NC0055271_Permit Issuance_20110420

. NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
April 20, 2011
Mr. Jerry L. Shields
1341 NC Hwy 87 N
Elon College, N.C. 27224
Dee Freeman
Secretary
Subject: Issuance of NPDES Permit NCO055271
Shields Mobile Home Park WWTP
Class WW-1
Alamance County
Dear Mr. Shields:
Division personnel have reviewed and approved your application for renewal of the subject
permit. Accordingly, we are forwarding the attached NPDES discharge permit. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215.1 and -the -
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency dated October 15, 2007 (or as subsequently amended).
This final permit includes the following significant changes from the draft
permit sent to you on March 2, 2011.
➢ A nutrient reopener condition has been added. This condition may be used if the
Division needs to collect more detailed nutrient data from dischargers in the Cape Fear
River Basin.
➢ The facility class has been corrected.
Travis Creek is listed as an impaired waterbody on the North Carolina 303(d) Impaired
Waters List. Addressing impaired waters is a high priority with the Division, and instream data
will continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be required.
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.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
One
512 North Salisbury Street, Raleigh, North Carolina 27604
NofthCarolina
Phone: [phone] / FAX [phone] / http://portal.ncdenr.org/web/wq
;Vaturallff
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

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 Charles Weaver at
telephone number [phone].
Si ely,
.6oleen H. Sullins
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit

.. Permit NC00.55271 -
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,
Mr. Jerry L. Shields
is hereby authorized to discharge wastewater from a facility located at the
Shields Mobile -Home Park WWTP -
1355 NC Highway 87 North
Elon
Alamance County
to receiving waters designated as Travis Creek in subbasin 03-06-02 of the Cape
Fear 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 June 1, 2011.
This permit and authorization to discharge shall expire at midnight on May 31, 2016.
Signed this day April 20, 2011
C en H. Sullins, Direct -
ivision of Water Quality
By Authority of the Environmental Management Commission
t It

_ . Permit NCO055271, ;
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.
Mr. Jerry L. Shields is hereby authorized to:
1. Continue to operate an existing 0.006 MGD wastewater treatment system with
the following components:
♦ Six septic tanks
♦ Recirculating surface sand filter
♦ Recirculation tank
♦ UV disinfection system
♦ Backup tablet chlorination with chlorine contact chamber
♦ Pumps and reaeration
The facility is located near Elon (1355 NC Highway 87 North) at the Shields
Mobile Home Park WWTP in Alamance County. _
2. Discharge from said treatment works at the location specified on the attached
map into Travis Creek, classified WS-V NSW waters in hydrologic unit 03030002
of the Cape Fear River Basin.

CIO
x•, Discharge Location ><
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At
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46I -A
NCO055271 - Shields Mobile Home Park WWTP Facility
�C
Latitude: 36 08 32" Sub -Basin: 03-06-02 Location. '•
Longitude: 79°29'48" River Basin: Cape Fear
USGS Quad: Lake Burlington
Stream Class:' WS-V NSW
Receiving Stream: Travis Creek FAlamance County
Hydrologic Unit: 03030002 ✓ � ��J�N I� lea not to scale

