NC0055271_Permit Issuance_20170315

ROY COOPER
Govemor
Water Resources
ENVIRONMENTAL QUALITY
March 15, 2017
Mr. Jerry L. Shields
Shields Mobile Home Park
1341 NC Hwy 87 N
Elon, NC 27244
MICHAEL S. REGAN
Secrelaty
S. JAY ZIMMERMAN
Subject: Issuance of NPDES Permit NCO055271
Shields Mobile Home Park WWTP
Alamance County
Class WW-1
Dear Mr. Shields:
Director
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 no major changes from the draft permit sent to you on June 29,
2016.
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 any other Federal, State, or Local governmental permit that may be required. If you
have any questions concerning this permit, please contact Charles H. Weaver at telephone number (919)
807-6391.
A
y,
mmerman,
Director, Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq. nc.gov/aboutldivisionslwater-resourcestwater-resources-permits/wastewater-branch/npdes-wastewater-permits

Permit NCO055271
SX.
TATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
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 Nome Park W WTP
1355 NC Highway 87 North
Elon
Alamance County
to. receivingwaters designated.as.Travis Creekin,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 April 1, 2017.
This permit and authorization to discharge shall expire at midnight on May 31, 2021.
Signed this day March ' 15, 2017
y Zimmerman, P.G. �—
irector, Division of Water Resources
By Authority of the Environmental Management Commission
PageA of 6

Permit NC0055271
SUPPLEMENT TO PERMIT COVER SKEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any.prexiously 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.
Page 2 of 6

Permit NCO055271
Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING F • REQUIREMENTS
[1-5A-NC-AC 02B.0400 ,et seq., 15A NCAC 028.0500 i t seq.j
During the period beginning on ,the 'effective date- of this permit. and lasting. mtil expiration,
the. Permttee- is,authorized to discharge from outfall 001. Such discharges shallbe limited
and monitored! by the Permittee as, specified below:,
PARAMETER: " ' _
' [ L1MRS j �a '''
4afr]ONITORING`RitQUIREMENTS'
IPCS code]; .
:Monthly=Average
Daily Maximum M1
.°Measurement'
` Sampie Ty jie
_
Frettuency
'
Locationz
Flow
50050
0.006 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5 day (200C)
10.0 mg/L '
15 0 mg/L
21Month' '
Grab'
Effluent
[CO310
Total Suspended Solids
C0530 ;
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NHs as.N (April 1—October 31)
2.0 mg/L `
10.0mgA
'?JMbin tti
Grab ''
Effluent
CO610
NH3 as N (November 1— March 31)
CO6,10 ,
4.0 mg/L
20.0 mg/I
2/Month
Grab
Effluent
Dissolved Oxygen
00"]
Daily � — �
Dai aver > 6:O:mg
Way
Grab
Effluent '
Dissolved Oxygen
Weekly
Grab
' U. & D
Fecal Coliform (geometric mean)
200/100 ml
400/100 ml
?]Month
Grab
Effluent
31616
1[500601
Total Residual Chlorine (TRCY
1.7 µg/L
2/Week
:Grab
Effluent
Temperature (°C)
Weekly,
Grab.
Effluent,
101
,
Total,Nitrogen (NOz+Ng3 3T N)
'
Quarterly
Grab
Effluent
C0�0]
Total Phosphorus
IC0669
Quarterly
Grab
Effluent
pH
00400.....
> 6.0 and < 9.0 standard units
- —
2/Month •;
Grab.
Effluent
Footnotes
1. The permittee shall submit 'discharge monitoring reports electronically using the Division's
eDMR,system! [see'A. (3)1:
2. U: upstieam'at least 75 feet above the outfall, D: downstream at NCSR 1529.
3. Limit and monitoring requirements apply' oni4 if chlorine is used for disinfection.
The facility shall report ali effluent TRC values reported by a NC certified laboratory
including field certified. However, e$luentvalues 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
Page 3 of 6

