NC0070033_Permit (Issuance)_20040713

NPDES DOC /WENT SCANNING COVER SHEET
NC0070033
Quail Run MHP
NPDES Permit:
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File
- Historical
Engineering Alternatives (EAA)
Application
Instream Assessment
(67b)
Environmental Assessment (EA)
Permit
History
Document Date:
July 13, 2004
This clicsemmerrt is printed ozz reuose paper - i ore any
cozzteat ozi the re.srerse side

Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
July 13, 2004
Mr. Fred P. Cox
Quail Run Mobile Home Park
P.O. Box 631
Stanleytown, Virginia 24168
Subject: NPDES Permit Issuance
Permit Number NC0070033
Quail Run Mobile Home Park
Davidson County
Dear Mr. Cox:
Division personnel have reviewed and approved your application for renewal of the subject
permit. Accordingly, we are forwarding the attached final 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 May 9,
1994 (or as subsequently amended).
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 permit shall be final and binding.
Please take notice that this permit is not transferable. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Quality or permits
required by the Division of Land Resources, Coastal Area Management Act, or any other Federal or
Local governmental permits which may be required.
If you have any questions or need additional information, please do not hesitate to contact Dave
Goodrich of my staff at [phone], extension 517.
Sincerely,
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E.
cc: Central Files
NPDES Unit Files
Winston-Salem Regional Office
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1617 - TELEPHONE [phone]/FAX [phone]
VISIT US ON THE WEB AT http://h2o.enr.state.nc.us/NPDES

Permit NC0070033
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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,
Fred P. Cox
is hereby authorized to discharge wastewater from a facility located at
Quail Run Mobile Home Park
136 Quail Place Drive
Winston-Salem
Davidson County
to receiving waters designated as Miller Creek in the Yadkin -Pee Dee River Basin in accordance with
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, Ill, and IV hereof.
The permit shall become effective August 1, 2004.
This permit and the authorization to discharge shall expire at midnight on May 31, 2009.
Signed this day July 13, 2004.
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0070033
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.
Fred P. Cox
is hereby authorized to:
1. Continue to operate an existing 0.017 MGD wastewater treatment plant, consisting of:
• two 3,200 gallon septic tanks
• one 4,000 gallon septic tank
• two 4,500 gallon septic tanks
• an 8,400 gallon recirculating dosing tank
• a 4,250 square foot recirculating surface sandfilter
• tablet chlorinator
• a 350 gallon chlorine contact tank
located at the Quail Run Mobile Home Park, 136 Quail Place Drive, Davidson County, and
2. Discharge from said treatment works at the location specified on the attached map into Miller Creek,
which is classified C waters in the Yadkin -Pee Dee River Basin.

QUai1
RUI1 Mobile Home Park
Latitude: 35° 59' 12" N Lon ktude: 80° 15' 59" W
Streann Class: C Reoeiviu Stream Miller Creek
Sub -Basin: 03-07-04 State Grid/ USGS Quad: D 17 NEfKemersville, NC
Drainage Basin: Yadkin — Pee Dee Permitted Flow: 0.017 MGD
Facility
Fac
Loca
tion Location
not to scale
x
North
NPDES Pennit NC0070033
Davidson County

Permit NC0070033
Part I. Section A
1. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized to
discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
PARAMETER
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Weekly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location'
Flow (MGD)
0.017
30.0 mg/L
45.0 mg/L
Weekly
Instantaneous
I or E
BOD5
2/month
Grab
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/month
Grab
E
NH9 N
(April 1 — October 31)
6.9 mg/L
25.8 mg/L
34.5 mg/L
35.0 mg/L
2/month
Grab
Grab
E
E
NH; N
(November 1 — March 31)
2/month
Dissolved Oxygen
(April 1 — October 31)
Monitor
200/100 ml
& Report
400/100 ml
Weekly
Grab
Grab
E, U, D
Fecal Coliform
(Geometric Mean)
2/month
E
Total Residual Chlorine2
28 ug/L
2NVeek
Grab
E
Temperature
Monitor & Report
Daily
Grab
E
Temperature
Monitor & Report
Weekly
Grab
U, D
Total Nitrogen
(TKN + NO2+ NO2)
Monitor & Report
Quarterly
Grab
E
Total Phosphorus
Monitor & Report
Quarterly
Grab
E
pH
Between 6.0 and 9.0 Standard Units
2/month
Grab
E
Notes:
1 E - Effluent, I — Influent, U — Upstream approximately 100 feet above the discharge point, D — Downstream
from the discharge point approximately 300 feet.
2 The limit for total residual chlorine will take effect February 1, 2006.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

