NC0063762_Renewal (Application)_20230622

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Ryan Hotchkiss, Managing Member
Carolina Village Mhc LLC
Priest Bridge Dr Ste 7
Crofton, MD 21114
Subject: Permit Renewal
Application No. NCO063762
Carolina Village Mobile Home Park
Cabarrus County
Dear Permiee:
NORTH CAROLINA
Environmental Quality
June 22, 2023
The Water Quality Permitting Section acknowledges the June 22, 2023 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 15OB-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality 1 Division of Water Resources
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville. North Carolina 28115
704.663.1699

CSC
C' 251 Little Falls Drive
CSC Wilmington, DE 19808
To: State of North Carolina, Department of Environmental Quality
From: Business License Filing Team
Phone: [phone] ext. 66028
Email: [e-mail]
Date: 6/9/2023
Order: 535641-1
RE: Wastewater Discharge Permit !S�
Nee
TO WHOM IT MAY CONCERN:
Enclosed, please find:
• Business License Renewal/Application
• Check in the amount of $0
RECEIVED
JUN 2 2 2023
NCDEQ/DWR/NPDES
Please take the following action:
• File the renewal/application in your office
• Confirm the filing is complete by returning the license certificate(s) to the
mailing address listed and/or email a copy to the provided email address
above
• Please provide an invoice if any payment amount is due.
For any questions or concerns please reach out to CSC
at [e-mail] or call 800-927-9801 ext. 66028
Thank you for your assistance .

North Carolina
Department of Environmental Quality
Division of Water Resources
Modified Application Form 2A
Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0.1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECE ED
JUN1 2 2 2323
NCDEQl,►\jVRINPDE
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

RFr,EivEo
NPDES Permit Number
Facility Name
Modified Application Form 2A
NC0063762
Carolina Village MHC,LLC
Modified March 2021
n
Form
NC Department of Environmental Quality - Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES (Before completing this form, please read the instructions. Failure to JbIlaw
NPDES
the instructions mly result in denial of the application.)
SECTION•N
INFORMATION FOR
Facility name
1.1
Horizon Entities JV 1 - Carolina Village MHC LLC
Mailing address (street or P.O. box)
251 Little Falls Drive,
City or town
State
ZIP code
o
Wilmington,
Delaware
19808
E
Contact name (first and last)
Title
Phone number
Email address
Susan Gotshall
[e-mail]
c
_
Location address (street, route number, or other specific identifier) ❑ Same as mailing address
m
2401 Lancaster Street
City or town
State
ZIP code
Concord
INC
28027
1.2
Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission No
requirements for new dischargers.
1.3
Is applicant different from entity listed under Item 1.1 above?
❑ Yes ® No SKIP to Item 1.4.
Applicant name
Applicant address (street or P.O. box)
0
E
City or town
State
ZIP code
0
Contact name (first and last)
Title
Phone number
Email address
Q
a
a
1.4
Is the applicant the facility's owner, operator, or both? (Check only one response.)
❑ Owner ❑ Operator ® Both
1.5
To which entity should the NPDES permitting authority send correspondence? (Check only one response.)
❑ Facility Applicant ❑ Facility and applicant
(they are one and the same)
1.6
Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.
wExisting
Environmental Permits
NPDES (discharges to surface
❑ RCRA (hazardous waste)
❑ UIC (underground injection
water)
control)
aU
E
L
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
c
w
rn
Z
❑ Ocean dumping (MPRSA)
❑ Dredge or fill (CWA Section
❑ Other (specify)
w
404)
Page 1
-J