Permit NCO055271
A. (2) NUTRIENT REOPENER CONDITION
[NCGS. 143-215.661
Pursuant to N.C. General Statute 143-215 and the implementing rules found in the North
Carolina Administrative Code at 15A NCAC 2H.0112 (b) (1) and 2H.0114 (a) and Part II
sectioris-B-12'6thd 8-13 of this permit; the Director may reopeii this permit to require
-supplemental nut 6iit monitoring of4he Aiscl arge.*_ Tl e purpose of the additional-'n onitonng
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.
A. (3) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
f NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge. monitoring reports (DMRs)
and program reports. The final NPDES Electronic Reporting Rule was adopted and became,
effective on December 21, 2015.,
NOTE: This special condition supplements or supersedes the following sections within. Part II
of this, permit (Standard Conditions for NPDES Permits):
• Section B_ ,(H.) Signatory Requirements
• Section ID. (2.) Reporting
• ._-Section.D. (6.) Records.Retention
• Section E. `(5.) Monitoring Reports
I. ReporUna Requirements (Supersedes Section D. (2.) and Section E. (5.) (a)]
The permittee shall report discharge monitoring data electronically using the NC DWR's
Electronic Discharge Monitoring Report (eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each
month and submitted electronically using eDMR. The eDMR system allows permitted_
facilities to enter monitoring data and submit DMRs electronically using the internet.
Until such time that the state's eDMR application is compliant with EPA's Cross -Media
Electronic Reporting Regulation (CROMERR), permittees will be required to submit all
discharge monitoring data to the state electronically using eDMR and will be required to
complete the eDMR. submission by printing, "signing, and. submitting one .signed • original
and a copy of the computer printed eDMR. to the following address:
NC DENR,/ Division of Watei-:Resources / Water Quality Permitting. Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh,. North Carolina 2,7699-1617
If a permittee is unable to use the eDMR system due to a demonstrated hardship or due
to the facility being physically located in an area where less than 10 percent of the
Page 4 of 6

Permit NCO055271
households Have broadband. - access, then a temporary waiver from the NPDES electronic
reporting requirements may lie granted -and discharge 3n ' nitotmg data may be submitted
on paper DMR forms (MR 1,` `l .1 2, 3) or alternatide forms` approved by the Director:
Duplicate signed copies shall lie submitted to the mailing address above. See "How "to
Request. a Waiver from Electronic Reporting" section below.
Regardless of the submission method, the first DMR is due on the last day of the month
following the issuance of the permit or in the case of a new facility, on the last day of the
month following the commencement of discharge.
Starting on December 21, 2020, the permittee must electronically report the following
compliance'monitonng data and reports; when applicable:
Sewer Overflow/bypass Event Reports;
Pretteatmeht' Prograio Annual Reports; and
Clean Wdtef Act- (CWA) Section 316(b) Annual Reports:
The permittee may seek an electronic reporting waiver from the Division (see "How to
Request aWaiver from Electronic Reporting" section below). '
2. Electronic Submissions
In accordance with 40 CFR 122.410)(9), the. permittee must identify the initial recipient at
the time of each electronic submission. The pe'rmittee ;should use the EPA's website
resources to identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES=regiilated facilities means
the entity (EPA or the state authorized by EPA to implement the NPDES program) that is
the designated entity for receiving electronic NPDES data [see 40 CFR 127..2(b)],
EPA plans to establish-a`website that "will also link to the appropriate electronic reporting
. _ ,
tool for.eac'h type of electronic subanission'and or eacli state instructions on how to '
access -arid case the appropriate' electronic reporting tool will be a�ailabie` as well.
Irif"ation on EPA's NPDES'Electtonic'Reporting'Rule' is f, u 'ai
q.
http://wiivvi2.epa:�ov%compliancelfinal-national=pollutant-discharge=elimination-system-
npdes-electr6nic-reliortin�-rule.
Electronic submissions must start by the dates_ listed: in the "Reporting Reguirements"-
section above. -
3. How-to Request Waiver from Electronic-Reportiag
The permittee may seek a temporary electronic reporting waiver from the Division. To
obtain an electronic reporting waiver, a permittee must first submit an electronic
reporting waiver request to the Division. Requests for temporary electronic reporting
waivers must be submitted in writing to the Division for written approval at least sixty
(60) days prior to the date the facility would be required under this permit to begin
submitting monitoring data and reports. The duration of a temporary waiver shall not
exceed 5 years and shall thereupon expire. At such time, monitoring data and reports
shall be submitted electronically to the Division unless the permittee re -applies for and is
Page 5 of .6

