NC0044253_Regional Office Historical File Pre 2018

i' PERMIT NO.: NC0044253 PERMI"1" "4'ER
TV NAME: Camp Dogwood W1V'1`P CLASS: WW_2
O'NER NAME: North Carolina Lions Foundation Inc, ORC: Gregory Al
ORC ETAS CHANGED: N
1rERSION: 1,0
GRADE: WW-2
eDMMR PERIOD: 07-2019 (duly 21914;
RER: 10(159(15
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SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: N(
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1 NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 07-2019 (July 2019)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Gregory Alexander Trombello
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
Ajf
ORC/Certifier Signature: Gr g Trombello
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 1005905
STATUS: Processed
SUBMISSION DATE: 08/30/2019
08/30/2019
E-Mail: gmetwater a.yahoo.com
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
08/30/2019
Permittee/Submitter Signature:*** Gre;Trombello E-Mail:gmetwaterrryahoo.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Shen -ills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB 11: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.nedenr.org/web/wg/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 213
.0506(b)(2)(D).

ERR
NC0044253
imp Dogwood w'WTP
NI:R NAME: North Carolina Lions Foundation lnc
CRAM:: 'W \W-2
eD11R PERIOD: 06.20 V, .ne 2019)
IT
PERMIT VERSION: 4,0
CLASS: Wby�!"..1
ORC: Gregory r\leksindcr
ORC; FIAS CHANCED: No
RTRSION: 1.11
PERMIT STITES: o ctsve
C'at:rvaha
ORC CF"R'1" NUNIDER: 11104{ 1ir,TDf N to
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCI
NioNCINN ANerawn
Dad). iq#yiaia¢ais:
dtYn CNN,

NPDES PERMIT NO.: NC0044253
F %CILITY NAME: Camp Dogwood WWTP
OIER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 06-2019 (June 2019)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Gregory Alexander Trombello
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone]
ORC CERT NUMBER: 1005905
SUBMISSION DATE: 07/30/2019
.A
ORC/Certifier Signature: G eg Trombello E-Mail:[e-mail]
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
07/30/2019
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
1,Ac
07/30/2019
Permittee/Submitter Signature:*** Gr g Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/Forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO:: NC0044253
FACILITY AME: Camp Dogwood 'MIT
PERNHT VERSION: 4„0
CLASS: WW-2
OWNER NAME: North Ca dati0 c ORC: Gregory AlnarlildJo
-
GRADE: WW-2
eDNIR PERIOD: 05-2019 (May 2019)
ORC HAS CHANGED: No,
VERSION: ; .0
PERMIT STATES; Active
^"30)
COUNTY: Cut cam 3„33
ORC CERT NUNIRER.: 1005905
Y4SCENtEoNCD5NRIDWP
STATuS: Processed
SAMPLING LOCATION: EFFLUENT DISCH iiRGE NO.: HI NO DISCI)
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NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
:`
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 05-2019 (May 2019)
COMPLIANCE STATUS: Compliant
ORC/Certifier Signature:
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Gregory Alexander Trombello ORC CERT NUMBER: 1005905
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 06/30/2019
06/30/2019
Trombello E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES permit.
/au--
06/30/2019
Permittee/Submitter Signature:*** GrJ Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per l5A NCAC 2B
.0506(b)(2)(D).

\PDCS PERMIT NO.: NC0044153
FACETY NAME; Camp Dogwood WW-TP
OWNER NAME: North Carolina. Lions Poundat on Inc
GRADE: WAY-2
cOMR PERK/1E04-2019 (ApL2iV9)
41
444
PERMIT VERSION: 4.0
WWL-.2
ORC: Gregory A lakando: Trombello81
L 21i
OR( HAS ()AGED: \o
VERSION: 1,0
PERMIT STATUS: Activo
COUNTY: Catawba
()RC CERT NUMBE :
RECE CON (MEN RICOR
STATUS: P cosset!
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISC
431 .3.3
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133
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6 6/66 6,
XEV EXE4 Ey
444814844

NPDES PERMIT NO.: NC0044253
PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACII:1}'Y NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Gregory Alexander Trombclla ORC CERT NUMBER: 1005905
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 04-2019 (April 2019) VERSION: I.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 06/02/2019
ORC/Certifier Signature: GGrr g Trombello E-Mail:[e-mail] Phone #:[phone] Date
06/02/2019
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permitter becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
11'
Permittee/Submitter Signature:*** Grkg Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
06/02/2019
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.nedenr.org/web/wglswp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on tile with the state per 15A NCAC 2B
.0506(b)(2) (D).

Nv,:r DES PERMIT NO.: NCOOT4253 PERMIT VER.SION: 4
F.A.L.ITY NAME: Camp Dogwoo CLASS: 'WW-2.
OWNER NAME: North(arohnaUons Foundation tn. ) ORC: GTegory A lexivnd c!:•/rom 1
CRADE: WW2 ORC HAS CHANCED: No,
e.DMR PERIOD: OL2O9 Match 2019) VERSION: 1,0.
'PERMIT STATUS: Active
COENT\': Critawkr
ORC CERT NUMBER:
0F2 VE CDENRIDWP,
STA l'US: Processed
VVCROS
SAMPLING, LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCI It ot,FR
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**** No Reporring Reavon: ENF RUSE: 0. No HOW-ReuseiRe0yelc);. ENV' WTHR x Vivitimen - A dN'CriO W03002,0 NO010033( No floss; 1101...113.A.Y - No 30vi1.3000 - 3tofiday

NPDES PERMIT NO.: NC0044253
FA�,'.,.ITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 03-2019 (March 2019)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Gregory Alexander Trombello
ORC HAS CHANGED: No
VERSION: 1,0
CONTACT PHONE #: [phone]
inlAtv
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 1005905
STATUS: Processed
SUBMISSION DATE: 04/30/2019
04/30/2019
ORC/Certifier Signature: Gretg Trombello E-Mai1:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
04/30/2019
Permittee/Submitter Signature:*** Greg Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr,org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per ISA NCAC 28
.0506(b)(2) (D).

NPDES Pf.' MIT NO.: NC:0044253
FACILITY NAME: Camp Dogwood WWFP
OWNER NAME: North Carolina Tions Foundation
GRADE: WW-2
elEVIR PERIOD: 02-2' 9 :"cbrua 20 t,tt
PER.MIT VERSION: .4:0
ECT,`,E1\iED PERMIT STATUS: Aeusp
CLASS: W W-2 CO ON'Ii V: Catawba RE CE f vElD,NrnENwp
'c o Vi.C: Gregory A loxItnsior 1 rom4.11 ' 8 ? 019 ORC CEI-°NUMBER: 1005905
ORO WAS CHANGED: NoCEN 1 itiAL FILE8
VERSICON: om rTINR SECTION STATE:S: Processed
WO R Os
MOO RIF SVi L t .F.:' R. EC; ()NA .', 0 rFiCe
SAMPLING 1....00ATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
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71 135
25
30
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"t4 No Reporting Reason: ENtiRtiliti, — No 1MI, ,RettstAccycle; tiNvw1 I - No 171,11.111011 71i1\7111rSt1107,N&Ier1 74,14111.0W 7t110110))11 HOL11A `f --, No Visqa1110 — May

NPDES PZ42MIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Gregory Alexander Trombello ORC CERT NUMBER: 1005905
GRADE: WW-2 • ORC HAS CHANGED: No
eDMR PERIOD: 02-2019 (February 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 03/30/2019
VS/ 03/30/2019
ORC/Certifier Signature: G eg Trombello E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
03/30/2019
Permittee/Submitter Signature:*** Greg Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 SherriIls Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orglweb/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permitter: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per I SA NCAC 2B
.0506(b)(2)(D).

