NC0056201_Permit Issuance_20041112

& WA.7"i? Michael F. Easley, Governor
Q State of North Carolina
-37 William G. Ross, Jr., Secretary
- j (_ Jlj1L�l r Department of Environment and Natural Resources
1
-C
Alan W. Klimek, P.E., Director
Division of Water Quality
November 12, 2004
Mr. Sam Misuraca
Oakridge Management
3161/2 South Main Street Ste 202
Royal Oak, MI 48067
Subject: Issuance of NPDES Permit
NC0056201
Countryside MHP WWTP
Rockingham County
Dear Mr. Misuraca:
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 May 9,1994 (or
as subsequently amended).
This final permit includes no major changes from the draft permit sent to you on September 1,
2004.
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 other permits which may be required by the Division of Water Quality or
permits required by the Division of Land Resources, the Coastal Area Management Act or any other
Federal or Local governmental permit that may be required. If you have any questions concerning this
permit, please contact Toya Fields at telephone number [phone], extension 551.
Sincerely,
ORIGINAL SIGNED BY
SUSAN A. WILSON
Alan W. Klimek, P.E.
cc: Central Files
Winston-Salem Regional Office/Water Quality Section
NPDES Unit
North Carolina Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
FAX [phone]
On the Internet at http://h2o.enr.state.nc.us/

Permit # NC0056201
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision 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,
Countryside Communities LLC
is hereby authorized to discharge wastewater from a facility located at
Countryside Mobile Home Park
On NCSR 1534
South of Glenola
Randolph County
to receiving waters designated as an unnamed tributary to Caraway Creek in 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.
This permit shall become effective December 1, 2004.
This permit and authorization to discharge shall expire at midnight on January 31, 2009.
Signed this day November 12, 2004.
ORIGINAL SIGNED BY
SUSAN A. WILSON
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit # NC0056201
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of this
permit 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.
Countryside Communities LLC is hereby authorized to:
1. Continue operation of an existing 0.015 MGD wastewater treatment system,
consisting of the following components:
> Influent pump station
> Equalization basin
> High water alarm
> Standby power
> Bar screen
> Extended aeration basin
> Clarifier
> Chlorine contact tank with liquid sodium hypochlorite
> Post aeration
> Flow meter
> Dual tertiary sand filters
> Dechlorination with sodium metabisulfite
The facility is located at the Countryside Mobile Home Park WWTP on NCSR
1534, South of Glenola in Randolph County.
2. Discharge wastewater from said treatment works at the location specified on the
attached map through outfall 001 into a UT to Caraway Creek which is classified
C waters in the Yadkin -Pee Dee River Basin.

