WQCSD0495_Regional Office Physical File Scan Up To 2/1/2021

ROY COOPER
Governor
MICHAEL S. REGAN
Secretaw
S. JAY ZIMMERMAN
Director
April 5, 2017
Diane F.-Larkin
Hideaway Campground Inc.
525,,Shuler Rd #18
Bryson City, NC 28713
SUBJECT: Collection System Inspection - Follow Up
Hideaway Campground WWTP
Permit No: WQCSD0495
Swain County
Dear Ms. Larkin:
Enclosed please find a copy of the Collection System Inspection Form from the inspection conducted on
3/15/2017. The facility was found to be in compliance with permit WQCSD0495.
The Asheville Regional Office is recommending that your collection system be removed from the Deemed
Collection System list. 'However, you remain covered under NCAC 02T .0403.
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,
Beverly Prce
Environmental Senior Specialist
Enclosure: Inspection Report
cc: Mark Teague, Environmental Inc.
MSC 1617-Central Files -Basement
U�—Ashwille F 1e 0-
G:\WR\WQ\Swain\Collection SystemsUEdeaway Campground Deemed Collection System\CEI.03.15.17.Follow Up.docx
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. Highway 70 Swannanoa, NC 28778
828 296 4500 �'

Compliance Inspection Resort
Permit: WQCSD0495 . Effective: 08/31/09
Expiration:
Owner: Hideaway Campground Inc
SOC: Effective:
Expiration:
Facility: Hideaway Campground WWTP
County: Swain
525 Shuler Rd, .
Region: Asheville
Bryson City NC 28713
Contact Person: Diane F Larkin
Title: Owner
Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Certification:
Phone:
Secondary ORC(s):
On -Site Representative(s):
24 hour contact name
Diane F Larkin
941-748-2219
Related Permits:
Inspection Date: 03/15/2017 Entry Time:
03:30PM Exit Time: 04:OOPM
Primary Inspector: Beverly Price cjQ Phone: [phone]
Secondary Inspector(s):
Reason. for Inspection: Follow-up Inspection Type: Collection System Inspect Non Sampling
Permit Inspection Type: Deemed permitted collection system management and operation
Facility Status: Compliant Not Compliant
Question Areas:
Miscellaneous Questions Performance Standards Operation & Maint Reqmts
Records Inspections
(See attachment summary)
Page: 1

Permit: WQCSD0495 Owner- Facility: Hideaway Campground Inc
Inspection Date: 03/15/2017 Inspection Type: Collection System Inspect Non Sampling Reason for Visit: Follow-up
Inspection Summary:
This inspection was a follow up to the 2015 compliance inspection. The inspection was.conducted by Beverly Price of the
Asheville Regional Office. Mr. Mark Teague and Ms. Diane Larkin assisted with the inspection.
The collection system map has been updated to include pipe size, approximate age, material and pump station capacity.
A Grease Control Program has been implemented and educational materials are hand delivered to campground occupants.
An Operation & Maintenance Plan has been developed.
There is one small pump station that consists of a septic tank with a small control panel and alarm. The pump station is
inspected daily. The alarm was working at the time of inspection.
The annual general observation is now being documented.
The Asheville Regional Office recommends removing this collection system from the deemed permitted list. However, the
system is still covered under NCAC 02T .0403.
Page: 2

Permit: WQCSD0495 Owner -Facility: Hideaway Campground Inc ,
Inspection Date: 03/15/2017 Inspection Type": Collection System Inspect Non Sampling Reason for Visit: Follow-up
Inspections
Yes No NA NE
Are maintenance records for sewer lines available?
❑ ❑ ,❑
Are records available that document pump station inspections?
®❑ ❑ ❑
Are SCADA or telemetry equipped pump stations inspected at least once a week?
❑ ❑ ® ❑
Are non-SCADA/telemetry equipped pump stations inspected every day?
M ❑- ❑ ❑
Are records available that document citizen complaints?
❑ ❑ ❑
# Do you have a system to conduct an annual observation of entire system?
M ❑ ❑ El
# Has there been an observation of remote areas in the last year?
❑ ❑ 0 ❑
Are records available that document inspections of high -priority lines?,
❑ ❑ ❑
Has there been visual inspections of high -priority lines in last six months?
❑ ❑ O ❑
Comment:
Operation & Maintenance Requirements
Yes No NA NE
Are all log books available?
0 ❑ ❑ ❑ ,
Does supervisor review all log books on a regular basis?
❑ ❑ 0 ❑
Does the supervisor have plans to address documented short-term problem areas?
❑ ❑ E ❑
What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas?
Are maintenance records for equipment available?
M ❑ ❑ ❑
Is a schedule maintained for testing emergency/standby equipment?
❑ ❑ ❑
What is the schedule for testing emergency/standby equipment?
Do pump station logs include:
Inside and outside cleaning and debris removal?
❑ ❑ 0 ❑
Inspecting and exercising all valves?
❑ . ❑ M ❑
Inspecting and lubricating pumps and other equipment?
❑ ❑ M ❑
Inspecting alarms, telemetry and auxiliary equipment?
❑ ❑ 0 ❑
Is there at least one spare pump for each pump station w/o pump reliability?
❑ 11011
Are maintenance records for right-of-ways available?
❑ ❑ ❑
Are right-of-ways currently accessible in the event of an emergency?
■ ❑ ❑ ❑
Are system"cleaning records available?
0 ❑ ,❑ ❑
Has at least 10% of system been cleaned annually?
❑ .❑ 0 ❑
What areas are scheduled for cleaning in the next 12 months?
Is a Spill Response Action Plan available?
M ❑ ❑ ❑
Does the plan include:
24-hour contact numbers
0 ❑ ❑ ❑
Page: 3