TP13ES PERMIT kI4253 PERMIT 'ERSJON:4 0
FACILITY NAN*: Camp 1 P
OWNER NAMES North CanrvrIina Lions
GRADE: W'-?
cl»IR PERIOD 0I-20(9 yJanuary .0 3
CLASS: W\1=-2
dal:on hie ORC: Gregory Alexander Trombr�l�,a OR(` HAS ("HANGED; No ii!
VERSION:
STATUS: ,,Active
ORC CERTNUMBER: I0055H15
Proces,rid
SAMPLING L OC TION; EFFLUENT DISCCE NO.: 001 NO DISC

NPDES PERMIT NO.: NC0044253
FACILITY NAN E: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 01-2019 (January 2019)
COMPLIANCE STATUS: Compliant
ORC/Certifier Signature:
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Gregory Alexander Trombello
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
IAA/
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 1005905
STATUS: Processed
SUBMISSION DATE: 02/27/2019
Trombello E-Mail:[e-mail] Phone #:[phone]
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
02/27/2019
Date
The pennittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittcc became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by pare II.E.6 of
the NPDES permit.
02/27/2019
Permittee/Submitter Signature:*** reg Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the infonnation submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false infommtion, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Usc only units of mcasuretnent designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there arc no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Pennittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

NPIFY S PFRMIT 1().: NC0044
PERMIT 4" -AMO\ 4.(t
CLASS;
1SS;
OGregory
North (�'�ew lir�bi Lit,iR, F �r..nnydAir�rrta c BrfC}RC : (,
GRADE: l4''L1''-
arkIR, PERI()I). 12 201 A. (Dec
()RC OAS (i 1\(J 1): N a
VER.SI()\F 1,0
r CER"I` NLAIBLR
SAMPLING LOCATIO1 :E FI. LIEN I° DIS(HAR(E NO.: OO NO DI
Iti,NFP USE her Houk-Reitae'it vc f \V'LM1:1 Y R

NPDES PERMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Gregory Alexander Trombcllo ORC CERT NUMBER: 1005905
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 12-2018 (December 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 01/30/2019
0 1/3 0/20 19
ORC/Certifier Signature: Greg QTrombcllo E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part 11.E.6 of
the NPDES permit.
01/30/2019
Permittce/Submitter Signature:*** Greg /I'rombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombcllo
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/fonns.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permitter: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPD,; S PERMIT NOE: N( '4253
PERMIT VERSION: RSR)N: 4.0
FACILITY NAME: (:amp Dogwood.' V""E"P CLASS: NV 1V-2
OW'1IIER NAME: North Carolina Lions roundzirearta Inc ()RC": (rcgory
GRADE: W .2 (flU H.A..S CHANGE
el)MR PERIOD: 112OE8 1Norrerrs
V"FRSI() :I.l
SAMPLING LOCATION: l+ FFL.,UF N'I'
rGi17 .42
t3a)9 25 Iy
IL40
1).35
I255
6845
0703
a«s No Reporftng Reason: ENFRLSE No FI<Dw.Reuse"Rccycle; ENV WIHR - No 1'Isitab
RECEI
•MET STATUS; Active
UNTli: Catawba
R()RC CER E` NUMBER: 1CPt1 9(
CENJµd t. FILES
DWR SECTIOM l"F(.1S F'ira-essid
Y fM
EiN 001 NO DISCHARGE*,
pw( \V .. No Flaw; IiGrt 1p;1No Visitation - Holiday

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNR NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 11-2018 (November 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Gregory Alexander Trombello ORC CERT NUMBER: 1005905
ORC HAS CHANCED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 12/30/2018
ORC/Certifier Signature: Gr(g Trombello E-Mail:gmetwater®yahoo.com Phone #:[phone]
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
12/30/2018
Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permitter becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
12/30/2018
Permittee/Submitter Signature:*** reg Trombello E-Mail:[e-mail] Phone #:[phone]I65 Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Labs Inc.
CERTIFIED LAB #: 50
PERSON(s)COLLECTING SAMPLES: Greg Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http:llportal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box Wm) discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

PER m rr NO.; NC0044253
FACILTI'Y NAME: Camp Doph4m4d
OWNER NAME: North Carol Lions Found:11Po
GRADE: WW-2
er)Nti,t pEF,tiOD: 10,32018 (0cmtvr 2018)
44-3,34
PERMIC VERSION: 0 TE3,3 PERMIT STATt Act[v,33
CLASS: WW- 2 COUNTY: Flam,.3,133.,
flL ORC: Gmgory A 443.x.Imict 'From! 4 21,,,) (n“,- CERT NT 11.13ER: s
OR( 11AS ANG ED:
VERSION: TO STATUS: Pfocessed
SAMPLING LOCATION: EFFLUENT DISC 11 ARC F: NO.: 001 NO DISC HAW4,1i,l,iro,N()c
52000 1 02016,,, 1
1(22010 0200,20
2 10 0,2131 I1 01'0/,
r 71
‘3,.,,,,,k3.,
, 2 12 %. trs.,,333313
1
13 ye 1. 4.41343N33433.333ty,„ :! ;2'7, 00203
21— - 10 0305
1,30201,
1 0 ,120,14
13,, .1,31 _ 34'214 — 4,if4:4 34f
: 1 ,
1 ,
i
34-
1 — ;
'T-
i i 1 i i
....._„..„r
1i
i 4
-----7
,
r-
3
7 0 433 10,
1
4
....,r,. ;
;
;
ij
' 1
,, ,,,,,, k, • ,,,,
0 00 i I ,, 1 33r
11
21° 1 11
1 ,
1 i 1
f,"" .......1
. .............,. 4,
1,
i
,
2 1 0: .3,2-12n
2 ,
*"'"' Pt:poling Reas.mc ENF R US E No Flow,RemseRecycle, EN FWD No NW:Mk:41 ,Nds3 4t433 '3,4,334430 N(g t 33V ,„ 13[3,3, Fit43; liD y No 44

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eDMR PERIOD: 10-2018 (October 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Gregory Alexander Trombello ORC CERT NUMBER: 1005905
ORC HAS CHANGED: No
VERSION: 1,0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 1 1/30/2018
1 1 /30/2018
ORC/Certifier Signature: Gre �Trombello E-Mail:gmetwaterg yahoo.com
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge.
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
lithe facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES permit.
11/3 0/201 8
Permittee/Submitter Signature:*** GreTrombello E-Mail:gtnetwater(Jyahoo.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true.
accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Laboratories
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and. as a result, there arc no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: if signed by other than the permitter. then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

IT NO.: NC0044253
ME: Camp Dogwood WWI
North Carolina Lions Foundation
el/MR PERIOD: 09-2018 (September'2018)
SAMPLING LOCA
PERMIT VERSION: 4.0 t d' IIT,«I i1. .AetA�
CLASS: W1k'- C3I s'1"k`; C ia��ka
n` O11C:Gregory xarcl r'I"rsaatP,s 1) s dC("I R"V NE j
ORC HAS CHANGED: No
VERSION: 1 I? t'> 9 TES: 0rtw.+. * d
N: EFFLUENT L SC11A1 C E NO.: 001 NO DISCITIV
Refining Reason: ENERUSE Y low,Rcuse'Reaycle; — lasiiti4dufii—:kai'vea tin t` sttncr; NF.)i k-f,iA\ C+� t'6 rvr. &tiJl�,[t3;t,i:' Ne 4'isittaF tsn - tla Fitch

IT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
. Y NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
NER NAME: North Carolina Lions Foundation Inc ORC: Gregory Alexander Trombello ORC CERT NUMBER: 1005905
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 09-2018 (September 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE {l: 7049890165 SUBMISSION DATE: 10/30/2018
10/30/2018
ORC/Certifier Signature: G g Trombello E-Mail:gmetwater a yahoo.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES permit.
Permittee/Submitter Signature:***
10/30121;
Trombello E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Laboratories
CERTIFIED LAB 4: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orglweblwq/swplps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
*** Signature of Permittee: If signed by other than the perm ittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

-
b PERMIT NOaNC 4£53
f (AL, ¥l Cm
OWNER NAME No
nIRRUmm OR
7 U\FRSI :4
CLASS: WW
Inc Rl( (ireprr, Ale
ORCHAS CHANGED: N
VERSION: 0
PERK,
:RRI. bgAm
SAMPLING LOCA ON; EFFLUENT LSC/AR(E NO.: NI NO DISCPTARGVtLN
R hWUSE =w}oR G Ae www_, Advorce ,1 qn«»=y How, HOLIDAY « m6w ;&W

NPDOPERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-2
eD,ti1R PERIOD: 08-2018 (August 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Gregory Alexander Trombello
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE ##: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 1005905
STATUS: Processed
SUBMISSION DATE: 09/30/2018
09/30/2018
ORC/Certifier Signature: Greg Tro
ello E-Mail:gmetwaterrryaboo.com Phone #:[phone]
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge.
Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part 1I.E.6 of
the NPDES permit.
09/30/2018
Pormittee/Submitter Signature:*** Greg Trombello E-Mail:[e-mail] yahoo.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Laboratories
CERTIFIED LAB ##: 50
PERSON(s) COLLECTING SAMPLES: Gregory Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

\PwJ:rs PERMIT NO NC(444253.
41"A(°II hhti. NAME: Camp Dogwood AV'A1 P
OWNER NAME: North Carolina Lions Foundation Inc.
GRADE: AlW-4,
eDA-IR PERIOD: 07-20l1 (114 2018)
PERMIT w E RSIU\: 4 0
CLASS: ASS: W W-2
OR(": Dostin Kyle: Atorescon
OR("DAS(TEAM; ED
VERSION: 'l.it GEN1
DWP, ,;
SAMPLING LOCATION: MI
PERM u"I""1A`)C`g
COI \ I`ti'. (:°:atmwlau
(:°CE;R1"NUMBER:
IDISCIIARGE NO.: 0 N() DISC:
`iv rliNC' .;.NrDW'R

