NCG500648_Regional Office Historical File Pre 2018

(6000
Atrium Health
Andrew Pitner, Assistant Regional Supervisor
North Carolina Department of Environmental Quality
Mooresville Regional Office
6 10 East Center Avenue, Suite 3 01
Mooresville, NC 2811
J, (" "Ie j 19
Re: Name Change Request for "Carolinas Medical Center — Mercy" to "Atrium Health Mercy, a facility
of Carolinas Medical Center"
General Wastewater Discharge Permit NCG500000, Certificate NCG500648, effective October 13, 2015
Dear Sir:
The purpose of this letter is to request a name change for The Charlotte -Mecklenburg Hospital Authority
d/b/a Carolinas Medical Center — Mercy.
Currently, the name is as follows: Carolinas Medical Center - Mercy [The Charlotte -Mecklenburg
Hospital Authority d/b/a Carolinas Medical Center -- Mercy]
Effective August 1, 2019, the "doing business as" name of the Hospital is changing. Accordingly, please
update your records to reflect the new name of the Hospital as follows:
Name: Atrium Health Mercy, a facility of Carolinas Medical Center [The Charlotte -Mecklenburg
Hospital Authority d/b/a Atrium Health Mercy]
Please note that this is simply a d/b/a name change -- there will be no change in ownership, control,
address, personnel, officers, or any other operations of the Hospital as a result of this d/b/a name change,
and the Hospital will continue to be an operating division of The Charlotte -Mecklenburg Hospital
Authority.
Please do not hesitate to contact me at 704-681-1,177 or Hal.Zablocki@,atriumhealtli.org if you have any
questions or need additional inforniation regarding this d/b/a name change.
Sincerely,
IoOWA�1_
Hal Zablocki
Manager/Service Leader
91 7199 9991 7031 0756 6201
2015-01962

UnitedStates Environmental Protection Agency Form Approved.
EPA J l Washington„ D,C. 20,180 OMB No 2040-0057
Water Compliance Inspection Report Approval expires 8-31-98
Section A: National Data System Coding (i.a., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
NI....,.I 2 J NCG500648 111 12 15/11/03 17 18 � j.
19 I e � 20 LJ
21 6 .�,_J
Inspection Work Clays Facility Self -Monitoring Evaluation Rating B1 QA --------Reserved------
67 1.0 1.0 � 701, 1 71 I 72 1 N 1 73 74 751 8
Section B: Facility Data
Flame and location of Facility Inspected (For Industrial Users discharging to POTW, also Include Entry Time/Date Permit Effective Gate
PUTW name and NPOES oer it Number) 12:50PM 1 /11/a3 15/10/13
Carolinas Medical Center - Mercy
Exit Time/Date Permit Expiration Date
2001 Vail Ave
01.50PM 15111103 20f07131
Charlotte NC 28207
Name(s) of Unsite Representative(s)tTlties(s)iPhone and Fax Number(s) Other Facility Data
!!f
Brian Palm!/t
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Brian PaIm,P0 Box 32861 Charlotte NO 28232/PQM Facilities Mgrt7o4-574-7751/
No
Section C: Areas Evaluated [luring Inspection (Check only those areas evaluated)
In Permit in Flow Measurement operations & Maintenan F Records/Reports
IS Self -Monitoring Program in Facility Site Review Effluent/Receiving Waters Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and ignature(s) of Inspector(s) Agency/OfficefPhone, and Fax Numbers Date
Uri A Tuvla MRO WQt/704-663-1859f
R§E
Reviewer Agency/Uffice(Phona and Fax Numbers Date
\"eSata
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page# 1

NPDES yr/Mo/day Inspection Type
31 NCG500648 12 15/11/03 17 18 [Pjl
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page# 2

Permit; NCG500648 Owner - Facility: Carolinas Medical Center _ Mercy
Inspection DaW 41103/2015 inspection Type: Compliance Evaluation
CQgerations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? N d El 1:1
Does the facility analyze process control parameters, for ex; MLSS, MCRT, Settleable
Solids,', pH, DO Sludge Judge, and other that are applicable?
Comment: The maintenance areas for the pumos, air compressors. i ing systems, etc, were
ggnerally clean and well maintained
Permit Yes No NA NE
(If the present permit expires in 6 months or less). Has the perittee submitted a new ® 0 IND
application?
Is the facility as described in the permit? No 11 El
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public? 0 C1 11 11
Is the inspector granted access to all areas for inspection? 0 El 0 11
Comment:
Record leeraing Yes No NA NE
Are records kept and maintained as required by the permit? In 0 11 13
Is all required information readily available, complete and current;' N El 11
Are all records maintained for 3 years (lab. reg. required 5 years)? Q 0 In 11
Are analytical results consistent with data reported on DMRs? [l 0 11 El
Is the chain -of -custody complete? 11 0 ❑ El
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Gates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
Has the facility submitted its annual compliance report to users and DWQ? © El 11 Q
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator Cl 0 N 11
on each shift?
Is the ORC visitation log available and current? 13 0 Is Cl
Is the +C RC certified at grade equal to or higher than the facility classification? 11 C1 11 11
Is the backup operator certified at one grade less or greater than the facility classification? 11 El is Q
Is a copy of the current NPDS permit available on site? 11 [l 1 El
Page#

Permit: NCG500648 owner - Facility: Carolinas Medical Center- Mercy
Inspection Date: 1110312015 Inspection Type: Compliance Evaluation
Record Keecina Yes No NA NE
Facility has copy of previous year's Annual Report on file for review? ❑ ❑ ❑
Comment: The records reviewed during the ins action were organized and well maintained
Effluent Sampling Yjs No NA NE
Is composite sampling flow proportional? ❑ ❑ a ❑
Is sample collected below all treatment units? ❑
Is proper volume collected? Q ❑ 0 ❑
Is the tubing clean? ❑ ❑ is ❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ ❑ 0 ❑
Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling type 11 ❑ © ❑
representative)?
Comment:
Laboratory Yes No bA NE
Are field parameters performed by certified personnel or laboratory? ❑ D ❑ ❑
Are all other parameters(e cluding field parameters) performed by a certified lab? ❑ 0 ❑ ❑
Is the facility using a contract lab? ❑ El ❑ ❑
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ ❑ ❑ ❑
Celsius)?
Incubator (Fecal Coli#orm) set to 44,5 degrees Celsius+/- 0.2 degrees? ❑ ❑ ❑ ❑
Incubator (E3OD) set to 20.0 degrees Celsius +f- 1.0 degrees? ❑ ❑ ❑ ❑
Comment: A contracted com an RM eLorms the on -site field analyses and collects samples.'
Samples are anal zed by Shealy nviromental.
Page# 4

