NCG550168_Regional Office Historical File Pre 2018

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Environmental
Quality
June 5, 2017
Mr. Larry -Adams
4809 Jamee Drive
Gastonia, NC 28056
[ROY
0-0:PER
(�
ti
; ..Governor
MICH_AEL S.
REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Notice of Deficiency
Compliance Evaluation Inspection
NOD72017-PC-0186
4809 Jamee Drive
Certificate of Coverage No. NCG550178
Gaston County.:
Dear Mr. Adams:
Enclosed is a copy of the Compliance Evaluation Inspection for the inspection conducted at
the subject facility on May 31, 2017, by Ori Tuvia. Your cooperation during the site visit was much
appreciated.
The following deficiencies were found during the inspection, and should be corrected:
1) No chlorine tablets were found on site or in the chlorinator.
2) No sampling results were available to be reviewed during the inspection. Permitee must
perform and maintain records so they can be reviewed during future inspections,. (list of
approved labs was provided)
. Similar deficiencies were indicated on the previous inspection conducted by.Mooresville
Regional Office staff on May 22, 2015. A follow up inspection will be conducted. Please make efforts
to resolve the deficiencies noted.
The report should be self-explanatory; however, should you have any questions concerning
this report, please do not hesitate to contact Ori Tuvia at [phone], or at
[e-mail]
Sincerely,
W. Corey Basinger
Regional Supervisor.
Mooresville Regional Office
Division of Water Resources
Cc: NPDES Unit, MRO Files
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service:1-877-623-6748
Internet: www,ncwaterqualfty.org

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0057
Water Compliance Inspection Report
Approval. axpires 8-31-98.
Section A: National Data System Coding '(i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
IN 1 2 15 1 3 NCG550178 I11 12 17/06/05 17 18 L,j 19 1 S 1 201 I
2111111-1111111111111111111 111111111111_����� �6
Inspection Work Days Facility -Self -Monitoring Evaluation Rating B1 QA Reserved
67 1.0 70 i, i 71 l„ .l 72 I ., I 731 I 174 751 1 1 1 � j80
LJ IJ I I I
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number) .
09:55AM 17/06/05
13/08/01
4809 Jamee Drive
4809 Jamee Dr
Exit Time/Date
Permit Expiration Date
Gastonia NC 28056
10:20AM 17/06/05
18/07/31
Name(s) of Onsite Representative(s)Ttles(s)/Phone and Fax Number(s)
Other Facility Data
///
Larry D Adams/l704-866-0268 /
Name, Address of Responsible Official/Title/Phone and Fax Number
i
Contacted
Larry D Adams,4809 Jamee Dr Gastonia NC 28056/f704-866-0268/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program. Facility Site Review EffluenUReceiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ori A Tuvia MRO WQ/1704-663-1699/ ,6
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
W. Corey Basinger MRO WQ//704-235-2194/
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type 1
31 NCG550178 I11 12 17/06/05 97 18 I C i
Section-D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page# 2

Permit: NCG550178 Owner -Facility: 4809 Jamee Drive
Inspection Date: 06/05/2017 Inspection Type: Compliance Evaluation
Permit
Yes No NA NE
' (if the present permit expires in 6 months or less). Has the permittee submitted a new
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E
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application?
Is the facility as described in the permit?
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# Are there any special conditions for the permit?
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Is access to the plant site restricted to the general public?M
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Is the inspector granted access to all areas for inspection?
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Comment: The subject permit expires on 7/31/2018.
Record Keeping
Are records kept and maintained as required by the permit?
Is all required information readily available, complete and current?
Are all records maintained for 3 years (lab. reg. required 5 years)?
Are analytical results consistent with data reported on DMRs?
Is the chain -of -custody complete?
Dates, times and location of sampling
Name of individual performing the sampling
Results of analysis and calibration
Dates of analysis
Name of person performing analyses
Transported COCs
Are DMRs complete: do they include all permit parameters?
Has the facility submitted its annual compliance report to users and DWQ?
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator
,on each shift? -
Is the ORC visitation log available and current?
Is the ORC certified at grade equal to or higher than the facility classification?
Is the backup operator certified at one grade less or greater than the facility classification?
Is a copy of the current NPDES permit available on site?
Facility has copy of previous year's Annual Report on file for review?
Yes No NA NE
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Comment: No sampling results were available to review during the inspection. Permittee must perform
(as required by the permit) and maintain records of sampling Mow permitting). A list of
approved labs was provided during the inspection.
Operations & Maintenance Yes No NA NE
Page# 3

Permit: NCG550178 Owner - Facility: 4809 James Drive
Inspection Date: 06/05/2017 Inspection Type: compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? E ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS,. MCRT, Settleable ❑ ❑ 0 ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment:
Septic Tank
Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational?
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Is septic tank pumped on a schedule?
0
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Are pumps or syphons operating properly?
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Are high and low water alarms operating properly?
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Comment: Septic tank was last pumped on 8/4/2016.
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
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Is the distribution box level and watertight? ,
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Is sand filter free of ponding?
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Is the sand filter effluent re -circulated at a valid ratio?
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# Is the sand filter surface. free of algae or excessive vegetation?
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# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
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Comment: The sand filter is underground. No wetness was observed in area.
Disinfection -Tablet
Yes No NA NE .
Are tablet chlorinators operational?
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Are the tablets, the proper size and type?
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0
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Number of tubes in use?
Is the level of chlorine residual acceptable?
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Is the, contact chamber free of growth, or sludge buildup?
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Is there chlorine residual prior to de -chlorination?
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Comment: Permittee didn't have tablets at the time of inspectiori. Permittee was advised to get tablets
and start adding again Permittee was also advised that tablets safe for waste water use
(calcium hypochlorite) were required.
Effluent Pipe Yes No NA NE
Is right of way to the outfall properly maintained? 0 ❑ ❑ ❑
Are the receiving water free offoam other than trace amounts and other debris? 0 ❑ ❑ ❑
Page# 4
L

Permit: NCG550178 Owner - Facility: 4809 Jamee Drive
Inspection Date: 06/05/2017 Inspection Type: Compliance Evaluation
Effluent Pipe Yes No NA NE
If effluent (diffuser pipes are required) are they operating properly? ❑ ❑ M ❑
Comment:. Low flow was observed at the time of the inspection.
Page# 5

Environmental
Quality
May 5, 2017
Mr. Larry Adams or current tenant
4809 Jamee Drive
Gastonia, NC 28056
ROY COOPER
Governor
Lf? MICHAEL S. REGAN
11 ' - Secretary
S. JAY ZIMMERMAN
Director
Subject: Compliance Evaluation Inspection
4809 Jamee Drive
Certificate of Coverage No. NCG550178
Gaston County -
Dear Mr. 'Adams or current tenant:
Please be advised that NCDEQ inspector will be coming to inspect subject permit on
May 3-1, 2017, at about 10 AM..Your presence during the inspection is advised to discuss
compliance with the conditions listed in subject permit.
If you wish to reschedule or have any questions,. please contact Ori Tuvia at (704) 235-
2190, or via email at ori.tuvia cr lacdenngov.
Sincerely,
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DEQ
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service:1-877-623-6748

"m
"r
FILE
"L47
RMENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, North Carolina 28056
Dear Mr. Adams:
Donald R. van der Vaart
Secretary
May 22, 2015
Subject: Compliance Evaluation Inspection
Adams Single Family Residence
COC # NCG550178
Gaston County
Enclosed is a copy of the Compliance Evaluation Inspection report (CEI) for the inspection
conducted at the subject facility on May 20, 2015 by Mr. Barry Love with this Office. Thank you for your
assistance and cooperation during the inspection.
The report should be self-explanatory. Please -take special note of the comments sections for things
which need to be addressed. No chlorine tablets have been added to the system in about a year. Please provide
documentation to.this office when you have purchased new tablets. These must be safe for wastewater use as
required. No analytical results were available at the time of the inspection. The permit requires annual
monitoring of the system. Please provide a copy of the analytical results when available. The septic tank
should be pumped every five years or as needed.
If you have any questions, comments, or need assistance with understanding any aspect of your
permit or this report, please do not hesitate to contact me at (704)-663-1699.
Sincerely,
Barry Love, Environmental Specialist
Mooresville Regional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDENR
Cc: MRO SFR - Adams
Central Files
Mooresville Regional Office, 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone] Internet: www.ncwaterquality.org
An Equal Opportunity \ Affirmative Action Employer — Made in part by recycled paper

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.c.20460
OMB No. 2040-0057
Water Compliance Inspection Report
ApprovalexpiresB-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac,Type
1 IN 1 2 15 I 3 I NCG550178 I11 12 15/05/20 117 18 Ld 19 1 G i 201
211111111IIIIIIIIIIIIIIIIIIIIIIII III.IIIIIIII t66
Inspection Work Days. Facility Self -Monitoring Evaluation Rating B1 CIA --- Reserved-- —
67 70 L71 j72 N 73 I 174 751 I I I I I
80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:30AM 15/05/20
13/08/01
4809 Jamee Drive
4809 Jamee Dr
Exit Time/Date
Permit Expiration Date
Gastonia NC 28056
11:00AM 15/05/20
18/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Larry D Adams,4809 Jamee Dr Gastonia NC 28056/r704-866-0268/
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Operations & Maintenance Records/Reports 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 Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Barry F Love MRO WQ/l704-663-1699 Ext.263/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#

NPDES yr/mo/day Inspection Type
3I NCG550178 I11 12 15/05/20 17 18 ICI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page#

Permit: NCG550178 Owner - Facility: 4809 Jamee Drive
Inspection Date: 05/20/2015 Inspection Type: Compliance Evaluation
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ ❑
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ M ❑
Solids, pH, DO, Sludge Judge, and other that are applicable?
Comment: Analytical results were not available. Permittee needs to do analytical sampling as required
by permit.
Permit
Yes No NA NE
(If the present permit expires in 6 months or less). Has the permittee submitted a new
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application?
Is the facility as described in the permit?
0
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# Are there any special conditions for the permit?
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E
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Is access to the plant site restricted to the general public?
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N
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Is the inspector granted access to all areas for inspection?
0
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Comment:
Septic Tank
Yes No NA NE
(If pumps are used) Is an audible and visual alarm operational?
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0
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Is septic tank pumped on a schedule?
0
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Are pumps or syphons operating properly?
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Are high and low water alarms operating properly?
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0
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Comment: Septic tank was last pumped on 4/4/2011. The permit requires that it be
pumped every
5
years or as needed.
Sand Filters (Low rate)
Yes No NA NE
(If pumps are used) Is an audible and visible alarm Present and operational?
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M
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Is the distribution box level and watertight?
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M.
Is sand filter free of ponding?
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Is the sand filter effluent re -circulated at a valid ratio?
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# Is the sand filter surface free of algae or excessive vegetation?
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# Is the sand filter effluent re -circulated at a valid ratio? (Approximately 3 to 1)
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Comment: The sand filter is underground. -No, wetness was observed in area.
Disinfection -Tablet Yes No NA NE
Are tablet chlorinators operational? ❑ ❑ ❑
Are the tablets the proper size and type? ❑ ❑ ❑
Page# 3

Permit: NCG550178 Owner - Facility: 4809 James Drive
Inspection Date: 05/20/2015 Inspection Type: Compliance Evaluation
Disinfection -Tablet Yes No NA NE
Number of tubes in use?
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
Is there chlorine residual prior to de -chlorination?
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Comment: Permittee didn't have tablets at the time of inspection and hadn't added any tablets in about
ayear. Two tubes were in area, but tops couldn't be removed. Permittee stated chlorine
contact was under concrete cover, but dirt was all around which would require a shovel to
remove. Permittee was advised to get tablets and start adding again. Permittee was also
Advised that tablets safe for waste water use (calcium hypochlorite) were required.
Page# 4