Permit: WQCSD0495 Owner - Facility: Hideaway Campground Inc
Inspection Date: 03/15/2017 Inspection Type : Collection System Inspect Non Sampling Reason for Visit:" Follow-up
Operation & Maintenance Requirements
Response time
Equipment list and spare parts inventory
Access to cleaning equipment
Access to construction crews, contractors, and/or engineers
Source of emergency funds
Site sanitation and cleanup materials
Post-overflow/spill assessment
Is a Spill Response Action Plan available for all personnel?
Is the spare parts inventory adequate?
Comment:
Performance Standards
Is Public Education Program for grease established and documented?
.What educational tools are used?
Information is hand delivered to park applicants.
Is Sewer Use Ordinance/Legal Authority available?
Does it appear that the Sewer Use Ordinance is enforced?
Is Grease Trap Ordinance available?
Is Septic Tank Ordinance available (as applicable, i.e. annexation)
List enforcement actions by permittee, if any, in the last 12 months
Has an acceptable Capital Improvement Plan (CIP) been implemented?
Does CIP address short term needs and long term \"master plan\" concepts?
Does CIP cover three to five year period?
Does CIP include Goal Statement?
Does CIP include description of project area?
Does CIP include description of existing facilities?
Does CIP include known deficiencies?
Does CIP include forecasted future needs?
Is Cl P designated only for wastewater collection and treatment?
Approximate capital improvement budget for collection system?
Total annual revenue for wastewater collection and treatment?
CIP Comments
Is system free of known points of bypass?
If no, describe type of bypass and location
Yes No NA NE
❑ ❑ ❑
■❑❑❑
■❑❑❑
❑❑❑■
❑❑❑
❑ ❑ ❑
M.❑ El El
Yes No NA NE
■❑❑❑
M
Page: 4

Permit: WQCSD0495 Owner - Facility: Hideaway Campground Inc
Inspection Date: 03/15/2017 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Follow-up
Performance Standards
Yes No NA NE
Is a 24-hour notification sign posted at ALL pump stations?
❑ ❑ IN ❑
# Does the sign include:
Instructions for notification?
❑ ❑ ® ❑
Pump station identifier?
❑ ❑ ■ ❑
24-hour contact numbers
❑ ❑ ❑
If no, list deficient pump stations
# Do ALL pump stations have an "auto polling" feature/SCADA?
❑ ❑ ® ❑
Number of pump stations
Number of pump stations that have SCADA
Number of pump stations that have simple telemetry
Number of pump stations that have only audible and visual alarms
Number of pump stations that do not meet permit requirements
# Does the permittee have a root control program?
❑ 110 ❑
# If yes, date implemented?
Describe:
Comment:
Records Yes No NA NE
Are adequate records of all SSOs, spills and complaints available? ❑ ❑ ■ ❑
Are records of SSOs that are under the reportable threshold available? ❑ ❑ ❑
Do spill records indicate repeated overflows (2 or more in 12 months) at same location? ❑ ❑ 0 ❑
If yes, is there a corrective action plan? ❑ ❑ ❑ ❑
Is a map of the system available? 0 ❑ ❑ ❑
Does the map include:
Pipe sizes
M ❑ ❑ ❑
Pipe materials
0 ❑ ❑ ❑
Pipe location
0 ❑ ❑ ❑
Flow direction
0 ❑ ❑ ❑
Approximate pipe age
M ❑ ❑ ❑
Number of service taps
0 ❑ ❑ ❑
Pump stations and capacity
0 ❑ ❑ ❑
If no, what percent is •complete?
List any modifications and extensions that need to be added to the map
# Does the permittee have a copy of their permit?
❑ 110 ❑
Page: 5

Permit: WQCSD0495 Owner- Facility: Hideaway Campground Inc
Inspection Date: 03/15/2017 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Follow-up
Records Yes No NA NE
Comment:
Page: 6