PUBLIC
NOTICE
STATE OF NORTH
CAROLINA
ENVIRONMENTAL
MANAGEMENT
COMMISSION
NPDES UNIT
1617 MAIL
SERVICE CENTER
RALEIGH, NC
27699-1617
NOTIFICATION
OF INTENT TO
ISSUE A
NPDES
WASTEWATER
PERMIT
On the basis of thor-
ough staff review and
application of NC Gen-
eral Statute 143.21,
Public law 92-500 and
other lawful standards
and regulations, the
North Carolina Environ-
mental Management
Commission proposes
to issue a National Pol-
lutant Discharge Elimi-
nation System (NPDES)
wastewater discharge
permit to the persons)
listed below effective
45 days from the pub-
lish date of this notice.
Written comments re-
garding the proposed
permit will be accepted,
until 30 days after the
publish date of this no-
tice. All comments re-
ceived prior to that
date are considered in
the final determinations
regarding the proposed
permit. The Director of
the NC Division of Wa-
ter Quality may decide
to hold a public meet-
ing for the proposed
permit should the Divi-
sion receive a signifi-
cant degree of public
interest.
Copies of the draft per-
mit and other support-
ing information on file
used to determine con-
ditions present in the
draft permit are availa-
ble upon request and
payment of the costs of
reproduction. Mail com-
ments and/or requests
for information to the
NC Division of Water
Quality at the above
address or call Ms. Va-
lery Stevens at (919)
733-5083, extension
520. Please include the
NPDES permit number
(attached) in any com-
munication. Interested
persons may also visit
the Division of Water
Quality at 512 N. Salis-
bury Street, Raleigh, NC
27604-1148 between
the hours of 8:00 a.m.
and 5:00 p.m. to review
information on file.
Bill's Truck Stop has ap-
plied for renewal of its
NPDES permit
NC0040045. The per-
mitted facilitydischarg-
es treated wastewater
to South Potts Creek in
the Yadkin -Pee DeerRiv-
er Basin. Currently
BOD5, Total Residual
Chlorine, Total Sus-
pended;_Salids,,apd Fe-
cal Coliform are water
quality limited: This dis-
charge may affect fu-
ture allocations in this
portion of South Potts
Creek.
Davidson • County
Schools .P.O.. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0041629 for its Ex-
tended Day School
WWTP in Davidson
County. This permitted
facility discharges
treated wastewater to
an unnamed tributary
to Hamby Creek in the
Yadkin -Pee Dee River
Basin. Currently BOD,
Ammonia Nitrogen, and
Total Residual Chlorine
are water quality limit-
ed. This discharge may
affect future allocations
in this portion of the
watershed.
STATE OF NORTH CAROLINA
DAVIDSON COUNTY
Lexington, County and
Quail Run Mobile Home
Park, has applied for re-
newal of its NPDES per-
mit NC0070033. The
permitted facility dis-
charges treated waste-
water to Miller Creek in
the Yadkin -Pee Dee Riv-
er Basin. Currently
BOD5, Ammonia as Ni-
trogen, Total Residual
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Miller Creek.
Davidson County
Schools, P.O. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042129 for its Pilot
Elementary School
WWTP in Davidson
County. This permitted
facility discharges
treated wastewater to
Jimmy's Creek in the
Yadkin -Pee Dee River
Basin. Currently Ammo-
nia Nitrogen and Total
Residual Chlorine are
water quality limited.
This discharge may af-
fect future allocations
in this portion of the
watershed.
Davidson County
Schools, P.O. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042145 for its Mid-
way Elementary School
WWTP in Davidson
County. This permitted
facility discharges
wastewater to an un-
named tributary to Leo-
nard Creek in the Yad-
kin -Pee Dee River Ba-
sin. Currently Ammonia
Nitrogen and Total Re-
sidual Chlorine are wa-
ter quality Limited. This
discharge may affect
future allocations in this
portion of the water-
shed.
Captain Stevens Sea-
food Restaurant, has
applied for renewal of
its NPDES permit
NC0059218. This per-
mitted facility discharg-
es treated wastewater
to an unnamed tributa-
ry to Reedy Creekin
the Yadkin-Pee.-Dee-Riv-
er Basin.- ` Currently.
BOD5, Total Residual
AFFIDAVIT OF PUBLICATION
Lexington,N.C.
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Reedy Creek.
Hilltop Living Center,
has applied for renewal
of its NPDES permit
NC0059536. The per-
mitted facility discharg-
es treated wastewater
to art unnamed tributa-
ry to Yadkin -Pee Dee
Basin. Currently BOD5,
Ammonia as Nitrogen,
Total Residual Chlorine,
Total Suspended Solids,
Total Phosphorus and
Fecal Coliform are wa-
ter quality limited. This
discharge may affect
future allocations in this
portion of the Yadkin
River.
April 19, 2004.
0 1 A 2004
FR Ot1\LI CY
DENR-WA� _ E r R7,1'4CH
2004
of THE DISPATCH, a newspaper published in the city of
State aforesaid, being
which the attached is a true copy,
day of
me, this
duly sworn,
says the
foregoing legal of
was published in said newspaper once the
2004.
My commission expires

