NC0070033_Permit (Issuance)_20140521

NPDES DOCUMENT SCANNING COVER SHEET
NC0070033
� MHP
NPDES Permit:
d4;/ no
D xT
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:
May 21, 2014
This document is printed on reuse paper - more any
content on the reirerse side

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla III
Governor Secretary
May 21, 2014
Mr. Fred P. Cox, Jr.
P.O. Box 631
Stanleytown, VA 24168-0631
Subject:
Dear Mr. Cox:
Issuance of NPDES Permit NC0070033
Quail Run Mobile Home Park WWTP
Davidson County
Class WW-1
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).
This final permit includes no major changes from the draft permit sent to you on March
12, 2014.
➢ NOTE: Proposed Federal regulations require electronic submittal of all discharge monitoring
reports (DMRs). Accordingly, NC DENR has established an electronic data -submission system.
Permittees must begin using the system no later than 270 days following the effective date of
permit renewals. In your case, that deadline is April 1, 2015.
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 Weaver at telephone number (919) 807-
6391.
Thomas A. Reeder, Director
Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / http://portal.ncdenr.org/weblwq
An Equal Opportunity/Affirmative Action Employer— 50% Recycledl10% Post Consumer Paper

Permit NC0070033
'I
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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,
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 subbasin 03-07-04 of the Yadkin -Pee Dee
River Basin in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, and IV hereof.
The permit shall become effective July 1, 2014.
This permit and the authorization to discharge shall expire at midnight on May 31, 2019.
Signed this day May 21, 2014
T ► as A. Reeder, Director
'vision of Water Resources
By Authority of the Environmental Management Commission
1 of 5

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 that includes the
following components:
• Two 3,200-gallon septic tanks
• 4,000-gallon septic tank
• Two 4, 500-gallon septic tanks
• 8,400-gallon recirculating dosing tank
• 4,250 ft2 recirculating surface sand filter
• Tablet chlorinator
• 350-gallon chlorine contact tank
This permitted facility is located at the Quail Run Mobile Home Park WWTP [136 Quail
Place Drive, Winston-Salem] in Davidson County.
2. Discharge from said treatment works at the location specified on the attached map into
Miller Creek, currently classified C waters in subbasin 03-07-04 of the Yadkin -Pee Dee
River Basin.
2 of 5

Permit NC0070033
Part I
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
[PCS CODE]
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sam le Tye
pp
Sample.
Location
Flow
[50050]
0.017 MGD
Weekly
Instantaneous
Influ or
Efflueent ntt
BON [00310]
30.0 mg/L
45.0 mglL
2/month
Grab
Effluent
Total Suspended Solids [00530]
30.0 mg/L
45.0 mg/L
2/month
Grab
Effluent
NH3-N [00610]
(April 1— October 31)
6.9 mg/L
34.5 mg/L
2/month
Grab
Effluent
NH3-N [00610]
(November 1— March 31)
25.8 mg/L
35.0 mg/L
2/month
Grab
Effluent
Dissolved Oxygen [00300]
(April 1— October 31)
Weekly
Grab
Effluent,
U & D
Fecal Coliform [31616]
(geometric mean)
200/100 ml
400/100 ml
2/month
Grab
Effluent
Total Residual Chlorine (TRC)3
[50060]
28 NglL
2/Week
Grab
Effluent
Temperature
[00010]
Weekly
Grab
Effluent,
U & D
Total Nitrogen [00600]
(TKN + NO2 + NO3)
Quarterly
Grab
Effluent
Total Phosphorus [00665]
Quarterly
Grab
• Effluent
pH [00400]
> 6.0 and < 9.0 standard units
2/month
Grab
Effluent
Notes:
1 No later than April 1, 2015 the permittee shall begin submitting discharge monitoring reports
electronically using the Division's eDMR application system [see A. (3)].
2 U: approximately 100 feet upstream from the outfall. D: at least 300 feet downstream from the
outfall.
3 The Permittee shall report all effluent TRC values reported by a NC -certified laboratory
[including field -certified]. Effluent values < 50 µg/L will be treated as zero for compliance
purposes.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE
AMOUNTS.
3 of 5

