NC0065358_Permit (Issuance)_20160901

Water Resources
ENVIRONMENTAL OUALiTY
September 1, 2016
Mr. Sean Dyer
Quincy Management
P.O. Box 692571
Quincy, MA 02269-2571
PAT MCCRORY
(ort>N U,'
DONALD R. VAN DER VAART
s,,,,
S. JAY ZIMMERMAN
Subject: Issuance of NPDES Permit NC0065358
Hidden Forest Estates WWTP
Randolph County
Class WW-2
Dear Mr. Dyer:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
2016.
This final permit includes no major changes from the draft permit sent to you on July 13,
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles H. Weaver at telephone number (919)
807-6391.
S. Jay Zimmerman, P
Director, Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
State of North Carolina l Environmental Quality i Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

Permit NC0065358
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
SIP Hidden Forest, LLC
is hereby authorized to discharge wastewater from a facility located at the
Hidden Forest Estates WWTP
6602 Holder Inman Road Extension
Randleman
Randolph County
to receiving waters designated as an unnamed tributary to Randleman Lake in
subbasin 03-06-08 of the Cape Fear River Basin in accordance with effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV hereof.
This permit shall become effective October 1, 2016.
This permit and authorization to discharge shall expire at midnight on August 31, 2021.
Signed this day September 1, 2016.
ay Zimmerman, P.
Director, Division of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NC0065358
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
SIP Hidden Forest, LLC is hereby authorized to:
1. Continue to operate an existing 0.027 MGD wastewater treatment facility with the
following components:
• Influent surge tank with bar screen
♦ Extended aeration basin
• Clarifiers (2)
• Sludge digester
• Tertiary sand filters (2)
♦ Ultraviolet disinfection unit
♦ Standby power generator
This facility is located near Randleman off the Holder Inman Road Extension at
the Hidden Forest Estates WWTP in Randolph County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Randleman Lake, currently classified WS-IV CA*
waters in hydrologic unit 03030003 of the Cape Fear River Basin.
Page 2 of 6

Permit NC0065358
Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
During the period beginning on the effective date of the permit and lasting until
expiration, the Permittee is authorized to discharge from outfall 001. Such discharges
shall be limited and monitored' by the Permittee as specified below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[PCS code]
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample
Type
Sample
Location
Flow
[50050]
0.027 MGD
Continuous
1
Recording
Influent or
Effluent
BOD, 5-day (20°C) (April 1 —October 31)
[C0310]
5.0 mg/L
7.5 mg/L
3/Week
Composite
Effluent
BOD, 5-day (20°C) (November 1 — March 31)
[C0310]
10.0 mg/L
15.0 mg/L
3/Week
Composite
Effluent
Total Suspended Solids
[C0530]
30.0 mg/L
45.0 mg/L
3/Week
Composite
Effluent
NH3 as N (April 1 — October 31)
[C0610]
2.0 mg/L
10.0 mg/L
3/Week
Composite
Effluent
NH3 as N (November 1 — March 31)
[C0610]
4.0 mg/L
20.0 mg/L
3/Week
Composite
Effluent
Dissolved Oxygen
[C0300]
Daily average > 6.0 mg/L
3/Week
Grab
Effluent
Fecal Coliform (geometric mean)
[31616]
200 / 100 ml
400 / 100 ml
3NVeek
Grab
Effluent
Total Residual Chlorine (TRC)2
[50060]
17 pg/L
_
3NVeek
Grab
Effluent
Temperature (°C)
[00010]
3NVeek
Grab
Effluent
Total Nitrogen (NO2+NO3+TKN)
[C0600]
Monthly
Composite
Effluent
Total Phosphorus3
[C06651
2.0 mg/L Quarterly average
Weekly
Composite
Effluent
pH
[00400]
> 6.0 and < 9.0 standard units
— —
3/Week
Grab
Effluent
Footnotes:
1. No later than December 21, 2016, the permittee shall begin submitting discharge monitoring
reports electronically using the Division's eDMR system [see A. (3)].
2. Limit and monitoring requirements apply only if chlorine is added to the treatment system. The
Permittee shall report all effluent TRC values reported by a NC -certified laboratory [including field -
certified]. Effluent values below 50 µg/L will be treated as zero for compliance purposes.
3. Compliance shall be based on a quarterly average of weekly samples.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE
AMOUNTS.
Page 3 of 6