Beverly Byes
Governor
Mr. Micha
Carolinas
A 4i 44L+, 1
Subje+
r. Klosek.
1 2011 -'
Compliance Evaluation Inspection
Carolinas Medical Center -- Mercy
NPDES Permit No. NCt 50064
Mecklenburg County, NC
subject facility on November 17, 2011 by Mr. Wes Bell of this Office.
The report should be self-explanatory; however, should you have any questions concerning this report,
se do not hesitate to contact Mr. Bell at [phone].
Sincerely,
Robert B.,Krebs
Surface Water Protection Regional Supervisor
(sure:
ection report
Gregory Mackin, Efl&S Manager, Carolinas l-IealthCare System
Rusty Rozzelle, MCWQP
Regional Office
10 EaEft Center Ave., Suite 301 Mooresville, NC 28115 One �
4) 663-1699't Fax. [phone] t Customer Service: 1-877-623-6748 -Nort � . +wifin
p{tl)orfiaE,ncdenr;or,gt�7rebfWq �
urtunity k Affirmative Action Employer lover 501C Re cled 10% Posl C`onsomer paper 4 " � ��

1
211
6
United State
v
W for (rimn
bection A, Nair
NPOE5
31 NCG500648
Is Facility Self -Monitoring Evaluatic
169 7a 1
S
)ES permit Number)
Biter - Mercy
Agrt704-512-6968 f7045127290
antal Protection Agency Form Approver
0.c. 20460 OMB No. 2040
Approval expire
an Report
Q,,efsam C``.nrtinn n o Pr..gl
day
ks
e i I
Inspection Type
18U
731 1 174
V1AV t'IVti if I III t
Exit Time/Crate
03:00 PM 11/11/17
Other Facility Data
acted
es
e(s) of Inspector(s) AgencytOffice/Phone and Fax Numbers Date
MRO WQ1t704-6-1699 Ext.2192!
lent Q A Reviewer Agency/Office/Phone and Fax Numbers Date
MRO WQ/1704-663-1699 Ext. 2041
u -94) Previous editions are obsolete.
Page ## 1

NPDES yr/mo/day Inspection Type
3 N G500 48 111 12 11/11/17 117 181 1
Sectican Gt: Summary oaf FindincglComments (Attach additional sheets of narrative and checklists as necessa )
Page

CG500648 Owner - Facility
1117/2011 Inspection Typ+
Minas Medical center - Mercy
Y
;xpires in 6 months or less). Has the permittee submitted a new application?
bed in the permit?
it conditions for the permit?
site restricted to the general public?
d access to all areas for inspection?
etc.l
iwater drainage system.
Yes No N
I maintainers as required by the permit?
0 (
ation readily available, complete and current?
r t
:wined for 3 years (lab. reg. required 5 years)?
0 01
i consistent with data reported on DMR ?
01
dy complete?
M 01
ocation of sampling
I performing the sampling
s and calibration
erforming analyses
s
: do they include all permit parameters?
0
iitted its annual compliance report to users and D Q?
00
> 5 MGD permitted flow) Cho they operate 24t7 with a certified operator on each shift? 0 0 NO
log available and current? is
13
at grade equal to or higher than the facility classification? n- ■ o
or certified at one grade less or greater than the facility classification? o 0
is 0
ant NPDS permit available on site?
arevious year's Annual Report on file for review? is
Page

Permit: NCG50064
Inspection Date: 11/17/2011
Record Keeping
Comment- The record,,
Laboratory
Are field parameters performe
Are all other parameters(exclu
# Is the facility using a contrac
# Is proper temperature set for
Incubator (Fecal Coliform) set
Incubator (BOD) set to 20,0 de
temperature, total residu,
grease samples are anal,
facility staff must ensure I
conform to Standard Metl
Effluent Sampling
Is composite sampling flow pro
Is sample collected below all It
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for
Is the facility sampling perform(
Comment- Previous sar
tower discharges that enti
events should only be per
Owner -Facility: Carolinas Medical Center- Mercy
Inspection Type: Compliance Evaluation
Yes No NA NE
during the inspection were organized and well
Yes No NA NE
by certified personnel or laboratory?
008 0
ng field parameters) performed by a certified tab?
a 0 0 0
ample storage (kept at less than or equal to 6.0 degrees Celsius)?
a 0 0 0
,ompany (Terracon) performs the on -site field analyses (pH,
chlorine) and collects the oil & grease samples. The oil &
,ed by Pace Analytical Services, Inc. (Certification #12). The
at the analytical/testing methods for the field analyses
)ds for the Examination of Wastewater, 18th-20th Editions.
Yes No NA NE
0000
IS? 00no
OONO
ige (kept at less than or equal to 6,0 degrees Celsius)? 00no
d by the permit (frequency, sampling type representative)? U000
nts were performed on the boiler blowdown/cooling
anitary sewer system. Future effluent sampling
i the wastewater being discharged to the receiving
i. An effluent sampling location was identified during
3t ensure that both the samples are collected prior to
arges (stormwater, groundwater, etc.) and all
ilemented during the sampling events.
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex- MILSEE
Judge, and other that are applicable?
'

FPermit: NCG500648 Owner - Facility: Carolinas Medical Center - Mercy
Inspection Date: 11/17/2011 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE --
Comment: The maintenance areas for the pumps, air compressors, piping systems,
Yes No NA NE
the outfall properly maintained? a 0 0 0
water free of foam other than trace amounts and other debris? U000
-1 in 0
,r pipes are required) are they operating property? C1. L
he effluent appeared clear with no floatable solids or foam.
Page# 5

AECEIVED
OCT'
w
MOORESVILLE
North Carolina Department Of Environmental Quality
Pat McCrory, Governor Donald R. van der Vai
October 13, 2015
Mr. Mark Rabon
Carolinas Healthcare System
2001 Vail Ave
Charlotte, NC 28207
Subject: Renewal of General Permit NCG500000
Carolinas Medical Center - Mercy
Certificate of Coverage NCG500648
Mecklenburg County
Dear Permittee:
The Division has renewed the subject General Permit. In response to your request for an
•iiiiiiij I III I III 1 111,1 11111111111 1111� 1 11; 11,11111111111111
•
Zlligl�#
governmental permit that may be required. If you have any questions concerning the requirements of the
General Permit, please contact Charles Weaver of the NPDES staff [919 807-6391 or
charles.weaver@,nedenr.gov].
Since ly,
13
Jay Zimmerman, c or
e� for 4S-i Y Zimmerman,
Division of Water 7esources
IR
cc:
NPM"e
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] /Intemet" www,ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer - 506 Recycled/10% Post Consumer Paper

