTS: 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 maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters curre tly in yourpermit. Mark other parameters "N/A".
Parameter i
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
43.7
31.5
MG/L
Fecal Coliform
NA
NA
CFU/ 100ML
Total Suspended Solids
54.3
27.9
MG/L
Temperature (Summer)
26.3
25.3
C
Temperature (Winter)
17.4
14.2
C
pH
7.9
7.4
UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO044199
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
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.
1M. (ZOSG fir- Ehvivy),\ t.g, ' 0 16noUe-✓'
Printed name of Person Signing Title
5
Signature of Applicant Date -:-
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or 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.)
3 of 3 Form-D 11/12

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt., Inc.
To Whom It May Concern:
Sludge from this facility (Sam's Mart #45 WWTP NCO044199 is pumped by Mike's Septic Tank
Service and is permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
Juanita J es
James and James Environmental Mgt., Inc.
[e-mail]

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt., Inc
To Whom It May Concern:
This letter is to request the renewal of the permit for the waste water treatment facility of Sam's Mart
#45 WWTP, NPDES number NC0044199.
Sincerely
c/J
Juanita James
James and James Environmental Mgt., Inc.
[e-mail] .

BROOKS
ENGINEERING ASSOCIATES
February 15, 2017
NCDEQ Asheville Regional Office
2090 Highway US 70
Swannanoa, NC 28778-8211
Planning & Project Management / Civil Engineering
Surveying / Environmental Engineering & Services
17 Arlington Street / Asheville NC 28801
www.brooksea.com / 828-232-4700
Attention: Mikal Wilmer, Environmental Specialist
Regarding: Final Inspection & Certification Letter
- Sams Mart # 45
Haywood County NC
BEA Project # 444816
Dear Ms. Wilmer:
Brooks Engineering Associates, P.A. appreciates your oversight of the pump tank replacement
at the Sams Mart #45 in Haywood County NC. The pump station is employed as part of
NPDES Permit NC0044199. This letter is to serve as the final inspection of the installation and
the engineer's certification.
The pump system that was previously existing at the site failed structurally (caved in). There
was a block wall that was partially on top of the tank. A new 2,250 gallon precast septic tank
was installed for the pumps (NC tank certification STB-883). A septic tank was utilized based
on the operator's suggestion that the baffle wall was is needed to help keep trash away from
the pumps. The same pumps that were in the prior tank were installed in the new tank. A new
control panel was installed on the exterior of the building with a NEMA 4X box and
audible/visible alarm. Bollards were installed around the tank to keep traffic off of it. Pictures
of the installation are attached.
BEA visited the site on January 18, 2017 for a final inspection. The tank -installation appeared
to be in accordance with the engineer's recommendations. The duplex pumping system was
operational as were the float switches. The system is operational.
If there are any questions please feel free to contact me at [phone].
Sincerely,
Brooks Engineering Associates
Mark C. Brooks, P.E.
RECEIVED
Dhftlan of t1YNar Resources
k
FEB 2 2 2U17 a:
Water Qua1Ny Reglonal Operations
Ashev0le Regional Office

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Robert M. Rose, Jr.
Sam's Mart, Inc.
Sam's Mart #45
7935 Council Pl., Suite 200
Matthews, NC 28105
Dear Permittee:
Donald R. van der Vaart
Secretary
August 5, 2015
Subject: Acknowledgement of Permit Renewal
Permit NCO044199
Haywood County
The NPDES Unit received your permit renewal application on August 04, 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 Joe
Corporon at [phone].
Sincerely,
1Vl re w -TktAfOro�
Wren Thedford
Wastewater Branch
cc: Central Files
�Asheva�lle-Re g1onaWffice
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.ora
.1i�q T?;-ti.ca:.-r1�c's,�ernF�?vuF7�s'`.
:..;
RFC
E'V]ce
Division of Water
1
AUG 1 0' Re ioWater (>r.iality 9nai•j Ahe'te r-lr .
An Equal OpportunitykAffirmativeAction Employer

PAT MCCRORY
Water Resources
ENVIRONMENTAL QUALITY
Robert M. Rose, Jr, Environmental Manager
Sam's Mart, Inc.
7935 Council Place, Suite 200
Matthews, North Carolina 28105
Dear Mr. Rose:
a„ rel-1,,,•
DONALD R. VAN DER VAART
s atlllly
S. JAY ZIMMERMAN
April 29, 2015
Subj ect: Review of Permit DRAFT
NPDES NCO044199
Sams Mart #45 WWTP
3360 Crabtree Road, Waynesville
Haywood County
The Division of Water Resources (the Division) hereby issues the attached NPDES permit for the
subject facility. We issue this permit pursuant to the requirements of North Carolina General Statute
143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency dated October 15, 2007, or as subsequently amended.
Changes for Renewal. The Division understands that you have made no significant changes to your
treatment processes since last renewal. We have therefore made only minimal changes to your permit by
updating your permit format and site map. However, please note that electronic reporting of Discharge
Monitoring Reports (DMRs) is now required.
Implementing Electronic Discharge Monitoring Reports (eDMRs). Please be advised that the Division
has implemented an electronic Discharge. Monitoring Report (eDMR) program, in accord with adopted
requirements by the Environmental Protection Agency (EPA). We include updated details to implement
the eDMR program in this permit [see Section A. (2.)].
Effective December 21, 2016, federal regulations require electronic submittal of all DMRs and specify
that, if North Carolina does not establish a program to receive such submittals, Peimittees must then
submit eDMRs directly to EPA. For more information on eDMRs, registering for eDMR submittal, and
obtaining an eDMR user account, please visit DWR's webpage:
http://portal.ncderu.or web/wq/admili/bog/i u/p edinr
For information on EPA's proposed NPDES. Electronic Reporting Rule, please visit EPA's website:
http://www2.epa. ov/com liance/proposed-npdes-electronic-re oilin -rtile
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, North Carolina 27699-1611
919 707 9000

Robert M. Rose, Jr
Sam's Mart, Inc.
February 24, 2016
Page 2
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable, you have the right to an adjudicator:y hearing, upon written request submitted within
thirty (30) days after receiving this letter. Your request must take the form of a written petition
conforming to Chapter 1 SOB of the North Carolina General Statutes, and you must file it with the office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-6714. Unless
such a demand is made, this permit shall be final and binding.
This permit is not transferable except after notifying the Division of Water Resources. The Division
may require permit modification, or revocation and re -issuance. Please note that this permit does not
affect your legal obligation to obtain other permits required by the Division of Water Resources, the
Division of Land Resources, the Coastal Area Management Act, or other federal or local governments.
If you have questions, or if we can further assist you, please contact Joe Corporon at
Fjoe.cor op rongncdenr.gov] or call [phone].
spe tfully,
C
S. Jay Zimmerman, P.G.
Enclosure: NPDES Permit NC0044199 (issuance final)
hc: NPDES Program Files
ARO/SWPS, Landon Davidson
Central Files
ec: ARO/SWPS, Landon Davidson
OCU, Maureen Kinney

Permit NCO044199
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Sam's Mart, Inc.
is hereby authorized to discharge wastewater from a facility located at
Sam's Mart #45
3360 Crab Tree Road @ NC Highway 209, Waynesville
Haywood County
to receiving waters designated as the Pigeon River in subbasin 04-03-05 of the French Broad River
Basin in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I,11, III and IV hereof.
This permit shall become effective June 1, 2016.
This permit and authorization to discharge shall expire at midnight on January 31, 2021.
Signed this day April 29, 2016.,
S-XZimmerman, P.G. Director
Division of Water resources
By Authority of the Environmental Management Commission
Page 1 of 5

Permit NCO044199
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.
Sam's Mart, Inc.
is hereby authorized to:
1. continue to operate an existing 0.015 MOD extended -aeration wastewater treatment facility
utilizing;
♦ two (2) modular grease -interceptor units
♦ influent lift station
♦ manual bar screen
♦ aeration basin with dual (2) blowers providing diffused air
♦ clarifier with skimmer and sludge return
these facilities located at Sam's Mait,#45, 3360 Crab Tree Road (at NC Highway 209) north of
Waynesville in Haywood County, and
2. discharge from said treatment works via Outfall 001, at the location specified on the attached map,
into the Pigeon River [stream segment 5-(7)], currently classified C waters within subbasin 04-03-05
[HUC 06010106] of the French Broad River Basin.
Page 2 of 5

Permit NCO044199
Part I
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq.; 02B .0500 et seq.]
During the period beginning on the effective date of this permit and lasting until expiration, the
Permittee is authorized to discharge from Outfall 001. Such discharges shall be limited, monitored, and
reported 1 by the Permittee as specified below:
EFLTJENT <
LIMITS
Iv10N1TORZrIG REQUIREMENTS
r ,,
G`HARACTERISTICS. 4
y 3t L
1Ylonthl
s � Y�
z
Dail Y 5
Measurement
t Sarti 1e
"` Sample
�-[Paranaete>" Code) j
r
Average
'Maxunum
.Frequency
Type
ocafion
L
Flow
50050
0.015 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5 day (20°C)
C0310
F30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Temperature (°C)
00010
Weekly
Grab
Effluent
pH
00400
Not < 6.0 nor > 9.0 s. u.
Weekly
Grab
Effluent
Ammonia [NH3 as N]
C06107
2/Month
Grab
Effluent
Footnote:
1. Effective December 21, 2016, the permittee shall report discharge monitoring data
electronically using the NCDWR's Electronic Discharge Monitoring Report (eDMR)
internet application [see section A. (3)].
Condition: The Permittee shall discharge no floating solids or foam.
A. (2.) FECAL COLIFORM CONDITION
[G.S. 143-215.3(a)(2)] and/or [G.S. 143-215.66]
In the event that violations of North Carolina water -quality standards for fecal coliform occur as a result
of this discharge, disinfection will immediately be required and the permit re -opened to include a fecal
coliform effluent limit.
A. (3.) ELECTRONIC REPORTING - DISCHARGE MONITORING REPORTS
[G.S. 143-215.1(b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program
reports and specify that, if a state does not establish a system to receive such submittals, then permittees
must submit monitoring data and reports electronically to the Environmental Protection Agency (EPA).
The final NPDES Electronic Reporting Rule was adopted and became effective on December 21, 2015.
Page 3 of 5

Permit NCO044199
NOTE: This 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.)
• Section D, (6.)
• Section E. (5.)
Reporting
Records Retention
Monitoring Reports
1. Reporting Requirements [Supersedes Section D. (2.) and Section E. (5.) (a)1
Effective December 21, 2016, the permittee shall report discharge monitoring data electronically
using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application.
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 DENR / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
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. See "How to Request a Waiver fiom Electronic Reporting" section below.
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.
Starting on December 21, 2020, the permittee must electronically report the following compliance
monitoring data and reports, when applicable:
Sewer Overflow/Bypass Event Reports;
Pretreatment Program Annual Reports; and
Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to Request a
Waiver from Electronic Reporting" section below).
Page 4 of 5

Permit NCO044199
2. How to Request a Waiver from Electronic Reporting
The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an
electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to
the Division. Requests for temporary electronic reporting waivers 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 submitting monitoring data and reports. The duration of a
temporary waiver shall not exceed 5 years and shall thereupon expire. At such time, monitoring data
and reports shall be submitted electronically to the Division unless the permittee re -applies for and is
granted a new temporary electronic reporting waiver by the Division. Approved electronic reporting
waivers are not transferrable. Only permittees with an approved reporting waiver request may
submit monitoring data and reports on paper to the Division for the period that the approved
reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are found on
the following web page:
http://portal.ncdeiu.org/web/wq/admin/bog/i u/p edmr
3. Signatory Requirements [Supplements Section B (11) (b) and Supersedes Section B (11) (d)1
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part il,
Section B. (I 1.)(a) or by a duly authorized representative of that person as described in Part II,
Section B. (11.)(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://poilal.nedenr.org/,,,veb/wq/admin/bog-/ipu/ednir
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:
U 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, trite, accurate, and complete. I
am aware that there are significant penalties for submitting false information, including the
possibility offines and imprisonmentfor knowing violations. "
4. 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
may be extended by request of the Director at any time [40 CFR 122.41].
Page 5 of 5

f,
6 ( a
a! / 1 si
V J 1*
� • `{lam` tam-,�_� , i1 - �
Crawford Road ' a . _ 4 ,,a •
02
N qQ-4 J.Rivera / l^ f r i 0` s i. 1'✓r
a-_
eOA
Approilnai
- property boundary 1.
✓ta. k IJl 'tip •
:Interstate
\ c.
./ 11'`r i its ar
k
- rd fr t;yrS a °
Outfall
lowsWM/,ry
F` (�����/ (���.�! ��� _ \ l ! •�'.. � • `/� 1 V .
09.
A
We
r 1
vj "V
S am's
Mart, Inc.
Sam's Mart #45 WWTP
DrainagCBasin:
French Broad
Receiving Stream:
Pigeon River
Latitude:
35° 34' 01" N
State Grid/USGS:
F9NE / Clyde, NC
Longitude:
82° 57' 23" W
Permitted Flow:
0.015 MGD
Stream Segment:
5-(7)
Stream Class:
C
HUC:
06010105
Sub -Basin:
04-03-05
North NPDES PermitNC0044199
Haywood County

Cantwell, Janet
From: Davidson, Landon
Sent: Thursday, May 05, 2016 8:19 AM
To: Cantwell, Janet
Subject: FW: Issuance Final NC0044199 for Sam's Mart #45, Haywood County
Attachments: 44199 Sam's Mart #45 issuance May2016.pdf
FYI. Please save a copy to the appropriate G; drive folder. Thanks.
G. Landon Davidson, P.G.
Regional Supervisor —Asheville Regional Office
Water Quality Regional Operations Section
NCDEQ — Division of Water Resources
828 296 4680 office
828 230 4057 mobile
Landon. Davidson CcD-ncden r. gov
2090 U.S. Hwy. 70
Swannanoa, N.C. 28711
Nothing Compares.
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Corporon, Joe
Sent: Thursday, May 05, 2016 8:09 AM
To: Davidson, Landon <[e-mail]>
Cc: Kinney, Maureen <[e-mail]>
Subject: Issuance Final NC0044199 for Sam's Mart #45, Haywood County
For your records; hardcopy to follow by mail.
Respectfully,
Joe R. Corporon, L. G.
NCDEQ
r4 ` _`=7' lothing Compares.:_--,..,,._
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.

N
Water Resources
ENVIRONMENTAL QUALITY
t
PAT MCCRORY
J ' Governor
D - DONALD R. VAN DER VAART
,Secrelm•y
S. JAY ZIMMERMAN
� f7.
Director
February 24, 2015
Robert M. Rose, Jr, Environmental Manager
Sam's Mart, Inc.
7935 Council Place, Suite 200
Matthews, North Carolina 28105
Dear Mr. Rose:
Subject: Review of Permit DRAFT
NPDES NCO044199
Sams Mart #45 WWTP
3360 Crabtree Road, Waynesville
Haywood County
In response to your request to renew the subject NPDES permit, received August 4, 2015, the Division
of Water Resources (DWR or the Division) hereby transmits this draft for your review and comment.
Please review this docuinent,carefully to assure your understanding of the permit limits and monitoring
conditions, and to correct errors, if any.
Concurrent with this notification, the Division will solicit public comment on this draft by publishing a
notice in newspapers having circulation in the general Haywood County area, as required by the
NPDES Program. Please provide your written comments, if any, to me via email
[e-mail]], or write to my attention care of NCDEQ / DWR / NPDES Program no
later than March 25, 2016, approximately 30 days after receiving this letter. Your written comments
are welcome but are not mandatory.
Changes for Renewal. The Division understands that you have made no significant changes to your
treatment processes since last renewal. We have therefore made only minimal changes to your permit by
updating your permit format and site map. However, please note that electronic reporting of Discharge -
Monitoring Reports (DMRs) is now required.
Implementing Electronic Discharge Monitoring Reports (eDMRs). Please be advised that the Division
has implemented an electronic Discharge Monitoring Report (eDMR) program, in accord with pending
requirements by the Environmental Protection Agency (EPA). We include the details to implement the
eDMR program in this permit [see Section A. (2.)].
Proposed federal regulations require electronic submittal of all DMRs and specify that, if North
Carolina does not establish a program to receive such submittals, Permittees must then submit eDMRs
directly to EPA. For more information on eDMRs, registering for eDMR submittal, and obtaining an
eDMR user account, please visit DWR's webpage: '
http://Portal.ncdenr.or,/web/wq/admin/bo g/ipu/cdmr
State of North Carolina I Environmental Quality I Water Resources
1611 Mail service Center I Raleigh, North Carolina 27699-1611
919 707 9000

Robert M. Rose, Jr
Sam's Mart, Inc,
February 24, 2016
For information on EPA's proposed NPDES Electronic Reporting Rule, please visit EPA's website:
http://www2.epa.gov/comi)liance/l)rol)osed- des-electronic-reDortiniz-iule
Following the mandatory 45-day public comment period, the Division will review all pertinent
comments, if any, and take appropriate action prior to issuing an NPDES permit final. If you have
questions concerning. this draft, please e-mail me [e-mail]], or call my direct line
[phone]. _
Enclosure: NPDES Permit NC0044199 (i
hc: NPDES Program Files [draft permit and Fact Sheet]
ec: ARO/SLAPS, Landon Davidson [draft permit, Fact Sheet]
OCP, Maureen Kinney [draft permit and Fact Sheet]

Permit NCO044199
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
'TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal. Water Pollution Control ct, as amended,
Sam's Mart, N;
is hereby authorized to discharge wa t ater fro a facili bcated at
Sa ar-t .4
3360 Crab Tree Rd 209, Waynesville
to receiving waters designated a t_ : e Pi edn ver ' sl bbasin 04-03-OS of the g French Broad River
Basin in accordance wit eff1: ent 1` Mons �i ron'to requirements, and other conditions set forth in
Parts I, H, III and h eof
This permit shall become6 fictive 2016.
This permit and authorization to discharge shall expire at midnight on January 31, 2021.
Signed this day 2016.
S. Jay Zimmerman, P.G. Director
Division of Water resources
By Authority of the Environmental Management Commission
Page I of 5

Permit NCO044199
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.
Sam's Mart, Inc.
is hereby authorized to:
1. continue to operate an existing 0.015 MGD extended -aeration yv�tewater treatment facility
utilizing;
♦
two (2) modular grease -interceptor units .
influent lift station
manual bar screen
aeration basin with dual (2) blowers provii
clarifi
these facilitie
Waynesville i
(at NC Highway 209) north of
2. discharge from said treatment works via Outfall 001, at the location specified on the attached map,
into the Pigeon River [stream segment 5-(7)], currently classified C waters within subbasin 04-03-05
[HUC 06010106] of the French Broad River Basin.
Page 2 of 5

Permit NCO044199
Part I
A. (l.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B .0400 et seq.; 02B .0500 et seq.]
During the period beginning on the effective date of this permit and lasting until expiration, the
Permittee• is authorized to discharge fiom Outfall 001. Such discharges shall be limited, monitored, and
reported 1 by the Permittee as specified below:
EFFLUENT
-LIMITS
MONITORING RE�QUIItEMENTS
CHARACTERISTICS
1
Monthly
-
� Daxly
1VIeasurement,.
,A Sample �
Sample
f �[Patameter Code) ' ;
,
Average
Maximum
UFrequency
Type :`
Location :
Flow
50050
0.015 MGD
We kly
Instantaneous
went of
/ \
Effluent
BOD, 5 day (20°C)
C0310
30.0 mg/L
45.0 mg/L
�QVeekl
Grab
Effluent
Total Suspended Solids
C0530
30.0 mg/L
4 5. 0 i ftL
Weekly
Grab
Effluent
Temperature (°C)
00010
Wee ly
rab
Effluent
PH
00400
Not < 6.0 �0��0 s. u.
ekly
b
Effluent
Ammonia [NH3 as N]
C0610
\�CIVI\onth
Grab
Effluent
Footnote:
1. Effective D
inteinet ap lic-ion [seems
Condition: The Per it e shall
r
A. (2.) FECAL COL O.
[G.S: 143-215.3(a)(2
i ee shal r ort discharge monitoring data
s lectr6" Ra . is�liacge Monitoring Report (eDMR)
boating solids or foam.
�DITION
[G.S. 143-215,66]
In the event that violations of North Carolina water -quality standards for fecal colifonn occur as a result
of this discharge, disinfection will immediately be required and the permit re -opened to include a fecal
coliform effluent limit.
A. (3.) ELECTRONIC REPORTING - DISCHARGE MONITORING REPORTS
[G.S. 143-215.1(b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program
reports and specify that, if a state does not establish a system to receive such submittals, then permittees
must submit monitoring data and reports electronically to the Environmental Protection Agency (EPA).
The final NPDES Electronic Reporting Rule was adopted and became effective on December 21, 2015.
Page 3 of 5

