NC0051969_Fact Sheet_20221104

DENR / DWQ / NPDES Unit
FACT SHEET FOR NPDES PERMIT DEVELOPMENT
NPDES Permit NC0051969
Facility Information
Applicant/Facility Name:
Castle Hayne Health Holdings LLC / Castle Creek Memory Care WWTP
Applicant Address:
P.O. Box 2568, Hickory, NC 28603-2568
Facility Address:
4724 Castle Hayne Road; Castle Hayne, NC 28429
Permitted Flow
0.012 MGD
Type of Waste:
82% domestic; 18% WTP backwash
Facility/Permit Status:
Class II / Renewal
County:
New Hanover County
Miscellaneous
Receiving Stream:
UT Prince George Creek
Regional Office:
Wilmington
Stream Classification:
C-Swamp
USGS Quad:
New Hanover
303(d) Listed?
No
Permit Writer:
Emily Richards
HUC:
030300070807
Date:
June 2022
Drainage Area (mi2):
0
•
Lat. 34" 20' 20" N Long. 77" 54' 47" W
Summer 7Q10 (cfs)
0
Winter 7Q10 (cfs)
0
Average Flow (cfs):
0
IWC (%):
100
Facility Summary
Castle Hayne Health Holdings LLC operates a healthcare facility serviced by a combined RO-treatment
system to provide potable water (groundwater) and a wastewater treatment plant (WWTP) serving rest -
home residents and staff. Effluents combine to discharge at the same outfall, 001. Two converted sand
filters remove iron. An ion exchange unit is maintained for water softening. Filter backwash discharges to
a storage tank draining as influent to the WWTP. The WWTP is treated utilizing an aeration basin, dual
clarifiers, drum filter and UV disinfection.
Effluent and Compliance - Data Review
2022 renewal: Castle Hayne Health Holdings entered into a Compliance Agreement with NCDEQ in 2019
after struggling to meet copper limits once the initial compliance period expired. The compliance
agreement forgave 60% of penalties assessed against the facility while the facility attempted to find a
solution to copper limit issues. The facility used a multi -phased study and did not find success. In order to
avoid having to pay the remaining penalties at expiration of the compliance agreement, the facility
temporarily closed and re -homed its residents. Currently, the facility is not discharging and is undergoing
renovations including updates to the water treatment components to regain compliant status. This permit
renewal utilized available hardness data reported by the permittee and found that copper limits could be
relaxed, since copper is a hardness -dependent metal. There is still reasonable potential for the permittee to
exceed this new limit, but this should help the facility achieve compliance with permit requirements.
Facility has passed all WET tests this permit cycle.

eDMR summary January 2018-Dec2022
Effluent Data Summary - Outfall 001
Parameter Mean Minimum Maximum
00010 - Temperature, Water Deg. Centigrade
00070 - Turbidity
00094 - Conductivity
00300 - Oxygen, Dissolved (DO)
00400 - pH
00410 - Alkalinity, Total (as CaCO3)
00480 - Salinity
00900 - Hardness, Total (as CaCO3)
00940 - Chloride (as C1)
00951 - Fluoride, Total (as F)
01042 - Copper, Total (as Cu)
01092 - Zinc, Total (as Zn)
31616 - Coliform, Fecal MF, MFC Broth, 44.5 C -
50050 - Flow, in conduit or thru treatment plant 5569.32
50060 - Chlorine, Total Residual 16.18
70295 - Solids, Total Dissolved 811.25
CO310 - BOD, 5-Day (20 Deg. C) - Concentration 3.27
CO530 - Solids, Total Suspended - Concentration 9.99
CO610 - Nitrogen, Ammonia Total (as N) - Concentration 0.37
21.54
9.85
1421.92
8.12
7.96
201.00
0.70
223.27
278.56
0.42
37.72
42.75
9.00
0.50
740.00
6.01
7.23
201.00
0.40
59.00
22.00
0.10
5.00
15.00
1.00
1.00
10.00
520.00
2.00
2.50
0.10
32.00
39.70
2280.00
12.35
8.48
201.00
1.30
331.00
714.00
1.90
4430.00
125.00
2420.00
19900.00
47.00
1270.00
15.00
43.50
3.70
209
48
48
209
209
1
48
48
209
20
209
20
210
1331
418
20
216
214
209
Maximum, monthly avg flow for past 36 months: 10,273
Instream Data Analysis
Upstream and downstream data from January 2018 to the present were analyzed. Dissolved oxygen sample
results downstream generally show an improvement over upstream sample results. However, most
downstream samples are still under 5.0 mg/L, as may be considered typical of Class C-Sw conditions.
Conductivity shows a downstream increase. The Division recommends continuing the current required
weekly instream monitoring.
Upstream Monitoring Summary
Parameter Mean Minimum Maximum
00010 - Temperature, Water Deg. Centigrade 18.48 0.00
00094 - Conductivity 728.60 197.00
00300 - Oxygen, Dissolved (DO) 2.43 0.25
00480 - Salinity 0.34 0.10
00900 - Hardness, Total (as CaCO3) 163.83 54.00
31616 - Coliform, Fecal MF, MFC Broth, 44.5 C- 1.00
N
222.00 207
2230.00 48
9.15 207
1.10 47
734.00 47
60000.00 205
Downstream Monitoring Summary
Parameter
Mean Minimum Maximum
N
00010 - Temperature, Water Deg. Centigrade 19.40 5.00 30.00 209
00094 - Conductivity 1164.60 171.00 2210.00 48
00300 - Oxygen, Dissolved (DO) 4.78 1.05 10.54 209
00480 - Salinity 0.58 0.10 1.10 48
00900 - Hardness, Total (as CaCO3) 145.25 94.00 194.00 4
31616 - Coliform, Fecal MF, MFC Broth, 44.5 C - 1.00 120000.00 209

Reasonable Potential Analysis (RPA) for Toxicants
The need for toxicant limits is based upon a demonstration of reasonable potential to exceed water quality
standards, a statistical evaluation that is conducted during every permit renewal utilizing the most recent
effluent data for each outfall. The RPA is conducted in accordance with 40 CFR 122.44 (d) (i). The NC
RPA procedure utilizes the following: 1) 95% Confidence Level/95% Probability; 2) assumption of zero
background; 3) use of/2 detection limit for "less than" values; and 4) streamflows used for dilution
consideration based on 15A NCAC 2B.0206. Effective April 6, 2016, NC began implementation of
dissolved metals criteria in the RPA process in accordance with guidance titled NPDES Implementation of
Instream Dissolved Metals Standards, dated June 10, 2016.
A reasonable potential analysis was conducted on effluent toxicant data collected between January 2018
and December 2021. Pollutants of concern included toxicants with positive detections and associated water
quality standards/criteria. Based on this analysis, the following permitting actions are proposed for this
permit:
• Effluent Limit with Monitoring. The following parameters will receive a water quality -based
effluent limit (WQBEL) since they demonstrated a reasonable potential to exceed applicable water
quality standards/criteria: Copper, Fluoride, Chlorides
• Monitoring Only. The following parameters will receive a monitor -only requirement since they
did not demonstrate reasonable potential to exceed applicable water quality standards/criteria, but
the maximum predicted concentration was >50% of the allowable concentration: no parameters
• No Limit or Monitoring: The following parameters will not receive a limit or monitoring, since
they did not demonstrate reasonable potential to exceed applicable water quality standards/criteria
and the maximum predicted concentration was <50% of the allowable concentration: Zinc
Proposed Changes for Renewal
• Updated facility description on supplement to cover page to include 12-digit HUC
• Updated Section A. (2.) to include instructions for electronic submittal of WET results
• Updated Section A. (3.) to be consistent with current federal requirements for electronic reporting
• Based on newly available in -stream and effluent hardness data, the limit for copper, a hardness -
dependent metal, has been re -calculated. New limits for copper are:
o Monthly Average: 50.13 µg/L
o Daily Maximum: 80.54 µg/L
• Copper monitoring frequency is reduced to monthly, per RPA guidance
• Monitoring for Zinc has been removed from the permitted effluent limits and monitoring
requirements, as this parameter did not demonstrate reasonable potential to exceed applicable water
quality standards.
NPDES Implementation of Instream Dissolved Metals Standards — Freshwater Standards
The NC 2007-2015 Water Quality Standard (WQS) Triennial Review was approved by the NC
Environmental Management Commission (EMC) on November 13, 2014. The US EPA subsequently
approved the WQS revisions on April 6, 2016, with some exceptions. Therefore, metal limits in draft
permits out to public notice after April 6, 2016 must be calculated to protect the new standards - as
approved.
Table 5. NC Dissolved Metals Water Quality Standards/Aquatic Life Protection
Parameter
Acute FW, µg/1
Chronic FW, µg/1
Acute SW, µg/1
Chronic SW, µg/1
(Dissolved)
(Dissolved)
(Dissolved)
(Dissolved)