' s..3. t; cr
i4�5� k � 9�� :. x �' '`u�`P
�4&"# $'. 2 V
�_ _
Y,F •'A�''`,' �" ,F'f ., 9E 'n �"^'
�. �' �' . #
t�L^ a: ��_� #£ £?c t : }��Y�`
'A i a "S
_ #'•c.,C� ��^r.. ��'r� k4 Z
ff' 7
a s sx a fz1
��� �'^ .?� � § �',�*
Yam. r1 r; 1.''
d }� ;• Z� �"�P� 8 i.Y
#,� � dY 1
.c xP 'S,r•:¢P' ri-' } r ""'`
# a ,�di ''� X � '•"�k�1 �• .N�' :..;� "4' � �6e'� �Yrcrc' �� L
t •.+.:� .ae+"sn s^i.
£;. -�d t- yF 'a � d �<. "' �+^��
� 4 � � 3 § 4 ` ' �..�� � �5 v��- i
>?�,^..
�^ 3Lx ua 7�t��ti'aSttv,
_
i�%i�' Y .�i-. 4<�".?�<±vii:. .,}s'.f, 2c�y. } i Y
poli
�t
Y u+ i 4, .0 f. Y-. },',,� ]
Discharge location
9; ,-
�^Yh �' i'� 9Y 'P•"" ,a...<. xr & Y .
ta- g+ia k gyp, '$ 3 �ckc
'r v,
•�,_
g
. x}}�n,? £;.S'•.c aa' ' .. s s »v+• 5' 999 u . ¥"''$t i Z5R, .. uc.'•r
' _ #""` '#. b w a
'
� �
; sty.. ram. � a� �.•"" L _'a`''
_
; '� �� 2� µ£`f, '� w, ' d t •q +� -2 � r'� a q
art?% .,F� � .
S N �, ,., , ..rr-'a
�� �.� „�y .��
Wit'`
'"�.n
'
t .0 �t
• {,S,
�� � �SkY �a_
t_ Fivb, x_e�' r
q d �� a� = _^^'e„4yt ,...:b^T•�.'x{.•�T y
.?f' .':•
Iffi � 'l k.:.x §i 'v�•5' 1.:�..v'��i5.'�C•* . �'�1�'�'✓ - `.�_
0 4?'{ �"-- 4i'i.FP-
t{ —•-w
�` <�ktf'} .. .. T, 5 F1-�a. 'k
..c.•:.`w "'(1`p �•� $.ka'`?L
.._. --�.
�r� .. .� � '. .' t 32 ram k`, tq,�, .z%` .� �a, �'" �>n.i FL
Cc�tt'yS1JL�--1' ;:�(20
' . ks' ^ [�
�`5_� "�`�;{ j!
Yac�ir�(��I'
Svc } •p'
S•"P� �7� .'o„-'�ai' `.B A'ln:N {'a ,i '�s "�^f' s-.�y.: i" { k, +s.,: � ..FK.
c_ *1
uaNamJno
et -ex r'.: ''
to -ex ig�}Seam iJ1 S t#► ara a free c
O
Long 9 54 48
- ,
�'S t+w � SXT §• �
S ream 1SS-'��''s .>5 t fy-`� ,'' «`µ
a ,.
b�x. ���k3ez
'±#�:i �.. __�R x..,,3,E•, [.#5.4�Y'}a i.'�:`.;N`kiE Yzti '±..:YTv.-r.+3ur ks _v. .'.. A,e a
A` L ' • �„,
"''X' 2.0 S i {S .' ii f
'.M�»... �:. :;a;",
1 •4 �
i '.. .t`-:,g,,....F"
...._,`..,�
be .s%Mvrr.T$..�x. ., .r .� _ ,.. ,. `�x -„ .a..�.1

Permit # NC0056201
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee
is authorized to discharge treated wastewater from outfall(s) 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
EFFLUENT
CHARACTRSTICS
LIMITS r
Ri QU REMEN
S
� [ONITORING
�.. r _.....
Monthly
verage,.
Weekly'
Average
Dailr
Maximum
Measuremlenf
Frequency
Sample Type
,... "
Sample
•
I=oeation?
Flow
0.015 MGD
Continuous
Recording
I or E
5-day, 20°C
(Apr
(April 1-October 31)
5.0 mg/1
7.5 mg/1
Weekly
Grab
E
BOD, 5-day, 20°C
(November 1- March 31)
10.0 mg/1
15.0 mg/1
Weekly
Grab
E
Total Suspended Residue
30.0 mg/1
45.0 mg/1
Weekly
Grab
E
NH3-N
(April1-October31)
2 mg/1
10 mg/L
Weekly
Grab
E
NH3-N
(November 1- March 31)
4 mg/1
20 mg/L
Weekly
Grab
E
Total Residual Chlorine
17 ug/1
2/Week
Grab
E
Temperature
Daily
Grab
E
pH
Between 6.0 and 9.0 s.u.
Weekly
Grab
E
Dissolved Oxygen
Weekly
Grab
E, U, D
Fecal Coliform
(Geometric mean)
200/100 ml
400/100 ml
Weekly
Grab
E
Temperature
Weekly
Grab
U, D
Footnotes:
1. Sample Location: I — Influent; E — Effluent; U — Upstream at least 100 feet from outfall 001; D —
Downstream at least 300 feet from outfall 001.
2. The daily average dissolved oxygen effluent concentration shall not be less than 6.0 mg/1.
There shall be no discharge of floating solids or foam visible in other than trace amounts.