Water Resources
ENVIRONMENTAL. QUALITY
PAT MCCRORY
• ""T � �— Governor
DONALD R. VAN DER VAART
Secretary
- -- S. -JAY ZIMMERMAY —
Director
December 22, 2015
CERTIFIED MAIL 7014 0510 0000 4466 8307
RETURN RECEIPT REOUESTED
Diane F. Larkin
Hideaway Campground, Inc.
2240 Mystic Drive
Sarasota, FL 34232
SUBJECT: NOTICE OF DEFICIENCY
NOD-2015-PC-0305 a_
Compliance Evaluation' Inspection
Hideaway Campground Deemed Collection System .
Permit No: WQCSD0495
Swain County
Dear Ms. Larkin:
Enclosed please find a copy of the Collection System Inspection Report from the inspection conducted on
December 18, 2015. The Compliance Evaluation Inspection was conducted by Beverly Price of the Asheville
Regional Office. The facility was found to benon-compliant with the Deemed Collection System requirements.
The requirements for your sewerage collection system can be found in 15A NCAC 02T .0403, Permitting By
Regulation. These regulations place significant operation, maintenance and reporting requirements on those
entities that own or operate a wastewater collection system with average daily flows of.less than 200,000 gallons
per day. I have included a copy. of, the regulations for your reference.
The following items were missing at the time of the inspection:
1. An updated map including pipe size, approximate age, material and pump station capacity.
2. A Grease Control Program as follows: For privately owned collection systems, the Grease Control
Program shall include at least bi-annual distribution of grease education materials to users of the
collection system.
3. An Operation and Maintenance Plan.
* Documentation for daily inspection of the pump station.
5. Documentation for the annual general observation of the entire system.
a
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. Highway 70 Swannanoa, NC 28778
828 296 4500

Ms. Larkin
December 22, 2015
ti
Page 2 of 2 -
If you Have'auy questions-coriceriiing the regulations or those items'that'were missing please-d6 not'hesitate to
contact me. The assistance of Mr. Mark Teague was greatly appreciated during the inspection. If you or your
staff have any questions, please call me at [phone].
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations
Asheville Regional Office
Enc.
cc: Mark Teague, Environmental Inc.
MSC 1617-Central Files -Basement
�A�sh��?le.4F•1
G:\WR\WQ\Swain\Collection Systems\Hideaway Campground Deemed Collection Sustem\CEI 15 NOD-2015-PC-0305.docx
k

Compliance Inspection -Report
'Permit: WQCSD0495 Effective: 08/31/09 Expiration: Owner: Hideaway Campground Inc
SOC: Effective: _ Expiration: Facility:
Hideaway Campground WWTP
County: Swain
525 Shuler Rd
Region: Asheville
-Bryson City NC 28713
Contact Person: Diane F Larkin
Title:
Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Certification:
Phone:
Secondary ORC(s):
On -Site Representative(s):
On -site representative
Mark F Teague
828-586-5588
Related Permits:
Inspection Date: 11/18/2015
Entry Time: 12:30PM Exit Time:
01:OOPM
Primary Inspector: Beverly Price
Phone: [phone]
Secondary Inspectors):.
Reason for Inspection: Routine
Inspection Type:
Collection System Inspect Non Sampling
Permit Inspection Type: Deemed permitted
collection system management and operation
Facility Status: Compliant
Not Compliant
Question Areas:
Miscellaneous Questions
Performance Standards
Operation & Maint Reqmts
Records
Inspections
(See attachment summary)
Pager 1

Permit: WQCSD0495 Owner - Facility: Hideaway Campground Inc
Inspection Date: 11/18/2015 Inspection Type : Collection System Inspect Non Sampling Reason for Visit: Routine
Inspection Summary:
The following issues need to be addressed to bring the facility into compliance:
1. The map should be updated to include pipe size, pipe material, approximate pipe age and pump station capacity.
2. An Operation & Maintenance Plan should be developed.
3. The pump station should be inspected daily.
4. A general observation of the entire sewer system should be conducted at least once per year.
5. A Grease Control Program should be established.

Permit.• WQCSD0495 Owner.- Facility: Hideaway Campground Inc
Inspection Date: 11/18/2015 Inspection Type : Co llection.System.Inspect Non Sampling
Reason for Visit: Routine
Performanee Standards
Yes No NA NE
Is Public Education Program for grease established and documented?
❑ M ❑ ❑
What educational -tools are used?
A Grease Control Program should be,developed.
Is Sewer Use Ordinance/Legal Authority available?
❑ ❑ ❑
Does it appear that the Sewer Use Ordinance is enforced?
❑ ❑ 'N. ❑.
Is Grease Trap Ordinance available?
❑ ❑ 0 ❑
Is Septic Tank _Ordinance available (as applicable, i.e. annexation)
❑ ❑ W ❑
List enforcement actions by permittee, if any, in the last 12 months 1
Has an acceptable Capital Improvement Plan (CIP) been implemented?
❑ ❑ N ❑
Does CO address short term needs and long term \"master plan\" concepts?
❑ ❑ M ❑
Does CIP cover three to five year period?
❑. ❑ .M ❑
Does CIP include Goal Statement?
❑ ❑ M, ❑
Does CIP include description of project area?
❑ ❑ ❑
Does ClP include description of existing facilities?
❑ ❑ EJ
Does CIP include known deficiencies?
❑ ❑ W.n.
Does CIP include forecasted future needs?
❑ ❑ M ❑
Is CIP designated only for wastewater collection and treatment?
❑- ❑ M ❑
Approximate capital improvement budget for collection system?
Total annual revenue for wastewater collection and treatment?
CIP Comments
Is system free of known points of bypass?
M ❑ ❑ ❑• .
If no', describe type of bypass and location
Is a 24-ho6r notification sign posted at ALL pump stations?
❑ ❑ M ❑
Does the sign include:
Instructions for notification?
❑ OS ❑
Pump`station identifier?
El ❑ El
24-hour contact numbers
❑ ❑ M ❑
If no, list deficient pump stations
There is only one lift station. The station appears to consist of a septic tank with a small control panel with
alarm. There is no switch on the control panel to test the alarm.
# Do ALL pump stations have an "auto polling" feature/SCADA?
❑ ❑ N ❑
Number of pump stations
1
Number of pump stations that have SCADA
0
Number.of pump stations that have simple telemetry
0
Number of pump stations that have only audible and visual alarms
1
Page: 3

