NC0074110_LV20160199_20160929

Certified Mail # 7014 0510 0000 4466 5009
Return Receipt Requested
September 29, 2016
Mizpah Healthcare Inc
260 Center Way Drive
Hendersonville, NC 28792
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 WW Permit No. NCO074110
Mizpah Healthcare Inc
Mountain View Assisted Living WWTP
Case No. LV -2016-0199
Henderson County
Dear Permittee:
RECEIVEOINCDEUD'WR
OCT 112016
Mater Guaiily
Permitting Sectiot]
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $466.62 ($350.00 civil penalty +
$116.62 enforcement costs) against Mizpah Healthcare Inc.
This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report (DMR)
submitted by Mizpah Healthcare Inc for the month of May 2016. This review has shown the subject facility to be in
violation of the discharge limitations and/or monitoring requirements found in NPDES WW Permit No. NC0074110. The
violations, which occurred in May 2016, are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Mizpah Healthcare Inc violated the terms, conditions or
requirements of NPDES WW Permit No. NCO074110 and G.S. 143-215.l(a)(6) 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 Environmental Quality and the Director of the Division of Water Resources, I, G. Landon Davidson,
P.G., Regional Supervisor, Asheville Regional Office hereby make the following civil penalty assessment against Mizpah
Healthcare Inc:
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. 70 Highway, Swannanoa, NC 28778
828-296-4500

$100.00 1 of the 1 violations of 143-215.1(a)(6) and Permit No.NC0074110, by discharging wastewater into
the waters of the State in violation of the Permit Daily Maximum for BOD - Cone.
$250.00 1 of the 1 violations of 143-215.1(a)(6) and Permit No.N00074110, by discharging wastewater into
the waters of the State in violation of the Permit Monthly Average for BOD - Cone.
$350.00 TOTAL CIVIL PENALTY
$116.62 Enforcement Costs
$466.62 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 G.S. 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 (30) days of receipt of this notice, you must do one of the following:
(1) - Submit payment of the penalty, OR
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environmental Quality (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:
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Option 2: Submit a written request for remission or mitigation 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) was wrongfully
applied to the detriment of the petitioner;
(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 had 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 of Civil Penalties
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form within thirty Q 0) 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:
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Option 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 (3 0) 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 petition may be filed by facsimile (fax) or electronic mail by an attached file (with restrictions) - provided
the signed original, one (1) copy and a filing fee (if a filing fee is required by NCGS §15013-23.2) is received in the
Office of Administrative Hearings within seven (7) business days following the faxed or electronic transmission. You
should contact the Office of Administrative Hearings with all questions regarding the filing fee and/or the details of the
filing process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Tel: [phone]
Fax: [phone]
One (1) copy of the petition must also be served on DEQ as follows:
Mr. Sam M. Hayes, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, North Carolina 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 Janet Cantwell with the Division of Water Resources staff of the Asheville
Regional Office at [phone] or via email [e-mail].
Sincerely,
G. Landon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS
Cc: WQS Asheville Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File
James & James Environmental/ ORC
G: 44Ri�1'Q'•.FTzndarscn Cv ure:varert\dinonAklountain bier: Assismd Living 74i IMJX-]Glu-019v f

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV -2016-0199 County: Henderson
Assessed Party: Mizpah Healthcare Inc/ Mtn View Assisted Living
Permit No.: NC0074110 Amount Assessed: $466.62
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(6), remission of a civil
penalty may be granted only when one or more of the following five factors apply. 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 (i.e., 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:

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
COUNTY OF HENDERSON
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
Mizpah Healthcare Inc )
Mountain View Assisted Living )
PERMIT NO. NCO074110 ) CASE NO. LV -2016-0199
Having been assessed civil penalties totaling $466.62 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated September 29, 2016, 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 (3 0) days of receipt of the notice
of assessment. No new evidence in support of a remission request will be allowed after (3 0) days from the receipt of the
notice of assessment.
This the day of , 20
SIGNATURE
ADDRESS
TELEPHONE