Permit NCO044199
NOTE: This special condition supplements or supersedes the following sections within Part H of this
permit (Standard Conditions for NPDES Permits):
• Section B. (11.)
Section D. (2.)
• Section D. (6.)
Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reportinrr Requirements [Supersedes Section D. (2.) and Section E. (5) (a)1
Effective December 21, 2016, the pennittee shall report discharge monitoring data electronically
using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and
submitted electronically using eDMR. The eDMR system allows ok�mitted facilities to enter
monitoring data and submit DMRs electronically using the inter/fTntil such time that the state's
eDMR application is compliant with EPA's Cross -Media Eleo." c Reporting Regulation
(CROMERR), permittees will be required to submit all 'scha� 'toring data to the state
electronically using eDMR and will be required to co pl the eD \submission by printing,
signing, and submitting one signed original and a e6p ,6f the compute • � nted•eDMR to the
following address:
NC DENR / Division of Water
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699
If a perknittee is unable to r
being physically located,' ai
access, then a tempor-ary:w
and discharge oring�ai
alternative forika • roved b
mailing address abo c�. See'
ceg / W ter Qual'ty Permitting S
tem d'e to a deril6nstrated hardship or due to the facility
s thah10 percent of the households have broadband
'DES ,tropic reporting requirements maybe granted
i ed on paper DMR forms (MR 1, 1. 1, 2, 3) or
Duplicate signed copies shall be submitted to the
a Waiver from Electronic Reporting" section below.
Regardless of the sub Sion in th d, the first DMR is due on the last day of the month following
the issuance of the perkni o�i.in t case of a new facility, on the last day of the month following the
commencement of discharg
Starting on December 21, 2020, the permittee must electronically report the following compliance
monitoring data and reports, when applicable:
Sewer Overflow/Bypass Event Reports;
Pretreatment Program Annual Reports; and
Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to Request a
Waiver from Electronic Reporting" section below).
Page 4 of 5

Permit NCO044199
2. How to Request a Waiver from EIectronic ReportinLy
The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an
electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to
the Division. Requests for temporary electronic reporting waivers 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 submitting monitoring data and reports. The duration of a
temporary waiver shall not exceed 5 years and shall thereupon expire. At such time, monitoring data
and reports shall be submitted electronically to the Division unless the permittee re -applies for and is
granted a new temporary electronic reporting waiver by the Division. Approved electronic reporting
waivers are not transferrable. Only permittees with an approved reporting waiver request may
submit monitoring data and reports on paper to the Division for the period that the approved
reporting waiver request is effective.
Information on eDMR and the application for a temporary electr mc'yeporting waiver are found on
the following web page: ..
http://poi �poital.ncdenr.org/web/wq/admin/bog/iD
u/edmr
Si natoi Requirements [Supplements Section B.nd•Sir emedes a tion B. 11. d
All eDMRs submitted to the permit issu' , g authority s�a 1 b' signed by a perso described in Part II,
Section B. (I 1.)(a) or by a duly authorized ei $E tative��', hat person as described in Part U,
Section B. (11.)(b). A person, and not a po 't% , st be d 18 ated signatory authority for eDMR
reporting purposes.
For eDMR submissions, the rson si and u �ttin the DMR must obtain g g am an eDMR user
account and login cpedezrtia,1 occ s the eD s stem. For more information on North
% / f
Carolina's eD /s em re rs rm , or eDMR a� d , btaining an eDMR user account, please visit
the following <fxep page. `
Certification. Any peiso submji'tii g an electronic DMR using the state's eDMR system shall make
the following certificatN 14,0 CFR 122.221. NO OTHER STATEMENTS OF CERTIFICATION
WILL BE ACCEPTED:
1 certify, tinder penalty of law, that this document and all attachments were prepared under nay
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 offanes and imprisonmentfor lcnowingviolations. "
4. 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 aperiod of at least 3 years from the date of the report. This period
may be extended by request of the Director at any time [40 CFR 122.41].
Page 5 of 5

� • s �� (( ' t'�'b•� I < it �,x r
J� •.2.� Crawford Road [� SS
`i L1:�t r S t1 v I R 4 'C
'IS
\� Y
4 !r
24
i E Pigeon River`T.
(flows N)
oIoc
,
Apploxlmate
s Q
S` iu
C (j/
r'
u.�+,7. ai': ♦ rv!�' fi' .i J ,�iSV �2 s x k ♦.f7 ..tt
�� •- f' '� 'fdil {� z z.a uat�ws i � t
k �,�95�� Outfatl 001 t' i fir; { ' z �k
t/ / Q'r ��r7 �� ��..��� • �T' \ � � � rd i3s r��.:�ne i� ;
1 7 J
IN
> h�F-.�'` ({��' (NC Hwy 209) �� '°� � � �.-•- s �� ,- � �'r}�' � �';
Aai
11 y \\\^
Sam's
Mart, Inc.
Sam's Mart #45 WWTP
Drainage Basin:
French Broad
Receiving Stream:
Pigeon River
Latitude:
35' 34' 01" N
State Grid/USGS:
F9NE / Clyde, NC
Longitude:
82° 57' 23" W
Permitted Flow:
0.015 MGD
Stream Segment:
5-(7)
Stream Class:
C
HUC:
06010105
Sub -Basin;
04-03-05
NOY,tL NPDES PermitNCO044199
�6 ,Haywood County

NCDEQ / DWR / NPDES Unit
FACT SHEET FOR EXPIDITED PERMIT RENEWAL
NPDES Permit NCO044199
.Applicant:(_r'aclityName Sam's Mart, Inc. dba —Sams Mart # 45 WWTP
Ap hcant Address:_ 7539 Council Place, Suite 200, Matthews, NC 28105
Tacil. Address 3360 Crab Tree Road HWY 209, Waynesville, NC 28785
PeKmttedFlow.;:,,_ = . 0.015 MGD
T.- e of100%Domestic
Faclity/1?emit.Statgs..-,;; Renewal
Kecexvnig:heam
Pigeon River [seg: 5-(7)]
`
River Basin
French Broad
:Regional .Office'
'ILL Asheville
Stream Classificafion
C
;State, Grid/USGS;To' o Quad F9NE/ Clyde, NC
3.03 d) Listed?
No
'Permit Writer Joe R. Coi oron, L.G
Subbasm /:HUC
04-03-05 / 06010106
17Feb2016
Drama e Area mil)
238
Summer 7Q10 cfs)
89
OWN (cfs)
104
Avera e Flow (cfs):
497
IWC % -
0.026
Primary SIC Code_;;
5541 & 5812
This extended -aeration, continuous -flow wastewater treatment system (WWTP) servicing a commercial
facility restaurant, bathrooms and showers (est..15 people), the system consisting of:
♦ two (2) modular grease -interceptor units
♦ influent lift station
♦ manual bar screen
♦ aeration basin with dual (2) blowers,
♦ clarifier and skimmer with sludge return
Renewal Summary - A review of effluent data (Jan2012-Jan2016) suggests regular discharge
typical of"a 100.%-domestic wastewater. The application reveals no significant changes in facility
operations since last renewal; no changes in flow (see Flow Summary below).
While this facility does not disinfect, the insh-eam waste concentration (IWC) is less than 0.03 %
suggesting that receiving -stream impacts may be considered negligible. However, a permit condition
allows the Division to add fecal limits and disinfection in the event that future impacts can be
attributed to this facility [see Section A. (2)],
Compliance Summary - BIMS compliance record shows sporadic permit -limit violations (short
periods, one per year) in 2012, 2014 and lastly in January 2015. Past NOVs are confined to BODs and
TSS limit exceedances; the two weeks in September 2014 proceeding to the only -enforcement. This
facility does not test for Whole Effluent Toxicity (WET), likely due to negligible IWC - no changes.
recommended,
Page 1 of 2

NCDEQ / DVVR NPDES Unit
FACT SHEET FOR EXFMITED PERMIT RENEWAL
NPDES Permit NCO044199
ReceivinLy Stream - This facility discharges directly to the Pigeon River (Class C; not impaired), French
Broad River Basin (IWC summer = 0.026 %; this facility does not monitor the receiving stream - no
changes recommended.
DMR BIMS Data Review
Table 2: Flow Summary in Million Gallons per Day (MGD):
g2
0.001
0.0001
0.003
53
2013
0.0012
0.0001
0.003
52
0.0006
0,00001
0,001
50
0.001
0.0005
0.002
243
Table 3: BIMS Summary of DAD? Database - Outfall 001,[Jan2012 - Jan2016]
F1
TIA
D
T ;Ammonia
Temp
P H
0&1-
X-j"
N.
-A -9,L
Average
0.001
11.9
14.7
4.12
18.1
7.0
Maximum
0,003
44.3
54.3
50.6
29.2
8.0
Nunimum
0.0001
2,0
2.27
0.10
5.9
6.0
Count
203
208
207
94
209
207
Proposed Schedule for Pern-ift Issuance
Draft Permit to Public Notice:
Permit Scheduled to Issue:
Permit Effective Date (Tentative):
NPDES,Oontact�
Jo�. Corporon,
February 24, 2016
April 8, 2016
May 1, 2016
.90v]; direct line [phone]
Date: ('�Rgob 61
Page 2 of 2

. • - - •••• . •--- - -11 � � —., 1 rw� 0 vvcn VIULAI IUN ACTION COMMENT LAST UPDATED BY lD
NCO044199 Sam's Mart#45 BOD, 5 01/31/2015 mgA 30 31.45 5 Monthly Average Exceeded NOV janetcantwell
NCO044199 Sam's Mart#45 Flow 01/03/2015 mgd Frequency Violation NOV janetcantwell
NCO044199 Sam's Mart#45 TSS 09/09/2014 mgA 45 54.30 21 Daily Maximum Exceeded Enforce NOV-NRE. JAC.2/4/15. janetcantwell
NCO044199 Sam's Mart#45 TSS 09/04/2014 mgA 45 51.40 14 Daily Maximum Exceeded Enforce NOV-NRE. JAC.2/4/15. janetcantwell
NCO044199 Sam's Mart#45 BOD, 6 05/31/2012 mgA 30 31.36 5 Monthly Average Exceeded NOV janetcantwell
NCO044199 Sam's Mart#45 TSS 05/31/2012 mgA 30 35.14 17 Monthly Average Exceeded NOV janetcahtwell
s
�t�Ic�
c

IWC Calculations
Sam's Mart #45 WWTP
N00044199
Prepared By: Joe Corporon, NPDES Program
17-FebA6
Enter Design Flow (MGD):
Enter s7Q10 cfs :
Enter. w7Q10 (cfs):
Residual Chlorine
Ammonia (NI-13 as N)
(summer)
7Q10 (cfs)
- 89
7Q10 (CFS)
89
DESIGN FLOW (MGD)
0.015
.DESIGN FLOW (MGD)
0.016
DESIGN FLOW (cfs)
0.02325
DESIGN FLOW (cfs)
0.02325
STREAM STD (ug/L)
17.0
STREAM STD (mg/L)
1.0
UPS BACKGROUND LEVEL (1
IWC
0
UPS BACKGROUND LEVEL (mg/L;
0.22.
(%)
0.03
IWC (%)
0.026
Allowable Conc. (ug/1)
65092
Allowable Conc. (mg/1)
2986.8
Ammonia (NIi3 as N)
(winter)
7Q10 (CFS)
104
Fecal Limit
Not Required DESIGN FLOW (MGD)
0.015
(if DF >331; Monitor)
DESIGN FLOW (cfs)
0.02325
(If DF <331; Limit)
STREAM STD (mg/L)
1.8
Dilution Factor (DF)
3828.96
UPS BACKGROUND LEVEL (mg/L;
0.22
IWC (%)
0.02
Allowable Conc. (mg/1)
7069.3
INPDES Servor/Current Versions/IWC
a
2M7/2016

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
January 3, 2011
Mr. Haytham Kasem
Sam's Mart, Inc.
7985 Council Pl, Suite 200 ry
Matthews, N.C. 28105
Subject:
Dear Mr. Kasem:
Issuance of NPDES Permit NCO044199
Sam's Mart #45 WWTP
Haywood County
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
November 10, 2010.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Quality or permits
required by the Division of Land Resources, the Coastal Area Management Act or any other Federal'or Local
governmental permit that may be required. If you have any questions concerning this permit, please
contact Charles Weaver at telephone number [phone].
Sincerely,
-,,fColee* n -Sulu
or
cc: Central Files [ ,
�Vhoville Regional-0f1'ice/Su`rface Wader roteetio
NPDESUnit f ILII I JAN 1 8 2011'
h, North Carolina 27699-1617 E WATER QUALITY S=CTION
1617 Mail Service Center, Raleigh, ASHEVILLE REGIOt�N0126-F ICC'= 512 North Salisbury Street, Raleigh, North Carolina 27604 1� O1li1t,aTOlI
Phone: [phone] / FAX [phone] / http://portal.ncdenr.org/web/wq
,t y+ l
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Pape �+�" " i

.Permit NC0044199.
,STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations -
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution
Control Act, as amended,
LSAA, Inc. dba Sam's Mart
is hereby authorized to discharge wastewater from a facility located at
Sam's Mart #45
3360 Crab Tree Rd @ NC Highway 209
Waynesville
Haywood County
to receiving waters designated as the Pigeon River in subbasin 04-03-05 of the French Broad River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III and IV hereof.
This permit shall become effective February 1, 2011.
This permit and authorization to discharge "shall expire at midnight on January 31, 2016.
Signed this day January 3, 2011.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO044199
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.
LSAA Inc. dba Sam's Mart is hereby authorized to:
1. Continue to operate an existing 0.015 MGD extended aeration wastewater
treatment facility that includes the following components:
♦ Two modular grease interceptor units
♦ Influent lift station
♦ Manual bar screen
♦ Aeration basin with dual blowers providing diffused air
♦ Clarifier with skimmer and sludge return
The facility is located at Sams Mart #45, on Crab Tree Rd at NC Highway 209
north of Waynesville in Haywood County.
2. Discharge from said treatment works at the location specified on the attached map
into the Pigeon River, currently classified C waters in hydrologic unit 06010106 of
the French Broad River Basin.

NCOQ44.1.9.9.
EFFLUENT LIMITATIONS AND. MONITORING REQUIREMENTS' . .
During the period beginning on the effective date, of this permit and lasting until
expiration, the Permittee is authorized to discharge from outfall 001. Such discharges sha11
be limited and monitored by the Permittee as specified below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[PCS Code]
Monthly Average
Daily Maximum
Measurement
Sample Type
Sample
Frequency-
Location
Flow
0.015 MGD
Weekly
Instantaneous
Influent or
[500501
Effluent
BOD, 5 day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
C0310
Total Suspended Solids
30.0 mg/L.
45.0 mg/L
Weekly
Grab
Effluent.
C0530
NH3 as N
2/Month
Grab
Effluent
C0610
Temperature (T)
Weekly
Grab
Effluent
00010
pH
> 6.0 and < 9.0 standard units -
Weekly
Grab
Effluent
00400
There shall be no discharge of floating solids or visible foam in other.than trace amounts.
A. (2) - FECAL COLIFORM CONDITION
In the event that violations of the North Carolina water quality standards for fecal coliform
occur as a result of this discharge, disinfection will immediately be required and the permit
re -opened to include a fecal coliform effluent limit.

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.
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 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 requires prior approval by the Director. This method may
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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. 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 122.2)
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 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 Environmental 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.
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.
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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 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, 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 122.41].
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
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
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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 11 penalty not to exceed $177,500.
[33 USC 1319 (g) (2) and 40 CFR 122.41 (a) (3)]
2. Duly 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 H. 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.
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 150B-23].
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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. Signatory 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]
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]
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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:
"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 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 (f)].
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 MonitoringFee ee 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) (2) may cause this Division to initiate action to revoke the permit.
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.0201].
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
➢ Comply with 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 a new 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 back-up ORC
➢ A vacancy in the position of ORC or back-up ORC.
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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)]
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)]
0) 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 H. 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. (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.
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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 II. B. 2. of this permit.
c. 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) 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. Monitorins and Records
1. 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 122.410)].
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 / Surface Water Protection Section
ATTENTION: Central Files
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
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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
Divisions 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 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.
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].
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;
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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 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).
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 122.410) (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 122.41 (1) (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.
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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, 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 Divisions 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 U. E. 6. of
this permit [40 CFR 122.41 (1) (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. 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.
10. Availabili, 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.
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 tocbe 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].
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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.
The report shall be sent to:
NC DENR / Division of Water Quality / Surface Water Protection Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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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, 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 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 Discharee 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 Reauirements
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 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 (i) and 0)]
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 POTW's NPDES 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 POTW's NPDES permit, or of an instream water quality standard. [15A NCAC 2H.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 21-1.0903 (b) (27)]
"Significant Industrial User" or "SIU"
An industrial user that discharges wastewater into a publicly owned treatment works and that [15A NCAC
21-1.0903 (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
maximum 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 POTW's operation or for violating any
pretreatment standard or requirement or POTW's receiving stream standard, or to limit the POTW's sludge
disposal options.
Section S. Publicly Owned Treatment 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)]:
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.
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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 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. 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)]:
3
4.
(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 isspecifically 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;
(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; 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,
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.
The Permittee shall require any Industrial User discharging to the POTW to meet Federal Pretreatment
Standards developed under Section 307(b) of the Act as amended (which includes categorical standards and
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specific local limits, best management practices 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 0) (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 21-1.0900, 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 0) (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 (b) (1), (2)]
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 0) (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. 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.
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 .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 122.441. 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 (b) and 15A NCAC 2H.0909. Pursuant to 40 CFR 403.5, local limits are
enforceable Pretreatment Standards as defined by 40 CFR 403.3(1).
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 HWA and the limits from
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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 (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. [15A NCAC 2H.0906 (b) (6) 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 pretreatrnent standards. [15A NCAC 2H .0908(d); 40 CFR 403.8(f)(2)(v)]
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 at least 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. IU 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 NCAO�21-1 .0908. [15A NCAC 2H .0906(b)(4) and .0905; 40 CFR 403.8(f)(1)(v) and (2)(iii); 40 CFR
122.440) (2) and 40 CFR 403.12]
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
remedies, enforcement actions and other, shall be consistent with the Enforcement Response Plan (ERP)
approved by the Division. [15A NCAC 2H .0906(b) (7) and .0905; 40 CFR 403.8(f)(5)]
10. Pretreatment Annual Reports (PAR)
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
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 twelve months to the Division at the
following address:
NC DENR / Division of Water Quality / Surface Water Protection Section
Pretreatment, Emergency Response, and Collection Systems (PERCS) Unit
1617 Mail Service Center
Raleigh, North Carolina 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);
Version 1012912010

NPDES Permit Standard Conditions
Page 18 of 18
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 (IDSF)
Monitoring data from samples collected by both the POTW and the Significant Industrial User (SILT) in
SNC. 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. [15A NCAC 2H .0903 (b) (35),.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 including general records, water quality records, and records of industrial impact on
the POTW. [15A NCAC 211.0908(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 Significant Industrial Users (SIUs), and Monitoring Plan modifications, shall be
considered a permit modification and shall be governed by 40 CFR 403.18,15 NCAC 2H .0114 and 15A NCAC
2H .0907.
Version 1012912010

Pat McCrory
Governor
4 ;
NCDENR
North.Carolina Department of Environment and Natural Resources
June 2, 2015
CERTIFIED MAIL 7013 2630 0001 8998 0829
RETURN RECEIPT REOUESTED
Mr. iHaytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place; Ste. 200
Matthews, NC 28105
Dear Mr. Kasem:
Donald R: van der Vaart
Secretary
RECEIVED
Division of Water Resources
JUN - 5 2015
Water Ouality Regional Operations
Asheville Regional Office
Subject: Remission Request of Civil Penalty Assessment
NPDES Permit Number NCO044199
Sam's Mart #45.WWTP
Haywood County
Case Number LV-2015-0033
In accordance.with North Carolina General Statute 143-215.6A(f),and delegation from the Director of
the North Carolina Division of Water Resources, John,E. Hennessy, supervisor of the Water Quality
Permitting Section's --Compliance and Expedited Permitting Unit, considered the information you
submitted in support of your request for remission and did.not find grounds to modify the civil penalty
assessment of $259.26. A copy of the remission decision is attached.
Two'options are available to you at this stage of the remission process:
You may pay the penalty.
If you decide to pay the penalty please make your check payable to the Department of Environment and
Natural Resources (DENR). Send the payment within thirty (30) calendar days of your receipt of this
letter to the attention of:
Bob Sledge
NC DENR-DWR — Wastewater Branch
Compliance & Expedited Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
14
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone]ntemet: www.ncwaterquallt .org
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

Mr. Haytham Kasem
LV-2015-0033 Remission Decision
p. 2
You may decide to have the Environmental Management Commission's (EMC) Committee on
Civil Penalty Remissions make the final decision on your remission request.
If payment is not received within 30 calendar days from your receipt of this letter, your request for
remission with: -supporting -documents and the recommendation of the North Carolina Division of Water
l esourcga will;be deliverqd to the Committee on Civil Penalty Remissions for final agency decision.
you or your representative N
e attached`Re "u st''for' Oral
>nd the completed form to:
like to speak before the Committee, you must complete and return
station Form within thirty (30) calendar days of receipt of this letter.
Bob Sledge
NC DENR-DWR — Wastewater Branch
Compliance & Expedited Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
The EMC Chairman will review the supporting documents and your request for an oral presentation (if
you make the request). If the Chairman determines that there is a compelling reason to require a
presentation, you will be notified of when and where you should appear. If a presentation is not
required, the final decision will be based upon the written record.
Please be advised that the FMC's Committee on Civil Penalty Remissions will make its,remission
decision based on the original assessment amount.. Therefore, the EMC may choose to uphold the
original penalty amount and offer no remission, they may agree with the Division of Water
Resources' remission recommendation detailed above, or the penalty amount may be further
remitted.
Thank you for your cooperation in this matter. If you have any questions, please contact me at (919)
807-6398, or via e-mail at [e-mail].
Sincerely,
Bob Sledge, Environmental Specialist
Compliance & Expedited Permitting Unit
Division of Water Resources
Attachments
cc: Asheville-Regional_Office--DWR/W ater�Quali—T ity
Enforcement File
DWR Central Files