NORTH CAROLINA
FORSYTH COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified, and authorized by law to administer oaths, personally
appeared D.H. Stanfield, who being duly sworn, deposes and says: that he is
Controller of the Winston-Salem Journal, engaged in the publishing of a newspaper
known as Winston-Salem Journal, published, issued and entered as second class mail
in the City of Winston-Salem, in said County and State: that he is authorized to
make this affidavit and sworn statement: that the notice or other legal advertisement,
a true copy of which is attached hereto, was published in Winston-Salem Journal on
the following dates:
April 17, 2004
and that the said newspaper in which such notice, paper document, or legal
advertisement was published was, at the time of each and every such publication, a
newspaper meeting all the requirements and qualifications of Section 1-597 of the
General Statues of North Carolina and was a qualified newspaper within the meaning
of Section 1-597 of the general statues of North Carolina.
This 19th day of April, 2004
(signature of perso
Sworn to and subscribed before me, this 19th day of App 2004
5C •
1 The Yam, Inc (PA. Box 78 White PlaiCoonns NC 27031) has applied for re-
newal of NPDES permit Nr p61808 for the Neighbcrs Fuet Center #12
in Surry County. This permitted facility doges treated wastewater to
the Little Fisher River in the Yadkin -Pee Dee River Barn. Currently BCD,
total suspended solids, oil and grease, and total residual chbnne are
water quality limited. This discharge may affect future allecatkrns in this
portion of the Yadkin -Pee Dee River Basel. —tl
NC Department of Transportation (1557 Mal Service Center, Raleigh,
NC 27699) has applied for renewal of NPDES permit N00029190 for the
the Surry County Rest Area. This permitted facility discharges 0.030
MGD of treated wastewater to Naked Run in the Yadkin -Pee Dee River
Basin. Currently 80D and total residual chlorine are water quality limited.
This discharge may affect future allocations in this portion of the Yadkin -
Pee Dee River Basin. "M6 I.W
The Surry County Board of Edur tide [P.O. Box 364, Dobson, NC
27017) has applied for renewal of NPDES permit NC0041947 for the
North Story High School WWTP. This permitted facility discharges treat-
ed domestic wastewater to Stewarts Creek in the Yadkin -Pee Dee River
Basin. Currently fecal colitorm and total residual chlorine are water male 1
. This discharge may affect future allocations in this portion of I
Creek. --��
Virginia DOT (1401 East B ad Street, Richmond VA, 23219) has ap-'
pied for renewal of NPOES permit NC0039420 for the I-77 Rest Area
WWTP in Forsyth County. This permitted facility discharges 0.02D MGD
of treated wastewater to Naked Run in the Yadkin -Pee Dee River Basin.
Curremy BOO, ammonia nitrogen and total residual chlorine are water
quality limited. This discharge may affect f� a8ocationsintfisportion
of the Yadkin -Pee Dee River Basin. p W
The Suny County Board of Educatidlf [P.O. Box 364, Dobson, NC
27e171 has applied for renewal of NPDES permit N00041904 for the Flat
Rock Elementary School WWTP. This permitted facility discharges treat-
ed domestic wastewater to an unnamed tributary to Cramp Creek in the
Yadkin -Pee Dee River Basin. Currently fecal coliform is water quality lim-
ited. This discharge may affect future allocations in this portion of Champ
Creek. C.
(Pikes County
The Roaring Gap Club, Inc P.O. Box 129, Roaring Gap, NC 28868) has
applied for renewal of NPDES permit NC0088997 for the Roaring Gap
Club in Wilkes County . This permitted facility discharges treated waste-
water to the unnamed tributary to the Mitchell River in the Yadkin -Pee
Dee River Basin. Currently BOD total suspended solids, and total resid-
ual chlorine are water quality Ihenited. This discharge may affect future al-
locations in this portion of the Yadkin -Pee Dee River Basin.
Notary yl lblic
Head Mobile Flame Park, has applied frenewal o1 itO NPOES permit
Forsyth Co
p NCL iCd3. The permitted featly discharges treated wastewater to an
28 unnamed tributary to Little Creek in the Yadkin -Pee Dee River Basin.
Currently B0135, Ammonia as Nitrogen, Total Residual Chlorine, Total
Suspended SAlids and Fecal Coliform are water quaky limited. This die-.
rlrarpe may affect future allocations in this portion of Creek
The Heater Utilities, Inc (P.O. Drawer 4889, Cary, NC 275f9]'f_...r.-
pied for renewal of NPDES permit NC0084409 Icr the Wellesley Place
WWTP in Forsyth County'. This permitted facility discharges treated
wastewater to the Milt Creek in the Yadkin -Pee Dee River Basin. Current-
ly BOO, total suspended solids, ammonia nitrogen and total residual
chlorine are water quality Winded. This dscharee may affect t lure alloca-
tions in this portion of the Yadkin -Pee Dee River Basin. ace
Scarlet Acres Mobile Home Subdivision, has applied for ertewal aftts
NPDES permit NC0061204. The permitted facility discharges treated
AL SI wastewnter to an unnamed tributary to Mill Creek In the Yadkin -Pee Dee
River Basin. Currently B005, Ammonia as Nitrogen, Total Residual
, NOrt Chlorine, Total Suspended Solids. and Fecal Collform are water quality
F FO limited. This dschar�ge may affect future allocations in this portion of Muth
�OH Hlgh Point Healthy'fe Center, has applied for renewal of its NPDES
permit NC0046035. The permitted facility discharges treated wastewater
to Rich Fork in the Yadkin -Pee Dee River Basin. Currently 8005, Ammo-
- ria as Nlrogen and total residual chlorine are water quaky landed: This
discharge may affect future allocations in this portion of Rich Fork
Lucent Technologies (3370 Lexington Rd, Winston-Salem,- NC 27107)
has applied for renewal of NPDES permit NC0080853 for the Salem
Business Park groundwater remediation site in Forsyth County. This per-