DEPAR
i
V ERTIF
DISCHARGE OF NON-Ct
BLOWDOWN, CONDENSX,
WITH HYDROELECTRIC
In compliance with the provisiox
regulations promulgated and: ad(
the F(
is hereby authorized to disc]
to receiving waters designated
subbasin 03-0 -34 of the C tav
monitoring requirements, and
This Certificate of Coverage
Signed this day October 13,
fo)
ERAL PERMIT NCG
ONS, AND SIMILAR)
nas Healthcare System
)m a facility located at
144V V -L V all 1
Charlott
Mecklenburg t
ILITY
rcy
r Creek, a class C stream in
1-1, 4-1—
:es effect October 13, 2015.
tall remain valid for the duration of the General Permit.
15
I
L , Director
:Resources �
to Environmental Management Commission !
C
C

CMC — Mercy
Terracon Project
November 18, 20,
Parameter
Flaw NIA
Temperature'
Total residual N
chlorine
Coil and grease 1 r
pH
No more 'than 2 8*CC abov
temperature for trout wa
2 Applies only for discharges
ugL - micrograms per liter
mg/L - milligrams per Liter
Source Type 11 in the
hydroelectric facilities
According to the disc)
monitored on a semi-r
Parameter snot
Ave
Flow N
Temperature'
pH I
Semi-Annu
17 ug/L _ Semi-Annu<
r compressor condensate
rmit describes effluent limitations
!semi-Annua
Must b
3rab Effluent
e than 0,50C above natural water
nonitoring requirements for
imilar wastewater sources.
twina oarameters must be
C above natural water
I requirements for
astewater sources.
rameters must be

CMC — Mercy
Terracon Project No
November 18, 2011
Parameter
e
Flow
Ai
Temperature' 1
F
Total residual
chlorine
Oil and grease
Ai
pH to
No more than 2.8°C at
temperature for trout
2 Upstream and down:
discharge to a storm
3 Applies only for dischar
ug/L — micrograms per La
mg/L —milligrams per Lit
BDL — Below laboratory
The pH of the boiler
11, 2011 wastewate
outside of the 6.0
General Wastewatei
is discharged to the
the site. Therefore,
General Wastewatei
of Water Quality hE
accidental release a
Non -contact coolingi
cooling tower interi(
contact water are I
31
NIA
per aay
111 degrees
NIA
Fahrenheit
17 ug/L
0.49 ug/L
9 mg/L
BILL
Must be
between 6.0
9.
and 9,0
:rature measurements are not ap licat
rge outfall
ipressor condensate
s
mowing paramTers.
4
rd units during the November
insistently exhibited pH levels
IR Division of Water Quality;
M Mr. Klosek, boiler blowdown
Drm water discharge points at
NR Division of Water Quality
is understanding the Division
,ed due to a concern for an
at does not pass through the
Significant quantities of non-
*s during routine operations.
s noted at one cooling tourer

CMC - Mercy
Terracon Project No. 71107731
November 18, 2011
Flow
N/A
N/A
Anticipated
Temperature'
to be 105-
N/A
110 degrees
Fahrenheit
Total rei7id—ual
N/A
17 ug/L
chlorine
-dil and —grease-3-
—15mg/L
—20mg/L
Anticipated
Must be
a -No
Estimate
precipitation
69 degrees
Grab
Fahrenheit
0,0 ug/L
Grab
N/A
Grab
5.87
Grab
for trout waters
downstream temperature measurements are not applicable since boiler blowdo\A
a storm water discharge outfall
discharges of air compressor condensate
is per Liter
5 per Liter
field measurements, none of the measured parameters exceeded the p(
ver condensate water.
our reconnaissance, Terracon sampled cooling water from one
)le provides analytical results and field measurements obtained di
Flow N/A
N/A 20 gallons Estimate Effluent
per clay
Anticipated
perature to be 75-85
N/A 73 degrees Grab Effluent
degrees
Fahrenheit
Fahrenheit I
5

CIVIC — Mercy
Terracon Project No. 71107731
November 18, 2011
Limits Monito
Parameter Monthly Daily Measurement S
Average Maximum
Antici aced Must
«•.
Based on the results of the wastewater sampling and
November 2011 at ;CIVIC -Mercy, the pH of ` the boiler
Wastewater Discharge hermit NCG500000 limit of 6.0 tr
established by the permit did not exceed applicable permi
exceeds the permitted limits, the boiler blowdown sloes not
the site. Should boiler blowdown accidentally be discharge
during a'rain event, Terracon recommends that CIVIC - Mer
bailer blowdown to lower the pH and achieve compli
Wastewater Discharge Permit.
If on -site wastewater discharge source areas are removi
contacted to re-evaluate the permitted wastewater param
General Wastewater Discharge Permit NCG 0000 ,
ng protocol reported in the
ease was not analyzed for
sampling events. Coil and
future events since it is not
Hydroelectric Facilities —
ng sumps, drains or other
iples or field measurements
aasurements conducted in
un exceeded the General
The remaining parameters
While boiler~ blowdown pH
ge to Storm water drains at
storm water drain such as
dish a'treatment method for
th the NC ENR General
tered, Terracon should be
establish compliance with

CIVIC — Mercy
Terracon Project No. 71107731
November 18, 2011 Irerrac
aly,
recon
U1 q
Oily, LE� AP Christopher L.torbitt, P.C-
nmental cientist Environmental Services M
nents: General Wastewater Discharge Permit NCG500000
Laboratory Analytical Results

DEPARTM
TO DISCHARGE NQI
BLOOD
ASSOCIA
0MIDN"I
This permit shall become effectiv
This permit shall expire at midnig,
DIVISION OF WATER QUA]
lust 1, 2007.
July 31, 2012.
gin
Date: July 20, 2007
Quality
ent Commission

ater classifications 2.8 C
Recei
upper
Recetl
pie dtr
iter classifications 0.50
Recoil
er classifications O'8'Cf` E
12°C
Recei
General Perm:
RT I
IS
expiration, the Permittee is autho
e the natural water temperature during any other months'
water temperature shall not exceed a maximum of 32T fa
t necessary if the discharge is to a receiving stream that
=,quire ent applies only for discharges of air compressor condensate.
less than 6.8 standard units nor greater than 8.5 standard units for saltwater class
•omium, zinc or copper added to the system except as pre -approved additi
tatic life (other than additives previously approved by the Division). Such notification shall include completion of
r sh et Fordo 101 (if" applicable), a copy of the MSDS for the additive and a map indicating the dischargepoint
ng stream.
ttact cooling water discharge piping shall be designed and constructed such that representative samples can be
• to commingling with any other waters or substances, such as storm water or surface water.
s collected should be from a representative discharge event.
I be no discharge of floating solids or visible foam in other than trace amounts.
Page'2 of 13