ATTACHMENT A
,Mizpah Healthcare Inc
CASE NUMBER: LV -2016-0199
PERMIT: NCO074110
FACILITY: Mountain View Assisted Living
LIMIT VIOLATION(S)
SAMPLE LOCATION: Outfall 001 - Effluent
REGION: Asheville
COUNTY: Henderson
Violation
Date
Report
Month/Yr
Parameter
Frequency
Unit of
Measure
Limit
Value
Calculated
Value
% Over
Limit
Violation
Type
Penalty
Amount
5/24/2016
5-2016
BOD, 5 -Day (20 Deg.
Weekly
mg/I
7.50
10.30
37.3
Daily Maximum
$100.00
C) - Concentration
Exceeded
5/31/2016
5-2016
BOD, 5 -Day (20 Deg.
Weekly
mg/I
5
6.40
27.3
Monthly
$250.00
C) - Concentration
Average
Exceeded

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (File)
Violator: Miznah Healthcare Inc
Facility Name: Mountain View Assisted Living WWTP
Permit Number: NCO074110
County: Henderson
Case Number: LV -2016-0199
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 from the violation;
All effluent violations may be detrimental to the receiving stream but may not be immediately quantified.
2) The duration and gravity of the violation;
One Daily Max BOD exceeded the permit limit by 3 7.3 3 %.
One Monthly Average BOD exceeded the permit limit by 27.3%.
3) The effect on ground or surface water quantity or quality or on air quality,-
All
uality;All effluent violations may be detrimental to the receiving stream but may not be immediately quantified.
4) The cost of rectifying the damage;
The cost is unknown.
5) The amount of money saved by noncompliance;
The amount of money saved would include the cost of excess solids removal and additional aeration. It
would also include,more operating and maintenance time on site and the cost of additional chemical
treatment.
The amount of money saved would include the cost of collection of the additional samples and the cost of
analyzing them at a certified lab.
6) Whether the violation was committed willfully or intentionally;
It does not appear to be either.
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
There have been three civil penalty enforcements in the twelve months prior to this violation.
8) The cost to the State of the enforcement procedures.
$116.62
Oct-�_ (�
Date G. Landon Davidson, P.G., Regions upervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ

Permit Enforcement History Details by Owner ✓ ' l!��C y
9/28/2016
1
Owner: Mizpah Healthcare Inc
Facility : Mountain View Assisted Living
Permit: NCO074110
Region: Asheville County Henderson
Penalty Remission Ent Enf EMC EMC OAH Collection Has
Assessment Penalty Enforcement Request Conf Remission Hearing Remission Remission MemoSent Total Balance Pmt Case
Case MR Approved Damages Received Held Amount Held Amount Amount To AGO Paid Due Plan Closed
Number
PP Amount Costs
LV -1998-0218 11/6/98 $1,000.00 $150.83 12/7/98 2/3/99 $1151 $0.00 No 3/11/99
LV -1999-0431 10/22/99 $1,000.00 $120.98 12/1/99 2/2/00 $0 $1,120.98 $0.00 No 3/22100
LV -2003-0326 1-2003 3/31/03 $250.00 $100.00 $350.00 $0.00 No 8/4/05
LV -2007-0398 4-2007 10/12/07 $350.00 $208.57 $558.56 $0.00 No 10/31/07
LM -2010-0024 1-2010 6/9/10 $350.00 $67.00 7/13/10 3/25/11 $0 $417.00 $0.00 No 5/26/11
LV -2010-0270 4-2010 8/20/10 $550.00 $67.00 9/23/1.0 5/12/11 $0 $617.00 $0.00 No 4/17/12
LM -2010-0045 5-2010 10/22/10 $200.00 $67.00 11/19/10 5/10/11 $0 3/13/12 $0.00 $267.00 $0.00 No 4/17/12
LV -2012-0040 7-2011 3/15/12 $200.00. $137.00 4/10/12 4/16/13 $60 $277.00 No
LM -2012-0010 10-2011 3/26/12 $450.00 $137.00 $0 $0.00 8/7/12 $587.00 $0.00 No 1/28/13
LV -2012-0061 11-2011 5/2/12 $750.00 $137.00 5/23/12 4/16/13 $225 $662.00 No
LV -2013-0028 9-2012 2/18/13 $100.00 $137.00 7/16/13 $237.00 $0.00 No 9/27/13
LV -2013-0094 1-2013 5/16/13 $100.00 $137.00 $237.00 No
LM -2016-0007 10-2015 3/2/16 $350.00 $158.22 $508.22 No
LV -2016-0102 12-2015 5/31/16 $450.00 $113.93 $563.93 No
LV -2016-0164 1-2016 8/25/16 $350.00 $112.94 $462.94 No