NPilES PERMIT NO.: NC0044253
I.FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 07-2018 (July 2018)
COMPLIANCE ATVS: Comp t
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 08/29/2018
08/29/2018
OR i 1 ier Si nature: Dusty /Kyle Metreyeon E-Mail:[e-mail] aol.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within'24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
08/29/2018
Permittee/Su mitt Signal:*** Dusty Kt4le Metreyeon E-Mail:dmetwatcrC3naol.com Phone #:[phone] Date
Permittee Addres CSR 1849 Shen -ills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Laboratories
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Greg Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http:/lportal.ncdcnr.org/weblwq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee. then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

\FIAS Pj;R UT N(„: NC00442a3 PFR 1IT° VERSION: I 0
I'• (1I 1T1' wi,, » Camp Dereood Wt4'`)`P CLASS \SS: V \' 2
OWNER ME Nh Caroh hi ns F°°indatwc n In:t. ORC: Kyle P 1^ar
GRADE; V4WW04
ellNER PERIOD: a 2
OR( TINS C IIANC F;D:
VERSION: & 0
PERMIT STATUS: =tenve.
COUNTY: (taw
OR(° C ERT NUN
SAMPLING L )CATION: EFFLUENT DISCHAR : E NO.: OM NO DIS
*•"• No Reporting Reason: ENFRUSE '`ya$Fow,,Ret e:hrc,y...lc; ltNV N Novv„ ow =_ No How, Hot, [my
N`o L.

NF»ES !OMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FA:ILITY,NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metreyeon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CHANGED: Yes
eDMR PERIOD: 06-2018 (June 2018) VERSION: 1.0 STATUS: Processed
COMPLIAN 'TATUS: Coy . :ant CONTACT PHONE #: [phone] SUBMISSION DATE: 07/25/2018
ature: D
07/25/2018
y Kyle Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pemiittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, lease attach a list of corrective actions being taken and a time -table for improvements to be made as required by'part II.E.6 of
the NPDES permit.
07/25/2018
Permittee/S •miir' Signature:*** Dusty Kyle Metreyeon E-Mail:dmetwaterriaol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility alines and imprisonment for
knowing violations.
LAB NAME: Water Tech Laboratories Inc.
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Greg Trombello
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature ofPermittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES P. .RMIT NQ.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 06-2018 (June 2018)
Report Comments:
Greg Trombello is ORC
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metrcycon
ORC HAS CHANGED: Yes
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed

\PDES PERMIT NO
FACILITY \: NAME: Camp Ikq.400 d V W II CLASS': 1 1'-
OWNER NAME: North Carolina I.L ons, 1 ndation Inc OR('t Dustin hula. �Ecau��on.
Asa,
GRADE. WW-4, OR(" R'RAS t`11 % CE I1 No
eDNIR PERIOD: 05-2018 (Ma a 2018)
PER\'I1°I' VERSION: 4 0
%F:RtiHO:N: I o C E
D 'V°
PERNII"I` STATES:
S:
OR(` iCER`I" NUMBER:
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.. 001 NO
Reason: F\FRUS) -- tics
CH
/NCOE 3R, D rt

4
NPDES PERMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metrcyeon ORC CERT NUMBER: 11697
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 06/27/2018
GRADE: WW-4.
eDMR PERIOD: 05-2018 (May 2018)
COMPLIANCE STATUS: Compliant
ORC/Certif'
06/27/2018
y Kyle Mceon E-Mail:[e-mail] aol.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES perm
06/27/20I 8
Permitteemitter S ure:*** Dust Kyle Mctreyeon E-Mail:dmetwaterrraol.com Phone 4:704-506-4255 Date
Permittee Address: NCSR 1849 Sherrills Ford NC 8673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech Laboratories Inc
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Greg Trombello
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to he entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
** * Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.05 06(b)(2)(D).

`PDE'S PERMIT NO.: NC0044253 PERMIT VERSION; 4
FACIIIT'YNAME: Camp Dog c WWI'P (1.,ASS.'Y W-2
UV%% ER NAME: North Carolina Eio s Foundation Inc ORC: Dustin Kyle Met ve n
ORC IIAS CHANCED: V'
k,\DE: WW-4.
cDVIR PERIOD: 04-2018 (April 2018)
%FRSIOti: I.t? N F S
° SECT
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.:
PERMIT SI Al
('[?L`NTY: Catawba
ha
ORCCFRrNUMR R:
S'1A` I'S
NO DISCI
VFF lNCFCNRIDWR
*.." No Reporting Reason` ENFRI,SE — Nu Flnm�h"�ensetR .;y¢:te: Li4�a'v`4�'C)tl. = ":r Y`assY�Ktu& u - e r3�ct:�va ro ea�h�u; NOH,ObAF No How. 1101,1D,\1' _. Holiday
OFFICE

NPDE. PERMIT NO.: NC0044253 PERMIT VERSION: 4.0
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metreyeon
GRADE: WW-4. ORC HAS CHANGED: Yes
eDMR PERIOD: 04-2018 (April 2018) VERSION: 1.0
COMPLIANCE STA i Compliant CONTACT PHONE #: [phone]
ORC/Ccrt
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 05/30/2018
05/30/201 a
re: Dusty KyI Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part 11.E.6 of
the NPDES permit.
05/30/2018
Permittee/Submi ignature:*** Dusty Kyk6 Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: R 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech Laboratories Inc
CERTIFIED LAB #: 50
PERSON(s) COLLECTING SAMPLES: Greg Trombcllo
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orglweb/wq/swp/ps/npdcs/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit Ibr reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 28
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0044253
FAC1iITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 04-2018 (April 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CHANGED: Yes
VERSION: 1.0
Report Comments:
The ORC changed on April 1, from Dusty Metreyean to Greg Trombello.
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 04-2018 (April 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CHANGED: Yes
VERSION: 1.0
Report Comments:
The ORC changed on April I, from Dusty Metreyeon to Greg Trombello.
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed

NIAES PERMIT NO.: NC0044253 PERMIT vERSK": 4 li PERMIT STATUS: ,Aolve 6,6
F6,11,11,1TY NA,ME: Camp Dorwood WWIP CLASS: WW-2 F „,,,FD cotf SFR': Catav,,Pa
OW \ER NAME: North Carolina Lions Foundation Ine ORC: .Dostin f:334a3 kotetreyeurl "'"' OR( Cl'AT NUMBER: It 697
G WADE: WW-4. ORC flAS COANCEI): Is4:, NC, 6 i :. :20)8 RECCiVEDINCDENARMR
OMR PERIOD: 02-2018 (Febrt.ory 20 I ./1)
12
211
VERMONT U CEN ,,L HIES
DAR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE Na: 001 NO DISCHARGE*: 143ROs
mo R E S V! L L G NAL COP C,E
. k1110
„ 1,484 dock
4557
120 211
011.40
1520
1242
0945
1125
22430
1500
10t
10
144,441444y .,tivego,
M,444444y 0464,v4/4,
0 CC
6666-6
44410 444,04,44or
4040 Mkok5kkon,
(.1* 1 11161.6. 1,
X 4,21kk. '44416
(OP
041421 . 0444
1.11 55544,
DOM 04416.0
sTNTIS:. Proces3t3d
04510 04445
• 2 X 444,4
(it 0 GIN4114
044L4144404`.. Coot
5 20
1141)7;',
55" No keportinK ReAson. fiNIAITSE 6 No Flow-Rcuse,,itcyy4 4°5 11114411TY:W " 1104,44444, Weatkei. 011111.421111 0, l,, HOLIDAY 033 Visnavioa -l110y
Wee44,
r0.44 BR

NF1;ES PERMIT NO.: NC0044253
FAuILITY NAME: Camp Dogwood WWTP
01WVNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 02-2018 (February 2018)
COMPLIANCE STATU:: C mpliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CHANGED: No
VERSION: 1.00
CONTACT PHONE #: [phone]
ORC/Cer if' L ignatu Dusty ,Kyle
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 03/30/2018
etreyeon E-Mail:dmetwater@n aol.com
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
03/30/2018
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a List of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe
03/30/2018
Perms W ubmitte Signature:*** usty Kyle Metreyeon E-Mail:dmetwaterrraol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/pslnpdcs/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Perrnittee: If signed by other than the permittee, then delegation of the signatory authority must be on tile with the state per I5A NCAC 213
.0506(b)(2)(D).