P.
3&etbtnt1e 13e)jtcth
1921 VANCE STREET P.O. BOX 2157
REIDSVILLE, NC 27320 336-349-4331
PUBWC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT
COMMISSION/NPDES UNIT
1617 MAIL SERVICE CENTER '
RALEIGH, NC 27699-1617
NOTIFICATION OF INTENT TO ISSUE A NPDES
• WASTEWATERPERMIT
Onthe basis of thorough 'staff'review and ap-
plication of NC General: Statute 143.21, Public
law 92-500 and other lawful standards and
regulations, the North ,Carolina environ-
mental Management Commission proposes
to issue a National Pollutant. Discharge Elimi-
nation System (NPDES) wastewater dis-
charge permit to the. person(S) .listed below
effective 45 days from the publish date . of
this notice.
Written comments regarding then proposed
permit will be accepted until 30 days after
the publish date of this notice, :All comments
received prior to that_ date are considered in
the final determinations reading 'the pro-
posed permit. The Director of the NC Derision
of. Water Quality may decide to hold a public
meeting for- the proposed ppermit should the
Division receive a significant degree of public
interest: -
Copies.of the draft permitand other, support-
ing information . on file used: to: determine
conditions present in the draft -.permit ' are
available upon 'request and payment of the
costs of reproduction. Mail comments an-
d/or request for information to' the. NC DM-
sion of Water Quality, at the above address or
call .Ms. Carolina, Bryant at„(919)733,5083;.,ex-
tension 520:- Please include the NPDESItpermit
number (attached) •in'anyy communication._In-
terested yperstins may also.:visit the Division
of Water Quality at-.512 N. Salisbury. Street,
Raleigh, NC 276044148 between rs the hours -'of
8:00-am:.and 5:00 pm.to: ,review information
on file. y
Countryside; LLC -(708 M Battlefield .Blvd Ste
102 Chesapeake VA 23322) ` has applied NI'•
renewal of -NPDES, permit: NC0056201 for the
Countryside Mobile Home Park WWTP
Rockingham :County. `This ..permitted facility
discharges 0.015MGD of treated wastewater
to Caraway_ Creek inr the Yadkin -Pee Dee • Riv.
• er. Basin.'. Currently . BOD, ammonia' nitrogen
and total residual chlorine . are:: water quality'
limited. This ;dischargemay affect future of
locations in this portion of the Yadkin -Pee
Dee River Basin. -
September 3, 2004
i 1 2 20C
DENR - WATER QUALITY
POINT SOURCE BRANCH
AFFIDAVIT OF PUBLICATION
NORTH CAROLINA
ROCKINGHAM COUNTY
Before the undersigned, a Notary Public of Said
County and State, duly commissioned, qualified, and
authorized by law to administer oaths, personally appeared
Judy Sizemore, who being first duly sworn, deposes and says.
That she is an official of Media General Inc, of Reidsville
engaged in the publication of a newspaper known as The
Reidsville Review, published, issued, and entered as second
class mail in the City of Reidsville, in said County and State;
that she is authorized 'to make this affidavit and sworn
statement, that the notice or other legal advertisement, a true
copy of which is attached hereto, was published in The
Reidsville Review on the following dates:
'3, ,9o04
and that the said newspaper in which such notice, paper
document, or legal advertisement was published, at the time
of each and every such publication, a newspaper meeting all of
.the requirements and qualifications of Section I-597 of the
General Statutes of North Carolina and was a qualified
newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
Sworn to and su,5scrilrd before me, this
day of (; :.�i,2
PM� Ms%
i ; oQ�c.;NOT •�.po )
tp
a • A
•UBLIG ,,,
My coifiJ�iibti oxpiles Q, l ? day of
„:94M CO0.�•'''.
,
ooq
otary Public

11/09/2004 23:30 12483999975
OAK RIDGE
PAGE 01/03
FACSIMILE TRANSMISSION
Sam Misuraca
OAK RIDGE COMMUNITIES
3161/2 South Main Street, Suite 202
Royal Oak, MI 48067-2614
Phone: [phone] ext. 10 • Fax: [phone]
E-Mail: [e-mail]
DATE:
TO: /0 ` //Lid
FAX#: (cji/ 9) —CW7
FROM: Lela Wilbur
RE: 717 /1 ffld
tJ
Pages including this cover sheet.
If there are any problems with this transmission, please call 248.399.7755 ext 10
MESSAGE:
-Mrs is --/kc, Aax;&Altale. /avnaSo
1 f 4,.._.i1-7.7c 'wi,v,A,,1.
diezrucx 4,49 Arr.
,L,4 4/4 u race._
A/J Y"`x II.�W Coy f� .
�0

