NC0022098_Renewal (Application)_20160205

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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 Permit NC0022098
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 NC Land Lease, LLC
Facility Name Cranbrook Village
Mailing Address PO BOX 2533
City Christiansburg
State / Zip Code VA / 24068 RECEIVED/NCDEQ/DWR
Telephone Number [phone] FFR n 5 2016
Fax Number [phone]
Water Quality
e-mail Address [e-mail] Permitting Section
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 4309 Old Liberty Place
City Greensboro
State / Zip Code NC / 27406
County Guilford 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 Paul Smith
Mailing Address PO BOX 269
City Reidsville
State / Zip Code NC / 27323
Telephone Number [phone]
Fax Number ( )
e-mail Address [e-mail]
1 of 3 Form-D 11/12

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
Residential X Number of Homes 75
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile home park
Number of persons served: 150
5. Type of collection system
X 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 X No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Little Alamance Creek
8. Frequency of Discharge: X Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: 24
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.
Influent pump station, sludge holding tank, bar screen, aeration basin, clarifier, effluent
chlorine disinfection and contact basin, tablet dechlorination and 22.5 degree V notch
weir
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .010 MGD
Annual Average daily flow .007 MGD (for the previous 3 years)
Maximum daily flow .010 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X 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.
RENEWAL 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) 20 4 Mg/1
Fecal Coliform 50 10 200/100 ml
Total Suspended Solids 24 10 mg/1
Temperature (Summer) 28 25 C
Temperature (Winter) 18 16 C
pH 7.3 N/A SU
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 NC002098 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.
James Radford III Managing Member
Printed name of Person Signing Title
Sid ature of Applicant 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 11/12

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N.C. Land Lease, LLC
Cranbrook Village Mobile Home Community h,
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James Radford III
N.C. Land Lease, LLC :,
Cranbrook Village Mobile Home Community
PO BOX 2533 ' �^
Christiansburg, VA 24068 L.
Ms. Wren Thedford
NC DEQ/DWR/NPDES
1617 Mail Service Center Y
Raleigh, NC 27699-1617 ;°
Sludge Management Plan:
The sludge is removed as needed from a holding tank. The removal is done by a pumping 4'�;,:
company. We are currently using Carolina Septic Inc.
Thank you,
James Radford III
Managing Member
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N.C. Land Lease, LLC
Cranbrook Village Mobile Home Community
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2/2/2016
James Radford III 110
N.C. Land Lease, LLC
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Cranbrook Village Mobile Home Community :;` ,,-
PO BOX 2533 14,i'
Christiansburg, VA 24068 A
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Ms. Wren Thedford
NC DEQ/ DWR/ NPDES =L
1617 Mail Service Center
Raleigh, NC 276994617 A ..
Greetings, ._
NC Land Lease, LLC is requesting renewal of the permit for the Cranbrook Village Mobile Home
Community. Which is a mobile home park located at 4309 Old Liberty Place,Greensboro, NC
27406. There have been no changes to the facility since the issuance of the last permit.
Thank you, '< "
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'.' es Radford Ill
Managing Member 1-
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PAT MCCRORY
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DONALD R. VAN DER VAART
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY n"`•u"'
February 4, 2016
James Radford, III
NC Land Lease, LLC
PO Box 2533
Christiansburg, VA 24068
Subject: Acknowledgement of Permit Renewal
Application No.NC0022098
Greensboro Terminal
Guilford County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on February 05,
2016. A member of the NPDES Unit will review your application. They will contact you if additional
information is required to complete your permit renewal. Per G.S. 150B-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. Please respond in a timely manner to
requests for additional information necessary to complete the permit application.
If you have any additional questions concerning renewal of the subject permit, please contact Derek
Denard at 919-807-6307 or [e-mail].
Sincerely,
W ree off aro
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality j Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-307-6300