(2) EFFLUENT LIMITA".
FACILITIES — ONCE
During the period beginning
discharge once -through coolin.
water., turbine guidecooling
hydroelectric facilities from of
assigned by the permittee). Su
PARAMETER
Meath]
Arrera
Flaw
Temperature - see note 1
pH — see note 2
I: Effluent temperature will
more than:
Fresh water classificati
"Trout water classificati
Upstream and downstream
any flowing water at the time
2: The pH shall not be less
classifications.
The pH shall not be less
classifications.
There shall be no chromiur
o biocidal cv poun(
The permittee shall obtain app
The permittee shall notify the l
additive which may be toxic to
notification shall include con pl
additive' and a snap indicating t
All 1.
samples can be talon prior t
All samples collected should be fro
There shall be no discharge of floc
trout waters.
charge.
6.0 standard units nor grea
,increase
29 C for
32" C for
20 C for
Lot contain
sit water
saltwater
Edditive
ischarge.
y
Such
for the
sentativ
SlA t�4:l. t✓4 VF.A.AA4Sn�y �SA4AA lA� r:Sli431 A1A YY'GIUGt S.FA
z trace amounts) in the effluent,
Page 3 of 1

General Permit
)d beginning on August 1, 2007 and lasting until expiration, the Permitte
m outfalls numbered serially beginn
,, Such discharges shall be limited a
the hydroelectric facility.
call not be less than 6.0 standard units nor greater than 9.0 standard unit;
ions;
call not, be less than. 6.8 standard units nor greater than 8.5 standard units
ions.
311E for the proposed solvent,
°aticns which do not contribute any wastewater to the discharge
cleaning operations may be conducted as often as necessary to e
d , zinc or capper added to the system except as pre -al
plea collected should be from a representative discharge event.
ball be no discharge of floating solids or visible foam (other than trace amounts) in the effluent.
Page of 13

SECTION B. SCHEDULE OF CON
L The mailing address and telephor
The facility name, address and to
The permit number of any NPDE
4. A description of the discharge,
discharge and any treatment rmetl
5. The name of the receiving waters
6. An analysis of nose -discharge a]
disposal and spray irrigation.
T A 7.5 minute series USGS topogi
& Final plans and specifications for
A certification that the informati
DANCE
;sec lootnoee xt I). Z,
es of discharges:
eric cooling systems (air conditioners,
ice.
its permit.
lualify for coverage under this General Permit,
i-contact cooimg water is aexmeo
trial, intermediate product, waste
mating water for the purpose of
Ynentraticn in amounts exceeding'
ne of discharge, the frequency of
yr collection system, subsurface
Gted.
Gpplicable).
to
Page 5 of 13

STANDARD COND
SFCTIQNA. DEFINITIONS
1, Permit Issuing Authority: The Director of the Div
feasurements
General Permit N
4S FOR NPDES PERMITS
Water Quality.
:ion Control Act, als(
um of the concentra
al samples of at least 100 m
rianually.
as the Clean Water
charge during a calei
t calculated from
sits" in Part I of the I
y, It is determined i
me of sampling, wh
m the facility wbicl
shall be monitore(
ance activities on tht
period of time not
Page 6 of 13

General Permit NCG50000
SECTION R. 1 N L + UNUITIONS'
1. Duty to Comply
The permittee must comply with all conditions of this individual 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 upon renewal application.
a. The permittee shall comply with standards or prohibitions established under section 307(a) of the Clem Water Act for
toxic pollutants within the time provided in the regulations that establish these standards or prohibitions, even if the
permit has not yet been modified to incorporate the requirement.
b. The Clean Water Act provides that any person who violates a permit condition is subject to a civil penalty not to
exceed $25,000 per day for each violation. Any person who negligently violates any permit condition is subject to
criminal penalties of $2,500 to $25,000 per day of violation, or imprisonment for not more than 1 year, or both. Any
person who knowingly violates permit conditions is subject to criminal penalties of $5,000 to $50 000 per day o
violation, or imprisonment for not more than 3 years, or both. Also, any person who ''violates a permit condition may
be assessed an administrative :penalty not to exceed $ 1 0,000 ;per violation with the maximum amount not to exceed
$125,000. [Ref: Section 309 of the Federal Act 33 USCG 1319 and 40 C'FR 122.41(a).]
c. Under state law, a daily civil penalty of not more than twenty-five thousand dollars ($25,000) per violation may b
assessed against any person who violates or fails to act in accordance with the terms, conditions, or requirements of a
permit, [Ref: North Carolina General Statutes 143-215.6A]
rL .Any person may be assessed an administrative penalty by the Director r for violating section 301, 302, 306, 307, 303
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. Administrative penalties for Class 1 violations are not to exceed $10,000 per violation,
with the maximum amount of any Class 1 penalty assessed not to exceed $25,000, Penalties for Class'11 violations are
not to exceed $10,000per day for each day during; which the violation continues, with the maximum amount of any
Class 11 penalty not to exceed $125,000.
2. PMto itigat
The pertnittee shall take all reasonable steps to minimize or prevent any discharge in violation of this permit,
3. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part 11, C.4.) and "Power Failures" (Part 11, 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 U C" 1319 Furtbermore, the permittee is
responsible for consequential damages, such as fish kills, even though the responsibility for effective compliance may b
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- 15.75 et seq. or
Section 311 of the Federal Act, 33 USG 121. Furthermore, the permittee is responsible for consequential d ages, such
as fish kills, even though the responsibility for effective compliance may be temporarily suspended.'
5. Profse 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.
6. C)nshore 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.
T Severability
`The provisions of this permit are severable, and 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.
Page 7 of 13

I:? to Provide infcarmatior
The permittee shall Furnish to the Permit Issuing Authority, within a
permit or to determine compliance with this permit. T'e permittee
request, copies of records required to be kept by this permit.
Pub to Remy
If the permittee vaishes to continue an activity regulated by this pert
must apply for and obtain a new perinit.
M Permit Terminatio
After public notice and opportunity: for a hearing, the general permi
permit may be terminated for cause.'
11. When an Individual Permit mav be Re aired
of
afi this permit.~
may be terminated as to an individual owner for
vith N:C'.G.B. 14 -21 a. .
lividual Permit a be 12e nested
Ints
arts, or information submitted to the Permit is
cations shall be signed as follows:
of a corporation, by a principal executive o
General Permit NCG
cble time, any:: information which th
f
A to, the following.
v(,.r€.d by this n rinit
d official, or other duly authorized employee;
)n: Any person signing a document under paragraph a, of this section shall make the folios
. certify, under penalty of law„ that this document and all attachments were prepared tinder my direction o
apervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate
Ee information submitted. used on my inquiry of the person or persons who manage the system, or those
wrsons directly responsible for gathering the information, the information submitted is, to the best of m
riowledge?and belief,, true accurate, and complete. I am aware that there are significant penalties for submitting;
rise information, ation, including the possibility of fines and imprisonment for knowing violations."
Page 8 of 1