DIVISION OF WATER RESOURCES
CIVIL PENALTY REMISSION FACTORS
Case Number: LV-2015-0033 _ Region: Asheville County: Haywood
Assessed Entity: Sam's Mart 445 WWTP Permit: NCO044199
❑ (a) Whether one or more of the civil penalty assessment factors were wrongly applied to the
detriment of the petitioner:
® (b) Whether the violator promptly abated continuing environmental damage resulting from the
violation:
The WWTP's normal operation was augmented with the addition of alum to encourage settling- of solids. The
sludge in the WWTP was replaced by new sludge from another source. These actions returned the WWTP to
compliance.
DMR data indicate the WWTP was restored to compliant performance, after about three weeks of higher than
normal TSS values being reported.
® (c) Whether the violation was inadvertent or a result of an accident:
The facility states the violations were due to the restaurant at the site not being in service at the time, denying
the WWTP both its normal flow and waste loading, and disturbing normal operational conditions.
Operation offacilities in such situations can be modified to provide an alternative food source for the treatment
organisms within the system.
❑ (d) Whether the violator had been assessed civil penalties for any previous violations:
The facility has not been assessed civil penalties during the five years prior to this civil assessment.
❑ (e) - .Whether payment of the civil penalty will prevent payment for the remaining necessary
remedial actions:
DECISION (Check One)
Request Denied In
Full Remission ❑
Partial Remission ❑
Retain Enforcement Costs? Yes ❑ No ❑
$ (Enter Amount)
J
E. Hennessy Date
rev 1.0 — 8.31.09

STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT
COMMISSION
COUNTY OF HAYWOOD
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST:
LSAA, Inc. dba Sam's Mart
DWR Case Number LV-2015-0033
REQUEST FOR ORAL PRESENTATION
I hereby request to make an oral presentation before the Environmental Management Commission's Committee On Civil Penalty
Remissions in the matter of the case noted above. In making this request, I assert that I understand all of the following statements:
• This request will be reviewed by the Chairman of the Environmental Management Commission and may be either granted or
denied.
• Making a presentation will require the presence of myself and/or my representative during a Committee meeting held in Raleigh,
North Carolina.
• My presentation will be limited to discussion of issues and information submitted in my original remission request and because
no factual issues are in dispute, my presentation will be limited to five (5) minutes.in length.
The North Carolina State Bar's Authorized Practice of Law Committee has ruled that the appearance in a representative capacity at
quasi-judicial hearings or proceedings is limited to lawyers who are active members of the bar. Proceedings before the Committee on
Remissions are quasi-judicial. You should consider how you intend to present your case to the Committee in light of the State Bar's
opinion and whether anyone will be speaking in a representative capacity for you or a business or governmental entity. If you or your
representative would like to speak before the Committee, you must complete and return this form within thirty (30) days of receipt of
this letter.
Depending on your status as an individual, corporation, partnership or municipality, the State Bar's Opinion affects how you may
proceed with your oral presentation. See www.ncbar.com/ethics, Authorized Practice Advisory Opinion 2006-1 and 2007 Formal
Ethics Opinion 3.
If you are an individual or business owner and are granted an opportunity to make an oral presentation before the Committee,
then you do not need legal representation before the Committee; however, if you intend on having another individual speak
on your behalf regarding the factual situations, such as an expert, engineer or consultant, then you must also be present at the
meeting in order to avoid violating the State Bar's Opinion on the unauthorized practice of law.
If you are a corporation, partnership or municipality and are granted an opportunity to make an oral presentation before the
Committee, then your representative must consider the recent State Bar's Opinion and could be considered practicing law
without a license if he or she is not a licensed attorney. Presentation of facts by non -lawyers is permissible.
If you choose to request an oral presentation, please make sure that signatures on the previously submitted Remission Request form
and this Oral Presentation Request form are: 1) for individuals and business owners, your own signature and 2) for corporations,
partnerships and municipalities, signed by individuals who would not violate the State Bar's Opinion on the unauthorized practice of
law.
Also, be advised that the Committee on Civil Penalty Remissions may choose not to proceed with hearing your case if the Committee
is informed that a potential violation of the statute concerning the authorized practice of law has occurred.
This the day of 220
SIGNATURE
TITLE (President, Owner, etc.)
ADDRESS
TELEPHONE

&74
�► -
- NCDENR
.
North Carolina Department of.Environment and Natural Resources
Pat McCrory
Governor
-April 17, 2015
'Mr. Haytham. Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place
Suite 200
Matthews, North Carolina 28105-5000
Donald R. van der Vaart
.Secretary
Subject: NOTICE OF VIOLATION
NOV-2015-LM-0017
Permit No. N000441.99
Sam's Mart #45 WWTP
Haywood County
Dear Mr. Kasem:
A review of Sam's Mart#45's WWTP monitoring report -for January 2015 showed the following violations:
Parameter
Date.
Limit Value
Reported Value
Limit Type
BOD, 5-Day
01/31/20.1.5
30.00 mg/I
31.45 mg/I
Monthly Average 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 above subject violation, it is not
requested. that a response be submitted.
Parameter
Date
Measuring Frequency
Violation =
Flow
Week ending 01/03/2015
Weekly
Failure to Monitor
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 DMR-and also a copy to this office.
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_ a— �--WQAsheville .File
MSC 1617-Central Files -Basement
James & James Environmental/ ORC
G:1W RlWQIHaywoodlW2stewaterlMinarslSam's Mart #45 (Citgo) 441991NOV-2015-LM-001 Tdoc
Water Quality Regional Operations —Asheville Regional Ofice.-
2090 U.S. Highway 70, Swannanoa, North Carolina 28778
Phone: [phone]. Fax: [phone]
Internet: hitpJ/portal.ncdenr.org/web/wq -
An Equal Opportunity/ Affirmative Action Employer

�.JAMES & JAMES ENVIRONMENTAL
:..�PO BOX 1354,
OFFICE
PERFORMANCE ANNUAL REPORT - 2011
Sam's Mart #45 Ms. Erin O'Connor Permit Number: NCO044199
System Description
An influent pump station located near the store pumps the wastewater into a 15,000 gallon
extended aeration facility with clarifier. Two modular grease interceptors are in place.
Performance
This system had one violation the entire year with regard to Total Suspended Solids. The rest of
the year the facility ran very well.
Violations and corrective actions taken
1. January, 2011
a. Total Suspended Solids
i. 1 / 13 @ 47.9 MG/L
1. Partial blockage of the discharge line with leaves and
twigs caused the facility to back up resulting in additional
fine particles in the effluent. The facility quickly regained
compliance once the line remained unclogged.
This report has been sent to the Owner with directions to give notification of the availability of this report
to each of their users. A certified statement will be sent to the State when this notice has been issued.
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. I also certify that this report has been given to the
owner of this facility with explicit directions to make the user aware of the availability of this report and the
location with which a copy can be viewed or received. James & James Environmental Mgt., Inc cannot
certify that the latter has been completed and will enclose a letter of certification to be mailed to the State
of North Carolina on behalf of t
conclusion of this requirement.
Thank you,
Juanita James
James & James Environmental

PERFORMANCE ANNUAL REPORT - 2011
Sam's Mart #45 Ms. Erin O'Connor
Permit Number: NCO044199
A copy of the Performance Annual Report has already been filed with the
State of North Carolina Division of Water Quality in triplicate by James &
James Environmental Management, Inc. and should be in your possession at
this time. On that report, the certification was stated that I, the responsible
party of this facility, has received a copy of this report and was directed to
give the users knowledge of this report and access to it.
Therefore:
I certify under penalty of law that this report prepared by James & James
Environmental Management, Inc. 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 this documented system and that those users have been
notified'of its availability.
Thank you,
Ms. Erin O'Connor
Sam's Mart #45

��-
�ip
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
August 25, 2011
Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place
Suite 200
Matthews NC 28105-5000
E-_IFILE COPY
Dee Freeman
Secretary
SUBJECT: Compliance Evaluation Inspection
Sam's Mart #45
Permit No: NCO044199
Haywood County
Dear Mr. Kasem :
Enclosed please find a copy of the Compliance Evaluation Inspection conducted
on August 11, 2011.
There are some spots on the facility which are beginning to rust through. Patching
the rusted out places and painting the plant would extend the lifespan of this facility. No
violations of permit requirements or applicable regulations were observed during this visit.
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,
Jeff Menzel
Environmental Specialist
Enclosure
cc: Juanita Reed James, ORC
Central Files
�heville-Files
SURFACE WATER PROTECTION — ASHEVILLE REGIONAL OFFICE
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778 NOAIiCarolina
Phone: [phone]\FAX: [phone]\Customer Service: 1-877-623-6748 //
Internet: www.ncwaterauality.org 9411— NatmATIlly
S:\SWP\Haywood\Wastewater\Minors\Sam's Mart #45 (Citgo) 44199\CEI 2011.docx

United States Environmental Protection Agency
Form Approved.
EPA Washington, 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 I SI 31 NCO044199 111 121 11/08/11 117 18I CI
191 S1 20I
Remarks
2111111111111111111111111111IIIIIIIIIIIIIIIIIIIII6
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA---------Reserved--
---
671 169 701 31 711 I 72I N I 73 L ]j 74
751 I I I I I Li 80
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)
Sam's Mart #95
01:00 PM 11/08/11
11/02/01
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville NC 28786
01:15 PM 11/08/11
16/01/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Juanita Reed James/ORC/828-697-0063/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Haytham Kasem,7935 Council Pl Matthews NC
281055000//704-567-8424/7045678432 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Operations & Maintenance E Facility Site Review N 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 Insp (s) Agency/Office/Phone and Fax Numbers
Date
Jeff Menzel ARO WQ//828-296-4500/
Signature of Management Q ON!ewer 6 Agency/Office/Phone and Fax Numbers
D, fe
v
EPA Form 3560-3 (Rev 9-94) Previou editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCO044199 I11 12I 11/08/11 117 18ICI
Section D: • Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
There are some spots on the facility which are beginning to rust through. Patching the rusted out places and
painting the plant would extend the lifespan of this facility.
No violations of permit requirements or applicable regulations were observed during this visit.
Page # 2

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 08/11/2011 Inspection Type: Compliance Evaluation
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 ■ fl ❑ 0
Judge, and other that are applicable?
Comment: There are some spots on the facility which are beginning to rust through.
Patching the rusted out places and painting the plant would extend the lifespan of this
facility.
Page # 3

7_
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 20, 2015
Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council PI
Ste 200
Matthews, NC 28105
SUBJECT: Compliance Evaluation Inspection
Sam's Mart #45
Permit No: NCO044199
Haywood County
Dear Mr. Kasem:
Donald R. van der Vaart
Secretary
Enclosed please find a copy of the Compliance Evaluation Inspection form from the inspection conducted on ,
May 20, 2015. The facility was found to be in compliance with permit NC0044199.
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,
Katherine H. Jimison
Chemist I
Enclosure
cc: Juanita Reed James, ORC
MSC 1617-CentmLFiles-Basement
Ashevil_ le Files-- — p
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 1 Affirmative Action Employer
G:IWRIWQ1HaywoodlWastewaterlMinors\Sams Mart#45 (Citgo) 44199\44199 CEI 2015.doc

United States, Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Insoection Report
,.
Approval expires 8-31-98
Section>& National -Data System,Coding (i.e., PCS) .
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1. IN 1 2 15 1 3 l NC0044199 I11 -12. 16/05/20 17
18 I c ! I 191S I 1 201 IJI,
21111111IIIIIII11IIIIIIIIIIIIIIII
f6
1
Inspection
Work Days Facility Self -Monitoring Evaluation Rating B1 QA
Reserved — _
67
70 1, 1 71 j 72 L1 N �
LJ :J
731 1 I�74 75I I I I I I I• I80
I I
Section B: Facility Data
Name and Lobation of Facility Inspected (For Industrial Users discharging to POTW, also include -
EntryyTime/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:OOAM 15/05/20
11/02/01
Sam's Mart #46
NCH wy 209
Exit ,Time/Date
Permit Expiration Date
Waynesville NC 28786
11:OOAM 15/05/20
16/01/31
Name(s) of Onsite Representative(s)Mtles(s)/Phone and Fax Number(s)
Other Facility Data
///
Juanita Reed James/ORC/828-697-0063/
Name, Address of Responsible Official7Title/Phone and Fax Number
Contacted
Haytham Kasem,7935 Council PI Matthews NC
2810550001/704-567-842'4/1046678432 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Records/Reports Facility Site Review
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(§) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers
Date
Kathy 5Jimison ARO WQ//828-296-4500/ .
C 4//
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#

NPDES yr/mo/day Inspection Type 1
31 NC0044199 I11 12 15/05/20 17 18 I ( I
Section D: Summary of Find ing/Comments. (Attach additionalsheetsof narrative and checklists as necessary)
Ms. Juanita James assisted in this inspection.
The facility is showing age and is severely rusted. This should be addressed and repaired.
The permit expires on January 31, 2016. Request a permit renewal within 6 months of expiration.
Page# 2

Permit: NCO044199 Owner -Facility: San. rt#45
Inspection Date: 05/20/2015 ' . 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
1-1 0
N
❑•
application? .
Is the facility as described in the permit?
0 ❑
❑
❑
# Are there any special conditions for the permit?
❑ '
❑
❑
is access to the plant site restricted to the general public?
0 ❑
'❑
❑
Is the inspector granted access to all areas for inspection?
0 . ❑
❑
❑
Comment: Juanita James, with James and James environmental assisted inthis inspection.
Operations & Maintenance
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:
Aeration Basins
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?(1.0to 3.0 mgH)
Comment: Dual blowers operational.
Secondary Clarifier
Is the clarifier free of black and odorous wastewater?
Is the site free of excessivebuildupof 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?
Yes No NA NE
❑
❑
❑
❑
❑
❑
■
Yes No NA :NE
Ext. Air ,
Diffused
❑.
❑
❑
❑ ❑
■
❑
❑
❑
❑
0. ❑
❑
❑
0, El
❑
❑
❑ ❑
❑
■
❑ ❑
❑.■
Yes No NA NE
❑
❑
❑
❑
❑
■
❑
■
❑
❑
❑
■
❑
❑
❑
■
❑
❑
❑
■
❑
❑
❑
■
❑
❑
❑
Page# 3

Permit: NC0044199 Owner -Facility: Sa r�`aart#45
Inspection Date: 05/2012015 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes No NA NE
Is the drive unit operational?
❑
❑
M
❑
Is the return rate acceptable (low turbulence)?
0
❑
❑
❑
Is the overflow clear of excessive solids/pin floc?
M
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately'/4 of the sidewall depth)
❑
❑
❑
M
Comment:
Page# 4

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place
Suite 200
Matthews, North Carolina 28105-5000
Dear Mr. Kasem:
Division of Water Quality
Charles Wakild, P.E.
Director
September 25, 2012
Subject: NOTICE OF VIOLATION
NOV-2012-LV-0479
Permit No. NCO044199
Sam's Mart #45 WWTP
Haywood County
Dee Freeman
Secretary
A review of Sam's Mart #45's WWTP monitoring report for May 2012 showed the following
violations:
Parameter
Date
Limit Value
Reported
Limit Type
Value
Solids, Total Suspended -
05/31/2012
30 mg/I
35.14 mg/I
Monthly Average
Concentration
Exceeded
BOD, 5-Day (20 Deg. C) -
05/31/2012
30 mg/I
31.36 mg/I
Monthly Average
Concentration
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
cc .:.DWQ_Asheville`Files,
DWQ Central Files
James & James Environmental/ ORC
S:\SWP\Haywood\Wastewater\Minors\Sam's Mart #45 (Citgo) 44199\NOV-2012-LV-0479.doc
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone]
Internet: www.ncwatercivality.org FAX [phone]
NorthCarolina
Na4=1111

i
NCDENR FILE Cory.
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place
Suite 200
Matthews, North Carolina 28105-5000
Dear Mr. Kasem:
Division of Water Quality
Coleen H. Sullins
Director
May 10, 2011
Subject: NOTICE OF VIOLATION
NOV-2011 -LV-01 70
Permit No. NCO044199
Sam's Mart #45 WWTP
Haywood County
Dee Freeman
Secretary
A review of Sam's Mart #45's WWTP monitoring report for January 2011 showed the following
violation:
Parameter
Date
Limit Value
Reported Value
Limit Type
Solids, Total Suspended -
Concentration
01/13/2011
45 mg/I
47.9 mg/I
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: however, should you have additional information
concerning the violations or comments which you wish to present, please submit them to the attention of Janet
Cantwell.
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
8281296-4600.
Sincerely,
D
Roger C. Edwards, Regional Supervisor
Surface Water Protection Section
cc' D.W�Q---sheeilletRail- S
C D1NQ entral Files.
James & James Environmental/ ORC
S:1SWP1Haywood\Wastewater\Minors\Sam's Mart #45 (Citgo) 441991NOV-2011-LV-0170.doc
No°rthCarolina
Ivatura!!y
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, N.C. 28778 Phone[phone] Customer Service
Internet: www.ncwaterauality.org FAX [phone]

Sam's Mart #45
JAMES & JAMES ENVIRONMENTAL MANAGEMENT, INC
PO BOX 1354, MOUNTAIN HOME, NC 28758
[phone] OFFICE
[phone] FAX
PERFORMANCE ANNUAL REPORT - 2009
Ms. Erin O'Connor Permit Number: NCO044199
System Description
A influent pump station located near the store pumps the wastewater into a 15,000 gallon extended
aeration facility with clarifier. Two modular grease interceptors are in place.
Performance
This system was contracted by James & James in December. I do not have record of the
operations of the facility prior to that date. Upon the start of operations, the previous operator was required
to install a blower that was already purchased.
Violations and corrective actions taken
none
This report has been sent to the Owner with directions to give notification of the availability of this report
to each of their users A certified statement will be sent to the State when this notice has been issued.
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. I also certify that this report has been given to the
owner of this facility with explicit directions to make the user aware of the availability of this report and the
location with which a copy can be viewed or received. James & James Environmental Mgt., Inc cannot
certify that the latter has been completed and will enclose a letter of certification to be mailed to the State
of North Carolina on behalf of this entity along with all pertinent information regarding this system for the
conclusion of this requirement.
ank you,
Ju mita James
James & James Environmental Management, Inc.
2/28/10
MAR 6 5 Z010 I
MAR 1 6 2010
i
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE {

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&74 J rL
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue
Governor
CERTIFIED MAIL 70091680 0002 2464 6197
RETURN RECEIPT REQUESTED
Mr. Adnan Jazairi
LSAA Inc, dba Sams Mart
7935 Council PI
Suite 200
Matthews, NC 28105-5000
Dear Mr. Jazairi:
Coleen H. Sullins
Director
February4, 2010
w
r
Dee Freeman
l� li FEB - 8 2010
WATER QUALITY SECTiJfJ
ASHEVILLE REGIQNI:;L CFF ICE
Subject: NOTICE OF VIOLATION — NOV - 2010 - LR - 0008
Sams Mart #43 WWTP NCO044199
Haywood County
,ru
This is to inform you that the Division of Water Quality has not received your monthly monitoring report for
November 2009.after the required reporting date. This is in violation of Part II, Condition D (2) of the NPDES permit, as
well as 15A NCAC 2B .506(a), which requires the submittal of Discharge Monitoring -Reports no later than the thirtieth
(30th) day following the reporting period. Failure to submit reports as required will subject the violator to the
assessment of a civil penalty of up to $25,000 per violation. You will be considered noncompliant with the.self-
monitoring requirements of your NPDES permit until the report has been submitted.
Please submit the November 2009 DMR report within 15 days of receipt of this notice if you have not yet
submitted it. To prevent further action, please submit future monthly reports within the above -mentioned
timeframe to avoid further enforcement actions.
The Division must take these steps because timely submittal of discharge monitoring reports is essential to the
efficient operation of our water quality programs. We appreciate your assistance in this matter. If you have any questions
about this letter or Discharge Monitoring Reports, please contact me at 919-807-6387.
Sincerely,
Bob Guerra
Western Region NPDES Unit
cc: DWQ Asheville Surface Water Protection Supervisor
Central Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One Phone: [phone] FAX: [phone] Customer Service:1-877-623-6748 NofthCarohna
Internet: vrww.ncwaterquality.org 1�N� //�
An Equal Opportunity \ Affirmative Action Employer ��` L l