Permit: WQCSD0495 Owner - Facility: Hideaway Campground Inc
Inspection Date: 11/1812015 Inspection Type: Collection System Inspect Non Sampling Reason for Visit: Routine
Number of pump stations that do not meet permit requirements 0
# Does the permittee have a root control program?
# If yes, date implemented?
Describe:
❑ ❑ M ❑
Comment: There is only one lift station. The station appears to consist of a septic tank With a small control
panel with alarm. There is no switch on the panel to test the alarm.
Inspections
Are maintenance records for sewer lines available?
Are records available that document pump station inspections?
Are SCADA or telemetry equipped pump stations inspected at least once a week?
Are non-SCADA/telemetry equipped pump stations inspected every, day?
Are records available that document citizen complaints?
# Do you have a system to conduct an annual observation of entire system?
# Has there been an observation of remote areas in the last year?
Are records available that document inspections of high -priority lines?
Has there been visual inspections of high -priority lines in last six months?
Comment: There were no inspection records.
Operation & Maintenance Reauirements
Are all log books available?
Does supervisor review all log books on a regular basis?
Does the supervisor have plans to address documented short-term problem areas?
What is the schedule for reviewing inspection, maintenance, & operations logs and problem areas?
Are maintenance records for equipment available?
Is a.schedule maintained for testing emergency/standby equipment?
What is the schedule for testing emergency/standby equipment?
Do pump station logs include:
Inside and outside cleaning and debris removal?
Inspecting and exercising all valves?
Inspecting and lubricating pumps and other equipment?
Inspecting alarms, telemetry and auxiliary equipment?
Is there at least one spare pump for each pump station w/o pump reliability?
Are maintenance records for right-of-ways available?
Are right-of-ways currently accessible in the event of an emergency?
Are system cleaning records available?
Has at least 10% of system been cleaned annually?
What areas are scheduled for cleaning in the next 12 months?
Yes No NA NE
❑ ❑ ❑
❑■❑❑
❑❑■❑
❑ M ❑ ❑
❑ ❑ M ❑
❑ E ❑ ❑
❑ ❑ ❑
❑ ❑ M ❑
❑ ❑ M ❑
Yes No NA NE
❑■❑❑
❑❑s❑
❑ ❑ M ❑
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ® ❑
1111 M ❑
❑ ❑ M ❑
❑T❑ 110
❑❑®❑
❑ ❑ ❑
M ❑ ❑ ❑
❑❑0R
❑ ❑ M ❑
Page: 4

r
• 4Ok
Permit: WQCSD0495 owner - Facility: Hideaway Campground Inc
Inspection Date: 11/18/2.015 Inspection Type: Collection System Inspect Non Sampling
Reason for Visit: Routine
Is a Spill Response Action Plan available?
❑ 0 ❑ ❑
Does the plan include:
24-hour contact numbers
❑ 0 .❑ ❑
Response time
❑ 0 ❑ ❑
Equipment list and spare parts inventory
❑ M ❑ ❑
Access to cleaning equipment
❑ 0 ❑ ❑
Access to construction crews, contractors, and/or engineers
❑ 0 ❑ ❑
Source of emergency funds
❑ 0 ❑ ❑
Site sanitation and cleanup materials -
❑ M ❑ ❑
Post-overflow/spill assessment
❑ 0.❑ ❑
Is a Spill Response Action Plan available for all personnel?
❑ 0 ❑ ❑
Is the spare parts inventory adequate?
❑ ❑ ❑ 0
Comment: An Operation & Maintenance Plan should -.be developed
Records
Yes No NA.NE'
Are adequate records of all SSOs, spills and complaints available?
❑ ❑ ❑
Are records of SSOs that are under the reportable threshold available?
❑ ❑ ❑
Do spill records indicate repeated overflows (2 or more in 12 months) at same. location?
❑ ❑ ❑
If yes, is there a corrective action plan?
❑ ❑ -❑
Is a map of the system available?
0 ❑ ❑ ❑
Does the map include:
Pipe sizes.
❑ 0 ❑ ❑ .
Pipe materials
❑ M ❑ ❑
Pipe location
0 ❑ ❑ ❑
Flow direction
0 ❑ ❑ ❑
Approximate pipe age
❑ 0 ❑ ❑
Number of service taps
_ ❑ ❑ ❑
Pump stations and capacity
❑ M ❑ ❑
If no, what percent is complete?
List any modifications and extensions that need to be added to the map
# Does the permittee have a copy of their permit?
❑ ❑ 0 ❑
Comment: The map should be updated to include pipe size, material, Pump'station capacity and
approximate pipe age.
Page: 5