11/09/2004 23:30 12483999975
OAK RIDGE
PAGE 02/03
Michael F. Easley
Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
WATER QUALITY SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NICI 0 / 0 / 576 4-10 /,Li or
Certificate of Coverage Number: NIC1G/ l_I / / / /
1. Permit holder's name: CO Jt rY S/� Pi LLC
2. Permit's signing official's name and title:
(Person legally responsible for permit)
101°I7MJ C
y� (tle)
3. Mailing address: 4l(c fit • �/ 1�lll� W o2 ob City: Ro #4. TiOat(
State: ins Zip Code: zilife&7
II. NEW OWNER/NAME INFORMATION:
1. This request for change is a result of:
❑ Change in ownership of company 0 Name change for company
Change in ownership of property/facility . (�❑ change ange for property/facility
4. Other (please explain): /)€4tJ Ch(.P P t pered7 C'er
2. Owner/Operator Information
Company or Owner or Operator Name: Cocc,^yside, L. L.
,--- (name to be put on permit / certificate o�f�coyerage) fl ,
Owner's/operator's or signing' official's name: mike— �l Title: (ff1E. OPERA7fJOFF/e-4-_-e
Owner Contact: 41 / Kt ! 1 L CCJ il Title: CII/EP O1 X*7/A/ 7 QF` CL7L-
Mailing address: Jr& `%z. `�' MA- e20 2d City: ,qO V"L Oilic.
State: m-a- ZU Oip Code: �lQ7 Phone:*.24ar) J q'17'7`55 ei-1
E-mail address: Oi11K (. Da.K'erA41 7-•C01
Phone: gc/f) fig ' `T7,SS gte-
A/o o tusi'&T.SIS IP Ckbtq e-
3. Facility Information
Facility Name: CIO
D� S! L�
Facility Contact: f— V c �
El Title: in N0i'C7
Facility Mailing address: 1-/S / tDY /? 014.7atit City: `SOIL///f2'
State: WC,/ Zip Code: 273 Z 0 Phone: (334 ) 43/ -- 0,20 e
E-mail address:
SWU-239-080'02

11/09/2004 23:30 12483999975
OAK RIDGE PAGE 03/03
PERMIT NAME / OWNERSHIP CHANGE FORM
4. Permit Contact Information (if different from facility contact) %}
Permit Contact: / V/ /ff✓L/V &7ZTitle: CHrr— v�} fR/T/N&7 OF CE11---/
Mailing address: oiffo'/ S •420// / #°ZO0 City: Ro}eL Oec
State: lin . Zip Code: 7480(.0% Phone: E;2 ) c 776 e t /t
E-mail address: 117Iki @ Ofirdtrig7a 12E77 Carl
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER QUALITY UNLESS
ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application
A/0 *retils-pi, O 'per-
2. Legal documentation of the transfer of ownership (such as a contract, deed, articles of incorporation)
Certification must be completed and signed by both the current permit holder and the new applicant in the case of change of
ownership. For name change only, complete and sign the application certification.
Current Permittee's Certification:
attest that this application for name/ownership change has
been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application
are not completed and that if all required supporting information and attachments are not included, this application package will be
returned as incomplete.
Signature: Date:
Applicant's Certification:
i, /nikc / -LCOied
, attest that this application for a name/ownership change
has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as inco • • ,40.0
Signature- /. 77�Date: /wey
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
Point Source Branch
Attn: Valery Stephens
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-239-080102

/lam V ' M / L — �- i Case
•
(Y,, V��� - S
.1/eel &peg. (Y1 069(4 Areij
S)a001-
00,(44L6-,3 Z 6.0 3 u
YA n/ 1 law iYlverth Aecee ig)c.e
21')c) - to Poo (
Q
NH3 m,-1'h/l � ,e,oc��o
/dub -
cfr/ 1(1400+) :1 , doo
A°(' qik I��� 12c w, ��, loos moef.
C d it do 03 . iu€w ,1- zee b,ein ►rlo ec

MONITORING REPORT(MR) VIOLATIONS for:
Faci►t
PERMIT: NC0056201
FACILITY: Countryside LLC - Countryside Mobile Home Park WWTP
Report Date: 08/30/04
lolation Category n/# Program Catego
5utibasm �/a Iolat<on Act+
COUNTY: Randolph
Page: 4 of 4
REGION: Winston-Salem
Reporting Violation
MONITORING OUTFALL
REPORT / PPI LOCATION PARAMETER
05 - 2002
11 - 2002
11 - 2003
VIOLATION
UNIT OF CALCULATED
DATE FREQUENCY MEASURE LIMIT VALUE VIOLATION TYPE VIOLATION ACTION
05/31/02
12/31/02
12/31/03
Compliance Status Missing
BIMS
Pre -Production
Violation
Late/Missing DMR None
Late/Missing DMR None