Insnection Date
S/� ® /! S Rfnrt TIITY,i2+A CT / 0 ' 30e .__ Gnel Timc• ) I ! O o _
14
- SINGLE FAMILY WASTEWATER SYSTEM CHECKLIST
1012812014 '
Permittee: L. etr r Y a, a
Permit: AIC
G_6so
l? g
Address: If- 90 `f V'a,�e
Phone: 7( d q-) 86 6 - o z 613 Cell Phone:(
County: �Q �
County:
The Permittee is responsible for the operation and maintenance of the entire wastewater. treatment and disposal system.
Doesn't
Did Not
Yes. No
Apply
Investigate
1. Is the current resident in the home the Permittee?
71
2. If not does the resident rent from the permittee?
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3. Change of Ownership form needed? (mail the form with the inspection letter)
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4. Is there a inspection and maintenance agreement with a contractor?
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5. If yes to #4 who is the contractor?
SEPTIC TANK The septic tank and filters should be checked annually and pumped/cleaned as nee :
6. Is all wastewater from the home connected to the septic tank?
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7. Does the permittee/resident know where the septic tank is located?
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8: Has the septic tank been pumped in the last 5 years? ;z, V i
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9. If yes to #8 date, if known f.. If proof, describe r�-� t
_ `-
T (Tm m m>11
10. Does the septic tank have an EFFLUENT FILTER or SANITARY T? (circle one)
11. o filter when was -the filter cleaned? By Who?
SAND FILTER TREATMENT PODS YES NO
If no proceed to the next section.
alter surfaces shall be raked and leveled every six months and any vegetative growth shall be removed manually.
1El
2. Is system something other than a sand filter?
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13. If yes, what kind? (examples - Peat, Textile or brand name - Advantex, etc.)
14. Does the permittee know where the filter is?
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15. If above ground does the filter require maintenance? -
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If ma'intenace is required explain in the comment section. Sol
DISINFECTION / UV YES NO
If no proceed to the next section.
The ultraviolet unit shall be checked weekly. The lamps and sleeves should be cleaned or replaced as needed to ensure. er disinfection.
16. Is UV working?
17. Has the UV Unit been serviced and bulbs cleaned?
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18. Who completes the -weekly check for the UV?( Non -Discharge)
DISINFECTION / TABLETS YES NO
If no proceed to the next section.
The tablet chlorinator unit shall be checked weekly to ensue continuous and proper operation. .
19."Does the permittee have the correct chlorine tablets?(If none, mark No)FIT
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22. Does the.Permittee know the locatio of the chlorinator?
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6.��✓1 C( 166LlT y
23. Were chl?r'ne tablets observed irtLthe chl6rina�o . c o �� ►�
6i o c�. I pl .5 e_ei e o K G YZ `/ �i O �/ .ems 1� i D"
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D
24. Are tablets contacting water? If possible poke th�m to de�rmir
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DECHLOR (Discharge only) YES NO Lj
If no proceed to the next section.
The dechlorinator unit shall be checked weekly to ensure continuous and proper operation.
25. Does the permittee know -where the dechlor is?
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26. Does the permittee have the correct dechlor tablets?
27. Were dechlor tablets observed in the dechlorination chamber?
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DRAFT Doesn't. Did Not 0
Yes No Apply Investigate
128. Are tablets contacting water? If possible poke them to determine.
PUMP TANK YES NO
If no proceed to the next section.
All pump and alarm sytems shall be inspected_ monthly. (non -discharge)
29. Is the pump working?
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30. Is the audible and visual high water,alarm operational?
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31. Did the permittee know how to check the pump & high water alarm?
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32. Last functional test?
DISCHARGE ONLY YES NO
If no proceed to the next section.
A visual review of the outfall location shall be executed twice each year (one at the time of sampling to ensure �no visib solids or evidence of a malfunction.
33. Does the permittee know where the outfall is?
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34. Were you able to locate the outfall?
35. Is the end of the discharge pipe visible? If not, explain why.
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36. Is outlet discharging?
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37. Is right of way maintained around the discharge point?
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38. Any Lab Results vaiI ble?a �� o f �r �� �'" ` f �'s d'-' 9
✓Jo c✓
)nt?
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39. Is there evidence of solids around the disch�rge
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DRIP or SPRAY YES LJ NO
If no proceed to the next section.
The irrigation sysetm shall be inspected monthly to ensure the system is free of leaks and equipment is operating as designed.
40. Is the system DRIP or IRRIGATION (circleone)? If irrigation number of sprinkler heads.
41. Are the buffers adequate?
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42. Is the site free of ponding and runoff?
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43. Does the application equipment appear to be working properly?
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44. Is there a two wire fence?
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GENERAL
45. Are the treatment units locked and or secured?�
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37. Has resident had any sewage problems? If yes explain in the comments ection.
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37. Is the system compliant?
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38. Is the system failing? . If yes, take pictures if possible.
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39. If system is failing, any sign of children or animals contacting sewage? .
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Comments: Photos Taken?
YES
NO
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'F`�l L E
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, NC 28056
Dear Mr. Adams:
Donald R. van der Vaart
Secretary
May 4, 2015
Subject: Compliance Evaluation Inspection
Single Family Residence Wastewater
Treatment System
NPDES General No. NCG550178
Gaston County
Division of Water Resources (D)ATR) database records show that you currently own/operate a
single family residence (SFR) wastewater treatment and disposal system. Such being the case, it is
necessary to conduct a comprehensive inspection of your system and your records in order to verify
that your system is operating properly and to determine the compliance status of the system pursuant
to your NCG550455 permit. We'anticipate such an inspection would take approximately one hour,
provided that all needed documentation and data is readily available at the time of the site visit.
Due to the difficulties involved with scheduling inspections with homeowners who work
during the workday, I would like to pre -schedule this site visit with you to ensure we can meet and
complete the inspection as expeditiously as possible.. In order to set up a time that will be beneficial
to your schedule, please contact me at 704-663-1699, between the hours of 8AM and 5PM, Monday
through Friday to set up the best possible time for me to visit your residence.
Also, in the interest of conducting the most efficient inspection possible, we ask that you have
the following items on hand at the time of the site visit. These items include the following:
1. Permit/Certificate of Coverage: Issued by DWR, you would have received this via regular
U.S. Postal Service mail.
2. A Schematic of the Treatment/Disposal System: Please have available all schematics or other
technical drawings and/or design specifications that show the complete and/or partial layout of
your treatment/disposal system.
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone]/Customer Service 1-877-623-6748
Internet: www.ncder'r.gov
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Mr. Adams
May 4, 2015
Page 2
3. Documentation of Analytical Monitoring: Required in Part I(A) of the General NCG550000
permit, please have available all official records of analytical monitoring conducted to date.
4. Documentation of Septic Tank Inspections/Pumping: Required in Part I(A) of the General
NCG550000 permit, please have available all records of annual septic tank inspections and
any septic tank pumping.
5. Chlorination/Dechlorination Tablets: Please have available the original containers in which
both the chlorination and dechlorination tablets were stored when you purchased them. If the
containers are not available, documentation of purchase or the location where purchased
should be provided.
If for some reason you're unable to contact us, we will make every effort to contact you to
schedule the review of your system. If you have questions or concerns about this letter or the
proposed inspection, I can be contacted between the hours of 8AM and 5PM, Monday through
Friday at 704-663-1699.
Sincerely,
Barry Love, Environmental Specialist
Water Quality Regional Operations
Mooresville Regional Office-NCDENR

A7iA-
WDENR
North Carolina Department of Environment and Natural Resources
Division of Water.Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
June 18, 2010
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, NC 28056
Subject: Compliance Evaluation inspection
Single. Family Residence
NPDES Permit No. NCG550178
Gaston County
Dear Mr. Adams:
Dee Freeman
Secretary
Enclosed is a copy of the Compliance Evaluation Inspection (CEI) for the inspection conducted at the
subject facility on June 9, 2010, by Ms. Barbara Sifford with this Office. Thank you for your assistance and
cooperation during the inspection. The system appeared to be operational and maintained.
Analytical data for compliance monitoring for the treatment system has not been evaluated.
Documentation of the septic tank being pumped was unavailable. This should be pumped at least every 5 years
as stated in the permit. This should be completed before renewal in 2012.
The chlorine tablet dispenser was appropriately located in the wastewater flow. Chlorine tablets for
pools should not be used in the system as they are toxic to aquatic life. Chlorine tablets can be purchased from
USA Blue Book on line or'McCall Brothers plumbing supply in Charlotte. A MSDS is enclosed stating the
required type of chlorine compound and proper product use. Please submit a copy of the laboratory data for the
permitted parameters within 90 days of receipt of this letter.
The enclosed reports should be self-explanatory. If you have any questions, comments, or need
assistance with understanding any aspect of your permit or this report, please do not hesitate to contact me at
[phone],ext 2196.
Sincerely,
Barbara Sifford
Technical Consultant
Enclosure —Inspection report
Chlorine tablet information
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 One
Phone: [phone] Fax: [phone] Customer Service:1-877-623-6748 NorthCarohna
Internet: www.ncwaterqualit .org Nahlrall'#An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled110% Post Consumer paper

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
ONO No. 2040-0057
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I NI 2 15I 11 NCG550178 Ill 121 10/06/09 117 18I CI 19I sI 20I II
Remarks
6
211 1 1 1 1 1 1 1 1 1 1 1 I I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 LLJ—i
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ----- —------ ----Reserved--------------
67I 169 701 I 711 I 72I N I 73 L1J 74 751 I I I I I I 180
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
07/10/26
10:30 AM 10/06/09
4809 Jamee Drive
Exit Time/Date
Permit Expiration Date
4809 Jamee Dr
Gastonia NC 28056
11:30 AM 10/06/09
12/07/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Larry D Adams,4809 Jamee Dr Gastonia NC 28056//704-866-0268/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit ® Operations & Maintenance ® Records/Reports ® Self -Monitoring Program
Sludge Handling Disposal ® Facility Site Review ® Compliance Schedules is Effluent/Receiving Waters
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Barbara Sifford MRo WQ//704-663-1699 Ext.2196/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type
3I NCG550178 111 121 10/06/09 117 18ICI
Section D: Summary of. Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

Permit:. NCG550178 owner - Facility: 4809 Jamee Drive
Inspection Date: 06/09/2010 Inspection Type: Compliance Evaluation
Yes
Compliance Schedules
No NA NE
❑
®n
Is there a compliance schedule for this facility?
Is the facility compliant with the permit and conditions for the review period? ❑
® ❑
Comment: Analytical has not been completed yet. Mr. Adams has contacted Prisim
labs and has a cooler ready to sample and return to them. Submit this data when
completed. Septic tank has been pumped in the past no records were available but
should be done before next permit cycle begining July 2012.
Yes
No NA NE
Operations & Maintenance
®nnn
Is the plant generally clean with acceptable housekeeping?
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge ❑
p
Judge, and other that are applicable?
Comment: Area around discharge line was clear. Pool chlorine tablets are not to be
used in wastewater disinfection application. They have a long life and continue to kill
algaeand other aquatic life in the stream.
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
nnn
®nnn
Is the facility as described in the permit?
# Are there any special conditions for the permit?
®n
nn
Is access to the plant site restricted to the general public?
®nnn
nnn
Is the inspector granted access to all areas for inspection?
Comment: Permit fees are paid annually.
Page # 3

Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
January 14, 2009
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, NC 28056
Subject: Single Family Residence Wastewater Treatment
System
NPDES General Wastewater Permit No./Certificate
of Coverage NCG550178
Compliance Evaluation Inspection
Dear Mr. Adams:
Division of Water Quality (DWQ) database records show that you currently own/operate a single
family residence (SFR) wastewater treatment and disposal system. DWQ personnel from the Mooresville
Regional Office (MRO) need to conduct a comprehensive review of your system with you in order to
verify that your system is operating properly. and to determine the compliance status of the system
pursuant to your NCG550178 permit. We anticipate such a review would take approximately one to two
hours, provided that all needed documentation and data is readily available at the time of the site visit.
Due to the difficulties involved with catching owners at home during the workday, we would like
to pre -schedule this site visit with you to ensure we can meet and complete the required system review as
expeditiously as possible. In order to facilitate this we ask that you contact Ms. Barbara Sifford, of our
office, at 704-663-1699, between the hours of 9AM and 4PM, Monday through Friday. Please contact
Ms. Sifford within the next 10 days to identify the best possible time for an evaluator to visit your SFR
and conduct this review with you.
Also, in the interest of conducting the most efficient evaluation possible, we ask that you have
certain items of documentation on hand at the time of the site visit. These items include the following:
I. PermitlCertificate of Coverage: Issued by DWQ, you would have received this via regular U.S.
Postal Service mail.
2. A Schematic of the Treatment/Disposal System: Please have available all schematics or other
technical drawings and/or design specifications that show the complete and/or partial layout of
your treatment/disposal system.
3. Documentation of Analytical Monitoring: Required in Part I(A) of the general NCG550000
permit, please have available all official records of analytical monitoring conducted to date.
4. Documentation of Septic Tank Inspections/Pumping: Required in Part I(A) of the general
NCG550000 permit, please have available all records of annual septic tank inspections and septic
tank pumping.
5. Chlorination/Dechlorination Tablets: Please have available the original containers in which
both the chlorination and dechlorination tablets were stored when you purchased them.
North Carolina Division of Water Quality Mooresville Regional. Office
Internet: h2o.enr.state.nc.us 610 East Center Avenue, Suite 301
Surface Water Protection Phone [phone]
Mooresville, NC 28115 FAX [phone]
Noe Carolina
Nturaily
Customer Service
1-877-623-6748
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Mams
January. 14, 2009 .
We appreciate your time and understanding of our mission to preserve the natural resources of our
great state and look forward'to you contacting us to schedule this site visit. If for some reason you're
unable -to contact us, we will make every effort to contact you to schedule the review of your system. If
you have questions or concerns about this letter or the required review, please contact Ms. Sifford between
the hours of 9AM and 4PM, Monday through Friday at 704-663-1699.. If she is not'there when you call,
please leave your name and a good contact phone number and she will return your call as soon as possible.
Sincerely,
. G
�2 Robert B. Krebs
Surface Water Protection Section Supervisor
Division of Water Quality
Mooresville Regional Office
Enclosures
Technical Bulletin
General Permit Page 2 (Monitoring Parameters)

KDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Coleen H. Sullins, Director
October 26, 2007
Larry D. Adams .
4809 Jamee Drive
Gastonia, NC 28056
Subject:_ Renewal of coverage ! General Permit NCG550000
4809 Jamee Drive
Certificate of Coverage NCG550178
Gaston County
Dear Permittee:
In accordance with your renewal application [received on February.1, 20071, the Division is renewing
Certificate. of Coverage (CoC) NCG550178 to discharge under NCG550000. This CoC is issued, pursuant to the
requirements -of. North Carolina General Statue 143-215.1.and the Memorandum of Agreement between North
Carolina and the US Environinental Protection agency dated May 9, 1994 [or as subsequently amended].
If any parts, measurement frequencies or sampling requirements contained in this General Permit are
unacceptable to you, you have the right to request an individual permit, by submitting an individual permit
application. Unless such demand is made, the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to the
Division. The Division may require modification or revocation and reissuance. of the certificate of coverage.
Regional Office staff will assist' _you in documenting the transfer of this CoC.
This permit does not affect the legal requirements to obtain other permits which: may be required: by
the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area
Management Act or any other. Federal or Local governmental permit that may be required.
If you.have any questions concerning the requirements of the General Permit, please contact Toya
Fields [919 733-5083, extension 551 or toya.fieldsC cmail.netl or Susan Wilson [919 '733-5083, extension 510
or [e-mail]].
Sincerely,R*1r
J 1VL`D
for Coleen H..Sullins . OCT. 3 1 2007
cc: Central Files
ooresvnll'eiRe�d--V ffice l Surface WaterVPretection �+ AI p��
NPDES file e, pg� �x N,. , a^ NC DENR MRO
DONS -Surface Water Protection
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
One
512 North Salisbury Street, Raleigh, North Carolina 27604 NOl thCarolina.
Phone: [phone] / FAX-91.9 733-0719 / Internet: www.ncwaterquality:org
aturallry
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Directions to Gastonia, NC 28056-1349
Directions. to Gastonia, NC 28056-1349
Summary and Notes
START- P Nc Department of Natural Resources
[phone]
.9.1.9 N Main St, Mooresville, NC 28115-
2355
FINISH P 4809 Jamee Dr, Gastonia, NC 28056-
1349
Total Distance: 52.4 miles, Total Time:
1 hour 3 mins.(approx.)
Page i of 2
"A�E400 LOCAL
Map:
Add your notes here...
uiaance
,; 919 N MAIN ST, MOORESVILLE, NC 28115-2355
1. Start at 919 N MAIN ST[NC-152], MOORESVILLE going
go.1.1 mi
toward STEWART AVE
2• Turn Q to follow NC-152
go 1.0 mi
3. Turn 0 on PLAZA DR
go 1.9 mi
4. Turn 0 onto 1-77 SOUTH
go 22.3 mi
5. Take exit-#13B onto 1-86 SOUTH toward SPARTANBURG
go 18.7 mi
6. Take exit #20/NC-279. toward DALLAS
go 0.2 mi
7. Turn on N NEW HOPE. RD
go 0.6 mi
8. Turn on FRANKLIN BLVD
go 1.9 mi
9• Turn G.on S CHESTER ST
go 0.9 mi
10. Bear 0 on S YORK ST
go 0.2 mi
11. Continue on S YORK RD
go 1.6 mi
12. Continue on YORK HWY
go 0.9 mi
13. Turn on LITTLE MOUNTAIN RD
go 0.9 mi
14. Turn on KAY DR
go 0.1 mi
15. Turn 0on JAMEE DR
go 0.1 mi
1.6. Arrive at 4809 JAMEE DR, GASTONIA, on the �.
P 4809 JAMEE DR, GASTONIA, NC 28056-1349
Distance: 52.4miles, Time: 1 hour 3 mins
http://xmll.maps.yahoo.com/pMt.php?v3=0&&q2=4809 JAMEE DR, Gastonia, NC, 2805... 4/19/2007

PVI
SOC PRIORITY PROJECT: Yes —No x
If Yes, SOC No.
To: Permits and Engineering Unit
Water Quality Section
Attention: Charles Weaver
Date: April 25, 2007
NPDES STAFF REPORT AND RECOMMENDATION
County: Gaston
MRO# 07-08
Permit No. NCG550178
PART I - GENERAL INFORMATION
1. Facility and Address: Larry Adams Residence
4809 Jamee Drive
Gastonia, North Carolina 28054
2. Date of Investigation: April 19, 2007
3. Report Prepared By: Samar Bou-Ghazale, Env. Engineer I
4. Persons Contacted and Telephone Number: Mr. Larry Adams, Tel # [phone].
5. Directions to Site: From the junction of S.R. 2420 (Little Mountain Road) and S.R. 2827
(kay Drive) in south-central Gaston County, travel south on S.R. 2827 approximately 100
yards and turn left onto S.R. 2825 (Jamee Drive). The residence is on the left side of
Jamee Drive after traveling approximately 0.15.
6. . Discharge Point(s). List for all discharge points:
Latitude:35°12'02" Longitude:80'11'36"
Attach a U.S.G.S. map extract and indicate treatment facility site and discharge point on
map.
U.S.G.S. Quad No.: G 14 NW U.S.G.S. Name: Gastonia South, N.C.
7. Site size and expansion are consistent with application? Limited area available for
expansion if necessary.

8. Topography (relationship to flood plain included):. Facility is not located in a flood plain.
Slopes range from 2 to 5%.
9. Location of nearest dwelling: None within 300 feet of the discharge point.
10. Receiving stream.or affected surface waters: U.T. to Crowders Creek.
a. Classification: C
b. River Basin and Subbasin No.: Catawba River Basin
C. Describe receiving stream features and pertinent downstream uses: Very little
flow was observed in the receiving stream. No detrimental effects were observed
as a result of this discharge.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater to be permitted: 0.001 MGD
b. What is the current permitted capacity of the wastewater treatment facility? N/A
C. Actual treatment capacity of the current facility (current design capacity)? N/A
d. Date(s) and construction activities allowed by previous Authorizations to
Construct issued in the previous two years: N/A
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: The existing facility consists of a 1000 gallon capacity septic
tank followed by a subsurface sand filter and tablet disinfection.
f. Please provide a description of proposed wastewater treatment facilities: N/A
g. Possible toxic impacts to surface waters: N/A
h. Pretreatment Program (POTWs only): N/A
2. . 'Sludge Handling and Disposal Scheme: Removed as needed by a septage hauler.
3. Treatment plant classification (attach completed rating sheet): no rating
4. SIC Code(s): 9999
Primary: Secondary:
Main Treatment Unit Code:

PV.
PART III - OTHER PERTINENT INFORMATION
1 Is this facility being constructed with Construction Grant Funds or are any public monies
involved (municipals only)? N/A
2. Special monitoring or limitations (including toxicity) requests: N/A
3. Important SOC, JOC or Compliance Schedule dates: (please indicate): N/A
4. Alternative Analysis Evaluation: Has the facility evaluated all of the non -discharge
options available? Please provide regional perspective for each option evaluated.
Spray Irrigation: The property owned by Larry Adams is insufficient for spray irrigation.
Connection to Regional Sewer System: Connection to a Regional Sewer System is not a
viable alternative.
Subsurface: Space is limited.
5. Air Quality and/or Groundwater concerns or hazardous materials utilized at this facility
that may impact water quality, air quality, or groundwater: No AQ or GW concerns nor
are hazardous materials utilized at this facility.
PART IV - EVALUATION AND RECOMMENDATIONS
The wastewater treatment facilities serving the Adams' residence appeared to be in good
operational condition. However, the discharge pipe is broken approximately 50 feet from the
discharge location and needs to be repaired. Subsurface sand filter could not be evaluated,
however, no evidence of sand filter failure was observed.
It is recommended,the subject permit be renewed as requested.
�4
Signature of Repo Preparer
Water Quality Regional Supervisor
Wz- -le 7
Date

•,70"AL OFFICE
02/01/2007 12:34 FAX[phone]
PE
(/
�7 North Carolina Department of Environment and Natural Raso}ices FEB 0 12007
r Division of Water Quality
RENEWAL FORM FOR = TING PERNIITTED FACILTT]CES
NPDES renewal application for continued coverage under General Perm G56 0 a• `
Certificate of Coverage NCG550178
(Please verify the information in items I & 2 as correct, or note- any corrections that should be made.)
(Please print or type all other answers)
X) Mailing address' of property owner.
Owner Name Larry D Adams I
Street Address 4809 James Dr
-_-,Address- -... -.Ga&A iar•lyP,- 2W5P- • - • - — _ - - __: _�-- --� . —. _ —__ _ -
Telephone (Hoare) [phone] (Mobile)
(e-mail address) I
I
Address to which all permit correspondence will be mailed
2) Location of facility producing discharge*:
Facility M Adams Larry D- Residence
Address: 4809 Jaxnee Dr,
Gastonia, NC 28058 (Gaston County)
Telephone (Home) _(70 )866-0 68 (Mobile)
* If the facility is not yet constructed, give the street address or lot number where the structure will be
built.
S) . Description of Discharge-
: --a)- P-ea produ`c'm'gwdgte'k'plas -one : —. — - -- - ---- - -- --
Primary residence
❑ Vacation/second home
© Undeveloped property
❑ Other [describe]:
4) Please check the components that comprise the wastewater treatment system:
IIM Septic tank ❑ Dosing tank ❑ Primary sand filter Q. Secondary sand filter
❑ Recirculating sand filter(s) C] Chlorination ❑-Dechlorination
0 Other form of disinfection: ❑ Post Aeration (describe)
Page 1 of 2

02/01/2047
12:35 FA?( 7048523410
12 003
NCG550000 renewal. form
5) Other Wormation,
a) When was the septic tank last pumped out?
NOTE: the septic tank suet be pumped out at least once every 3-5 years
b) Is the facility (home] occupied year-round, or only seasonally?
c) Approximately how many people use the facility when it is occupied?
d) When was the wastewater system installed?
6) Certification:
I certify that i am familiar with the information contained in this application and that to the best of xny
knowledge and belief such information is true, co=plete, and accurate.
Printed Name of Person Signing. .
(Signature ofApplaant)
North Carolina General Statute 149.215.6 b (i) provides that,
JAN. 27, 2007
(Date Signed)
Any person who knowingly makes any false statement, representation, or certification in any
application, record, report, plan or other document filed or required to be maintained under Article
21 or regulations of the Environmental Management Commission implementing that Article, or who
falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or
method required to be operated or maintained under Article 21 or regulations of the Environmental
,Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C.
Section 1001 provides a ,punishment by .a fine of not more than $26,000 or imprisonment not more
than 5 years, or.both, for a similar offense.)
Mail this completed form and a copy of the refor your lastfieptic servic-Q to:
Mr. Charles H. Weaver, Jr.
NC DENR / DW4Q / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Page 2 of 2

Date: June 30, 1989
NPDES STAFF REPORT AND RECOMMENDATIONS
County: Gaston
NPDES Permit No. NC 0050776
PART I - GENERAL INFORMATION
1. Facility and Address: Larry Adams Residence
4809 Jamee Drive
Gastonia, North Carolina 28054
2. Date of Investigation: June 29, 1989
3. Report Prepared By: Michael L. Parker, Environmental
Engineer I
4. Person Contacted: No one; telephone number [phone]
5. Directions to Site: From the junction of S. R. 2420
(Little Mountain Road) and S. R. 2827 (Kay Drive) in
south-central Gaston County, travel south on S. R. 2827
approximately 100 yards and turn left onto S. R. 2825
(Jamee Drive). The residence is on the left side of Jamee
Drive after traveling approximately 0.15 mile.
6. Discharge Point - Latitude: 350 12' 02"
Lon.gitude;.: .8,1° . 11' 611
Attach a USGS Map Extract and indicate treatment plant site
and discharge point on map.
USGS Quad No.: G 14 NW
7. Size (land available for expansion and upgrading): Limited
area available for expansion if necessary.
8. Topography (relationship to flood plain included): Gently
rolling, 2-5o slopes. Residence not located in a flood
plain area.
9. Location of Nearest Dwelling: Several dwellings located
within 300 feet of the site.
10. Receiving Stream or Affected Surface Waters: Unnamed
tributary to Crowders Creek
a. Classification: C
-b. River Basin and Subbasin No.: Catawba 030837

Page Two
C. Describe receiving stream features and pertinent
downstream uses: Very little flow observed in
receiving stream at the point of discharge. Area is
somewhat rural, however, the discharge point is
between two (2) existing residences located
approximately 75-100 feet from the stream. No
detrimental effects were observed on the receiving
stream as a result of this discharge.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. Type of wastewater: 100% Domestic
0% Industrial
a. Volume of Wastewater: 0.001 MGD
b. Types and quantities of industrial wastewater: N/A
C. Prevalent toxic constituents in wastewater: N/A
d. Pretreatment Program (POTWs only): N/A
2. Production Rates (industrial discharges only) in Pounds:
N/A
3. Description of Industrial Process (for industries only) and
Applicable CFR Part and Subpart: N/A
cL.. Treatment (spec.j.f-y-whethc~ -Proposed o:r..existina).::
The existing facility consists of a 1000 gallon capacity
septic tank followed by a subsurface sand filter and tablet
disinfection..
5. Sludge Handling and Disposal Scheme: Removed as needed by
,a septage hauler.
6. Treatment Plant Classification: N/A
7. SIC Code(s): 9999
Wastewater Code(s): 04
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grants
Funds (municipals only)? No
2. Special monitoring requests: N/A
3. Additional effluent limits request: N/A
4. Other: N/A
PART IV - EVALUATION AND RECOMMENDATIONS
The wastewater treatment facilities serving the Adams'
residence appeared to be in good operational condition. No
evidence of sand filter failure was observed.

