NC0060224_Renewal Application_20141020

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 1NC0060224
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 Jonas Ridge Properties,LLC
Facility Name Jonas Ridge Adult Care Facility
Mailing Address P 0 Hoz 519
City Newland
State / Zip Code NC 28657
Telephone Number 828-733-0141
Fax Number 828-733-9064
e-mail Address sfre com
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 9051 Highway 181 RECEIVEDIDENRIDWR
City Jonas Ridge OCT 2 0 2014
State / Zip Code NC 28641
Water c.tual'
County Burke Permitting Section
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)
Jonas Ridge Properties,LLC
Name
Mailing Address P. O. Boz 519
City Newland
State / Zip Code NC 28657
Telephone Number 828-733-0141
Fax Number 828-733-9064
e-mail Address rfrenchigmhstechnologies.com
•
1 d 3 Form-011112

NPDEB APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters<1.0 MOD
4. Description of wastewater.
Facility Generating Wastewater(check all that applyk
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential Number of Homes
School Number of Students/Staff
Other x Explain: Nursing Home
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing home domestic waste
Number of persons served: 70
5. Type of collection system
X Separate (sanitary sewer only) 0 Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points_l
_l
Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (NSW applicants:Provide a map showing the exact location of each
outfall):
Unnamed tributary to Camp Creek
8. Frequency of Discharge: X Continuous 0 Intermittent
If intermittent:
Days per week discharge occurs: Duration:
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.
0.0075MGD facility with influent bar screen, equalisation basin with two(2) pumps,
aeration basin, clarifier, chlorine contact chamber, dechlorination unit, post-aeration
tank.
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 0.0075MQD
Annual Average daily flow 0.0035 MOD (for the previous 3 years)
Maadmum daily flow 0.0098 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X No
12. Effluent Data
NEW APPLTCANPP$:Provide data for the parameters listed.Fecal Coliform, Temperature and pH shall be grub
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 past 36 months for parameters currently in your permit. Mark other parameters `N/A'.
Parameter Daily Monthly Units of
>IIsodmsm Average Measurement
Biochemical Oxygen Demand (BODS) 50.6 31.5 MG/L
Fecal Coliform 23 3.4 CFU/100ML
Total Suspended Solids 30 17.1 MG/L
Temperature (Summer) 24.5 23.4 C
Temperature (Winter) , 9.3 6.5 C
pH 9.0 8.1 units
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste(RCRA) NESHAPS(CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES NC0060224 Dredge or fill(Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the
best o
of my knowledge
and belief
fssuch information is true, complete, and
' / e.
r/ Lill/4e� toe-.-1-/De-it�
Printed te of Person Signing Title
(&'-q€ SOU . /o - �s- -
Signature of Ap licant Date
North Cardin General Statute 143-215.6(bM2)states: Any person who knowingly makes any false statement representa ion, a certification in any
application,record,report, pian,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 sirdar offense.)
3 of 3 Foran-011/12

iire7A
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, Ill
Governor Secretary
October 21,2014
George Ware,President
Jonas Ridge Properties,LLC
PO Box 519
Newland,NC 28657
Subject: Acknowledgement of Permit Renewal
Permit NC0060224
Burke County
Dear Mr. Ware:
The NPDES Unit received your permit renewal application on October.20, 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,
W re h•Meobfo-rot,
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:[phone] Fax:[phone]/Customer Service:1-877-623-6748
Internet:www.ncwater.orq
An Equal OpportunityV firmative Action Employer