MONITORING REPORT(MR) VIOLATIONS for:
PERMIT: NC0056201
FACILITY: Countryside LLC - Countryside Mobile Home Park WWTP
COUNTY: Randolph
Report Date: 08/30/04
Page: 1 of 4
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
REPORT / PPI LOCATION PARAMETER
03 - 2001 001 Effluent BOD, 5-Day (20 Deg. C)
04 - 2001 001 Effluent BOD, 5-Day (20 Deg. C.)
04 - 2001 001 Effluent
05 - 2001 001 Effluent
05 - 2001 001 Effluent
06 - 2001 001 Effluent
06 - 2001 001 Effluent
07 - 2001 001 Effluent
07 - 2001 001 Effluent BOD, 5-Day (20 Deg. C)
10 - 2001 001 Effluent
11 - 2001 001 Effluent
04 - 2002
08 - 2002
04 - 2003
04 - 2003,
04 - 2003
001 Effluent
001 Effluent
001 Effluent
001 Effluent
001 Effluent
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
VIOLATION UNIT OF CALCULATED
DATE FREQUENCY MEASURE LIMIT VALUE
03/31/01 Weekly mg/I 10 11.5
04/30/01 Weekly mg/I 7.5 48.2
04/30/01 Weekly mg/I 5 48.2
05/31/01 Weekly mg/I 7.5 54
05/31/01 Weekly mg/I 5 54
06/30/01 Weekly mg/I 7.5 11
06/30/01 Weekly mg/I 5 11
07/31/01 Weekly mg/I 7.5 8.6
07/31/01 Weekly mg/I 5 8.6
10/31/01 Weekly mg/I 5 5.4
11/30/01 Weekly mg/I 15 22
04/30/02 Weekly mg/I 7.5 7.7
08/31/02 Weekly mg/I 7.5 7.9
04/16/03 Weekly mg/I 7.5 18
04/30/03 Weekly mg/I 7.5 18
04/30/03 Weekly mg/I 5 7
VIOLATION TYPE
Monthly Average Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
Monthly Average Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
VIOLATION ACTION
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
BIMS
Pre -Production
Violation
No Action, BPJ
Proceed to NOV
Proceed to
Enforcement Case
No Action, BPJ
No Action, BPJ

06 - 2003
06 - 2003
06 - 2003
08 - 2003
08 - 2003
04 - 2004
MONITORING REPORT(MR) VIOLATIONS for:
PERMIT: NC0056201
FACILITY: Countryside LLC - Countryside Mobile Home Park WWTP
COUNTY: Randolph
Report Date: 08/30/04
Page: 2 of 4
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
REPORT / PPI LOCATION PARAMETER
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
BOD, 5-Day (20 Deg. C)
04 - 2003 001 Effluent
001 Effluent
001 Effluent
001 Effluent
001 Effluent
001 Effluent
001 Effluent
04 - 2004 001 Effluent BOD, 5-Day (20 Deg. C)
01 - 2002 001 Effluent Chlorine, Total Residual
02 - 2002 001 Effluent Chlorine, Total Residual
03 - 2002
11 - 2001
01 - 2002
05 - 2002
03 - 2001
06 - 2001
001 Effluent Chlorine, Total Residual
001 Effluent
001 Effluent
001 Effluent
001 Effluent
Coliform, Fecal MF, M-FC
Broth,44.5C
Coliform, Fecal MF, M-FC
Broth,44.5C
Coliform, Fecal MF, M-FC
Broth,44.5C
DO, Oxygen, Dissolved
001 Effluent DO, Oxygen, Dissolved
VIOLATION UNIT OF CALCULATED
DATE FREQUENCY MEASURE LIMIT VALUE
04/30/03 Weekly mg/I 5 7
06/04/03 Weekly mg/I 7.5 8
06/12/03 Weekly mg/I 7.5 7.8
06/30/03 Weekly mg/I 7.5 8
08/07/03 Weekly mg/I 7.5 9.4
08/31/03 Weekly mg/I 7.5 9.4
04/30/04 Weekly mg/I 7.5 20
04/30/04 Weekly mg/I 5 5.8
01/31/02 2 X week ug/I 17 0.5
02/28/02 2 X week ug/I 17 1.4
03/31/02 2 X week ug/I 17 0.4
11/30/01 Weekly #/100m1 400 600
01/31/02 Weekly #/100m1 400 600
05/31/02 Weekly #/100m1 400 1,800
03/31/01 Weekly mg/I 6 5.21
06/30/01 Weekly mg/I 6 5.8
VIOLATION TYPE
Monthly Average Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Monthly Average Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Maximum Exceeded
Daily Minimum Not Reached
Daily Minimum Not Reached
VIOLATION ACTION
Proceed to
Enforcement Case
Proceed to NOV
Proceed to NOV
No Action, BPJ
Proceed to
Enforcement Case
No Action, BPJ
Proceed to
Enforcement Case
Proceed to
Enforcement Case
BIMS
Pre -Production
Violation
BIMS
Pre -Production
Violation
Proceed to
Enforcement Case
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history