Page Three
The current effluent limitations are more stringent than
the limitations as promulgated by the writer based on current
SFD WLA guidelines. This Office, therefore, recommends that the
existing limitations (water quality limited) continue to apply
for this facility. It should be noted that this facility
interacts with NC 0059366 located approximately 50 feet
downstream.
It is recommended that the Permit for this facility be
renewed.
Signature of Report Preparer
/?- e,
Water Quality Re oval Supervisor

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State of North Carolina
Department of Natural Resources and Commur*-� Development
Division of Environmental Management Ptl'-oU"° aArU�
512 North Salisbury Street Raleigh, Nortl-1 Car`olinaZymny J)zj'r, tg T
James G. Martin, Governor
`c `%" ` ``'%t ' `f �= .l(J�1 R. Paul Wilms
__. ,` b
William W. Cobey, Jr., Secretary. a °'t 1989 Director
D1V131011 OF
E"'V -WAfERl7rii MAX IOEHEIg
MOORESVILLE RESIOHA
- L Off1EE
Subject: NPDES Permit Application
NPDES Permit No. NC00
County
Dear -.7 ..'
js
> +`!
This is to acknowledge receipt of the following documents
_---- Application Form,
Engineering Proposal (for proposed control facilities),
-Request;__for permit renewal,
'---Application Processing Fee of $,`;`;'
Other
The items checked below are needed before review can begin:
Application form (Copy enclosed),
Engineering Proposal 7See Attachment.),
_ Application Processing Fee of $ ,
Other
If the application is not made complete within thirty 30 days, it will
be returned to you and may be resubmitted when complete.
This application has been assigned to
(919/733-5083) of our Permits Unit for r_e lew'. You w: lfl`be advised of
any comments recommendations, questions or other information necessary
for the review of the application.
I am, by copy of this letter, requesting that our Regional Office
Supervisor prepare a staff report and recommendations regarding this
discharge. If you have any questions regarding this application, please
contact the review person listed above.
cc:
(Si nclere,ly,
IMrthur Mouberry, P.E.
Supervisor, Permits and Engineering
t - f
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

NORTH CAROLINA DEPT..OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
ENVIRONMENTAL MANAGEMENT CO!IMMISSION
NATIONAL -POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR'PERMIT TO DISCHARGE- SHORT FORM D FOR
AGENCY
USE
To be filed only by services, wholesale and retail .trade.
and other commercial establishments including vessels
APPLICATION N11MIJF R
All
C
05
DATE RECEIVED
0161
113
YEAR MO. DAY
Do not attempt to complete this form without reading the accompanying instructions
Please print or type
1.' Name, address, and telephone number of facil i y producing discharge
A. Name k/fAteLlsrc,�
B. Street address aw 9 j4plee ' �45
C. City , (9,�S7-o r/i/t ^ C • D. State 1,0401/1( /,✓V
E. County 64 -tom F. ZIP a r rj/
G. Telephone No.41
�G.
Area
Code RE(3E�
2. sic JUN 12-1999
(Leave blank) PERMITS & ENGINEERING
3. Number of employees --
A.
4. Nature of business
5. (a) Check here if discharge occurs all year or
(b) Check the month(s) discharge occurs:
1, o January 2. O February 3. O March 4.0 Apri 1 5. 0 May
6.13 June 7. O July e. o August 9.o September 10. 0 October
11.13 November 12.0 December
-(c) How many days per week
1. o f 2. 0 2-3 3.0 44k0 64
..6. Types of waste water discharged to surface waters only (check as applicable)
Flow, gallons per operating day
Volumetreated before
discharging (percent)
Discharge per
operating day
0.1-999
1000-4999
50004999
10,000-
50.000
None
0.1-
30-
65-
95-
49.999
or.sore
29.9
64.9
94.9
100
-0)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
A.. Sanitary. daily
/
average
✓
B. Cooling water..etc.,
daily average
C. Other discharge(s).-
daily average;
Specify
D. Maximum per operat-
ing day for combined
:discharge (all types)

any of the types of waste identified in item 6, either treated or un-
treated, are discharged to places other than surface waters, check below
as applicable,
Waste water is discharged to:
0.1-999
(1)
-1006-4999
(2)
5000-9999
(3)
.10.000-49,999
(4)'
SO,000.or more
,; M.
A. Mun tr. i pa 1 .ewer . •system
II, Ilrulrrgruunrl wr•II
C. Septic• tank
U. Evaporation lagoon or pond
E. Other, specify:
8. Number of�parate discharge points:
A. PJ1 , B. 02-3 C.O 4-5 D.O 6 or more
9. Name of receiving water or waters
.10. Does your discharge contain or is it possible for your discharge to contain
one or more of the following substances added as a result of your operations,
activities, or processes: ammonia, cyanide, aluminum, beryllium, cadmium,
chromium, copper lead, mercur nickel, selenium, zinc, phenols, -oil and
grease, and or n (residual,
A. O'yes B. o no-
i certify that I am familiar with the information contained in the application and
that to the best of my knowledge and belief such Information is true, complete.- and
accurate.
Printed Name of Person Signing
Jitje
Date Applicati n.Signe'd
Signature of Applicak
Forth Carolina General Statute 143-215.6(b)(2) rovides.that: Any person.who knowingly,makes
any false statement representation, or certification in a ny.,.applicatt.on,'record, report; plan,
or other'document files or required to be maintained under "Article 21 or regulations of the
En,%ziranaetttal Management Commission implement ttg that Article,'or who falsifies, tampers w=th,
ur.knowly renders inaccurate any. recording or nonitorigg-device or method required .to be
operated;or maintained under Artiale_ 21%-oir regulatio69 •of the Environmental Management Commission
implementing that 'Aiticle, shalibe.ei� tv of a misdemeanor punishable by a -fine not to exceed
$10,000,'or by imprisonment' not to exceed six months, or by both. (18 U.S.C. Section 1001 prmv:_:::
a punishment by a fine of`Aot more than $10,000 or imprisonment not more than 5 years, or both,
Lor a sinilar offense.)

Permit No. NCO050776
STATE OF NORTH CAROLINA
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
PERMIT
To DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE. ELIMINATION SYSTEM
In compliance with.the',provisions;'of North Carolina General Statute-143-215.1,
other lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission,,and the Federal Water Pollution Control Act, as
amended,
Mr. Larry Adams
is hereby authorized to discharge wastewater -..from a.facility located at
Larry'Adams._Residence.
48.0a': Jamee Drive..
southeast-.of -. south.. Gastonia
Gaston County
to receiving waters designated as:_ an; unnamed` tributary. to Crowders_ Creek in.. the
Catawba River Basin'
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth.in Parts I, _II, and III hereof.
This permit.shall become effective
This permit and the"authorization to discharge, -shall expire at midnight on
4 '
Signed this day
t
R. Paul Wilms, Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Permit No. NC0050776
SUPPLEMENT TO_PERMIT COVER SIIEET
Mr. Larry Adams
is hereby authorized to:
1. Continue to.operate an existing wastewater treatment system consisting of
a 1000 gallon capacity septic tank, subsurface sand filter and tablet
disinfection located at the Larry Adams, Residence, 4809 Jamee .Drive,
southeast of south Gastonia, Gaston County (See. Part III of this Permit);
and
2. Discharge from said, treatment -.works at the location specified on the
attached map into an. unnamed:..tributary to Crowders Creek' which is
classified class C waters in the Catawba River. Basin.

cp
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A. (). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS .,,Final
NPDES No. NCO050776
During the period beginning
on .the effective date ,of the Permit and lasting until expiration, the Permittee
is authorized. to discharge
..from outfall(s) serial number(s).
001.
Such discharges shall be limited and
monitored by the Permittee as
specified below:
Effluent Characteristics
Discharge Limitations
Monitoring Requirements
Lbs da. Other Units
(Specify)'-
Measurement Sample .*Sample.
Monthly Avg.
Weekly Avg. Monthly Avg.'
Weekly
Avg.
Frequency Type Location
Flow
. 0.001 ,MGD
. BOD, SDay, 20 Degrees C,
11'.0 mg/.1
16.5
mg/l
Total Suspended Residue
3,0.'0.mg/l
45.0
mg/1.
NH3 as N'.
4A mg/1
6.0
mg/1
Dissolved Oxygen (minimum)
.6.0 mg/1
6.0
mg/1
Fecal Coliform (geometric mean)
1000.0/106;.ml
2000.'0/100
,ml
Total Residual,Chlorine
Temperature
The chlorinator shall be inspected weekly to ensure there is an ample supply of chlorine tablets for
continuous disinfection of the effluent.
The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids -or visible fotim in other than trace amounts.
M3

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
Larry D. Adams
4809 Jamee Drive
Gastonia, NC 28056
Dear Mr. Adams <or> Current Occupant:
January 5, 2006
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Subject: NPDES Permit NCG550178
Gaston County
Our files indicate that a domestic wastewater discharge permit was issued to Larry D.
Adams for a domestic wastewater discharge from the subject single family residence. The
Surface Water Protection Section requests that you contact our staff if you do not have a copy of
the current permit, if a change in property ownership has occurred, or should you have any
questions regarding system operations and monitoring requirements.
Pursuant to the conditions of North Carolina General Permit NCG550000, the following
documentation is required to be maintained, and readily available for inspection for a period of at
least three (3) years:
• All operation and maintenance activities relating to the wastewater treatment system
• Analytical monitoring results for the parameters listed in Part I, Section A — "Effluent
Limitations and Monitoring Requirements — Final" to be performed annually by a North
Carolina Certified Laboratory
O Inspections of septic tank and disinfection/dechlorination apparatus (if applicable)
Thank you in advance for your cooperation. Should you have any questions concerning
this matter, please contact me at [phone].
Sincerely,
ames B. Bealle III
Environmental Technician
enclosures
cc: Gaston County Environmental Health Department
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone] / Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarohna
Naturally

'JAMES B.`HUNTJR'-,
Larry D. Adams or Current Occupant
4809 Jamee Drive
Gastonia, North Carolina 28056
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
MOORESVILLE REGIONAL OFFICE
DIVISION OF WATER QUALITY
June 16, 1999
Subject: Wastewater Discharge Permit
Larry D. Adams Residence
NPDES Permit No. NCG550000
Cert. of Coverage No. NCG550178
Gaston County, NC
Dear Mr. Adams or Current Occupant:
Our files indicate that the subject wastewater discharge permit was issued to Larry
D. Adams for a wastewater discharge from the subject residence. The Mooresville
Regional Office requests that you contact this Office if you do not have .a copy of the
subject permit, if a change in property ownership has occurred, or if you have any
questions regarding this matter.
Pursuant to conditions of North Carolina General Permit Number NCG550000,
the following documentation must be kept and readily available for inspection for a period
of at least three years:
► required maintenance activities relating to the wastewater treatment system
► yearly sample analyses results for the parameters listed on the effluent
limitation/monitoring page of the permit
► required inspections of disinfection apparatus and septic tanks
Please do not. hesitate to contact Wes Bell at [phone] if you have any
questions.
Sincerely,
D. Rex Gleason, P.E.
Water Quality Regional. Supervisor
cc: Gaston County Health Department
WB
91 9 NORTH MAIN STREET, MOORESVILLE, NORTH CAROLINA 281 15
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER - SO% RECYCLED/10% POST -CONSUMER PAPER

e �,aSWE'v
State of North Carolina
Department of Natural Resources and Community Development
Mooresville Regional Office
James G. Martin, Governor Albert F. Hilton, Regional Manager
S. Thomas Rhodes, Secretary
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 12, 1987
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, North Carolina 28057
Subject: NPDES Permit No. NC 0050776
Gaston County, NC
Dear Mr. Adams:
Our files indicate that the subject Permit for a wastewater
discharge to the surface water expired on April 30, 1987.
General Statute 143-215.1(c) requires that an application for
renewal must be filed 180 days prior to the expiration date. We
have not received an application for renewal from you as of this
date.
A renewal application shall consist of a letter requesting
renewal along with the appropriate completed and signed
application form referenced in Title 15 of the North Carolina
Administrative Code, Subchapter 2H, .0105. A processing fee of
$100.00 and a public notice fee of $50.00 must accompany the
application. One check for $150.00 may be submitted with the
application.
This matter should be given prompt attention in that
continued discharge after the Permit's expiration, without the
filing of a complete and timely application for renewal,
constitutes discharge without a permit and is a violation of
General Statute 143-215.1(a) and the Federal Clean Water Act of
1977. Application for renewal should be submitted to:
Permits & Engineering Unit
N. C. Division of Environmental Management
Post Office Box 27687
Raleigh, North Carolina 27611-7687
919 North Main Street, P.O. Box 950, Mooresville, N.C. 28115-0950 • Telephone [phone]
An Equal Opportunity Affirmative Action Employer

Mr. Larry D. Adams
Page Two
November 12, 1987
For further information, please contact me at 704/663-1699.
Sincerely,
Ronald L. McMillan
Regional Supervisor
RGP:se
tf

State of North Carolina
Department of Environment, Health, and Natural Resources
Mooresville Regional Office
James G. Martin, Governor Albert F. Hilton, Regional Manager
William W. Cobey, Jr., Secretary DIVISION OF ENVIRONMENTAL MANAGEMENT
September 20, 1989
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, North Carolina 28057
Subject:
Dear Mr. Adams:
NPDES Permit No. NC 0050776
Larry Adams Residence
Gaston County, NC
Our records indicate that NPDES Permit No. NC 0050776 was
issued on September 15, 1989 for the discharge of wastewater to
the surface waters of the State from your facility. The purpose
cf this letter is to advise you of the importance of the Permit
and the liabilities in the event of failure to comply with the
terms and conditions of the Permit. If you have not already done
so, it is suggested that you thoroughly read the Permit. Of
particular importance is Page M3.
Page M3 sets forth the effluent limitations and monitoring
requirements for your discharge(s). Your discharge(s) must not
exceed any of the limitations set forth. The section headed
"Monitoring Requirements" describes the measurement frequencies,
sample types and sampling locations. Upon commencement of your
discharge (or operation), you must initiate the required
monitoring. The monitoring results must be entered on the
reporting forms furnished to you by this Agency. If you have not
received these forms, they should be arriving shortly. If you
fail to receive the form, please contact this Office as quickly
as possible. I have enclosed a sample of the "Effluent"
reporting form (DEM Form MR-1), plus instructions for completing
the form. It is imperative that all applicable parts be
completed, and the original and one copy be submitted as
required.
The remaining Parts of the Permit (Parts II and III) set
forth definitions, general conditions and special conditions
applicable to the operation of wastewater treatment facilities
and/or discharge(s). The conditions include special reporting
requirements in the event of noncompliance, bypasses, treatment
919 North Main Street, Mooresville, N.C. 28115 • Telephone [phone] • FAX [phone]
An Equal Opportunity Affirmative Action Employer