mitted facility discharges 0.301 MGD of treated wastewater to Salem
Creek in the Yadkin -Pee Dee River Basin. Currency no parameters are
water quality limited. This discharge may a fN allocations in the
portion of the Yadkin -Pee Dee River Basin.
The Winston-Salem / Forsyth County Board of Educftion [4897 Lan-
sing Drive, Winston-Salem, NC 27105) has applied for renewal of
NPDES permit NC0034827 for the 01d Richmond Elementary School.
This permitted facility discharges treated domestic wastewater to an un-
named tributary to Fries Creek in the Yadkin -Pee Dee River Basin. Cur-
r ammonia nitrogen and fecal coliform are water quality limited. This
da1ge may Meet future allocations in this portion of Fries Creek.
C Davie County -
The Davie County Board of Education [220 Cherry Street, Mocksville,
NC 27028] has applied for renewal of NPOES perm N00033162 for the
William R. Dave Elementary School. This permitted facility discharges
treated domestic wastewater to an unnamed tributary to Greasy Creek in
the Yadkin.Pee Dee River Basin. Currently 60D, ammonia nitrogen and
feral cotiform are water quality limited. This discharge may affect future
allocations in this portion of Greasy Creek.
WSJ: April 17, 2004
PUBLIC NOTICE
STATE OF NORTH CAROIJNA
ENVIRONMENTAL MANAGEMENT COMMISSIONINPDES UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699.1617
NOTIFICATION OF INTENT TO ISSUE
A NPDES WASTEWATER PERMIT
0n the bass of thorough staff review and application of NC General Stat-
ute 14321, Public law 92-500 and other lawful standards and regula-
tions, the North Carolina Environmental Management Commission pro-
poses to issue a National Pollutant Discharge Elimination System
(NPDES) wastewater discharge permit to the persons) listed below ef-
fective 45 days from the publish date of this notice.
Written comments regarding the proposed permit' will be accepted until
30 days after the publish date of this notice. All comments received prior
to that date are considered in the final determinations regarding the pro-
posed permit The Director of the NC Division of Water Quality may de-
cide to hold a public meeting for the proposed permit should the Division
receive a significant degree of public interest
Copies of the draft permit and other supporting information on file used
to determine conditions present in the draft permit are available, upon re-
quest and payment of the costs of reproduction. Mad commens and/or
requests fcr information to the NC Division of Water Quality at this above
address or call Ms. Valery Stephens at (919) 73 -5083, extension 52D.
Please include the NPDES permit number (attached) in any communica-
tion Interested persons may also visit the Division of Water Quality at
512 N. Salisbury Street. Raleigh, NC 27604-1148 between the tours of
8:00 a.m. and 5:00 p.m. to review information on file.
Davidson County
Davidson County Schools, P.O. Bois 2057; Lexington, NC has
for renewal of NPDES pemhit NC0042145 for its Midway Elementary
School WWTP in Davidson County. This-permtted facility discharges
treated wastewater to an unnamed tnbirlary to Leonard Creek in the Yad-
kin -Pee Dee Ram Basin. Currrently BOO: ammonia nitrogen; and, toter
residual chlorine are water quality Tested.. This dscharge may affect fu-
ture allocations in thus portion of the watershed: r� tt
Bills Truck, Stop, has 'applied for , renewal. i of its NPDES permit
NC0040045. The permitted facility discharges treated wastewater to
South Potts Creek m the Yadkin -Pee Dee River Basin. Currently B005,
Total Residual Chlorine, Total Suspended Solids and Fecal Ceitorm are
water quality limited. This discharge may affect future allocations in this
portion of South Potts Creek.
Davidson County Schools, P.O. Box 2057, Lexington, NC has applied
for renewal aid NPDES permit NC0041629 far its Extended Day School
WWTP in Davidson County. This permitted facility discharges treated
wastewater to an unnamed tributary to Hamby Creek in the Yadkin -Pee
Dee River Basler. Currently 60D, ammonia rxtrogen, and total residual
chlorine are water quality limited. This discharge may affect Mire aflcca-
hons in this portion of the watershed. ,.
Quail Run Mobile Horne Perk, has applied for rn of its NPDES per-
mit NC007003:3. The permitted fadTrrry discharge s treated wasewater to
Milier Creek in the Yadkin -Pee Dee River Basin. Currently B005, Ammo-
nia as Nitrogen, Total Residual Chlorine;- Total Suspended Solids and
Fecal Coliferm are water quality limitetk"Tte&dscharge phay affect future
allocations in this portion of Miller Creek.' • y2-1
Davidson County Schools, P.O. Box 2057, Lexington, NC has applied
for renewal of NPDES permit NC0042129 for its Pilot Elementary School
WWTP in Davidson County. This permitted facility discharges treated
wastewater to Jimmys Creek in the Yadkin -Poe Dee River Basin. Cur-
rently ammonia nitrogen and total residual chlorine are water quality lim-
ited. This discharge may affect future allocations in this portion of thewa-
tershed.
Captain Stevens. Seafood eta rant, has applied for renewal of its
NPDES permit NC6059218. The permitted facility discharges treated
wastewater to an unnamed tributary to Reedy Creek in the Yadkin -Pee
Dee Rarer Basin. Currently 8005, Total Residual Chlorine, Total Sus-
pended Solids and Fecal Coliform are water quality (knifed. This dis-
charge may affect future allocations in this portion of Reedy Creek.
Hilltop Living Center, has applied for renewal of its NPDES permit
NC0059536. The permitted facility discharges treated wastewater to an
unnamed tributary to Yadkfn.Rtver in the Yadkin -Pee Dee River Basin.
CurrentlyB0D5, Ammonia as Nitrogen, Total Residual Chlorine, Total
Suspended Solids, Total Phosphorus andjecal Colitorm are water qua I-
ity limited. This discharge may affect future allocations in this portion of
Yadkin River-'f76i