MONITORING REPORT(MR) VIOLATIONS for:
PERMIT: NC0056201
FACILITY: Countryside LLC - Countryside Mobile Home Park WWTP
COUNTY: Randolph
Report Date: 08/30/04
Page: 3 of 4
REGION: Winston-Salem
Limit Violation
MONITORING OUTFALL
REPORT /PPI LOCATION PARAMETER
07 - 2001 001 Effluent
11 - 2002 001 Effluent DO, Oxygen, Dissolved 11/30/02
03 - 2001 001 Effluent Flow, in conduit or thru treatment 03/31/01
plant
03 - 2001 001 Effluent Nitrogen, Ammonia Total (as N) 03/31/01
04 - 2001 001 Effluent
05 - 2001 001 Effluent
06 - 2001 001 Effluent
07 - 2001 001 Effluent
10 - 2001 001 Effluent Nitrogen, Ammonia Total (as N) 10/31/01 Weekly
03 - 2001 001 Effluent Solids, Total Suspended
04 - 2001 001 Effluent Solids, Total Suspended
04 - 2001 001 Effluent Solids, Total Suspended
05 - 2001 001 Effluent Solids, Total Suspended
05 - 2001 001 Effluent Solids, Total Suspended
06 - 2001 001 Effluent Solids, Total Suspended
10 - 2003 001 Effluent pH
VIOLATION
DATE FREQUENCY
DO, Oxygen, Dissolved
07/31/01 Weekly
Nitrogen, Ammonia Total (as N) 04/30/01
Nitrogen, Ammonia Total (as N) 05/31/01
Nitrogen, Ammonia Total (as N) 06/30/01
Nitrogen, Ammonia Total (as N) 07/31/01
Weekly
Weekly
Weekly
Weekly
Weekly
Weekly
Weekly
03/31/01 Weekly
04/30/01 Weekly
04/30/01 Weekly
05/31/01 Weekly
05/31/01 Weekly
06/30/01 Weekly
10/31/03 Weekly
UNIT OF
MEASURE
mg/I
mg/I
mgd
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
mg/I
su
CALCULATED
LIMIT VALUE
VIOLATION TYPE
6 4.9 Daily Minimum Not Reached
6 5.7 Daily Minimum Not Reached
0.015 0.0181 Monthly Average Exceeded
4 5.8 Monthly Average Exceeded
4 16.3 Monthly Average Exceeded
2 15.5 Monthly Average Exceeded
2 4.2 Monthly Average Exceeded
2 2.6 Monthly Average Exceeded
2 2.4 Monthly Average Exceeded
30 33.3 Monthly Average Exceeded
45 120.3 Daily Maximum Exceeded
30 120.3 Monthly Average Exceeded
45 174.4 Daily Maximum Exceeded
30 174.4 Monthly Average Exceeded
30 40.5 Monthly Average Exceeded
6 0 Daily Minimum Not Reached
VIOLATION ACTION
DMR conversion
history
Proceed to NOV
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
DMR conversion
history
No Action, Data
Entry Error

FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
/VGoo6-6Z-o/
Facility Name
u0 j•hissh 44 tii/®
Reviewer
M v
Basin/Sub-basin
o 4 a 709
Receiving Stream
ea ret
Is the stream impaired (listed on 303(d))?
o
4/ 3
Is stream monitoring required?
%i
Do they need NH3 limit(s)?
ife1 (Gc, % 0,1
Do they need TRC limit(s)?
No
Do they have whole -effluent toxicity testing?
A70
Are there special conditions?
4/0
Any obvious compliance concerns?
,C1499..
Existing Expiration Date
//3i /
Proposed Expiration Date
,/ , /oy
Miscellaneous Comments:
- oei %,'/c ,p,a.,,- 4/
,.�
/te,
.
— n�-mu 0,40//rrc l) c. — tdwe,..44 .
G<a.r f a, /ram
Circle one:
DO NOT EXPEDITE
If expedited, is this a simpler permit or a more difficult one?
S7Gr/e