Mr. Larry D. Adams
Page Two
September 20, 1989
unit/process failures, etc. Also addressed are requirements for
a certified wastewater treatment plant operator if you are
operating wastewater treatment facilities. Any changes in
operation of wastewater treatment facilities, quantity and type
of wastewater being treated or discharged, expansions and/or
upgrading of wastewater treatment facilities must be permitted or
approved by this Agency.
Failure to comply with the terms and conditions of an NPDES
Permit subjects the Permittee to enforcement action pursuant to
Section 143-215.6 of the North Carolina General Statutes. A
civil penalty of up to $10,000 per violation plus criminal
penalties may be assessed for such violations. If you find at
any time that you are unable to comply with the terms and
conditions of the Permit, you should contact this Office
immediately. A Consent Order may be necessary while pursuing
action to obtain compliance.
As a final note, an NPDES Permit is normally issued for a
five-year period. Permits are not automatically renewed.
Renewal requests must be submitted to this Agency no later than
180 days prior to expiration. P lease.make note of the expiration
date of your Permit. This date is set forth on Page M-1 or I-1
of the Permit. Also note that NPDES Permits are not
transferable. If you, as the Permittee, cease to need this
Permit, then you should request that the Permit be rescinded.
As mentioned previously, the purpose of this letter is to
advise you of the importance of your NPDES Permit. Please read
the Permit and contact this Office at 704/663-1699 in Mooresville
if you have any questions or need clarification. We look forward
to providing any assistance.
Sincerely,
D. Rex Gleason, P. E.
Water Quality Regional Supervisor
Enclosure
DRG:se

State of North Carolina
Department of. Environment,
Health and Natural Resources _:..
Division of Water Quality
1999
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Larry D. Adams
4809 Jamee Drive
Gastonia, NC 28056
Dear Permittee:
LT.R;TA
A&14
�EHNF1
July.21,1997
Subject: Certificate of Coverage No. NCG550178
Renewal of General Permit
Adams, Larry D. - Residence
Gaston County
In accordance with your application for renewal of the subject Certificate of Coverage, the Division is forwarding
the enclosed General Permit. This renewal is valid from the effective date on the permit until July 31, 2002. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum of
Agreement between North Carolina and the U.S. Environmental Protection Agency dated December 6, 1983. If any
parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to you, you have
the right to request an individual permit by submitting an individual permit application. Unless such demand is
made, this Certificate of Coverage shall be final and binding.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modification or revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, the Division of Land Resources, Coastal Area Management Act or any other Federal or Local
governmental permit that may be required.
If you have any questions concerning this permit, please contact the NPDES Group at the address below.
cc: Central Files .
�IvToresville_Regional_Office-_'
NPDES Group
Facility Assessment Unit
Sincerely,
A. Preston Howard, Jr., P.E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX [phone] p&[e-mail]
An Equal Opportunity Affirmative Action Employer 50% recycled / 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG550000
CERTIFICATE OF COVERAGE NO. NCG550178
TO DISCHARGE DOMESTIC WASTEWATERFROM SINGLE FAMILY RESIDENCES
AND OTHER DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE':'
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Larry D. Adams
is hereby authorized to operate a wastewater treatment facility which includes a septic tank, sand filter
and associated appurtenances with the discharge of treated wastewater from a facility
located at
Adams, Larry D. - Residence
4809 Jamee Drive
Gastonia
Gaston County
to receiving waters designated as subbasin 30837 in the Catawba River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, II, III and IV of General Permit No. NCG550000 as attached.
This certificate of coverage shall become effective August 1, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 21, 1997.
. Preston Howard, Jr., P.E., Director
(r-4-1*-D1ivision of Water Qualit
y
By Authority of the Environmental Management Commission

State. of. North- Carolina
Department of' Environment,
Health -and Natural Resources
Division. of` Environmental Management
James. &.. Hunt,. Jr., Governor
Jonathan: B. Howes, Secretary
A. Preston, Howard, Jr., P.E., Director
LARRY D. ADAMS
ADAMS' RESIDENCE (LARRY D)
4809 JAMEE DRIVE
GASTONIA NC 28057
Dear Permittee:
September 30,1993
r'J
!� E N F1
?
C'. �
2 .5 %993
- u��64.MENt
Subject: ADAMS RESIDENCE (LARRY D)
Certificate of Coverage NCG550178
General Permit NCG550000
Formerly NPDES Permit NC0050776
Gaston County
The Division of Environmental Management has recently evaluated all existing individual permits for potential
coverage under general permits currently issued by the Division. 15A N.C.A.C. 2H .0127 allows the Division to
evaluate groups of permits having similar discharge activities for coverage under general permits and issue coverage
where the Division finds control of the discharges more appropriate in this manner. The Division has determined
that the subject discharge qualifies for such coverage. Therefore, the Division is hereby issuing the subject
Certificate of Coverage under the state-NPDES general permit no. NCG550000 which shall void NPDES Permit
NC0050776. This Certificate of Coverage is issued pursuant to the requirements of North Carolina and the US
Environmental Protection Agency Memorandum of Agreement dated December 6,1983 and as subsequently amended.
If any parts, measurement frequencies or sampling requirements contained in this general permit are unacceptable to
you, you have the right to submit an individual permit application, associated processing fee and letter requesting
coverage under an individual permit. Unless such demand is made, this decision shall be final and binding. Please
take notice this Certificate of Coverage is not transferable. Part II, E.4. addresses the requirements to be followed in
case of change of ownership or control of this discharge.
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the
Permittee shall take immediate corrective action, including those as may be required by this Division, such as the
construction of additional or replacement wastewater treatment or disposal facilities. Construction of any
wastewater treatment facilities will require issuance of an Authorization to Construct from this Division.
Failure to abide,by the requirements contained in this Certificate of Coverage and respective general permit may
subject the Permittee to an enforcement action by the Division of Environmental Management in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C. Please note that the general permit does require
monitoring in accordance with federal law. The monitoring.data is not required to be submitted to the Division
unless specifically requested, however, the permittee is required to maintain all records for a period of at least three
(3) years.
Post Office Box.29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled -10% post -consumer paper

Page 2
LARRY D. ADAMS
ADAMS RESIDENCE (LARRY D)
Certificate of Coverage No. NCG550178
The issuance of this Certificate of Coverage is an administrative action initiated by the Division of
Environmental Management and therefore, no fees are due at this time. In accordance with current rules, there
are no annual administrative and compliance monitoring fees for coverage under general permits. The only fee
you will be responsible for is a renewal fee at the time of renewal. The current permit expires July 31,1997.
This coverage will remain valid through the duration of the attached general permit. The Division will be
responsible for the reissuance of the general permit and at such time, you will be notified of the procedures to
follow to continue coverage under the reissued permit. Unless you fail to follow the procedures for continued
coverage, you will continue to be permitted to discharge in accordance with the attached general permit.
The issuance of this Certificate of Coverage does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances which may be required by the Division of Environmental Management
or permits required by the Division of Land Resources, the Coastal Area Management Act or any Federal or Local
other governmental permit that may be required.
If you have any questions or need additional information regarding this matter, please contact either the
Mooresville Regional Office, Water Quality Section at telephone number 704/ 663-1699, or a review engineer in
the NPDES Group in the Central Office at telephone number 919/733-5083.
S' erely,
A. Preston Howar , P.E.
cc: Mooresville Regional Office
Central Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT �, c,ROf �
Q,DM" M DEVUWP3MNT
GENERAL PERMIT NO. NCG550000 SEP 2.8 1993
CERTIFICATE OF COVERAGE No. NCG550178
Iffin Or E11Y ooffila
11QO�fS4Ei E �'� Gird
TO DISCHARGE TREATED DOMESTIC WASTEWATERS FROM SINGLE FAMILY RESIDENCES AND
SIMILIAR WASTEWATERS UNDER THE
NATIONAL POLLUNTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
ADAMS RESIDENCE (LARRY D)
is hereby authorized to discharge treated domestic wastewater from a facility located at
ADAMS RESIDENCE (LARRY D)
. Gaston County
to receiving waters designated as the UT CROWDERS CREEK/CATAWBA RIVER BASN
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III and IV of General Permit No. NCG550000 as attached.
This certificate of coverage shall become effective November 1, 1993.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day, September 30, 1993.
A. Preston Howar , Jr., P.E.,Director
Division of Environmental Management
By Authority of the Environmental Management Commission

REC:EIVEI)
G1Y1S10N (IF
ENV.IR WNTAL MA@AGEMEM
SEP 19 1989
1000RESb11LE.
State of North Carolina
Department of -Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
William W. Cobey, Jr., Secretary
Mr. Larry D. Adams
4809 Jamee Drive
Gastonia, N.C. 28057
Dear Mr. Adams:
September 15, 1989
Subject: Permit No. NCO050776
Larry Adams Residence
Gaston County
R. Paul Wilms
Director
In accordance with your application for discharge permit received on June 12,
1989, we are forwarding herewith the subject State - NPDES permit. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215.1 and
the Memorandum of Agreement between North Carolina and the US Environmental Protection
Agency dated December 6, 1983.
If any parts,.measurement frequencies or sampling requirements contained in
this permit are unacceptable to you, you may request a waiver or modification pursuant
to Regulation 15 NCAC 2B .0508(b) by written request to the Director identifying the
specific issues to be contended. Unless such request is made within 30 days following
receipt of this permit, this permit shall be final and binding. Should your request
be denied, you will have the right to request an a.djudi_ca.to.ry hearing.
Please take notice that this permit is not transferable. Part II, D.3.
addresses the requirements to be followed in case of change in ownership or control of
this discharge.
This permit does not affect the legal requirements to obtain other permits
which may be required by the Division of Environmental Management or permits required
by the Division of Land Resources, Coastal Area Management Act or any other Federal or
Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Mr. Mack
Wiggins at telephone number 919/733-5083.
cc: Mr. Jim Patrick, EPA _
Tlo�o esvi- _Regional 6ff_t'cei
Sincer.e.ly, _
ORONAL SIGNED BY
DENNIS -R. RAMSEY
R. Pa Rl Wilms
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
An Equal Opportunity Affirmative Action Employer

Permit No. NCO050776
STATE OF NORTH CAROLINA
DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
PERMIT
To DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1,
other lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission, and the Federal Water Pollution Control Act, as
amended,
Mr. Larry Adams
is hereby authorized to discharge wastewater .from a facility located at
Larry Adams Residence
4809 Jamee Drive
southeast of south Gastonia
Gaston County
to receiving waters designated as an unnamed tributary to Crowders Creek in the
Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, and III hereof.
This permit shall become effective October 1, 1989
This permit and the authorization to discharge shall expire at midnight on
September 30, 1994
Signed this day September 15, 1989
ORiINAI SIGNED BY
I)FNIgt" RAMSEY
FOR
R. Paul Wilms, Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Permit No. NC0050776
SUPPLEMENT TO PERMIT COVER SIICET
Mr. Larry Adams
is hereby authorized to:
1. Continue to operate an existing wastewater treatment system consisting of
a 1000 gallon capacity septic tank, subsurface sand filter and tablet
disinfection located at the Larry Adams. Residence; 4809 Jamee Drive,
southeast of south Gastonia, Gaston County (See Part III of this Permit);
and
2. Discharge from said treatment works at the location specified on the
attached map into an unnamed tributary to Crowders Creek which is
classified class C waters in the Catawba River Basin.
'ri

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A. (). EFFLUENT LIMITATIONS AAID MONITORING REQUIREMENTS Final NPDES No. NCO050776
During the period beginning on the effective date of the Permit and lasting until expiration, the Permittee
is authorized to discharge from outfall(s) serial number(s.). 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
Effluent Characteristics
Discharize Limitations
Lbs da
Monthly Avg. Weekly Avg.
Flow
BOD, 5Day, 20 Degrees C
Total Suspended Residue
NH3 as N
Dissolved Oxygen (minimum)
Fecal Coliform (geometric mean)
Total Residual Chlorine
Temperature
M3
Other Units (Specify)
Monthly Avg. Weekly Avg.
0.001 MGD
11.0 mg/l
30.0 mg/l
4.0 mg/1
6.0 mg/1
1000.0/100 ml
16.5 mg/1
45.0 mg/1
6.0 mg/1
6.0 mg/1
2000.0/10.0 ml
Monitoring Requirements
Measurement Sample Sample
Frequency Type Location
The chlorinator shall be.inspected weekly to ensure there is an ample supply of chlorine tablets for
continuous disinfection of the effluent.
The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

PART I
"Act" used herein means the Federal Water Pollution Control Act, As
Amended.
"DEM" used herein means the Division of Environmental Management of
the Department of Natural Resources and Community Development.
"EMC" used herein means the North Carolina Environmental Management
Commission.
DPfinitions
a. The monthly average, other than for fecal coliform bacteria, is
the arithmetic mean of all the composite samples collected in a
one -month period. The monthly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -month period.
b. The weekly average, other than for fecal coliform bacteria, is the,
arithmetic mean of all the composite samples collected during a
one -week period. The weekly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -week period.
C. Flow, Mi/day (MGD): The flow limit expressed in this pe:.mit is the
24-hour average flow, averaged monthly. It is determined as the
arithmetic mean of the total daily flows recorded during the calendar
month.
d. Arithmetic Mean: The arithmetic mean of any set of values is the
summation of the individual values divided by the number of indi-
vidual values.
e. Geometric Mean: The geometric mean of any set of values is the Nth
root of the product of the individual values where N is equal to the
number of individual values. The geometric mean is equivalent to
the antilog of the arithmetic mean of the logarithms of the indi-
vidual values. For purposes of calculating the geometric mean,
values of zero (0) shall be considered to be one (1).