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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
January 25, 2010
CERTIFIED MAIL 7009 1680 0002 2464 6135
RETURN RECEIPT REQUESTED
Mr. Adrian Jazairi
LSAA Inc, dba Sams Mart
6407 Idelwild Road, Suite 204
Charlotte, NC 28212 .
Subject: NOTICE OF VIOLATION —NOV -2010 - LR - 0008
Sams Mart #43 WWTP NCO044199
Haywood County
Dear Mr. Jazairi:
This is to inform you that the Division of Water Quality has not received your monthly monitoring report for
November 2009 after the required.reporting date. This is in violation of Part II, Condition D (2) of the NPDES permit, as
well as 15A NCAC 2B .506(a), which requires the submittal of Discharge Monitoring Reports no later than the thirtieth
(30'h) day following the reporting period. Failure to submit reports as required will subject the violator to the
assessment of a civil penalty of up to $25,000 per violation. You will be considered noncompliant with the self -
monitoring requirements of your NPDES permit until the report has been submitted.
Please submit the November 2009 DMR report within 15 days of receipt of this notice if you have not yet
submitted it. To prevent further action, please submit future monthly reports within the above -mentioned
timeframe to avoid further enforcement actions.
The Division must take these steps because timely submittal of discharge monitoring reports is essential to the
efficient operation of our water quality programs. We appreciate your assistance in this matter. If you have any questions
about this letter or Discharge Monitoring Reports, please contact me at 919-807-6387.
SincerrelyyV
Bob Guerra
Western Region NPDES Unit
cc: DWQ--I
le -•Surface Water Protection Supervisor
Central Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: 9IM07-64951 Customer Service:1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
D
JAN 2 '8 2010
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
One
NorWarohna
;Vaturallrf

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
January 7, 2010
Mr. Adnan Jazairi
LSAA LLC - dba: Sam's Mart
7935 Council Place; Suite 200;
Matthews, NC 28105-50.00
SUBJECT: Compliance Evaluation Inspection
Sam's Mart #45
Permit No: NCO044199
Haywood County
Dear Mr. Jazairi:
Enclosed please find a copy of the Compliance Evaluation Inspection form from the
inspection conducted on December 30, 2009. The facility was found to be in compliance with
permit NC0085952.
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,
Wanda P. Frazier
Environmental Specialist
Enclosure
NorthCarolina
Central Files Aatmraliff
As.'he�illerF.iles�:,
SURFACE WATER PROTECTION —ASHEVILLE REGIONAL OFFICE
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterguality.org
F1,

United States Environmental Protection Agency
Fort Approved.
EPA Washington, 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/mc/day Inspection Type Inspector Fac Type
1 I NI 2 I SI 31 N00044199 Ill 121 09/12/30 117 181 CI 19I sl 20III
Remarks
211 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I .1 I I I I I I I 116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA ---- Reserved ----
67 I 1.0 169 70131 711 I 721 NJ 73I I 174 751 I I I I I Li 80
W
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)
Sam's Mart #45
11:30 AM 09/12/30
06/12/01
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville NC 28786
12:00 PM 09/12/30
11/01/31
Name(s) of Onsite Rep resentative(s)rritles(s)/Phone and Fax Number(s)
Other Facility Data
Joseph Carmon Simmons/ORC/828-898-6277/
Name, Address of Responsible OfficialrTitle/Phone and Fax Number
Jessica Schley,7935 Council Pl Matthews NC Contacted
281055000//704-567-8424/7045678432 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 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/Offic hone 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 NCO044199 I11 12I 09/12/30 117 18I CI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
OPERATIONS AND MAINTENANCE / EFFLUENT / SUMMARY:
Ms. Juanita James, assisted in the inspection.
This facility appears to be well operated.
The facility now has two operational blowers.
The metal treatment plant is badly rusted and corroded and needs maintainance..
The effluent appeared to be clear, indicating compliance with permit limits.
PERMIT/IN SPECTION / LOG:
A review of the files indicates that the last compliance evaluation inspection was conducted on
5-1-2009 by Wanda Frazier.
A copy of the current permit was on -site.
The permit expires on 10-31-2010. Please request a permit renewal 6 months prior to expiration.
A renewal notice will be mailed as a reminder.
The log book was present on -site and had good notation of daily events.
PERFORMANCE ANNUAL REPORT:
The Annual Performance Report for the reporting period July 1, 2008 - June 30, 2009 been filed for the year.
(Note: The owner or operator of any wastewater treatment works or wastewater collection systems that
treats or collects primarily domestic or municipal waste must provide an Annual Report to its users or
customers and to the Department of Environment and Natural Resources that summarizes the treatment
works' and collection system's performance over a 12 month period.)
Page # 2

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 12/30/2009 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?
■
n
❑
n
# Are there any.special conditions for the permit?
n
■
n
n
Is access to the plant site restricted to the general public?
®❑
❑
❑
Is the inspector granted access to all areas for inspection?
■
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?
■
❑
❑
❑
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
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■
❑
n
n
Are surface aerators and mixers operational?
❑
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)
■
❑
❑
❑
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?
❑
n
■
❑
Are weirs level?
■
n
n
n
Page # 3

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 12/30/2009 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No
NA
NE
Is the site free of weir blockage?
■
❑
❑
Cl
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:
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
00
Judge, and other that are applicable?
Comment:
Page # 4

EMVIROMMEMAL
—Inc. water & Wastewater Services
ela..Al 117&
P.O. Box 954, Cullowhee, NC 28723 (50 West Sylva Shopping Center, Sylva, NC 28779)
Phone: [phone], .Fax: [phone],
E-mail: [e-mail]
August 1, 2009
Attn.: System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Annual- Report
NPDES #EUCQ0441-99
Citgo Truck Stop
Haywood County
E
SEP 2 2 2009
WATER QUALITY SECTION t
ASHEVILLE REGIONAL OFFICE Ry)•
The attached document is pursuant to House Bill 1160, the Clean Water Act of 1999,
which was signed into law by the Governor on July 21, 1999. The legislation is intended
to instill public oversight by requiring spill notification and annual reporting by all entities
owning or operating wastewater treatment facilities in the state of North Carolina.
Concerned persons may obtain more detailed information concerning the above
referenced facility by contacting me at [phone].
Sincerely,
Mark Teague
Operator in Responsible Charge
Encl.: Annual Report
CC: - Sam's Mart
%u"A
DENR - WATER QUALITY
POINT SOURCE BRANCH

PERFORMANCE ANNUAL .-EPORT
I. General Information
Facility and System Name:
Citgo Truck Stop
Highway 209 at I-40
Haywood County
Permit: NCO044199
Owner:
LSAA, Inc.
6407 Idlewild Road, Suite 204
Charlotte, NC 28212
Operator:
Environmental, Inc.
ORC:
Mark Teague
P.O. 'Box 954
Cullowhee, NC 28723
Description of Collection System or Treatment Process:
Citgo Truck Stop operates a 0.015.MGD wastewater treatment facility consisting of two modular
grease interceptor units, an aeration basin and a clarifier with sludge returns, located at Citgo
Truck Stop, at Highway 209 off I-40, north of Waynesville, Haywood County. Discharge from
said treatment works is into the Pigeon River, which is classified as Class C water in the French
Broad River Basin.
II. PERFORMANCE
Summary of System Performance July 1, 2008 to June 30, 2009
Analytical results indicate that no permitted monthly limits were exceeded during the reporting
period. In addition, no bypasses or overflows occurred.
III. NOTIFICATION ,
A copy of this report is available by contacting:
LSAA, Inc.
6407 Idlewild Road, Suite 204
Charlotte, NC .28212
IV. CERTIFICATION
I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify this report has been made available to users_ or customers of the
Citgo Truck Stop.
Mark Teague
Operator in Responsible Charge
Environmental, Inc. 8/1/09

A7A
NCDENP
North Carolina Department of EnvironmE
Division of• Watem
Beverly Eaves Perdue ColeenRH. JStallins
Governor Director
September 11, 2009
ADNAN JAZAIRI
VICE PRESIDENT
LSAA, INC. DBA SAM'S MART
6407 IDLEWILD RD,STE 204
CHARLOTTE NC 28212
SUBJECT: Payment Acknowledgment
Civil Penalty Assessment
Sam's Mart #45
Permit Number: NCO044199
Case Number: LR-2008-0001
Haywood County
Dear Mr. Jazairi:
and Natural Resources
Dee Freeman
Secretary
This letter is to" acknowledge receipt of check number 0074883 in the amount of $600.00 received from you
dated -September 3, 2009. This payment satisfies in full the above civil assessment levied against the subject
facility, and this case has been closed. Payment of this penalty in no way precludes future action by this
Division for additional violations of the applicable Statutes, Regulations, or Permits.
If you have any questions, please call Bob Guerra at 919-807-6387.
Sincerely,
Jovonah Weeden
cc: . Central. Files
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.ncwaterquality.org
An Equal Opportunity 1 Affirmafive Action Employer
�7F •.
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f
f I SEP 7 4 2009 1
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WATER QUALITY SECTION
ASHEVILLE RE\G• IONAL OFFICE
ae
Northcaroliria "`
Nahlralli

ROY COOPER
Attorney General
Mr. Sanu I. Nafisi
LSAA, Inc.
7935 Council Place
Matthews, N. C. 28105
ew5CAiFs
y.
•q ��r
State of North Carolina
Department of Justice
PO Box 629
Raleigh, North Carolina
27602
August 10, 2009
CERTIFIED MAiL
RETURN RECEIPT
Francis W. Crawley
Phone: [phone]
Fax: [phone]
[e-mail]
RE: Assessments of Civil Penalties Against LSAA, Inc., LR 0001
Dear Mr. Nafisi:
You will find enclosed the Final Agency Decision of the Environmental Management Commission
assessing the civil penalties and investigative costs as set forth in the decision document. According to
North Carolina General Statutes _§ 143-215.5 and §15013-45, LSAA, Inc. may seek judicial review
of the Commission's decision in the Superior Court of Haywood County or Wake County by filing
a petition within 30 days of receipt of a written copy of the final agency decision. Otherwise,
payment of the civil penalty assessment and costs must be submitted to the Department of
Environment and Natural Resources within 30 days ofreceipt of these final agency decision by mailing
a check made payable .to the Department of Environment and Natural Resources in an envelope addressed
as follows:
Mr. Kevin Bowden ,'hone (919) 807-6.397]
Compliance Oversight Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If LSAA, Inc .fails to pay the penalty within 30 days of receipt of the final decision
document, the Department will seek to collect the amount due through a civil action commenced in
Superior Court.
Very truly yours,
(��1.�^G�i� tom• ��
Francis W. Crawley
Special Deputy Attorney General
Commission Counsel
Enclosure

CERTIFICATE OF SERVICE
This is to certify that I have this day served a copy of the foregoing FINAL DECISION on
the parties listed below by the methods indicated:
Mr. Sami I Nafisi
LSAA, Inc.
7935 Council Place
Matthews, N. C. 28105
Mr. Roger Edwards
DWQ Regional Supervisor
2090 US Hwy 70
Swannanoa, N. C. 28778
This the /© day of August, 2009.
CER I'IFIED MAIL
RETURN RECEIPT
ELECTRONIC DELIVERY
ROY COOPER
Attorney General
Cca U).
Francis W. Crawley
Special Deputy Attorney General
N.C. Department of Justice
P. O. Box 629
Raleigh, N.C. 27602
919/716-6600

State of North Carolina
Department of Justice
ROY COOPER PO Box 629
Attorney General Raleigh, North Carolina
27602
July 28, 2009
Mr. Adnan CERTIFIED -MAIL
LSAA, Inc. RETURN RECEIPT
6407 Idewild Road, Suite 204
Charlotte, N. C. 28212
Francis W. Crawley
Phone: [phone]
Fax: [phone]
[e-mail]
RE: Assessments of Civil Penalties Against LSAA, Inc., LR .0001
Dear Mr. Adnan:
You will find enclosed the Final Agency Decision of the Environmental Management Commission
assessing the civil penalties and investigative costs as set forth in the decision document. According to
North Carolina General Statutes §143-215.5 and §150B-45, LSAA, Inc. may seek judicial review
of the Commission's decision in the Superior Court of Haywood County or Wake County by filing
a petition within 30 days of receipt of a written copy of the final agency decision. Otherwise,
payment of the civil penalty assessment and costs must be submitted to the Department of
Environment and Natural Resources within 30 days of receipt of these final agency decision by mailing
a check made payable to the. Department of Environment and Natural Resources in an envelope addressed
as follows:
Mr. Kevin Bowden [Phone [phone]]
Compliance Oversight Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If LSAA, Inc .fails to pay the penalty within 30 days of receipt of the final decision
document, the Department will seek to collect the amount due through a civil action commenced in
Superior Court.
Very truly yours,
� j
Yam/
rancis A W. Crawley
Special Deputy Attorney General
Commission Counsel
Enclosure

STATE OF NORTH CAROLINA
COUNTY OF HAYWOOD
IN THE MATTER OF: )
Assessment of Civil Penalties )
Against )
LSAA, Inc. d/b/a Sam' Mart )
BEFORE THE
REMISSION COMMITTEE OF THE
ENVIRONMENTAL MANAGEMENT
COMMISSION
LR 2008-0001
FINAL DECISION
THIS MATTER came before the Committee on Civil Penalty Remissions of the
Environmental Management Commission, pursuant to N.C.G.S. §143-215.6A and §143B-282.1,
on July 9, 2009, upon recommendation of the Director of the Division of Water Quality for entry
of a final decision on the assessment of civil penalties and investigation costs against LSAA, Inc.
in the amount of $600.00 ($500.00 plus $100.00 investigative costs). LSAA, Inc.'s request for
remission was presented to the Committee on Civil Penalty Remissions for consideration.
LSAA, Inc. did not request oral argument; therefore, its request for remission was presented to
the Committee on Civil Penalty Remissions based on its written submissions and those of the
Division of Water Quality.
Having considered the record and the factors set forth in N.C.G.S. §143B-282.1(b) and
(c), the Committee on Civil Penalty Remissions finds the facts contained in the Director's
Findings and Decision and Assessment of Civil Penalties as stipulated by LSAA, Inc., that the
Findings of Fact support the Conclusions of Law, and that the Director properly applied the
criteria set forth in N.C.G.S. §143B-282.1 in determining the amount of the civil penalty. The
Committee further finds that there are no grounds shown for remission or reduction of the
penalty assessed by the Director for violation of N.C.G.S. § 143-215.65 and the terms of NPDES

-3-
CERTIFICATE OF SERVICE
This is to certify that I have this day served a copy of the foregoing FINAL DECISION on
the parties listed below by the methods indicated:
Mr. Adnan Jazairi CERTIFIED MAIL
LSAA, Inc. RETURN RECEIPT
6407 Idewild Road, Suite 204
Charlotte, N. C. 28212
Mr. Roger Edwards ELECTRONIC DELIVERY
DWQ Regional Supervisbr
2090 US Hwy 70
Swannanoa, N. C. 28778
This the a;,S day of July, 2009.
ROY COOPER
Attorney General
Gtw W
Francis W. Crawley
Special Deputy Attorney General
N.C. Department of Justice
P. O. Box 629
Raleigh, N.C. 27602
919/716-6600

-2-
Permit No. NCO044199 by failing to submit the July 2007 Discharge Monitoring Report within
thirty days of the close of the reporting period.
Upon duly made motion and vote, the Committee finds that the assessment of civil
penalties and costs in the amount of $600.00 ($500.00 civil penalty plus $100.00 investigation
costs) should be upheld.
THEREFORE, IT IS ORDERED:
That the assessment of civil penalties and costs in the amount of $600.00 against
LSAA, Inc. is AFFIRMED.
2. That this Final Decision and Order be served upon LSAA, Inc. and upon receipt
hereof, the amount of $600.00 be paid to the Department of Environment and Natural Resources
within thirty days as required by jaw.
This the 2 day of July, 2009.
Stephen T. Smith, Chairman
Environmental Management Commission

State of North Carolina
Department of Justice
ROY COOPER PO Box 629
Attorney General Raleigh, North Carolina
27602
July 28, 2009
Mr. Adnan CERTIFIED MAIL
LSAA, Inc. RETURN RECEIPT
6407-Idewild Road, Suite 204
Charlotte, N. C. 28212
Francis W. Crawley
Phone: [phone]
Fax: [phone]
[e-mail]
RE: Assessments of Civil Penalties Against LSAA, Inc., LR 0001
Dear Mr. Adnan:
You will find enclosed the Final Agency Decision of the Environmental Management Commission
assessing the civil penalties and investigative costs as set forth in the decision document. According to
North Carolina General Statutes § 143-215.5 and § 15013-45, LSAA, Inc. may seek judicial review
of the Commission's decision in the Superior Court of Haywood County or Wake County by filing
a petition within 30 days of receipt of a written copy of the final agency decision. Otherwise,
payment of the civil penalty assessment and costs must be submitted to the Department of
Environment and Natural Resources within 30 days of receipt of these final agency decision by mailing
a check made payable to the Department of Environment and Natural Resources in an envelope addressed
as follows:
Mr. Kevin Bowden [Phone [phone]
Compliance Oversight Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If LSAA, Inc .fails to pay the penalty within 30 days of receipt of the final decision
document, the Department will seek to collect the amount due through a civil action commenced in
Superior Court.
Very truly yours,
t
.ancis W. Crawy
Special Deputy Attorney General
Commission Counsel d
Enclosure

-3-
CERTIFICATE OF SERVICE
This is to certify that I have this day served a copy of the foregoing FINAL DECISION on
the parties listed below by the methods indicated:
Mr. Adnan Jazairi CERTIFIED MAIL
LSAA, Inc. RETURN RECEIPT
6407 Idewild Road, Suite 204
Charlotte, N. C. 28212
Mr. Roger Edwards ELECTRONIC DELIVERY
DWQ Regional Supervisor .
2090 US Hwy 70
Swannanoa, N. C. 28778
This the a:43 day of July, 2009.
ROY COOPER
Attorney General
Cb- to
Francis W. Crawley
Special Deputy Attorney General
N.C. Department of Justice
P. O. Box 629
Raleigh, N.C. 27602
919/716-6600

STATE OF NORTH CAROLINA
COUNTY OF HAYWOOD
IN THE MATTER OF: )
Assessment of Civil Penalties )
Against )
LSAA, Inc. d/b/a Sam' Mart )
BEFORE THE
REMISSION COMMITTEE OF THE
ENVIRONMENTAL MANAGEMENT
COMMISSION
LR 2008-0001
'FINAL DECISION
THIS MATTER came before the Committee on Civil Penalty Remissions of the
Environmental Management Commission, pursuant to N.C.G.S. § 143-215.6A and § 143B-282.1,
on July 9, 2009, upon recommendation of the Director of the Division of Water Quality for entry
of a final decision on the assessment of civil penalties and investigation costs against LSAA, Inc.
in the amount of $600.00 ($500.00 plus $100.00 investigative costs). LSAA, Inc.'s request for
remission was presented to the Committee on Civil Penalty Remissions for consideration.
LSAA, Inc. did not request oral argument; therefore, its request for remission was presented to
the Committee on Civil Penalty Remissions based on its written submissions and those of the
Division of Water Quality.
Having considered the record and the factors set forth in N.C.G.S. §143B-282.1(b) and
(c), the Committee on Civil Penalty Remissions finds the facts contained in the Director's
Findings and Decision and Assessment of Civil Penalties as stipulated by LSAA, Inc., that the
Findings of Fact support the Conclusions of Law, and that the Director properly applied the
criteria set forth in N.C.G.S. §143B-282.1 in determining.the amount of the civil penalty. The
Committee further finds that there are no grounds shown for remission or reduction of the
penalty assessed by the Director for violation of N.C.G.S. § 143-215.65 and the terms of NPDES

-2-
Permit No. NC0044199 by failing to submit the July 2007 Discharge Monitoring Report within
thirty days of the close of the reporting period.
Upon duly made motion and vote, the Committee finds that the assessment of civil
penalties and costs in the amount of $600.00 ($500.00 civil penalty plus $100.00 investigation
costs) should be upheld.
THEREFORE, IT IS ORDERED:
1. That the assessment of civil penalties and costs in the amount of $600.00 against
LSAA, Inc. is AFFIRMED.
2. That this Final Decision and Order be served upon LSAA, Inc. and upon receipt
hereof, the amount of $600.00 be paid to the Department of Environment and Natural Resources
within thirty days as required bylaw.
This the 2 0 day of July, 2009.
Stephen T1. Smith, Chairman
Environmental Management Commission

NCDENR
North Carolina Department. of Environment and Natural Resources
Division of Water Quality;
Beverly Eaves Perdue Coleen H. Sullins Dee' Freeman
Governor Director
June 10, 2009
Mr. Adnan Jazairi
LSAA, Inc. dba Sam's Mart
6407 Idlewild Road; Suite 204
Charlotte, NC 28212
J U N 1 1 2009
f,
�t
ti. WATER QUALITY SECTION
-` ASHEVILLE REGIONAL OFFICE
SUBJECT: Request for Remission of Civil Penalty
Pursuant to N.C.G.S. 143-215.6A(f)
Sam's Mart #43 WWTP
Case Number LR-2008-0001
NPDES Permit NCO044199
Haywood County
Dear Mr. Jazairi:
A final agency decision on your request for remission of the subject civil penalty will be made by the
Committee On Civil Penalty Remissions (Committee) of the.Environmental Management Commission
(EMC) on Thursday, July 9, 2009.
V No request for oral presentation was made. You may attend this meeting, but you will not be
permitted to speak regarding your case.
The EMC Chairman has considered the written record and determined that no oral presentation
will be made. You may attend this meeting, but you will not be permitted to speak regarding
your case.
The EMC Chairman has considered the written record and determined that an oral presentation is
necessary. Please come prepared to present your remission request at this meeting. You will be
allowed approximately five (5) minutes to speak. Please be advised that the Committee cannot
consider any information other than that submitted in the original remission request. Please note,
the State Bar's recent Opinion regarding the unauthorized practice of law affects your method of
presenting at the Committee.
If you are an individual or business owner and are granted an opportunity to make an oral presentation
before the Committee, then you do not need legal representation before the -Committee; however, if you
intend on having another individual speak on your behalf regarding the factual situations, such as an,
expert, engineer or consultant, then you must also be present at the meeting in order to avoid violating
the State Bar's Opinion on the unauthorized practice of law.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
Location:512 N,.Salisbury St. Raleigh, North Carolina27604 NorthCarolina
Phone: [phone] \ FAX: [phone] Customer Service:1-877-623-6748
Internet: www.ncwaterquality.org NaAM1911yAn Equal Opportunity \ Affirmative Action Employer