Arsenic
340
150
69
36
Beryllium
65
6.5
---
Cadmium
Calculation
Calculation
40
8.8
Chromium III
Calculation
Calculation
---
Chromium VI
16
11
1100
50
Copper
Calculation
Calculation
4.8
3.1
Lead
Calculation
Calculation
210
8.1
Nickel
Calculation
Calculation
74
8.2
Silver
Calculation
0.06
1.9
0.1
Zinc
Calculation
Calculation
90
81
Table 1 Notes:
1. FW= Freshwater, SW= Saltwater
2. Calculation = Hardness dependent standard
3. Only the aquatic life standards listed above are expressed in dissolved form. Aquatic life
standards for Mercury and selenium are still expressed as Total Recoverable Metals due to
bioaccumulative concerns (as are all human health standards for all metals). It is still necessary to
evaluate total recoverable aquatic life and human health standards listed in 15A NCAC 2B.0200
(e.g., arsenic at 10 µg/1 for human health protection; cyanide at 5 µg/L and fluoride at 1.8 mg/L for
aquatic life protection).
Table 2. Dissolved Freshwater Standards for Hardness -Dependent Metals
The Water Effects Ratio (WER) is equal to one unless determined otherwise under 15A NCAC
02B .0211 Subparagraph (11)(d)
Metal
NC Dissolved Standard, µg/1
Cadmium, Acute
WER*{1.136672-[ln hardness](0.041838)} • e^{0.9151 [ln hardness]-
3.1485}
Cadmium, Acute Trout
waters
WER*{1.136672-[ln hardness](0.041838)} • e^{0.9151[ln hardness] -
3.62361
Cadmium, Chronic
WER*{1.101672-[ln hardness](0.041838)} • e^{0.7998[In hardness]-
4.4451 }
Chromium III, Acute
WER*0.316 • e^{0.8190[ln hardness]+3.7256}
Chromium III, Chronic
WER*0.860 • e^{0.8190[ln hardness]+0.6848}
Copper, Acute
WER*0.960 • e^{0.9422[ln hardness]-1.700}
Copper, Chronic
WER*0.960 • e^{0.8545[ln hardness]-1.702}
Lead, Acute
WER* { 1.46203-[ln hardness](0.145712)} • e^ {1.273 [ln hardness]-1.460}
Lead, Chronic
WER* {1.46203-[lnhardness](0.145712)} •e^{1.273[ln hardness]-4.705}
Nickel, Acute
WER*0.998 • e^{0.8460[ln hardness]+2.255}
Nickel, Chronic
WER*0.997 • e^{0.8460[ln hardness]+0.0584}
Silver, Acute
WER*0.85 • e^{1.72[ln hardness]-6.59}
Silver, Chronic
Not applicable
Zinc, Acute
WER*0.978 • e^{0.8473[ln hardness]+0.884}

Zinc, Chronic
WER*0.986 • e^{0.8473[ln hardness]+0.884}

LOCALiQ
StarNews I The Dispatch
Times -News
PROOF OF PUBLICATION
Wren Thedford
Wren Thedford
Deq-Division Of Water Res
1617 MAIL SERVICE CENTER
Raleigh NC 27699
STATE OF NORTH CAROLINA, COUNTY OF NEW HANOVER
The Wilmington Star -News, a newspaper printed and published in
the city of Wilmington, and of general circulation in the County of
New Hanover, State of North Carolina, and personal knowledge of
the facts herein state and that the notice hereto annexed was
Published in said newspapers in the issue dated:
08/19/2022
and that the fees charged are legal.
Sworn to and subscribed before on 08/19/2022
Notary, State t f
My commision expires
Publication Cost: $168.30
Order No: 7672281
Customer No: 512930
PO #:
'I'IIIS IS NOT AN INVOICE!
Please du not use this Jurm Jur payment remittance.
# of Copies
1
SARA -IF BERTELSEN
Notaly Public
State of Wisconsln
PO Box 631245 Cincinnati, OH 45263-1245
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
NC0051969 Castle Hoyne Health
Holding, LLC
The North Carolina Environmen-
tal Management Commission
proposes to issue a NPDES
wastewater discharge permit to
the person(s) listed below. Writ-
ten 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 o
public hearing should there be a
significant degree of public inter-
est. 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/publ ic-
notices,or by calling (919) 707-
3601. NPDES Permit Number
NC0051969: Castle Hoyne Health
Holdings LLC (PO Box 2568,
Hickory, NC 28603-2568) applied
to renew Its NPDES permit for
its New Hanover County facility
discharging treated wastewater
to a UT to Prince George Creek,
Cope Fear River Basin. Cur-
rently, copper, HOD, ammonia
nitrogen and total residual chlo-
rine are water quality limited.
This discharge may affect future
wasteload allocations in this
portion of the receiving stream.
Page 1 of 1

Freshwater RPA - 95% Probability/95% Confidence Using Metal Translators
MAXIMUM DATA POINTS = 58
REQUIRED DATA ENTRY
Table 1. Project Information
Facility Name
WWTP/WTP Class
NPDES Permit
Outfall
Flow, Qw (MGD)
Receiving Stream
HUC Number
Stream Class
❑ CHECK IF HQW OR ORW WQS
Castle Creek Memory Care WWTP
WW-2
NC0051969
001
0.010
UT to Prince George Creek
030300070807
C;Sw
❑ Apply WS Hardness WQC
7Q10s (cfs)
7Q10w (cfs)
30Q2 (cfs)
QA (cfs)
1Q10s (cfs)
0.00
C
0.00
C
0.00
C
1.20
C
7r00
Effluent Hardness
Upstream Hardness
Combined Hardness Chronic
Combined Hardness Acute
217.92 mg/L (Avg)
163.83 mg/L (Avg)
217.92 mg/L
217.92 mg/L
Data Source(s)
❑ CHECK TO APPLY MODEL
Table 2. Parameters of Concern
Par01
Par02
Par03
Par04
Par05
ParO�
Par07
Par08
Par09
Par10
Par11
Par12
Par13
Par14
Par15
Par16
Par17
Par18
Par19
Par20
Par21
Par22
Par23
Par24
Name
WQS
Type Chronic Modifier
Acute
PQL Units
Arsenic
Aquactic Life
C
150
FW
340
ug/L
Arsenic
Human Health
Water Supply
C
10
HH/WS
N/A
ug/L
Beryllium
Aquatic Life
NC
6.5
FW
65
ug/L
Cadmium
Aquatic Life
NC
3.0210
FW
21.3730
ug/L
Chlorides
Aquatic Life
NC
230
FW
mg/L
Chlorinated Phenolic Compounds
Water Supply
NC
1
A
ug/L
I. Total Phenolic Compounds
Aquatic Life
NC
300
A
ug/L
Chromium III
Aquatic Life
NC
693.5120
FW
5331.4495
ug/L
Chromium VI
Aquatic Life
NC
11
FW
16
pg/L
Chromium, Total
Aquatic Life
NC
N/A
FW
N/A
pg/L
Copper
Aquatic Life
NC
50.1305
FW
80.5452
ug/L
Cyanide
Aquatic Life
NC
5
FW
22
10
ug/L
Fluoride
Aquatic Life
NC
1,800
FW
ug/L
Lead
Aquatic Life
NC
31.5956
FW
810.7968
ug/L
Mercury
Aquatic Life
NC
12
FW
0.5
ng/L
Molybdenum
Human Health
NC
2000
HH
ug/L
Nickel
Aquatic Life
NC
232.5176
FW
2093.4498
pg/L
Nickel
Water Supply
NC
25.0000
WS
N/A
pg/L
Selenium
Aquatic Life
NC
5
FW
56
ug/L
Silver
Aquatic Life
NC
0.06
FW
12.2829
ug/L
Zinc
Aquatic Life
NC
793.7086
FW
787.2688
ug/L
NC0051969 FW RPA total dissolved metals 06-2022, input
9/22/2022