.Permit:-N:C0055271
A. (1). EFFLUENT LIMITATIONS AND -;MONITORING REQUIREMENTS
-During the period beginning on the effective date of this -permit- and lasting until expiration,
the Permittee is authorized to discharge from outfall 001. Such discharges_ shall be limited
and.monitored bv.the Permittee as snecifed below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
[PCS code]
Monthly Average
Daily Maximum
Measurement
Sample Type
Sample
Frequency
Location'
Flow
50050
0.006 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5-day (20°C)
C0310
10.0 mg/L ; :-.
•:-- 15.0 mg/L
2/Month
-Grab
; -. -. Effluent
Total Suspended Solids
C0530
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NH3 as N (April 1— October 31)
2.0 mg/L
10.0 mgll
2/Month
Grab
Effluent
C0610
NH3 as N (November 1— March 31)
4.0 mg/L
20.0 mg/l
2/Month
Grab
Effluent
C061 01
Dissolved Oxygen
Daily average > 6.0 mg/L
Weekly
Grab
Effluent
00300
Dissolved Oxygen
Weekly
Grab
U & D
00300
Fecal Coliform (geometric mean)
2001100 ml
400/100 ml
2/Month
Grab
Effluent
31616
Total Residual Chlorine2
17 Ng/L
2/Week
Grab
Effluent
50060
Temperature (°C)
Weekly
Grab
U & D
00010
Temperature (°C)
2/Week
Grab
Effluent
00010
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Grab
Effluent
C0600
Total Phosphorus
Quarterly
Grab
Effluent
C0665
pH
00400
> 6.0 and < 9.0 standard units
— —
2/Month
Grab
Effluent
Footnotes:
1. U: upstream at least 75 feet above the outfall. ' D: downstream at NCSR 1529.
2. Limit and monitoring requirements apply only if chlorine is used for disinfection. The
facility shall. report all effluent TRC values reported by a NC certified laboratory including
field certified. However, effluent values below 50 µg/L will be treated as zero for
compliance purposes.
There shall be no discharge of floating solids or visible foam in other than trace amounts
A. (2) NUTRIENT REOPENER CONDITION
Pursuant to N.C. General Statutes Section 143-215.1 and the implementing rules found in
the North Carolina Administrative Code at 15A NCAC 214.0112 (b) (1) and 2H.0114 (a) and
Part II sections B-12 and B-13 of this permit, the Director may reopen this permit to
require supplemental nutrient monitoring of the discharge. The purpose of the additional
monitoring will be to support water quality modeling efforts within the Cape Fear River
Basin and shall be consistent with a monitoring plan developed jointly by the Division and
affected stakeholders. In addition, the results of water quality modeling may require that
limits for Total Nitrogen and Total Phosphorus be imposed in this permit upon renewal.

Weaver, Charles
From: Mike Carson [[e-mail]]
Sent: Wednesday, March 23, 2011 8:49 AM
To: Weaver, Charles
Subject: Shields MHP Permit Draft
Dear Mr. Weaver,
Our system is a Septic tanks with a sand filter to make sure I was not wrong I call Mike Micky with DWQ and he
confirmed it was a WW1. I have been ORC for the Shields MHP for the last 10 years and it has always been a WW1.
Please send me a corrected Draft and where changes have been made, thank you for the job you do for our state and us.
Thank you for your time on this matter,
James M Carson
ORC/#NCOOSS271
Mike carson
Graham -Mebane Water Treatment Plant
Superintendent / ORC
Office 336-578-3264
City Cell 336-516-7450
mcarson(@citvoferaham.com
wr7

Client:
NRDES#: NC n Qt
Test Initiated by:�1
Dilution Water: 10% Dilute Mineral Water. Batch #&
Randomization?: Yes
Incubator#:
Meritech.Inc.
Data Sheet for 24 Hour Acute LC 50
Fathead Minnow
No. of Organisms per Chamber: 10
Test Vessel Size: 250 ml
Test Solution Volume: 200ml
No. of Replicates per Treatment: 2
Temp. of Stock: °C
Reference run on: 7 D
Start: Date: / Dj' Time: %1
End: Date: 117k Time: %{
Test Organism: Pimephaies prometas Age: 17 days
Born: Date: Y OSTime:
Test Terminated by:- rd
Reviewed
Concen-
tration,
units =
p
Number Exposed
Mortality after 24 Hrs.
Total
No.
Dead
p H
Dissolved
Oxygen (mg1L)
Temperature
(6C)
Conduc-
osl cm)
{umhosl
Residual
(mgiL) Chlorine
Total
Hardness
(mg/L of
CaCO3)
Rep
A
Rep
B-
i
Rep
A
Rep
B
0
24
0
24
0
24
0
0
0
Control
10
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pH of 100%
Conductivity of 100%
(umhos/cm)
Residual Chlorine of.
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Date and time fed prior to test initiation:} �) (�-t� T/ 1 t�� 1 krn Fed by: (T)