Mr. Adnan Jazairi
LR-2008-0001 CCPR Notification
p. 2
If you are a corporation, partnership or municipality and are granted an opportunity to make an oral
presentation before the Committee, then your representative must consider the recent State Bar's
Opinion and could be considered practicing law without a license if he or she is not a licensed attorney.
Presentation of facts by non -lawyers is permissible.
Also, be advised that the Committee on Civil Penalty Remissions may choose not to proceed with the
hearing of a case if the Committee is informed that a potential violation regarding the unauthorized
practice of law has occurred.
Time and Location of Meeting
The Committee will convene at 11:00 a.m. or immediately following the closing of the regularly
scheduled business meeting of the Environmental Management Commission. The Committee meeting
will be held in the Ground Floor Hearing Room of the Archdale Building, located at 512 North
Salisbury Street in Raleigh, North Carolina (see enclosed map).
Other Things to Know About The Meeting
The length of an Environmental Management Commission meeting is determined by its agenda of the
day and the amount of discussion given to each topic — meetings often extend into the early afternoon.
You are advised to arrive for the Committee meeting no later than 11:00 a.m. in order to ensure your
opportunity to listen to consideration of your case in the event that the Committee begins at its appointed
time. If the Commission meeting runs long and you need refreshment or food, Division of Water
Quality staff can direct you to a canteen/snack bar that is located on the basement floor of the Archdale
Building or to other local eateries.
If you have any questions concerning this matter, please call. Bob Sledge of the Point Source Branch at
[phone].
Sincerely,
Coleen H. Sullins
enclosure
cc' shevi=lle�Regional-Off ce
Enforcement File
Central Files

Frazier, Wanda
From: Frazier, Wanda
Sent: Thursday, June 04, 2009 12:57 PM
To: 'Erin O'Connor'
Subject: RE: Sam's Mart #45 NOV-2009-PC-0424
Erin,
Thanks for calling and responding to the NOV inspection.
All of this sounds good.
You may have until July 1, 2009 to make the recommended repairs and improvements.
If you need me, give me a call or email me anytime.
Thanks for your prompt response. `
Wanda
Wanda Frazier
Email: [e-mail]
North Carolina Department of
Environment and Natural Resources
Asheville Regional Office
Division of Water Quality
Surface Water Protection Section
2090 US 70 Highway
Swannanoa, NC 28778
Switchboard: 828-296-4500 x 4662
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: Erin O'Connor [ma i Ito: eocon [e-mail]]
Sent: Thursday, June 04, 2009 10:10 AM_
To: Frazier, Wanda
Cc: Adnan Jazairi; Crystal Burnette
Subject: Sam's Mart #45 NOV-2009-PC-0424
Good morning Wanda,
I'm writing you regarding the Notice of Violation you issued for the inspection completed on April 28, 2009. 1 have spoken
with Mark Teague with Environmental Inc. to fix the compliance issues. Our permit is current and does not expire until
January 31, 2011. We will get a copy of the permit and post it. Mark informed me that the plant has already been pumped
and reseeded. As for the other issues, Mark Teague will get the grease trap pumped and is getting a quote for the motor
and blower. Since the issues will not be resolved in time, we are asking for an extension. Please allow LSAA, LLC dba
Sam's Mart to have until July 1, 2009 to repair all the compliance_ issues.
If you need any further information, please let me know.
1

Thank you,
Erin O'Connor
Human Resources
and Environmental Administrator
7935 Council Place Ste. 200
Matthews, NC 28105
(P) 704-563-3998
(F) 704-405-8674

Ala
-��-��' copy;
Beverly Eaves Perdue
Governor
CERTIFIED MAIL
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
. . SURFACE WATER PROTECTION SECTION
RETURN RECEIPT REQUESTED
Mr. Adnan Jazairi, Vice -President
LSAA, LLC dba: Sam's Mart
7935 Council Place, Suite 200
Matthews, NC 28105
Dear Mr. Jazairi:
May 5, 2009
Dee Freeman
Secretary
Subject: NOTICE OF VIOLATION
NOV-2009-PC-0424
Compliance Evaluation Inspection
Sam's Mart #45
Permit No. NCO044199
Haywood County
E .Z1
Enclosed please find a copy of the Inspection Report from the inspection conducted on April
28, 2009, by Wanda Frazier of the Asheville Regional Office. The treatment facility was found to be in
violation of Permit NCO044199 for the following:
Compliance issues found during the inspection are:
Inspection
Compliance Issue
Area
Permit
The contract operator needs a copy of the new permit. It should be kept on -site.
Operations and
The bacterial population in the plant appeared to be very old, dark and dead. The
Maintenance
operator indicated that the plant needed to be pumped and reseeded.
Operations and
The grease trap probably needs to be pumped as well, since there appeared to be an
Maintenance
excess amount of FOG (fats, oils and grease).
Operations and
A motor and blower is needed. There is only one working motor and blower.
Maintenance
"ASHEVILLE REGIONAL OFFICE ATOne
2090 U.S. Highway 70, Swannanoa, NC 28778 1V orthCarolina
Phone: [phone] FAX: [phone]Ammally
Customer Service:1-877-623-6748
Internet: www.ncwaterguality.org

Mr. Adnan Jazairi
May 5, 2009
Page 2 of 2
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 me or Wanda Frazier at
828-296-4500.
Sincerely,
Roger C. Edwards, Regional Supervisor
Surface Water Protection Section
Attachment
cc: Mark Teague, Environmental Inc. contract ORC, with attachment
qVA-s-Heville-fire-i =with -attachment—"
WQ Central files, with attachment
Bob Guerra, Compliance / Enforcement Unit, with attachment

United States Environmental Protection Agency
Form Approved.
EPA Washington, 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 NCO044199 111 121 09/04/28 117 18I CI 19I SI 20II
Remarks
21111111111111IIII IIIIIIIIIIIIIIIIIIII•IIIIIIIIIIIll
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ------------ —------------ Reserved -------------- -------
67 I 1.0 169 70I 3 I 71 I I 72) N � 73 � 74 751 I I I I I Li 80
u
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)
02:40 PM 09/04/28
06/12/01
Sam's Mart #45
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville NC 28786
03:10 PM 09/04/28
11/01/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Mark Fredrick Teague//828-293-9396 /
Mark Fredrick Teague/ORC/828-293-9396/
Name, Address of Responsible Official/Title/Phone and Fax Number
Jessica Schley,6407 Idelwild Road, Ste 204 Charlotte NC Contacted
28212//704-567-8424/7045678432 No
Section C: Areas Evaluated During Inspection (Check only'those areas evaluated)
Permit ® Operations & Maintenance ® 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/
Roo 7
Signature of Management Q A Reviewer Agency/Office/Phone an Fax Numbers Date
�u
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
31NC0044199 I11 12I 09/04/28 1
17 18ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
The contract operator needs a copy of the new permit. It should be kept on -site.
The bacterial population in the plant appeared to be very old, dark and dead.
The operator indicated that the plant needed to be pumped and reseeded.
The grease trap probably needs to be pumped as well, since there appeared to be an excess amount of
FOG (fats, oils and grease).
A motor and blower is needed. There is only one working motor and blower.
Page # 2

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 04/28/2009 Inspection Type: Compliance Evaluation
(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?
®❑
❑
n
Comment: A copy of the current permit needs to be kept on -site.
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?
®❑
❑
❑
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
'Type of aeration system
Diffused
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: The activated sludge appeared to be very old, dark and dead.
The plant appeared to need pumping and reseeding.
The aeration basin DO was 2.27 mg/I.
There is only one blower & motor. Another blower and motor is needed.
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
❑
❑
❑
Page # 3

Permit:.NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 04/28/2009 Inspection Type: Compliance Evaluation
Secondary Clarifier
Yes
No NA NE
Is the site free of excessive buildup of solids in center well of circular clarifier?
n
n ® n
Are weirs level?
®❑
n n
Is the site free of weir blockage?
®
n n n
Is the site free of evidence of short-circuiting?
®
n n n
Is scum removal adequate?
®❑
n n
Is the site free of excessive floating sludge?
n n n
Is the drive unit operational?
❑
❑ ® n
Is the return rate acceptable (low turbulence)?
®
n n n
Is the overflow clear of excessive solids/pin floc?
Cl
N n n
Is the sludge blanket level acceptable? (Approximately'/4 of the sidewall depth)
■
n n n
Comment: There was pin floc present in the clarifier.
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 B n n n
Judge, and other that are applicable?
Comment: The grease trap at the restaurant probably needs to be pumped, since
there appeared to be an excess amount of FOG (fats, oils & grease) in the plant.
Page # 4

tuE
ENVIRONMENTAL
—Inc.
&AW.1611'
WO'�
P.O. Box 954 (5690 Old Cullowhee Road), Cullowhee, North Carolina, 28723
Phone: [phone], Fax: [phone]
E-mail: environmentalinc@aoLcom
August 1, 2008
Attn.: System Performance Annual Report `C`]V`D
R E
North Carolina Division of Water Quality
1617 Mail Service Center h2008
Raleigh, NC 27699-1617 -Quqz�%j t-
Re: Annual Report DENR - WATER QUALITY
NPDES # NCO044199 POINT SOURCE BRANCH
Citgo Truck Stop
Haywood County
The attached document is pursuant to House Bill 1160, the Clean Water Act of 1999,
which was signed into law by the Governor on July 21, 1999. The legislation is intended
to instill public oversight by requiring spill notification and annual reporting by all entities
owning or operating wastewater treatment facilities in the state of North Carolina.
Concerned persons may obtain more detailed information concerning the above
referenced facility by contacting me at [phone].
Sincerely,
Gray ike
Operator in Responsible Charge
V.
Encl.: Annual Report � P
5J �l r- • ..tr,.-,M.
CC..T
Sam's Mart
DEC - 4 2008
t; 1NATER QUALITY SECTION
e' ASHEVILLE REGIONAL OFFICE

i
�ORMANCE ANNUAL ._.'PORT
I. General information
f' ' Facility and System Name:
. Description of
Citgo Truck Stop o
grease interceptor
Truck Stop, at Hig
said treatment wo
Broad River Basin.
II. PERFORMANCE
Summary of System
ner:
V U. .
ORC:
t,F
Citgo Truck Stop - Sa,S /7/gr'& -# �s
Highway 209 at I-40
Permit: NCO044 99
LSAA, mac.
r haFlette NG 282 1 2 _
Environmental, Inc.
Gray Wike
P.O. Box 954
Cullowhee, NC 28723
System or Treatment Process:
7g3.5 evulle � /i.
�afdeaDa
.2 gJ6-!�
crates a 0.015 MGD wastewater treatment facility consisting of two modular
nits, an aeration basin and a clarifier with sludge returns, located at Citgo
vay 209 off I-40, north of Waynesville, Haywood County. Discharge from
s is into the Pigeon River, which is classified as Class C water in the french
July 1, 2007 to 3une 30, 2008
Analytical results in that no permitted monthly limits were exceeded during the reporting
period. In addition, no bypasses or overflows occurred.
NOTIFICATION
A copy .of this reps
LSAA, mac:-h—
CERTIFICATION
I certify under pe
knowledge. I furl
Citgo Truck Stop.
Gray Wike
Operator in Responsible
Environmental,, Inc. 8/1
is available by contacting:
r of law that this report is complete and accurate to the best of my
certify this report has been made available to users or customers of the

Michael F. Easley, Governor
] 1�� William G. Ross Jr., Secretary
North Carolina Department d� ronment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
Asheville Regional Office
SURFACE WATER PROTECTION SECTION
September 30, 2008
Ms. Jessica Schley .
LSAA, Inc. dba Sam's Mart
6407 Idelwild Road, Suite 204
Charlotte, North Carolina 28212
SUBJECT: Compliance. Sampling Inspection
Status: Compliant
Sam's Mart #45 WWTP
Permit No: NCO044199
Haywood County .
Dear Ms. Schley:
Enclosed please find a copy of the Compliance Sampling Inspection form from the
inspection conducted on September 18, 2008. The facility appeared to be in compliance with
permit NC0044199. There'are, however, a couple of items which need immediate attention:
1) Immediate attention should be given to the repair of the broken water faucet which is
necessary for the proper operation and maintenance of the plant and is also a necessity
for the operator. This was mentioned in two previous inspections on 5122107 and 8110106. .
2) The gap between the fence and the gate is in immediate need of repair to prevent
unauthorized access.
Please respond to this office in writing within 15 days with a timetable for . the above
mentioned repairs and maintenance.
-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,
et Cantwell
Environmental Specialist
Enclosure
cc: DWQ Asheville -i es
entraI it s
Environmental Inc./ ORC w/ attachment
G:\WPDATA\DEMWQ\Haywood\44199 Citgo Truck Stop\44199-CS1.08.doc W51e Carolina
Nawa!!y
2090 U.S. Highway 70, Swannanoa, NC 28778 Telephone: [phone] Fax [phone] Customer Service 1 877 623-6748

I
United States Environmental Protection Agency
Form Approved.
EP/�A Washington, D.C.20460
OMB No.2040-0057
Water Compliance Inspection Report
Approval expires 6-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 INI 2 151 31 NCO044199 I11 121 08/09/18 117 181cl 19u 20 U
u u
U. J
Remarks
21111111111111IIIIIIII IIIIIIIIIIII I I I I I I I I IIII1116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA -----------Reserved-----------
67 I 169 70 U 71 U 72 L N j 73I ' 174 751 I I I I I Li 80
'--'
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)
12:15 PM 08/09/18
06/12/01
Sam's Mart #45
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville -NC 28786
01:05 PM 08/09/18
11/01/31
Name(s) of Onsite Representative(s)/ritles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of, Responsible Official/Title/Phone and Fax Number
Jessica Schley,6407 Idelwild Road, Ste 204 Charlotte NC Contacted
No
28212//704-567-8424/7045678432
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations,& Maintenance E 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 Signatureof Inspector(s) _ ff Agency/Office/Phone and Fax Numbers Date
!i"s)
Janet Cantwell ARO WQ//828-296-4500 Ext.4667/
Sign ture of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
0 A k 3 D
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete
Page # 1

NPDES yr/mo/day Inspection Type (cont. 1
3I NC0044199 I11 12I 08/09/18 117 18, _'
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Gray Wike/ ORC assisted in the inspection of this facility.
One of the two motors is out but is on order to be replaced.
The water faucet is in immediate need of repair: this was mentioned in two previous
inspections on May 22, 2007, and August 10, 2006. Availability of a clean water source
in everyday operations, Is necessary for proper operation and maintenance.
There is a gap between the fence and gate which Is also in need of immediate repair
to prevent access by unauthorized personnel.
Compliance Sampling was done during the inspection and will be sent separately when
received from the lab.
Page # 2

Permit: NCO044199 Owner -Facility: Sam'sM.art#45
Inspection Date:. 09/18/2008 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? ❑ ❑ ■ ❑
Is the facility as described in the permit? ■ Cl ❑ ❑
# 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: There is a gap between the fence and the gate which could allow entry by
unauthorized personnel.
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 gap between the fence and the gate is in need of immediate repair to
prevent unauthorized personnel.
The water faucet is not operable and also needs to be fixed immediately.
Record Keeping
Yes No
.NA
NE
Are records kept and maintained as required by the permit?
i ❑
❑
❑
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?
01100
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?
■ ❑
❑
❑
Page # 3

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 091181.2008 Inspection Type: Compliance Sampling
Record Keeping
Yes No
NA
NE
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?
■ ❑
❑
❑
Facility has copy of previous. year's Annual Report on file for review?
■ ❑
❑
❑
Comment:
Yes No
NA
NE
Aeratlon Basins
Mode of operation
Ext. Air
Type of aeration system
Diffused
Is the basin free of dead spots?
■ ❑
❑ ❑
Are surface aerators and mixers operational?
❑ ❑
■ ❑
Are the diffusers operational?
■ ❑
Cl ❑
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/I)
❑ ❑
❑ ■ '
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:
Page # 4

County: - I� tAlftNO
River Basin FRB
Report To AROSP
Collector:
J CANTWELL
Region:
ARO
Sample Matrix:
WASTEWATER
Loc. Type:
EFFLUENT
Emergency Yes/No
Sample,ID:
PO Number#
Date Received:
Time Received:
Labworks LoginlD
Date Reported:
Report Generated:
COC Yes/No VisitlD L
Loc. Descr.: SAM'S MART 945, 44199
yl
Location ID: SAMSMART4544199_ Collect Date: 09118/2008 Collect Time:: 00:00
Sample Depth
Sample Qualifiers and Comments
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
B4-Filters have counts of both >60 or 80 and < 20; Estimated
B6-Too 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
NI -The component has been tentatively identified based on mass spectral library search and has an estimated value
LAB
AB35842
8W7308
09/2412008
08:00
SMATHIS
10/3108
10/03/2008
/D 0
N3-Estimated concentration is < PQL and >MDL
NE -No established PQL
P-Elevated PQL due to matrix interference and/or sample dilution
W-Holding time exceeded prior to receipt at lab.
Q2-Holding time exceeded folio g receet
PQL- Practical Quantitation Limit- ubje'ct1o'cf?P.0a pa oin�trument serasitiviq� •;,,: .-
v
U- Samples analyzed for this comPoun ppp
X1- Sample not analyzed for this epiup
OCT -.8 2008
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 1 of 2

NC DWQ La6oratory Section ResultsSample ID A635842
Location ID: SAMSMART4544199 Collect Date: 0911812008
Loc. Descr.: SAM'S MART #45, 44199 Collect Time:: 00:00
Visit ID
uAb IF Analyte Name PQL Result Qualifier Units Analyst/Date Approved By /Date
Sample temperature at receipt by lab 2.9 °C DSAUNDERS SMATHIS
Method Reference 9124/08 9/24108
NUT
NH3 as N.in liquid 0.02 0.04 mg1L as N MOVERMAN CGREEN
Method Reference Lac10-107-06-1-J 9/24/08 10/3/08
Laboratory Section» 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone] Page 2 of 2

'iHAYWOM=
County:
Sample ID:
River Basin FRB
aY.r
PO Number #
Report To AROSP
cey
Date Received:
Collector: J CANTWELL
ti' -
TT�g'
Time Received:
Region: ARO
ti
Labworks LoginlD
Sample Matrix: WASTEWATER
Date Reported:
Loc: Type: EFFLUENT
Report Generated:
Emergency Yes/No
COC Yes/No
VisitlD
Loc. Descr.: SAM'S MART #45-44199
Location -ID: SAMSMAR '
Collect Date: 0911812008
Collect Time:: 12:55
Sample Depth
Sample Qualifiers and Comments
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
81-Countable membranes with <20 colonies; Estimated
B2- Counts from all filters were zero. NE -No established PQL
B3-Countable membranes with more than 60 or 80 colonies; Estimated P-Elevated POL due to matrix interference and/or sample dilution
B4-Filters have counts of both >60 or 00 and < 20; Estimated Q1-Holding time exceeded prior to receipt at lab.
B5-Too many colonies were present; too numerous to count (TNTC) Q2- Holding time exceeded following race 141414=11
Li B edngPQL Practical Quantitation u �
J2- Reported value failed to meet QC criteria for either precision or accuracy; Estimated ,�;�rt, �. y r.c� A•
poFjjlitiµl'tr�tkfed
J3-The sample matrix Samples analyzed for this co
ix interfered with the ability to make any accurate determination; Estimated �,•.
X1- Sample not analyzed for this-cpm r� a
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
OCT
1
ARO
Laboratory Section 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
AB35696
ARO
09/18/2008
15:20
KJIMISON
10/3/08
10/03/2008
SECTION
WATER QUALITY
OFFICE
I_E REGIONAL
age 1 of 2 ...�...:sS�..
L•
f

