NC0037311_Permit Issuance_20180529

Wafer Resources
ENVIRONMENTAL QUALITY
May 29, 2018
Mr. William Hammonds
Hammond Properties
P.O. Boa 1487
%rnersville, NC 27285-1487
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Issuance of NPDES Permit NCO037311
Creekside Manor Rest Home W WTP
Forsyth County
Class WW-2
Dear Mr. Hammonds:
Division personnel have reviewed and approved your application for renewal of the subject permit.
This permit renewal 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 significant changes from the draft permit previously sent to
your consultant (James M. Cheshire) on April 3, 2018.
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)
907-6391 or via email (charles.weaver@ncderingov).
cc: Central Files
NPDES files
ec: James M. Cheshire
mcere
Linda Culpepper
Interim Director, Division of Water Resources
State of North Carolina I Envirotanental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
httpsl/deq.nc.govlabouttdivisionstwater-resourceslwater-resourcesT=itstwastewater-branchlnpdes-wastewater-permits

a
STATE 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,
Hammond Properties
is hereby authorized to discharge wastewater from a facility located ' at the
Creekside Manor Rest Home
6206 Reidsville Road
Kernersville
Forsyth County
to receiving waters designated as an unnamed tributary to Belews Creek in subbasin 03-02-
01 of the Roanoke 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 July 1, 2018.
This permit and authorization to discharge shall expire at midnight on February 28, 2022.
Signed this day May 29, 2018
Culpepper, Interim Director __
Division of Water Resources
By Authority of the Environmental Management Commission
Paee 1 of 6

SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this 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.
Hammond Properties
is hereby authorized to:
1. Continue to operate an existing 0.01 MGD wastewater treatment system that
includes the following components:
♦ Bar screen
♦ Aeration basin with diffused air
♦ Secondary clarifier
♦ Tablet chlorination
♦ Chlorine contact basin
♦ Tablet dechlorination
♦ Sludge holding tank
This facility is located in Kernersville at Creekside Manor Rest Home off Reidsville
Road in Forsyth County.
2. Discharge from said treatment works via Outfall 001, at the location specified on
the attached map into an unnamed tributary to Belews Creek [stream index 22-
27-(2)), currently classified C waters in subbasin 03-02-01 [HUC: 030101031 of
the Roanoke River Basin.
Page 2 of 6

Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
Beginning with the effective date of this permit and lasting until expiration, the Permittee is
authorized to discharge treated wastewater from Outfall 001. Such discharges shall be limited
and monitored' by the Permittee as specified below:
PARAMETEREFFLUENT
Parameter Code
UWAT IONS
- MITORING'REQUIREMENTS
Monthly
Average
Daily
MaXIM.UM '
Measu.muent
Frequency
-Sample
Type,
Sample
� Location
Flow 50050
0.010 MGD
Weekly
Instantaneous
Influent or
Effluent
BOD, 5-day, (20°C) C0310
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids C0530
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
NH3 as N — Summer" C0610
2.0 mg/L
10.0 mg/L
Weekly
Grab
Effluent
NH3 as N — Winter* C0610
4.0 mg/L
20.0 mg/L
Weekly
Grab
Effluent
Dissolved Oxygen 00300
Daily average > 5.0 mg/L
Weekly
Grab
Effluent
Dissolved Oxygen 00300
Weekly
Grab
U & D 2
Fecal i31616
c (geometretric mean)
2001100 ml
400/100 ml
Weekly
Grab
Effluent
Total Residual Chlorine 50060
17 Ng/L
2/Week
Grab
Effluent
Temperature (*Q 00010
Daily
Grab
Effluent
Temperature (°C) 00010
Weekly
Grab
U & D 2
pH 00400
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
*Summer. April 1- October 31
*Winter. November 1. - March 31
Footnotes:
1. The permittee shall submit discharge monitoring reports electronically using the NC DWR's eDMR
application system (see A. (2)].
2. U: approximately 100 feet upstream from the outfall. D: approximately 300 feet downstream
from outfall.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN
TRACE AMOUNTS.
Pane 3 of 6

A. (2) ELECTRONIC REPORTING OF MONITORING REPORTS
[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. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting Requirements [Supersedes Section D. t2.) and Section E. (5.�, iali
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 DEQ / Division of Water Resources / Water Quality Permitting Section
ATTENTION: Central Files
1617 Mail Service Center
Raleigh, North Carolina 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. 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.
Page 4 of 6