QUAIL RUN MOBILE HOME PARK
136 QUAIL PLACE DRIVE
WINSTON-SALEM, NORTH CAROLINA 27127
September 23, 2003
Mrs. Valery Stephens
NC DENR/Water Quality/Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: NPDES Permit Number — NC0070033
Dear Mrs. Stephens:
L
ly ll lri r �l
OCT - 6 2003 vJ
GE;;R - WATER QUALITY
F • :iHT SCi:RCE BRANCH
This is to request renewal of the above referenced NPDES Permit. There
have been no changes to this facility since the last permit renewal.
Yours truly,
Fred Cox
Owner

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
http://h2o.enr.state.nc.us/NPDES/
North Carolina NPDES Permit Number
1. Contact Information:
NCO() 70033
Please print or type
Facility Name QUAIL RUN MOBILE HOME PARK
Owner Name FRED P COX
Street Address P 0 BOX 631
City STANLEYTOWN
State / Zip Code VIRGINIA 24168
Telephone Number ( 276 ) 629-8033
Fax Number ( )
e-mail Address QRH(aKIMBANET. COM
Operator Name QUENTIN CAMPBELL
Street Address 3336 BECKS CHURCH RD
City LEXINGTON
State / Zip Code NC 27292
County DAVIDSON
Telephone Number ( 336 ) 357-5398
2. Location of facility producing discharge:
Check here if same as above I —
Facility Name (If different from above)
Street Address or State Road
City
State / Zip Code
County
136 QUAIL PLACE DR
WINSTON-SALEM
NC 27127
DAVIDSON
3. Reason for application:
Expansion/Modification * Existing Unpermitted Discharge
Renewal New Facility
XX
* Provide a description of the expansion/modification:
Page 1 of 3 Version 12/02