NC (DWQ Laboratory Results
Sample ID AB35696
Location ID: SAMSMART' ,S't?CtZo12 6S2lCtS
Collect Date: 09/18/2008
Loc. Descr.: SAM'S MART#46-44199
Collect Time:: 12:55
Visit ID
UAb IF Anatyte Name
PQL Result Qualifier Units
AnalysttDate
Approved By, /Date
Sample temperature at receipt by lab
1.3 °C
KJIMISON
SMATHIS
Method Reference
9118108
9/19/08
BOD, 5-Day In liquid
2.0 9.9 mg/L
KJIMISON
MOVERMAN
Method Reference APHAS210B
9118/08
1012/08
Residue Suspended in liquid
6.2 15 mg/L
KJIMISON
MOVERMAN
Method Reference APHA2540D-20th
9123/08
10/2108
7
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 (919) 7333908 Page 2 of 2

tN.
June 9, 2008 ,
CERTIFIED MAIL 7007-0710-0000-5376-7549
RETURN RECEIPT REQUESTED
Mr. Adnan Jazairi
LSAA Inc. dba Sams Mart
6407 Idelwild Road, Suite 204
Charlotte, NC 28212
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
JUN
2008
1
+' WATER QUALITY SECTION
r #
ASHEVILLE REGIO !AL OFFICE
Subject: Remission Request of Civil Penalty Assessment
Sams Mart#43 WWTP
NPDES Permit NCO044199
Case Number LR-2008-0001
Haywood County
Dear Mr. Jazairi:
I have considered the information submitted in support of your request for remission in accordance
with North Carolina General Statute (N.C.G.S.) § 143-215.6A(f) and have found no grounds to remit
your $600.00 civil penalty assessment and enforcement costs.
If you choose to pay the civil penalty assessments and enforcement costs of $600.00, please send
payment to me at the letterhead address within thirty (30) days of -receipt of -this letter. Please make
your check payable to the Department of Environment and Natural Resources (DENR).
If payment is not received within thirty (30) days of receipt of this letter, in accordance with N.C.G.S. §
143-215.6A(f), your -request for remission of the civil ,penalty (with supporting documents) and my
recommendation to deny the request (with supporting documentation) will be delivered to the North
Carolina Environmental Management Commission's (EMC) Committee On Civil Penalty Remissions
(Committee) for final agency decision.
If you desire to' make an oral presentation to the Committee on why your request for remission meets
one or more of the five statutory factors you were asked to address, you must complete and return the
attached form within thirty (30) days of'receipt of this letter. Please mail the completed form to the
attention of Bob Guerra, NPDES Western Unit at the following address:
- .'�oin�Rt1htCarolina
Naturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: www.ncwaterquality.org Location: 512 N. Salisbury St. Raleigh, NC 27604 Fax [phone]
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper

i
Point Source Branch
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Your request for an oral presentation and the documents in this matter will be reviewed by the EMC .
Chairman and, if it is determined that there is a compelling reason to require an oral presentation from
you, you will be notified by certified mail of the date, time, and place that your oral presentation can be
made. Otherwise, the final decision on your request for remission will be made by the Committee
based on the written record.
Thank you for your cooperation in this matter. If you have arty questions about this letter, please
contact Bob Guerra at [phone], extension 539.
Attachment
Sincerely,
p� �-
14
r ,
AIL Coleen H. Sullins
cc: Asheville Regional Qffice�_
Enforcement file
Central Files -
0

STATE OF NORTH CAROLINA ENVIRONMENTAL MANAGEMENT
COMMISSION
Mr. Adnan Jazaira, LSSA Inc. dba Sams Mart DWQ Case Number LR-2008=0001
IN THE MATTER OF ASSESSMENT )
OF CIVIL PENALTIES AGAINST: )
SAMS MART #43 WWTP NCO044199 )
REQUEST FOR ORAL PRESENTATION
I hereby request to make an oral presentation before the Environmental Management
Commission's Committee On Civil Penalty Remissions in the matter of the case noted above. In
making this request, I assert that I understand all of the following statements:
• This request will be reviewed by the Chairman of the Environmental Management
Commission and may be either granted or denied.
• Making a presentation will require the presence of myself or my representative during a
Committee meeting held in Raleigh, North Carolina.
• My presentation will be limited to discussion of issues and information submitted in my
original remission request, and because no factual issues are in dispute, my presentation will
be limited to five minutes in length.
This the day of 920
SIGNATURE
TITLE (President, Owner, etc.)
ADDRESS
TELEPHONE

OF W ATF MichaelF. Ea"sley, Go or
9
William G. Ross Jr., Secretary
rNorth Carolina Department of Environment and Natural Resources ,
p Coleen.H._Sullins. Director
r Disiou of ateri;Quality
April 4, 2008. -7
Lf APR - 4 2008
Ms. HeatherTeague; Owner
�- --
Environmental Inc.
P.Q. Box 954 WATER QUALITY SECTION '
AcF". i__r" r�nNAL 3F ICE'''
Cullowhee, NC 28732 _�--,-__._
- Subject: Remission Request of Civil Penalty•Assessment
Sams Mart #45 WWTP
NPDES Permit NCO044199
Haywood County
Case Number LR-2008-0061
Dear Ms. Teague:
This letter is to acknowledge the'receipt and of your request for remission of the civil. penalties levied
against the subject entity. Your request will. be placed ,on the agenda of the Director's next.. scheduled
enforcement conference and you will be notified of the result.. .
If you have any question or I can be.of•further assistance about -this matter, please contact me at (919)
733=5083, extension 539.
Sincerely,
Robert Guerra, Western Region-NPDES
Point Source Branch'
Cc-, Mr. Adnan Jazairi
LSAA Inc. dab Sams Mart
6407 Idelwild Road, Suite 204
Charlotte, NC .28212
A�cill HegjQc
Enforcement file w/originals .
Central Files
None Carolina
tArldy
North Carolina. Division of Water Quality 1617 Mail Service Center Raleigh; NC 27699-1617• Phone [phone] Customer Service .
'Internet:-www.ncwatMualiiy.org Location: 512 N. Salisbury St. Raleigh, NC 27604: . Fax [phone]- '
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10'/° Post Consumer Paper- . 3

Mi�eeE/sley vemor
�- - J William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
February 21, 2008
CERTIFIED MAIL 7002 3150 0003 7052,6492
RETURN RECEIPT REQUESTED
Mr. Adnan Jazairi
LSAA Inc. dab Sams Mart
6407 Idelwild Road, Suite 204
Charlotte, NC 28212
Subject: Assessment of Civil Penalty for Violations of Reporting Requirements
Sams -Mart #43-WWTP
NPDES Permit NCO044199
Case Number LR-2008-0001
Haywood County
Dear Mr. Jazairi:
Coleen H. Sullins, Director
Division of Water Quality
E C E D
FEB 2 7 2008 0
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFIC
This letter transmits notice of a civil penalty assessed against the Sams Mart #43 WWTP in the amount of
$600.00 ($500.00 civil penalty + $100.00 in enforcement costs).
This assessment is based upon the following facts: the July 2007 discharge monitoring report was not filed with
the Division of Water Quality within the thirty (30) day reporting period in accordance with the monitoring and
reporting requirements contained in your NPDES permit. A Notice of Violation (NOV-2007-LR-0054) was sent to
you dated September 21, 2007 (received by you on September 27, 2067), for failure to submit the July 2007
discharge monitoring report. Within said Notice, you were informed that future reports not received within the
required timeframe would result in a recommendation for assessment of civil penalties.
Based upon the above facts, I conclude as a matter of law that the Sams Mart #43 WWTP violated or failed to act
in accordance with the requirements of NPDES Permit NCO044199 and G.S. 143-215.65. A civil penalty of not
more than $25,000.00 per violationmay be assessed against a person who fails to file, submit, or make available
any documents, data, or reports required by G.S. 143-215.65. The State's enforcement costs in this matter may
be assessed pursuant to G.S. 143-215.3(a)(9) and G.S. 143-282.1(b)(8),
Based upon the above findings of fact and conclusions of law, and pursuant to the authority delegated to me by
the Secretary of the Department of Environment and Natural Resources and the. Director of the Division of Water
Quality, I hereby make the following civil penalty assessment against the Sams Mart #43 WWTP:
$ $500.00 for failing to submit the July 2007 bischarge Monitoring Report as required by
NPDES Permit NCO044199 and G.S. 143-215.65.
$ $100.00 Investigation Costs
$ $600.00 TOTAL AMOUNT DUE
None Carolina
�tura!!y
North Carolina Division of Water. Quality' 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: www.ncwaterouality.org Location: 512 N. Salisbury St. Raleigh, NC 27604 Fax [phone]
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper

t
Pursuant to G.S. 143-215.6A(c), in determining the amount of the,penalty, I have taken into account the Findings of�\
Facts and Conclusions of Law and have considered each and every specific factor set out in G.S. 14313-282.1(b),
which are:
(1) The degree and extent of harm to the natural resources of the State, to public health, or to private property
ro�sul�ting f o . he violation;
(2) The tluratro '` nd gravity of the violation;
(3) The effect on the 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 days of receipt of this notice, you must do one of the following:
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:
Point Source Branch
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
OR
2. Submit a written request for remission or mitigation including a detailed justification for
such request.
A request for remission or mitigation is limited to consideration of the reasonableness of the
amount of the penalty and is not the properprocedure for contesting the accuracy of any of the
statements contained in the assessment letter. 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 that there are no factual or legal issues in dispute. You
must execute and return to this office the attached waiver and stipulation form and a detailed
statement, which you believe establishes.whether:
(a) one or more of the civil penalty assessment factors in G.S. 143B-282.1(b) were
wrongfully applied to the detriment of the petitioner;
(b) the violator promptly abated continuing environmental damage resulting from the
violation; -
(c) the violation was inadvertent or a result of an accident;
(d) the violator had been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial
actions.
Please submit this information to the attention of:
Point Source Branch
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Please note that all information presented in support of a request for remission must besubmitted
in writing. The'Director of the Division. of Water Quality will review the information during a
bimonthly enforcement conference and inform you of his decision in the matter.of the remission
request. His response will provide details regarding case'status, directions for payment and
.provision for further appeal of the penalty to the Environmental Management Commission's
Committee on Civii Penalty Remissions. Pleasebe advised that the Committee cannot consider
information that was not part -of the original remission request considered by the Director an'd
therefore, it is veryimportant that you prepare a complete and thorough statement in 'support of
your request for remission:
OR
3. Submit a written request for an administrative hearing:
If you wish to contest any statement in this. assessmenf letter, you must -request an administrative
hearing. This request must be in the form of a written petition to the Office of Administrative Hearings
and must conform to Chapter 150B of the North Carolina General Statutes. You: must:
File your original petition with the
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, North Carolina 27699-6714
and
Mail or hand -deliver a copy of the petition`to
General Counsel
Department.pf Environment and Naturaf•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 days as evidenced by a date stamp (not a postmark)
indicating when we received your response, will result in this matter being referred to the Attorney General's
Office with a request to initiate:a civil action to collect the penalty. Please be advised that additional assessments
may be levied for violations that occur after the 'review period of this -assessment.
If you have any questions concerning this matter, please'eontact Mr. Bob Guerra'at [phone], `extension
539.
Sincerely,
usan A. Wilson, P.E., Supervisor
Western NPDES Program
Attachments
co: ON urfac ,1NafePQtetion wlaitaehments
' "Enforcement File w/attachments
Central Files w/attachments

JUSTIFICATION FOR REMISSION REQUEST
DWQ Case Number: ' LR 2008-0001 County: Haywood
Assessed Party: Sams Mart #43 WWTP
Permit Number: NCO044199 Amount Assessed: $600.00
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 o{
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
applies. 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 Q. 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•

w A Michael F. Easley, Governor
_� y William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
—i
Coleen H. Sullins, Director
Division of Water Quality
September 21, 2007.
CERTIFIED MAIL 7002 3150 0003 7052 6263
RETURN RECEIPT REQUESTED
Mr. Adnan Jazairi
LSAA Inc, dba Sams Mart
6407 Idelwild Road, Suite 204
Charlotte, NC 28212
Subject: NOTICE OF VIOLATION - NOV- 2007- LR- 0054
Sams Mart #43 WWTP NCO044199
Haywood County
Dear Mr. Jazairi:
This is to inform you that the Division of Water Quality has not received your monthly monitoring report for July
2007 after the required reporting date. This is in violation of Part II, Condition D(2) of the NPDES permit, as well as 15A
NCAC 2B .506(a), which requires the submittal of Discharge Monitoring Reports no later than the thirtieth (30th) day
following the reporting period. Failure to submit reports as required will subject the violator to the assessment of a
civil penalty of up to $25,000 per violation. You will be considered noncompliant with the self -monitoring requirements
of your NPDES permit until the report has been submitted.
Please submit the June 2007 DMR report within 15 days of receipt of this notice if you have not yet
submitted it. To prevent further action, please submit future monthly reports within the above -mentioned
timeframe to avoid further enforcement actions.
The Division must take these steps because timely submittal of discharge monitoring reports is essential to the
efficient operation of our water quality programs. We appreciate your assistance in this matter. If you have any questions
about this letter or Discharge Monitoring Reports, please contact me at 919-733-5083, extension 539.
Sincerely,
aa"ivl - -
Bob Guerra
Western Region NPDES Unit
cc: DW.Q Asheville Surface 1NaterProtectionSupelvlsor
Central -Files
..:e: t.,. '�. na..z'.e+ss°'c �„�; tit,•'_. <:...ht� .C> ..
. - .., •:F: �. •• .. 1.
C
F�
SEP 2 5 2007
WATER QUALITY SECTION
ASh#EVILLE RECm?�ONAL OFFIC_ E
'.
IV��oo;;etttlttCarolina
�Nlilurdiff
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer - Paper

E
Lsflrafi�r, %/G'
L
P.O. Box 954 (5690 Old Cullowhee Road), Cullowhee, North Carolina, 28723
Phone: [phone], Fax: [phone]
E-mail: environmentalinc@aol,com
August 1, 2007
Attn.: System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Annual Report
NPDES # NCO044199
Citgo Truck Stop
Haywood County
The attached document is pursuant to House Bill 1160, the Clean Water Act of 1999,
which was signed into law by the Governor on July 21, 1999. The legislation is intended
to instill public oversight by requiring spill notification and annual reporting by all entities
owning or operating wastewater treatment facilities in the state of North Carolina.
Concerned persons may obtain more detailed information concerning the above
referenced facility by contacting me at [phone].
Sincerely,
Michael Williams
Operator in Responsible Charge
Encl.: , Annual Report
CC: Sams Mart

-PERFORMANCE ANNUA'.w-. EPORT
I. 'General Information
Facility and System Name:
Citgo Truck Stop
Highway 209 at 1-40
Haywood County
Permit: NCO044199
Owner:
LSAA, Inc.
6407 Idlewild Road, Suite 204
Charlotte, NC 28212
Operator:
Environmental, Inc.
ORC:
Michael Williams
P.O. Box 954
Cullowhee, NC 28723
Descriptlon of Collectlon System or Treatment Process:
Citgo Truck Stop operates a 0.015 MGD wastewater treatment facility consisting of two modular
grease Interceptor units, an aeration basin and a clarifier with sludge returns, located at Citgo
Truck Stop, at Highway 209 off I-40, north of Waynesville, Haywood County._ Discharge from
said treatment works is into the Pigeon River, which is classified as Class C water in the French
Broad River Basin.
II. . PERFORMANCE
Summary of System Performance July 1, 2006 to June 30, 2007
Analytical results indicate that 'no permitted monthly limits were exceeded during the reporting
period. In addition, no bypasses or overflows occurred.
III. NOTIFICATION
A copy of this report is available by contacting:
LSAA, Inc.
6407 Idlewild Road, Suite 204
Charlotte, NC 28212
IV. CERTIFICATION
I certify under penalty of law that this report is complete and accurate to the,best of my
knowledge. I further certify this report has been made available to users or customers of the
Citgo Truck Stop.
Michael Williams
Operator in Responsible Charge
Environmental, Inc. 8/1/07

onus .�_...�..........
s
1
P.O. Box 954 (5690 Old Cullowhee Road), Cullowhee, North Carolina, 28723
Phone: [phone], Fax: [phone]
f E-mail. [e-mail]
August 1, 2007
Attn.: System Performance Annual Report
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Annual Report
NPDES * NCO044199
Citgo Truck Stop
Haywood County
The attached document. is pursuant to House Bill 1160, the Clean Water Act of 1999,
which was signed into law by the Governor on July 21, 1999. The legislation is intended
to instill public oversight by requiring spill notification and annual reporting by all entities
owning or operating wastewater treatment facilities in the state of North Carolina.
Concerned persons may obtain more detailed information concerning the above
referenced facility by contacting me -at [phone].
Sincerely,
Michael Williams
Operator in Responsible Charge
Encl.: Annual Report
CC: Sam's Mart

PERFORMANCE ANNUAi— REPORT
I. General information
Facility and System Name:
Citgo Truck Stop
Highway 209 at I-40
Haywood County
Permit: NCO044199
Owner:
LSAA, Inc.
6407 Idlewild Road, Suite 204
Charlotte, NC 28212
Operator:
Environmental, Inc.
ORC:
Michael Williams
(
P.O. Box 954
4
Cuilowhee, NC 28723
Description of Collection System or Treatment Process:
`Citgo Truck Stop operates a 0.015'MGD wastewater treatment facility,consisting of two modular
`grease interceptor units, an aeration basin and a clarifier with sludge returns, located at Citgo
Truck Stop, at Highway 209 off I-40, north of Waynesville, Haywood County. Discharge from
,I said treatment works is Into the Pigeon River, which Is classified as Class C water in the French
Broad River Basin.
IL PERFORMANCE
Summary of System Performance July 1, 2006 to ]une 30, 2007
Analytical results indicate that no permitted monthly limits were exceeded during the reporting
period. In addition, no bypasses or overflows occurred.
III. 1, NOTIFICATION
A copy of this report is available by contacting:
LSAA, Inc,
6407 Idlewild Road; Suite 204
Charlotte, NC 28212
IV. 'CERTIFICATION
I certify under penalty of law that this report is complete and accurate to the best of my
knowledge. I further certify this report has been made available to users or customers of the
'Citgo Truck Stop.
Michael Williams
Operator in Responsible Charge
Environmental, Inc. 8/1/07

o�o� war�RQ�
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department vironment and Natural Resources
Coleen H.Sullins, Director
Division of Water Quality
-_.,_ Asheville Reqional Office
SURFACE WATER PROTECTION '
L
.June 1, 2007tEz,
Ms. Pamela Strayer
LSAA, Inc. dba Sam's Mart
6407 Idlewild Road, Suite 204
Charlotte, North Carolina 28212
SUBJECT: Compliance Evaluation Inspection
Status: Compliant
LSAA, Inc. dba
Sam's Mart #45 WWTP
Permit No: NCO044199
Haywood County
Dear Ms. Strayer:,
Enclosed please find a copy of the Compliance Evaluation Inspection form from
the inspection conducted on May 22, 2007.. The. facility appeared to be in compliance
with permit # NCO044199 and the operator is doing a fine job. There are, however, a
couple of items which need attention:
1. .Immediate attention should be • given to repair of the broken water faucet: it is
necessary for the proper operation and maintenance of the facility.
2. Tree limbs over -hanging the facility and shrubbery around' the fence area need to
be trimmed back for proper operation and maintenance.
Please respond to this office in writing within 15 days with a timetable for the
above mentioned repairs and maintenance.
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,
et Cantw
Environmental Specialist
Enclosure
-%"h itie F w/ atta "b"m - 1 - _
WQ Central Files w/ attachment
Environmental Inc./ORC w/ attachment
_ NorthCarohna
�Qtll!'11��1f
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. 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 L 31 N0O044199 111 121 07/05/22 117
18I CI 191 SI 20I
Remarks
21111111111111IIIIIII11111]IIIIIIIIIIIIIII
I I I I I116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA
----------------------- --- Reserved ---------------------
671 169 701 1 711 I 721 N I
73I I 174 711 I I I I I 11 80
�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)
Sam's Mart #45
10:45 AM 07/05/22
06/12/01
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville NC 28786
11:05 AM 07/05/22
11/01/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Jessica Schley,6407 Idelwild Road, Ste 204 Charlotte NC Contacted
28212//704-567-8424/7045678432 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 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)
(See attachment summary)
Name(s) and Sigriature(s) of Inspector(s) Q Agency/Office/Phone and Fax Numbers Date
Janet Cantwell ARO WQ//828-296-4500 Ext.4667/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
R-�m�
65 L 3
EPA Form 3560-3:(Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type ' (cont .) 1
3I NCO044199 L11 12I 07/05/22 117 18'C
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Michael Williams/ORC of Environmental Inc. assisted in the inspection of this facility.
The previous compliance evaluation inspection was conducted on August 10, 2006, by Jim Reid.
A review, of the files indicates that the perm it will expire January 31, 2011.
The aeration basin ,process control data on the day of the inspection:
Dissolved Oxygen = 3.7 m g/I
Temperature = 20.5 degrees Celcius
PH = 2.9 units _
The effluent data on the day of the inspection:
Dissolved Oxygen = 2.5 m g/I
Temperature = 20.4 degrees Celcius
PH = 7.01 units
The log book was present on -site and had good records of daily events.
The effluent was clear.
This facility appears to be well operated and the operator is doing a fine job.
Immediate attention should.be given to repair of the broken water faucet. This was mentioned in
the August 10, 2006, inspection of the facility by Jim Reid.
Tree limbs over -hanging the facility and shrubbery around the fence area need, to be trimmed back for
proper operation.
The Asheville Regional Office currently has on staff a Wastewater Treatment Consultant to offer technical
assistance to Wastewater Treatment Plants (WWTP) and Collection Systems (CS) with operational ,
concerns. This service is free and non -regulatory to assist in the identification and correction of operational
problems. The 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.
Page # 2