9/28/2016
2
Total Cases: 15 Total Penalty Amount: $6,450 Total Enforcement Cost: $1851.47 Sum Of Total Paid: $4,154.54 Total Balance Due: $2,711.09
Sum of Total Case Penalties: $8,301.47 Total Penalties After Remissions: $6,865.63
Ir

(p, 1; � 6 f-; �-� Y)
NPDES PEIUNIIT NO. NG0074110 DISCHARGE NO. 001 MONTH MAY NrEAR 2016
FACILITY NAiM. MOUNTAIN VIEW REST HOME CLASS II COUNTY HENDERSON
u
CERTIFIED LABORATORY (1) JAMES & JAMES ENVIRONMENTAL MGT., INC. CERTIFICATIOM NO. 482
(fist additional laboratories on the backside/page 2 of this farm)
OPERATOR IN RESPONSIBLE CHARGE (ORC) KEVIN BRYAN GRADE it CERTIFIC. -11ON NO. 1002130.
PERSON(S) COLLECTING SAMPLES KEVIN BRYAN ORC PHONE [phone]
CHECK BOX IF ORC 11 -AS CHANGED NO h"LOiI` DISCHARGE FROhI SITZ• :.
Mail ORIGn AL and ONE COPY
ATTN: CENTRAL FILES
DIVI1617 MANQERVICECLN- TE L &�,y 2016
1617 MAIL SERVICE C'E:VTE �II
RALEIGIi, NC 27699-1617
BY THYS SIGNATURE, I CERTIFY THAT THIS REPORT L4
dCCC`[t4TE AND COMPLETE TO THE HEST OF'MY ICNOWLEDGE.
6/20/2016
1
E
50030
00010
00400
50060
00310
00610
00530
31616
03
4i
rY E
o } N
a'o °�
6
I
Y
s
c
FLOW
EFF 19
INF LI
0
h
�_
1
LU�
w E
¢z
O C
i
Au
d"sinfectian
I
J
qU
8q.
fl3C-4
Lu
z�
00
{p0
�Z
Q
J LU
El L
i<zQ�
k- Wu
fLLLj
0Y
}
J Z
a0=
t0V`4J��
Loa
Uei
C9
W ^G
�u
co<
1
JULp
I1RS f1RS
Y'CS/N
MGD
0
C
UNITS
UG/L
MG/L
DiGA.
AIGIL
',J10011L
tilGiL
t
0.00
0.002
2
1805 0.58
Y
0.002
19.5
7.7
29
6.3
1745 0.42
Y
0.002
19.6
) 'u4 u(--: 'vMj-
4
1145 0.50
Y
0.002
18.0
3.898
10.1 f
9.7
<1
s
1650 0.42
Y
0.002
16.5
<15
L vlu
6
13'10 0.33
Y
0.001
17.0
` J
Vii;, P 'I
7
0.00
0.001t;-urr•
s
0.00
M011
I
9
1455 0.67
Y
0.001
17.3
7.4
<15
5.9
io
1430 0.50
Y
0.001
17.8
i t
1230 0.17
Y
NO FLOW
i
12
1430 0.17
Y I
u° FLOW
i
131
1115 0.33
Y
0.00 i
18.2
<15
7AB I
0.4
66.66
<1
14
0.00 1
1
0.001
15
0.00
0.001
16
1510 0.67
Y
0.001
16.7
7.4
<15
9.8
17
1545 0.33
Y
0.002
17.2
is
1225 0.50
Y
0.002
17.9
(
3.878
0.1
5.2
<1
19
1355 0.33
Y
0.002
17.6
<15
20
1140 0.33
Y
0.002
17.1
I
21
om
0.002
22
0.00
0.002
23
1430 0.58
Y
0.002
17.7
7.2
18
9.3
241
1425 0.42 1
Y
0.002
18.4
9 10.38
0.2
7.6
<1
251
1455. 0.42
Y
0.002
18.4
i
26
1500 0.33
Y
0.002
19.6
<15
27
1130 0A2
Y 10.002
19.8
28
0.00
0.002
ape
29
0.00
0.002
30HOuDAY 0.00
0.002
311
1525 0.30 1
Y
0.002
20.7
'
3
Al ERAGI:
O.002
18.1 N
3.0
66.4
0.2
7.3
0.0
7.8
MAXIMUM
0.002
20.7
7.7
29.0
10.3
0.4
9.7
<1.0
9.8
°tli4'TML'lJ
0.001
16.5
7.2
<15
3.9
<0.1
5.2
<1.0
5.9
comp. (C) / Grab (G)
G
G i
G
G
G
G i
G
G
G
Nlonthl Limit
0.005 I
NL
6-9 i
28
517.5
2/10 } 30/45 1200/4001
763.0 }
OWQ Farm MR -1 LI IIOJI T

