NC0075353_Renewal Application_20141013

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Linda Isaacs
McDowell Assisted Living
PO Box 909
Marion, NC 28752
Dear Mr. Isaacs:
John E. Skvarla, III
Secretary
October 13, 2014
Subject: Acknowledgement of Permit Renewal
Permit NCO075353
Marion County
The NPDES Unit received your permit renewal application on October 13, 2014. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30 -45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Charles
Weaver (919) 807 -6391.
Sincerely,
1AI rre w Tkt of f a -0(
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699 -1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: 919 - 807 -63001 Fax: 919 - 807- 6492/Customer Service: 1-877-623-6748
Internet:: www.ncwater,org
An Equal OpportunitylAffirmative Action Employer

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 Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699 -1617
NPDES Permit LWC0075353
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
Facilitv Name
Mailing Address
City-
State / Zip Code
Telephone Number
Fax Number
e -mail Address
McDowell Assisted Living, LLC
McDowell Assisted Living
P. O. Box 909 RECEIVED /DENROWR
Marion O r T I 1 2014
NC 28752
w . _... water Duality
828- 652 - 3033 Permitting Section
(828)659 -8649
ma152315a hotmaiLcom
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road NC Highway 226
City Marion
State / Zip Code
County
McDowell
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility
referring to the Operator in Responsible Charge or ORC)
Name McDowell Amsted Living, LLC
Mailing Address P. 0. Sox 909
City Marion
State / Zip Code NC 28752
Telephone Number 828 -652 -3033
Fax Number (828 }659 -5649
e -mail Address maI5235ahotmail.com
(Note that this is not
1 of 3 Form -0 (1;17

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating I0016 domestic wastewaters <1.0 MGD
4. Description of wastewater* RECEIVEDMENROWR
F
Ac4ity,geqeratt�ng_Wastevatertcheek all that applyJ� i 14
0(. ! i 3 I11
Industrial Number of Employees Water Quality
Commercial X Number of Employees Section
. .... 13-0 Water
Residential Number of Homes
School Number of Students/ Staff
Other z Explain: Residents
U)eseribe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Assisted Living Home
Number of persons served:
S. Typo of collection system
X Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Out fall Information:
Number of separate discharge points I
Outfall Identification number(a) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (AWW a
qmUcants Provide a map showing the exact lor, tion of each
North Muddy Creek in Catawba River Basin
S. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent.
Days per .%,eek discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BBD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
0.010 MGD facility with extended aeration basin, clarifier, chlorination equipment and
sludge digester
Form -D 11112

NPDES APPLICATION - FORM D
For privately- owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.010 __MGD
Annual Average daily flow 0.0014 MGD (for the previous 3 years)
Maximum daily flow 0.007 MOD (for the previous 3 years)
11. Is this facility located on Indian country?
0 Yes
►.
RECEIVED/1`11: - -'-
111M
[IIM
Water Uuaiii.
Permittino So
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal C.oliform, Temperature and pH shall be grab
sarryales> 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 rmudmum.
RENEWAL APPLICANTS: Provide 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`.
13. List all permits, construction approvals and /or applications.
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES
PSD (CAA)
Non- attainment program (CAA)
NCO075353 Dredge or fill (Section 404 or CWA)
Other
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.
Printed name of Person Signing Title
/o - 9 -aol
re of Applicant Date
North Carolina General Statute 143 -215.1 (b}(2) states Any person who knowingly makes any false statenxnt representation, or certification in any
appkatson. record report, plan, or other document files or required to be maintayned under Article 21 or regutations of the Environmental Management
Commission implementing that Article or who falsifies, tampers with, or knowingty 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 impleme ibng tat 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. 118 U S C, Section 1001
provides a punishment by a fine of not more ;hart $25.000 or imprisonment not we than 5 years. or both: for a similar offense)
30f 3 Form -I} 11112
Daily
Monthly
Units of
Parameter
Maximum
Avesra a
Measurement
Biochemical Oxygen Demand (BODs)
22.3
12.7
Mti /L
Fecal Coliform
102
2.5 �
CFU/ 1001&
Total Suspended Solids
36.7
21.6
MG /L
Temperature (Summer)
27.1
24.9
C
Temperature (Winter)
14.0
13.0
C�
pN
8.1
7.6
UNITS
13. List all permits, construction approvals and /or applications.
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES
PSD (CAA)
Non- attainment program (CAA)
NCO075353 Dredge or fill (Section 404 or CWA)
Other
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.
Printed name of Person Signing Title
/o - 9 -aol
re of Applicant Date
North Carolina General Statute 143 -215.1 (b}(2) states Any person who knowingly makes any false statenxnt representation, or certification in any
appkatson. record report, plan, or other document files or required to be maintayned under Article 21 or regutations of the Environmental Management
Commission implementing that Article or who falsifies, tampers with, or knowingty 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 impleme ibng tat 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. 118 U S C, Section 1001
provides a punishment by a fine of not more ;hart $25.000 or imprisonment not we than 5 years. or both: for a similar offense)
30f 3 Form -I} 11112