NC0038822_Permit Issuance_20140328

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. James M. Cheshire
Research & Analytical Laboratories, Inc.
P.O. Box 473
Kernersville, NC 27284-0473
Dear Mr. Cheshire:
John E. Skvarla III
Secretary
March 28, 2014
Subject: Issuance of NPDES Permit NCO038822
Central Care WWTP
Surry County
Class WW-1
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
January 29, 2014.
➢ The proposed ammonia nitrogen (NH3 as N) limits in the draft permit have been
removed, and the toxicity testing in your previous permit has been restored. We
apologize for the confusion caused by the draft permit.
➢ NOTE: Proposed Federal regulations require electronic submittal of all discharge
monitoring reports (DMRs). The proposed regulations specify that if a state does not
establish a system to receive such submittals permittees must submit DMRs
electronically to the Environmental Protection Agency (EPA). Accordingly, NC DENR
has established an electronic data -submission system. Permittees must begin using the
system no later than 270 days following the effective date of permit renewals. In your
case, that deadline is February 1, 2015.
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 512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / http://portal.ncdenr.org/web/wq
An Equal Opportunity/Affirmative Action Employer — 501/o 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 any other Federal, State, or Local governmental permit
that may be required.
If you have any questions concerning this permit, please contact Charles Weaver at
telephone number [phone].
ince ly,
G
Thomas A. Reeder, irec �r
Division of Water Resources
cc: Central Files
Winston-Salem Regional Office
NPDES Unit
Billy Payne / Central Care [139 Apex Lane, Mount Airy, NC 270301

Permit NCO038822
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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,
Central Care, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Central Care WW`.PP
139 Apex Lane
Mount Airy
Surry County
to receiving waters designated as an unnamed tributary to Stewarts Creek in subbasin
03-07-03 of 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 May 1, 2014.
This permit and authorization to discharge shall expire at midnight on February 28, 2019.
Signed this day March 28, 201
T,,'or�nas A. Reeder, Director__ - . -
Division of Water Resources
By Authority of the Environmental Management Commission
.1of6

Permit NCO038822
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.
Central Care, Inc. is hereby authorized to:
1. Continue to operate an existing 0.010 MGD wastewater treatment system with the
following components:
♦ Septic tank
♦ Dosing chamber
♦ Surface sandfilter
♦ Tablet chlorination
♦ Tablet dechlorination
The facility is located off Apex Lane, south of Mount Airy in Surry County.
2. Discharge from said treatment works at the location specified on the attached map into
an unnamed tributary to Stewarts Creek, currently classified C waters in subbasin 03-
07-03 of the Yadkin -Pee Dee River Basin.
2of6

Permit NCO038822
Part I
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' by the Permittee as specified below:
PARAMETER
LIMITS
MQNITORINGAEQUIREMENTS'
[PCS Code]
Monthly Average ,
Daily Maximum
Measurement
Sample Type
Sample
Frequency.
Locatidn?
Flow
0,010 MGD
Weekly
Instantaneous
Influent or
[500501
Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
P0310]
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
[00530]
Dissolved Oxygen
Weekly
Grab
Effluent,
[00300]
U & D
Fecal Coliform [31616]
200/100 ml
400/100 ml
2/Month
Grab
Effluent
(geometric mean)
Total Residual Chlorine (TRC)3
17 pg/L
2/Week
Grab
Effluent
[50060]
Temperature (IC)
Daily
Grab
Effluent
[00010]
Temperature (IC)
Weekly
Grab
U & D
[00010]
Total Nitrogen (NO2+NO3+TKN)
Quarterly
Grab
Effluent
[00600]
Total Phosphorus
Quarterly
Grab
Effluent
[00665]
Chronic Toxicity4
Quarterly
Grab
Effluent
[I GP3B]
pH
P04001
> 6.0 and < 9.0 standard units
— —
2/Month
Grab
Effluent
Footnotes:
1. No later than February 1, 2015, the permittee shall begin submitting discharge monitoring reports
electronically using the Division's eDMR application system [see A. (4)].
2. U: at least 100 feet upstream from the outfall. D: at least 300 feet downstream from the outfall.
3. The facility shall report all effluent TRC values reported by a NC certified laboratory including field
certified. However, effluent values < 50 µg/L will be treated as zero for compliance purposes.
4. Chronic Toxicity (Ceriodaphnia) limit with quarterly sampling [see A. (2)].
There shall be no discharge of floating solids or visible foam in other than trace amounts.
3of6