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC, LLC
Modified March 2021
1.7
Provide the collections stem information
requested below for the treatment works.
Municipality
Population ''
Collection System Type
Status
Served
Served
indicatepercentage)Ownership
100 % separate sanitary sewer
® Own ❑ Maintain
d
% combined storm and sanitary sewer
❑ Own ❑ Maintain
Private
680
❑ Unknown
❑ Own ❑ Maintain
c
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
a
N/A
N/A
❑ Unknown
❑ Own ElMaintain
a
% separate sanitary sewer
❑ Own ❑ Maintain
M
% combined storm and sanitary sewer
❑ Own ❑ Maintain
M
N/A
N/A
❑ Unknown
❑ Own ❑ Maintain
d
% separate sanitary sewer
❑ Own ❑ Maintain
% combined storm and sanitary sewer
❑ Own ❑ Maintain
N/A N/A
❑ Unknown
❑ Own ❑ Maintain
U
Total
d
Population
U
Served 680
Separate Sanitary Sewer System
Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line in miles
100 %
0
1.8
Is the treatment works located in Indian Country?
c
0
❑ Yes {f No
1.9
Does the facility discharge to a receiving water that flows through Indian Country?
❑ Yes [O No
1.10
Provide design and actual flow rates in the designated spaces.
Design Flow Rate
.090 mgd
a.Q
Annual Average Flow Rates Actual
� c
Two Years Ago
Last Year
This Year
C o
mgd
.040 mgd
.056 mgd
�U
.035
Maximum Daily Flow Rates Actual
Two Years Ago
Last Year
This Year
.025 mgd
.045 mgd
.062 mgd
1.11
Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
o
Total Number of Effluent Discharge Points by Type
a
a'
Combined Sewer
Constructed
Treated Effluent
Untreated Effluent
Overflows
Bypasses
Emergency
L
Overflows
w
ONE
0
0
0
0
Page 2

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12
Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes 0 No 4 SKIP to Item 1.14.
1.13
Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Im oundment Location and Dischar a Data
Average Daily Volume
Continuous or Intermittent
Location
Discharged to Surface
(check one)
Impoundment
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
❑ Intermittent
❑ Continuous
gpd
N
❑ Intermittent
s
1.14
Is wastewater applied to land?
❑ Yes No 4 SKIP to Item 1.16.
0
1.15
Provide the land application site and discharge data requested below.
C
Land Application Site and Discharge Data
o
o
Average Daily Volume
Continuous or
�
N
Location
Size
Applied
Intermittent
check one
acres
d
gpd
❑ Continuous
o
❑ Intermittent
❑ Continuous
s
o
acres
d
gpd
ElIntermittent
acres
d
gpd
El Continuous
❑ Intermittent
1.16
Is effluent transported to another facility for treatmeWtrior to discharge?
o
ElYes No 4 SKIP to Item 1.21.
1.17
Describe the means by which the effluent is transported (e.g., tank truck, pipe).
1.18
Is the effluent transported by a party other than the applicant? Type text here
❑ Yes 9 No 4 SKIP to Item 1.20.
Provide information on the transporter below.
1.19
Transporter Data
Entity name
Mailing address (street or P.O. box)
City or town
State
ZIP code
Contact name (first and last)
Title
Phone number
Email address
Page 3