NC0051969 FW RPA total dissolved metals 06-2022, input
9/22/2022

REASONABLE POTENTIAL ANALYSIS
H1
Effluent Hardness
Date Data BDL=1/2DL Results
1 1/3/2018 222 222 Std Dev.
2 59 59 Mean
3 210 210 C.V.
4 275 275 n
5 276 276 10th Per value
6 229 229 Average Value
7 197 197 Max. Value
8 225 225
9 272 272
10 331 331
11 227 227
12 249 249
13 280 280
14 270 270
15 292 292
16 241 241
17 301 301
18 270 270
19 326 326
20 306 306
21 280 280
22 223 223
23 196 196
24 284 284
25 206 206
26 220 220
27 252 252
28 256 256
29 124 124
30 158 158
31 152 152
32 132 132
33 144 144
34 122 122
35 124 124
36 130 130
37 144 144
38 172 172
39 12/29/2021 122 122
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use "PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
67.7827
217.9231
0.3110
39
124.00 mg/L
217.92 mg/L
331.00 mg/L
H2
Upstream Hardness
Date Data BDL=1/2DL Results
1 1/3/2018 109 109 Std Dev.
2 2/2/2018 106 106 Mean
3 3/1/2018 69 69 C.V.
4 4/4/2018 249 249 n
5 5/4/2018 109 109 10th Per value
6 6/13/2018 107 107 Average Value
7 7/13/2018 734 734 Max. Value
8 8/1/2018 56 56
9 9/21/2018 194 194
10 10/4/2018 184 184
11 12/6/2018 125 125
12 1/8/2019 128 128
13 2/6/2019 118 118
14 3/5/2019 80 80
15 4/4/2019 136 136
16 5/15/2019 228 228
17 6/5/2019 443 443
18 7/3/2019 321 321
19 8/8/2019 284 284
20 9/3/2019 243 243
21 10/1/2019 284 284
22 11/6/2019 161 161
23 12/5/2019 184 184
24 1/3/2020 151 151
25 2/6/2020 134 134
26 3/3/2020 130 130
27 4/7/2020 139 139
28 5/8/2020 144 144
29 6/1/2020 120 120
30 7/2/2020 96 96
31 8/3/2020 198 198
32 9/2/2020 244 244
33 10/13/2020 156 156
34 11/4/2020 128 128
35 12/2/2020 96 96
36 1/5/2021 100 100
37 2/11/2021 116 116
38 3/3/2021 114 114
39 4/6/2021 136 136
40 5/6/2021 144 144
41 6/3/2021 134 134
42 7/7/2021 92 92
43 8/4/2021 92 92
44 9/1/2021 72 72
45 10/6/2021 114 114
46 11/3/2021 54 54
47 12/1/2021 144 144
48
49
50
51
52
53
54
55
56
57
58
Use"PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
113.2284
163.8298
0.6911
47
87.20 mg/L
163.83 mg/L
734.00 mg/L
NC0051969 FW RPA total dissolved metals 06-2022, data
- 3 - 9/22/2022

REASONABLE POTENTIAL ANALYSIS
Par05
Chlorides
Date Data BDL=1/2DL Results
1 11/24/2020 397 397 Std Dev. 126.0129
2 12/2/2020 373 373 Mean 170.0
3 12/9/2020 290 290 C.V. 0.7412
4 12/16/2020 593 593 n 58
5 12/21/2020 501 501
6 12/29/2020 525 525 Mult Factor = 1.0
7 1/5/2021 487 487 Max. Value 593.0 mg/L
8 1/13/2021 324 324 Max. Pred Cw 593.0 mg/L
9 1/21/2021 149 149
10 1/27/2021 120 120
11 2/4/2021 136 136
12 2/11/2021 92 92
13 2/17/2021 101 101
14 2/24/2021 65 65
15 3/3/2021 80 80
16 3/12/2021 124 124
17 3/17/2021 188 188
18 3/25/2021 92 92
19 3/31/2021 120 120
20 4/6/2021 122 122
21 4/14/2021 115 115
22 4/21/2021 281 281
23 4/28/2021 357 357
24 5/6/2021 164 164
25 5/12/2021 154 154
26 5/19/2021 80 80
27 5/27/2021 162 162
28 6/3/2021 131 131
29 6/10/2021 134 134
30 6/17/2021 166 166
31 6/23/2021 182 182
32 6/28/2021 148 148
33 7/7/2021 101 101
34 7/15/2021 95 95
35 7/20/2021 303 303
36 7/28/2021 133 133
37 8/4/2021 89 89
38 8/11/2021 101 101
39 8/18/2021 83 83
40 8/25/2021 131 131
41 9/1/2021 130 130
42 9/8/2021 141 141
43 9/15/2021 74 74
44 9/22/2021 60 60
45 9/29/2021 60 60
46 10/6/2021 131 131
47 10/13/2021 79 79
48 10/20/2021 105 105
49 10/27/2021 98 98
50 11/3/2021 117 117
51 11/10/2021 116 116
52 11/17/2021 90 90
53 11/22/2021 149 149
54 12/1/2021 80 80
55 12/9/2021 115 115
56 12/15/2021 190 190
57 12/22/2021 66 66
58 12/29/2021 71 71
Pall
Use "PASTE SPECIAL -
Values'. then "COPY" .
Maximum data points =
58
Copper
Date Data BDL=1/2DL Results
1 11/24/2020 14 14 Std Dev. 9.4773
2 12/2/2020 19 19 Mean 15.6207
3 12/9/2020 10 10 C.V. 0.6067
4 12/16/2020 14 14 n 58
5 12/21/2020 11 11
6 12/29/2020 14 14 Mult Factor = 1.00
7 1/5/2021 12 12 Max. Value 72.00
8 1/13/2021 13 13 Max. Pred Cw 72.00
9 1/21/2021 18 18
10 1/27/2021 26 26
11 2/4/2021 41 41
12 2/11/2021 72 72
13 2/17/2021 19 19
14 2/24/2021 18 18
15 3/3/2021 27 27
16 3/12/2021 21 21
17 3/17/2021 18 18
18 3/25/2021 16 16
19 3/31/2021 16 16
20 4/6/2021 21 21
21 4/14/2021 15 15
22 4/21/2021 13 13
23 4/28/2021 14 14
24 5/6/2021 13 13
25 5/12/2021 12 12
26 5/19/2021 10 10
27 5/27/2021 13 13
28 6/3/2021 15 15
29 6/10/2021 13 13
30 6/17/2021 30 30
31 6/23/2021 15 15
32 6/28/2021 13 13
33 7/7/2021 17 17
34 7/15/2021 17 17
35 7/20/2021 13 13
36 7/28/2021 12 12
37 8/4/2021 12 12
38 8/11/2021 9 9
39 8/18/2021 8 8
40 8/25/2021 11 11
41 9/1/2021 11 11
42 9/8/2021 9 9
43 9/15/2021 11 11
44 9/22/2021 10 10
45 9/29/2021 9 9
46 10/6/2021 13 13
47 10/13/2021 15 15
48 10/20/2021 17 17
49 10/27/2021 11 11
50 11/3/2021 8 8
51 11/10/2021 6 6
52 11/17/2021 13 13
53 11/22/2021 9 9
54 12/1/2021 16 16
55 12/9/2021 12 12
56 12/15/2021 14 14
57 12/22/2021 16 16
58 12/29/2021 11 11
Use "PASTE SF
Values" then ",
. Maximum c
points = 5
NC0051969 FW RPA total dissolved metals 06-2022, data
- 4 - 9/22/2022