Permit NCO055271
granted a new temporary electronic reporting waiver by the Division. Approved electronic .
reporting waiyei-s are - not transferrable. Only permittees with an approved reporting
waiver request may submit'monitoring data and reports on paper to the Division for the
period that the approved reporting waiver request is, effective.
Information on eDMR and the application for a temporary electronic reporting waiver are
found on the following web page:
http: / / deg.nc.gov / about/ divisions /water -resources / ed=
4. Sienatoiy Regiii emeiits ' 1Suppieiiients Section B. I i i.) -(b) and Supersedes Section B.
(11.) idil
All eDMRs submitted to the permit issuing authority shall be signed by a person
described in Part 11, Section B. (11.)(a) or.by a duly authorized representative -of that
personas described in Part II, Section B: ; (11.) (b)., A person, and not_ a position, must be
delegated signatory authority for eDMR reporting purposes.
For eDMR submissions, the.person;sigmng .and .submitting the DMR must obtain an
eDMR user account and login credentials to access the eDMR system. For more
information on North Carolina's eDMR system, registering for eDMR and obtaining an
eDMR user account, please visit the following web page: I • . _ . . .
http: / "/ de6.nc. g6v / about/ divisions %water_resources / edmr
Certification. Any person submitting -an electronic `DMR using the state's eDMR system
shall make the following certification .[40 CFR 122.221, NO OTHER STATEMENTS OF
CERTIFICATION:WILL,BE ACCEPTED: ;
"I 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
qualp ;personnel properly "gat "her `and evaluate the information submitted.' Based 'on my
inquiry of the person*or persons whd manage the'*-' ystem, or those persons directly
responsible for gatheriiic� the information, the ircforrigtion submttfed is,' to the best of my
knowledge and belief, true, accurate, and complete: I am aware that there are si hi nt
penalties for submitting false information, including the possibUity of fines and
imprisonment for knowing violations."
5. Reeords Retention (Supplements Section D. 16.11
The permittee shall retain records of all Discharge Monitoring Reports, including eDMR
submissions. These records or copies shall be maintained for a period of at least 3 years
from the date of the report. This ,period may be extended_ by request of the Director, at any
time [40 CFR 122.41].
Page 6 of 6

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NCO055271 - Shields Mobile Home Park WWTP
ude:
36°08'32" Sub -Basin: 03-06-02
itude:
79029'48" River Basin: Cape Fear
S Quack
Lake Burlington
}m Class:
WS-V NSW
wine Stream: Travis Creek
Flogic Unit
03030002
��/-,&INIM1■
Facility�r
J,ocatioIl
A r� Alamance County
J l� Map not to scale