SECTION .0400 — SYSTEM -WIDE COLLECTION SYSTEM PERMITTING
15A NCAC 02T .0401 SCOPE
The rules ofthis Section apply to system -wide collection systems pursuant to G.S. 143 -215.9B, where the Director may
issue system -wide permits for collection systems relating to operation and maintenance of sewers, pump stations, force
mains and all appurtenances.
History Note: Authority G.S. 143-215.1(a); 143-215.3(a); 143-215.9B,
Eff. September 1, 2006
15A NCAC 02T .0402 DEFINITIONS
The following -definitions are used in this Section:
(1) "Collection system" means a public or private sewer system, consisting of sewer lines, force mains,
pump stations or any ,combination thereof that conveys wastewater to a designated wastewater
treatment facility or separately -owned sewer system. For purposes of permitting, the collection system
is considered to be any existing or newly installed system extension up to the wastewater treatment
facility property or point of connection with a separately -owned sewer system.
(2) "High -priority sewer" means any aerial sewer, sewer contacting surface waters, siphon, sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer,
or sewer designated as high priority in a Division issued permit where the sewer does not meet
minimum. design requirements.
History Note: Authority G.S. 143-21.5.1(a); 143-215.3(a); 143-215.9B,
Eff. September 1, 2006
15A NCAC 02T .0403 PERMITTING BY REGULATION
(a) Collection systems having an actual, permitted or Division approved average daily flow less than 200,000 gallons per
day are deemed permitted. pursuant to Rule ..0113 of this Subchapter provided the system meets the criteria in Rule .0113
of this Subchapter and all specific criteria required in this Rule:
(1) The.sewer system is effectively maintained and operated at.all times to present discharge to land or
surface waters, and to prevent any contravention of groundwater standards or surface water standards.
(2) A map of the sewer system has been developed and is actively maintained.
(3) An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
(4) Pump stations that are not connected to a telemetry system (i.e., remote alarm system) are inspected by
the permittee or its representative every day (i.e., 365 days peryear). Pump stations that are connected
to a telemetry system are inspected at least once per week.
(5) High -priority sewers are inspected by the permittee or its representative at least once every six -months
and inspections are documented.
(6) A general observation by the permittee or its representative of the entire sewer system is conducted at
least once per year.
(7) Overflows and bypasses are reported to the appropriate Division regional office in accordance with
15A NCAC 02B .0506(a), and public notice is provided as required by G.S. 143-215.1C.
(8) A Grease Control Program is in place as follows:
(A) For publicly owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of educational materials for both commercial and residential users and the
legal means to require grease interceptors for new construction and retrofit, if necessary, of
grease interceptors at existing establishments. The plan shall also include legal means for
inspections of the grease interceptors, enforcement for violators and the legal means to
control grease entering the.system from other public and private satellite sewer systems.
(B) For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
(C) Grease education materials shall be distributed more often than required in Parts (A) and (B)
of this Subparagraph if necessary. to prevent grease -related sanitary sewer overflows.
(9) Right-of-ways and easements are maintained in the full easement width for personnel and equipment
accessibility.
NORTH CAROLINAADMINISTRATIVE CODE Eff. January 1, 2009 23