REASONABLE POTENTIAL ANALYSIS
'ECIAL•
COPY"
iota
18
Par13
Fluoride
Date Data BDL=1/2DL Results
1 1/3/2018 1900 1900 Std Dev.
2 4/4/2018 200 200 Mean
3 7/13/2018 300 300 C.V.
4 10/4/2018 200 200 n
5 1/8/2019 1800 1800
6 4/4/2019 1200 1200 Mult Factor =
ug/L 7 7/3/2019 200 200 Max. Value
ug/L 8 9/3/2019 200 200 Max. Pred Cw
9 10/1/2019 200 200
10 1/3/2020 100 100
11 4/7/2020 200 200
12 6/1/2020 200 200
13 7/2/2020 200 200
14 10/9/2020 300 300
15 1/5/2021 200 200
16 5/6/2021 100 100
17 6/3/2021 200 200
18 7/7/2021 200 200
19 10/6/2021 300 300
20 11/3/2021 200 200
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use "PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
539.5905
420.0000
1.2847
20
1.74
1900.0 ug/L
3306.0 ug/L
Par21
Use "PASTE SF
ZincValues" then
. Maximum
points = 5
Date Data BDL=1/2DL Results
1 1/3/2018 24 24 Std Dev. 28.9843
2 4/4/2018 26 26 Mean 42.7500
3 7/13/2018 45 45 C.V. 0.6780
4 10/4/2018 25 25 n 20
5 1/8/2019 36 36
6 4/4/2019 54 54 Mult Factor = 1.41
7 7/3/2019 21 21 Max. Value 125.0
8 10/1/2019 36 36 Max. Pred Cw 176.3
9 11/6/2019 53 53
10 1/3/2020 34 34
11 4/7/2020 54 54
12 7/2/2020 16 16
13 10/9/2020 17 17
14 1/5/2021 15 15
15 2/11/2021 112 112
16 4/6/2021 48 48
17 5/6/2021 47 47
18 7/7/2021 125 125
19 10/6/2021 27 27
20 11/17/2021 40 40
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
1
NC0051969 FW RPA total dissolved metals 06-2022, data
- 5 - 9/22/2022

REASONABLE POTENTIAL ANALYSIS
'ECIAL•
COPY"
iota
18
Par22
Date Data BDL=1/2DL Results
1 Std Dev. NO DATA
2 Mean NO DATA
3 C.V. NO DATA
4 n 0
5
6 Mult Factor = N/A
ug/L 7 Max. Value N/A
ug/L 8 Max. Pred Cw N/A
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Par23
Use "PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
0
Date Data
BDL=1/2DL Results
Std Dev.
Mean
C.V.
n
Mult Factor =
Max. Value
Max. Pred Cw
NC0051969 FW RPA total dissolved metals 06-2022, data
- 6 - 9/22/2022

REASONABLE POTENTIAL ANALYSIS
Use "PASTE SPECIAL•
Values" then "COPY"
. Maximum data
points = 58
Par24
0
NO DATA
NO DATA
NO DATA
0
N/A
N/A
N/A
Data BDL=1/2DL Results
1 Std Dev.
2 Mean
3 C.V.
4 n
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Use "PASTE SPECIAL
Values" then "COPY"
. Maximum data
points = 58
Par25
0
NO DATA
NO DATA
NO DATA
0
Mult Factor = N/A
Max. Value N/A
Max. Pred Cw N/A
Date Data BDL=1/2DL Results
1 Std Dev.
2 Mean
3 C.V.
4 n
5
6 Mult Factor =
7 Max. Value
8 Max. Pred Cw
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Date
NC0051969 FW RPA total dissolved metals 06-2022, data
- 7 - 9/22/2022

REASONABLE POTENTIAL ANALYSIS
Use "PASTE SPECIAL•
Values" then "COPY"
. Maximum data
points = 58
NO DATA
NO DATA
NO DATA
0
N/A
N/A
N/A
NC0051969 FW RPA total dissolved metals 06-2022, data
9/22/2022

Castle Creek Memory Care WWTP
NC0051969 Freshwater RPA - 95% Probability/95% Confidence Using Metal Translators
MAXIMUM DATA POINTS = 58
Qw (MGD) = 0.0100
1Q1OS (cfs) = 0.00
7Q10S (cfs) = 0.00
7Q10W (cfs) = 0.00
30Q2 (cfs) = 0.00
Avg. Stream Flow, QA (cfs) = 1.20
Receiving Stream: UT to Prince George Creek HUC 030300070807
WWTP/WTP Class: WW-2
IWC% @ 1Q1OS = 100
IWC% @ 7Q1OS = 100
IWC% @ 7Q1OW = 100
IWC% @ 30Q2 = 100
IW%C @ QA = 1.275195393
Stream Class: C;Sw
Outfall 001
Qw = 0.01 MGD
COMBINED HARDNESS (m¢/L)
Acute = 217.92 mg/L
Chronic = 217.92 mg/L
PARAMETER
TYPE
NC STANDARDS OR EPA CRITERIA
—1H
m
REASONABLE POTENTIAL RESULTS
RECOMMENDED ACTION
Chronic
Applied
Standard
Acute
Il
# Dot. Max Pred Cw Allowable Cw
Chlorides
NC
230
FW
mg/L
58
58
593.0
Acute: NO WQS
___ _ _______ _____
Chronic: 230.0
11 value(s) > Allowable Cw
_ _ _ _ _ _ _ _ _ _ _ ___
RP shown - apply Monthly Monitoring with Limit
Copper
NC
50.1305
FW
80.5452
ug/L
58
58
72.00
Acute: 80.55
-- _ _ _ ----_ _
Chronic:-50.13------------------------------
1 value(s) > Allowable Cw
RP shown - apply Monthly Monitoring with Limit
Fluoride
NC
1800
FW
ug/L
20
20
3,306.0
Acute: NO WQS
_ _ _ _ _ _ _ _ _ _ _ _ _
Chronic: 1,800.0
1 value(s) > Allowable Cw
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
RP shown - apply Monthly Monitoring with Limit
Zinc
NC
793.7086
FW
787.2688
ug/L
20
20
176.3
Acute: 787.3
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Chronic: 793.7
No value > Allowable Cw
_ _ _ _ _ _ _ _ _ _ _ _ _ _
No RP, Predicted Max < 50% of Allowable Cw - No
Monitoring required
0
0
N/A
Acute:
_ _ _ -- - --- - ---
-- Chronic:
— — — — — — — — — — — — — —
0
0
N/A
Acute:
___ _ ___________
Chronic:
0
0
N/A
Acute:
-- _ _ _
------------ Chronic:
0 0
N/A
Acute:
-- ---------- Chronic:
Page 9 of 9
NC0051969 FW RPA total dissolved metals 06-2022, rpa
9/22/2022