AFFIDAVIT OF INSERTION OF ADVERTISMENT
The Times -News Publishing Company
Burlington, NC
Alamance County
I, Debbie Shue, Legal Advertising Manager of the Times -News Publishing Co.,
do certify that the advertisement of entitled
Public Notice North Carolina Environmental Management Commissions
Measuring 61 LINES appeared in The Times -News, a newspaper published
In Alamance County, Burlington, NC, in issues of
January 27, 2017
Order # 22657873/ 22661961
Legal Advertising Manager
Sworn to and subscribed before me this ^ day of , 2017
N
My commission expires: January 26, 2020
PubliCa ro i ice
North
Environmental
Management
;ommission/NPDES Unit
1617 Mail Service
Centern Raleigh, NC
27699-1617
Notice of Intent to Issue
a NPDES Wastewater
Permit
The North Carolina Envi-
ronmental Management
Commission proposes to
issue a NPDES waste-
water discharge permit to
the person(s) listed be-
low. Written comments
regarding the proposed
permit will be accepted
until 30 days after the
publish date of this notice
The Director of the NC Di
vision of Water Resources
(DWR) may hold a public
hearing should there be a
significant degree of pub-
lic interest. Please mar
comments and/or infor-
mation requests to OWR
at the above address.ln
-
terested persons may
visit the DWR at 512 N
Salisbury Street, Raleigh,
NC to review informatior
on file. Additional infor.
mation on NPDES permit!
and this notice may bE
found on our website
http://deq.nc.gov/about/d
visions/water-resources,
water -resources -permits,
wastewater-branch/npdr
s-wastewater/public-notii
es,or by calling (919
807-6397.
Jerry I. Shields requeste(
renewal of NPDES permi
NCO055271/Shields Mo
bile Home Par
WWTP/Alamance County
Facility discharges ti
Travis Creek/Cape Fea
River Basin. BOD, ammo
nia nitrogen, dissolved or
ygen, fecal coliform an
Jennifer L. Hensley

Weaver, Charles
From: Mickey, Mike
Sent: Friday, July 01, 2016 9:47 AM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NC0055271 / Shields MHP
Charles— Looks fine. No comments.
[e-mail]
NC DEQ Winston-Salem Regional Office
Division of Water Resources —Water Quality Programs
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Phone: [phone]
E-mail correspondence to and from this address maybe subject to the North
Carolina Public Records Law and may be disclosed to third parties.
From: Weaver, Charles
Sent: Monday, June 27, 2016 2:51 PM
To: Kinney, Maureen <[e-mail]>; Mickey, Mike <[e-mail]>; Hudson, Eric
<[e-mail]>
Subject: DRAFT permit renewal for NCO055271 / Shields MHP
This is a class WW-1 facility in Alamance County.
Please send me any comments by July 29tn
As always, thanks for your help.
Charles H. Weaver
Environmental Specialist
N.C. Division of Water Resources
N.C. Department of Environmental Quality
919-807-6391
charles.weaverCcDncdenr.gov
(physical address) 512 North Salisbury Street, Raleigh, NC 27604
(mailing address) 1617 Mail Service Center, Raleigh, NC 27699-1617
=I- Nothing Compares _,
Email correspondence to and from this address is subject to the North Carolina Public Records Law and maybe disclosed
to third parties.

PA'r MCCRORY
DONALD R. VAN DER VAART
S. JAY ZIMMERMAN
June 27, 2016
MEMORANDUM
To: Eric Hudson
NC DEQ / DWR / Public Water Supply
Winston-Salem Regional Office
From: Charles H. Weaver, Jr.
NPDES Unit
Subject: Review of Draft NPDES Permit NCO055271
Shields MHP WWTP
Alamance County
Please indicate below your agency's position or xiewpoint on the draft permit and return this
form by July 29, 2016. If you have any questions on the draft permit, please contact me at
919-807-6391 or via e-mail [charles.weaverCwncdenr.gov].
§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§§
RESPONSE: (Check one)
®Concur 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:
❑ Opposes the issuance of the above permit, based on reasons stated below, or attached:
Signed
Date: � b -�/6,­,
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https:.' deq.nc.govlabout/divisions/water-resourceshvater-resources-permits/wastewater-branch/npdes-wastewater-permits

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 — 6/27/2016
Permit Number
NCO055271
Facility 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 NH3 limits?
No — already present
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
Yes — nutrient reopener for Cape Fear permits
Does permit have instream monitoring?
Dissolved oxygen and temperature
Is the stream impaired (on 303(d) list)?
Yes. Benthos issues / fair bioclassification;
added to 303 (d) list in 2008
Any obvious compliance concerns?
None. No enforcements since 2008. One
NOD and one NOV in this permit cycle.
Any permit mods since last permit?
No
New expiration date
5/31 /2016
Comments received on Draft Permit?
Added eDMR requirements
Added regulatory citations
Reduced effluent temperature monitoring to
Weekly
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that 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."
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"The facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values below 50 µg/1 will be treated as zero
for compliance purposes."

