NC0033600_Renewal (Application)_20150923

North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der Vaart
Governor Secretary
October 13, 2015
Mr. Bob Leatherwood, Administrator
Silver Bluff Village
100 Silver Bluff Drive
Canton,NC 28716
Subject: Acknowledgement of Permit Renewal
Application No. NC0033600
Pigeon Valley Rest Home
Haywood County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on September
30, 2015. 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
Wren Thedford at 919-807-6304 or [e-mail].
Sincerely,
W re w Tl�.eol fo-rof�
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office, Water Quality Regional Operations Section
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] Fax:[phone]/Customer Service:1-877-623-6748
Internet:www.ncwater.orq
An Equal Opportunity'Attlrmatve Action Employer

l,� � � � � � � Civil and Environmental Engineering
Environmental Consulting
f'` , — ASSOCIATES -- utility operations
Environmental Laboratory
September 23, 2015
Wren Thedford
NC DENR/DWR/NPDES Unit RECEIVEDIDENR/DWR
1617 Mail Service Center
Raleigh, NC 27699-1617 SEP 3 0 2015
Water Quality
Permitting Sectior
RE: NPDES#NC0033600 Permit Renewal
Silver Bluff Village (Pigeon Valley Rest Home WWTP)
Dear Mr.Thedford:
Enclosed please find all items required for NPDES Permit Renewal for the above referenced system.
If you have any questions please call(864)882-8194,ext. 122.
ii
Sincerely,
Goldie and Associates
".11/)-17*4-C/116'5t---- .
Christopher Martin
Operations Manager
CC: Bob Leatherwood,Silver Bluff Village
210 W.North 2nd Street www.goldleassociates.com Phone:[phone]
Seneca,SC 29678 WE LISTEN.WE SERVE. Fax:[phone]

G 0 1. Co I E Civil and Environmental Engineering
0Environmental Consulting
— ASSOCIATES — Utility Operations
Environmental Laboratory
September 23, 2015
Wren Thedford RECEIVED/DENR/DWR
NC DENR/DWR/NPDES Unit
1617 Mail Service Center SEP 3 0 2015
Raleigh, NC 27699-1617
Water Quality
• Permitting Section
RE: NPDES#NC0033600 Permit Renewal
Silver Bluff Village(Pigeon Valley Rest Home WWTP)
Dear Mr.Thedford:
Any sludge or solids that are produced as a part of this wastewater treatment operation will be removed
by a licensed hauler and transported for proper treatment and disposal to the Town of Waynesville.
If you have any questions please call [phone],ext. 122.
Sincerely,
Goldie and Associates
6,42p4 4/b&k...---
Christopher Martin
Operations Manager
CC: Bob Leatherwood,Silver Bluff Village
210 W.North 2nd Street www.goldieassociates.com Phone:[phone]
Seneca,SC 29678 WE LISTEN.WE SERVE. Fax:[phone]

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 Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit *COO 33600
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 Silver Bluff Village
Facility Name Silver Bluff Village (Pigeon Valley Rest Home WWTP)
Mailing Address 100 Silver Bluff Drive
City Canton
State / Zip Code NC/28716 •
Telephone Number [phone]
Fax Number (
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above El
Street Address or State Road
City
State / Zip Code
County Haywood 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 Goldie 8s Associates / Gifford Raulerson
Mailing Address 210 W North Second Street
City Seneca
State / Zip Code SC/29678
Telephone Number [phone]
Fax Number [phone]
e-mail Address gifford213Lr bellsouth.net
1 of 3 •
Form-D 9/2013

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 0 Number of Employees
Residential ❑ Number of Homes
School 0 Number of Students/Staff
Other ® Explain: (it.&may tflOs1�
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing home
Number of persons served: 383
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 01
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact Iocation of each
outfall):
Pigeon River
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.
BOD and TSS Removal: at least 87% (based on 250 mg/L in and 30 mg/L permit limit)
Nitrogen: at least 80%removal of NH3-N (based on 40 mg/L TKN in and 8 mg/L permit limit)
See Attachments: Flow, capacities, and upgrades
2 of 3 Form-D 912013

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.025 MGD
Annual Average daily flow 0.012 MOD (for the previous 3 years)
Maximum daily flow 0.017 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 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 "IV/A".
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 118 28.32 mg/L
Fecal Coliform 101 21 # / 100 ml
Total Suspended Solids 36 15.2 mg/L
Temperature (Summer) 26 25.8 °C
Temperature (Winter) 19 18.75 °C
pH 7.4 —
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 NC0033600 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.
' 1. 0 Lva eR in is-6-4Yer-
Printed e of Person 'gning Title
ti...---..egrr.?" ? Z,4/5—
Signatu op licant 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, a 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-0 912013

j \)-11(A.C.CV YY)
1. Continue to operate an existing 0.025 MGD wastewater treatment facility with the
following components:
o Flow Splitter
e Aeration Basin
o Aerated Sludge Holding
+ Dual Clarifiers with Sludge Return
+ Chlorine Disinfection
o Dechlorination
+ Post Aeration
The facility is located at Pigeon Valley Rest Home WWTP, 100 Silver Bluff Drive,
south of Canton, Haywood County.
•
2. Discharge from said treatment works at the location specified on the attached map
into the Pigeon River which is classified WS-III- Trout waters in the French Broad
River Basin.

Afri,A
North Carolina De artm SENA
p ent of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colean H.Sullins
Governor Director Dee Freeman
Secretary
October 21,2009
Mr. Bob Leatherwood
Silver Bluff Realty,LLC
100 Silver Bluff Drive
Canton,North Carolina 28716
SUBJECT: Authorization to Construct
-A to C No. 033500A01
Silver Bluff Realty, LLC
Silver Bluff Village WWTP
Haywood County
Dear Mr.Leatherwood:
A letter of request for an Authorization to Construct was received April 30,2009, by the
Division of Water Quality (Division), and final plans and specifications for the subject project
have been reviewed and found to be satisfactory. Authorization is hereby granted for the
construction of modifications to the existing 0.025 MGD Wastewater Treatment Plant, with
discharge of treated wastewater into the Pigeon River in the French Broad River Basin.
This authorization results in no increase in design or permitted capacity and is awarded
for the construction of the following specific modifications:
Installation of a refurbished 7,100 gallon flow equalization tank, influent bar screen, 80
GPM influent grinder,flow diverter box,and two (2)43 GPM flow equalization pumps;
conversion of an existing sludge digestion basin into an aeration basin;installation of a
refurbished 7,100 gallon sludge digestion basin,decant and skimmer sludge pumps;a 60
scfm blower,and associated yard piping,electrical work and control systems, in
conformity with the project plans, specifications,and other supporting data subsequently
filed and approved by the Department of Environment and Natural Resources.
This Authorization to Construct is issued in accordance with Part III, Paragraph A of
NPDES Permit No.NC0033600 issued December 1, 2006,and shall be subject to revocation
unless the wastewater treatment facilities are constructed in accordance with the conditions and
limitations specified in Permit No.NC0033600.
+s+”Mea 5ervka Gcnlo nareigh,Norin Carolina 27699.1617
Locallors 512 N.Salisbury St.Raleigh,North Carolina 21604 None
Phone:[phone] FAX:[phone] t Customer Service: -877-623-6748
Internet:www.noaalarquaUty.org �y Carolina
An Urm
Equal opportunity t Aatrvo Action EmdoYer !i¢p�yon//o'

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