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Castle Hayne Health Holdings, LLC
Attn: Charles E. Trefzger, Manager
PO Box 2568
Hickory, NC 28603-2568
Subject: Permit Renewal
Application No. NC0051969
Castle Creek Memory Care WWTP
New Hanover County
NORTH CAROLINA
Environmental Quality
January 20, 2022
Dear Applicant:
The Water Quality Permitting Section acknowledges the January 20, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Division of Water Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington. North Carolina 28405
910.796.7215

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Form
NPDES
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to follow
the instructions ma result in denial of the a , ' lication:
Facility Information
N 1. BASIC
1.1
APPLICATION INFORMATION FOR ALL APPLICANTS (40 CFR 122.21(j)(1) and (9))
Facility name
Castle Hayne Health Holdings, LLC dba Castle Creek Memory Care
Mailing address (street or P.O. box)
P.O. Box 26255 •
City or town
Winston-Salem
State
NC
ZIP code
27114
Contact name (first and last)
Rodney Propst
Title •
Maintenance Engineer
Phone number
[phone]
Email address
[e-mail]
Location address (street, route number, or other specific identifier) • ❑ Same as mailing address.
4724 Castle Hayne Road
City or town -- •
Castle Hayne
• State •
NC
ZIP code
28429
1.2
Is this application for a facility that has yet to commence
Yes 4 See instructions on data submission
- requirements for new dischargers.
discharge? '
r -No
Applicant Information
1.3
Is applicant different from entity listed under Item
- Yes
1.1 above? •
Item 1.4.
✓ No 5 SKIP to
' t name
Applicant address (street or P. .
City or town
ZIP code
Contact name (first and last)
Title
Phone number
Em ' ess-
1.4
Is the applicant
the facility's owner, operator, or both? (Check only one response.)
❑ Operator ❑ Both •
✓ Owner
1.5
To which entity should the NPDES permitting authority send correspondence? (Check
❑ Facility ❑ Applicant
only
one response.)
Facility and applicant
(they are one and_thesame)
r
Existing Environmental Permits
1.6
Indicate below any existing environmental permits. (Check all that t apply, and print or type the corresponding permit
number for each.)
Existing Environmental Permits
v NPDES
(discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
• control)
water)
( NC0051969
❑ PSD (air emissions)
0 Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA) •
❑ Dredge or fill (CWA Section ,
404) • •
❑ Other (specify)
Page 1

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Collection System and Population Served
1.7
Provide the collection system information requested below for the treatment works.
Municipality
Served
Population
Served
Collection System Type
(indicate percentage)
Ownership Status
-
Up 84
no % separate sanitary sewer
0 Own ❑ Maintain
to Persons
0 % combined storm and sanitary sewer
0 Own ❑ Maintain
0 Unknown
0 Own ❑ Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
0 Own 0 Maintain
% combined storm and sanitary sewer
0 Own 0 Maintain
❑ Unknown
0 Own 0 Maintain
% separate sanitary sewer
El Own 0 Maintain
% combined storm and sanitary sewer
0 Own ❑ Maintain
Total
Population
Served
Up to 84 Persons
❑ Unknown
Separate Sanitary Sewer System
0 Own 0 Maintain
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line (in miles)
100 %
°
/°
Indian Country
1.8
Is the treatment works located in Indian
❑ Yes
Country?
✓
No
1.9
Does the facility discharge to a receiving
❑ Yes
water that flows through
v
Indian Country?
No
Design and Actual
Flow Rates
1.10
Provide design and actual flow rates
in the designated spaces.
Design Flow Rate
0.012 mgd
Annual Average Flow Rates (Actual)
Two Years Ago
Last Year
This Year
0.006254 mgd
0.006238 mgd
0.004630 mgd
Maximum Daily Flow Rates (Actual)
Two Years Ago
Last Year
This Year
0.0155 mgd
0.0144 mgd
o.011 mgd
Discharge Points
by Type
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
Total Number of Effluent Discharge Points by Type
Treated Effluent
Untreated Effluent
Combined Sewer
Overflows
Bypasses
Constructed
Emergency
Overflows
1
Page 2

NPDES Permit Number
NC0051969
. Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods
'Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds,
for discharge to waters of the State of North Carolina?
❑ Yes
or other
surface impoundments that do not have outlets
+ SKIP to Item 1.14.
v No
.
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
" Location = -
Average Daily Volume
Discharged to Surface -
- Impoundment - "
Continuous or Intermittent
(check one)
gpd
■
Continuous
Intermittent
•
,gpd
■ Continuous
❑ In nt
gpd
0
Continuous
Intermittent
■
1.14
Is wastewater applied to land?
❑ Yes
4 SKIP to Item 1.16.
✓ No
1 *5
Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
Location
Size -
•(check
Average Daily Volume
Applied
Continuous or
Intermittent
one)
acre
gpd
0 Continuous
■ Intermittent
acres
d
■ Continuous
Intermittent
acres
gpd
❑• us
❑ - Intermittent
1.16
Is effluent transported to another facility for treatment
❑ Yes
prior to discharge?
-I SKIP to Item 1.21.
✓ No
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transporte arty other than the applicant?
❑ Yes - ❑ No -I SKIP to Item 1.20.
1.19
Provide information on the transporter below.
Tra rter Data
Entity name
"ng address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Outfalls and Other Discharge or Disposal Methods Continued
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
rece ' acility.
Receiving Facility Data
Facility name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
l -
Phone number
Email address
NPDES number of receiving facility (if any) 0 None
Average daily flow rate
1.21
Is the wastewater disposed of in a manner other than
not have outlets to waters of the State of North Carolina
❑ Yes ✓
those already mentioned in Items 1.14 through 1.21 that do
(e.g., underground percolation, underground injection)?
No 4 SKIP to Item 1.23.
•rovide information in the table below on these other disposal methods.
Information on Other Disposal Methods
Disposal
Method
Description
._; of
Disposal Si a
Size of
Disposal Site
Annual Average
Daily Discharge
Volume
Continuous or Intermittent
(check one)
ac =
gpd
❑ Continuous
❑ Intermittent
acres
• 9P'
❑ Continuous
■ . -rmittent
acres
gpd
■ Intermittent
Variance
Requests
1.23
Do
Consult
❑
✓
you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
with your NPDES permitting authority to determine what information needs to be submitted and when.)
Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Section 301(h)) 302(b)(2))
Not applicable
Contractor Information
1.24
Are
the
v
any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
responsibility of a contractor?
Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
Contractor name
(company name)
Kevin Woodward
Lewis Farms & Liquid Waste, In
Mailing address -
(street or P.O. box)
5096 Edinboro Ln.
8155 Malpass Corner Rd.
City, state, and ZIP
code
Wilmington, NC 28409
Currie, NC 28435
Contact name (first and
last)
Kevin Woodward
Wesley Wooten
Phone number
[phone]
[phone]
Email address
[e-mail]
Operational and
maintenance
responsibilities of
contractor
Operate, maintain, collect
samples, regulatory
inspection, coordinate repair
Waste disposal and WWTP
cleaning.
Page 4