\PDES PERMIT NO.: NC0044.253
FACILITY NAME: Camp Ilswpod
OWNER NAME: North Carolina LAoris Fount:anon In
GRADE: WW-4,
elIMR rEittoo; 91-2.)
anuars
PERMIT VERSIO
(*LASS:
ekiVED
ApR 9 2016
04442 iyup,,,
ow if ( \id 1E,IsirRAL FILES
DVVR SECTION
I RSIOA
PERMIT STATUS: \itiue
COI N°1`11: Catawba
OH( ERT Ni 697
S `S: Prirce,,Ned
RECE ED:0\1C: %..EN R/D104, R
SAMPLING LOCATION; EFFIALIENE DISCHARGE NO.: 001. NO DISCHAl.WL*: NO
oFF-,10E.
Ittiktti
ith
ptlY fltitttilitti ,t),(;)1 , t om-
it.
ttilp.,11`1 doll c
titti tAttitt.
i”
titmititti itit,
that Mitt...
W
'irahgth
VMS, Cow
tit
„ t
***:. No Repo:ming R0415011:1 NFRISE No 1 1011„.01V 1iow, 1(11 Visitliaco - lohday

NPDES PERMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Mctreveon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CIIANGED: No
eDMR PERIOD: 01-2018 (January2018) VERSION: 1.0 STATUS: Processed
COMPLIANCTUS: Comp! CONTACT PI IONE 4: 7045064255 SUBMISSION DATE: 02/26/2018
02/26/2018
ORC•ICd tifj(er Signature: Dusty Kyle Metrcyeon E-Mail:dmetwaterrraol.com Phone 4:704-506-4255 Date
By this signature, I certify that this report is accurate and complete to the hest of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance That potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the lime the permittce became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittce becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part 11.E.6 of
the NPDES < it.
02/26/2018
Perm t e/Submitter Signature:*** Dusty Kyle Metreycon E-Mail:[e-mail] aol.com Phone 4:704-506-4255 Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of taw, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB II:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by '.isiting http://portal.ncdcnr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Pcrnittee: If signed by other than the perntittee, then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0044253
FACILITY NAME: i:aim 17ngtiseood
OWNER NAME: North Carolina Lions Foundation
GRADE: WW-4
eDMR 'PERIOD: 12 20 h2 Ooatr:he*r 20
SAMPLING LOCATIO:
PTRMI I A FUSION:.I+! IPERMIT51 ATI>S: , civs
('IaASS; Ll \\ RECEIVED ((11,1 I"ti'. Cat:rwh
(1ti(`, Iaos:y ,I 1 ;, I)RCCERT VIAMER:
j
( IR( II % ('11 %\CIA): `:i
CENTRAL FILES
A FI(Iat DWR SECTION
•••• No Reporting Rcasvni ki:NF1;(Sflb - ti d I�€u •tl{c+a r �1 .t';y-t,il:.. t >ailk 9 �i Wi. az k rai
1I1S41'1-yAR(E NO.. 001 NO 1)15(
7
z;NO , IC ,,.

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 12-2017 (December 2017)
COMPLIANC cTATUS: Complia t
PERMIT VERSION: 4,0
CLASS: WW-2
ORC: Dustin Kyle Metreycon
ORC HAS CHANGED: No
VERSION: 1 0
CONTACT PHONE tl: 7045064255
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 01/29/2018
01/29/2018
ter Si, ature: Dus Kyle Metreycon E-Mnil:dmetwater rr,aol.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the hest of my knowledge.
The permittee shall report to the Director or the appropriate Regional Oflice.any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pcnnittec became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittce becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
01/29/2018
Permitte/ T mitter S ature:*** Dus y Kyle Metreyeon E-Mail:dmetwateraaol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford N 28673 Permit Expiration Date: 04/30/2020
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit (9191 807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/pslnpdeslforms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and. as a result, there arc no data to he entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittce, then delegation oldie signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NCOO442i
FACILITY NAME: Camp Do(ay.••ood 'TP
OWNER NAME: North Carolina Lions Foundarrun
GRADE: WW-4.
eDMR PERIOD: 11-2017 (Novcm( e 2b17)
REC
D
cm( ,,,L,icENTRAL FILES
DWR SECTION
""s No Reporting Reasor r.FNFRUSF: No Flow-Re+trrfRe ,
FF: PaIIT 4T`ATL S: Vc6ve
el,„)t NTV Catawba
ORC C ERT NUMBEIIt 11697
i CHARGE*:

NPDES PERMIT NO.: NC0044253
FACILITY. NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 1 1-2017 (November 2017)
COMPLIANCE STATUS: Com .liant
ORC/Cent j ' 'gnat e: Dusty
PERMIT VERSION: 4
CLASS: W\V
ORC: Dustin Kyle MetreE cirn
ORC HAS CIIANGED: No
VERSION: 1.0
CONTACT P110
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
#: 7045064255 SUBMISSION DATE: 12/22/2017
12/22/2017
yle Mctreycou I:-Mail:drnetwuter?rraol.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best allay knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from Met ime the permitter became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the,permittee becomes aware ofthe circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time-tablefor improvements to be made as required by part 11.E.6 of
the NPDES permit.
Permittee/Submitter
Permittee Address: NCS
12/22/2017
re:* ust) Kylc h treycon i;-Mtail:dmetwatcrrii)aol.com Phone #:[phone] Date
Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the infbrrnation. the information submitted is. to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information. including the possibility of fines and imprisonment for
knowing violations.
CERT1F1liI) LABORATORIES
LAB NAME:
CERTIFIED LAB tS:
PERSON(s) COLLECTING SAMPLES:
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
lOO'I NOTES
Use only ;units of measurement designated in the reporting facility's NPDfiS permit tbr.reporting data.
* No FIow/Discharge From Site: Check this box if no discharge occurs and. as a result. there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2E
.0506(b)(2)(D).

N PI)ES PERMIT NO.: 'N4
P1=:I0I11' 0 1.Ittil(i�';
FA(,1IMI' NAME: tampDo ood!h'4'I`F
OWNER NAME: North Carolina Lions Fotamrtllttion Inc
GRADE: WV -4.
eDNIR PERIOD: 10-20 i 7 (October '2(} 17)
12
44
IS
14
17
r9
24
29
34
CLASS: 144 V' „°
(IR(' I IA Si ltN(4h.I1_ ?5ia
SAMPLING LOC,- "I'II.)N. EFTI
1140
1440
1230
1120
10
1000
1242
1444
14 40
16,40
IOW
444
1423
..r. ,No Reporting Reason
311,114444 4,erag,, I.Os
w 4,v,
Daily 0ansimnnn;��...,,
f +4si
24 4,
NO DISCHARGE*: NO
No 19ow-Reuss. Rcr: o}e, I, slap l.1 V, No 0 'ec; )1it1.I0) V ` No Visit:lrin-I01i y:

NPDES PERMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FA4ITY NAME: Camp Dogwood WWTP CLASS: WIN2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Mctrcycon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CHANGED: No
cDMR PERIOD: 10-2017 (October 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT I'IIONE #: 7045064255 SUBMISSION DATE: 11/28/2017
ORC/Cer
11/28/2017
nature: Dusty Kyl Metre) eon E-Mnil:dmctwater,naol.com Phone #:[phone] Date
By this signature,) certify that this report. is accurate and complete to the best ()fray knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall he provided orally within 24 hours from the time the permittce became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the pennittee becomes aware ofthe circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
Permittee/Submitt
11/28/2017
nature.. Dusty Ky)' Mctreyeon E-Mail:dntetwaterg,aol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
PARAM L'1'ER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swpfps/npdesfforms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit For reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and. us a result. there arc no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittce. then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDE.,PERMIT NO.: NC:OO44,25.1
` AC.II ITY° NAME: Camp Dogwood
OWNER NAME: : North Carolina Iron
GRADE: WW-4.
eDMR PERIOD: 08-201 (Au ;u t 01
PF:101F"1' �9tilt,'I
PEWMLI`"T
ty1.NTY:ri��
ORC CER`F NUMBER:
�.57:1l1.r"a: Processed
t 1;'t<° P k ION
SAMPLING GCAEFFLUENT DISCI] .<1RC; I. N ).: 001 N() DISCHARGE*: NO
•••* No Reporting R
OR(' 111,S C: II iiN p1
VERSION: I.li CENTIN
n:ENFRId51:° No Flow.ldoias�.'R,o cli. I'41.1"4'fPl, VisixiS4crPr-l-�iulerl