Starting on December 2 X* 2020, the permittee must electronically report the following
compliance monitoring data and reports, when applicable:
• Sewer Overflow/Bypass Event Reports;
• Pretreatment Program Annual Reports; and
• Clean Water. Act (CWA) Section 316(b) Annual Reports.
The permittee may seek an electronic reporting waiver from the Division (see "How to
Request a Waiver 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 permittee should use the EPA's. website
resources to identify the initial recipient for the electronic submission.
Initial recipient of electronic NPDES information from NPDES-regulated 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 each type of electronic submission and for each state. , Instructions on how to
access and use the appropriate electronic reporting tool will be available as well.
Information on EPA's NPDES Electronic Reporting Rule is found' at:
http:I /www2.epa.,^ovlcompliancelfinal-national-pollutant-discharge-eBmination-
system-npdes-electronic-reporting-rule.
Electronic submissions must start by the date_ s listed in the "Reporting Requirements"
section above.
3. How to Request a Waiver from Electronic Reporti�a
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
granted a new temporary electronic reporting waiver by the Division. Approved electronic
reporting waivers 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 well page:
http: / / deq.nc. gov j about / divisions / water -resources/ edmr
4. Signator4 Requirements ft"lements Section B. (11.1 &1 and Supersedes
Section B. I11.1(dll
PaLwe 5 of 6

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 H, 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: / /deg.nc.gov/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 122.22]. 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. "
5. 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 122.411.
Page 6 of 6

NCO037311 - Creekside Manor Rest Home
Latitude:
36'12'49" Sub -Basin: 03-02-01
Longitude:
W03'49" HvdroloOc Unit 03010103
USGS Quad:
Belews Creek
Stream Class:
C
Receiving Stream:
UT to Belews Creek
Facility
Location J
Af___lQ Forsyth County
to scale]

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
Natalie Norberg — 3/28/2018
Charles Weaver — 5/29/2018
Permit Number
NC0037311
Facility Name
Creekside Manor Rest Home
Basin Name/Sub-basin number
Roanoke / 03-02-01
Receiving Stream
Unnamed tributary to Belews Creek
Stream Classification in Permit
C I Stream Index: 22-27 2
Does permit need Daily Max NH3 limits?
No — already resent
Does permit need TRC limits/language?
Yes — added to draft
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes — temperature and dissolved oxygen
is the stream impaired on 303 d list)?
No
Any obvious compliance concerns?
There have been three enforcements for the
current permit cycle as a result of limits
violations. Poor compliance period in late
2014 — early 2015. Sporadic violations
otherwise. Most recent data shows generally
pod compliance.
Any permit mods since last permit9
No
New expiration date
2/28/2022
Changes to 2012 Permit?
Added eDMR requirements
Added regulatory citations
Corrected TRC footnote
Changed owner name
Changes to Draft Permit?
No comments received. No changes made to
draft limits & monitoring frequencies.

Winston-Salem Journal
Advertising Affidavit
P.O Box 3159
Winston-Salem, NC 27102
NCDENR/DWO/POINT SOURCE BRANCH
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Account Number
3376309
Date
April 08, 2018
PO Number Order Category Description
PUBLIC NOTICE 0000453617 Legal Notices PUBLIC NOTICE North Carolina Environmental Management Commission! NPDES Unit 161
PUBLIC NOTICE
North Carolina Environments
Management Commission/
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a NPDES
Wastewater Permit
The North Carolina Environmental
Management Commission proposes
to issue a NPDES wastewater dis.
charge permit to the person(s) listed
below. Written comments regarding
the proposed permit will be accept-
ed until 30 days after the publish
date of this notice. The Director of
the NC Division of Water Resources
(DWR) may hold a public hearing
should there be a significant degree
of public interest. Please mail com-
ments and/or information requests
to DWR at the above address. Inter-
ested persons may visit the DWR at
to?evieN. w info mato ory -Street,n Raleigh,
A dI
tional information on NPDES permits
noticeand this
website: http://deq.nc.gov/about/di
visions/water-resources/water.
resources-permits/wastewater.
notices or byocalling [phone] �-
re-
newal of m permit onds reNC0037311./
Creekside Manor Rest Home
WWTP/Forsyth County. Facility dls-
charges to an unnamed tributary to
Belews Creek/Roanake River Basin.
Currentnitrogen ly dissolved oxygen, ammonia -
residualchlornelare�fwaterorm nquality
l
limited.
Wsi: April 8,2018 _ 1
Publisher of the
Winston-Salem Journal
Before the undersigned, a Notary Public of Guilford, North Carolina, duly commissioned,
qualified, and authorized by law to administer oaths, personally appeared the Publisher
Representative who by being duly swam deposes and says: that he/she is the Publisher's
Representative of the Winston-Salem Journal, engaged in the publishing of a newspaper
known as Winston-Salem Journal, published, issued and entered as second class mail in the
City of Winston-Salem, in said County and State: that he/she is authorized to make this
affidavit and swom statement: that the notice or other legal advertisement, a copy of which
is attached hereto, was published in the Winston-Salem Journal on the following dates:
04/08/2018
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
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.
(sign r jperson making afdavir)
Sworn to and subscribed before me the 16 day of April, 2018
LEA ANNE LAMB
NOTARY PUBLIC
GUILFORD COUNTY, NC
My Commission Expires 06-15-19
(Notary Public)
IP.16y �y;•[i� / \ l��» �_�9�7_\Iy:Zildi�l�►�LilNl�1:I:Lls(+l�J