Facility States: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(inciuding weekly averages, ifappticabte) 0
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the
environment, Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A
written submission shall also be provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be tirade as required by Part H..E.6
of the NPDES permit.
"I certify, wider penaify ofiaw, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed The system, or those
Perolls &ecthvaesponsible for gathering- the infomration, the information submitted is, to the best ofmi knowledge and belief. true, accurate, and compieta. I am
aware that there are significant penalties for submitting Use information, including the possibility of fines and imprisonment for knowing violation ."
MOUNTAIN VIEW REST HOME
Permittee (Please print or type)
9' 6/20/2016
S• azure of Perm ee*"` Date
(Required unless submitted electronically)
RT 11, BOX 238, HENDERSONVILLE, NC 28739 828-697-0063 11/30/2015
Permittee Address Phone Nuutber e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABOPUTORI , S
Certified Laboraton (2) Certification No.
Certified Laboratory (v)
Certification No.
Certified .Laboratory (4)
Certification No.
Certified Laboratory (5)
Certification No.
r
PARA -METER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at (91 9f) 807-6300 or by,.isiting htip:/,'portal.nedenr.oritvebi�vq/swp/ps/npdes/appfonns.
measurement designated in the reporting facility's NPDES permit for reporting data.
iN•¢o`°MwWischarge From Site: Check this box if no discharge occurs and, as a result; there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
URC On Site?: ORC must visit facility and document visitation of facility as required per I5A NC -AC 30.02041.
•• `x• Siguirture of,Permittee: If signed by other than the permittee_ then the delegation of the signatory authority must be on
file with the slate per 15A NCAC 213.0-506(b)(2)(1)).

(F,ez d�t�)
- tee:•JAMES & JAME S ENVIRONMENTAL MANAGEMENT, INCPO BOX 1354, MOUNTAIN HOME, NC 28758(828) 697-0063 OFFICE(828) 697-0065 FAX
May, 2016
Client: Mountain View Assisted Living
NPDES PERMIT NUMBER: NC0074110
Dear Client,
We are pleased to notify you that your facility operated most of the month within your National Pollutant
Discharge Elimination System (NPDES) permit. We did experience a result that was greater than the
permit discharge limits. Your permit has both a monthly maximum and a daily maximum. Your facility
exceeded the permit discharge limits on the items listed below:
BOD 10.3 mg/l on the 24th
6.4 mg/1 Monthly Average
This gave a daily maximum violation on one day and did give a monthly violation. We determined that the
cause of the violation was probably due a couple different issues. (1) The temperatures became excessive
quickly and additional time was placed on the clock to compensate for the extreme heat and (2) grease has
been entering the facility from the establishment. I have spoken with Mr. Crummie regarding pumping the
grease trap and discarding the grease into a disposal.
You may receive a monetary fine for this month. Thank you for your understanding in this matter.
Thank you for choosing James & James as your service company.
J anita James