(10) Documentation shall be kept for Subparagraphs (a)(1) through (a)(9) of this Rule for a minimum of
- -- three years with -exception of -the map, which shall be maintained for the life of the system..
(b) Private collection systems on a single property serving an industrial facility where the domestic wastewater
contribution is less than 200,000 gallons per day shall be deemed permitted.
(c) The Director may determine that a collection system should not be deemed to be permitted in accordance with this
Rule and Rule .0113 of this Subchapter. This determination shall be made in accordance with Rule .0113(e) of this
Subchapter.
History Note: Authority G.S. 143-215.1(a); 143-215.3(a); 143-215.9B;
Eff. September 1, 2006
15A NCAC 02T .0404 MULTIPLE COLLECTION SYSTEMS UNDER COMMON OWNERSHIP
If a public entity owns multiple but separate collection systems (i.e., tributary to separate plants) and any one is subject to
an individual permit, all collection systems shall be covered under one permit. This shall not be applicable to public
utilities authorized to operate by the North Carolina Utilities Commission who own several individual systems within the
state. -
History Note: Authority G.S. 143-215.1(a); 143-215.3(a); 143-215:9B;
Eff. September 1, 2006.'
15A NCAC 02T .0405 IMPLEMENTATION
(a) Permit applications for the initial issuance of a collection system permit shall be completed and submitted to the
Division within 60 days of the collection system owner's certified mail receipt of the Division's request for application
submittal. Permit renewal requests shall be submitted to the Director at least 180 days prior to expiration, unless the
permit has been revoked in accordance with 15A NCAC 02T .0110. All applications must be submitted in duplicate,
completed on official forms, and fully executed.
(b) Collection systems subject to an individual permit shall comply with the standards in Rule .0403 of this Section until
such time as their individual permit is issued.
History Note: Authority G.S.. 143-215. 1 (a); 143-215.3(a); 143-215.9B,
Eff. September 1, 2006
NORTH CAROLINA ADMINISTRATIVE CODE Eff. January 1, 2009 24

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ENVIRONMENTAU'
1 ■ Water i Wastewater Services 1 r
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 # NCO061620
Hide -Away Campground
Swain 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] or the campground at (828)
488-2083.
Sincerely,
G
Mark Teague
Operator in Responsible Charge
Encl.: Annual Report
CC: Diane Larkin

P pppp�
FRFORMANCE ANNUAL __SPORT
I. General Information
Facility and System Name:
Hide -Away Campground
Swain County
Permit: NCO061620
Owner:
Diane Larkin
P.O. Box 9220
Bradenton, FL 34206
Operator:
Environmental, Inc.
ORC:
Mark Teague
P.O. Box 954
Cullowhee, NC 28723
Description of Collection System or Treatment Process:
Hide -Away Campground operates a 0.010 MGD extended aeration package wastewater
treatment plant within an aeration basin, two blowers, clarifier and chlorine contact
chamber at Hide -Away Campground on NCSR 135444, Southeast of Bryson City in Swain
County. Discharge from said treatment works into the Tuckaseegee River, which are
classified B waters in the Little Tennessee River Basin.
II. PERFORMANCE
Summary of System Performance 3uly 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:
Diane Larkin
P.O. Box 9220
Bradenton FL 34206
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 Hide -
Away Campground.
Mark Teague
Operator in Responsible Charge
Environmental, Inc. 8/1/09

Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, 6
Pressure Sewer Extensions
Primary Reviewer
forrest.westall
Permitted Flow
o7/09/01
Permit Tracking Slip
status Project Type
In review New Project
Version Permit classification
Individual Fl
Permit Contact I S 1 IC IC m I!
Ap 1 12001
Facility HEVILIt api.SEOijp�j
Facility Name Major/Minor Region
:.:a _n-urao. rramro R.rP Asheville
Development
lescation Address I noun<
el ��I A
owner
Owner Name Owner Type
Qiai'e`I Non -Government
Dates/Events
Draft Scheduled Public
orig lease APp Received Initiated issuance Notice Ireue, Effective Expiration
06/28/01
Regulated Activitisa Regueated/Received Events
Lodging/campground/rest area RO staff report received
RG staff report requested
Additional information requested
Y� Additional information received
Groundwater comments requested
Groundwater comments received
outfall NULL
waternody Name
stream ndex Number
current class Subbasin
—
5389
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GENTLEMEN:
WE ARE SENDING YOU [� Attached
❑ Shop Drawings ❑ Prints ❑ Plans
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Date: JVF 1;a _ih5/ ,
Project:4[1�F-- A W �.� °mplianc IN
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Job No. F7 O 5C)k
❑ Under separate cover via
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the following items:
COPIES
SOURCE
DESCRIPTION
CODE
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THESE ARE TRANSMITTED as indicated below:
1. No exceptions taken 2. Make corrections noted, forward three (3) corrected copies
4. Rejected 5. For your information and file
CC:
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3. Revise and resubmit
6. Submit specified item
&HN ASSOCIATES
BY:
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v e e r i n g S u r v e y g 0 P l a n n i n g
Herron Associates, P.A. • PO Box 1265 • 721 Main Street . Bryson City, NC 28713
828.488.8949 • FAX: [phone] • Toll Free: 888.475.7300 • www.herronassociates.com

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GENTLEMEN:
WE ARE SENDING YOU RAttached ❑ Under separate cover via the following items:
❑ Shop Drawings ❑ Prints ❑ Plans [descriptive Data ❑
COPIES
SOURCE
DESCRIPTION
CODE
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6. Submit specified item
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ASSOCIATES
E n g i n e e r i n g S u r v e y i Ad P l a n n i n g
Herron Associates, P.A. • PO -Box 1265 • 721 Main Street •Bryson City, NC 28713
828.488.8949 • FAX. [phone] • Toll Free: 888.475.7300 • www.herronassociates.com