Permit NCO038822
A. (2) CHRONIC TOXICITY PERMIT LIMIT (QUARTERLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant
mortality to Ceriodaphnia dubia at an effluent concentration of 90%.
The permit holder shall perform (at a minimum) quarterly monitoring using test procedures
outlined in the "North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised
December 2010, or subsequent versions or "North Carolina Phase II Chronic Whole Effluent
Toxicity Test Procedure" (Revised- December 2010) or subsequent versions. The tests will be
performed during the months of March, June, September, and December. These months signify
the first month of each three-month toxicity testing quarter assigned to the facility. Effluent
sampling for this testing must be obtained during representative effluent discharge and shall be
performed at the NPDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV
below the permit limit, then multiple -concentration testing shall be performed at a minimum, in
each of the two following months as described in "North Carolina Phase II Chronic Whole Effluent
Toxicity Test Procedure" (Revised -December 2010) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent
Discharge Monitoring Form (MR-1) for the months in which tests were performed, using the
parameter code TGP3B for the pass/fail results and THP3B for the Chronic Value. Additionally,
DWR Form AT-3 (original) is to be sent to the following address:
Attention: NC DENR / DWR /Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no
later than 30 days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and
all concentration/response data, and be certified by laboratory supervisor and ORC or approved
designate signature. Total residual chlorine of the effluent toxicity sample must be measured and
reported if chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring
is required, the permittee will complete the information located at the top of the aquatic toxicity
(AT) test form indicating the facility name, permit number, pipe number, county, and the
month/year of the report with the notation of "No Flow" in the comment area of the form. The
report shall be submitted to the Environmental Sciences Section at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required,
monitoring will be required during the following month. Assessment of toxicity compliance is based
on the toxicity testing quarter, which is the three month time interval that begins on the first day
of the month in which toxicity testing is required by this permit and continues until the final day
of the third month.
Should any test data from this monitoring requirement or tests performed by the North Carolina
Division of Water Resources indicate potential impacts to the receiving stream, this permit may be
re -opened and modified to include alternate monitoring requirements or limits.
If the Permittee monitors any pollutant more frequently than required by this permit, the results
of such monitoring shall be included in the calculation & reporting of the data submitted on the
DMR & all AT Form submitted.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control
organism survival, minimum control organism reproduction, and appropriate environmental controls, shall
4of6

Permit NCO038822
constitute an invalid test and will require immediate follow-up testing to be completed no later than the last
day of the month following the month of the initial monitoring.
A. (3) NUTRIENT REOPENER FOR HIGH ROCK LAKE
This permit may be reopened and modified to implement nutrient requirements in accordance
with any future TMDL and / or nutrient management strategy for High Rock Lake.
A. (4) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS
Proposed federal regulations require electronic submittal of all discharge monitoring reports
(DMRs) and specify that, if a state does not establish a system to receive such submittals, then
permittees must submit DMRs electronically to the Environmental Protection Agency (EPA). The
Division anticipates that these regulations will be adopted and is beginning implementation.
NOTE: This special condition supplements or supersedes the following sections within
Part II of this permit (Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning no later than February 1, 2015, the permittee shall begin reporting 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 Water Resources / Information Processing Unit
ATTENTION: Central Files / eDMR
1617 Mail Service Center
Raleigh, NC 27699-1617
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 households have
broadband access, then a temporary waiver from the NPDES electronic reporting requirements
may be granted and discharge monitoring data may be submitted on paper DMR forms (MR 1,
1. 1, 2, 3) or alternative forms approved by the Director. Duplicate signed copies shall be
submitted to the mailing address above.
5of6