SECTION
c
•
0
ca
2. ADDITIONAL INFORMATION
Outfalls to Waters of
NPDES Permit Number
• NC0051969
(40 CFR 122.21(j)(1) and
the State Of North Carolina
Facility Name
Castle Creek Memory Care
(2))
Modified Application Form 2A
Modified March 2021
2.1
Does the treatment works have a design
❑ - Yes
flow greater
than or equal to 0.1 mgd?
No 4 SKIP to Section 3.
✓
Inflow and Infiltration
Provide the treatment works' current average daily volume of inflow
. : ' filtration.
Average Daily Volume of Inflow and Infiltration
gpd
. Indicate the step - facility is taking to minimize inflow and infiltration.
Topographic
Map
2.3
Have you attached a topographic map to this application contains all the required -information? (See instructions for
specific requirements.)
❑ Yes ❑ No
E
c t°
`•
L c
2.4 -
-
Have you attached a process flow diagram or schematic to this application that contains all th- :'wired information?
(See instructions for specific requirements.)
❑ Yes ❑ No
Scheduled Improvements and Schedules of Implementation
2.5 -
Are improvements
to the facility scheduled?
❑ No 4 SKIP to Section 3.
v Yes
Briefly list and describe the scheduled improvements.
1 Updates to the WWTP to ensure compliance with Permit limits on Cu in effluent.
2.
3.
4.
2.6
Provide scheduled or actual dates of completion for•improvements.
Scheduled or Actual Dates of Completion for Improvements -
Scheduled
Improvement
(from above)
Affected
Outfalls
(list outfall
number)
- Begin
Construction
(MM/DDIYYYY)
- End-
Construction
(MM/DD/YYYY) '
Begin
Discharge
•(MMIDDIYYYY)
Attainment of
- Operational
Level
(MM/DD/YYYY)
'09/16/2022
1.
001
07/11/2022
07/18/2022
08/17/2022
2.
3.
4.
7
2.7
Have appropriate permits/clearances
response.
❑ • Yes
concerning
other federal/state requirements been obtained?, Briefly explain your
No ❑ None required or applicable
✓
Explanation: -
Authorization to Construct will be sought once project schematics are finalized. Project is being done in cooperation with'
DEQ.
Page 5

SECTION
. .
3. INFORMATION
3.1
ON
Provide the following
- NPDES
NC0051969
EFFLUENT DISCHARGES
information
Permit Number
(40 CFR
for each outfall. (Attach
Facility Name -
Castle Creek Memory Care
122.21(j)(3) to (5))
additional sheets if you have
Modified Application Form 2A
Modified March 2021
more than three outfalls.)
Outfall Number o01
Outfall Number
Outfall Number
State
NC
ce
1
w
County
New Hanover
- • O
0
City or t01Nn
Castle Hayne
`s
0.
Distance from shore.
I. ft.
ft.
ft.
d
Depth below surface
0 ft.
ft.
ft.
ta
Average daily flow rate
0.006 mgd
mgd
mgd
Latitude
30° 20' 13.6� N
° II
Longitude
.77° 54' 28.1t' W
' "
°
Seasonal or Periodic Discharge Data
3.2
Do any of the outfalls described
❑ Yes
under Item 3.1 have seasonal or
periodic
CJ
discharges?
- No-4 SKIP to Item 3.4.
.
so, provide the following information
for each applicable outfall.
Outfall Number
Outfall Number
Outfall Number-
Nurriber. of times per year -
discharge occurs
Average duration of each
discharge (specify units)- :.
•
Average flow of each
discharge
mgd-
d
mgd
Months in which discharge
occurs
•
Diffuser Type
3.4
Are any of the outfalls listed under Item 3.1 equipped -with -a diffuser?
❑ Yes
✓
No 4 SKIP to Item 3.6.
.
• iefl describe the diffuser type
at each applicable outfall.
Outfall Number
Outfall Number
Outfall Number
Waters of
the U.S.
3:6
Does
one
✓
the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
or more discharge points?-
Yes ❑ No -"SKIP to Section 6.
Page 6

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Receiving Water Description
3.7
Provide the receiving water and related information (if known) for each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Receiving water name
Prince George Creek
Name of watershed, river,
or stream system
NE Cape Fear River
U.S. Soil Conservation
Service 14-digit watershed
code
unknown
Name of state
management/river basin
unknown
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
unknown
Critical low flow (acute)
o cfs
cfs
cfs
Critical low flow (chronic)
o cfs
cfs
cfs
Total hardness at critical
low flow
mg/L of
80 CaCO3
mg/L of
CaCO3
mg/L of
CaCO3
Treatment Description
3.8
Provide the following information
describing the treatment provided for discharges from each outfall.
Outfall Number 001
Outfall Number
Outfall Number
Highest Level of
Treatment (check all that
apply per outfall)
0 Primary
0 Equivalent to
secondary
0 Secondary
❑ Advanced
❑ Other (specify)
❑ Primary
❑ Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
❑ Primary
❑ Equivalent to
secondary
0 Secondary
0 Advanced
0 Other (specify)
Design Removal Rates by
Outfall
BOD5 or CBOD5
*
Unknown
TSS
*
Unknown %
%
%
Phosphorus
® Not applicable
0 Not applicable
0 Not applicable
Nitrogen
® Not applicable
0 Not applicable
0 Not applicable
Other (specify)
0 Not applicable
%
0 Not applicable
%
0 Not applicable
* Observed performance is a >95% removal rate.
Page 7

NPDES Permit Number
NC0o51969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Treatment Description Continued
3.9
Describe the type of disinfection used for the effluent fromeachoutfall in the table below. If disinfection varies by
season, describe below.
Ultraviolet disinfection is used year-round.
Outfall Number
001
Outfall Number
Outfall Number
Disinfection type
Ultraviolet
•
Seasons used
All
Dechlorination used?
v
Not applicable
❑ - Not applicable
❑ Yes
❑ No
❑ Not applicable
❑ Yes
❑ No
❑ -Yes
❑ No
Effluent Testing Data
3.10
Have you completed
monitoring for all Table A parameters and attached the results to the application package?
❑ No
✓ 'Yes
3.11
Have you conducted
discharges or
any WET tests during the 4.5 years prior to the date of the application on any of the facility's
on any receiving water near the discharge points?
• ❑ No 4 SKIP to Item 3.13.
✓ Yes
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number 001
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
• Acute
Chronic
Number of tests of discharge
water
0
20
Number of tests of receiving
water
0
0
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere
reasonable potentialto discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine.
in the treatment
process, or otherwise have
Complete Table B, omitting chlorine.
✓ No 4
3.15
Have you completed monitoring for all applicable Table B pollutants
package?
❑ Yes
and attached
the results to this application
Flow-= < 0.1 mgd
✓ No
3.18
Have you completed
attached the results
monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
to this application package?
No additional sampling required by NPDES
permitting authority.
✓ Yes
Page 8

NPDES Permit Number
NC0051969
Facility Name -
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
Effluent Testing Data Continued
3:19
Has the POTW
or (2) at least
conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
four annual WET tests in the past 4.5 years?
❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
✓ Yes
3.20
Have you previously
submitted the results of the above tests to your NPDES permitting authority?
0 No 4 Provide results in Table E and SKIP to
Item 3.26.
Yes
3.21
Indicate the dates the data were submitted to your NPDES permitting authority and provide.a summary of the results.
Date(s) Submitted,.
,(MM/DD/YYYY)
Summary of Results
_•
01/21/2021;
09/27/2021;
04/29/2021;
11 /02/2021
AIIresults passing. •
3.22
Regardless of how you provided your WET testing
toxicity?
❑ - Yes -
data to the NPDES permitting authority,
did any of the tests result in
Item 3.26.
✓ -_ No 4 SKIP to
e cause(s) of the toxicity:
3.24
•Has the treatment works conducted a toxicity reduction
❑ Yes s
evaluation? •
Item 3.26.
✓ No 4, SKIP to
tails ofany toxicity reduction evaluations conducted.'
3.26
Have you completed
Yes
Table E for all applicable outfalls
and attached the results to the application
Not
package? -
because previously submitted
NPDES .ermittin. authori .
applicable
information to the
Page 9

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Modified Application Form 2A
Modified March 2021
cn
Checklist and Certification Statement
0
rn rn o+
N
• .1
r 1 0
- . a an. d))
In Column 1 below, mark the sections
of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section
1: Basic Application
for All Applicants
wl variance request(s) ❑ w/ additional attachments
CM
Information
Section
2: Additional
❑ w/ topographic map ❑ w/ process flow diagram
❑ w/ additional attachments
Information
w/ Table A v w/ Table D
Section
3: Information on
Discharges
❑ wl Table B ❑ wl additional attachments
Effluent
❑ wl Table C
Section 4: Not Applicable
Section 5: Not Applicable
Section
6: Checklist and
Statement
❑ wl attachments
Certification
Certification Statement
1 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
Manager,
Charles E. Trefzger
Castle Hayne Health Holdings, LLC
Si a OW
1
•
Date signed
1/70/D02x
Page 10