2014 AU Number-.j AU Name:
AU Description:
16-11-14-2b South Buffalo Creek
From McConnell Rd to US 70
Cape Fear River Basin
AU Length Area: AU Units: Classification:
4.7 FW Miles WS-V;NSW
IRCategory:
ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
5
EC
Fish Community Poor (Nar, AL, FW)
2003
1998
16-32 Terrells Creek (Ferrells Creek) (North Side Haw Riv 7.6 FW Miles WS-IV;NSW
From source to Haw River
IRCategory: ACS: Parameter Of Interest: Collection Year: 303(d) yr:
5 EC Benthos Fair (Nar, AL, FW) 2008 2010
16-41-1-12-(1) Third Fork Creek 5.2 FW Miles WS-V;NSW
From source to a point 2.0 miles upstream of NC Hwy. 54
IRCategory: ACS: Parameter Of Interest: Collection Year: 303(d) yr:
5 EC Zinc (50 µg/I, AL, FW) 2012 2008
5 EC Dissolved Oxygen (4 mg/I, AL, FW) 2012 2008
5e EC Copper (7 µg/I, AL, FW) 2012 2012
16-41-1-12-(2) Third Fork Creek 3.9 FW Miles WS-IV;NSW
From a point 2.0 miles upstream of NC HWY. 54 to New Hope Creek
IRCategory:
ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
5e
EC
Copper (7 µg/I, AL, FW)
2008
2008
5
EC
Dissolved Oxygen (4 mg/l, AL, FW)
2012
2008
16-12-1 Tickle Creek (Trickle Creek)
From source to Travis Creek
5.0 FW Miles WS-V;NSW
Zategory: ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
EC
Benthos Fair (Nar, AL, FW)
2006
2008
16-12 Travis Creek
From source to Haw River
7.3 FW Miles WS-V;NSW
Category: ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
EC
Benthos Fair (Nar, AL, FW)
2006
2008
16-6-(3) Troublesome Creek 1.8 FW Miles WS-V;NSW
From dam at Lake Reidsville to Haw River
IRCategory:
ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
5
EC
Dissolved Oxygen (4 mg/I, AL, FW)
2012
2010
16-38-4 Turkey Creek 4.1 FW Miles WS-IV;NSW
From source to Robeson Creek
IRCategory:
ACS:
Parameter Of Interest:
Collection Year:
303(d) yr:
5
EC
Benthos Fair (Nar, AL, FW)
2009
2012
2014 NC 303(d) List -Category 5 Final December 19, 2014 Page 15 of 149

To: Renewal Dept.
From: James M. Carson
ORC/Field Lab
Reference: Change in new permit
Under our current permit we are required to sample Effluent Temperature two times a week.
I would like to request that under the new permit that the Temperature sample to be reduced to
sampling Temperature once a week. Due to Mr. Shields is 80 years old and having some health
problems, which has made it harder for him to collect this sample. To have someone else to perform
this would add additional cost to them, which would be a hardship on them due to they are retired and
on a fixed income.
Historically the Temperature does not change that much in a week on our effluent looking back the last
3 years.
Sincerely,
OJaes M. C son
ORC/Field Lab

To: Whom it may concern
Date: 1/18/2016
Ref: Requesting permit renewal for permit number NC0055271
Our permit will expire on May 312016
Sincerely,
Jerry L. Shields

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
1
Jerry L. Shields Date:
RECEIVEDINCDEUDWR
FEB 0 2 2016
Water Quality
Permitting Section