I'. pprmit Antinne
This permit may be n
permit modification,'
noncompliance ce does i
15, Permit _Modification
The issuance of this
permmttee shall notify the D.
status. NOTE, This requir
the f ircility. Currently, fitel
2. Pro er erasion and airi
The perraaitte shalt at all ;t
related appurtenances) whiff
permit. Proper operation
procedures. This provision
by a permittee only when tli
I Need to Halt or Reduce not
It shall not be a defense fm
permitted activity in order tt
4. BvDassina ofTreatment Fac
a, Bypass not exceeding li
The pernaittee may ally
also is for essential m2
Paragraphs b. and c, of
b. Notice
(1) Anticipated bypass
possible at least to
affect of the bypass
(2) Unanticipated byp
this permit, (4-h€
e. Prohibition of Bypass
(1) Bypass is prolubite
unless:
(a) Bvnass was
titan:
y operate and maintain
assure efficient operation, These t
nitatios to be exceeded,
,s are not subject to the 1
000
For a
ated
,ssurance
installed
duce then
ti the pate or the nypass,; inctuaing an evamanon or tne: amaczpateo quatuy ana
uttee shalt submit notice of an unanticipated bypass as required in Part 11, F, 5, of
mit Issuing Authority may take enforcement action against a permittee for bypass
o prevent loss of life, personal injury or severe property damage;
ternatives'to the Bypass, such as the use of auxiliary treatment facilities, retention
untenance during normal periods of equipment downtime, This condition is not
ap equipment should have been installed in the exercise of reasonable engineering
)ass which occurred during normal periods of equipment downtime or preventive
Page 9 of 13

General Permit NCG500000
The Permit Issuing Authority may approve an anticipated bypass, after considering its adverse affects, if the
Permit Issuing Authority determines that it will meet the three conditions listed above in Paragraph c. (1) of this
section,
,ect of an upset.
administrative review of claims that noncompliance was cause(
final administrative action subject to judicial review.
b. Conditions necessary for a demonstration of upset,
A permittee who wishes to establish the affirmative defense
contemporaneous operating logs, or other relevant evidence that
'he permittee complied with any remedial measures refit
m of proof,
�Lubstances
for noncompliance with such technology based permit
condition are met. No determination made during
by upset, and before an action for noncompliance, is
A upset shall demonstrate, through properly signed,
ise(s) of the upset;
4; and
at 11,1 5, (b) (2) of this permit.
I under Part 11, B. 2. of this permit.
the occurrence of an upset has the burden of proof,
sludge use or disposal practices.
es
,e is responsible for maintaining adequate safeguards as required by DWQ Regulation, Tit
of inadequately treated effluent,
SECTLON D.— MONITORING AND RECORDS
1, Represent i4Lve Sam ling
_ p
Samples collected and measurements taken, as required herein, shall be characteristic of the volmr,
permitted discharge. Samples collected at a frequency less than daily shall be taken on a day and time
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.
2, Flow Measurements
propriale new measurement ueviucs ana Inemous Consistent will] acuuptcu st;lufuluu pjdlalkx-,� w1all VC "sulukewu 41JU w'u'u
-nsure the accuracy and reliability of measurements of the volume of monitored discharges. The devices shall be
.ailed, calibrated and maintained to ensure that the accuracy of the measurements are consistent with the accepted
ability of that type of device. Devices selected shall be capable of measuring flows with a maximum, deviation of less
a 10% from the true discharge rates throughout the range of expected discharge volumes. Non -contact cooling water
Page 10 of 13

flaw which is monitored by pump logs (car meters) based on the manufacturer's
requirement.
"Test Procedures
.
Rec
The
ori!
peril
requ
6.
Reci
Tor
info
a.
b.
C,
d.
e.
f: `
T
Ins"
The
doc
a.
b.
C.
d.
SECTIC
L
Saba
Sulu
infci
the a
time
perm
,
Chaj
A 11 1
polio
of tf
d must be used.
wirector at any time.
wits
rement or sample taken pursuant to the reguiremen
ed,
he analyses;
)ds used; and
wr, or an authorized representative,
to;
yes where a regulated facility or actiN
on.
[TS
Page 11 of 13
rn iti;the permittee shall record th
i the presentation of credem
00
his
ill-
V VV „a4
other
cords

General Permit NCG5000ffi
Planned C yes
The permittee shall give notice to the Director as soon as possible of any planned physical alterations or additions to the
permitted facility, Notice is required only when:
a. The alteration or addition to a permitted facility may meet one of the criteria for determining whether a facility is a
new source in 40 CFR Part 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 which are subject neither to effluent limitations in :the permit, nor to notification
requirements under 40 CFR Part 122.42,(a) (1).
4, Antici aced Noncom li ce'
The permittee shall give advance notice to the Director of any planned changes in the permitted facility or activity which
may result in noncompliance with permit requirements.
S, Transfers
This permit is not transferable to any person except after notice to and approval by the Director. The Director may require
modification or revocation and reissuance of the permit and incorporating such other requirements as may be necessary
under the Clean Water Act.
6.
Duty to Report lioncomiance
a. The permittee shall report to the central office or the appropriate regional office any noncompliance which may
endanger 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 clays of the time
the permittee becomes aware of the circumstances.
(1) 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.
b. The following shall be included as information which must be reported within 24 hours under this paragraph.
(1) Any unanticipated bypass which exceeds any effluent limitation in the permit.
(2) Any upset which exceeds any effluent limitation in the permit.
() Violation of a maximum daily discharge limitation for any of the pollutants listed by the Director in the permit to
be reported within 24 hours.
c, The Director may waive the written report on a case -by -case basis for reports under paragraph b, above of this%
condition if the oral report has been received within 24 hours.
. Other Infortiaation
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.
°Noncom fiance Notification. Procedure
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`folloaving.
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 reader 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 in letter form within 5 days following first
knowledge of the occurrence.
Page 12of 13

o be confidential under NCGS 14 - 15.3(a)(2) or
more than two years per violat
PART III
OTHERREQUIRE)
mits issued to this facility for
,o%ed by issuance of this perinj
and provisions of this perrn
discharges from this facility.
d specifications
Facilities and/or
ciencies, design
bility, it is the
h deficiencies. '
.onditions or is otherwise more stringent than y efrluenl
ant not limited in the permit.
A or reissued under this paragraph shall also contain
.I IT IR.ING FEE
`ee (if any such fee is assessed) within 30
ly manner in accordance with 15 NCAC:
of Coverage.
Page 13 of 13