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
http://h2o.enr.state.nc.us/NPDES/
North Carolina NPDES Permit Number
1. Contact Information:
Facility Name
Owner Name
Street Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Operator Name
Street Address
City
State / Zip Code
County
Telephone Number
NCOO 56201
Please print or type
Countryside Mobile Home Park
Countryside L.L.C.
708-M Battlefield Blvd. Ste. 102
Chesapeake VA 23322
Virginia
( 751) 546-7511
( 751) 546-7495
Paul Smith
235 Richardson Rd.
Reidsville
North Carolina / 27320
Rockingham County
( 336) 932-9347 (Cell)
2. Location of facility producing discharge:
Check here if same as above
Facility Name (If different from above)
Street Address or State Road
City
State / Zip Code
County
3. Reason for application:
Expansion/Modification *
Renewal
NCSR 1534
South of Glenola
North Carolina
Randolph County
Existing Unpermitted Discharge
X New Facility
* Please provide a description of the expansion/modification:
Page 1 of 3 Version 12/02

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
4. Description of the existing treatment facilities (list all installed components with
capacities):
0.015 mgd extended aeration package wastewater treatment plant with influent pumping
station. Primary treatment includes a bar screen and an equalization basin. Secondary treat-
ment includes a single aeration basin and clarifier. Tertiary treatment includes two sand
filters. Liquid sodium hypochlorite is used for disinfection in a chlorine contact tank and
followed by dechlorination with sodium metabisulfite.
5. Description of wastewater (check all that apply):
Type of Facility Generating Wastewater
Industrial Number of Employees
Commercial Number of Employees
Residential X Number of Homes
School Number of Students/Staff
Other
65
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
Mobile home park
6. List all permits, construction approvals and/or applications (check all that apply):
Tie Permit Number Type
RCRA Non -Attainment
UIC Ocean Dumping
NPDES NC0056201 Dredge/Fill Permits
PSD Other
NESHAPS
Permit Number
ATC 0056201A01
7. Number of separate wastewater discharge pipes. (wastewater outfalls):
One
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall:
Not Applicable
Page 2 of 3 Version 12/02

NPDES APPLICATION FOR PEgeRNIITrs of 1RENa RENEWAL- SHORT FORM D flow)
To be filed only by privately -owned
9. Name of receiving. stream(s) (Provide a map showing the exact location of each outfall):
10. Is this facility located on Native American lands? (check one)
YES ❑ NO 4
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
Date Signed
Signature of Applicant ALA....Lye.--___--
North Carolina General Statute 143-215.6(b)(2) provides that Any person who knowingly makes any false statement representation, or
certification in any application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any
recording or monitoring device or method required to be operated or maintained under Article 21. or regulations of the Environmental
Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $10,000, or by
imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $10,000 or
imprisonment not more than 5 years, or both for a similar offense.)
Version 12/02
Pane 3 of 3

Countryside Mobile Home Park
Sludge Management Plan
November 6, 2003
Countryside Mobile Home Park produces approximately 36,000 gallons of 10%
solids sludge per year. The sludge is aerobically digested and decant is piped
back to the influent pumping station. The sludge is disposed of by Carolina
Backhoe and Septic Tank Company and is hauled about six times per year or as
needed. Normally, 6,000 gallons of sludge is hauled at a time.

uwA
NCDENR
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Michael). Power
Countryside LLC
1423 North Great Neck Road, Suite 205
Virginia Beach, VA 23454
Dear Permittee:
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
November 14, 2003
Subject: Notice of Violation
Failure to Submit Renewal Application
NPDES Permit NC0056201
Countryside Mobile Home Park WWTP
Randolph County
The subject permit's expiration date is January 31, 2004. Federal [40 CFR 1221 and state (15A NCAC
2H.0105(e)) requires that an application for permit renewal be filed at least 180 days prior to expiration of the current
permit. To satisfy this requirement, your renewal package should have been sent to the Division postmarked no later
than August 4, 2003.
As of this date, the Division has not received your renewal application. This is a violation of Part II. B. 10.
of your permit, which states "Any permittee that has not requested renewal at least 180 days prior to expiration...will
subject the permittee to enforcement procedures as provided in NCGS 143-215.6 and 33 USC 1251 et. seq.".
To prevent an assessment of civil penalties you must submit a completed permit application (see enclosed
forms) within 10 days of your receipt of this letter. Submit the completed application package to the address listed at
the bottom of this page.
If all wastewater discharge from your facility has ceased and you wish to rescind this permit, contact Robert
Farmer of the Division's Compliance Enforcement Unit at [phone], extension 531. You may also contact the
Winston-Salem Regional Office at [phone] to begin the rescission process.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must
submit with the permit renewal application. If you have any questions, please contact Valery Stephens of my staff.
Mrs. Stephens' telephone number, fax number and e-mail address are listed at the bottom of this page.
Sincerely,
ORIGINAL SIGNED B
Charles H. Weaver Jr.
Alan W. Klimek, P.E.
cc: Central Files
Winston-Salem Regional Office, Water Quality Section
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 520 (fax) 919 733-0719
VISIT us ON THE INTERNET @ http://h2o.enr.state.nc.us/NPDES e-mail: [e-mail]