NPDES Permit Number
Facility Name
0utfall Number
NC0051969
Castle Creek Memory Care
001
Modified Application Form 2A
Modified March 2021
TABLE A. EFFLUENT PARAMETERS
FOR ALL POTWS
Average Daily Discharge
Analytical
ML or MDL
Pollutant
Maximum Daily Discharge
Value
Units
Value
Units
Number of
Samples
Method'
(include
units)
Biochemical oxygen demand
CIBOD5 or o CBOD5
re.ort one
15
mg/L
1.92
mg/L
156
0 ML
SM 5210 B-2016 2 mg/L El MDL
Fecal coliform
2420
CFU/100m1
2.6
CFU/100m1
156
0 ML
SM 9222 D-2015 M 1 CFU/100 O MDL
Design flow rate
0.0155
7.50
8.48
23
MGD
S.U.
s.u.
°C
0.005707
MGD
1095
pH (minimum)
pH (maximum)
Temperature (winter)
15.8
°C
38
Temperature (summer)
32
°C
27.3
°C
38
Total suspended solids (TSS)
44
mg/L
9.67
mg/L
0 ML
156 SM 2540 D-2015 2.5 mg/L O MDL
' Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 11

EPA Identification Number
NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE B. EFFLUEN'' , :q9*6
'lri1:I_1111Ie1iTWIY111i7ngilmik upIumm3e7:ivra:ilaa►uIi
eis
Analytical
Methods
ML or MDL
(include
units)
Pollutant
Maximum Daily Discharge
Average Daily Discharge
Value
Units
Value
Units
Number of
Samples
Ammonia (as N)
0 ML
❑ MDL
Chlorine
(total residual, TRC)2
❑ ML
❑ MDL
Dissolved oxygen
0 ML
❑ MDL
Nitrate/nitrite
���
❑ ML
❑MDL
Kjeldahl nitrogen
0 ML
❑ MDL
Oil and grease
0 ML
❑ MDL
Phosphorus
❑ ML
0 MDL
Total dissolved solids
L
O iMOL
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection, do not use chlorine elsewhere in the treatment process, and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A (Revised 3-19)
Page 12

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
Pollu .
.N.
NPDES Permit Number
NC0051969
FOR SELECTED POTWS
Facility Name
Castle Creek Memory Care
Outfall Number
Modified Application Form 2A
Modified March 2021
Maximum Daily Discharge Average Daily Discharge
Analytical ML or MDL
Methods (include units)
Value
Units Value
Units
Number of
Samples
Metals, Cyanide, and Total Phenol
Hardness (as CaCO3)
�
❑ ML
❑ MDL
Antimony, total recoverable
❑ ML
❑MDL
Arsenic, total recoverable
❑ ML
❑MDL
Beryllium, total recoverable
❑ ML
❑ MDL
Cadmium, total recoverable
❑ ML
❑ MDL
Chromium, total recoverable
0 ML
❑ MDL
Copper, total recoverable
0 ML
❑ MDL
Lead, total recoverable
0 ML
❑MDL
• . •••�• .• -
❑ML
0 MDL
• . -•• . • -
\__
0 ML
0 MDL
• . • .•
❑ML
0 MDL
• . • .•
0 ML
0 MDL
Thallium, total recoverable
0 ML
❑ MDL
Zinc, total recoverable
0 ML
❑ MDL
Cyanide
0 ML
❑ MDL
Total phenolic compounds
0 ML
❑ MDL
Volatile Organic Compounds
Acrolein
❑ ML
❑ MDL
Acrylonitrile
0 ML
❑MDL
Benzene
❑ ML
❑ MDL
Bromoform
El
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 13

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0051969
FOR SELECTED POTWS
Castle
Facility Name
Creek Memory Care
Outfall Number
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Maximum Daily Discharge
Average Daily Discharge
Polluta
Value
Units
Value
Units
Number of
Samples
Carbon tetrachloride
❑ ML
❑ MDL
Chlorobenzene
❑ ML
❑ MDL
Chlorodibromomethane
❑ ML
❑ MDL
Chloroethane
❑ ML
❑ MDL
2-chloroethylvinyl etherN.NN.
❑ ML
❑ MDL
Chloroform
❑ ML
❑ MDL
Dichlorobromomethane
0 ML
❑ MDL
1,1-dichloroethane
\
0 ML
0 MDL
1,2-dichloroethane
0 ML
❑ MDL
trans-1,2-dichloroethyleneNN.
0 ML
❑ MDL
1 ,1 -dichloroethylene
0 ML
❑ MDL
1,2-dichloropropane
\
0 ML
0 MDL
1,3-dichloropropylene
0 ML
❑ MDL
Ethylbenzene
0 ML
❑ MDL
Methyl bromide
0 ML
❑ MDL
Methyl chloride
0 ML
❑ MDL
Methylene chloride
\
0 ML
❑ MDL
1,1,2,2-tetrachloroethane
`
NN
0 ML
❑MDL
❑ ML
❑ MDL
0 ML
❑ MDL
0 ML
❑MDL
Tetrachloroethylene
Toluene
1,1,1-trichloroethane
1,1,2-trichloroethane
0 M L
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 14

EPA Identification Number
TABLE C. EFFLUENT PARAMETERS
NPDES Permit Number
NC0051969
FOR SELECTED POTWS
Castle
Facility Name
Creek Memory Care
Outfall Number
Modified
Analytical
Methods
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Maximum Daily Discharge
Average Daily Discharge
Poll
Value
Units
Value
Units
Number of
Samples
Trichloroethylene
0 ML
❑ MDL
Vinyl chloride
❑ ML
❑ MDL
Acid -Extractable Compounds
p-chloro-m-cresol
❑ ML
❑ MDL
2-chlorophenol
❑ ML
❑ MDL
2,4-dichlorophenol
❑ ML
❑ MDL
2,4-dimethylphenol
El ML
❑ MDL
4,6-dinitro-o-cresol
❑ ML
❑ MDL
2,4-dinitrophenol
❑ ML
❑ MDL
2-nitrophenol
❑ ML
❑ MDL
4-nitrophenol
❑ ML
❑ MDL
Pentachlorophenol
0 ML
❑ MDL
Phenol
0 ML
❑ MDL
2,4,6-trichlorophenol
0 ML
❑MDL
Base -Neutral Compounds
Acenaphthene
0 ML
❑ MDL
Acenaphthylene
-NNt.
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
\ 0 ML
❑ MDL
Anthracene
Benzidine
Benzo(a)anthracene
Benzo(a)pyrene
❑ ML
❑ MDL
3,4-benzofluoranthene
0 MD
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 15

EPA Identification Number
TABLE C. ' LUENT PARAMETERS
Polluta
NPDES Permit Number
NC0051969
FOR SELECTED POTWS
Maximum Daily Discharge
Castle
Facility Name
Creek Memory Care
Average
Outfall Number
Daily Discharge
Modified
Analytical
Methods
Application Form 2A
Modified March 2021
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
Benzo(ghi)perylene
❑ ML
❑ MDL
Benzo(k)fluoranthene
0 ML
❑ MDL
Bis (2-chloroethoxy) methane
\
0 ML
❑ MDL
Bis (2-chloroethyl) ether
0 ML
❑ MDL
Bis (2-chloroisopropyl) ether
0 ML
❑MDL
Bis (2-ethylhexyl) phthalateNNN.
MDL
4-bromophenyl phenyl ether
0 ML
❑ MDL
Butyl benzyl phthalate
0 ML
❑ MDL
2-chloronaphthalene
0 ML
❑ MDL
4-chlorophenyl phenyl ether
0 ML
o MDL
Chrysene
0 ML
❑ MDL
di n butyl phthalate
\
o ML
0 MDL
di-n-octyl phthalate
0 ML
❑ MDL
Dibenzo(a,h)anthracene
0 ML
0 MDL
1,2-dichlorobenzene
0 ML
❑ MDL
1,3-dichlorobenzene
0 ML
❑ MDL
1,4-dichlorobenzene
0 ML
❑ MDL
3,3-dichlorobenzidine
0 ML
0 MDL
Diethyl phthalate
\
0 ML
0 MDL
Dimethyl phthalate
0 ML
❑ MDL
2,4-dinitrotoluene
0 ML
❑ MDL
2,6-dinitrotoluene
❑ M`
❑ MDL
EPA Form 3510-2A (Revised 3-19)
Page 16