CHAIN -OF -CUSTODY t Analytical Request D urgent
ZAical*
Tho Chain -of -Custody ;s a LEGAL DOCUMENT. All relevant fields must be completed accurately.
t
+
� i�IlRca#tmri�'�i,Rw
X1PR wia
� �
• .
,,..
a e .
III
.
M,
Codes
Drinking Water w
w
Water
WT
w
wastewater
Product
ww
+ ..
SL`r
w
SAMPLE •
oil
w
a«
WPO
Air
AR
►s MU$T 13E UNIQUE
Tissue
TSi
Other
owns goals nognmaul
I
so
loon
Ems
Is
No
no Nunn
In
0
on
IN
an 0
0
t ♦ " •
w
e x
i6
,

Pace Analytical Services, Inc.
Pace Analytical Services, Inc.
fcal 205 Past Meadow Road - Suite A
2225 Riverside Dr
M Eden, NC 27288
Asheville, NC 28804
[phone]
[phone]
011
7
d
^ 28206,
CIVIC Mercy
roject No,. 92106363
r;
otherwise footnoted.
s concerning this report, please feel free to conto
co
>erveces, inc.
ve Suite 100
fie, NC 28078
r O4)875-9092
me.
Page I of

� Pace Analytical Services, €�, Pace Analytical Services, Inc.
Pace Analytical Services, [no.
//
c�p a%�l 205 East Meadow.Road - Suite A 2226 Riverside Or:
9800 Kincey Ave. Suite 100
c'
✓
7t }#�sS,IX2rdi
Eden, NC 27288 Asheville, NC 28804
Huntersville, NC 28078
[phone] [phone]
[phone]
CERTIFICATIONS
Project: CMC Mercy
Pace Project No,, 921`06363
Charlotte Certification IDs
9800 Kinsey Ave. Ste 100, Huntersville, NC 28078
Connecticut Certification* PH-0104
North Carolina
Drinking Water Certification #: 37706
FloodalNELAP Certification ; E87627
North Caroline
Field Services Certification : 5342
Kentucky LIST Certification ##: 84
North Carolina Wastewater
Certification #,, 12
Louisiana D H Drinking Water # LA 100031
South Carolina Certification
#: 9006001 >
West Virginia. Certification #: 357
South Carolina Drinking Water Cert. #• 99006003
VirginiaNELAP Certification #: 460144
Virginia Drinking Water Certification ##: 001
REPORT OF LABORATORY ANALYSIS
Page 2 of 6
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc

90cal"
Pace Analytical Services, Inc, Pace Analytical Services, Inc.
East Meadow Road - Suite A 2226 Riverside Dr,
Pace Analytical Services, Inc.,
980OKincey Ave, Suite too
Eden, NC 27288 Asheville, NC 28804
Huntersville, NC 28078
[phone] [phone]
[phone]
ANALYTICAL RESULTS
CMC Mercy
92106363
Blowdown
LabID: 92106363001 Collected: 11/11111 09A0 Received: 11/11/11 15:35
Matrix: Water
ameters
Results Units Report Limit DF Prepared Analyzed
CAS No. Qual
ease
Analytical Method: EPA 1664A
ND mg/L 5,0 1 11/15/1109:07
04:44 PM
REPORT OF LABORATORY ANALYSIS
Page 4 of 6
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc-

Fnalytical Services, Inc. Pace Analyi
Meadow Road -Suite A
Eden, NC 27288 A
[phone]
Analysis Description:
Matrix: Water
Blank Report'
ND
Spike LS
Conc, Result
40 31
F YGwlU@! wvF tiA'. P \Ga'1. Uu
5.2> 40 4
Wits 100
C 28078
175-9092
Page 5 of 6

Pace Analytical
f...
2ce
Analytical 205 East Meadow R
.pa bs. Ede
(3
Project: CMC Mercy
Pace Project Nri,; 9210636
DEFINI'nONS
lF - Dilution Factor, if reported, represents the factor ppl
I Detection Limit,
ervices, Inc, Pad,
ed - Suite A
n, NC 7288
36)623-8921
QUALIFIERS
ybeal Services Inc. Pace Ana
2225 Riverside Dr, 9800 i<
Asheville, NC 28804 H
[phone]
anges in sample preparation, dilution c
,led reporting limit.
)oratory Control Sample (Duplicate)
rix Spike (Duplicate)
le Duplicate
e Percent Difference
Iculale.
3el - Clean -tip`
the compound was analyzed for, but not detected,
henylarnine decomposes and cannot be separated from Diphenylarnine using ;Method 8270, The result reported for
r is a combined concentration,
ation may not be appropriate for 2-Chloroethylvinyl ether, Styrene, and Vinyl chloride,
cal is TNI accredited, Contact your Pace PM for the current list of accredited analytes.
Pace Analytical Services - Charlotte
°44 PM REPORT OF LABORATORY ANALYSIS Page 6 of 6
This report shall not be reproduced, except in full,
without the whiten consent of Pace Analytical Services, Inc.:

RP
r
North�•Jina 1•
hart Jr. P.E.
ter
J Stone
on Street, Suite 1400
8202
and Natural `Resources
Director
RECEIVED `
March 18, 2011
Subjec
hart;
Trended.
1 SICI A'ATER C
r.b R 2 2a
"111-
SVVP SECTION
MOORE5 `iLt_E I Et It ,NW
tttecklenburg County
feral or Local governmental permit that may be required. If you have any questions concerning this permit, please contact Bob
arra at telephone number (910) 07-6 87.
/,8inc lely,
ColeenH. Sullins
achment. NG500648 Corrected Permit expiration date
Central Files
NPDES General Permit Files
Judy.hefftc erm.com
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] t PAX: 919-867-6495 t Customer Service:1-877-623-6748 NofthCarohna
Internet: www,ncwaterquality.org
An Equal Opportunity l Affirmative Action Employer Naturall#

Pennit NCG501
STATE OF NORTH CAROLINA
Carolinas Medical Center — Mercy
2001 Vail Avenue
Charlotte, NC 28207
Mecidenburg County
waters designated as a UT to Brier Creek, a class C water in the Catawb
shall, become effective February 15, 20 10.
sate of Coverage shall expire at midnight on July 31, 2012.
day March 18, 2011.
Coleen H. Sullins., Director
Division of Water Quality
By Authority of the Environmental Management Commission