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y.<J1kW-41

DES APl LIC&TI N FOR PEPAIT RENEWAL - FORM D
Par privately owned imatmeat systems treating 1000/a domestio wastewaters <0.1 RUQD
Nag the complete appHeatiton to:
1C. C. Department of Environment and Natum l Resources
Division of waftg lty / MES unit
161.7 MA SetAce Ceatmv VdW, NO 27699-1617
IMES Permit I' G271
1f you are completing this form in computer use the TAB key or the up -- down arrows to move from, one
field to the new. To check the boxes, click your mouse on top of the boat. Otherwise, please prim or type.
I. Contact Information:
Owner Name
Mr. Jewry L. Shields
Facility Name
Shields Mobile Home Farm
Mailing Address
1341 N HW 87 North
City
Elon
State / Zip Code
NC / 27244
Telephone Number
[phone]
Fax Number
N/A
e-mail Address
N/A
2. Location of facility producing discharge. -
Check here if same address as above n
Street Address or State Road 1355 NC. HWY 87 North
City Elon
State / Zip Code NC / 27244
County Alamance
S. operator is ormatioaa.
.Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Churxge or ORC)
Name James M. Carson
Mailing Address 1356 St. Regis Dr
City . Burlington
State / Zip Code NC / 27217
Telephone Number [phone] RECEIVED/NCDEQ/DWR
Fax Number [phone] FEB 0 2 2 Q 16
Water Quality
Permitting Section
l of 4 Fomkl] 4105

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owners treatment systems treating 1006% domestic wastewaters <0.1 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Commercial
❑
Residential
School
❑
Other
❑
Number of Employees
Number of Employees
Number of Homes 13
Number of Students/ Staff
Explain:
Describe the source(s) of wastewater (example:. subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile Home park
Population served: 24
6. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm 'sewer and sanitary sewer)
6. outian Wosmation.
Number of separate discharge points 1
Oaitfall Identification. number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes N No
7. Name of recei g stream(s): (Provide a map showing the exact location of each outfalift .
Travis Creek
S. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
.. Describe the treatment zystem
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.
Components as follows:
Sias septic tanks, recirculating surface sand filter, Recirculation tank, i'JV system (tablet
Chlorination) for track -up, Contact chamber, Pumps * Reaeration.
See attachment for capacities
2 of4 form-0 4105

J
NPDES APPLICATION FOR PERMIT RENEWAL ® FORM D
For privately owned treatment systems treating 100% domestic wastewaters <0.1 MGD
10. Flow Information:
Treatment Plant Design flow .006 NGD
Annual Average daily flow .0035 MGD (for the previous 3 years)
Maximum daily flow .0063 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® 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 (BOD5)
5.5
2.2
Mg/l
Fecal Coliform
1.0
1.0
#/ 100 (GM)
Total Suspended Solids
7.0
2.9
Mg/l
Temperature (Summer)
28.6
23.1
° C
Temperature (Winter)
21.3
12.8
C
pH
7.0 ,
6.6
Units
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NCOOS5271
14. APPLICANT CERTIFICATION
Ocean Dumping (MPRSAA)
Dredge or fill (Section 404 or CWA)
Other
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
3 of 4 Form-D 4105

NPDES APPLICATION FOR PERMIT RENEWAL - FORM D
For privately owned treatment systems treating 1000/o domestic wastewaters <0.1 MGD
01
Signaf4re of
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any Use 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 knowly 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 of4 form-D4105

To: Renewal Dept.
From: James M. Carson
ORC/Field Lab
Reference: Change in new permit
Under our current permit we are required to sample Effluent Temperature two times a week
I would like to request that under the new permitthat the Temperature sample to be reduced to
sampling Temperature once a week. Due to Mr. Shields .is 80 years old and having some health
problems, which has made it harder for him to collect this sample. To have someone else to perform
this would add additional cost to them, which would be a hardship on them due to they are retired and
on a fixed income.
Historically the Temperature does not change that much in a week on our effluent looking back the last
3 years.
Sincerely,
Ja es M. C son ,
ORC/Field Lab