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 08-2017 (August 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Mctrcycon
ORC HAS CIIANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 09/29/2017
09/29/2017
OR 1 erti'rer gnature: usty Ky]e Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public liealth or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
09/29/2017
Permitt= itte Signature:*** Dusty Ky]e Metreyeon E-lvlail:[e-mail] Phone #:[phone] Date
Permitte- tress: NCSR 1849 Sherrilis Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPUES.PERMIT NO.;, NC 044253
FACILITY NAME: Camp Dogwood W'PJ"CP
OWNER NAME: North Carolina I,.ions J etart
C'RAUE: W -4,
e)MR PERIOD: 06 2017 (June 2017 )
PERMIT VERSION: 4.0
(:'LASS: WW-2 . E C F lC D
ORC: Ertactin4'Se 59c`I'c fain
ORC HAS CHANG
0 : eU)1
PERMIT STATUS: A
COUNTY: Cara b.
ORC CER.T WORE,,I
VERSION: 1CENTRAL FILES STATUS: Prtxea d
DIAIR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*;
**'• Nu Reporting Rca.son ENFRUSE w No Flow-Reuse/Rccycic; ENVWTI
Advcr c k1 tither, NCfFLOW 4 No Flow. HOLIDAY -No \'isi
id

NPDES\PERM1T NO: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
)WNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metreyeon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CHANGED: No
eDMR PERIOD: 06-2017 (June 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 07/21/2017
OR/C
07/21/2017
ature: D sty Kyle Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES permit.
07/21/2017
?er mitter Signature:* * Dusty Kyle Metreyeon E-Mail:[e-mail] Phone #:[phone] Date
!'::rmit a A. +ress: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orgiweb/wq/swp/ps/npdcs/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5ANCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDFS PERMIT NO.: NC0044253 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metreyeon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CHANGED: No
eDMR PERIOD: 06-2017 (June 2017) VERSION: 1.0 STATUS: Processed
Report Comments:
Wednesday 6-27-17. No visitation, family emergency....plant was visited within same week on Saturday 7-1-17. My understanding weeks are Sunday thru Saturday. This report
will not allow me to include Saturdays visitation. Onsite 0950... flow .001...hrs .25...ORC on site.

NPDES PERMIT NO,: "NC53
PERMTT 4 E.RSIO\ A.ci
FAt�It,ITY NAME; Camp Dogwood WWTP CLASS: "h IA'-?
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kv`lc Mctrcycon
GRADE: WW-T. t RC HAS CHANGED: No
eDMR PERIOD; 05-20i 7 (May 2'017)
VERSION: 1,0
SAMPLING LOCATION: EFFLUENT
PERMIT" STATUS: Active
VE D COUNTY. Catawba.
CENTRAL
DWR SEC.
SCIIARGE NO.: 901 NO DIS
ORC CERT NUMBER
** "* No Reporting Reasons ENFRUSE No Ftcaw.Rcusc/Rcc'=cic, EN'\ WI HR No Vitita?ion dYe s%" 2Gihcr: NJF
STATUS: Processed
2 X month
Grab
MMU-' . Com
DAY = No Visi
— Holiday
orr, to

NPDES PERMIT NO.: NC0044253 PERM1T VERSION: 4.0 PERMIT STATUS: Active
A(:1LITY NAME: Camp Dagwood WWTP CLASS: WW-2 COUNTY: Catawba
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Mctroyeon ORC CERT NUMBER: 11697
GRADE: WW-4. ORC HAS CHANGED: No
eDMR PERIOD: 05-2017 (May 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compli. CONTACT PHONE #: [phone] SUBMISSION DATE: 06/23/2017
ORC/Certifier S
06/23/2017
y Kyle etreyeon E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
06/23/2017
Permittee/Submitter Sign•OF Dust• Kyle Metr yeon E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: NCSR 1849 S rd NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature ofPermittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NP1 +:4 PERMI:1` NO.. NCO 4 PERMIT VERSION: 4.
FACI1 1"'1 NAME: Carrt}i Ditgwoac
OWNER NAME: North Carotin i
C:R WW'-4.
eDMR PERIOD: t : 1017 (Mar(h't'lF
CLASS: \ \\
()RC: Dustin In Motcoo
()RC HAS CHANGED: ED: No E', *
VERSION: f.ii t +}rtu`R
'ER\lIT STATUS: Active
INTVa Catawba
ORC CERT NLMKE„R: 'I [697
:ec
SAMPLING LOCATION: f;I FI C ENT DISCHARGE NO..: 001 NO DISCHARGE NO
.,:i V,,) ik OFFICE
SHAN Cam
11,0
Moaivalk n,eem.. OM
,i. oi.mutmo
tr
*=r^" No Reporting Reason: ENFKisrt mieiv..l'itetisettee elt°. 1 \Ck61 F1'I"t r No ..
Grab
Cent

NV% tS MIT NO.: NC0044253
FACILITY NAME:Camp Dogwood Vi/WTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 03-2017 (March 2017)
COMPLIANCE STATUS: Compliant
„,/
ORrertifi Signatur
PERMIT VERSION: 4,0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CHANGED: No
VERSION:1,0
CONTACT PHONE #: 70
PERMIT STAFIS:Acuve
COUNTY: Catawba
ORC CERT NUMBER: ' 6
STATUS: Processed
164255 SUBMISSION DATE; 04/28/2017
4 ZS'
04/28/20 1 7
Dusty Kyle Metreyeon E-rvkiil.dinetwater@aol,com Phone #[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.,
The permittee shall report to the Director or the appropriate Regional Office any noncompliance Mat potentially threatens public health or the environment,
Any information shall be provided orally within, 24 hours front the time the per mittee became aware of the cireu.mstanees, A written submission shall also be
provided within 5 days of the time the permince becomes aware of the:circumstances,
II the facility is noncompliant, please attach a list of corrective ;Actions 'being taken and afor irnpros,e.
the NPDES oermi
-e:*** Dusty Kyle Mettcycon E-Mail:dinetwater@aoLcom
made, as required by part 11E6 of
04/28/2017
Phone #:[phone] Date
Perrnittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit E,xpiration Date: 04/30/2021)
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly, gather and evaluate the ntom-nation submitted, biased on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the inforniation, the information submitted is, to the hest of my knowledge and belief, trite,
accurate, and complete. I am aware that there are significant penalties for submitting, false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LA F3ORATORIES
PARAMETER coin
'Parameter Code assistance may he obtained by calling the NPDFS Urn( t 919 807-6300 or by \ig'
p ;I/porta cden org/we b/wq/swpipsinpdes/forms,
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDFS permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge UCLUI iiid, a a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
ORC on Site?: ORC must visit facility and document visitation of facility ts required per 15A NCAC 8G .0204s
*** Signature of Permit -tee: If signed by other than the permittec, then delegation of the signatory authority must he on file with the state per 15A NCAC 2B
.0506(b)(2)(D).-

N!,'DES PERMIT Na: NC0044253
EkCILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina011S Foundation Inc
GRADE: WW-4
eDMR PERIOD: 02-2017 (Fehruar) 2017)
PERM] r vcusioN: 4m : „
rIRMIIT STATUS Actiko
CLASS: W‘V-2, (101!Nrc.:calawba
a 0 8 0
OR(:1)u,im Ky0c Mctrqeon ORC cERT DWP
OK( HAS CHANG VD: N“ CENTRAL FL,ES
DWR SECTION
vERSION: I STATCS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 1 NO DISCI'
. :
1 IL
&,.
9,p,1 tk91 c
R0;0 WOW .00,00
COMO • COfiti!. c05.,14) 31614S
Mt
-%tokly Wc<kly
Chub Grab 3ra Grab Grab
Cfli.ORiNE , Ni13-N Com< r!Z!",i ' frOLI tiR
!<0 tutT21 09,11
Ok <
e
<
6 i
• 701.091
•
< 0 2 <
Monti -Ay Artrage
t25
Mutt A1419.91199 00;
, I
i.!!aat) Mar, )(XII
No Repoaing Reasott ENFRI SE No Flow-Roisdkecylc\' 1 1 IR 'Osito.siorl Ad 99 W99Aitik99 NOULOW .9` No 1ow 111U rmy Vislunitm