PART I
A. MANAGEMENT REQUIREMENTS
1. Change in Discharge
All discharges authorized herein shall be consistent with the terms
and conditions of this permit. The discharge of any pollutant
identified in this permit more frequently than or at a level in
excess of that authorized shall constitute a violation of the
permit. Any anticipated facility expansions, production increases,
or process modifications which will result in new, different, or
increased discharges of pollutants must be reported by submission
of a new NPDES application or, if such changes will not violate the
effluent limitations specified in this permit, by notice to the DEM
of such changes. Following such notice, the permit may be modified
to specify and limit any pollutants not previously limited.
2. Facilities Operation
The permittee shall at all times maintain in good working order and
operate as efficiently as possible all treatment or control facili-
ties or systems installed or used by the permittee to achieve com-
pliance with the terms and conditions of this permit.
3. Adverse Impact
The permittee shall take all reasonable steps to minimize any adverse
impact to navigable waters resulting from noncompliance with any
effluent limitations specified in this permit, including such accel-
erated or additional monitoring as necessary to determine the nature
and impact of the noncomplying discharge.
4. Bypassing
Any diversion from or bypass of facilities necessary to maintain com-
pliance with the terms and conditions of this permit is prohibited,
except (i) where unavoidable to prevent loss of life or severe
property damage, or (ii) where excessive storm drainage or runoff
would damage any facilities necessary for compliance with the
effluent limitations and prohibitions of this permit. The permittee
shall promptly notify the Water Quality Section of DEM in writing of
each such diversion or bypass.
5. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the
course of treatment or control of wastewaters shall be disposed of in
a manner such as to prevent any pollutant from such material from
entering waters of the State or navigable waters of the United
States.

PART II
6. Power Failures
In order to maintain compliance with the effluent limitations and
prohibitions of this permit, the permittee shall either:
a. Provide an alternative power source sufficient to operate
the wastewater control facilities;
or, if such alternative power source is not in existence,
b. Halt, reduce, or otherwise control production and/or all dis-
charges from wastewater control facilities upon the reduction,
loss, or failure of the primary source of power to said waste-
water control facilities.
B. RESPONSIBILITIES
1. Right of Entry
The permittee shall allow the Director of the Division of Environ-
mental Management, the Regional Administrator, and/or their author-
ized representatives, upon the presentations of credentials:
a. To enter upon the permittee's premises where an effluent
source is located or in which any records are required to
be kept under the terms and conditions of this permit; and
b. At reasonable times to have access to and copy any records
required t•o be kept under the terms and conditions of this
permit; to inspect any monitoring equipment or monitoring
method required in this permit; and to sample any discharge
of pollutants.
2. Transfer of Ownership or Control
This permit is not transferable. In the event of any change in con-
trol or ownership of facilities from which the authorized discharge
emanates or is contemplated, the permittee shall notify the prospec-
tive owner or controller by letter of the existence of this permit
and of the need to obtain a permit in the name of the prospective
owner. A copy of the letter shall be forwarded to the Division of
Environmental Management.
3. Permit Modification
After notice and opportunity for a hearing.purstiant to NCGS 143-215.1
(b)(2) and NCGS 143-215.1(e) respectively, this permit may be modi-
fied, suspended, or revoked in whole or in part during its term for
cause including, but not limited to, the following:

PART II
a. Violation of any terms or conditions of this permit;
b. Obtaining this permit by misrepresentation or failure to
disclose fully all relevant facts; or
c. A change in any condition that requires either a temporary
or permanent reduction or elimination of the authorized
discharge.
4. Civil and Criminal Liability
Except as provided in permit conditions on "Bypassing" (Part II.
A-4) and "Power Failures (Part II, A-6), nothing in this permit
shall be construed to relieve the permittee from civil or criminal
penalties for noncompliance pursuant to NCGS 143-215.6 or Section
309 of the Federal Act, 33 USC 1319.
5. Property Rights
The issuance of this permit does not convey any property rights in
either real or personal property, or any exclusive privileges, nor
does it authorize any injury to private property or any invasion of
personal rights, nor any infringement of Federal, State, or local
laws or regulations.
6. 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 circumstance, is held invalid, the application of such provision
to other circumstances, and the remainder of this permit shall not
be affected thereby.
7. Expiration of Permit
Permittee is not authorized to discharge after the expiration date.
In order to receive authorization to discharge beyond the expiration
date, the permittee shall submit such information, forms, and fees
as are required by the agency authorized to issue permits no later
than 180 days prior to the expiration date. Any discharge without
a permit after the expiration will subject the permittee to enforce-
ment procedures as provided in NCGS 143-215.6 and 33 USC 1251 et seq..

PART II1
A., PREVIOUS PERMITS
All previous State water quality permits issued to this facility,.
whether for construction or operation, or discharge, are hereby
revoked by issuance of this permit. The conditions, requirements,
terms, and provisions of this permit authorizing discharge under the
National Pol.lutant.Discharge Elimination System govern discharges
from this facility.
B. CONSTRUCTION
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct have been issued. If no objections to Final .
Plans and Specifications have been made by the DEM after 30 days follow-
ing receipt of the plans or issuance of this permit, whichever is latter,
the plans may be considered approved and construction authorized.
C. SPECIAL CONDITIONS
1. The Permittee shall be, responsible for the following items regard-
ing the maintenance of the treatment system:
a. Septic tanks shall be maintained at all times to prevent
seepage of sewage or effluents to the surface of the -ground.
b. Septic tanks need routine maintenance and should be checked
at least yearly to determine.if solids need to be removed"
or other maintenance performed.
c. Contents removed from septic tanks shall be discharged into
an approved sewer -system, buried or plowed under at an
-approved location within 24 hours, or otherwise disposed of'
at a location and in a manner approved by the State or local
agency.
2. The permittee shall properly connect to an operational publicly -
owned wastewater collection system within 180 days of its availability
to the site.
G

STAFF REPORT AND RECOMMENDATIONS
Part I - INSPECTION OF PROPOSED WASTEWATER TREATMENT PLANT SITE
I. P1ace visited: Larry D. AdamsRe.sidence ..
4809 Jamee Drive
Gastonia, North'Carolina
2.. Date: March 16, 1932
SAX--
3 By: Larry.. D. Coble; Vaii Jones
4, Person -contacted: 119r. Larry D.-Adams,'owner
5. Directions to site: .From Gastonia; travel south on Highway 321 to
S. R. 2412; turn left on S. R. 2412 and travel southeast to'S. R.
2419.1 The site' is -on the 1 eft near the end of S . R. 2419
6,.. The bearing and distance 'to the proposed,{point of efflvent,discharge
is: Latitude 35012'55" and. Longitude 81
OII)'3-
.7. Size: .There is ample area,-for'the proposed facilities.
3. Rolling with slopes of 2-7%.
9. Location of nearest dwell ing: There are several dwell in'gs located
adjacent to -L{ie site.
10. Receivi.ng.Stream: Unnamed tributary to Crowders.Creek
(a).' 'Classification-: "C"
(b) Minimum 7--Day, 10-Year:-discharge `at site: 0.0'cfs (field estimate)
.(c) Usage: Fishing, boating, wading -and any other usage .except
for bathing or as a source of water_ sLIpply for drinking,, culinary.
or'food' ,processing purposes..
,Part II.. DESCRIPTION OF PROPOSED TREATMENT WORKS.
The applicant plans to install alseptic tank, subsurface sand filter;
and .effluent chlorination with 30-minute detention. This`facil'ity will.
replace an existing septic tank, nitri-fication system which has failed
due to_poor soil conditions. -The proposed facilities are'to serve an
existing residence. .
Part III EVALUATION AND RECOMMENDATIONS
It is recomraended that a Permit be issued as requested; provided .that the
designed facilities can comply wi-th-the final effluent limitations as..
assigned by.Technicai-Services.-.

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North Carolina Department of Natural
Resources &Community Development
James B. HuntJre •. Joseph W. Grimsley, Secretary
DIVISION -OF ENVIRONI%lui�s y� l�P
.. �i'�:I'3FK .7�h sum..' j.1:rLi�r tsPd�
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Et7fli71�(t
lii:fip17'15AL OFFICE
SUBJECT: Application for NPDES Permit
Larry Adams Residence
Gastonia County
Dear Mr. Adams
Receipt of the following documents is hereby acknowledged:
X Application Form
Engineering Proposal (for proposed control facilities)
Request for permit renewal
Other
If any of the items listed below are checked, the application received is
incomplete and the indicated item(s) must be received before review can begin:
_Application Form (copies enclosed)
Engineering Proposal (See (b) 1-5 on attached)
Other
If the application is not made complete within thirty (30) days, it will be
returned to you and may be resubmitted when complete.
This application has been assigned to David Adkins
(919/733-5181) of our Permits Unit for review and preparation of a draft per;nit.
Once the permit is drafted, public notice must be issued for forty-five (45) days
prior to final action on the issuance or denial of the permit. You will be ad
vised of any comments, recommendations; questions or other information necessary
for the review of the application.
I am, by copy of this letter, requesting that our Regional Office
Supervisor prepare a staff report and recommendations regarding this discharge.
If you have any questions regarding this application, please contact the review
person listed above.
Sincerely,
W. Lee Fleming, Jr., P.E.
Branch Head -Permits & Engineering Branch
Water Quality Section
cc: Mooresville Regional Supervisor Dairl ins
P. O. Box 27687 Raleigh, Ncrth Carolina 27611
An Equal Opportunity Atlirmat.••e Action Employer

NORTH CAROLIN:'� DEPT. OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF :,NVIRONMENTAL MANAGEMENT
P.O. BOX 27637, RALEIGH, NC 27611
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM APPLICATION NUMBER
APPLICATION FOR PER'11T TO DISCHARGE — SHORlMF4' EP . ®F Fw R;
RES():T&?Ol's SSE DATE RECEIVED
To be filed only by services, wholesale and retail trade® ZYL �V�L®PPs3E1V 6? p L
and other commercial establishments including vessels YEAR M0. DAY
Do not attempt to complete this form without reading �"�S1@(�c�Ihp��y{ 20E`��T�L� ; tions
h100RESY1lLEFCt`�A� O Ff �Era�
Please print or type
1. Name, address, and telephone number of facility producing discharge
A. Name A 'Ta 6z
B. Street address 46d v4&<-
p
D. State
C. City ir—� S i'Y/Y//�- -
E. :ounty
F. ZIP
G. Telephone No. f1
,
Area
Code
rat
24
2.
SIC
(Leave black)
PE-MTS ANV
3.
Number of
employees/li�/y�l(�If111'Yrrn
..
4.
Nature of
business L,l
5.
(a) Check
here if discharge occurs all year &, or
(b) Check
the month(s) discharge occurs:
1. ❑ January 2. ❑ February 3. ❑ March 4. ❑ Apri 1
.5. ❑ May
6. ❑ June 7. ❑ July 8. ❑ August 9. ❑ September
10. ❑ October
l l . ❑ November. 12. ❑ December
(c) How man-
days per week:
1.01 2. ❑r2-3 3. ❑ 4-5 4. ❑ 6-7
G
T,...— nF
.. +n Aicrhnrnori to curfArB waters onlv (check as applicable)
�r
Volume treated before
Flow, gallons per operating day
discharging (percent)
Discharge per
operating day
0.1-999
1000-4999
5000-9999
10,000-
50,000
None
0.1-
29.9
30-
64.9
65-
94.9
95-
100
49,999
or more
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
A. Sanitary, daily
average
366
B. Cooling water, etc.,
daily average
C. Other discharge(s),
daily average;
Specify
D. Maximum per operat-
ing day for combined
.discharge (all types)
PREVIOUS EDITION MAY BE USED

%. If any of the types of waste identified in item 6, either treated or un-
treated, are discharged to places other than surface waters, check below
as applicable.
Waste water is discharged to:
AVERAGE FLOW, GALLONS PER OPERATING DAB'
0.1-999
(1)
1000-4999
(2)
5000-9999
(3)
10,000-49,999
(4)
50,000 or more.
(5)
A..' Municipal sewer system
D. Underground well
C. Septic tank --
U. Evaporation lagoon or pond
E. Other, specify:
8. Number of separate discharge points:
A. W B. ❑ 2-3 C. ❑ 4-5 D. ❑ 6 or more
9. Name of receiving water or waters IA=- a cz='ga -
10. Does your discharge contain or is it possible for your discharge to contain
one or more of the following substances added as a result of your operations,
activities, or processes: ammonia, cyanide, aluminum, beryllium, cadmium,_
chromium, copper, lead, mercury, nickel, selenium, zinc, phenols, oil and
grease, and chlorine (residual).
A.❑yes Beno
I certify that I am familiar with the information contained in the application and
that to the best of my knowledge and belief such information is true, complete, and
accurate.
Printed Name of Person Signing
Tit e
-
Date Application Siane
Signature or Applicant
North Carolina General Statute 143-215.6(b)(2) provides that: Any person who knowingly makes
any false statement representation, or certification in any application, record, report, plan,
or other document.files or required to be maintained under Article 21' or regulations of the
Environmental Management Commission implementing that Article, or who falsifies, tampers with,
or knowly renders inaccurate any recording or monitoring device or method required to be
operated or maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed
$10,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provide
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both,
for a similar offense.)

