NC0075353_owner name change_19960705

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
July 5, 1996
James C. Childers
Rocky Pass Adult Care, LLC
P.O. Box 578
Marion, North Carolina 28752
Subject: Permit Modification -Name and
Ownership Change
Rocky Pass Adult Care, LLC
(formerly Rocky Pass Rest Home, Inc.)
NPDES No. NCO075353
McDowell County
Dear Mr. Childers:
In accordance with your request received April 3, 1996, the Division is forwarding the subject
permit. The only change in this permit regards ownership. All other terms and conditions in the
original permit remain unchanged and in full effect. This permit modification 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
December 6, 1983.
This permit does not affect the legal requirement to obtain other permits which may be
required by the Division of Environmental Management or permits required by the Division of
Land Resources, Coastal Area Mangement Act, or any other Federal or Local government permit
that may be required.
If you have any questions concerning this permit, please contact Ms. Jennifer Wolfe at
telephone number [phone], extension 538.
Sincerely,
Preston Howard, J . P.E.
cc: Central Files
Asheville Regional Office, Water Quality Section
Permits and Engineering Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Permit No. NCO075353
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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,
Mr. James C. Childers
is hereby authorized to discharge wastewater from a facility located at
Rocky Pass Adult Care, LLC
NC Highway 226
southeast of Marion
McDowell County
to receiving waters designated as North Muddy Creek in the Catawba River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I,
II, III and IV hereof.
The permit shall become effective July 5, 1996
This permit and the authorization to discharge shall expire at midnight on April 30, 2000
Signed this day July 5, 1996
-Preston How d, Jr.,'I ., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit No. NCO075353
SUPPLEMENT TO PERMIT COVER SHEET
Mr. James C. Childers
is hereby authorized to:
1. Continue to operate an existing 0.010 MGD extended aeration wastewater treatment facility with
sludge holding tank and effluent disinfection located at Rocky Pass Adult Care, LLC, NC
Highway 226, southeast of Marion, McDowell County (See Part III of this Permit), and
2. Discharge from said treatment works at the location specified on the attached map into North
Muddy Creek which is classified Class C waters in the Catawba River Basin.

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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
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WATER QUALITY SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
;; ► ► 1:u:y�t[1Rf3
1. Permit holders name: U LL> IN�-
2. Permit's signing officials name and title
(P legally respeftsible for permit)
(Title)
3. Mailing address:/06 13eX / �E City: MA.e/O.J
State: lo. C , Zip Code:2 8 ]2_Phone: ( 29V) Ko OZ - .30.3 3_
i
1I. NEW OWNER/NAME INFORMATION
1. This request for a name change is a result of:
- a. Change in ownership of property/company
_b. Name change only
...c. Other (please
2. New owner's name (name to be put on permit): o c.kLV 1pr� /1 f e 0 rl t- C
3. New owner's or signing official's name and tide: Q U
(Person legally responsible for permit)
(Title)
4. Mailing address* oSo)c: M8 City: as MI a n/
State- /U, L° Zip Code: Y7 S'°i Phone: (_may ) F "• .14 (

PERMIT NAME/OWNERSHIP_ CHANGE FORM
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF
ENVIRONMENTAL MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS
LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application
2. Processing fee of $ 100.00 (Checks to be made payable to DEHNR)
3. If an ownership change, legal documentation of the transfer of ownership (such as a contract, deed,
articles of incorporation)
CERTIFICATION -MUST BE COMPLETED AND SIGNED BY JIOTH THE CURRENT
PERMIT HOLDER AND THE NEW APPLICANT IN THE CASE OF CHANGE OF •• c
OWNERSHIP. FOR NAME CHANGE ONLY, COMPLETE AND SIGN THE
APPLICANT'S CERTIFICATION.
Current PermUtee's Certification:
I,(/W , attest that this application for nametownership change has been
revMand is accurate d complete to the best of my knowledge. ` I understand that if all required parts
of plication are not completed and that if all required supporting information and attachments are not
included, this application package will be retumed.as.incomplete. • .
Signature: Date: e'
Applicant's Certification:
I 4/499 C 0-H1 LOC I S , attest that this application for a name/ownership change has been
reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed and that if all required supporting information and attachments are not
included, this application package will be returned as incomplete.
Signatur • Date: J u Aj
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION
AND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
North Carolina Division of Environmental Management
Water Quality Section
Permits and Engineering Unit
P.O. Box 29535
Raleigh, North ' Carolina 27626-0535
Telephone: [phone]
Fax: [phone]