NC0071897_Renewal Application_20150429

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Robert Crummie, Administrator
Mizpah Healthcare, Inc.
Henderson's Assisted Living
PO Box 1029
Marion, NC 28752
Dear Permittee:
Donald R. van der Vaart
Secretary
April 29, 2015
Subject: Acknowledgement of Permit Renewal
Permit NCO071897
Henderson County
The NPDES Unit received your permit renewal application on April 28, 2015. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Bob
Sledge [phone].
Sincerely,
W rrew Tk" forgo
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office
NPDES Unit
1617 Mail Service Center, Ralegh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]/Customer Service:1-877-623-6748
Internet:: www rimater.orq
An Equal OpportunitylAffirmative Action Employer

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt., Inc.
To Whom It May Concern:
Sludge from this facility (Henderson's Assisted Living WWTP NCO071897 is pumped by Mike's Septic
Tank Service and is permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
Juanita ames
James and James Environmental Mgt., Inc.
[e-mail]

James & James Environmental Management, Inc.
3801 Asheville Hwy., Hendersonville, N. C. 28791
OFFICE: [phone] FAX: [phone]
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt., Inc
To Whom It May Concern:
This letter is to request the renewal of the permit for the waste water treatment facility of Henderson's
Assisted Living WWTP, NPDES number NC0071897.
Sincerely
Juanit ames
James and James Environmental Mgt., Inc.
[e-mail]

�+( NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 1009/6 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 C007189? '-
/f 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 Mizpah Healthcare, Inc. `
Facility Name Henderson's Assisted Living
Mailing Address P. 0. Box 1029
City Marion
State / Zip Code NC 28752
Telephone Number 828-652-3038 RECEIVEDIDENRIDWR
Fax Number [phone] APR 2 8 2015
e-mail Address robert(aemmmie.name Y8i
PermittinA r
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 602 Brookside Camp Road(NCSR 1528)
City Hendersonville
State / Zip Code NC 28792
County Henderson
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 Mizpah Healthcare, Inc.
Mailing Address P. 0, Box 1029
Citv Marion
State / Zip Code NC 28752
Telephone Number 828-652-3038
Fax Number [phone]
e-mail Address robert(a crummie.aame
1 of 3 Form•D 11112

• 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 applyr
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
Number of Students/ Staff
Other
X
Explain: Nursing Home_
Describe the source(s) of waste ater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing Home W /
Number of persons served: 5(0
S. 'hype of collection system
X Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification numbers) 001
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving streams) (bgW applicants: Provide a map showing the exact location of each
outfall/.
Unnamed tributary to Featherstone Creek in the French Broad River Basin _
S. 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 riot sufficient, attach the description of the treatment sys;em in a
separate sheet of paper.
A 0.007 MGD facility with bar screen, 9,100 gallon aeration basin, dual air blowers
providing diffused air, 1535 gallon rectangular clarifier with skimmer and sludge returns,
1400 gallon aerobic digestor, dual tertiary sand filter, tablet chlorinator, 185 gallon
baffled chlorine contact chamber, tablet dechlorinator, 60 gallon post aeration tank.
2 of 3 Form-D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.007 MOD
Annual Average daily flow 0.002 MOD (for the previous 3 years)
Maximum daily flow 0.007 MOD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X No
12. Effluent Data
ARW APPUCANTS: Provide data for the parameters listed. Fecul Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than oree analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, reporl as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the ast 36 months or arameters currentltj in our ermit. Mark other parameters N/A".
Daily Monthly Units of
Parameter Maximum Average ) Measurement
Biochemical Oxygen Demand (BODs) 14.5 6.3 MG/L
Fecal Coliform
54
9.4
CFU/ 100ML
Total Suspended Solids
Temperature (Summer)
Temperature (Winter)
; 34.0
{ 9.6
MG/L
27.7
16.8
24.3 C
10.8 C
pH
7.7
7.1__-. - - .l UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES M00071897 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.
P.s.e r/ / i��i.nn.�•fiPi 7404miNlSff1'Alor
Printed name
Title
Signature of Applicant 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 impiementing 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.)
Form-D 11112
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