NC0034924_Renewal (Application)_20150323

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 M
pWR
Mail the complete application to: RECEIVEDIDEN
N. C. DENR / Division of Water Quality / NPDES Unit MAR ' 3 2015
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INC0034924 Water n Se ion
Permitting
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 Flesher's Fairview Rest Home
Facility Name Flesher's Fairview Rest Home
Mailing Address P 0 Box 1160
City Fairview
State / Zip Code NC 28730
Telephone Number 828-628-1565
Fax Number a $ _ ^^g_r?�
e-mail Address C rn Cv T sv-crs.f 'n
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 3016 Cane Creek Road
City Fairview
State / Zip Code NC 28730
County Buncombe
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 Flesher's Fairview Rest Home
Mailing Address P. O. Box 1160
City Fairview
State / Zip Code NC 28730
Telephone Number 828-628-1565
Fax Number
e-mail Address
1 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential Number of Homes
School Number of Students/Staff
Other R Explain: Nursing Home d 0
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing home domestic waste --
I
Number of persons served:
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 No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfaIl):
Cane Creek in the French Broad River Basin
8. Frequency of Discharge: X 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.
A 5000 gallon pre aeration tank with influent bar screen, 9500 gallon flow equalization
tank with dual pumps and controls, six(6) 9000 gallon aeration tanks with
blowers,motors,diffusers and controls, two (2)3000 gallon clarifiers, 9000 gallon aerated
sludge holding tank, 750 gallon contact/post-aeration tank, flow meter, tablet
chlorination system,tablet dechlorinator system and effluent composite sampler.
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.035 MOD
Annual Average daily flow 0.008 MOD (for the previous 3 years)
Maximum daily flow 0.100 MOD (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 Iisted.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) 29.9 15.8 MG/L
Fecal Coliform 12 2.2 CFU/100ML
Total Suspended Solids 22.3 16.0 MG/L
Temperature (Summer) 26.9 24.2 C
Temperature (Winter) 13.7 11.3 C
pH 8.1 7.7 units
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 NC0034924 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.
OC)e. C. F-1 oxen i. Si
Printedname--ofname%f Person Signing Title
Signature of Applic t Date r.
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

A/7A
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R.van der Vaart
Governor Secretary
August 12, 2015
Transmitted via FAX - 2 pages total
MEMORANDUM
To: Mr. Roger C. Floren II / Flesher's Fairview Rest Home
From: Charles H. Weaver / NPDES Unit
Subject: Corrected page for permit NC0034924
Mr. Floren: The permit issued to you on July 31st has a typographical error. The
permit cover page has an incorrect effective date. The correct effective date is
November 1, 2015.
The attached page has the correct effective date. Please discard the cover page from
the permit you recently received, and replace it with the attached page.
I apologize for any confusion this may have caused. If you have any questions,
contact me at the telephone number or e-mail address listed below.
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 919 807-6391 (fax)919 807-6489
VISIT US ON THE INTERNET @ http://www.ncwaterquality.org charles.weaver@ ncdenr.gov
An Equal Opportunity/Affirmative Action Employer—50% Recycled/10% Post Consumer Paper

Permit NC0034924
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE •
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions 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,
Flesher's Fairview Rest Home
is hereby authorized to discharge wastewater from outfalls located at the
Flesher's Fairview Rest Home WWTP
3016 Cane Creek Road
Fairview
Buncombe County
to receiving waters designated as unnamed tributary to Cane Creek within the French Broad River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts 1,II,III and
IV hereof.
This permit shall become effective November 1, 2015.
This permit and authorization to discharge shall expire at midnight on October 31, 2020.
Signed this day July 31, 2015.
di?"
Er," •
S. Ja,/fImmerman, P.G., Director
Di Sion of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 5

Permit NC0034924
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of
this permit issuance, any previously issued permit bearing this number is no longer effective. Therefore, the
exclusive authority to operate and discharge from this facility arises under the permit conditions,requirements,
terms, and provisions included herein.
Flesher's Fairview Rest Home
is hereby authorized to:
1. continue discharging domestic wastewater from the existing wastewater treatment facility consisting of:
D one(1) 5,000-gallon pre-aeration tank
D one(l) influent bar screen
D one(1) 9,500-gallon flow equalization tank with dual pumps and controls
D six (6) 9,000-gallon aeration tanks with blowers, motors, diffusers, and controls
D two(2)3,000-gallon clarifiers
D one(1) 9,000-gallon aerated sludge holding tank
D one(1) 750-gallon contact/post-aeration tank
D one(1) flow meter
D one(1)tablet chlorination system
D one (1)tablet dechlorinator system
D one(1) effluent composite sampler
This facility is located at 3016 Cane Creek Road in Fairview at Flesher's Fairview Rest Home in Buncombe
County.
2. Discharge from said treatment facility through Outfall 001 at a specified location (see attached map) into an
unnamed tributary to Cane Creek, a waterbody classified as C waters in the French Broad River Basin.
Page 2 of 5

• P. 1
* * * Communication Result Report ( Aug. 12. 2015 11 : 20AM ) * * *
2)
Date/Time : Aug. 12. 2015 11 : 19AM
File Page
No. Mode Destination Pg (s) Result Not Sent
1247 Memory TX 918286283887 P. 2 OK
Reason for error
E. 1) Hang up or line fail E 2) Busy
E. 3) No answer E 4) No facsimile connection
E. 5) Exceeded max. E—mail size E 6) Destination does not support IP—Fax
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donal ft van der Vaad
Governor Searlary
August 12,2015
Transmitted via FAX—2 pages total
MEMORANDUM
To: Mr.Roger C.Floren II/Flesher's FairviewnRest Home
From. Charles H Weaver I NPDES Una / f
Subject: Corrected page for permit NC0034924 �V
Mr.Floren:The permit•saued to you on July 311 has a typographical error The
permit cover page has an incorrect effective date The correct effective date is
November 1,2015
_- The attached page has the correct effective date. Please discard the cover page from
the permit you recently received,and replace it with the attached page.
I apologize for any confusion this may have caused. If you have any questions,
contact me at the telephone number or e-mail address listed below.
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