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
1.20
In the table below, indicate the name, address, contact information, NPDES number, and average daily flow rate of the
receiving facility.
Receivina F cilitv Data
Facility name
Mailing address (street or P.O. box)
Carolina Vllla e MHC,LLC
2401 Lancaster Ave
City or town
State
ZIP code
o
Concord
NC
28027
0
N
Contact name (first and last)
Title
o
Dusty Metreyeon
ORC, Metwater, INC
Phone number
Email address
704-506-4255
in o
NPDES number of receiving facility (if any) ❑None
Average daily flow rate 060 mgd
CL
NCO063762
I
An
0
1.21
Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
not have outlets to waters of the State of North Carolina (e.g., underground percolation, underground injection)?
❑ Yes [Y No 4 SKIP to Item 1.23.
U
0
1.22
Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o
Disposal
Location of
Size of
Annual Average
Continuous or Intermittent
Method
Disposal Site
Disposal Site
Daily Discharge
(check one)
Description
Volume
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
❑ Continuous
acres
gpd
❑ Intermittent
1.23
Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)? (Check all that apply.
Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
a
❑ Discharges into marine waters (CWA ❑ Water quality related effluent limitation (CWA Section
Cr
Section 301(h)) 302(b)(2))
1 Not applicable
1.24
Are any operational or maintenance aspects (related to wastewater treatment and effluent quality) of the treatment works
the responsibility of a contractor?
Est Yes ❑ No +SKIP to Section 2.
1.25
Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1
Contractor 2
Contractor 3
o
Contractor name
(company name
Metwater, INC
E
Mailing address
street or P.O. box
1000 Wood h u rst d r.
o
City, state, and ZIP
code
Monroe, NC 28110
oContact
name (first and
U
last)
Dusty Metreyeon
Phone number
704-506-4255
Email address
[e-mail]
Operational and
maintenance ORC
SAMPLING, OPERATIONS,
ROUTINE, MAINTEN
NCE, RECORD KEEPIN
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Forth 2A
NCO063762 Carolina Village MHC LLC Modified March 2021
SECTIONDDI I IUNAL IWORIVIATION
o Outfalls to Waters of the State of North Carolina
2.1
Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o
❑ Yes Qj No 4 SKIP to Section 3.
0
2.2
Provide the treatment works' current average daily volume of inflow
Average Daily Volume of Inflow and Infiltration
L
and infiltration.
9Pd
Indicate the steps the facility is taking to minimize inflow and infiltration.
0
0
c
2.3
Have you attached a topographic map to this application that contains all the required information? (See instructions for
M a
specific requirements.)
o �
0
0
❑ Yes ❑ No
r•-
E
2.4
Have you attached a process flow diagram or schematic to this application that contains all the required information?
o
(See instructions for specific requirements.)
" An
❑ Yes ❑ No
2.5
Are improvements to the facility scheduled?
❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
R
1.
d
E
0.
2.
E
0
y
3.
-a
d
4.
U )
a
2.6
Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Im rovements
E
>
Scheduled
Affected
Outfalls
Begin
End
Begin
Attainment of
Operational
o
0.
Improvement
(list outfall
Construction
Construction
Discharge
Level
_
(from above)
number
(MM/DD/YYYY)
(MM/DD/YYYY)
(MM/DD/YYYY)
MM/DD/YYYY
LU
1.
d
t
U
2.
3.
4.
2.7
Have appropriate permits/clearances concerning other federal/state requirements been obtained? Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

NPDES Permit Number
Facility Name Modified Application Form 2A
Modified March 2021
NCO063762
Carolina Village MHC LLC
SECTION•'
• ON 1
Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
3.1
Outfall Number 001
Outfall Number
Outfall Number
State
NC
a
Y
County
Cabarrus
0
City or town
Concord
.Q
Distance from shore
3 ft.
ft.
ft.
Depth below surface
2
0
Average daily flow rate
.060 mgd
mgd
mgd
Latitude
35 ° 22 ' 16
Longitude
so ° 40 58
°
°
3.2
Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o
❑ Yes No 4 SKIP to Item 3.4.
3.3
If so, provide the following information for each applicable ouffall.
N
Outfall Number
Outfall Number
Outfall Number
0
Number of times per year
discharge occurs
a
Average duration of each
`o
discharge (specify units
oAverage
flow of each
mgd
mgd
mgd
U)
discharge
R
c)
Months in which discharge
occurs
3.4
Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes 0 No 4 SKIP to Item 3.6.
3.5
Briefly describe the diffuser pe at each applicable outfall.
CL
Outfall Number
Outfall Number
Outfall Number
0
Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
ui
a �
3 6
one or more discharge points?
9 Yes El No 4SKIP to Section 6.
Page 6