Permit NC0038822
Requests for temporary waivers from the NPDES electronic reporting requirements 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 using eDMR. Temporary
waivers shall be valid for twelve (12) months and shall thereupon expire. At such time, DMRs
shall be submitted electronically to the Division unless the permittee re -applies for and is
granted a new temporary waiver by the Division.
Information on eDMR and application for a temporary waiver from the NPDES electronic
reporting requirements is found on the following web page:
http://Portal.ncdenr.org/web/wq/admin/bog/ipuledmr
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.
2. Signatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B.
11. d
All eDMRs submitted to the permit issuing authority shall be signed by a person described in
Part II, Section B. (11.)(a) or by a duly authorized representative of that person as 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 signing 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:
http://portal.ncdenr.org/web/wq/admin/bog/ipu/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall
make the following certification [40 CFR 122.22]. 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 qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations."
3. Records Retention [Supplements Section D. (6.)l
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].

fj
l t_- • a13
�t
J
Discharge Location
t r
- N \' l-,`�� �\
C'-
NCO038822 - CentraL Care, Inc.
ude: 36027'11" Sub -Basin: 03-07-03
itude: 80038'52" River Basin: Yadkin -Pee E
SQuad: Dobson Stream Class: C
iving Stream: UT to Stewarts Creek
4•
�. r - aiO4
Facility
Location
IA r� Surry County
•/ {/ Map not to Scale

Weaver, Charles
From:
Sent:
To:
Cc:
Subject:
Dear Mr. Weaver:
[e-mail] on behalf of Research and Analytical Laboratories
<[e-mail]>
Tuesday, March 04, 2014 4:58 PM
Weaver, Charles
James Cheshire
Response to Central Care Draft NPDES Permit NCO038822
In response to the issuance of the Draft NPDES Permit NCO038822 concerning Central Care WWTF
(Surry County) we have reviewed the proposed requirements contained in this Draft Permit with the following
comments:
1) The Current NPDES Permit for Central Care WWTP (NC0038822) does not contain the currently
proposed Ammonia Nitrogen limitations which would be prohibitive for this facility to be able to
comply with due to the type of waste water treatment system that is currently being operated. We
propose that the current Biotoxicity testing requirements be included in the current proposed Draft
NPDES Permit and the Ammonia Nitrogen limits be removed.
2) t has been the acceptable practice of DENR in the past to allow the Biotoxicity testing requirements
to be substituted in lieu of the Ammonia Nitrogen limits of which Central Care has successfully
demonstrated during the last permitted period.
3 The potential nutrient allocation for Nitrogen and Phosphorous does not appear to be an issue with
this permitted facility due to the significant reduction in flow expected for this facility as well as the
current monthly average allocation of 0.010 MGD.
Central Care thanks you for this opportunity to be able to respond to the proposed Draft Permit NCO038822 and
if you have any further questions or concerns, please feel free to contact me at any time.
Best Regards,
James M. Cheshire
Research & Analytical Laboratories, Inc.
336-996-2841