Permit NC0065358
A. (2) PERMIT RE -OPENER: NUTRIENT MONITORING
[NCGS 143-215.1]
Pursuant to N.C. General Statutes Section 143-215.1 and the implementing rules found in the
North Carolina Administrative Code at 15A NCAC 2H.0112 (b) (1) and 2H.0114 (a) and Part II
sections B-12 and B-13 of this permit, the Director may reopen this permit to require
supplemental nutrient monitoring of the discharge. The purpose of the additional monitoring
will be to support water quality modeling efforts within the Cape Fear River Basin and shall
be consistent with a monitoring plan developed jointly by the Division and affected
stakeholders. In addition, the results of water quality modeling may require that limits for
Total Nitrogen and Total Phosphorus be imposed in this permit upon renewal.
A. (3) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
[NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge monitoring reports (DMRs)
and program reports and specify that, if a state does not establish a system to receive such
submittals, then permittees must submit monitoring data and reports electronically to the
Environmental Protection Agency (EPA). The final NPDES Electronic Reporting Rule was
adopted and became effective on December 21, 2015.
NOTE: This special condition supplements or supersedes the following sections within Part II
of this permit (Standard Conditions for NPDES Permits):
• Section B. (11.)
• Section D. (2.)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reporting Requirements 'Supersedes Section D. (2.) and Section E. (5.) fall
Effective December 21, 2016, the permittee shall report discharge monitoring data
electronically using the NC DWR's Electronic Discharge Monitoring Report (eDMR)
internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each
month and submitted electronically using eDMR. The eDMR system allows permitted
facilities to enter monitoring data and submit DMRs electronically using the internet.
Until such time that the state's eDMR application is compliant with EPA's Cross -Media
Electronic Reporting Regulation (CROMERR), permittees will be required to submit all
discharge monitoring data to the state electronically using eDMR and will be required to
complete the eDMR submission by printing, signing, and submitting one signed original
and a copy of the computer printed eDMR to the following address:
NC DENR / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Page 4 of 6

Permit NC0065358
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due
to the facility being physically located in an area where less than 10 percent of the
households have broadband access, then a temporary waiver from the NPDES electronic
reporting requirements may be granted and discharge monitoring data may be submitted
on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by the Director.
Duplicate signed copies shall be submitted to the mailing address above. See "How to
Request a Waiver from Electronic Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the month
following the issuance of the permit or in the case of a new facility, on the last day of the
month following the commencement of discharge.
Starting on December 21, 2020, the permittee must electronically report the following
compliance monitoring data and reports, when applicable:
• Sewer Overflow/Bypass Event Reports;
• Pretreatment Program Annual Reports; and
• Clean Water Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to
Request a Waiver from Electronic Reporting" section below).
2. Electronic Submissions
In accordance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at
the time of each electronic submission. The permittee should use the EPA's website
resources to identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated facilities means
the entity (EPA or the state authorized by EPA to implement the NPDES program) that is
the designated entity for receiving electronic NPDES data [see 40 CFR 127.2(b)).
EPA plans to establish a website that will also link to the appropriate electronic reporting
tool for each type of electronic submission and for each state. Instructions on how to
access and use the appropriate electronic reporting tool will be available as well.
Information on EPA's NPDES Electronic Reporting Rule is found at:
http / /www2.epa.gov/compliance/final-national-pollutant-discharge-elimination-system-
npdes-electronic-reporting-rule.
Electronic submissions must start by the dates listed in the "Reporting Requirements"
section above.
3. How to Request a Waiver from Electronic Reporting
The 'permittee may seek a temporary electronic reporting waiver from the Division. To
obtain an electronic reporting waiver, a permittee must first submit an electronic
reporting waiver request to the Division. Requests for temporary electronic reporting
waivers must be submitted in writing to the Division for written approval at least sixty
Page 5 of 6