EPA Identification Number
NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
Outfall Number
Modified Application Form 2A
Modified March 2021
TABLE C. E -UENT PARAMETERS
Pollutant
FOR SELECTED POTWS
Maximum Daily Discharge
Average Daily Discharge
Analytical
Method1
ML or MDL
(include units)
Value
Units
Value
Units
Number of
Samples
1,2-diphenylhydrazine
0 ML
❑ MDL
Fluoranthene
❑ ML
❑ MDL
Fluorene
❑ ML
❑ MDL
Hexachlorobenzene
❑ ML
❑ MDL
Hexachlorobutadiene
El ML
❑ MDL
Hexachlorocyclo-pentadiene
❑ ML
❑ MDL
Hexachloroethane
❑ ML
❑ MDL
Indeno(1,2,3-cd)pyrene
0 ML
❑ MDL
Isophorone
0 ML
❑ MDL
Naphthalene
0 ML
0 MDL
Nitrobenzene
0 ML
❑MDL
N-nitrosodi-n-propylamine
0 ML
MDL
N-nitrosodimethylamine
0❑
0 MDL
N-nitrosodiphenylamine
El ML
❑ MDL
Phenanthrene
0 ML
❑MDL
Pyrene
El ML
❑ MDL
1,2,4-trichlorobenzene
0 Ml_
iv
0 MDL ,
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A (Revised 3-19)
Page 17

NPDES Permit Number
NC0051969
Facility Name
Castle Creek Memory Care
0utfall Number
001
Modified
Analytical
Method1
Application Form 2A
Modified March 2021
ML or MDL
(include units)
TABLE D. ADDITIONAL POLLUTANTS
AS REQUIRED BY NPDES PERMITTING
AUTHORITY
Maximum Daily Discharge Average Daily Dischar
e
Pollutant
(list)
Value
Units Value
Units
Number of
Samples
•
No additional sampling is required by NPDES permitting authority.
Ammonia
3.4
mg/L
0.196
mg/L
156
EPA 200.7, R
ev 4.4,1994
0511 mg/I ❑ ML
❑ MDL
Copper
72
mg/L
16.4
mg/L
156
Re.4, 1
Rev EPA 54994
.005 mg/L ❑ ML
O MDL
Chloride
714
mg/L
265.9
mg/L
156
SM 4500 CI E-2011
❑ ML
.982 mg/L O MDL
Dissolved Oxygen
11.29
mg/L
8.20
mg/L
156
SM 4500-0 G-2000
❑ ML
0.01 mg/L El MDL
Conductivity
2280
µmhos/cm
1363.2
µmhos/cm
36
ReevvA 1 1982
R
❑ ML
10umhosh 0 MDL
Salinity
1.3
ppt
0.67
ppt
36
SM 2520 B-2011
0.10 ❑ ML
❑ MDL
Hardness
331
mg/L
227.9
mg/L
36
SM 2340 C-2011
0 ML
2 mg/L 0 MDL
Turbidity
35.4
NTU
10.34
NTU
36
SM 2130 B-2011
0 ML
0.1 NTU EI MDL
Total Dissolved Solids
1120
mg/L
766.5
mg/L
15
SM 2540 C-2015
2.5 mg/L l MDL
Zinc
125
mg/L
46.8
mg/L
14
EPA 200.7,
Rev 4.4, 1994
004 mg/L ❑ ML
0 MDL
Flouride
1.8
mg/L
0.36
mg/L
15
SM 4500 F C-2011
0.1 mg/L IDML
ElMDL
❑ ML
❑ MDL
❑ ML
❑ MDL
❑ ML
❑ MDL
0 ML
0 MDL
0 ML
0 MDL
0 ML
0 MDL
1 Samplina shall be conducted accordina to sufficiently sensitive test procedures (i.e.. methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
Page 18

From: Richards, Emily
To: Kevin Woodward
Subject: RE: [External] Re: FW: Electronic Delivery of NPDES permit
Date: Friday, November 4, 2022 3:23:00 PM
Attachments: NC0051969 Final Permit 2022.pdf
image001.pnq
Please see attached.
Thank you, and have a great weekend.
Emily Richards (she/her)
Environmental Specialist II
Division of Water Resources, Central Office
North Carolina Department of Environmental Quality
Phone: [phone]
emily.richardsPncdenr.gov
NORTH CAROLINA
E
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Kevin Woodward <[e-mail]>
Sent: Thursday, November 3, 2022 1:37 PM
To: Richards, Emily <[e-mail]>
Subject: [External] Re: FW: Electronic Delivery of NPDES permit
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Hi Emily,
That will be fine to send it to me. I'll make sure it's received by the appropriate people in the
permitee / owner organization.
Thank you,
Kevin

On Thu, Nov 3, 2022, 1:03 PM Richards, Emily <[e-mail]> wrote:
Hi Kevin,
I have not heard back from these contacts on the electronic delivery of the NPDES permit For
Castle Creek, which has been signed. I see in our system you are also listed as having Electronic
Signature Authority, so you are able to accept delivery of this permit. We began transmitting final
permits electronically in 2020. Is this method ok with you?
Best,
Emily Richards (she/her)
Environmental Specialist 11
Division of Water Resources, Central Office
North Carolina Department of Environmental Quality
Phone: [phone]
[e-mail]
E CIV,)
NORTH CAROLINA
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Richards, Emily
Sent: Wednesday, November 2, 2022 1:01 PM
To: '[e-mail]' <[e-mail]>; '[e-mail]'
<[e-mail]>;'[e-mail]'
<[e-mail]>
Subject: RE: Electronic Deliver of NPDES permit
Hello,
I have not heard back from anyone on this — are you able to accept the delivery of this permit
electronically?
Emily Richards (she/her)
Environmental Specialist 11
Division of Water Resources, Central Office

North Carolina Department of Environmental Quality
Phone: [phone]
[e-mail]
E
NORTH CAROLINA
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Richards, Emily
Sent: Friday, October 28, 2022 3:12 PM
To: [e-mail]; [e-mail];
vdagenhartPaffinitylivinggroup.com
Subject: Electronic Deliver of NPDES permit
Greetings,
This message is in regards to the NPDES wastewater permit for Castle Creek Memory Care WWTP
/NC0051969.
In order to provide more convenience, control, and security to our permittees and assist them in
processing their transactions, The Division of Water Resources is currently transitioning towards
electronic correspondence. This will hopefully provide more efficient service to our permittees
and other partners and will allow us to more effectively process and track documents. We are
writing to ask you for your approval of the transmittal of documents related to your permitting and
related activities with the Division in an electronic format. Documents will be emailed to the
appropriate contact person(s) in your organization in a PDF format.
Please respond to me through email with verification that transmittal of your documents in
an electronic manner is acceptable to you. If you have any questions, please feel free to
contact me.
Thank you,

Emily Richards (she/her)
Environmental Specialist 11
Division of Water Resources, Central Office
North Carolina Department of Environmental Quality
Phone: [phone]
[e-mail]
NORTH CAROLINDi E Q '',)
A
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.