.NUK'1'H CAROLINA
SURRY COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Ferris W. Simpson who being first duly
sworn, deposes and says: that he (she) is Business Manager
(Publisher or other officer or employee authorized to make affidavit) of
CIVITAS MEDIA, LLC, engaged in the publication of a newspaper known
as MOUNT AIRY NEWS, published, issued, and entered as periodicals
class mail in the city of Mount Airy in said County and State; that he (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 MOUNT AIRY NEWS on the following dates:
'11_� . I,'�_01�
and that the said newspaper in which such notice, paper, document or
legal advertisement was published was, at the time of each and every
such publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 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.
This �_ day of L G 1Lt� �f 2014
/_/ I '
Signature of person making
Swo9i to and subscribed before me, this day of
2014
Notary Pu is
My Commission expires: January 15 2018
BRIDGET HEN RED SON
NOTARY PUBLIC
Yadkin County
North Carolina
My commission Expires January 15, 201 S
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public hear-
ing should there be a signific-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
http://portal.ncdenr.org/web/wq
/swp/ps/npdes/calendar, or by
calling [phone]. Cent-
ral Care, Inc. requested renew-
al of permit NCO038822 for its
WWTP/Surry County. Facility
discharges to an unnamed trib-
utary to Stewarts
Creek/Yadkin-Pee Dee River
Basin. Currently ammonia ni-
trogen, fecal coliform and total
residual chlorine are water
quality limited. Aqua North
Carolina, Inc. (of Cary 27511)
applied to renew NPDES per-
mit NCO088536 for the Ban-
nertown Subdivision WTP,
Well #2, Town Lane, Mt Airy
27030, discharging to UT to
Faulkner Creek, Yadkin River
Basin, Surry County, Aqua
North Carolina, Inc., Surry
County, has applied to renew
NPDES permit for the Mitchell
Bluff Subdivision Well #1 WTP
[NC00884981 discharging filter -
backwash wastewater to
Mitchell River, Yadkin -Pee Dee
River Basin. Aqua North Caro-
lina, Inc., Surry County, has
applied to renew NPDES per-
mit for the Windgate Subdivi-
sion Well #1 WTP
(NC0088609) discharging filter
backwash wastewater to Fish-
er River, Yadkin -Pee Dee
River Basin, Aqua North Caro-
lina, Inc. (of Cary) applied to
renew NPDES permit
NCO088528 for the Hillcrest
Subdivision WTP, Well #3,
Lynnwood Dr., Mt Airy 27030,
discharging to UT to Champ
Creek, Yadkin River Basin,
Surry County. Surry County
Schools requested renewal of
NPDES permit
NC0041947/North Surry High
School WWTP. Facility dis-
charges to Stewarts
Creek/Yadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water quality limited. Surry
County Schools requested re-
newal of NPDES permit
NC0041939/J. Sam Gentry
Middle School WWTP. Facility
discharges to Stewarts
Creek/Yadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water quality limited.
Publish February 7, 2014

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 1/27/2014
Permit Number
NCO038822
Facility Name
Central Care WWTP
Basin Name/Sub-basin number
03-07-03
Receiving Stream
UT Stewarts Creek
Stream Classification in Permit
C
Does permit need Daily Max 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?
No
Does permit have instream monitoring?
Dissolved Oxygen, Temperature
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
None. One enforcements since 2010. One
violation in 2013, three in 2012.
Any permit modifications since last permit?
None. .
New expiration date
2/28/2019
Comments on Draft Permit
➢ Added parameter codes.
➢ Added High Rock reopener condition.
➢ Added eDMR requirements.
Most Commonly Used Expedited Language:
• 303(d) language for Draft/Final Cover Letters: "Please note that the receiving stream
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 permitted 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 < 50 µg/L will be treated as zero for
compliance purposes."
This page has been printed on scrap paper to save money and reduce our program's environmental.
Impact. Disregard any content on the back of this page.

q° RESEARCh & ANALYTICAL
LABORATORIES, INC.
Analytical/Process Consultations
September 5, 2013
Mr. Charles H. Weaver, Jr.
NPDES Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Renewal of NPDES Permit No. NCO038822
Central Caro '%VW T1'
Dear Mr. Weaver,
In response to your request for NPDES Permit Renewal concerning Central Care WWTP
(NPDES Permit No. NCO038822), Research & Analytical Laboratories, Inc. (RAL) has prepared
the enclosed required renewal package information for your review. The signed application form
in triplicate and a description of the method of sludge disposal are all attached.
Sincerely,
Research & Analytical Labs
James M. Cheshire
Authorized Ageri
JMC/js
Cc. William Payne, Central Care Inc.
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 •336-996-284
www.randalabs.com
6-0326