State of North Carolina �`�����
Department of Environment and Natural Resourc
Division of Water Quality
FAST -TRACK APPLICATION WATER QUALITY SECTION
for GRAVITY SEWERS, PUMP STATIONS, AND FMAM, GNWNSPliance Ent
(Pressure sewers systems are not to be included as part of this application package)
THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL
INSTRUCTIONS: Indicate that you have included the following list of required application package items by signing your
initials in the space provided next to each item. Failure to submit all required items will lead to additional processing and review
time for the permit application.
A. Application Form - Submit one original and one copy of the completed and appropriately executed application form.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not need
to submit detailed plans and specifications unless you respond NO to item IV 6 and/or item IV 10
N & B. Attachment - Submit the completed and properly executed Form WSCA 10/99 for each watershed within the project
location.
C. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of Environment
and Natural Resources (NCDENR).
D. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a privately -
owned public utility, submit two copies of the Certificate of Public Convenience and Necessity, which demonstrates
'that the public utility is authorized to hold the utility franchise for the area to be served'by the sewer extension. If a
Certificate of Public Convenience and Necessity has not been issued, provide two copies of a letter from the NC
Utilities Commission's Public Staff that states that an application for a -franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected.
E. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if the
sewer extension will be serving residential or commercial lots (e.g., houses, condominiums, townhomes, outparcels,
etc.) that will be owned by a homeowners' association or developer. If the applicant is a homeowners' association, use
Form HOA 10/99.• If the applicant is a developer, use Form DEV 10/99.
Oh- F. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies' of a flow acceptance letter from the. owner of the downstream sewers and WWTF. Flow acceptance
letters must contain the following minimum information: applicant and project name, amount of flow accepted, and
name and permit number of the receiving sewers/WWTF. The flow acceptance must not expire prior to permit
issuance and must be dated less than a year prior to the application date. Intergovernmental agreements or other
contracts will not be accepted in lieu of a project -specific flow acceptance letter.
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Senice:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
By Courier/Special Deliverv:
512 NORTH SALISBURY STREET, SUITE 1219
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
FACSIMILE NTUMBER: [phone]
For more information, visit our web site at: h2o.enr state.nc.us1ndpu1
FORM: FTA 06/00 Pacye 1 of 5

Application Number:
I. GENERAL INFORMATION:
(to be completed by DWQ)
1. Applicant's name (name of the municipality, corporation, individual, etc.):
2. Owner's or signing official's name and title (15A NCAC 2H .0206(b)):
3. Name and complete address of applicant: t0)�— ttD
5 2-E5 ZP•
City: -E>Pg5c7 ClN State: ILL Zip: 2g-7 0
Telephone number: (82$ ) 2-083 Facsimile number: ( )
4. Project name (name of the subdivision, facility or establishment, etc.):
!� � oE, • 1� - �-y C�Wtc� � � tsD - S t-C-E b t�lE1..Ej� nit �-r
5. County where project is located: sw.dlt i
6. Fee submitted: 400.00 (See Instruction C.)
7. Name and complete address of engineering firm: �0►� Lss�z (ems P�
�O• 8ox 12ce5
City: 8e sc>-L C.u�l State:
Telephone number: (8Z8) 48B - ?)Z4 9
r lC- Zip: Z2j 113
Facsimile number: ( 828 ) 4S8-Fj756
Name and affiliation of contact person who can answer questions about application:
II. PERMIT INFORMATION:
1. Project is: new; K modification
2. If this application is being submitted as a result of a modification to an existing permit, provide:
existing permit number mc- 00(0/(o20 and the issuance date
3. Applicant is: public Xc private
If private, units (lots, townhomes, etc.) are: -' - leased (Skip to item III.); sold
If sold, facilities owned by a:..
III. INFORMATION ON WASTEWATER:
public utility (See Instruction D.);
homeowners' association/developer (See Instruction E.)
1. Please provide a one- or two -word description specifying the origin of the wastewater .(school,
subdivision, hospital, commercial facility, industry, apartments, condominiums, etc.):
COMMEZQA.L- C,&MFr,Q©uttn
2. Volume of wastewater generated by this project: gallons per day
3. Explanation of how wastewater flow was determined (15A NCAC 2H .0219(1)):
8 S.Tgs x I Upr)/S�tt=. * 3GO C-tPD
4. Nature of wastewater: 100 % Domestic/Commercial;
% Industrial;
% Other waste - specify:
FORM: FTA 06/00 Pao e 2 of 5

