NC0037311_LV20150066_20150506

AVA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 6,2015
CERTIFIED MAIL#7013 1710 0002 1865 5498 RECEIVEDIDENR/DWR
RETURN RECEIPT REQUESTED
William R Hammonds,Consultant Management MAY 1 1 2015
Allegiance Healthcare Investors LLC
PO Box 485 Water Quality
Kernersville,NC 272850485 Permitting Section
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute(G.S.) 143-215.1(a)(6)
and NPDES Permit NC0037311
Allegiance Healthcare Investors LLC
Creekside Manor Assisted Living
Case No. LV-2015-0066
Forsyth County
Dear Mr. Hammond:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of$ 503.19 ($
350.00 civil penalty+$ 153.19 enforcement costs)against the Allegiance Healthcare Investors LLC.
This assessment is based upon the following facts: a review has been conducted of the discharge
monitoring report (DMR) submitted by the Allegiance Healthcare Investors LLC for the month of January 2015.
This review has shown the subject facility to be in violation of the discharge limitations and/or monitoring
requirements found in NPDES Permit NC0037311. The violations, which occurred in January 2015, are
summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that the Allegiance Healthcare Investors LLC
violated the terms, conditions or requirements of NPDES Permit NC0037311 and G.S. 143-215.1(aX6) in the
manner and extent shown in Attachment A. In accordance with the maximums established by G.S. 143-
215.6A(a)(2), a civil penalty may be assessed against any person who violates the terms, conditions or requirements
of a permit required by G.S. 143-215.1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority provided
by the Secretary of the Department of Environment and Natural Resources and the Director of the Division of Water
Resources, I, W. Corey Basinger, Water Quality Regional Operations Supervisor for the Winston-Salem Region,
hereby make the following civil penalty assessment against the Allegiance Healthcare Investors LLC:
•
450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105
Phone:[phone] Internet:www,ncwater.org
An Equal Opportunity 1 Affirmative Action Employer—Made in part by recycled paper

1 of the 3 violations of G.S. 143-215.1(a)(6)and NPDES Permit No.NC0037311,
$ 100.00 by discharging waste water into the waters of the State in violation of the Permit
Daily Maximum limit for TSS-Conc.
1 of the 1 violations of G.S. 143-215.1(a)(6)and NPDES Permit No.NC0037311,
$250.00 by discharging waste water into the waters of the State in violation of the Permit
Monthly Average limit for TSS—Conc.
$350.00 TOTAL CIVIL PENALTY
$153.19 Enforcement Costs
$503.19 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c),in determining the amount of the penalty I have taken into account the
Findings of Fact and Conclusions of Law and the factors set forth at GS. 143B-282.1(b),which are:
(1) The degree and extent of harm to the natural resources of the State,to the public health,or to private
property resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;and
(8) The cost to the State of the enforcement procedures.
Within thirty days of receipt of this notice,you must do one of the following:
1. Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural Resources (do not
include waiver form). Payment of the penalty will not foreclose further enforcement action for any continuing or
new violation(s). Please submit payment to the attention of:
NC DENR/DWR/NPDES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
OR
2. Submit a written request for remission including a detailed justification for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s)occurred or the accuracy of any of the factual statements contained
in the civil penalty assessment document. Because a remission request forecloses the option of an administrative
hearing,such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation
and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why
you believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address
listed below. In determining whether a remission request will be approved, the following factors shall be
considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b) were wrongfully

applied to the detriment of the violator;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator has been assessed civil penalties for any previous violations;or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of Water Resources will review your evidence and inform you of his decision in the matter
of your remission request. The response will provide details regarding the case status, directions for payment, and
provision for further appeal of the penalty to the Environmental Management Commission's Committee on Civil
Penalty Remissions (Committee). Please be advised that the Committee cannot consider information that was not
part of the original remission request considered by the Director. Therefore, it is very important that you prepare a
complete and'thorough statement in support of your request for remission.
In order to request remission,you must complete and submit the enclosed"Request for Remission, Waiver of Right
to an Administrative Hearing, and Stipulation of Facts" form within thirty(30) days of receipt of this notice. The
Division of Water Resources also requests that you complete and submit the enclosed"Justification for Remission
Request." Both forms should be submitted to the following address:
NC DENR/DWR/NPDES
1617 Mail Service Center
Raleigh,NC 27699-1617
OR
3. File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an
administrative hearing. You may obtain the petition form from the Office of Administrative Hearings. You must
file the petition with the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A
petition is considered filed when it is received in the Office of Administrative Hearings during normal office hours.
The Office of Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and
5:00 p.m., except for official state holidays. The original and one (1) copy of the petition must be filed with the
Office of Administrative Hearings. The petition may be faxed-provided the original and one copy of the document
is received in the Office of Administrative Hearings within five(5)business days following the faxed transmission.
The mailing address for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh,NC 27699-6714
Telephone[phone] Facsimile: [phone]
A copy of the petition must also be served on DENR as follows:
John Evans,General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh,NC 27699-1601
Please indicate the case number(as found on page one of this letter)on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an
internal date/time received stamp(not a postmark),will result in this matter being referred to the Attorney General's
Office for collection of the penalty through a civil action. Please be advised that additional penalties may be