Permit NC0065358
(60) days prior to the date the facility would be required under this permit to begin;
submitting monitoring data and reports. The duration of a temporary waiver shallnot
exceed 5 years and shall thereupon expire. At such time, monitoring data and reports
shall be submitted electronically to the Division unless the permittee re -applies for' and is
granted a new temporary electronic reporting waiver by the Division. Approved electronic
reporting waivers are not transferrable. Only permittees with an approved reporting
waiver request may submit monitoring data and reports on paper to the Division for the
period that the approved reporting waiver request is effective.
Information on eDMR and the application for a temporary electronic reporting waiver are
found on the following web page:
http: / / deq.nc.gov/ about! divisions/water-resources) edmr
4. Signatory Requirements (Supplements Section B. (11.1 (b) and Supersedes Section B.
(11.) (d)j
All eDMRs submitted to the permit issuing authority shall be signed by a person
described in Part II, Section B. (11.)(a) or by a duly authorized representative of that
person as described in Part II, Section B. (11.)(b). A person, and not a position, must be
delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an
eDMR user account and login credentials to access the eDMR system. For more
information on North Carolina's eDMR system, registering for eDMR and obtaining an
eDMR user account, please visit the following web page:
http: / /deo.nc.gov/about/divisions/water-resources/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system
shall make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF
CERTIFICATION WILL BE ACCEPTED:
"I certify, under penalty of law, that this document and all attachments were prepared
under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and
imprisonment for knowing violations."
5. Records. Retention [Supplements Section D. (6.11
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR
submissions. These records or copies shall be maintained for a period of at least 3 years
from the date of the report. This period may be extended by request of the Director at any
time [40 CFR 122.41].
Page 6 of 6

Latitude: 35°53'53"
Longitude: 79°49'22"
Stream Class: WS-IV CA*
Subbasin: 03-06-08
Hydrologic Unit: 03030003
Receiving Stream: UT Randleman Lake
USGS Quad: Pleasant Garden, N.C.
NC0065358
Hidden Forest Estates
WWTP
Facility
Location
Randolph County
Map not to scale

Water Resources
ENVIRONMENTAL QUALITY
July 11, 2016
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Director
MEMORANDUM
To: F a so a k : t&' 0.1 r it\S'4 . �Q��iQ•.,c„� n� y, a+'
NC DEQ / DWR / Public Water Supply
Winston-Salem Regional Office
From:
Subject:
Charles H. Weaver, Jr.
NPDES Unit
Review of Draft NPDES Permit NC0065358
Hidden Forest Estates WWTP
Randolph County
Please indicate below your agency's position or viewpoint on the draft permit and return this
form by August 12, 2016. if you have any questions on the draft permit, please contact me
at 919-807-6391 or via e-mail [[e-mail]].
RESPONSE: (Check one)
Concur with the issuance of this permit provided the facility is operated and maintained
properly, the stated effluent limits are met prior to discharge, and the discharge does not
contravene the designated water quality standards.
Concurs with issuance of the above permit, provided the following conditions are met:
Opposes the issuance of the above permit, based on reasons stated below, or attached:
eZ,uti•
Signed c - Date:
State ofNorth Carolina l Environmental Quality 1 Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
Mips://deq.nc. goviaboutldivisions/water-resources/water-resources-permits/wastewater-branchinpdes-wastewater-permits

THE. ha,/ -
COURIER -TRIBUNE
Affidavit of Publication
State of North Carolina,
Randolph County
To Whom It May Concern:
This is to certify the
advertisement attached
hereto has been published in
The Courier Tribune
on the following dates:
I- PK,
Sworn to on this AN day
of , 2016.
Courier -Tribune Representative
Sworn to and Subscribed
Befo e me this 22,ro day
of r , 2016.
otary Public
JOSEPHINE VIERA COOPER
Notary Public, North Carolina
Randolph County
My �omn ign Expires
Public Notice
North Carolina Environmental Management Commission/
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue
a NPDES Wastewater Permit
The North Carolina Environmental Management Commission
proposes to issue a NPDES wastewater discharge permit to the
person(s) listed below. Written comments regarding the proposed
permit will be accepted until 30 days after the publish date of this
notice. The Director of the NC Division of Water Resources (DWR)
may hold a public hearing should there be a significant degree of
public interest. Please mail comments and/or information requests to
DWR at the above address. Interested persons may visit the DWR at
512 N. Salisbury Street, Raleigh, NC to review information on file.
Additional information on NPDES permits and this notice may be
found on our website: http://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/npdes-
wastewater/public-notices,or by calling [phone].
SIP Hidden Forest, LLC requested renewal of permit
NC0065358/Hidden Forest Estates/Randolph County. Facility
discharges to the Deep River/Cape Fear River Basin. Currently, BOD,
ammonia nitrogen, dissolved oxygen, total phosphorus, fecal coliform,
and total residual chlorine are water quality limited.
It - 7/15/16