Public Notice
North Carolina
Environmental
AFFIDAVIT OF INSERTION OF ADVERTISMENT
Management
Commrssion/NPDES Unit
1611 Mail Service
The Times -News Publishing Company
Center
Raleigh, NC 21699-161 7
Notice of Intent to
Issue a NPDES
Wastewater Permit
The North Carolina Envr
ronmental Management
Burlington, NC
Commission proposes to
issue a NPDES waste
Alamance County
water discharge permit to
the person1s( listed below
Written comments regard
I, Debbie Shue, Legal Advertising Manager of the Times -News Publishing Co.,
ing the proposed permit
will be accepted until 30
do certify that the advertisement of entitled
days after the publish date
of this notice. The Director
of the NC Division of Water
Public Notice North Carolina Environmental Management Commissiol
Quality (DWQ( may hold a
public hearing should there
be a significant degree of
public interest. Please mail
Measuring 116 LINES appeared in The Times -News, a newspaper published in Alamance
comments and/or informa
County, Burlington, NC, in issues of
tion requests to DWQ at
the above address. Inter-
ested persons may visit
the DWQ at 512 N. Salis
bury Street, Raleigh, NC to
review information on file
Additional information on
NPDES permits and this
March 4, 2011
notice may be found on
our website.
I)ttp://portal.ncdenr.org/w
eb/wq/swp/ps/npdes/cafe
•'!ar, or by calling (919)
807-6304.
a
Order # 2?581858 22586954
,Jerry L. Shields requested
renewal of NPDES permit
NCO05527 1 /Shields MHP
WWTP/Alamance County,
discharges to
vity
ca
I ravis Creek/Cape Fear
River Basin. BOD, ammo -
Legal Advertising Manager
nia nitrogen, dissolved oxy-
yeri, fecal coliform, and to-
tal residual chlorine are
water quality limited.
Sworn to and subscribed before me this i 17-L day of (( C_ , 2011
you►y Angelia Ross Little
' U=
PUIDN\
a 2;
o c e GoJN ary Public
My commissioi' expires: January 20, 2015
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Weaver, Charles
From: Graznak, Jenny
Sent: Wednesday, March 02, 2011 4:01 PM
To: Weaver, Charles
Subject: comments on Alamance County draft permits
Hey Charles,
I spent some time today looking at the draft permits you just sent out yesterday. My comments are below. I realize
some of my comments are nit -picky — I think I missed my calling as a poorly paid copy editor or a grade school teacher.
At least I got the poorly paid part right. Anyway, I hope these are helpful. O
REEDY FORK MHP — NCO077968
The map needs to read "Reedy Fork Mobile Home Park' instead of "Horner's Mobile Home Park" since they
went through the name change a few years ago
The first bullet on Page 1 of "77968 draft" might be better worded as two sentences instead of three: "An
effluent limit for fecal coliform has been added to the permit due to the impairment of the receiving stream [see
below]. The limit will take effect six months after the permit's effective date."
The fifth bullet on Page 1 of "77968 draft" is unnecessary since the components at this facility did not change.
SHIELDS MHP — NCO055271
• Not a big deal but you can drop the College from Elon College since the town officially changed their name when
the college became a university.
• On the Supplement to Permit Cover Sheet, a "C" was inadvertently left off of Chlorine Contact Chamber
SAXAPAHAW WWTP — NCO042528
• The map should read "Saxapahaw WWTP" instead of "Saxapahaw Plant WWTP."
• The list of bullets on "42528 draft" needs the sentence "The list of installed components has been updated
based on your permit application," since UV disinfection was added since the last permit.
WESTERN ALAMANCE MIDDLE SCHOOL— NCO031607
• Same deal as before: you can drop the "College" from Elon College. I know locals probably still call it Elon
College, so either way ... it probably doesn't matter.
• On the Supplement to Permit Cover Sheet, an "s" was inadvertently left off of Two Activated Sludge Holding
Tanks.
WESTERN ALAMANCE HIGH SCHOOL— NCO045144
• The map still refers to Haw River as "C-NSW" instead of WS-V NSW.
• The flow limit on the Limits page is written as "0.0075 MGD" but the last permit flow limit was "0.0115 MGD." I
can't find anything in our file about their flow limit changing. Was that a typo?
B.E. JORDAN ELEMENTARY SCHOOL— NCO045152
The map still refers to Haw River as "C-NSW" instead of WS-V NSW.
On the Supplement to Permit Cover Sheet, "Chlorination" is misspelled.
Jenny Graznak
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC27107