ES PERMIT NO.: NC0044253
LITY NAME: Camp O gwntta
OWNER NAME: North ('arolina. Lion
GRADE: W'W-4°
eDNMR. PERIOD: 02-2017
uy
COMPLSTATUS: C ban
OR
PERMIT VERSION; 4 0
OR(': Dust ia Kyle Mt'treyenn
ORC 11AS (.,'EfANG-ElI' ,No
VERSION: RSION: 1.0
CONT.A.Cl—PI ONE.
h'letrelt^ore
PERMIT STATUS: Active.
COUNTY: Catawba
ORC CERT M. 41BER: 1 Iht37
S"1'A'EUS: F'rc,ecssed
SUBMISSION DATE: 27/2017
03f27/2017
il_dtnetca,ttcr0L'uuol.coin Phone #:[phone] Date
By this signature. I certify that this report is accurate, and complete to the best of my ktaoss'Iedgc.
I"Ite. }permittee shall report to the Director or the stppropriatte Re .iomat Office any ncmc0mpli
Any informationshall be provided orally within 24 hours tr
provided within 5 days of the time the pertn'ittee becomes :,t
If the facility is noncompliant, please attach a list of coiie,1la0 ,lc 0011s being token and a time-aahle ft
the NPDES
Per
Perrnittee
the time the perm'.
Kyle A+l c ": r e s` t' n
at lscalenlially thri.aatcns ,public health or the environment,
c of th.. oi'rcurtsstances% A written submis.sion. shall also be
nts Lta be made as required by part 1I.E,6 of
7/2017
zd:cduictwa+ter(r?',tul,caam Phone #:704
NCSR 1849 Sherrills Ford NC; 286-73 Perirr;u Expiration I)atte; 0413d)/;
1 certify, under penalty of"law, that this document: and all attachments were prepared under it
to assure that qualified personnel properly gather and evaluate lli information submitted. Based on my in
system, or those persons directly responsible for g:
accurate, and complete, 1 am aware that there are stet
knowing violations..
LAI31S ME:
CERTIFIED CERTIFIED LAR #:
PERSON(s) COLLECTING SANIP.
vision in accordance
y6-4255 Date
yst
designed
of the person or persons who ntanaaged the
ion, the informatitin submitted is, to the best of my knowledge and belief, true.
1 penalties for subni1111 g, false information, including the possibility of fines and imprisonment for
Al3ORATORII7S
l'AR;-1MIi'VI 1. CODES
Parameter Cnde assistance may he obtained by calling the NP111,S [Unit (11101 5)17-6300 or by v
Use only units of measurement deslgnaled
* No Flow/Discharge From Site: Check this box it n
for entire monitoring period.
* ORC on Site?: ORC must visit facility and rlocana
***Signature of Perntittee: If signed by other than the permitter% them dclmpl.
.0506(h)(2)(D),
lectern, /webJwq/swp/p /npdesltorm.,.
NPDI"S 1'tet Wait fsrr r p€rt tar'tg d°tta.
a reskrlt.:her<°.
f the parameters on the DIM
NCAC 8(1 .0204,
be on Ole with the state ocr 15A NCAC 2B

NNI)F'a NERi 1E ° f+ 0.; NCO )44253
EACH.. E1'Y NAME; Camp uod
OWNER NAME; North (
GRADE: WW-4,
clMR PERIOD: 01-20t7 (Jan
7
PER: 111'I° "t"RSI
(`LASS: W
OR(" OAS ('F01\
VERSION: I0
SAMPLING LOCATION: EFF.LI EN`
i3g Reason. L.;AER(`tipP
R
POI M
R E
Co
MAR 2
Iw H LE S
Ti NSrA-I'li`i; Processed
F 1441`)" SI ti"I!`S: Active
`OUNT Catawba
R: 1 E( 7
F NO.: 001 NO DISCHARGE*: N
tdic.i.r V,1`t-ahea". A
C0630

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Carnp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 01-2017 (January 2017)
COMPLIANCE STATUS: Compliant^
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Dustin Kyle bletrcycon ORC CERT NUMBER: 11697
ORC IIAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PIiONE #: 7045064255 SUBMISSION DATE: 02/27/2017
02/27/2017
ORC/Certifier SDusty yle Met cyeon E-Mail:dmetw•[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permitter became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES permit.
Permittee/Submitter Signat
02/27/2017
yle Metrtsyeon E-Mail:dmctwaternaol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information. the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete.' am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES pennit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and. as a result. there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 80 .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation oldie signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPOES7 'PER MIT NO.: NC004,12:5.3
FACILITY NAME: Camp DoworoodWWIP
klER NAME: North Carol Ma 1our-dal:on Inc,
GRADE: WW-4...
eDMR PERIOD: 12-2016 Wercrobor 2016)
PERMTI EFISION: 4.0
CLASS: OE,7.
CHIC: )tut IMeirm eon
OK( DAS ClIANCED: No
VERSION: I o
SAMPLING LOCATION: URA TNT
44
74d H r. 2.40(5 .14,6
1650
1345
20.5 2.5
0 ' 10 25
3i
020 20
03)0
330 33
1240 .25
(400
1.345 25
440
13.40
0460
102t.)
3045(1
ITI(N1'111‘' Ac1":.
FEB 0 8 20
10ficcg,Rr 116(47
CENTRAL ,Titis; processed
PWR SEOTPON
woRos
DISCHARGE NO.: 001 NO 1SE NUOFRCE
12:200.1.4x2xxx Canb
22
flEMP-t:
0 23 .2332
00 I
230
X 00
M3ptit0 :3.:3X3w3
02
22
313:11#0,
1(3;313.31s...: 0 to
We. Mini:n20
um
*"* No Reporting Reason: ENERUSE Flow,Rease:Ree>c IR - No Vomaron
00
fPx3:3:: 020300
601
.10
00303
4.4
02003
0.3:1:13
Grab
—2-
2202 row.
00
, 2 5
020002. 'VI: ex I her, r1„0\V No 103,, rIO IDAY Vkitati:on Holiday
302%
Grab

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
,f
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 12-2016 (December 2016)
COMPLIANC TUS: Compl
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Catawba
ORC: Dustin Kyle Mctrcyeon ORC CERT NUMBER: 11697
ORC HAS CHANGED: No
VERSION.: 1.0 STATUS: Processed
CONTACT PHOI E #: 7045064255 SUBMISSION DATE: 01/27/2017
ORC/C:'•r Sig' attire: Dusty/ Kyle Mctrcyeon E-Mail:dmctwaterrraol.com Phone 4:704-506-4255
By this signature,' certify that this report is accurate and complete to the best of my knowledge.
01/27/2017
Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permitter becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective act' i s being taken and a lime -table for improvements to be made as required by part 1I.E.6 of
the NPDES pe
01/27/2017
tgnature:r* Dusty Kyle Mctrcyeon E-Mail:[e-mail] Phone 4:704-506-4255 Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http:/lportal.ncdenr.orglweb/wq/swp/pslnpdeslfonns.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 80 .0204.
*** Signature of Permittee: If signed by other than the permitter, then delegation afire signatory authority must be on file with the state per l5A NCAC 2B
.0506(b)(2)(D).

NPDAS PERMIT NO,.: NC:0044253
FACILITY NAME: Campogwood WW`TP
OWNER NAME: North Carolina Lions Eou'ndutooc: Inc
GRADE: WW-4,
eDMR PERIOD: 107221 V 6 (October ctober 2016)
E:RSIO' d t
PI.R %1IT STATUS: Active
R 1 [697
SAMPLING LOCATION: FFFLIJE.NT DIS['IIARCIE Nf : 001 NO DISCHARGE*: NO
pertlflg Revsonr t`.NE'RI
RE JE V ED
DEL 0 5 `Q!h
CENTRAL FILES
DWR SECTION

NPDEI PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 10-2016 (October 2016)
COMPLIANCE: Com.liant
ORC/
PERMIT VERSION: 4 0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CIIANCEI): No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORGCERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 11/29/2016
11/29/2016
e Metreyeon E-Mail:dmetwateraaol.com Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
lithe facility is nonco
the NPDES perm
, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part I1.E.6 of
11/29/2016
PermitteelS bmitt Signs ore:*** Duriy Kyle Metreyeon E-Mail:dmetwateraaol.com Phone #:[phone] Date
Permittee Addre : SR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information. the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false intbrtnation, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/wcblwq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site: Check this box if no discharge occurs and. as a result, there arc no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the perntittee, then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NOd NC0044253 PERNIFF VERSION: 4 0
Fl%crinl" NAME: Camp Doovood WWTP CLASS: WW-2
OWNER NAME: North Carolina Lions Foundation Ino ORC: Doom Kyle Metroyeon
GRADE: VVW-T ORC DAS it:DANCED: No
ItIDAM PERIOD: 09-2016 (Serttehber 2016) VERSION: 1
3
PERMIT ST-VIUS: Active
O( Cartrxha
NO V 0 7 2:01@ OR( cF:wr N LAMER: 11697
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
10900 25
09.50 _49
42125
1105 .25
21t110.5 .25:
1020
11200
630 29
)450
tO2i1,
101.1110 M941641 OJl 0610 COftila
3 1Wee1.9. WeAli weekle
InStaM OM 4000_ 406
\IP-ft3431
:dee e so
Month Nvitraftt ii it,
Mentliti tiNeraget
3--
nxixxittor
aily Minimum,
001
12 \ week :44202ily 2 X 020,00
itati
20
K
16,9b Grab
Weekly:
914(i7iF. J4914 -3 N - Com 114,,1.35: - Cone
4101. intiet 621911int
14 33 143
0 24
(3 782
'11'1' No R.eporting Reason: ENFRUSE 4o 1lo Reu, Rec1 949 19 33349 94 Vosilation. Adver 04 p9» Ni 'FLOW No 1- .1 3994 No Visjuitiort
10 )4
9 7
13 3
0 7