I A Lv:Y
4-x49;
OCIDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Eaves Perdue
Coleen H, Sullins Dee'Freeman
Dr
Director Secretary
rr 7B 2 5
February 15, 2010
.ockhart Jr, PE
Wager
5t and Stone
,i Tryon Street, Suite 1400
NC 28202
Subject: General Permit No. NCG500000
Certificate of Coverage NCG500648
Carolinas Medical Center - Mercy
Mecklenburg County
Lockhart Jr.:
amended).
lermit NCG500000
hone number 919/807-6387 or by email at bob .guerra(&ncdgn[,ggy.
� , ely S' er
rely,
en ullins
ieral Permit Iles
3
hoe Center, Raleigh, North Carolina 27699-1617
N. Salisbury St. Raleigh, North Carolina 27604 One
17-6387 k FAX: [phone] k Customer Service: 1-877-623-6748 NofthCarolina,
ncwaterquality,org
unity k Affirrnative Action Employer

AW
D0648
General Perm:
•
AL
Carolinas Medical Center —`Mere
2001 Vail Avenue,
Charlotte, NC 28207
Mecklenburg County
to receiving waters designated ias a UT to Brier Creek, a class C w
Basin,
in accordance with effluent limitations, monitoring requirements
forth in Parts 1, 11, Ill and IV of the General Permit NCG 500000, z
This permit shall become effective February 15, 2010.
This Certificate of Coverage shall expire at midnight on July 31, 2
Signed this day February 15, 2010.
testa en H. Sullins., Director
Division of Water Quality
'By Authority of the Environmental Man
11 r%kL, CLZ, OA11K;11U1UU,
em
:ility located at the
I
.ter in the Catawba River
Lnd other conditions set
s attached.
igement Commission

SOC PRIORITY PROJECT: No
Western NPDES Unit
Surface Water Protection Section
Attention: Bob Guerra
Date: January 27, 2010
NPDES STAFF REPORT AND RECOMMENDATIONS
County: Mecklenburg
NPDES Permit No.: NCG500648
RT I - GENERAL INFORMATION
Physical Location
Facility and address: Carolinas Healthcare System - Mercy
Post Office Box 32861 2001 Vail Avenue
Charlotte, NC 28232 Charlotte, NC 28207
Date of investigation: January 26, 2010
Report prepared by: Michael L. Parker, Environmental Engineer ll
Person contacted and telephone number: Larry Lockhart, (704) 704-304-5801
Directions to site: The site is located at the physical address listed above.
Discharge point(s): Latitude. 350 12'29"
Longitude: 80" 49'08"
USG S Quad No.: G15NE
Receiving stream or affected surface waters- Unnamed tributary to Brier Creek
a. Classification: C
b. River Basin and SubbasinNo.- Catawba03O834
C. Describe receiving stream features and pertinent downstream uses: Receiving waters
is a headwaters channel that originates near the outlet of the storm drain. There was
some flow observed in the channel, however, the area had recently experienced
heavy rainfall. There are no other known downstream dischargers.
RT 11 - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
Boiler Blowdown Condensate
a. Proposed flow: 30 gpd 24 gpd
b. Current permitted capacity: N/A
C. Description of existing or substantially constructed WWT facilities- There are no
existing WWT facilities nor are any proposed at this time.
d. Possible toxic impacts to surface waters* Currently, there are no additives to the
boiler blowdown or the condensate discharges.

Page Two
. Compliance Background: No cornpliance information is available at this time.
PART III - OTHER PERTINENTINFORNIATION
1. Special monitoring or limitations (including toxicity) requests. None at this time.
PART IV - EVALUATION AND RECOMMENDATIONS
Carolina Healthcare System (Mercy Hospital) has requested a General Permit to discharge
boiler blowdown and condensate from existing floor drains and building drains into a storm drain
owned by the City of Charlotte. The storm drain eventually discharges at the headwaters of an
unnamed tributary to Brier Creek., which they passes through a older, residential area southeast of
the hospital. This discharge was discovered by Ms. Heather Sorenson with Mecklenburg County
Water Quality, who advised the applicant to submit the permit application.
Based on the location where the discharges; are produced, it is not feasible at this time to
connect the discharge to the CU sewer collection system without a significant expenditure by the
applicant. Issuance of the General Permit is reconmiended.
Signature of Report Preparr ate
Water Quality Regional Supervisor Date
h `dsr\dsr1Minercy.doc

NCDE
North Carolina Department of Envir
Division of Wat
Eaves Prue
Coleen H,
r
Dirct
December
Y LOCKHART=A PE`
rMANAGER
NEST AND STONE
rH TRY(N STREET, SUITE 1400
)TTE NC`28202
Subject.
Permit ##:
Facility:
Lockhart:
I
Em
inment and Natural Resources
r Quality
ifins Dee Freeman
Secretary
10, 2009 W .4
"G 00 48
[rolinas Medical Center - Mercy
-cklenburg County
,opy of this letter, we are also requesting a Staff Report from the Mooresville
perform a detailed review and contact you with a request for additional informat
ciency in processing permit applications, the Division requests your assistance in
to any additional information requests.
z stions please contact Bob Guerra at 19-807-6 87, or via e-mail at bob.guerra(
Ilable, you may leave a message, and they will respond promptly.
Sincerely,
Dina Sprinkle
Paint Source Branch
cc. Surface Water Protection Section
Central Files
Permit Application File NCG 00648
1617 Mail Service Center, Raleigh, North Caro4Erna 27699-1,617
I<ocatiom 512 N. Saliskiry St, Raleigh, Noah Carolina 27604 One
Phone: [phone]u61 FAX: [phone] Customer Service: E 877-623-t 48 N C -ofina
Internet wwwncwaterquality,org

id tir
#
Physical location Information:
Please provide a narrative description of how to get to the facility fuse street names, state 10*0 "U11 Vol 0,
and distance and direction from a roadway Intersection). agginaLn_q_al_tb_e_InLellgc-ttgnPLN-O-dh
it ''I npL _cjmpUj o rAn
_MW
(A copy of a county map or US quad sheet with facility clearly located on t a me is rl ad,, be submittedwith tO ID
ffo
wo
4) This NPDES permit application applies to which of the foil 7
M New or Proposed
0 Modification DEC 2 8 2009
Please describe the modification:
Cl Renewal
Please specify existing permit number and original issue dateDENR WATER OUALITY
()i 1!'rF RRMNCH
5) Does this facility have any other NPDES permits?
M No
0 Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
6) What Is the nature of the business applying for this permit? --Health qare -fa-c-1lit �hs i It a �Im dil
_off I "a
Page I of 04/05