C. DEPT. OF NATURAL� ESOURCDS AND
CO'DI MUNITV 13EVE1,OP1diF'NT
JUN P, IS82
DIVISION OF ENVIRONMENTAL MANAGEMENT
°m[MA OFEIC May 28, 1982
�OOttES ..
Mr. Larry D. Adams
Adams Residence (Larry D.)
4809 Jamee Drive
Gastonia, North Carolina 28057
Subject: Permit No. NC0050776
Adams Residence
Gaston County
Dear Mr. Adams:
1A
In accordance with your application for discharge Permit received
February 24, 1982, we are forwarding herewith the subject State-NPDES Permit.
This permit is issued pursuant to the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina
and the U. S. Environmental Protection Agency dated October 19, 1975.
If any parts, requirements, or limitations contained in this Permit are
unacceptable to you, you have the right to an adjudicatory hearing before a
hearing officer upon written demand to the Director within 30 days following
receipt of this Permit, identifying the specific issues to be contended.
Unless such demand is made, this Permit shall be final and binding.
Please take notice that this Permit is not transferable. Part II, 6.2.
addresses the requirements to be followed in case of change in ownership or
control of this discharge.
This Permit does not affect the legal requirement to obtain other Permits
which may be required by the Division of Environmental Management. If you
have any questions concerning this Permit, please contact Mr. David Adkins,
telephone [phone].
Sincerely yours,
Original Signed By
W. LEE FLEMING, JR., for
Robert F. Nelms
Director
cc: Mr. Jim Patrick, EPA
Mooresville Regional Office
Mooresville Regional Office Manager

Permit No.. NC 0050776
STATE OF NORTH CAROLINA I
DEPARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
P E R M I T
To Discharge Wastewater Under the NATIONAL
POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1,
other lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission, and the Federal Water Pollution Control Act, as
amended,
Mr. Larry D. Adams
is hereby authorized to discharge wastewater from a facility located at
4809 Jamee Drive
Gastonia
Gaston County
to receiving waters designated an unnamed tributary to Crowders Creek in the
Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, and III hereof.
This permit shall become effective MAY 2 8 W
This permit and the authorization to discharge shall expire at midnight
on APR 30 1067
Signed this day of . MAY 2 8 1982
Original Signed By
W. LEE FLEMING, JR.,. for
Robert F. Helms, Director
Division of Environmental Management
By Authority of the Environmental
Management Commission
M1 & I1

0
Permit No. NC0050776
SUPPLEMENT TO PERMIT COVER SHEET
Mr. Larry D. Adams
is hereby authorized to:
1. Enter into a contract for construction of wastewater
treatment facilities,
2. Make an outlet into ar, unnamed tributary to Crowders Creek,
3. After receiving an Authorization to Construct from the
Division of Environmental Management; construct and operate
a wastewater treatment facility located at 4809 Jamee Drive,
Gastonia (See Part III of this Permit), and
4. Discharge from said treatment works into an unnamed tributary
to Crowders Creek which is classified Class "C" waters.

A. (1). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS -Final
During the period beginning on the effective date of rmit and lasting until expiration,
the permittee is authorized to discharge from outfallCs) serial number(s) ool.
Such discharges shall be limited and monitored by the permittee as specified below:
Effluent Characteristics Discharge Limitations
Kg/day (lbs/da� Other -Units (Specify)
Monthly Avg. Weekly Avg. Mon__ vg. ee y vg.
Flow
BOD, 5 Day, 200C
NH as N
TSS
e
Fecal Coliform (geometric mean)
Dissolved. Oxygen (minimum)
The pH shall not be less than 6.0
0.001 MGD
11 mg/l 16.5 mg/1
4 mg/l 6 mg/l
30 mg/l 45 mg/1
1000/100ml 2000/100m1
6.0 mg/l 6.0 mg/l
Monitoring Requirements
Measurement Sample Sample
rrequency ape Location
standard units nor greater than
8.5 standard units®
There shall be no discharge of floating solids. or visible foam.in other than trace amounts.
z -0 -0 '0
C' %W of
(n --%
0 0(Dt+
0
(n
0
� z
� o 0
rn

Part I
Permi t No.. NC
B. SCHEDULE OF COMPLIANCE
1. The permittee shall achieve compliance with the effluent limitations
specified for discharges in accordance with the following schedule:
NOT APPLICABLE
2.: No later than 14 calendar days -following a date identified in the above
schedule of compliance., the permittee shall submit either a report of
progress or, in the case of specific actions being required by identified
dates,.a written notice of compliance or noncompliance. In the latter
case, the notice shall include the cause of noncompliance,'any remedial
actions taken,.and the probability of meeting the next scheduled requirement.

Part I
Permit No. NC
"Act" used herein means the Federal Water Pollution Control Act, As Amended.
"DEM" used herein means the Division of Environmental Management of the
Department of Natural Resources and=Community Development.
'EMC" used herein means the North Carolina'Environmental Management Commission.
C. MONITORING AND'REPORTING
1. .Representative Sampling
Samples and measurements taken as required herein shall be representative
'of the volume and nature of the monitored"discharge.
2. Reporting
Monitoring results obtained during the previous month(s) shall be
summarized for each month and reported on a Monthly Monitor.Tng Report
Form (DEM No. MR 1.0, 1.1, and 7.41... postmarked no .later than the
45th day following the completed reporting period.
The first report is due on AN i 4 10 Duplicate signed copies of
these,"and all other reports required herein, shall be submitted to
the .foll-owing -address:
Division of Environmental Management
Water Qual.i ty Section
Post Office Box 27687
Raleigh, North Carolina 27611
3. . Definitions
a. The monthly average, other than for fecal coliform bacteria, is the
arithmetic mean of all the composite. samples collected in a one- -
".month period. The 'monthly average for fecal caliform bacteria is ,r
,,the geometric mean of samples collected in a one -month period.
b.- .;The weekly: average, other than for fecal coliform bacteria, is the
arithmetic mean of all the.composite'samples collected during a
one -week period. The weekly average for fecal coliform bacteria
is the geometric mean of samples collected in a one -week -period.
c:_ Flow, M3/day (MGD): The f0ow limit expressed in this permit is the
24:hour average flow, averaged monthly. It is determined as the.
,arithmetic.mean of the total daily flows recorded during the calendar
.month.
d.' Arithmetic Mean: The arithmetic mean of any set of values is the
summation of the individual values divided by the number of -individual
Values.
M5

= Part I
Permit No. NC
e._-Geometric Mean: The geometric mean of any set of values is the
Nth root of the product of the individual values where N is equal
to the ...number -of indi-vidual values. The.geometric mean is equiva-
lent to the antilog of the arithmetic mean of the logarithms of
the individual values. For purposes of calculating the geometric
mean, values'of zero.(0) shall be considered-to'be-one (1.).
f. Composite Sample: A "composite sample" is any of the following:
{'1:) -.Not less than four influent or effluent portions collected
at regular intervals over.a period of 24 hours and composited
in.proportion to flow.
-(2) Not less than four equal_ volume infl-uent-or effluent portions
collected over. a period.'of 24 hours at intervals proportional
,...to the flow. _
"(3.) An influent or effluent portion coil-ected continuously over
:a period of 24 hours at a rate proportional to the flow:
g. ; Grab. Sample: . A "grab sample" is a single influent or effluent
portion which is not a -composite sample. The sample(s) shall be
_collected at the period(s) most representative of the total discharge.
4. Test Procedures
Test -'procedures for the analysis of pollutants shall conform to`the-EMC
regulations published pursuant to N. C. G. S. 143-215.63 et seq,,The
Water -and Air Quality Reporting Act, and to regulations publi_thed pursuant
to Section 304(g), 33 USC 1314, of.the Federal Water Pollution Control Act,
As Amended, and Regulation 40 CFR 136-.
5. Recording Results
For each measurement or sample taken pursuant to the requirements -of
this..permit, the permittee;shall record -the following information.
a. The -exact place, date,.and time of sampling;
b The: .dates 'the analyses were performed; and
c. The.person(s) who performed the analyses.
16

• PART I

PART 'I I
A.
Permit No: NC
MANAGEMENT REQUIREMENTS
I..Change in Discharge
All discharges authorized herein shall be consistent with the terms and
conditions.of this permit. The discharge of any pollutant identified
in this permit more.frequently than or at a level in excess of that
authorized shall constitute a violation of the permit. Any anticipated
facility expansions, production increases, or process modifications which
will result in new, different, or increased discharges of pollutants must
be reported by submission of a new NPDES application -or, if such changes
will not violate the effluent limitations specified in this permit, --by
notice to the DEM of such changes. Following such notice, the permit
may be modified to specify and limit.any pollutants not previously limited.
2. Non compliance Notification
If, for any -reason, the permittee does not comply with or, will be unable
to -comply with any effluent limitation specified in this permit, the per-
mittee shall provide the Division of Environmental'Management with.the
following information, in -writing, within five'(5) days of becoming aware
of such condition:
3.
4.
5.
a. A description of the discharge and cause of noncompliance -;'and
b. The period of noncompliance, including exact dates and ti.mes;,or,,.
if not corrected; the anticipated time the noncompliance.jss expected.
to.continue, and steps being taken to reduce, eliminate.and:prevent
recurrence of the noncomplying discharge..
Facil.i.ties.Operation
The permittee shall at all times maintain in good working order".and
operate.as efficiently as possible all treatment or,control facilities
or systems installed or used by the permittee to,achieve compliance with
the terms and conditions of this permit.
Advers;e;Impact
The permittee shall take all reasonable steps to minimize any adverse
impact to navigable waters resulting from noncompliance with any effluent
limitations specified in this permit, including such accelerated'or
additional monitoring as necessary to determine the nature and impact of
the noncomplying discharge. _
Bypassing _
Any diversion from or bypass of facilities necessary to maintain compliance
with the terms,and conditions of this permit is prohibited,'except (i) where
M 8 & I 7

PART II
Permit No. NC
unavoidable to prevent loss of life or severe property damage, or
(i.i) where excessive storm drainage or runoff .would damage any
facilities necessary for compliance with the effluent limitations
and prohibitions of this permit. The permittee shall promptly
notify the Water Quality Section of DEM in writing of each such
diversion or bypass.
6. Removed Substances
So lids, sludges, filter backwash, or other pollutants removed in the
course of treatment or control of wastewaters shall be disposed of in
a. manner such as to prevent any pollutant from such materials from
entering waters of the State or navigable waters of the United -States.
7. Power.Failures
In'order to maintain compliance with the effluent limitations and
.prohibitions of this permit, the permittee shall either:
a. In.�accordance with the Schedule of .Compliance contained in Part I,
provide an alternative power source sufficient to operate the waste-
water -control facilities;
or,;-if:,such alternative power source is not in existence, and no date for
its implementation appears in Part I,
b. Halt, reduce or otherwise control production and/or all discharges
from wastewater control facilities upon -the reduction; -loss, or
failure.of`the primary -source of power to.said wastewater -control
facilities.
8. Onsho're 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.
18

PART II
Permit No. NC
B. RESPONSIBILITIES
1. . Right. of Entry
The'permittee shall allow the Director of -the Division of Environmental.
Management, the Regional Administrator,'and/or.their authorized represen-
. _tatives, upon the presentations of credentials:
a. The enter upon.the permittee°s. premises where an effluent source is
locate! or In -which any records are required to be kept under the
terms anti conditions of this permit; and
b. At reasonable times to have.access to and copy any records required
n be kept under the terms and conditions of this permit; to inspect
any monitoring equipment or monitoring method required in this permit;
and to sample any discharge of -pollutants.
2.. Transfer -of Ownership.or Control
This permit is not transferable. In the event of any change in'control
or -ownership of _'-t-rilities from which the authorized discharge emanates
or :Is . contemplated, the perms ttee shall notify the prospective owner or
controller by letter of the existence -of this permit and of the need to
obtaiA.,a.,permit Ir the name of the prospective owner. A copy.of the
lette r O.ala.be forwarded to the Division of Environmental Management.
3. Avai l abi 1 i ty of Rkports
Except .or .data determined to be confidential under N. C. G — S..A43-215..
3(a)(2) or Section 308 of the Federal,Act, 33 USC 1318, all reports prepared
in accordance with the terms shall be available for public inspection.at the
offices . f.-the Division of Environmental Management. As required'by the; Act,
effluent.data shall not be considered confidential. Knowingly making -any
false statement of any such report may result in the I'm osition of.criminal
penalties as provided for in N. C. G. S. 143-215.6(b)(2� or -in Section
309:-of ,.the Fedoras Act.
4:. Permit..iModifIcation*
After notice and opportunity for a hearing pursuant to N. C. G. S. 143-
and,'G. S. 143-215.1(e) respectively, this permit maybe
modi-fied., suspender;, or revoked in whole or in part during .its: term for
cause;: I ncluding, but riot limited to, the following:
-4p_i0l:ation of.,an.y terms or conditions of this permit;
b; �:Obta ning this Permit,by misrepresentation or failure to -disclose u11:Y 311 -rel6vant facts; or
c.... change in any condition that requires either a temporary or
,pe:rmanent reduction or elimination of the authorized discharge.

PART II
Permit No. NC
5:. Toxic Pollutants
Notwithstanding Part II,-B-4 above, if a toxic effluent standard or
'prohibition (including any schedule of compliance specified in such
effluent -standard -or prohibition) is 61stablished under Section 307(a),
of the Act -for a'toxic pollutant which is present in the discharge and
such standard or Prohibition is more stringent,,.than any limitation for
such pollutant in phis permit, this permit shall be revised or modified
in accordance With'the toxic effluent standard or prohibition and the
permitte6-so notified.
6. CivilNand Criminal Liability
-Except:as provided in permit conditions on "Bypassing" (Part II, A-5)
and.'_'Power-Failures" (Pant II, A-7), nothing in this permit shall be
construed to relieve the permittee from civil or criminal penalties for
noncompliance.pursuant to N. C. G. S. 143=215.6 or Section 309.of the
Federal -Act, 33 USC 1319.
.7.. 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.-responsibi.lities,
l fabil:ities, -,or' penal ties to. which the permittee is or may be. subject
under,-N., C.- .-G.., S. 143-215.75 et seq. or Section 311 of the Federal.Act,
33_USC 1321
8. Pro _perty :Rights

PART II '
Permit No NC
10. Expiration of Permit
Permi.ttee.is not authorized to discharge after the expiration date.
I.n order to receive authorization to discharge beyond -the expiration
date.i-the permittee shall submit such information, forms, and fees as
are'required by the agency authorized to issue permits no later than 180
days prior to .the expiration date. Any discharge without a permit after
the expiration will subject the permittee to enforcement procedures as
provided in N..C. G. S. W-215.6 and 33 USC 1251 et seq.-.
J.

