NC0055913_Renewal (Application)_20160321

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 INCOO _=ie�q 13
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 pri rEKDINCDEQIDWR
1. Contact Information: MAR 2 12016
Owner NameWater Quality
Permitting Section
Facility Name Z"'I f?k) 4T? f S ,m ZIP
Mailing Address
S `� a )
`// 1 -On nc���.�r
City 4fr-S::f t!u c,,60 9 _ A/r '7,2`J
State /Zip Code
Telephone Number (336
Fax Number ( )
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road GAS,
City ���•,NS,ba/LL�
State /Zip Code .
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
Mailing Address //J �nG.IC%�P�����1 •^�/��
City
f�SNS oRd
State /Zip Code %(f c/o,
Telephone Number (3,34) _ Z Z 7�,-2—
Fax Number ( )
e-mail Address
1 of 4 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 Waste w ater(check all that apply):
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential Number of Homes /
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served: 1770
5. Type of collection system
9 Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s) Ccs
Is the outfall equipped with a diffuser? Yes ❑ No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
8. Frequency of Discharge: JW Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
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.
2 of Form-D 11/12

Date: 03.18.2016
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
Facility Name:
NPDES Permit Number: N I C o o 5 s 9 11 13 1
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications, discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506.
Individual#1 Individual #2 (ifopplicable)
Richard Hughes -
il
ORC
Matling'Adiiress ;- 12112 NC 138 Hwy
,0e Norwood, NC 28128
h salAddress -
�f`ilifJe�eri`t) -
Eraild'dress:
°OfficdPhsewageguyagmgel corn
one: `.�_ 704.474.0244 -
1VIobil ePlione 336.383.2325
If you have any questions regarding this letter,please feel free to contact me at either the phone
number or email address below.
Sincerely,
Authorized Signing Official's Signature
Thomas Monroe Owner
�?,/-Xo
Authorized Signing Official's Name (type or print) Title
5111 Mockingbird Rd. Greensboro,NC 27406
Mailing Address
Email Address
336.580.2202 336.580.2202
Office Phone Mobile Phone
cc: WSO Regional Office,Water Quality Permitting Section
(Enter region name)

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters<1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.03 MGD
Annual Average daily flow gyp_- MGD (for the previous 3 years)
Maximum daily flow D• d Z5'MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed.Fecal Coliform, Temperature and pII 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 currentl in your permit. Mark other parameters `N/A':
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand(BODS) Alp
Fecal Coliform /t'j G L_
Total Suspended Solids 32L—
Temperature (Summer) /V
Temperature (Winter)
pH 7 �?
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 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.
Printed name of Person Signs g % Title
Signature of A scant 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
3 of 4 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
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s)of wastewater(example:subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served:
5. Type of collection system
Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s) G� f
Is the outfall equipped with a diffuser? Yes ❑ No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
8. Frequency of Discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
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.
2 of 4 Form-D 11/12

V
H& R Water Service
12112 NC 13 8 Hwy
Norwood, NC 28128
RECEIVED/NCDEWWR
N.C. DENR/Division of Water Resources MAR 24 2016
1617 Mail Service Center
Water Quality
Raleigh, NC 27699-1617 Permitting Section
Subject: Permit -NC0055913
Renewal Application for
Monroe's MHP/WWTP
Dear Sir,
I would like to request the permit be renewed for Monroe's MHP/WWTP permit no.NC0055913
The facility consists of a bar screen/flow splitter box with pre aeration followed by parallel package
plants with 15,000 gallon aeration units, Clarifiers, sludge holding units, tablet chlorinators and contact
tanks followed by a single dechlorinator unit, post aeration and ultrasonic flow meter. The tertiary filter
is not operated and we have been producing effluent that is 90%below permit levels and would like to
remove this requirement as it is very expensive and we have not needed to put online in 10 to 15 years.
Also the revenue spent here would be spent on other issues at the facility.
Sludge Management Plan— Solids generated at this facility are concentrated in the sludge holding tanks
and when full it is collected by Keene Septic Company licensed to do business in Guilford County
and has contracted with the City of Greensboro WWTP for process.
If you need any more information on this subject feel free to call the owner Thomas Monroe at
336.580.2202 or myself at 336.383.2325.
Sincerely,
Richard Hughes
H&R Water Service
ORC-Monroe's MHP/WWTP

PAT MCCRORY
coi•ermn
DONALD R. VAN DER VAART
Secreiarj-
WaterResources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
L)u ec lar
April 4, 2016
Mr. Thomas Monroe
Monroe's Mobile Home Park
5111 Mockingbird Road
Greensboro,NC 27406
Subject: Acknowledgement of Pen-nit Renewal
Application No.NCO055913
Monroe's Mobile Home Park WWTP
Guildford County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on March 21,
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,
W re v Tkt f&ro�
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300