8. Topography (relationship to flood plain included): According to FEMA Flood
Insurance Rate Map # 37183CO120 B, the facility is not within a 500-year flood
zone.
9. ,Location of nearest dwelling: one quarter mile
_. 10. _ _Receiving stream or affected surface waters: UT to Little Brier Creek
a.: Classification:, C- NSW
b . River Basin, and •Subbasin No.: 03 04. 02
w ' c+,Describe receiving,stream features and pertinent downstream uses:
The discharge flows into a)dUT to Little Brier Creek. Little Brier Creek flows
..Anto Brier Creek,Lake; a flood.control.lake:
PART. II _ 'DESCRIPTION.-OF.DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater to be permitted: 0.05 MGD
- b.`Wliat.is'tlie eurrent.perriiitted capacity of the! Waste Treatment facility?"-, • :;
0:05 MGD:.',"
c: •Actual treafirient, capacity, -of the current facility (current design capacity)?
0.05 MGD
d. Date(s)' arid'construct on °activities allowed byprevi�ous'Autliorizatioii �to- onstruct
r issued iii'tlie previoustwoyears: -None
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: -Existing wastewater treatment " facility consists�� of influent
f pumps; a holding pond, ;ferric chloride mixing tank, :flocculation_ tank, settling
tank, sand and'anthracite-flter,'carbon filter, sludge liolding'. aiik, sludge filter
p "rigs, low rate sand filters, flow meter and in plant pumps.
f. Please.provide. a description of proposed wastewater treatment facilities: N/A
g.T,,ossible:toxic impacts to'surface waters PCB's
h, Pretreatment Program {P(?TWs only):.N/At
development: approved:
should be required: not needed:
2. - Residuals -.handling: and utilization/disposal scheme:.; :.:, ;
a. If residuals are being land applied, please specify DEM permit no.: N/A
Residual Contractor: -
.. Non -Discharge Staff Report
Page 2
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iA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor Coleen H. Sullins, Director
March 1, 2011
MEMORANDUM
To: Lisa Edwards
NC DENR / DEH / Regional Engineer
Winston-Salem Regional Office
From: Charles H. Weaver, Jr.
NPDES Unit
Subject: Review of Draft NPDES Permit NCO055271
Shields MHP WVffP
Alamance County
Dee Freeman, Secretary
Please indicate below your agency's position or viewpoint on the draft permit and return this
form by April 1, 2011. If you have any questions on the draft permit, please contact me at
the telephone number or e-mail address listed at the bottom of this page.
RESPONSE: (Check one)
F1Concur with the issuance of this permit provided the facility is operated and maintained
properly, the stated effluent limits are met prior to discharge, and the discharge does not
contravene the designated water quality standards.
❑ Concurs with issuance of the above permit, provided the following conditions are met:
1-1
Opposes the issuance of the above permit, based on reasons stated below, or attached:
Signed 9,; i' `" � Pt, Date: 3-1-11
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 807-6391 (fax) 919 807-6496
VISFT US ON THE INTERNET @ HTTP://PORTAL.NWENR.ORG/WEB/WQ charles.maver@ ncdenr.9ov
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10%a Post Consumer Paper

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Charles H. Weaver — 2/22/2011
Permit Number
NC0055271
Facilitv Name
Shields Mobile Home Park WWTP
Basin Name/Sub-basin number
Cape Fear / 03-06-02
Receiving Stream
Travis Creek
Stream Classification in Permit
WS-V NSW
Does permit need Daily Maximum NH; limits''
No — already resent
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing'!
No
Does permit have Special Conditions'?
No
Does permit have instream monitoring?
Yes
Is the stream impaired (on 303(d) list)?
Yes. Benthos issues / fair bioclassification
Any obvious compliance concerns?
No
Any permit mods since lastpermit.)
No
Neiv expiration date
5/31/2016
Comments received on Draft Permit?
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed
as an impaired waterbody on the North Carolina 303(d) Impaired Waters List.
Addressing impaired waters is a high priority with the Division, and instream data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"Ilse facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values below 50 µg/l will be treated as zero
for compliance purposes."