Weaver, Charles
From:
Sent:
To:
Subject:
Mickey, Mike
Friday, July 15, 2016 12:59 PM
Weaver, Charles
RE: DRAFT permit renewal for NC0065358 / Hidden Forest Estates
Charles — The draft looks fine except for the outfall location on the map. See screen shot below with slight adjustment
upstream. Thanks, Mike.
[e-mail]
NC DEQ Winston-Salem Regional Office
Division of Water Resources — Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
PhS,,ne: [phone]
E-mail correspondence to and from this address may be subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Weaver, Charles
Sent: Monday, July 11, 2016 11:16 AM
To: Kinney, Maureen <[e-mail]>; Mickey, Mike <[e-mail]>; Hudson, Eric
<[e-mail]>
1

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles H. Weaver — 7/11/2016
Permit Number
NC0065358
Facility Name
Hidden Forest Estates WWTP
Basin Name/Sub-basin number
Cape Fear / 03-06-08
Receiving Stream
UT to the Randleman Lake
Stream Classification in Permit
WS-IV CA*
Does permit need Daily Maximum NH3 limits?
No — already present
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Cape Fear nutrient reopener
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
One enforcement during this permit cycle.
Sporadic violations during permit cycle;
minor problems with TP limit.
Any permit mods since last permit?
None
New expiration date
8/31/2021
Comments received on Draft Permit?
Updated list of facility components
Added eDMR requirements
Added regulatory citations
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".

Supplemental classification intended to recognize those waters which have Low
velocities and other naturaL characteristics which are different from adjacent
streams.
Trout Waters (Tr)
Supplemental classification intended to protect freshwaters which have conditions
which shall sustain and allow for trout propagation and survival of stocked trout on
a year-round basis. This classification is not the same as the NC Wildlife Resources
Commission's Designated Public Mountain Trout Waters designation.
Unique Wetland (UWL)
Supplemental classification for wetlands of exceptional state or national
ecological significance. These wetlands may include wetlands that have been
documented to the satisfaction of the Environmental Management Commission as
habitat essential for the conservation of state or federally listed threatened or
endangered species.
SPECIAL
DESCRIPTIONS
Cape Fear River Basin
DESIGNATION
@ See rule 15A NCAC 26.0311: Development is not subject to rule 15A NCAC
2H.1006, if the governing municipality has deemed that the development is covered
under a "5/70 provision" as described in Rute15NCAC 213.0215(3)(b)(i)(E).
* This symbol identifies waters that are within a designated Critical Supply
Watershed and are subject to a special management strategy specified in 15A
NCAC 2B .0248.
# Discharges of sewage are prohibited to segments classified SB or SC with a
pound sign according to the provisions of 15 NCAC 26 .0203 and 2H .0404(a) in
order to protect adjacent shellfishing waters.