N DES PERMIT NO.: NC0044253
} CILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 09-2016 (September 2016)
COMPLIANCE: Compliant
ORC/Certifier
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreyeon
ORC HAS CIIANGED: No
VERSION: 1.0
ONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 10/28/2016
Kyle Metre eon E-Mail:dntctwateraaol.com Phone 4:704-506-4255
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
10/28/2016
Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pennittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attacl a list of corrective actions being taken and a time -table for improvements to be made as required by part 11.E.6 of
the NPDES permit.
P; rrnittee/Submitter Sign '* Dust
10/28/2016
Kyle MetreyeCon [e-mail] aol.com Phone 4:704-506-4255 Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of -my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting lttip:/lportal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and. as a result. there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the perntittec, then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

^a DES P R 4 N(it., NC`t?C)4 4253 PE R Rt1 i' "64lttit()N: 4
FACILITY NA 1l:: (n i7� x��c r�<! \VW'II� CLASS:
OWNER NAME: North C:rr'olina Lions Foundation Inc. OR(": I)us
(GRADE: WW-T OR( 1IASL"44Ay(. EIE A<<
tDAM PERIOD: 08 20I6(August2016) VVICSIC)N: Imo(1
I"I;It.til4"I`ti'I,�hIS: Act+ve
ciitaw he
OR(` CER'1' NI-AIBFR: I I ri7
as
SAMPLING LOCATION: EFFLUENT t' ISUHAW NO.: CtliI NO DISC ARCE*: NO
soy' t-\I Rta4°: No 11or

Use only: units ot'measurement design:
* No Flom Discharge From Site: Check this hox
(a r a nti moniLLtorin;g period,
ORC on Site?: ORC must visi4 t cilrty and da
*** Signature of P'ernaittee: If signed
0506(h)(2)(I)},
NPI)TS PERMIT NO.: NC004 4253
FACILITY NAME:, Camp Dogwood WWII,
Pr
ar
OWNER NAVE: Nortl CaInIina 1Msr�ns Found
CR.AC)E: WW-4.
PERMIT \ 1 RSIO\: t t;
CLASS: WW „?
ORC: Dosttn kyle- Nt.110 <<n1.
ORC IIAS r 1t.•vy(:I li: N„
e1)>1R PERIOD; 0S-20t6 (August2i16p VERSION:
C.:O MP \CI Co
Signa
F3v this signature, I certify that this re
Ct) v 1 ' (°T Pl lO' E 9.
PI
The permitlee shall report to the 'Director or the app. prixtc y noncl)rtapliauce than patemi.
Any information shall he provided orally to itlain 24 hours from the r
provided within. 5 days of the time the permittee hee:aar
If the facility is noncompliant, please attach a last ol'ec
the: NPDES
Pe
Pero NCSR 18.49 Sherrills Ford
, under penalty of law, that. this document and till an acl
x3sure that qualified personnel properly gather and evaluate the
system, or those persons directly respons
accurate, and complete„ 1 am aware- that t
knowing violations.
LA [i NAME:
CERTIFIED LAB #:
PERSON(s)COLLECTING SAMPLES:
r"In ince hecam4 aware
tanc:es,
be taaken a+rtlat tlraaettahle
gathering the inlornrallt
1-rkl;til:dinetwater(ri:a.ol
10/20 (l
e prepared under my direction or sit
M',�11Z�1N1LIl.1{ t tl.l)L.S
Parameter Code assistance may he obtained by calling the 'N91)1 I nit 1911)) 807-63(III or by rig
INtoits
;r,aalt tarr
e occur and. rr result, there: are
111it' tr: r•e'
l Ihe°
city m
'rP
O 1(i
'quired by part ILE.(i of
npdes/tonns.
he DNIR
5A NCAC 211

Scott, Michele
t :} Cimetwater
RE: Metwate
e,g4t. /VC
would just put in th
SWri
From: dmetwater [mailto:dmetw
Sent: Monday, October 03, 2016 8:50 AM
To: Scott, Michele <michele.scott@ncdenr.
Subject: RE: Metwater having trouble with
thank you.. what about hci
Dusty
Surat from m
11
irtp
-------- Original message ------
From: "Scott, Michele" <nmic
Date: 10/3/16 8:38 AM (GMT-05
To: dmetwater <dmetwater'a 1
Subject: RE: Metwater having trouble with. EMIR submittal
had a glitch in tape system.
er@ aoI.corn]
gov>
EDMR submittal
? V\ill 1 he noncefnrhlient.'
c
Good Morning Dusty,
Not sure what's going on there but deleted the August report. The sta tr showed Validated You can start over
now and create a new August report.
Michele
From: dmetwater [mailto:drnetw.Gat'
Sent: Friday, September 0, 2016 4:1
To: Scott, Michele <michele.scot
Cc: SVCeDMRadmin <elDMRacirr°m
Subject: Metwater having trouble with E
R submittal
Michele,
The program will not allow me to make an Awn
there is already one submitted but it eanls Ala.
reports... just this one.
«d. When 1 tr
o tr able:
1 left u a voice mail about 230 earlier. 44253. ny 1e Ip would be rppreci:rtcd.

NPDES PERMIT hO..: NC0044253
FACILITY NAME: Carnp Do
OWNER NAME: North Carolina
GRADE; WWI'-4.
el➢h1R PERIOD:
PERMIT '«'E:RSIO\`.
CLASS: §'SA
(MC: I)uS9tri F:cVL y1 u
ORC I IAS CHANGE
F:RSION: I
SAMPLING L©CATII N: EFFLUENT n1SCUARGE NO.: 001
Mtnr is AN4040 Limit
1 .Itk S, Avotagt..
Dinky Mmiinueeez
Oinl'g Minimum:
""•" No Reporting Reasorr NIRd SEe= iitoP'Ictw -R t�ise'R wt;le le."w0'S.l''i'11R No V'Ws6iattoo ; ri disc "t'euthc€, ^,ktt''1 (1 = Pact -w
wQRo
SCI ARGE*: NO

NPDES PERMIT NO.: NC0044253 PERMIT VERSION: 4.0
FACILITY NAME: Camp Dogwood WWTP CLASS: WW-2
OWNER NAME: North Carolina Lions Foundation Inc ORC: Dustin Kyle Metreyeon
GRADE: WW-4. ORC 1lAS CHANGED: No
eDMR PERIOD: 07-2016 (July 2016) VERSION: 1.0
COMPLIANCE: Compliant CONT tCT PHONE #: [phone]
ORC/Certifier
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed
SUBMISSION DATE: 08/30/2016
08/30/2016
usty K le Metreyeon E/fail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pcnnittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a List of corrective actions being taken and a time -table for improvements to be made as required by part ILE.6 of
the NPDES pe
08/30/2016
Permit 'bmitter k • Lure:*** %usty Kyle Metreyeon E-Mail:dmetw•ateriPaol.com Phone #:[phone] Date
Permittee Address: NCSR 1849 Sherrills Ford NC 28673 Permit Expiration Date: 04/30/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:
CERTIFIED LAB #:
PERSON(s) COLLECTING SAMPLES:
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portaincdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: if signed by other than the pcnnittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0044253
FACILITY NAME: Camp Dogwood WWTP
OWNER NAME: North Carolina Lions Foundation Inc
GRADE: WW-4.
eDMR PERIOD: 07-2016 (July 2016)
Report Comments:
First EDMR submittal.
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dustin Kyle Metreycon
ORC 1IAS CIIANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 11697
STATUS: Processed

NPDES PERMIT NO.
Facifity Name:
Operator in Response
Certified Laboratory (1):
Effluent
NC0044253 Disci -large No.
Camp Dogwood
rge (CRC): Dusty Metnavean
Water Tech Labs. Inc
CNECK BOX IF ORC HAS CHANGED
Mail ORIGINAL. and ONE COPY to:
ATTN: CENTRAL, FILES
DIVISION OF WATER Clown"
1617 MAL SERVICE CENTER
RALEI€ I4, NC 27N19.1617
0
c )1_ Month: ±. Year
Class: II County:
Grade: IV _ Phone: [phone]
(2)
COLLECTIi'`uAl49P'
TO THE BEST OF KY KNOWLEDGE.
E
DATE

Facility Status: (Please check one of the following)
All monitoring data andsampling frequencies meet permit requiremen
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet pet
ui
Compliant
Noncompliant
If the facility is noncompliant, please attach a list of corrective actions being taken and a tame-tabk for
improvements tt be made as required by Part Il.E.6 of the NPDES permit.
under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsibie
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations."
to
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory (2) Certifrcation No.
Laboratory (3) Certification No.
Cemflied Laboratory (4) Certification No.
Laboratory (5) Certification' No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at (9l9) 7
Water Protection Section's web site at
5
8 or by visiting the Surface
n.us/wgs and linking to the unit's information pages.
ofrrreasurme tit deli in the reportin;
's NPDES permit for reporting data.
No Flowfaseharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
***Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the suite per I5A NCAC 2B .0506(b)(2)(D).