5. If wastewater is industrial in nature:
a. Level of pretreatment that has been provided to ensure protection of the receiving collection system
and wastewater treatment facility:
b. If a pretreatment permit is required, has one been issued? Yes; No. If yes, please
attach a copy of the pretreatment permit. If no, provide date application was submitted:
IV. DESIGN INFORMATION:
I. Brief project description: `J l`t E ��s1Et. apN1�.1� Fob i�j �� II orl,p,l�
F_
2. Owner and name of wastewater treatment facility (WWTF) receiving wastewater (See Instruction F.): _
3. WWTF permit number (NC00***** or WQ00*****): KLC— 00(o I Cp20
4. List the owner(s) of any intermediate sewers if different from applicant or owner of WWTF (See
Instruction F.):
5. Summary of GRAVITY SEWER to be permitted:
Diameter
(inches)
Length
(linear feet)
293
6. Does the subject gravity sewer collection system comply with the most recent version of the Gravity
Sewer Minimum Design Criteria and ISA NCAC 2H .0200? %� Yes; No. If no, please
identify criteria and explain:
7. Summary of PUMP STATIONS to be permitted:
No. or
Name
Design Flow
(MGD) .
Pump Operational Points
GPM @_ feet TDH
Reliability Option
Selected
FORM: FTA 06/00 Page 3 of 5

8. Summary of FORCE MAIN to be permitted:
Diameter Length
(inches) (linear feet)
9. List any equipment being utilized that is not specifically mentioned elsewhere in the application or as
part ofAe Minimum Design Criteria (e.g., telemetry, hoist, odor control equipment, mechanical bar
screens, etc.):
10. Do the subject pump stations and force mains comply with the Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains document adopted June 1, 2000 and 15A NCAC 2H
.0200? Yes; No. If no, please identify criteria and,explain:
NOTE: If you responded NO to item IVA and/or item IV.10. above, two (2) copies
of detailed plans, specifications,' supporting information, and any other materials
pertaining to the identified criteria should be submitted with the
completed and appropriately executed application form.
FORM: FTA 06/00 Page 4'of 5

V. CERTIFICATIONS
Professional Engineer's Certification:
I, its, P. E., attest that this application for
SITE�p(appM�r.iT (55ats�j' E 10301) has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other
supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the
proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum
Design Criteria for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the
Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000. Although certain portions of
this submittal package may have been developed by other professionals, inclusion of these materials under
my signature and sea] signifies that I have reviewed this material and have judged it to be consistent with the
proposed design. Note: In accordance with NC Genera] Statutes 143-215.6A and 143-215.6B, any person
who knowingly makes any false statement, representation, or certification in any application shall be guilty of
a Class 2 misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to
$25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
1\I►111111rIp !l/ 4�.11�
Poo
i =
471 0 N
..........N
Applicant's Certification:
I, W.I `.0a attest that this application for tt�I�E VSM—i�U►UD
5M-t/EVEL0?MEtiT C ATE5- F E IC501) has been reviewed by me and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this application
are not completed and that if all required supporting information and attachments are not included, this
application package will be returned to me as incomplete. Note: In accordance with NC General Statutes
143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed $10,000 as pell as civil penalties up to $25,000 per violation.
Signature: Date:,V
FORM: FTA 06/00 Page 5 of 5

Envtroninentaf-Maitut-eii�aixeSystem $("a,
Environmental ftnagement Specialists • Wastewatar/Water Operations & Sampling
EPA Certified L4boratory • Pollution Control Equipment Sales & Service
0
, 14AY 21, 2001
r
Dear Mr. Herront �9�V" V?
This letter is to let .you know the pidey -Away Campground wast�i
water plant has a' daily -discha'r'ge•'floia of approximately
1500 gallons (1500• gpd). It you need any -,other information
please call 828-293.9396.
SINCERELY,
Post Office Box 1355. • ®lci ]HwY107.6 Cu towhee, North Carolina 28723 • 704-293-9396

■ Cote items 1, 2, and 3. I I A. 7SIlre [3
North CarAina Department of Environmental Quality
Division oflyater Resources
Water Qu ty Regional Operations Section
2090 U, &ighway 70, Swannanoa, NC 28778
Mane F_ IlarAin, Owner Secretary
iideaway. mpground, Inc.
!240 Myst c:Drive
Sarasota, Fe34232
1111111111111111111111111111111111111111111111111
9590 9403 0672 5196 9676 45
2._Article.Number_ITransfer_from.semice./alien
17014 0510 0000 4466 83071
B. Received V (Printed Name) Date
D. Is delivery address different from item 1? El
If YES, enter delivery address below: p,
3Service Type
❑ Priority Mail Express®
E Adult Signature
❑ Registered Mafl.m
❑ adult Signature Restricted Delivery
❑ Registered Mail Restricte,
Certified Mail®
Delivery
Certified Mail Restricted Delivery
�'Retum Receipt for
❑ Collect on Delivery
Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature ConfinnationTTM
❑ Insured Mail
❑ Signature Confi tion
❑ Insured Mail Restricted Delivery
Restricted Deliver
?R i=- gA11 An,a gni r, Dsni 7san_nc_nnn_anFn w tn71 - rl n 18i - 1PY-7 - i] '?m AC r)-- in Rafnm

UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
LISPS Permit No. G-•,
• Sender: Please print your name, address, and ZIP 40 ' this box*
G. LANDON DAVIDSON, SUPERVISOR
NCDEQ-DWR-WQROS
2090 U.S. HIGHWAY 70
SWANNANOA NC 28778
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