NCG500000 NAL
7) Description of Discharge:
a) Is the discharge directly to the receiving water? 0 Yes 0 No
If no, submit a site map with the pathway to the potential receiving waters clearly marked. This
includes tracing the pathway of the storm sewer to the discharge point, if the storm sewer is the only
viable means of discharge.
b) Number of discharge points (ditches, pipes, channels, etc. that convey wastewater from the
property):
c) What type of wastewater is discharged? Indicate which discharge points, if more than one.
11 Non -contact cooling water Discharge point(s)
M Boiler lowdown (#1 below) Discharge point(s)
11 Cooling Tower Blowdown Discharge point(s)
0 Condensate (#2 below) Discharge point(s) #:
El Other Discharge poiht(s) #:
(Please describe "Other")
d) Volume of discharge per each discharge point (in GPD):
#1: 3Q #2: 24 #3: #4
e) Please describe the type of process (i.e., compressor, A/C unit, chiller, boiler, etc.) the wastewater is
being discharged from, per each separate discharge point (if applicable, use separate sheet): #_1
8) Please check the type of chemical added to the wastewater for treatment , per each separate discharge
point (if applicable, use separate sheet): N/A
0 Biocides Name: Manuf.:
• Corrosion inhibitors Name: — Manut.:
• Chlorine Name: — Manuf.:
• Algaecide Name: — Manuf.:
El Other Name: — Manuf.:
C1 None
9) If any box in item (8) above, other than none, was checked, a completed Blocide 101 Form and
manufacturers' information on the additive is required to be submitted with the application for the
Division's review. _NLA
10) Is there any type of treatment being provided to the wastewater before discharge (ie., retention ponds,
settling ponds, etc.)? El Yes [N No
If yes, please include design specifics (i.e., design volume, retention time, surface area, etc.) with
submittal package. Existing treatment facilities should be described in detail. Design criteria and
operational data (including calculations) should be provided to ensure that the facility can comply With
the requirements of the General Permit, The treatment shall be sufficient to meet the limits set by the
general permits.
Note: Construction of any wastewater treatment facilities requires submission of three (3)
sets of plans and specifications along with the application. Design of treatment
facilities must comply with the requirements of 15A NCAC 2H .0138. If construction
applies to this discharge, include the three sets of plans and specifications with this
application.
Page 2 of 4 04/05

NCG600000 NAL
11) Discharge Frequency:
a) The discharge is: M Continuous 0 Intermittent 0 Seasonal*
1) If the discharge is intermittent, describe when the discharge will occur: ffglkLb1QW-dQ-W--rL
i!) If seasonal check the month(s) the discharge occurs: 11 Jan. 0 Feb. 0 Mar. El Apr.
11 May El Jun. Cl Jul. 0 Aug. El Sept. 0 Oct. 0 Nov. 0 Dec.
b) How many days per week is there a discharge? -S&v--q—n-U7
c) Please check the days discharge occurs:
CR Sat. 0 Sun. 19 Mon. 0 Tue. Z Wed. IN Thu. ZJ Fri,
12) Pollutants:
Please list any known pollutants that are present in the discharge, per each separate discharge point (if
applicable, use separate sheet): cane known
13) Receiving waters:
EMCEE=..
I . - -1. - . - - Z7 - - -, - - - - -,-- - - - -
a subsurface system is neither feasible nor practical as well as written confirmation indicating that
connection to a POTW is not an option. It should also include a present value of costs analysis as
outlined in the Division's "'Guidance For the Evaluation of Wastewater Disposal Altematives
16) Additional Application Requirements:
For new or proposed discharges, the following information must be included in triplicate with this
application or it will be returned as incomplete.
a) 7.5 minute series USGS topographic map (or a photocopied portion thereof) with discharge location
clearly indicated,
must e
a b
)b) Site map, if the discharge is not directly to a stream, the pathway to the receiving stream
clearly indicated. This includes tracing the pathway of a storm sewer to its discharge Point.
)c) If this application is being submitted by a consulting engineer (or e ngineering firm), include
documentation from the applicant showing that the engineer (Or firm) submitting the application has
been designated an authorized Representative of the applicant.
Page 3 of 4 04/05

-t$ co 1 monitoring device falsifies, tampers with or knowingly renders inaccurate any re rd ng or mon to ng dvi e 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.)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Mail three (3) copies of the entire package to:
NPDES Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Final
This application will be returned as incomplete unless all of the following Items have been
Included:
Check for $100 made payable to NCDEN R
3 copies of county map or USES quad sheet with location of facility clearly marked on map
3 copies of this completed application and all supporting documents
Cl 3 sets of plans and specifications signed and seated by a North Carolina P.E.
X Thorough responses to items 1-7 on this application
)< Alternatives analysis including present value of costs for all alternatives
ge 4 of 4 04/05

20o South Tryon Street, Suite 1400 'Charlotte, NC 28202
P+ 704 376 1555 f+ 704 376 7851 ,t+www.colejeneststrme.corn
Attachment 14 — Alternatives to Direct Discharge
Jenest
one For purposes of studying potential alternatives, it should be notE
the Carolinas Medical Center — Mercy facility are existing. The
to Environment of the facility and drain to the existing floor drains and building s
be PossibRities which connects to the site storm drainage system. Ms. Heather
representative of Charlotte -Mecklenburg Utilities, stated to Mr, Carolinas Healthcare System that the attached NPDES applicat
to operate the facility as it currently exists,
Charlotte
Raleigh
Wilmington
d the discharges from
discharges occur inside
form drainage system,
Sorenson, a
Mi
chael Klosek with
ColeJenest & Stone, PA has reviewed potential alternatives in order to achieve a non -
discharge configuration. The alternatives included connection to a municipal sanitary
sewer system, subsurface disposal, spray irrigation, and internal reuse. Based on our
review, we have found the potential to connect to the municipal sanitary sewer system
does exist; however, it is not a viable solution. In order to achieve this connection,
significant work would be required within the existing hospital spaces. This work
includes cutting and excavating building slabs, rerouting building roof leaders beneath
the slabs and overhead, installation of a pump station in order to lift the discharge to the
Smg level of the closest sanitary sewer pipe, new electrical service for the pump station, and
possible removal (temporary) of existing mechanical equipment, The projected cost to
Architecture achieve this connection is estimated to be in excess of $200,000.
cering In light of the work that would be required and as stated previously, we do not consider
gn the connection to be a viable solution for creating a non -discharge configuration.
Therefore, we request the aforementioned alternative be considered a hardship for the
Owner and that the discharge conditions be allowed to remain as they currently exist.
P:\SDSKPROJ�3957\—CorrespondenceL?009kMiscNIncompletelatternatives narrative.dou

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