Mail ORIGINAL a nd ONECOPY to:
DMWN OF WATillt L/TY
1817 MAL EBlVIcE GE I Eit
RALEIdI4, NO 27810.1617

Facility Status: (Please check one of the following)
Al! monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
Compliant
Noncompliant
If the facility is noncompliant, please attach a list of corrective actions being taken and a time-tabk for
improvements to be made as required by Part II.E.6 of the NPDES permit.
All monitoring data and sampling frequencies do NOT meet permit requirements
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who man. led the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations"
Perminee (P se print or
Date
submitted el onically)
e-mail a4dre•
E
ADOITIONAL CE RTI r
TOR E$
Certified Laboratory (2) Certification No.
Certified Laboratory (3) Certification No.
Certified Laboratory (4) Certification No.
Certified Laboratory (5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting the Surfae
Water Protection Section's web site at h2o.enr,statenus/was and linking to the unit's information pages.
ofmeasurement designated acility's NPDES pennit for portirig dat
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per ISA NCAC SG .0204,
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0306(b)(2)(D)
Page, 2

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
Noncompliant
lithe facility is noncompliant, please attach a list of corrective actions being taken and a time -table for
kCJ'
,lt
1
rov+ements to mad :, aired , y Part II.E.6 of the ' DES pc it.
3 -1 : i ' /, 1�� . e
-- !io r d:%/fly" I , : l.• w L► Q� t
e•
//, ems, o N aft} ., . . A �.''': 1
Ss;).& ire& of ' .� ail i• aiY orni3 eC •
"I certifyumrn�
, under penalty of law, that this docent aall anoehrtn nts were prepared under m = ion or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate; and
complete. •I am aware that there are significant penalties for submitting false information, including the possibility of ' `_
fines and imprisonment for knowing violations." ,
a1S
Permiltze Address
Phone Number
e-mail address PermitExpiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laborutory (2) Certification No.
Certified Laboratory (3) Certification No.
Certified Laboratory (4) Certification No.
ceztified Laboratory (5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by --visiting the Surface'
Water Protection Section's web site at h2o.enr.state.nc.usfwgs and linking to the unit's information pages.
Me only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Diu:barge From Site: ChecJc this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
" ORC On Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Sigoarture of Pe n ittee: if signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .050#J(b)(2XD).
Page 2 •

Effluent
NPDES PERMIT NO. NC0044253 Discharge No,:
Facility Name: Camp Dogwood
l
Operator in Responsible Charge (ORC): Dusty Metreyeon
Certified Laboratory (1): Water Tech Labs Inc
CHECK BOX IF ORC HAS CHANGED
Mali ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER.
RALEIGH, NC 27699-1617
31 JM Nr
AVERAGE
MAXIMUM
MINIMUM
© PERSO CO
2
X (SIGNAe E •"`'AIN E © SI LE CHARGE) (DATE,
BY THIS S1•,NA E, I CERTIFY THAT TtttS EPORT IS
ACCURATE DCO tPLETE TO THE BEST IWY KNOWLEDGE,
McaltFaly Iimit (Avg) NL S 0.t 3A 0 NL NL
Dail yy Maximum 4S. i 4 0 4
4
R PARAMETER COD E ABOVE

--
Facility Status: (Please check one of the following)
All monitoring'data-andsampling frequencies meet permit requirements
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do, NOT meet permit requirements
_.,\ \.\�
lithe facility is noncompliant, please attach alist of corrective actions being taken and a time -table for
improvements to be madeas required by Part II.E.6 of the NPDES permit.
Noncompliant
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, aecurate.;.and7`.
complete. 1 am aware that there are significant penalties for submitting false information, including the possibility off;: "._
fines and imprisonment forknowing violations." l \, \i •.
�..
Pernittee (Please print or type)
ittee***` -Date
d unless submitted electronically)
-2-g/i
fis
Permittee Address Phone Number e-mail address Permit E9'iration Date, 1, �.
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
ADDITIONAL CERTIFIED LABORATORIES •
Certification No.
Certification No.
Certification No.
Certification No-.
.�,
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting the Surface) ; : •,
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pagesV . •�i :��,
Use only units of measurement designated in the reporting facilit's NPDES perrhit for reporting dati.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
*** Signature of Permittee: if signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per ISA NCAC 2B .0506(b)(2)(D).
Page 2

Ef Wen
NPDES PERMIT NO. NC 044253 Discharge No.: 001 Month. Year.
Facility Name: Camp Dogwood Class: tl County: f alawha _
Operator in Responsible Charge (CRC): I© trey 9 � . G�� �,. 11� Phone: [phone]
Certified Laboratory (1): Water Tech Labs Inc
CHECK SOX IP ORC HAS CHARGED
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL. FILES OF 0 - 'I OR IN • PONS18LE CHARGE) DATE
DIVISION OF WATER QUALITY R TH ATURR, I CERTIFY THAT TM `-- REPORT 13
1517 MAIL SERVICE CENTER ACCLIR iTE AHD COMPLETE TO THE BEST OF MY K) OW .EDGE.,
RALEIGH, NC 27899-1817

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring
d
ling frequencies do NOT meet permit requirements
Lvt
Compliant
Noncompliant
If the facility is noncompliant, please Attach a list of corrective actions being taken and a time -table for
improvements to be arttade as required by Part II.E.6 of the NPDES permit.
"1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of nary knowledge and belief, true, accurate, and
complete. am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations."
(Pleas print or type)
13i
d un ubmitted electronically
Permi'ttee Address
Phone Num
tr
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
ADDITIONAL CERTIFIED LA ORATOR
PARAMETER CODES
Certification No,
Certification No.
Certification No.
Certification No.
Parameter Code assistance may be obtained by calling the NPDES Unit at (919) 733-5O83 or by visiting the Surface
Water Protection Section's web site at
etzr.sttaten c.its/ w s and linking to the unit's information pages,
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC Can Site?: CRC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: if signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 26 .0506(b)(2XD).

Effluent
NPDES PERMIT NO, NC0044253 Discharge No
Facility Name; Camp Dogwood
Operator in Responsible Charge (ORC): Dusty Metreyeon
Certified Laboratory (1): Water Tech Labs Inc
CHECK SOX IF ORC HAS CHANGED
Mail ORIGINAL and ONE COPY to: f X
ATTN: CENTRAL FILES
©VISION OF WATER QUALITY
161T MAIL SERVICE CENTER
RALEIGH, NC 27899-1617
Month:
Class:
Grade'
(2)
Year:
County;
Phone: Z
E'"So+i CO .,ECTING SAMPLE
OPERAT
BY THIS StGNATUR 1 CERTIFY 1"11AT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
Operators
AT
R
N RESPONSIBLE CHARGE)
DATE
J W
4 z
© 0
cc 0
Lu
AVERAGE
DailyMaximum
ENTER PARAMETER CODE ABOVE
NAMEAk fRlpSBELOW.'

Facility Status: (Please check one of the folk:twin)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
A 1 monitoring data and sampling frequencies do NOT meet permit requirements
Compliant
Noncompliant
If the facility is noncompliant, please attach a list of corrective actions being taken and tme4abte for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who managed the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for 'Glowing violations."
Date
'ffielfuired unless submitted electronically)
Perminee Address
Phone Number
4
Permit Expiration Date
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
A TIONAL CERTIFIED LABORATORIES
PARAMETER CODES
Certification No,
Certification No.
Certification No,
Certification No,
Parameter Code assistance may be obtained by calling the NPDES Unit at (91 9) 733-5083 or by visiting the Surface
Water Protection Section's web site at h2o.enr.state.nc.us/wqs and linking to the unit's information pages.
Use only units of measurement designated *n the reporting facility's NPDES perrn r reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for ail of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC SG .0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2