Permit NC0070033
A. (2) NUTRIENT REOPENER FOR HIGH ROCK LAKE
This permit may be reopened and modified to implement nutrient requirements in accordance with
any future TMDL and / or nutrient management strategy for High Rock Lake.
A. (3) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Proposed federal regulations require electronic submittal of all discharge monitoring reports
(DMRs) and specify that, if a state does not establish a system to receive such submittals, then
permittees must submit DMRs electronically to the Environmental Protection Agency (EPA). The
Division anticipates that these regulations will be adopted and is beginning implementation.
NOTE: This special condition supplements or supersedes the following sections within Part II of
this permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning no later than April 1, 2015, the permittee shall begin reporting 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 / Information Processing Unit
ATTENTION: Central Files / eDMR
1617 Mail Service Center
Raleigh, NC 27699-1617
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.
Requests for temporary waivers from the NPDES electronic reporting requirements must be
submitted in writing to the Division for written approval at least sixty (60) days prior to the
4 of 5

Permit NC0070033
date the facility would be required under this permit to begin using eDMR. Temporary waivers
shall be valid for twelve (12) months and shall thereupon expire. At such time, DMRs shall be
submitted electronically to the Division unless the permittee re -applies for and is granted a
new temporary waiver by the Division.
Information on eDMR and application for a temporary waiver from the NPDES electronic
reporting requirements is found on the following web page:
http://portal.ncdenr.org/web/wcdadmin/bog/ipu/edmr
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.
2. Signatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B.
(11.) (d)1
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://portal. ncde nr. org/web/wq/admin/bog/ip u/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."
3. Records Retention [Supplements Section D. (6.)1
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].
5 of 5

Quail Run Mobile Home Park
Latitude: 35° 59' 12" N Longitude:
Stream Class: C Receiving Stream:
Sub -Basin: 03-07-04 USGS Quad:
River Basin: Yadkin -- Pee Dee
80° 15' 59" W
Miller Creek
Kernersville, NC
Facility
Location
[not to scale]
??,ova
Permit NC0070033
Davidson County

42008346 J000471354
AFFIDAVIT OF PUBLICATION
STATE OF NORTH CAROLINA LEXINGTON, NC March 29, 2014
DAVIDSON COUNTY
I, Lynn Bowers OF THE DISPATCH, A NEWSPAPER PUBLISHED IN THE CITY OF LEXINGTON, COUNTY AND STATE
AFORESAID, BEING DULY SWORN, SAYS THE FOREGOING LEGAL OF WHICH THE ATTACHED IS A TRUE COPY,
WAS PUBLISHED IN SAID NEWSPAPER ONCE, BEGINNING THE 29th DAY OF March, 2014.
PUBLICATION FEE: $ 110.45
(pi in
(SEAL)
SW N TO AND SUBSCRIBED BEFORE ME, THIS DAY OF
,egiv?
MY COMMISSION EXPIRES 0?- ! (0 dL)r
Ad Copy:
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://portal. n cden r. orq/web/wq/
swp/ps/npdes/calendar or by
calling [phone]. Fred P.
Cox requested renewal of
NPDES permit
NC0070033/Quail Run Mobile
Home Park WWTP/Davidson
County. Facility discharges to
Miller CreeklYadkin-Pee Dee
River Basin. Currently
ammonia nitrogen, total
residual chlorine, and fecal
coliform are water quality
limited. Steve Pappas
requested renewal of permit
NC0059218/Captain Stevens
Seafood WWT/Davidson
County. Facility discharges to
an unnamed tributary to Reedy
Creek/Yadkin-Pee Dee River
Basin. Currently dissolved
oxygen, total residual chlorine,
oil and grease, and fecal
coliform are water quality
limited.
March 29, 2014
AA 0,h emt
N i L
Notary Public
Davidson County
=-My Commission ExpiresE
,��// r• rC1A�`p\\\\��

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 3/24/2014
Permit Number
NC0070033
Facility Name
Quail Run Mobile Home Park WWTP
Basin Name/Sub-basin number
03-07-04
Receiving Stream
Miller Creek
Stream Classification in Permit
C
Does permit need Daily Max 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?
No
Does permit have instream monitoring?
Dissolved Oxygen and Temperature
Is the stream impaired (on 303(d) list)?
For what parameter?
No
Any obvious compliance concerns?
None. Single enforcement in 2013, none prior.
Any permit modifications since last permit?
None.
New expiration date
5/31/2019
Comments on Draft Permit
> Added parameter codes.
> Added High Rock reopener condition.
> Added eDMR requirements.
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream
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 permitted effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"The facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values < 50 µg/L will be treated as zero for
compliance purposes."
This page has been printed on scrap paper to save money and reduce our program's environmental
impact. Disregard any content on the back of this page.

QUAIL RUN MOBILE HOME PARK
136 QUAIL PLACE DRIVE
WINSTON-SALEM, NC 27127
November 13, 2013
Wren Thedford
NC DENR / NPDES Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
1-01@mow[gp
Nov 19 2013
DENR-WATER QUALITY
POINT SOURCE BRANCH
Re: Renewal, NPDES Permit NC0070033
Please accept my request for renewal of the permit for our sewage treatment operation.
Enclosed is the application and related forms
There has been no changes made to the system since our last renewal.
Respectfully submitted,
QUAIL RUN MOBILE HOME PARK
/--- P
Fre
Owner
Enclosures
ox

QUAIL RUN MOBILE HOME PARK
136 QUAIL PLACE DRIVE
WINSTON-SALEM, NC 27127
November 13, 2013
Wren Thedford
NC DENR / NPDES Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
Re: Renewal, NPDES Permit NC007003
DESCRIPTION OF SLUDGE MANAGEMENT PLAN
Septic Tanks are pumped every three months by Forsyth Rooter Service, Inc.,
P 0 Box 24248, Winston-Salem, NC 27114, telephone [phone]

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit
coo ?0033
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name reed X
Facility Name QU d un/ i " o 6,!e. 4,rie f1�
Mailing Address P15 /30 (0 Si
City 4- A Weil w
y
State / Zip Code I M .. t,1 Flo g
Telephone Number j) 8/7' 4WD Die - f / e -
Fax Number fp%) a9 - AD % l (OA // k%e79
e-mail Address r in 20 M e4 4 . Ne7'
�/2of' d G�orrCAs`i.fret
eR�lal W�!/ c y �
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road /3 (QUA; / /0L,4 0,e/✓e_
City ) 64 /P m
State / Zip Code A(C a 7 r a '7
County 4:514
V /0/5
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
/1,15ille,e a. ,CeowAvee'
.56. a Aloe/As/de 0,e, ie-
le54/wripti
N.c-. 027 9-5
(33k) on, - v 84.P.
) wode-
Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
[.cL �uKtA-tiom.
m
1 of 3
Form-D 9/2013

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial 0 Number of Employees
Commercial ❑ Number of Employees
Residential Number of Homes
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served:
5. Type of collection system
lal-eparate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points /
Outfall Identification number(s) OD /
Is the outfall equipped with a diffuser? ❑ Yes Mate
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Fie(le
's
8. Frequency of Discharge: continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
nee e
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0. o/ 7 MGD
Annual Average daily flow . Do 78 MGD (for the previous 3 years)
Maximum daily flow . D') 9� MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes a No
12. Effluent Data
AWW APPLICANTS: Provide data for the parameters Iisted. 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: Provide the highest single reading (Daily Maximum) and Monthly Average over
the east 36 months for parameters currentlu in our permit Mark other parameters "N/A".
- Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
/5. g
/a, y
',id/4
r7/
Fecal Coliform
< /
a,?
Total Suspended Solids
9...?
,, . -5
n,, 61/4
Temperature (Summer)
a3
�C
Temperature (Winter)
/0
9
o
pH
nv/4
/vb>
AY'i
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES Ny 00700 3.3 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
Permit Number
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.
rzed (?,ox
Print • • = • a ' rson Signing Title
Signature of App "cant
North Carolina General tatute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certication 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