assessed for violations that occur after the review period of this assessment.
If you have any questions,please contact Ron Boone of the Winston-Salem Regional Office at 336-776-9800.
Sincerely,
r �
W.Corey Basinger
Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources
Attachments
cc: WSRO Files w/attachments
SW Central Files w/attachments
PSB-NPDES—Charles Weaver

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF FORSYTH
ALLEGIANCE HEALTHCARE INVESTORS LLC REQUEST FOR REMISSION
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINSTRATIVE HEARING AND
CREEKSIDE MANOR ASSISTED LIVING ) STIPULATION OF FACTS
)
)
)
)
PERMIT NO.NC0037311 ) FILE NO. LV-2015-0066
Having been assessed civil penalties totaling $ 503.19 for violation(s) as set forth in the assessment
document of the Division of Water Resources dated 5/6/2015, the undersigned, desiring to seek remission of the
civil penalty, does hereby waive the right to an administrative hearing in the above-stated matter and does stipulate
that the facts are as alleged in the assessment document. The undersigned further understands that all evidence
presented in support of remission of this civil penalty must be submitted to the director of the Division of Water
Resources within thirty(30)days of receipt of the notice of assessment. No new evidence in support of a remission
request will be allowed after(30)days from the receipt of the notice of assessment.
This the day of ,20
SIGNATURE
ADDRESS
TELEPHONE

JUSTIFICATION FOR REMISSION REQUEST
DWQ Case Number: LV-2015-0066 County: FORSYTH
Assessed Party: ,ALLEGIANCE HEALTHCARE INVESTORS LLC
Permit No.(if applicable):NC0037311 Amount Assessed: $503.19
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For
Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of
this civil penalty. You should attach any documents that you believe support your request and are necessary for the
Director to consider in evaluating your request for remission. Please be aware that a request for remission is limited
to consideration of the five factors listed below as they may relate to the reasonableness of the amount of the civil
penalty assessed. Requesting remission is not the proper procedure for contesting whether the violation(s)occurred
or the accuracy of any of the factual statements contained in the civil penalty assessment document. Pursuant to
N.C.G.S. § 143B-282.1(c),remission of a civil penalty may be granted only when one or more of the following five
factors applies. Please check each factor that you believe applies to your case and provide a detailed explanation,
including copies of supporting documents,as to why the factor applies(attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b)were
wrongfully applied to the detriment of the petitioner(the assessment factors are listed
in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the
violation (Le., explain the steps that you took to correct the violation and prevent future
occurrences);
(c) the violation was inadvertent or a result of an accident(i.e., explain why the violation
was unavoidable or something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial
actions (i.e., explain how payment of the civil penalty will prevent you from performing
the activities necessary to achieve compliance).
EXPLANATION:
I

DIVISION OF WATER RESOURCES-CIVIL PENALTY ASSESSMENT
Violator: ALLEGIANCE HEALTHCARE INVESTORS LLC
County: FORSYTH
Case Number: LV-2015-0066LV-2015-0066
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State,to the public health,or
to private/ property resulting
Jlfrom
�lthe violation; /� ,� �/
I"id3N.4. d�4gM }'"FY v''�*♦ �r evs40 _ ",�1.4uL, l.M1�'Ci�.�4y�'�ll'.y///{a.iT
1�r..i-tom 'rye -4144'M+�Q.- 1-"""47Q', ` ,� 417 �.F.r
2) The duration and gravity of the violation; AIS
,,a...�:.�,� ate'2vt 1--
3) The effect on ground or surface water quantity or quality or on air quality; 74' .444-e$14 ♦ � ,
itrwe- r o-c-44.."..l -J 4th. /� +.r«�+e �a+.I.�•....{-' d'�"
.Ar .40'4..4 -+4.46 Fk -A-s-0 - L..r..,.. . _
..+- 4 A' .46111,...
4) The cost of rectifying the damage;
5) The amount of money saved by noncompliance;
6) Whether the violation was committed willfully or7intentionally;
7) The prior record of the violator in complying or failing to comply with programs over which
the Environmental Management Commission has regulatory authority; and
J /
8) The cost to the State of the enforcement procedures. 4 is-3
e 1`« ?47 -; /
Date W.Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office