NC0065358_Renewal (Application)_20160404

NC DENR / DWR / NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Wren Thedford,
Hidden Forest is requesting the renewal of the wastewater treatment plant pe mit
NC0065358. No changes have been made to the treatment process since th-
last permit renewal. Please let me know if you have any questions or require
more information. Thanks
Respectfully,
RECEIVE'INCDEQ/DVdR
Sean Dyer APR 0
Quincy Management \Nat 4 c uaMv
Perrni. mg Section

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 M D
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NC0065358
If you are completing this form in computer use the TAB key or the up - down arrows to move om one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise,please print • type.
1. Contact Information:
Owner Name Sean Dyer
Facility Name Hidden Forest Estates WWTP
Mailing Address PO Box 692571
City Quincy
State / Zip Code MA 02269-2571
Telephone Number ( 617 ) 669-6809
r rr i !L..UI iGD \rdR
Fax Number ( ) APR 0 4 l`JiE'
e-mail Address [e-mail] Water Quality
Permitting Section
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road 6602 Holder Inman
City Randleman
State / Zip Code NC 27317
County Randolph
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 North Carolina 27323
Telephone Number ( 336 ) 932-9347
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 M D
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial Number of Employees
Commercial Number of Employees
Residential X Number of Homes 190...__
School Number of Students/Staff
Other Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping cente
restaurants, etc.):
Mobile Home Park
Number of persons served:
5. Type of collection system
epara - (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? es No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location pf each
outfall): Unnamed tributary to Randleman Lake
8. Frequency of Discharge: Continuous Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration:
9. Describe the treatment system
List all installed components, including capacities,provide design removal for BOD, TSS, nitroge , and
phosphorus. If the space provided is not sufficient, attach the description of the treatment syste , in a
separate sheet of paper.
Influent surge tank with bar screen, extended aeration basin, 2 clarifiers, tertiary dual sa d
filters, UV disinfection unit, digester tank, back up power generator,
2 of 3 Fo -D 11112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.027 MGD
Annual Average daily flow 0.010 MGD (for the previous 3 years)
Maximum daily flow 0.020 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
Yes No X
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".
Daily Monthly Units of
Parameter
MaximumAverage Measurement
•
Biochemical Oxygen Demand (BODS) E 8 2 mg/L
Fecal Coliform 50 5 200/100 ml
Total Suspended Solids 8 4 mg/L
Temperature (Summer) •
28 20 C
Temperature (Winter) 15 5 C
•
pH 7.3 7 SU
13. List all permits, construction approvals and/or applications:
Type Permit Type Permit
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) _ Ocean Dumping(MPRSA)
NPDES NC_011b5.1SR_ Dredge or fill (Section 404 or
PSD (CAA) Other
Non-attainment program
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.
5es,,r. Der Ow �r
r
Printed name of Persdh Signing Title
j:) ."7--1---7 3- z6 'Zo/
ignature of Applicaht Date
North Carolina General Statute 143-215.6 (b)(2) states:Any person who knowingly makes any false statement representation, or certific tion in any
application, record,report, plan,or other document files or required to be maintained under Article 21 or regulations of the Environmental anagement
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring devi or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Arti le, 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. ection 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 For -D 11/12

Sludge Management Plan
Hidden Forest Estates
NPDES Permit NC0065358
All sludge produce is hauled away and disposed of by a NC Certified Septic Tank company.
The Company takes the sludge to the city wastewater treatment plant for disposal.

PAT MCCRORY
DONALD R. VAN DER VAART
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY 1)n'rtui
April 4, 2016
Mr. Sean Dyer
Hidden Forest
Po Box 692571
Quincy, MA 02269-2571
Subject: Acknowledgement of Permit Renewal
Application No.NC0065358
Hidden Forest Estates WWTP
Randolph County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on April 5,
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 Charles
Weaver at 919-807-6391 or [e-mail].
Sincerely,
Wre vt, Tlr-e4 oro
Wren Thedford
Wastewater Branch.
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300