NC0069370_Renewal (Application)_20150528

•
*1
TREVCO
ENVIRONMENTAL * MAINTENANCE * CONSTRUCTION
2020 Howard Gap Road
Hendersonville,N.C.28792
Phone[phone]
Fax[phone]
5/12/15
Permit Renewal Request RECEIVED/DENR/DWR
MAY 2 8 2015
vvater Quartny
Permitting SectIoon
Wren Thedford
Please find enclosed a permit renewal package for Pine Park Retirement Inn
(NPDES permit# NC0069370). There have been no changes or
modifications to this facility since the issuance of the last permit. We
respectfully request this permit to be renewed. We also hope that you find
this package in order.
If we may be of further assistance please do not hesitate to call or
correspond.
Sincerely,
1revor C. McMinn

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 Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INC0069370
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 Brookdale
Facility Name Pine Park Retirement Inn
Mailing Address 2601 Chimney Rock Rd
City Hendersonville
State / Zip Code NC 28792
Telephone Number [phone]
Fax Number [phone]
e-mail Address hNEhmK /I T1aPvK-0J4LE• 60-rvl
C= RECEIVEDIDENR/DWR
2. Location of facility producing discharge:
Check here if same address as above X
Street Address or State Road MAY 2 8 2015
Water Quality
City Permitting Section
State / Zip Code
County
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 Brookdale
Mailing Address 2601 Chimney Rock Rd
City Hendersonville
State / Zip Code NC
Telephone Number [phone]
Fax Number (8A8)696-3713
e-mail Address ,&fe14 o, % givA p 0 .

f
NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.025 MGD
Annual Average daily flow 0.008 MGD (for the previous 3 years)
Maximum daily flow 0.021 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ yes Z No
12. Effluent Data
NEW APPLICANTS: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.
REREWAL APPLICANTS: Provide the highest single reading(Daily Maximum)and Monthly Average over
the past 36 months for parameters currently in your permit. Mark other parameters `N/A'.
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 30 16.5 Mg/1
Fecal Coliform 600 9 Co1/100 ml
Total Suspended Solids 49 27.5 Mg/1
Temperature (Summer) 26 26 Degrees C
Temperature (Winter) 22 20.5 Degrees C
pH 8.0 N/A S.U.
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste(RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES Dredge or fill(Section 404 or CWA)
PSD (CAA) Other
Non-attainment program(CAA)
14. APPLICANT CERTIFICATION
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.
Greg Penfold Executive Director
Printed ame of P n Signing Title
Wil$•iS
Signature c. Appli Date
North Carolina General Statute 143-215.6 (bX2) 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.)

5/12/15
Point Source Branch
Surface Water Protection Section
Division of Water Quality
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
Pine Park Retirement Inn
NPDES No.NC0069370
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following
individuals for all permit applications,discharge monitoring reports, and other
information relating to the operations at Pine Park Retirement Linn as required by all
applicable federal, state, and local environmental agencies specifically with the
requirements for signatory authority as specified in 15A NCAC 2B.0506.
Name Title
Trevor C. McMinn Operator In Responsible Charge
If you have any questions regarding this letter,please feel free to contact me at 828-692-
1911.
Sincerely,
Greg Penfold
Executive Director
ASitt-ing(IC
cc: cWhn Megtew>Regional Office, Surface Water Protection Section
Technical Assistance and Certification Unit

TREVCO
2020 Howard Gap Road
Hendersonville,N.C.28792
Phone[phone]
General information:
Facility System Name:Pine Park Retirement Inn
Responsible Entity:Brookdale
Person in Charge:Ed Gaven
Applicable Permit:NPDES#NC0069370
Description of treatment process:
The 0.025 MGD extended aeration facility consists of an influent lift station,bar screen,flow recorder,
aeration basin,clarifier,effluent pump station,and an aerated sludge holding basin.A dechlor tablet feeder
was installed in 2011 to comply with chlorine limits to take effect on 6/1/2012.
This facility is located at Pine Park Retirement Inn at 2601 Chimney Rock Rd in Henderson County
Sludge Management:
This facility builds sludge rapidly,due to the highly loaded moderate influent flow.As the need for sludge
removal becomes apparent it will be wasted to the digester where it will be stored and thickened for cost
effective hauling.As the flow increases at this facility it may become necessary to increase the frequency in
hauling. Sludge removal will be by truck by Mike's Septic, {828-253-2612}a local pump truck contractor.
He will haul the sludge to disposal at the Town of Brevard or the MSD waste treatment facility.All
associated costs of this hauling will be paid by Pine Park Retirement Inn.Removal and management of this
sludge will be done in a timely manner and in the best interests of facility operation and the environment.
Operator in responsible charge: Date:5/12/15
Trevor C.McMinn

Y
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 28,2015
Greg Penfold,Executive Dir.
Pine Park Retirement Inn
2601 Chimney Rock Rd
Hendersonville,NC 28792
Subject: Acknowledgement of Permit Renewal
Permit NC0069370
Henderson County
Dear Permittee:
The NPDES Unit received your permit renewal application on May 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 Maureen
Kinney at(919)807-6388.
Sincerely,
W re vv Tkzetioro('
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office
NPDES Unit
1617 Mail Service Center,Raleigh,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.ncwater.orn
An Equal OpportunitylAffirmative Action Employer