NPDES Perrnit NC0056201
Countryside LLC
Randolph County
The following items are REQUIRED for all renewal packages:
❑ A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit. Submit one signed original and two copies.
❑ The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
❑ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, submit written documentation showing the authority delegated to any such
Authorized Representative (see Part II.B.11.b of the existing NPDES permit).
❑ A narrative description of the sludge management plan for the facility. Describe how sludge (or other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following item must be submitted by Industrial facilities discharging process wastewater
and Municipal WWTPs with a permitted flow of 1.0 MGD or greater:
❑ Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of
Federal Regulations, Part 122) and municipal WWTPs with a permitted flow of 1.0 MGD or greater
must submit a Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21. If the PPA
cannot be completed by the time you complete your application package, submit the application
package without the PPA. Submit the PPA as soon as possible after you receive the completed analyses.
The above requirement does NOT apply to non -industrial facilities or municipal
WWTPs with permitted flows <1.0 MGD.
PLEASE NOTE:
Due to a change in fees effective January 1, 1999, there is no renewal fee required with your
application package.
,�.x.j, �,t,?")
Send"the corripleted'renewal package to:
Mrs. Valery Stephens
NC DENR / Water Quality / NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617

pG kin
7 NCDENR
Michael J. Power
Countryside LLC
316 1/2 South Main Street
Royal Oak, MI
Dear Permittee:
48067
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
3iglu', 2003
Subject: Renewal Notice
NPDES Permit NC0056201
Countryside MHP
Randolph County
Your NPDES permit expires on January 31, 2004. Federal (40 CFR 122.41) and North Carolina (15A NCAC
2H.0105(e)) regulations require that permit renewal applications must be filed at least 180 days prior to expiration of the current
permit. If you have already mailed your renewal application, you may disregard this notice.
To satisfy this requirement, your renewal package must be sent to the Division postmarked no later than August 4,
2003. Failure to request renewal of the permit by this date may result in a civil assessment of at least $500.00. Larger penalties
may be assessed depending upon the delinquency of the request.
If any wastewater discharge will occur after January 31, 2004, the current permit must be renewed. Discharge of
wastewater without a valid permit would violate North Carolina General Statute 143-215.1; unpermitted discharges of wastewater
may result in assessment of civil penalties of up to $25,000 per day.
If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact Vanessa Manuel of the
Division's Compliance Enforcement Unit at [phone], extension 532. You may also contact the Winston-Salem Regional
Office at [phone] to begin the rescission process.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must submit with
the permit renewal application. If you have any questions, please contact Valery Stephens at the telephone number or e-mail
address listed below.
cc: Central Files
Winston-Salem Regional Office, Water Quality Section
NPDES File
Sincerely,
17.7).7
Charles H. Weaver, Jr.
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 520 (fax) 919 733-0719
VISIT US ON THE INTERNET © http://h2o.enr.state.nc.us/NPDES e-mail: [e-mail]

NPDES Permit NC0056201
Countryside MHP
Randolph County
The following items are REQUIRED for all renewal packages:
❑ A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit. Submit one signed original and two copies.
❑ The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
❑ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, written documentation must be provided showing the authority delegated to any
such Authorized Representative (see Part II.B.11.b of the existing NPDES permit).
❑ A narrative description of the sludge management plan for the facility. Describe how sludge (or other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following items must be submitted by any Municipal or Industrial. facilities discharging
process wastewater:
Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal
Regulations, Part 122) and ALL Municipal facilities with a permitted flow >_ 1.0 MGD must submit a
Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21.
The above requirement does NOT apply to privately owned facilities treating 100%
domestic wastewater, or facilities which discharge non process wastewater (cooling
water, .filter backwash, etc.)
PLEASE NOTE:
Due to a change in fees effective January 1, 1999, there is no renewal fee required with your
application package.
Send the completed renewal package to:
Mrs. Valery Stephens
NC DENR / Water Quality / Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617