... PART I I I
Permit No. NC
B. Previous Permi.ts
All previous State water quality permits issued to this facility,
whether for construction or operation or .discharge, are hereby revoked
by issuance of this permit. The conditions, requirements, terms, and
provisions of this permit authorising discharge under the National
Pollutant Discharge Elimination System governs discharges from this
faci'l ity.
C. Construction
No construction of wastewater treatment facilities or additions thereto
shall be begun until Final Plans and Specifications have been submitted
to the Division of Environmental Management and written approval and
Authorization to Construct has been issued. If no objections to Final
...Plans and Specifications has been made by the DEM after 30 days following
receipt of the plans or issuance of this permit, whichever is latter, the
plans may be considered approved and construction authorized.
D. Certified Operator
Pursuant to Chapter 90A of North Carolina General Statutes, the permittee
shall employ a certified wastewater treatment plant operator in responsible
charge of the wastewater treatment facilities. Such operator must hold a
certification of the grade equivalent to the classification assigned to
the wastewater treatment facilities.
M15&I12

DIVISION, IF UVIROWNTAC MANAGEMENT
March 16. 1983
N11r. Larry W Adams .
4809 WaS Drive
Gastonia, Aorth Carolina 2057
Sub_ibcta Single FaMfly Owpiling Inspection
HPDES Permit No. MC-00 0775
Adams Residenc
Ora 'tan County, North, Carolina"
Dear Mr. Adams
Attached is a copy of the Di scha�rrge "F ai ci 1 i �f yq Tnspc cti on Report fo�� the
inspection conducts{! at tho sU ect facility on �'arch.2. ?33. J � 1. This Report'
should be self -=explanatory.
if you h.1w any - ques ti onS r please cobtac't this Office At telephone number .
[phone].
Si peraly,
6C.1NAL. SINED BY
D. ex' Gleason, P. E.
!dater Quality Regional Engineer
Attachment_
�,`� TDF:se

Note: P.6rmittee works at night: and sIeaps during the day; 'ther.Ofori-, ;
Periai•tta6 prefers to be ,cal-Ied to set tip future. inspections.
DISCf1l1'"E' FRILI I Y, I+�ISPECTIDia REPCRI -
Part I INSPECTION OF ' EXISTING WASTEWATEn 'TREATi iErlT PLANT .
1: a. -.Place visited: Larry D. Adams RLside'nCe'
b.- Mai Iing Address: - sir. ,Larry D. Adams
4809 Jamee 'Drive
Gastonia, ;c+r •tip- Czrol na 280"57
2. Date of Investigation:. '3/2/33' Date of Report: .-3/16/33.
3. By: `7ana, Fryer and •Larry CobI-e
-. a., . POrso.n .cohtac -Cd:. fir. Larry+ I).' Adams
b. PE�one rNo.. 70� 866--0263
'. Directions to site:-, Travel sozlth -•From Gastonia on Ffirhwa.y 321 to S.
2412.. Turn left an S.'R. 21412 and travel 4o: S. R. 2327_ (Array .Acres) Turn
right and travel to S . i? ..282'.-(Jame'p Dri ve) r -Turn l eft on,. S.- R. 28%J .
Resi dcnce-is: located on the left: neat theenu of S. P.. 2B.'.a.
5. USCSsiau No. - r .14 Rv1 (see: �attacherl r;an). '
7, Si? (land Available, --For. exomision ,and upgrading'): There is ample
land avail abl e for,' tlze wmstewa te. r treatment faci l i t7 es.
Topography: `3ol 7 i ng, wi th .s l p- of 2-= 790'
7. Location of nearest °,�el:linn: Th-eere are. several m;relling _locat,
..adjpcen.t to the site.
Part II DESCRIPI'Mil! OF EXISTING4 TREATPA11UHT FACILITIES
7 e Cxi s-i'ng Faci i iti es : The Peirni ttee has. a sep-tic tank;, s,Jbsurface
sand .fi.lter, and effluent C,00ririati6n.
Part III EtrALU;:TIC,J i1?'!DC'iV`iF�`lliATl'./e'IJ
1. Performance Evaluation: The system:, appears' to be.bperatinq'prop erly
4>>ith the :exception �t+tat no- chlorine tabl.cts are being r;sed...,
2. 0 &41 -:valuation: Tale: chlorinator did not contain chlori'b' tablets.

sago Two
Permit. Limits
Montiy_herag—
__ Sekly Alleraj
SilrF11a1' ? �@5111 tS
Flow
n00S.
11 Mg/1
16.5 ra0/1.
1..E m7/7
TSB
30.smtg/i
��� rig/i
2 tmmn/l
Fecal
1 000/100 m1'
MUM MI
<1 M R m1
Goliform
v.
Wcom meAtions and/or.
Special. Conditions :
" .The staff recommends the
Permittee add chlorino
t filets tO the chlorinator
as -necessary.
Samples. yore collected
Ater the rea had
had raifo 11 , .

4
B
r r C
i
N.C. DEPT. OF NATURAL RESOURCES & COMMUNITY
COUNTY: *^:.r; =�y DEVEtOPMENT
RIVER BASIN: Y I''-- = =-�- DIVISION OF ENVIRONMENTAL MANAGEMENT 0
REPORT TO: (Circle One) WATER QUALITY FIELD -LAB FORM (DMU
SAMPLE TYPE
ARO, FRO; MRO,`,RRO, WaRO WiRO, WSRO, BM, TS,
AMBIENT ❑CORE ❑COMPLIANCE
OTHER:
CLLOECTOji(S): _ra .� 4' d �t _r . C`..
BOD RANGE': SEED:
CHLORINATED: t
) ram.
LAB NUMBER 00008: _6 `" f
DATE RECIEVED:
RECIEVED BY: (rt s"� ll �7 r t.+' l� • `1 t
DATA ENTRY BY: CK:�d ✓ / r'
@ 6 ep
DATE REPORTED: - B 1 0 0 =�
ElINTENSIVE S. DSPLIT EMERGENCY
STATION LOCATION:
F
Station Number
Date Begin yy/mm/ )
Time Begin
Date End
Time End
Depth DM DS DBM
Value Type
Sample Type
Composite
r t i i
A H L
C G GNXX
T S B
BODs 310 f m /I
Chloride940 m /I
NH3as N 610 m /I
Mo—Mol bdenum 1062 u /I
COD High 340 m /I
Arsenic:Inorganic 1002 u /I
TKN as 625 mg/Img/I
No— Sodium 929 m /I
COD:Low 335 m /
Chi a: Tri 7 u /I
NO *NO3 as N 630 m /I
Ni — Nickel 1067 u /I
'c+``
C61iform;MF Feca,131616 � It-, /100m1
Chl a:Corr u /I
PO4 as P 70507 m /I
Pb— Lead 1051 u /
Coliform:MF Total 31504 /100m1
Pheo h tin a32213 u /I
P: Total as P 665 m /1
Sb— Antimony 1097 u /I
Coliform:Tube Feca131615 /100m1
Color: True 80 Pt —Co
P: Dissolved as P 666 mg/ I
Sn— Tin 1102 u /I
Coliform:Tube Total 31505 /100m1
Chromium:Hex.1032 u /I
A — Silver 1077 u /I
V — Vanadium 1087 u /I
Residue -Total 500 m /I
Cyanide 720 m /I
Al —Aluminum1105 u /I
Zn—Zinc 1092 u /I
Volatile 505 m /I
Fluoride951 mg/I
Ba — Barium 1007 u /I
Pesticides (Specify)
p
Fixed 510 m /I
Formaldehyde 71880 m /I
18e — Beryllium 1012 /I
ram.
r
Residue:5 ended 530 = m /I
Grease and Oils 556 m /I
Ca —Calcium 916 m /I
Volatile 535 m /I
ordness:Total 900 m /I
Cd— Cadmium 1027 u /
Fixed 540 m /I
MBAS 38260 m /I
Co— Cobalt 1037 u /I
(Specify)
—Organics
l�
H403 F� �= units
Phenols 32730 u /I
Chromium: otal 1034 u /I
Acidity to pH 4.5 436 m /I
Sulfate 945 m /I
iCu—CoDoer 1042 u /I
Acidity to PH 8.3 435 mg/I
Sulfide 745 m /I
Fe— Iron 1045 u /I
2
Alkalinity to PH 8.3 415 m /I
S ecific Cond.95 uMhos/cm
H—Mercur 900 u /I
2
Alkalinity to PH 4.5 410 m /I
Biomass: Dry Wt. 573 9/M
Li — Lithium 1132 u /I
2
TOC 680 rn /I
Biomass: Peri Ash Free 572 g/M
M —Magnesium 927 mg/I
2
ITurbidity 76 NTU
Chi a: Peri Fluro 82547 mg/M
IMn —Manganese 1055 u /1
Sampling Point
Water Temperature(°C)
D.O.
PH
Conductance
Alkalinity
Acidity
PT %
at 25`C
PH 8.3 pH 4.5
PH 4.5 pH 8.3
63 2
10
300
400
94
82244 431
82243 82242
Secchi(Maters)
Air Temperature (*C)
D•O.%Saturation
Salinity%,
Algae; Floating Mats
Precipitation(in/Day)
Cloud Cover;%
Wind Direction(Deg.)
Win Force
Severity
Beaufort
78
20
301
1480
11325
45
32
36
37
1 Hr. Settles a
Dead FishTurbidity
Severity
Odor;Atmosp ere
Stream Flow
Detergent Suds
Oil -Grease
Floating Debris
Sludge Severity
Matter (ml/I/Hr.)
Severity
11350
Severity
11330
Severity
�1351
Severity
Severity
Severity
50086
1340
1305 11300
1345
1315
DMl/Revised 1/81LA

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7
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9
10
12
13
14
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16
17
18
19
20
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DIVISION OF ENVIRONMENTAL MANAGEMENT
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Station Number
Date- .Begin yy/rrlm/ ).
Tim"e`.$�gfi
Date En
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Time End
Dept DM DB DBM
lValue Type
A H L.
Sample Type
*<a
C G ' GNXX
Composite
T S B
BOD 310 m /I
,
Chloride940 m /I
t ^�'F
NH as N 610 0 :`t m /I
Mo-Mol bdenum. 1062 u /I
COD -High 340 m /I
Arsenic: Inorganic 1002 u /I
TKN as 625 m /
Na-Sodium 929 m /I
COD:Low 335 m /
-Chi
a: Tri u /I
NO *NO as N 630 m /I
Ni - Nickel 1067 u /I
Coliform:MF Fecal 31616 /100ml
Chi a: Corr u /I
PO as P 70507 m /I
Pb- Lead 1051 u /
Colifor :MF Total 04 /100ml
Pheo h tin a u /I
P: Total as P 665 m /I
Sb- Antimony1097 u /I
Coliform:Tube Fecal31615 /100ml
Color:True 80 Pt -Co
P: Dissolved as P 666 m /I
Sn- Tin 1102 u /I
Coliform:Tube Total 31505 /100ml
Chromium: Hex. 1032 ug/I
A - Silver 1077 u /I
V -Vanadium 1087 u /I
Residue- Total 0 m /I
C anide720 m /I
Al -Aluminum1105 u /I
Zn-Zinc 1092 u /I
Volatile 505 m /I
Fluoride 951 mg/I
Ba- Barium 1007 u /I
Pesticides (Specify)
Fixed 10 m /I
Formaldehyde 71880 m /I
Be - Beryllium 1012 u /I
Residue:S' ended 530 m /I
Grease and Oils 556 m /I
Ca- Calcium 916 m /I
Volatile 535 m /1
Hardness:Total 900 m /I
Cd- Cadmium 1027 u /
Fixed 540 m /I
MBAS 38260 m /I
Co- Cobalt 1037 u /I
(Specify)
H403 units
Phenols 2730 u /I
Total 1034 u /I
-Organics
Acidityto H 4.5 436 m /I
Sulfate 945 m /I
-Chromium:
Copper Cu- 1042 u /I
Acidit to H 8-3 435 mg/I
Sulfide 745 m /I
Fe- Iron 1045 ug/I
Alkalinityto 8.3 415 m /I
-Specific
2
Cond. 95 uMhos/cm
H-Mercur 00 u /I
Alkalinityto H 4.5 410 m /I
2
Biomass: Dr Wt. 573 g/M
Li - Lithium 1132 u /I
-
TOC 8 m /I
2
Biomass: Peri Ash Free 572 g/M
M -Magnesium 927 m /I
Turbidity76 NTU
2
Chl a: Peri Fluro 82547 mg/M
Mn-Manganese 1055 u /I
Sampling Point
PT %
63 2
Water Temperature(°C)
10
D.O.
300
pH
400
Conductance
at 25°C
94
Alkalinity
PH 8.3 pH 4.5
82244 431
Acidity
pH 4.5 PH 8.3
82243 82242
Secchi (Meters)
78
Air Temperature (°C)
20
D.O. % Saturation
301
Salinity 7-
480
Algae; Floating Mats
Severity
1325
Precipitation (in/Day)
45 32
Claud Cover;%
Wind Direction(Deg.)
36
Win Force
Beaufort
37
1 Hr. Settleable
Matter(ml/IIHr,I
50086
Dead FishTurbidity
Severity
1340
Severity
11350
Odor;Atmosp ere
Severity
11330
Stream Flow
Severity
11351
Detergent Su s
Severity Severity
11305 11300
Oil -Grease
Floating Debris
Severity
11345
Sludge Severity
1315
DMl/Revised 1/81LA

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