NC 2010 Integrated Report Categories 4 and S Impaired Waters
All 13,123 Waters in NC are in Category 5-303(d) List for Mercury due to statewide fish consumption advice for several fish species
AU Number AU Name AU —Description LengthArea AU —Units Classification
Category Parameter Reason for Rating Use Category Collection Year 303(d)year
Cape Fear River Basin Big Alamance Creek Watershed 0303000203
Q 16-19-(4.5)a Big Alamance Creek From Dam at Lake Macintosh to confluence 5.6 FW Miles C;NSW
(Alamance Cr)(Lk with Stinking Quarter Creek
Macintoch)
5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2008 2006
Q 16-19-11
Little Alamance Creek
From source to Big Alamance Creek 12.6 FW Miles
C;NSW
(Gant Lake, Mays
Lake)(Alamance
County
5 Ecological/biological Integrity Benthos
Poor Bioclassification Aquatic Life 2006
2000
Cape Fear River Basin
Back Creek -Haw River Watershed 0303000204
Q 16-18-(1.5)a
Back Creek (Graham-
From .3 mile upstream of NC Hwy 119 to 580.3 FW Acres
WS-
Mebane Reservoir)
dam at Graham -Mebane Res excluding
II;HQW,NSW,
Quaker Arm of Reservoir above SR1927
CA
5 Chlorophyll a
Standard Violation Aquatic Life 2008
2010
Q 16-18-(1.5)b
5 Chlorophyll a
5 Turbidity
Back Creek (Graham- Quaker Creek Arm of Graham -Mebane
Mebane Reservoir) Reservoir
Standard Violation Aquatic Life
Q 16-(1)d3 HAW RIVER
4t Fecal Coliform (recreation)
Q 16-12-1 Tickle Creek (Trickle
Creek)
5 EcologicaUbiological Integrity Benthos
Q 16-17 Town Branch
4t Fecal Coliform (recreation)
Standard Violation Aquatic Life
From Service Creek to a NC 49
Standard Violation Recreation
From source to Travis Creek
Fair Bioclassification Aquatic Life
From source to Haw River
Standard Violation Recreation
Q 16-12 Travis Creek From source to Haw River
5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life
u sin Cane Creek -Ham
Q 16-27-(2.5)b Cane Creek (Cane From UT 0.5 miles downstream of SR1114
Creek Reservoir) to dam at Cane Creek Reservoir
5 Chlorophyll a Standard Violation Aquatic Life
Q 16-20-(4) Haw Creek From N.C. Hwy. 54 to Haw River
5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life
113.0 FW Acres
WS-
II;HQW,NSW,
2008
2010
2008
2010
2.1 FW Miles
C;NSW
2008
1998
5.0 FW Miles
C;NSW
2006
2008
4.2 FW Miles
C;NSW
2008
1998
7.3 FW Miles
C;NSW
2006
2001
River Watershed 0303000205
435.0 FW Acres
WS-
II;HQW,NSW,
2008
2010
3.8 FW Miles C;NSW
2008 2010
NC 2010 Integrated Report Category 4 and 5 303(d) List EPA Approved Aug 31, 201 9/20/2010 Page 5 of 145

To whom it may concern:
Date:10/15/10
F
From: Shields Mobile Home Park
Ref: Requesting permit renewal for permit number# NC0055271.
Our permit will expire on May 312011
Changes made to the system: On May 16, 2008 installed a UV system and keep the tablet chlorinator as
back up, this is the only changes made.
Jerry L. Shields w

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit CO055271
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Mr. Jerry L. Shields
Shields Mobile Home Park
1341 N HWY 87 North
Elon
NC 27224
[phone]
N/A
N/A
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 1355 NC HWY 87 North
City Elon
State / Zip Code NC 27224
County Alamance
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name James M Carson
Mailing Address 1356 St. Regis Dr
City Burlington 0 C T
State / Zip Code NC DENR WADER QUALIT`l
NCH
Telephone Number [phone]
Fax Number Same
1 of 4 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
i
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
X
Number of Homes
School
❑
Number of Students/Staff
Other
❑ '
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile Home Park
Population served: 14
5. Typeof collection system
X Separate (sanitary sewer only) . ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? x Yes ❑ No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
Travis Creek
8. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
Operate an existing .006 MGD Waste Water System with the following components:
Six septic tanks
Recirculation surface sand filter
Recirculation tank
UV system with back up Chlorination
Contact Chamber
Pumps and Re -aeration
2 of 4 Form-D 05/08

•'a
NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .006 MGD
Annual Average daily flow .0015 MGD (for the previous 3 years)
Maximum daily flow .00773 MGD (for the previous 3 years)
11. Js this facility located on Indian country?
❑ Yes X No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampling shall be used. If more than one analysis is reported, report daily maximum
and monthly average. If only one analysis is reported, report as daily maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
15
10
Mg/1
Fecal Coliform
400/ 100m1
200/ 100m1
GM/ml
Total Suspended Solids
45
30
Mg/1
Temperature (Summer)
N/A
N/A
Temperature (Winter)
N/A
N/A
pH
6-9
6-9
SU
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NCO055271 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Jerry L. Shields Owner
Printed name of Person Signing Title
Signatur)p of A
1 q�)
Date
North Carolina General Statute 143-215.6 (b)(2) states: 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 $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
4 of 4 Form-D 05/08

Shields Mobile Home Park
Permit # NC 0055271
Sludge Management: Contracts with Pee Wee Septic Tank Cleaning and have the
system pumped out two times a year and more if needed due to problems in
operations, Pee Wee off loads at the City of Burlington Wastewater Plant.
Pee Wee's Septic Tank cleaning
1830 Almond Ln
Dixon Rd
Graham, NC
C
Jerry L. Shields Date: 4 '�- ��