History Note:
15A NCAC 02B
15A NCAC 02B
15A NCAC 02B
15A NCAC 02B
STRATEGY
restored or enhanced. If proof is not presented within this timeframe, then the person shall be in
violation of both the State and a local riparian buffer ordinance.
The mitigation area shall be placed under a perpetual conservation easement that will provide for
protection of the property's nutrient removal functions.
The applicant shall submit annual reports for a period of five years after the riparian buffer
restoration or riparian buffer enhancement showing that the trees planted have survived and that
diffuse flow through the riparian buffer has been maintained. The applicant shall replace trees that
do not survive and restore diffuse flow if needed during that five-year period.
Authority G.S. 143-214.1; 143-214.7; .143-215.3(a)(1); S.L. 1999, c. 329, s. 7.1; S.B. 824-2003;
Temporary Adoption Eff. June 30, 2001 (exempt from 270 day requirement - S.L. 2001-418 & S.L. 2003-
340);
Eff August 1, 2004.
.0245 RESERVED FOR FUTURE CODIFICATION
.0246 RESERVED FOR FUTURE CODIFICATION
.0247 RESERVED FOR FUTURE CODIFICATION
.0248 RANDLEMAN LAKE WATER SUPPLY WATERSHED: NUTRIENT MANAGEMENT
(a) All waters of the Randleman Lake (Deep River) water supply watershed are classified for water supply uses and designated
by the Environmental Management Commission as a Critical Water Supply Watershed pursuant to G. S. 143-214.5(b). The
following rules shall be implemented for the entire drainage area upstream of the Randleman Lake Dam:
(1) Rule .0249 of this Section for Wastewater Discharges,
(2) Rule .0250 of this Section for Protection and Maintenance of Riparian Areas, and
(3) Rule .0251 of this Section for Urban Stormwater Management.
(b) Failure to meet the requirements of the Rules in this Section may result in the imposition of enforcement measures as
authorized by G.S. 143-215.6A (civil penalties), G.S. 143-215.6B (criminal penalties), and G.S. 143-215.6C (injunctive relief).
(c) Development activities may be granted minor and major variances from the requirements of Rules .0250 and .0251 of this
Section based on the process stated in 15A NCAC 2B .0104®. However, for the purposes of Rules .0250 and .0251 of this
Section, minor and major variances shall be defined as a variance from the more stringent Randleman Lake stormwater
management requirements for the lower watershed and the more stringent riparian area requirements for the upper and lower
watersheds.
History Note: Authority G. S. 143-214.1; 143-214.5; 143-215.3(a)(1); 143-215.6A; 143-215.6B; 143-215.6C;
Eff April 1, 1999.
15A NCAC 02B .0249 RANDLEMAN LAKE WATER SUPPLY WATERSHED: WASTEWATER DISCHARGE
REQUIREMENTS
The following is the National Pollutant Discharge Elimination System (NPDES) wastewater discharge management strategy for
the Randleman Lake watershed. For purposes of this Rule, permitted wastewater discharges means those facilities permitted to
discharge domestic wastewater or wastewaters containing phosphorus:
(1) The City of High Point's Eastside facility shall meet a total phosphorus concentration predicted to provide a
level of water quality in the Randleman Lake which meets all designated uses of those waters.
(2) There shall be no new or expanding permitted wastewater discharges in the watershed with the exception
that the City of High Point Eastside wastewater treatment plant may be allowed to expand provided that any
new permit contains concentration and mass limits predicted to provide a level of water quality in the
Randleman Lake which meets all designated uses of those waters.
History Note: Authority G. S. 143-214.1; 143-214.5; 143-215.3(a)(1);
Eff. April 1, 1999.
NORTH CAROLINAADMINISTRATIVE CODE Elf. Ma), 1. 2007 Page 100

NC DENR / DWR / NPDES Unit
1617 Mail Service Cen er
Raleigh, NC 27699-16 7
Wren Thedford,
Hidden Forest is requesting the renewal of the wastewater treatment plant pe mit
NC0065358. No changes have been made to the treatment process since th
last permit renewal. Plase let me know if you have any questions or require
more information. Thal7ks
Respectfully,
Sean Dyer
Quincy Management
RECEIVED/NCDEQ/D R
APR 0 4 2016
Water Quality
Permitting Section

For privately -owned
N.
1
If you are completing this
field to the next. To check
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
2. Location of facility p
Check here if same addre
Street Address or State R
City
State / Zip Code
County
3. Operator Information
Name of the firm, public
referring to the Operator in
Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
1013
treatment
C. DENR
117 Mail
NPDES
form
he boxes,
Sea
Hidden
1
I
NPDES APPLICATION - FORM D
systems treating 100% domestic wastewaters <1.0 MC
Mail the complete application to:
/ Division of Water Quality / NPDES Unit
Service Center, Raleigh, NC 27699-1617
Permit NC0065358
I
in computer use the TAB key or the up - down arrows to move fa
click your mouse on top of the box. Otherwise, please print or
h Dyer
Forest Estates WWTP
PO pox 692571
RECEIVED(NCDE4
Quincy
0 4
MA
APR
02269-2571 Water Qua,I
( 617) 669-6809 Permitting Sec
( )
[e-mail]
roducing
s as
)ad
)rgariization
Resllionsible
Paul
discharge:
Lbove
6602 Holder Inman
Randleman
NC 27317
Randolph
or other entity that operates the facility. (Note that this
Charge or ORC)
Smith
PO Box 269
Reidsville
North Carolina 27323
( 336) 932-9347
( )
[e-mail]
Form
D
om one
type.
�IDWR
16
ton
is not
-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 M D
4. Description of wastewater:
Facility Generating Waste�vater(check all that apply):
Industrial
Commercial
Residential
School
Other
X
Number of Employees
Number of Employees
Number of Homes
Number of Students/Staff
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping center
restaurants, etc.):
Mobile Home Park
Number of persons served:
5. Type of collection system
epara (sanitary sewer only) Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped wilJh a diffuser? es No
7. Name of receiving! stream(s) (NEW applicants: Provide a map showing the exact location
outfall): Unnamed tributary to Randleman Lake
8. Frequency of Discharge:
If intermittent:
Days per week discharge
Continuous Intermittent
occurs:
9. Describe the treatment stem
List all installed components, including capacities, provide design removal for BOD, TSS, nitroge
phosphorus. If the space provided is not sufficient, attach the description of the treatment syste
separate sheet of paper.
Influent surge tank with bar screen, extended aeration basin, 2 clarifiers, tertiary dual s
7 Duration:
filters, UV disinfection unit, digester tank, back up power generator,
s,
each
and
in a
2 of 3
For
m-D 11/12