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 05/22/2007 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?
■
❑
Cl
n
# Are there any special conditions for the permit?
❑
■
❑
n
Is access to the plant site restricted to the general public?
■
❑
❑
❑
Is the inspector granted access to all. areas for inspection?
■
❑
❑
❑
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 ■ Cl ❑ ❑
Judge, and other that are applicable?
Comment:
The handle to the water supply pipe is broken and needs to be repaired as soon as
possible. Availability of a clean water source in everyday operations is necessary for
proper operation and maintenance.
Tree -limbs over -hanging the facility and around the fence area need to be trim med to
maintain proper operation of the facility.
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?
Q
❑
❑
■
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
Cl
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? n n ■ n
Page # 3

n
Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 05/22/2007 Inspection Type: Compliance Evaluation
Record Keeping
Yes
No
NA
NE
Is the ORC visitation log available and current?
■
0
❑
❑
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?
■
❑
❑
❑
Is a copy of the current NPDES permit available on site?
■
❑
❑
❑
Facility has copy of previous year's Annual Report on file for review?
■
n
n
n
Comment:
Aeration Basins
Yes
No
NA
NE
Mode of operation
Ext. Air
Type of aeration system
Diffused
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
❑
n
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)
■
❑
n
n
Comment:
Secondary Clarifier
Yes
No
NA
NE
Is the clarifier free of black and odorous wastewater?
■
n
n
n
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?
■
❑
n
n
Is scum removal adequate?
■
❑
❑
❑
Is the site free of excessive floating sludge?
■
❑
❑
❑
Is the drive unit operational?
❑
❑
■
n
Is the return rate acceptable (low turbulence)?
■
n
❑
n
Is the overflow clear of excessive solids/pin floc?
■
❑
❑
❑
Is the sludge blanket level acceptable? (Approximately % of the sidewall depth)
❑
❑
❑
■
Page # 4

H
E c E
J U N Z 8 2007 0
WATER QUALITY SECTION
ASHEVILLE REGIONAL OFFICE
June 26, 2007
To whom it may concern:
This letter is to inform you that location 445-3360 Crab Tree Rd. Waynesville, NC.28785
permit 4NCO044199 is now in compliance with the inspection dated 05-22-07. The
repairs have been taken care of.
Tha
P ela Str er
Executive Administrative Assistant
Sams Mart

Septemberj"
-.20 -.---2pO
NC Division of Water Quality
Attention; James Reid,
2090 U.S. Highway 70,
Swannanoa, NC.2877.8
]Re:., Sam's Mart. #45
Permit, # NCO044199
Haywood. County
Dear Mr:' Reid,
Attached yoy will, find the fax letter to Mark Teague of Environmental Inc. that has
Sam's Mart's approval to repair our facility per your request and letter. As soon as
I hear from MarkJ will forward his confirmation of the repairs. If you have any
questions, please feel free to give me a call.
Sincerely,,
Robyn Bianco
Executive Assistant to Adnan "Danny" Jazairi
6407 Idlewild Rd. Suite 204 7
Charlotte,, NC 28212
Office':,(7,04) 567-8424 ext. 115
Fax: [phone]
SEP 2 1 2006
WATER QUALITY SECTION
VIL L OFIzIC
LE EREGIONSA
WATER QUALITY SECTION
6407 Idlew'ild Rd., Suite 204 AS3HEV1L1EPF=r,1nN1A1 -ICE
Charlotte, NC 28212
Phone [phone] - Fax 704-567-'-"'8432—

p • -
LSAA, Inc. dba
i
6 407 idlewild Rd. Smite 204
Charlotte, NC 25212
Phone: [phone] Fzx: 704:667.Se432
To: Fax. � �;• � . � ��,,.� �d
From: Date: f- b
Re: Pages: Including cover:
CC:
J
❑ Urgent ❑ For ❑ Please ❑ Please ❑ Please
Review Comment RePly Recycle
Notesq i L
6A
VQV-^
r

C.UUALIT
S.EQ-TIOM
NC L
Division bfWd EG
'
en, om Wa
nt
'".".
&N-166 Center
16 II'M61
.".Mkigh, `NC' '27699' MIT,
Z . 4
Ret.' Sm's Mart j95
-Perhift # NCO044199
Havwond Cmintiv
. . ........ .
U
Robyn Blanco
Executive Assistant to Adrian "Danny" Jazairi
WE -dUALLjIy'T')'-
DENR
CH 6407�,,:-Idl6Lw"il,d��Rd'.,',,�',S fil'
i"�� P,0INT--S6UkCt,`8t�A
. ........ .... ... .
CharloAt6NG'28'
Office: (704),. . . . . . . ....
'1',`567'-'
Fax: [phone]":`
6407 Idlewild Rd., Suite 204
Charlotte, NC 28212
Phone [phone] - Fax [phone]

-Inc.
P. 0. Box 954 (5690 Old Cullowhee Road), 611owhee, North Carolina, 28723
Phone: [phone], Fax, [phone], E-mail.- En vironmentalinc9aol com
State ofNorth'Carolino
Department of Environment & Natural Resources
Division of Water Quality
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699 1617
August 11, 2006
Re: Permit # NCO044199
Dear Ms. Carolyn Bryant:
In response to the missing information letter sent to Ms. Robyn Blanco on July 17, 2006 here are the two
additional items needed in order to process the permit renewal.
• . Approximately 4200 gallons of solids are removed each quarter.
Solids are pumped out by,a licensed waste management firm and disposed of at the local City of
Waynesville Wastewater Treatment plant.
If more information is needed for the completion of the permit renewal, please contact meat [phone].
Sincerely,
Mark Teague, President
Environmental Inc.
CC: Sam's Mart
Attn: Robyn Blanco
Z0/Z0 39Vd
ONI -1diN3WNONIAN3
90ZTE6Z8Z8 95:60 900Z/ZT/60

- �NQ Laboratory Section ROE ,"t_ s
Loc. Descr.: SAMS MART
Location ID: NCO086053 Sample ID: AB07233
County: HAYWOOD PO Number # A060602
River Basin �U,
T RVisitlD
Report To AROSP (�
Region: ARO Ct1 Date -Received: 08110/2006
Collector: J REID > r Time Received: 15:50
Sample Matrix: WASTEWATER
Labworks LoginlD MMA
Loc. Type: EFFLUENT Date Reported: 08/30/2006
Sample Depth 0.1
Collect Date: 08/10/2006
Collect Time:: 11:40
Analyte Name PQL Result Qualifier Units Approved By
ARO
Sample temperature at receipt by lab 1.0 . °C CGREEN
BOD, 5-Day in liquid 2.0 3.2 mg/L CGREEN
Residue —Suspended in liquid 2.5 17 mg/L CGREEN
7
SEP ` 8 2006
WATER QUALITY SECTION
„3HEVILLE REGIONAL OFFK
Laboratory Section>> 1623 Mail Service Center, Raleigh, NC 27699-1623 [phone]
Page 1 of 1

Off, WATF� r—� Michael F. Easley, Governor
William G. Ross Jr., Secretary
' North Carolina Department', =_ vironment and Natural Resources
r Alan W. Klimek, P.E. Director
>_ Division of Water Quality
Asheville Regional Office
SURFACE WATER PROTECTION
September 7, 2006
Ms. Robyn Blanco
LSAA, Inc. dba Sam's Mart
6407 Idelwild Road, Ste 204
Charlotte NC 28212
SUBJECT: Compliance Sampling Inspection
Sam's Mart #45.
Permit No: NCO044199
Haywood County
Dear Ms Blanco:
Enclosed please find a copy of the Compliance Sampling Inspection report from the
inspection conducted on August 10, 2006. James R Reid of the Asheville Regional Office
conducted the iinspection. The facility was found to be in compliance with permit NC0044199.
In order to maintain the compliant status, attention to the aeration system is required. One
blower assembly was out of service; as Part II.C.2 of the facility's permit requires operation and
maintenance of all installed apparatus, the non-functional blower assembly must be replaced. A
substantial mass of grease (sufficient to frustrate proper operation) was in the facility at the time of
inspection. If a grease trap is present on the drain from the kitchen, the operation of the trap
should be ensured. If a grease trap does not exist, installation of an adequate trap is HIGHLY
RECOMMENDED. Finally, installation of a water faucet at the treatment plant would greatly
facilitate operation and maintenance of the plant.
Kindly respond on or before September 29, 2006 advising when repair of the aeration
system is complete or is anticipated. Additionally provide any comments concerning a grease trap
and water supply for the facility.
Please refer to the enclosed inspection report for additional observations and comments.
If there are questions, please call me at 828-296-4500 Ext.4651.
Enclosure
cc: Mark Fredrick Teague, ORC
Central Files
AsheviII—e Rles
Sincerely,
Z, lac-;,(.
James R Reid
Environmental Engineer
o ehcarolina
NAatura!!ff
2090 U.S. Highway 70, Swannanoa, NC 28778 Telephone: [phone] Fax: [phone] Customer Service 1 877 623-6748

United States Environmental Protection Agency
20460
Form Approved.
EPA Washington, D.C.
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 31 N00044199 I ,11 121 06/08/10 117 18I sI 19I GI 20I
U
Remarks
21111111111111111111111111111111111111111111111116
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA-------- --- Reserved---------------
671 169 701 3 I 71 LI 72 N 731 I 174 751 I I I I I I 180
U I i I
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)
Sam's mart N95
11:30 AM 06/08/10
05/05/01
Exit Time/Date
Permit Expiration Date
NC Hwy 209
Waynesville NC 28786
11:55 Am 06/08/10
06/11/30
Name(s) of Onsite Representative(s)/Titles(s)%Phone and Fax Number(s)
Other Facility Data
Mark Fredrick Teague/ORC/828-293-9396/
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Jessica Schley,6407 Ideiwild Road, Ste 20.4 Charlotte NC
28212//704-567-8424/7045678432 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance ■ Self -Monitoring Program 0 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
meyR Reid / ARO WQ//828-296-4500 Ert.4651/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
�,eMYA 6,
?
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES . yr/mo/day Inspection Type
3I NC0044199 I11 121
06/08/10 117 18IS1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Grease Trap (if present) should be inspected; if not present, installation of one should be investigaged.
Installation of a water spigot would be beneficial to the operation of the facility.
Replacement of the 'but -of -service" blower must occur.
Effluent sample results: BOD was 3.2 mg/I v. mo. ay. limit of 30 mg/l. TSS was 17 mg/I v. 30 mg/I mo. ay.
limit.
Page # 2

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 08/10/2006 Inspection Type: Compliance Sampling
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:
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:
Effluent Pipe
Yes
No
NA
NE
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:
Grease Removal
Yes
No
NA
NE
# Is automatic grease removal present? ❑ ■ ❑ ❑
Is grease removal operating properly? ❑ ■ ❑ ❑
Comment: The plant appeared to have sufficient volumes of grease to make operation
difficult.
Aeration Basins Yes No NA NE
Mode of operation Ext. Air
Type of aeration system
Diffused
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
Does the foam cover less than 25% of the basin's surface?
■
❑
❑
❑
Is the DO level acceptable?
■
Cl
❑
❑
Is the DO level acceptable?(1.0 to 3.0 mg/1)
■
11110
Page # 3

Permit: NCO044199 Owner - Facility: Sam's Mart #45
Inspection Date: 08/10/2006 Inspection Type: Compliance Sampling
Aeration Basins
Comment: Only one blower assembly was in place.
Page # 4

DIVISION OF ENVIRONMENTAL MANAGEMENT
For Lab Use ONLY
WATER QUALITY FIELD -LAB FORM (DM1) U
COUNTY PRIORITY SAMPLE TYPE
RIVER BASIN ❑AMBIENT ❑ Qp ❑STREAM L^J EFFLUENT
REPORT TOMS RO MRO RRO WaRO WIRO WSRO TS
OtheerrAT i COMPLIANCE ❑ CHAIN ❑ LAKE ❑ INFLUENT
Other
_ OF CUSTODY
Shipped by: Bus Courier, -tlff7 Other EMERGENCY ❑ ESTUARY
C_
OL L
Lab Number: A 1 6 o L-o?,
Date Received: 3 - i0•-00 Time: i T!S7Z)
Rec'd by: a .5 From: Bus -Courier an
DATA ENTRY BY: ,TAILS CK: •.J 7
DATE REPORTED:
Estimated BOD Range; 0-5/5-25/25-65/40-130 or 100 plus STATION LOCATION -
Seed: Yes ❑ No ❑ 'Chlorinated: Yes ❑ No ❑ REMARKS:
Station # (ti( Date Begin (yy/mm/dd) Time Begin Date End Time End Depth .N
B DBM lValueType Composite Sample Ty
PJ1� " �� �� 0S U A H L T S B C G GNXX
- 1 y
3
BOD5 310 mg/1
v '
COD High 340 mg/l
3
COD Low 335 mg/l
4
Coliform: MF Fecal 31616 /100m1
5
Coliform: bIF Total 31504 /100ml
6
Coliform: Tube Fecal 31615 /100ml
7
Collform: Fecal Strep 31673 /100ml
q
Residue: Total 500 mg/1
9
Volatile 505 mg/1
.1
Fixed 510 mg/I
11
Residue: Suspended 530 7 mg/I
12
Volatile 535 mg/!
13
Fixed 540 mg/l
t4
pH 403 units
r L5
Acidity to pH 4.5 436 mg/1
Acidity to pH 8.3 435 mg/1
17
Alkalinity to pH 8.3 415 mg/l
18
(Alkalinity to pH 4.5 410 mg/I
19
TOC 630 mg/1
20I
Turbidity 76 NTU
Chloride 940 mg/1
Chi a: TO 32217 ug/I
Chi a: Corr 32209 ug/I
Pheophytin a 32213 ug/1
Color: True 80 Pt -Co
Color:(pH ) 83 ADMI
Color: pH 7.6 82 ADMI
Cyanide 720 mg/I
Fluoride 951 mg/l
Formaldehyde 71880 mg/l
Grease and Oils 556 mg/l
Hardness Total900 mg/I
Specific Cond. 95 uMhos/cm2
MBAS 38260 mg/l
Phenols 32730 ug/I
Sulfate 945 mgA
Sulfide 745 mg/1
NH3 as N 610 mg/I
TKN as N 625 mgA
NO2 plus NO3 as N 630 mg/1
P: Total as P 665 mg/l
PO4 as P 70507 mgA
P: Dissolved as P 666 mg/l
Cd-Cadmium 1027 ug/l
Cr-Chromium:Total1034 ugA
Cu-Copper 1042 ug/1
Ni-Nickel 1067 ug/1
Pb-Lead 1051 ug/I
Zn-Zinc 1092 ugA
Ag-Silver 1077 ug/I
AI -Aluminum 1105 ug/I
Be -Beryllium 1012 ug/I
Ca -Calcium 916 mgA
Co -Cobalt 1037 ug/1
Fe -Iron 1045 ug/I
Li-Lithlum 1132 ug/1
Mg -Magnesium 927 mg/l
Mn-Manganese 1055 ug/I
Na-Sodium 929 mg/i
Arsenic:Total 1002 ug/I
Se -Selenium 1147 ug/I
Hg-Mercury 71900 ug/1
Organochlorine Pesticides
Otgancphosplwrus Pesticides
Acid Herbicides
Base/ Neutral Extractable Organics
Acid Extractable Organics
Purgeable Organics (VOA bottle reg'd)
Phytoplankton
Sampling Point %
Conductance at 25 C
Water Temperature (C)
D.O. mg/I
pH
Alkalinity
Acidity
Air Temperature (C)
PH 8.3 pH 4.5
pH 4.5 pH 8.3
2
94
10
300 1.
400 •
82244 431
82243 182242
20
Salinity %
Precipition On/day)
Cloud Cover %
Wind Direction (Deg)
Stream Flow Severity
Turbidity Severity
Wind Velocity M/H
can Stream Depth ft.
Stream Width ft.
-
480
145
132
1 36 11351
1350 135
64 14
__ - ' �Yr1� tjF1C�t'1 clr!`t✓G1 L �n�

R.oY COOPER.
ATTORNEY GENERAL
STATE OF NORTH CAR 6UNA
DEPARTMENT OF JUSTICE
11.0. Box 629
ItA1.EIcr1, NC 27602
Ja y-12,.20,16
L.F. McDonald, Jr., Registered Agent
LSAA Inc., d/b/a Sam's Mart
7935 Council Place
Matthews, NC 28105-5000
RF.PI.YTO:JENNIF. WIII3Eut HALTSF.11
ENVIRONhIE-Nn L.1)IVISION
Tt.1: [phone]
rAx: [phone]
jhauser @Lncdoj.gov
Certified MaiUReturn Receipt Requested
Re: ass essment_of Civii-PenaIty_againsttiLSAA;-Inc.
LV�20,154- 33'
Dear Mr. McDonald:
Enclosed is the Final Agency Decision of the Environmental Management Commission
assessing a civil penalty and investigative costs against LSAA, Inc. d/b/a Sam's Mart totaling
= 25%26. Accordin to North Carolina General Statutes 143-215.5 and 150B-45 LSAA Inc.
g § § >
rmay elc judicial review of the Commission's decision in the appropriate Superior Court by
filing a petition within 30 days of receipt of the written copy of the Final Agency Decision. A.
copy of the judicial review petition must be served on the Commission's agent for service of
process at the following address:
Sam M. Hayes, General Counsel
Dept. of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601
If you choose to file a petition for judicial review, I request that you also serve a copy of
the petition for judicial review on me at the address listed in the letterhead.
If LSAA, Inc. does not appeal the Final Agency Decision, payment must be submitted to
the Department of Environmental Quality within 30 days of receipt of this final agency decision
by mailing a check made payable to the Department of Environmental Quality to
Mr. Kevin Bowden [Phone [phone]]
Compliance Oversight Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

�LSAA, Inc::d%h/a San's 11%Iarfi .
Novemlier
If you -fail to pay the- tWiy Within 30 days of.receipt of the. final decision document, the,
Department. ye 11 seek. to PQllect� the anigpt due• through as civil actionf :commended 'in Superior'
CouYt. -
Sfncerely,
Jennie W lhe]mft5a er
;Special I?eputy Attoxney. General and
Counsel 'for- the Envifci eAtal Management c-6in- imssioi
cc: _Gerard P Carroll, `Chair, -E-MC: (electrorifcally)
L` ois Thomas -Spence, Recoidirig-Clerk,:EMC,(eleefronicaliy
Kevin Bowden,(electrorucally)
Landon.Davrdson,,Regtonal Supervisor (electromcaliy)

North Carolina Department of Environmental Quality
Pat McCrory
Governor
October 14, 2015
Mr. Haytham Kasem
LSAA, Inc. dba. Sam's Mart
7935 Council Place; Ste. 200
Matthews, NC 28105
SUBJECT: Request for Remission of Civil Penalty
Pursuant to N.C.G.S. 143-215.6A(f)
Sam's Mart #45 WWTP
Case Number LV-2015-0033
NPDES Permit NCO044199
Haywood County
Dear Mr. Kasem:
Donald R. van der Vaart
Secretary
RECEIVED
Division of Water Resources
OCT 2 1 2015
Water Oualih, Regional Operations
Asheville Regional Off ice
Final agency decision on your request for remission of the subject civil -penalty will -be made by the
Committee On Civil Penalty Remissions (Committee) of the Environmental Management Commission
(EMC) on Thursday, November 5, 2015. 01
V No request for oral presentation was made:. You may attend this meeting, but you will not be
permitted to speak regarding your case.
The EMC Chairman has considered the written record and determined that no oral presentation
will be made. You may attend this meeting, but you will not be permitted to speak regarding
your case.
The EMC Chairman has considered the written record and determined that an oral presentation
is necessary. Please come prepared to present your remission request at this meeting. You will
be allowed approximately five (5) minutes to speak. Please be advised that the Committee
cannot consider any information other than that submitted in the original remission request.
Please note, the State Bar's recent Opinion regarding the unauthorized practice of law affects
your method of presenting at the Committee.
If you are an individual or business owner and are granted an opportunity to make an oral presentation
before the Committee, then you do not need legal representation before the Committee; however, if
you intend on having another individual speak on your behalf regarding the factual situations, such as
an expert, engineer or consultant, then you must also be present at the meeting in order to avoid
violating the State Bar's Opinion on the unauthorized practice of law.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: [phone] \Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer— Made in part by recycled paper

Mr. Haytham Kasem
LV-2015-0033 CCPR Notification
p. 2
If you are a corporation partnership or municipality and are granted an opportunity to make an oral
presentation before the Committee, then your representative must consider the recent State Bar's
Opinion and could be considered practicing law without a license if he or she is not a licensed attorney.
Presentation of facts by non -lawyers is permissible.
Also, be advised that the Committee on Civil Penalty Remissions may choose not to proceed with the
hearing of a case if the Committee is informed that a potential violation regarding the unauthorized
practice of law has occurred.
Time and Location of Meetin
The Committee will convene at 11:30 a.m. or immediately following the closing of the regularly
scheduled business meeting of the Environmental Management Commission. The Committee meeting
will be held in the Ground Floor Hearing Room of the Archdale Building, located at 512 North
Salisbury Street in Raleigh, North Carolina (see enclosed map).
Other Things to Know About The Meeting
The length of an Environmental Management Commission meeting is determined by its agenda of the
day and the amount of discussion given to each topic — meetings often extend into the early afternoon.
You are advised to arrive for the Committee meeting no later than 11:30 a.m. in order to ensure your
opportunity to listen to consideration of your case in the: event that the Committee begins at its
appointed time. If the Commission meeting runs long and you need refreshment or food, Division of
Water Resources staff can direct you to a canteen/snack, bar that is located on the basement floor of the
Archdale Building or to other local eateries.
If you have any questions concerning this matter, please contact Kevin Bowden of the Wastewater
Branch at [phone], or via e-mail at [e-mail].-
Sincerely,
S. Jay Zimmerman, P.G.
Director, Division of Water Resources
enclosure
cc: N,Ashe�ilLe Regional Offiee D_WPM— ate_r Quality
nE ement File
Kevin Bowden — Wastewater Branch
Central Files