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
3.7
Provide the receiving water and related information if known for each outfall.
Outfall Number
Outfall Number `
Outfall Number'
Receiving water name
Name of watershed, river,
c
or stream system
a
U.S. Soil Conservation
L
Service 14-digit watershed
o
code
L
ca
3
Name of state
management/river basin
rn
'
U.S. Geological Survey
8-digit hydrologic
cataloging unit code
Critical low flow (acute)
cfs
cfs
cfs
Critical low flow (chronic)
cfs
cfs
cfs
Total hardness at critical
mg/L of
mg/L of
mg/L of
low flow
CaCO3
CaCO3
CaCO3
3.8
Provide the following information
describing the treatment pr vided for discharges from each outfall.
Outfall Number
Outfall Number
Outfall Number
Highest Level of
❑ Primary
❑ Primary
❑ Primary
Treatment (check all that
❑ Equivalent to
❑ Equivalent to
❑ Equivalent to
apply per outfall)
secondary
secondary
secondary
❑ Secondary
❑ Secondary
❑ Secondary
❑ Advanced
❑ Advanced
❑ Advanced
❑ Other (specify)
❑ Other (specify)
❑ Other (specify)
o
a.
Design Removal Rates by
0
Outfall
o
BOD5 or CBOD5
%
%
%
c
d
E
CU
L
TSS
%
%
%
F—
❑ Not applicable
❑ Not applicable
❑ Not applicable
Phosphorus
aka
%
ova
❑ Not applicable
❑ Not applicable
❑ Not applicable
Nitrogen
%
%
%
Other (specify)
❑ Not applicable
❑ Not applicable
❑ Not applicable
%
%
%
RECEIVED
JUN 2 2 2023
NCDEQ/DWR/NPDES
Page 7

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
3.9
Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season, describe below.
d
_ .5
0
oOutfall
Number
Outfall Number
Outfall Number
fl
Disinfection type
U
N
N
Seasons used
d
E
Dechlorination used?
❑ Not applicable
❑ Not applicable
❑ Not applicable
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
3.10
Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes ❑ No
3.11
Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12
Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number
Outfall Number
Outfall Number
Acute
Chronic
Acute
Chronic
Acute
Chronic
is
0
Number of tests of discharge
rn
=
water
Number of tests of receiving
water
W
3.14
Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes -+ Complete Table B, including chlorine. ❑ No 4 Complete Table B, omitting chlorine.
3.15
Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes ❑ No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18
attached the results to this application package?
additional sampling required by NPDES
El Yes El
permitting authority.
Page 8

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
3.19
Has the POTW conducted either (1) minimum of four quarterly WET tests for one year preceding this permit application
or (2) at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20
Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑ No + Provide results in Table E and SKIP to
Item 3.26.
3.21
Indicate the dates the data were submitted to our NPDES permitting authority and provide a summary of the results.
Date(s) Submitted
Summary of Results
MM/DDNYYY
a:
c
R
3.22
Regardless of how you provided your WET testing data to the NPDES permitting authority, did any of the tests result in
o
toxicity?
tM
❑ Yes ❑ No SKIP to Item 3.26.
3.23
Describe the cause(s) of the toxicity:
c
�u
3.24
Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No SKIP to Item 3.26.
I,
3.25
Provide details of any toxicity reduction evaluations conducted.
3.26
Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES permitting authority.
Page 9

NPDES Permit Number
Facility Name
Modified Application Form 2A
NCO063762
Carolina Village MHC LLC
Modified March 2021
SECTIONrr
CERTIFICATION STATEMENT (40
6.1
In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to provide attachments.
Column 1
Column 2
Section ❑ 1. Basic Application
❑ w/ variance request(s) ❑ wl additional attachments
Information for All Applicants
❑ Section 2: Additional
❑ w/ topographic map ❑ wi process flow diagram
Information
❑ w/ additional attachments
I
❑ w/ Table A ❑ w/ Table D
❑ Section 3: Information on
❑ w/ Table B ❑ w/ additional attachments
z
Effluent Discharges
v
❑ w/ Table C
G
Section 4: Not Applicable
0
w
Section 5: Not Applicable
d
U
G
Section 6: Checklist and
❑
❑ w/ attachments
t°
Certification Statement
32
6.2
Certification Statement
! 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 property 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. l am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
KftTffL�E�I L�c��"T�LLG
G'NIEF OPE�T/�tiia 0"FF!
Signature,,---N
Date signed
181202
Page 10