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 Permitl NC0038822
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
Central Care, Inc.
Facility Name
Central Care WWTP
Mailing Address
139 Apex Lane
City
Mount Airy
State / Zip Code
NC / 27030
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road
City
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 Research & Analytical Laboratories, Inc.
Mailing Address 106 Short Street
City Kernersville
State / Zip Code NC / 27284
Telephone Number [phone]
Fax Number [phone]
1 of 3 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):
Industrial
❑
Number of Employees
Commercial
®
Number of Employees 5 - 10
Residential
®
Number of Homes 5
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing Home
Population served: 10 - 20
5. Type of collection system
® 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? ❑ Yes ❑ No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):'
Unnamed Tributary to Stewarts Creek
8. Frequency of Discharge: ❑ Continuous Intermittent
If intermittent:
Days per week discharge occurs: Random Duration: Random
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.
0.010 Wastewater Facility consisting of the following:
• Septic Tank
• Dosing Chamber
• Surface Sandfilter
• Tablet Chlorination
• Tablet Dechlorination
2 of 3 Form-D 05/08

. NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.010 MGD
Annual Average daily flow 0.002 MGD (for the previous 3 years)
Maximum daily flow 0.006 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 (BODs)
20.7
9.7
MG/L
Fecal Coliform
188
3.5
Col/ 100ml
Total Suspended Solids
25
8.2
MG/L
Temperature (Summer)
26
20.4
oC
Temperature (Winter)
20
10.1
oC
pH
7.1
6.51
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 NCO038822 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.
Printed name of Person
�Mwj� _
of
Title
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.)
3 of 3 Form-D 05/08

SLUDGE MANAGEMENT PLAN
CENTRAL CARE, INC.
WASTEWATER TREATMENT PLANT
NPDES PERMIT NO. NCO038822
Sludge from the Central Care wastewater treatment plant (WWTP) is disposed of in the
following way:
Central Care WWTP consists of a documented sludge hauling subcontractor
(V&S Septic; -Inc.) who periodically removes digested sludge from septic tank and
delivers waste sludge to a documented or approved wastewater treatment
facility. Information found in documented log includes date, time, volume of
sludge removed and location, date and time sludge transported to final
destination. The designated ORC coordinates the frequency in which digested
sludge is removed.

Weaver, Charles
From: Joe baskin <[e-mail]>
Sent: Tuesday, August 13, 2013 10:49 AM
To: Weaver, Charles
Subject: Re: renewal notice for NPDES permit NCO038822
Dear Mr. Weaver
I am no longer the WWTP operator at Central Care. I believe the operator now is Morgan
Turner with R&A Labs. 336-996-2841. Hope this helps. Thanks Joe
From: "Weaver, Charles" <charles.weaver(cDncdenr.gov>
To: `oe baskin(ci)-yahoo.com' <joe baskin(cD-Vahoo.com>
Sent: Tuesday, August 13, 2013 10:38 AM
Subject: renewal notice for NPDES permit NCO038822
The NPDES permit for the Central Care WWTP in Surry County expires on February 28, 2014. This notice is
being sent to explain the requirements f6r the permit renewal application.
Federal (40 CFR 122) and state (15A NCAC 211.0105 (e)) regulations require that permit renewal applications
be filed at least 180 days prior to expiration of the current permit. Your renewal application is due to the
Division no later than September 1, 2013. Failure to apply for renewal by the regulatory deadline would deny
this facility the automatic permit extension described in NCGS 150-B.
Use the attached checklist to complete your renewal package. The checklist identifies the items you must
submit with the permit renewal application.
If all wastewater discharge has ceased at this facility and you wish to rescind this permit, simply reply to this
message.
Charles H. Weaver
NPDES Unit
Messages to and from this address are subject to the NC Public Records Law and may be released to third
parties.