NPDES APPLICATION - FORM D
For privately -owned' trea meat systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant! Design flow 0.027 MGD
Annual Average daily flow 0.010 MGD (for the previous 3 years)
Maximum daily flow 0.020 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
Yes No X
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Pro de the highest single reading (Daily Maximum) and Monthly Average
over the past 36 months for parameters currently in your permit. Mark other parameters "N/A".
Parameter
Biochemical Oxygen Deman (BODs)
Fecal Coliform
Total Suspended Solids
Temperature (Summer)
Daily Monthly Units of
Maximum Average Measurement 1
f
r__ 1
8 2 1 mg/L 1
50 i 200/100 ml
.
8
28
5
4
20
mg/L
C
Temperature (Winter)
15
5
C
pH
7.3
7
SU
13. List all permits, constru
Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program
ion approvals and/or applications:
Permit
NC. off S 5R.
14. APPLICANT CERTIFICAT ON
I certify that I am familiar ith the
best of my knowledge and be#ef such
5e� r-. , dh,r
Printed name of Per sSigning
ignature of Applic'
Type
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or
Other
Permit
information contained in the application and that to the
information is true, complete, and accurate.
Title
3- z 6 "zoi6
Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article,; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3 of 3 Form-D 11 /12

Sludge Management Plan
Hidden Forest Estates
NPDES Permit NC0065358
All sludge produce is hauled away and disposed of by a NC Certified Septic Tank company
The Company takes the sludge to the city wastewater treatment plant for disposal

BRowN INVESTMENT
PROPERTIES
ESTABLISHED • 1960
February 13, 2012
Mrs. Dina Sprinkle
NC DENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: MANAGEMENT TRANSITION
SIP HIDDEN FOREST LLC
PWSID #NC0 G268 A/GOo 4,5151
Effective February 18, 2012, Brown Investment Properties, Inc. is no longer managing Hidden Forest
Mobile Home Park. Please contact the property owner directly with any questions or concerns.
The owner contact is:
Sean Dyer
665 Hancock Street Suite 3
Quincy MA 02170
Tel : [phone]
fax/office 617-786-0303
email : spse20,thotmail.com
Very truly yours,
BROWN INVESTMENT PROPERTIES, INC.
Peter Placentino
Senior Vice President
PP/mh
cc: NC DENR
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107-2241
Paul Smith
Smith Industries
235 Richardson Rd.
Reidsville, NC 27320
FEB 1 4 2012
DEr s:;—b t°ATE LIiYCH
440 West Market St. (27401) • P.O. Box 930 • Greensboro, NC 27402 • 336-379-8771 • Fax: [phone] • www.bipinc.com

9/22/20,16
Corporations Division
Click Here To:
North Carolina
Elaine F. Marshall DEPARTMENT OFTIIE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NC 27626-0622 i919i807-2000
View Document Filings File an Annual Report
Print a Pre -Populated Annual Report form
Corporate Names
Legal: SIP Hidden Forest, LLC
Limited Liability Company Information
Amend a Previous Annual Report
Sosld:
Status:
Annual Report Status:
Citizenship:
Date Formed:
Fiscal Month:
State of Incorporation:
Registered Agent:
Corporate Addresses
1153710
Current -Active
Current
Foreign
6/4/2010
December
MA
Incorp Services, Inc.
Reg Office:
Reg Mailing:
Mailing:
Principal Office:
176 Mine Lake Court, Suite 100
Raleigh, NC 27615-6417
176 Mine Lake Court, Suite 100
Raleigh, NC 27615-6417
665 Hancock St Suite #3
Quincy, MA 02170-2858
665 Hancock St Suite #3
Quincy, MA 02170-2858
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager:
Sean Dyer
665 Hancock St Suite #3
Quincy MA 02169
Account
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