STATE OF NORTH CAROLINA
COUNTY OF HAYWOOD
BEFORE THE
REMISSION COMMITTEE OF THE
ENVIRONMENTAL MANAGEMENT
COMMISSION
LV-2015-0033
IN THE MATTER OF )
ASSESSMENT OF CIVIL ) FINAL DECISION
PENALTIES AGAINST: )
LSAA, INC. d/b/a SAM'S MART )
THIS MATTER came before the Civil Penalty Remissions Committee ("Committee") of
the Environmental Management Commission, pursuant to N.C.G.S. §143-215.6A and §143B-
282.1, on November 5, 2015, for entry of a final decision on the assessment of a civil penalty and
investigation costs against LSAA, Inc. d/a/b Sam's Mart ("LSAA") totaling Two Hundred Fifty
Nine Dollars and Twenty -Six Cents ($259.26).
FACTUAL AND PROCEDURAL FINDINGS
1. On March 2, 2015 LSAA, Inc. was' assessed a civil penalty of $259.26 which
included one civil penalty totaling $100.00 and $159.26 for investigative costs. The civil penalty
was based on one effluent limitation violation of LSAA's National Pollutant Discharge
Elimination System (NPDES) permit No. NC0044199.
2. ' According to the United States Postal Services return receipt, LSAA received the
assessment document on March 6, 2015.
3. On April 1, 2015, the Division of Water Resources ("DWR") received a request
for remission of the assessed civil penalty from LSAA, including a Justification, for Remission
Request and LSAA's Waiver of Right to an Administrative Hearing and Stipulation of Facts.
4. DWR Director, S. Jay Zimmerman, P.G. delegated to the DWR Supervisor of the
Water Quality Permitting Section's Expedited Permitting Unit consideration of LSAA's request

.2 .
for remission of the assessed penalty and the justification submitted as well as the required
statutory factors, and it was determined that LSAA had not presented grounds to reduce the civil
penalty assessment.
5. On June 2, 2015, LSAA received the Decision to deny remission of the civil
penalty assessment.
6. LSAA's request for remission and DWR's recommendation to deny remission
were considered by the Civil Penalty Remissions Committee on November 5, 2015. LSAA did
not request oral argument; therefore, its request for remission was presented to the Civil Penalty
Remissions Committee based on written submissions from LSAA and the Division of Water
Resources.
CONCLUSIONS OF LAW -
Having considered the facts contained in the record, the oral presentations from DWR, and
the factors set forth in N.C.G.S. § 143B-282.1(b) and (c), the Civil Penalty Remissions
Committee finds and incorporates herein the facts contained in the Findings and Decision and
Assessment of Civil Penalties as stipulated to by LSAA. Additionally the Committee concludes
that the record supports the Findings of Fact. The Findings of Fact in turn support the
Conclusions of Law. The Committee further concludes that the Director properly considered and
applied the factors set forth in N.C.G.S. § 143B-282.1 in determining the amount of the civil
penalty and considering the request for remission. Pursuar -tto- N C:G.S §§-11-43B=282
u,,Committee concludes that.rio-giaundshave-been-shown byLSAA- to :support `the: request'for�
�v �� ...
remission_or:reduetion�ofthe.>penalty, assessed'by,_the DWR onMarch 2; 2015
�- s.--

3
'Upon duly made motion and vote, the Committee concludes that the civil penalty
assessment with investigative costs should be upheld in the total amount of Two Hundred Fifty
Nine Dollars and Twenty -Six Cents ($259.26) ($100.00 assessed for civil penalties, plus $159.26
for investigative costs).
THEREFORE, IT IS ORDERED AND ADJUDGED that:
::-- The asassessment-of-the-civil-penalty and-inve is gazyeicosts inffie-toW,-zamount-of
Two Liu re ra s and Twenty Srx Cents"($-259:26) aeai'nst_ESAA Inc -dka
S�am�'s Mart AFFIRMED
2. This Final Decision and Order shall be served upon LSAA, Inc. and upon receipt
hereof, the amount of Two Hundred Fifty Nine Dollars and.Twenty-Six Cents ($259.26) shall be
paid to `the Department of Environmental Quality within thirty days as required by law-.
This is the30`h day of December, 2015.
/!� dz�r, / I —
GerarVFTaiioll, Chairman
Environmental Management Commission

CERTIFICATE OPSERVICE.
This is to certify.1hatJ have ;this ,day served.a copy ofthe--foregoing FINAL DECISION-od
' the patties, listed below Vy, the thbtliod8li-ididatedt
L;E.AcDonql4,,--Jr.'Re gisferedAgent.
Ceri&ed Mail Riturn A8ceL(
tSAA,Jhc. d/b/aSAin'i Mart
9,3,5--Counq..il,Plgqq,- Suite',,200'
-Rc,b6ft.M'.-Rose i.Jn
-.Regular, US Mail'
103,S� 10oun'di-Pladej Suite 200
MattheW&M. 28105
Mr.. Kdvift'BoWden
Electrohicd1l
Compliance Oversight Unif
1617'Mail.'Service,.Cenfer
keviri-.b6w.d6n(@ncdenr..izov.'
R41eigb, N6rth-.-,C0olih4'21, 609-4 6"i T
Mr.. 0 avidsonj RE-, -
,,, Landon,l)
n
Ekctro i0i�y
Regional Supervisor
la'dd6h.day d§6n@.d&hf..gdv
Aslie�ile Regional Office'
Thisisthe,
ROY, :COOPER,
Attorney 'y . :Gene
ral
JenhieVillielm 14au'spr
General
Deputy 't- ­ Attorney ey,
Duy lI
Vqf _JuWC'6 Department
'of
'0. Box 629
RdNigh C_27G02
919/7-16'6600,

d
,�1 I Haytham Kasem LSAA, Inc.
a i d/b/a Sam's Mart --
I'' 7935 Council Place, Suite 200 _
Matthews, NC 28105-5000-------""

J r^
UNITED STATES POSTAL x sPulass Mall
t �` Pos" e.8� Fees Pald
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-• Sender Please punt your name,mcloress; andthls box • oc`' ;
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JANETCANTWELL
x% c NCDENR-DWR-WQRO
2090 Mt. HIGHWAY 70
SWANNANOA NC 28778
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_ � '� � 1 u�l1 s��l li�+i f 'I ��► !��! rji� jl i t. � t

Postage
C3 Certified Fee
Retum Receipt Fee - Postmark
C3(Endorsement Required), Here
-Restricted Delivery,Fee
C3 (Endorsement -Required)
vl Total Postage & Fees J
Haytham Kasem LSAA, Inc.
rq d/b/a Sam's Mart Ce - �P
o Sam's Mart #45
I'- 7935 Council Place, Suite 200
Matthews, NC 28105-5000
f

AA
ll NCDENR
Cr North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
April 8, 2015
Sent via e-mail
Mr. Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council Place; Ste. 200
Matthews; NC -28105 - - - -
Subject: Remission Request of Civil Penalty Assessment
Sam's Mart #45 WWTP
NPDES Permit NCO044199
Case Number LV-2015-0033
Haywood County
Dear Mr. Kasem:
This letter is to acknowledge your request for remission of the civil penalty levied against the subject
facility. Your request will be scheduled for review by the Director and you will be notified of the result.
If you have any questions about this matter, please contact me at [phone] or via e-mail at
bob. [e-mail].
Sincerely,
-k 02", 0J_
Bob- Sledge, Environmental -Specialist - - - - -
Compliance & Expedited Permitting Unit
Division of Water Resources
cc: Enforcement File w/originals
Central Files w/attachments
,Asheville Regional O�ffic_e_w/_attachmen s
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phone: 91M07-6300 \Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer— Made in part by recycled paper

March 30, 2015
NPDES Compliance/Enforcement Unit
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Mr. Zimmerman,
RECEIVEDIDENR/DWR
APR - 1 2015
Water Quality
Permitting Section
I am requesting remission of the civil penalties associated with Sam's Mart 45 (Case #: LV-2015-0033)
based on consideration 2 listed in the Assessment Letter.
The wastewater treatment system associated with this assessment is designed to provide treatment for
the convenience store and a restaurant. At the time of the violation, the restaurant was not in service
and there was very low flow into the system. After the violation occurred, our operator recommended
that we remove the waste in the system and replaced it with "fresh" waste so the system could operate
more effectively. This has been conducted in an effort to keep our system in compliance regarding our
Total Suspended Solids discharge.
Please take into consideration these factors and remove the penalty associated with this case.
If you have any questions please feel free to contact me at any time.
Sincerely,
Mitch Rose
Environmental Manager
encl
7935 Council Place, Suite 200
Matthews, NC 28105
Phone [phone] Fax [phone]
111

c
STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF HAYWOOD
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
LSAA, Inc. dba Sam's Mart )
Sam's Mart #45 1
PERMIT NO. NCO044199 ) CASE NO. LV-2015-0033
-Having—been—assessed—civil- penalties —totaling- 259:26 for violations) as set forth in the assessment document of the
Division of Water `Resources dated March 02, 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.
y9,
This the 3 b day of Yy\ Gt r tI x , 20 1 S
SIGNATURE
0
0
ADDRESS
`1 q 3 S Co u nGl l IaL,L .S uiy_ 24P
Maiflh"5, VC, I D 5
TELEPHONE
-70y- qHO- Ulf
f

A
I
Ap*
MCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Certified Mail # 7014 0510 0000 4466 0295
Return Receipt Requested
March 02, 2015
Haytham Kasem
LSAA, Inc. dba Sam's Mart
7935 Council PI
Ste 200
Matthews, NC 28105-5000
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. NCO044199
LSAA, Inc. dba Sam's Mart
Sam's Mart #45
Case No. LV-2015-0033
Haywood 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 LSAA, Inc, dba Sam's Mart.
This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report
(DMR) submitted by LSAA, Inc. dba Sam's Mart for the month of September 2014. This review has shown the subject
facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES Permit No.
NC0044199. The violations, which occurred in September 2014, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter . of law that LSAA, Inc. dba Sam's Mart violated the terms,
conditions or requirements of NPDES Permit No. NC0044199 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 LSAA, Inc. dba Sam's Mart:
2090 U.S. 70 Highway, Swannanoa, NC 28778
Phone: [phone] \ Intemet: wv%,%v.ncdenr.gov <http:/h,,wxv.ncdenr.gov>
An Equal Opportunity \ Affirmative Action Employer - Made in part by recycled paper

$100.00 1 of the 2 violations of 143-215.1(a)(6) and NPDES Permit No.NC0044199, by discharging
waste water into the waters of the State in violation of the Permit Daily Maximum for TSS - Cone.
$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) 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
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

I
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 at [e-mail].
Sincerely,
for S. Jay Zimmerman, P.G.
Acting 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
Y_ _
Cc: )WQS Asheville _Regional=0fce- Enfor_cement-_File! g (w/attachments )
NPDES Compliance/Enforcement Unit - Enforcement File (w/attachments)
Central Files, Water Quality Section (w/attachments)
F1

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV-2015-0033 County: Haywood
Assessed Party: LSAA, Inc. dba Sam's Mart
Permit No.: NC0044199 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
COUNTY OF HAYWOOD
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
LSAA, Inc. dba Sam's Mart )
Sam's Mart #45 )
PERMIT NO. NCO044199 ) CASE NO. LV-2015-0033
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 March 02, 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
SIGNATURE
ADDRESS
TELEPHONE

ATTACHMENT A
LSAA, Inc. dba Sam's Mart
CASE NUMBER: LV-2015-0033
PERMIT: NC0044199 FACILITY: Sam's Mart #45 COUNTY: -Haywood REGION: Asheville
Limit Violations
$0.00
9-2014
001
Effluent
TSS - Conc
9/4/14
Weekly
mg/I
45
51.40
14.2"
Daily Maximum Exceeded
$100.00
9-2014
001
Effluent
TSS - Conc .
9/9/14
Weekly
mgll
45
54.30
20.7
Daily Maximum Exceeded

r
DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (FILE)
Violator: Sam's Mart # 45 / LSAA / NCO044199
(September 2014 DMR)
County: Haywood
Case Number: LV-2015-0033
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;
Two Daily Max TSS's exceeded the permit limit by 14.2 % & 20.66%.
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
03/02/2015 Asheville Regional Office, NCDENR

NPDES PERMIT NO. NC0044199 DISCHARGE NO. 001 MONTH SEPT. YEAR 2014
FACILITY NAME SAM'S MART #45 CLASS II COUNTY HAYWOOD
CERTIFIED LABORATORY (1) JAMES & JAMES ENVIRONMENTAL MGT., INC. CERTIFICATION NO. 482
(list additional laboratories on the backside/page 2 of this form) _
OPERATOR IN RESPONSIBLE CHARGE,(ORC) KENNETH JASON RUMMEL GRADE II CERTIFICATION NO. 994182
PERSON(S) COLLECTING SAMPLES KENNETH JASON RUMMEL ORC PHONE [phone]
CHECK BOX IF ORC HAS CHANGED
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY .
1617 MAD, SERVICE CENTER
RALEIGH NC 27699-1617
NO FLOW / DISCHARGE FROM SITE
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.'
tz
rq
loll,
• .
DWQ Form MR -I (III" '
Facility Status: (Please rPe
ft followi
f"

6: ,
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable) EJ
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
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.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by Part II.E.6 of the
NPDES permit.
"I certify, under'penalty oflaw, 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 managed the system, ofthose persons directly
responsible for gathering the information, the information submitted is, to the best ofmy knowledge and belief, true, accurate, and complete. I am aware that there are
significant penalties for submitting false information, including the possibility of finesand imprisonment for knowing violations."
1 SAMS MART #45
._,PdrmilR a (Please print or type)
,�. 10/17/2014
t ature of Permittee* * Date
j
(R quired unless submitted electronically)
7935 COUNCIL PLACE. SUITE 200, MATTHEWS, NC 28105 828-697-0063 1/31/2016
Perrnittee Address - - Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory (2) - Certification No.
Certified Laboratory (3)
Certification No.
Certified Laboratory (4)
Certification No.
Certified Laboratory (5)
Certification No.
PARAMETER CODES
Parameter Code assistance maybe obtained by calling the NPDES Unit at [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 213.0506(b)(2)(1)).
7 ` 2

��M_
September, 2014 - DMR
JAM ES & JAMES ENVIRONMENTAL MANAGEMENT, INC
PO BOX 1354, MOUNTAIN HOME, NC 28758
[phone] OFFICE
[phone] FAX
Client: SamsMart #45
NPDES PERMIT NUMBER: NCO044199
Dear Client,
We are pleased to notify you that your facility operated most of the month within your National
Pollutant Discharge Elimination System (NPDES)' permit. We did experience a result that was greater than
the permit discharge limits. Your permit has both a monthly maximum and a daily maximum. Your
facility exceeded the permit discharge limits on the items listed below:
TOTAL SUSPENDED SOLIDS — 51.4 mg/1 on the 4Ta
54.3 mg/1 on the 9'
Monthly average compliant
This gave a daily maximum violation on two days and did not give a monthly violation. This
facility has been running exceptionally well over the last several months. The facility had lost a large
portion of the food entering the facility when the restaurant closed. The facility has been able to maintain
until this point. Another restaurant is in discussion with the Health Department about opening. During this
same time frame a toxic load of low pH entered the facility. This caused the bacteria to become unsettled.
Alum was used to settle the facility out. This took a couple of weeks to get the system polished. We also
recommended that the grease trap be pumped to remove any'potential residual preventing the settling out.
You may receive a monetary fine for this month. Thank you for your understanding in this matter.
Thank you for choosing James & James as your service company.
Harry & Juanita James

()��& �
Permit Enforcement History Details by Owner '
3/2/2015
1
Owner:
LSAA, Inc. dba Sam's Mart
Facility:
Sam's Mart #45
Permit:
NCO044199
-
Region :
Asheville
County : Haywood
Penalty
Remission
Enf
Enf
EMC
EMC OAH Collection
Has
Assessment
Penalty Enforcement
Request
Conf
Remission
Hearing
Remission Remission MemoSent Total
Balance Pmt Case
Case
MR Approved
Pp
Damages
Amount Costs
Received
Held
Amount
Held
Amount Amount To AGO Paid
Due Plan Closed
Number
�
LR-2008-0001 7-2007 2120/08
$500.00 $100.00
3/28/08
6/9/08
$0
7/9/09
$0.00 $600.00
$0.00 No 9110/09
Total Cases: 1 Total Penalty Amount: $500 Total Enforcement Cost: $100.00 Sum Of Total Paid: $600.00 Total Balance Due: $0.00
Sum of Total Case Penalties: $600.00 Total Penalties After Remissions: $600.00

.Pat McCrory
Governor
Jr 96i
NCDENR DL, Ez
North Carolina Department of Environment and Natural Resources
February 5, 2015
CERTIFIED MAIL
RETURN RECEIPT REQUESTED 7014 0610 0000 4466 0097
Mr. Haytham Kasem
LSAA, Inc. dba Sam's Mart
Sam's Mart #45
7935 Council Place
Matthews, North Carolina 28105-5000
Dear Mr. Kasem:
Donald R. van der Vaart
Secretary
Subj ect: Notice of Violation and ,
Recommendation for Enforcement
Tracking#: NOV-2015-LV-0051
Sam's Mart #45. WWTP
NPDES Permit No. NCO044199
Haywood County
A review of the September 2014 self -monitoring report for the subject facility revealed violations of the
following parameter:
Date
Outfall
Parameter-
Reported Value
Permit Limit
09/04/2014
001
TSS
51.4 mg/ 1
45 mg/ 1
09/09/2014
001
TSS
54.3 mg/ 1
45 mg/ 1
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. NC0044199.
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 Sepiember.2014 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/weblwq
An Equal Opportunity/ Affirmative Action Employer

1
Mr. Haytham Kasem t
February 5, 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
ce__WQ Asheville Files
MSC 1617-Central Files -Basement
WQ Enforcement/ NPDES Point Source Branch
G. li'R!\YQ\Ha}uocdU'Vasrewarerablinors�Savn'c Ffart i?45 (Citgc) 44199',�IOV-Nltfi-2U1 i-Ll'-0Oi Lduc

■ Complete items 1,12, and &` Also complete A. Sig u
item 4 if Restricted Delivery is desired. �.�13 ent■ Print your name and address on the reverse X Addresse
so that we can return the card to you. B. Received by (Printed Name) C. Date f D fiver
ArAttach_this_card_to_the-back_of_the_mailDiece. ,
North Carolina Department of different from item 1?
j,� • Environment and Natural Resources
Division of Water Resources[
esources livery address below: El No
Water Quality Regional Operations Section
NCDENR 2090 U.S. Highwayb, S 7wannagoa, NC 28778�
Haytharn KaseffS-LtAA, Inc`'.-> F. a
d/b/a Sam's Mart
Sams. Mart#45
7935-G8uncil Place, Suite 200
Matthews, NC 28105.5000
';
_..QF
;46'6U[197
Service Type
Certified Mail® ❑ Priority Mail Express"
Registered ,Return Receipt for Merchandis(
❑ Insured Mail ❑ Collect on Delivery
3estricted Delivery? (Extra Fee) ❑ Yes
i
;Wdil aas�= Lv-00s L
PS Form.381 I. July 2013 . , ... , . .. Domestic .Return Receiot

UNITED STATES; IDo�9TAtzSE�RVi-dff-.,
of V
*Sender. Please print your name, address, and ZIP49 in"k9'box"
FEB 1 1 2015 11
J—ANe ter Quajjfy
2090 U.S. HIGHWAY 70
SWANNANOA NC 28778

■ Complete items 1, 2, and 3. Also complete A. SI ture
item 4 If Restricted Delivery is desired. ❑ ent
■ Print your name and address on the reverse ❑ Addressee
so that we can return the card to you. B. ecelved by (Printed Name) C. Dat of Delivery
■ Attach this card to the back of the mailpiece, 3
1/3
—or-on the-front_if-sDaoe_Dermits. _
ss different from Rem 1? OYes,
North Carolina Department of
livery address below: ❑ No
• �r Environment and Natural Resources
Division of Water Resources
Water Quality Regional Operations -Section
`t ` .2090`IJ.S. Highway 70, Swannanoa, NC 28778
M.ZDENIi
Hayth;,m Kasem LSAA,.1nc,,,' fervice Type
d/b/a Sam's Mart rtified Mail 0 Express Mail7935 Council Place, Suite 200 gistered -q etum Recelpt for Merchandise
Matthews, NC 28105-5000 ured Mail, -.O' -
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UNITED STATES POSTAL SERVICE `F' st-Class'Mail
Po'
s e & Fees Paid
USP
/ PermS No. -
• Sender: Please print your name, address, and Z .;iin this4box • ocy
s `Q o) 4
- " o
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JANET CANTWELL
NCDENR-DWR-WQRO , I `�
2090 U.S. HIGHWAY 70
SWANNANOA NC 28778 �J
tltiiiiiniiIiIiilsiei111h1iitiltifill; if71iltill 'HilliI,III Id