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
4. Description of the existing treatment facilities (list all installed components with
capacities):
0.017 MGD wastewater treatment plant consisting of two 3,200 gallon septic
tanks, one 4,000 gallon septic tan, two 4,500 gallon septic tanks, an 8,400
gallon recirculating dosing tank, a 4,250 square foot recirculating surface
sandfilter, tablet chlorinator, and 350 gallon chlorine contact tank.'
5. Description of wastewater (check all that apply):
Type of Facility Generating Wastewater
Industrial Number of Employees
Commercial Number of Employees
Residential XX Number of Homes
School Number of Students/Staff
Other
45
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
Mobile Home Park
6. List all permits, construction approvals and/or applications (check all that apply):
Type
RCRA
UIC
NPDES
PSD
NESHAPS
Permit Number
NC0070033
Type
Non -Attainment
Ocean Dumping
Dredge/Fill Permits
Other
Permit Number
7. Number of separate wastewater discharge pipes (wastewater outfalls):
ONE (1)
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall:
Page 2 of 3 Version 12/02

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
9. Name of receiving stream(s) (Provide a map showing the exact Iocation of each outfall):
Miller Creek
10. Is this facility located on Native American lands? (check one)
YES El NO
I certify that I am familiar with the information contained in the application and that to
the best of my knowledge and belief such information is true, complete, and accurate.
Fred Cox
Printed Name of Person Signing
Owner
Title •
September 23, 2003
Signature of Applicant Date Signed
North Carolina General Statute 143-215.6(b)(2) provides that: Any person who knowingly makes any false statement representation, or
certification in any application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, or who falsifies, tampers with, or 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 $10,000, 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 $10,000 or
imprisonment not more than 5 years, or both for a similar offense.)
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QUAIL RUN MOBILE HOME PARK
NPDES Permit NC0070033
The sludge management of this facility is handled by Forsyth Rooter who
pumps the solids out of the septic tanks on a regular and/or as needed basis.
Fred Cox

FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
NrZE)' 3 3
Facility Name
40/4-C6: ,(1I t'liP
Reviewer
5=) - --
Basin/Sub-basin
--o` - —64
Receiving Stream
f-1 ( LL 2. c
L:c
(cA
Is the stream impaired (listed on 303(d))?
l 0
Is stream monitoring required?
tis
Do they need NH3 limit(s)?
Lt)-E S
Do they need TRC limit(s)?
���
Do they have whole -effluent toxicity testing?
Are there special conditions?
0
Any obvious compliance concerns?
`
Existing Expiration Date
3 f /to' -
Proposed Expiration Date
, ( /1 dc1
Miscellaneous Comments:
1,3656 c6(cfrP--- cal/tio, /0)-e-(^c cl—t5-
Circle one: EXPEDITE
If expedited, is thi
a simpler perm
DO NOT EXPEDITE
or a more difficult one?