NC0074110_LV20170109_20170405

Certified Mail # 70151520 0003 5463 4781
Return Receipt Requested
April 05, 2017
Mountain View Assisted Living
Mizpah Healthcare Inc
260 Center Way Dr
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 -2017-0109
Henderson County
Dear Permittee:
RECEV DINCDEUDWR
APR 10 2017
watmQu,"I'1 'ty .
Pe -i iirdlig s auldon,
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $991.62 ($875.00 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 October 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. NCO074110. The
violations, which occurred in October 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. 143-215.1(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

$250.00 1 of the 1 violations of 143-215. l(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.
$625.00 1 of the 1 violations of 143-215.1(a)(6) and Permit No.NC0074110, by discharging waste water into
the waters of the State in violation of the Permit Monthly Average for BOD - Cone.
$875.00 TOTAL CIV[L PENALTY
$116.62 Enforcement Costs
$991.62 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) dgys 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 (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 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 fling fee is required by NCGS §150B-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. William F. Lane, 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:IWR`,NQVEienderson\NV,utea.-arer`1•finors`�Ziourtnin Nriew Assisred Lh ing 74t I YLN'-2017.010%rtf

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV -2017-0109 _County: Henderson
Assessed Party: _ Mizpah Healthcare Inc / Mountain View Assisted Living WWTP
Permit No.: NC0074110 Amount Assessed: $991.62
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(c), 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
COUNTY OF HENDERSON
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Mizpah Healthcare Inc .
Mountain View Assisted Living
PERMIT NO. NCO074110
DEPARTMENT OF ENVIRONMENTAL QUALITY
WAWER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
CASE NO. LV -2017-0109
Having been assessed civil penalties totaling $991.62 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated April 05, 2017, 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
ADDRESS
TELEPHONE
SIGNATURE
20

ATTACHMENT A
Mizpah Healthcare Inc
CASE NUMBER: LV -2017-0109
PERMIT: NCO074110 '
FACILITY: Mountain View Assisted Living
LIMIT VIOLATION(S)
SAMPLE LOCATION: Outfall 001 - Effluent
REGION: Asheville
COUNTY: Henderson
Violation Report Unit of Limit Calculated % Over Violation Penalty
Date Month/Yr Parameter Frequency Measure Value Value Limit Type Amount
10/5/2016 10-2016 BOD, 5 -Day (20 Deg. Weekly mg/I 7.50 17.50 133.3 Daily $250.00
C) - Concentration Maximum
Exceeded
10/31/2016 10-2016 BOD, 5 -Day (20 Deg. Weekly mg/I 5 8.20 64.3 Monthly •$625.00
C) - Concentration Average
Exceeded

DIVISION OF WATER RESOURCES - CIVII. PENALTY ASSESSMENT (File)
Violator: Mizpah Healthcare Inc
Facility Name: Mountain View Assisted LivinE WWTP
Permit Number: NC0074110
County: Henderson
Case Number: LV -2017-0109
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 133.33%.
One -Monthly Average BOD exceeded the permit limit by 64.25%.
3) The effect on ground or surface water quantity or quality or on air quality;
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 is unknown.
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 six civil penalty enforcements in the twelve months prior to this violation.
8) The cost to the State of the enforcement procedures.
$116.62
Date andon Davidson, P.G., Regional Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ

NPDES PERMIT NO. NCO074110 DISCHARGE NO. 001 MONTH OCT YEAR 2016
FACILITY NAME MOUNTAIN VIEW REST HOME CLASS II COUNTY HENDERSON
CERTIFIED LABORATORY (1) JAMES & JAMES ENVIRONMENTAL MGT., INC.. CERTIFICATION NO. 482
(list additional laboratories on the backside/page 2 of this form)
OPERATOR IN RESPONSIBLE CHARGE (ORC) SHANNON JAMES GRADE II CERTIFICATION NO. 1002526
PERSON(S) COLLECTING SAMPLES SHANNON JAMES ORC PHONE [phone]
CHECK{ BOX IF ORC HAS CHANGED J NO FLOW / DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES X
J
DIVISION OF WATER QUALITY (SIG gi jjQSI$L
1617 MAIL SERVICE CENTER BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DWQ Form M R -I (11/04) I®
II 1
111 I
1111
II.I
,tll~`I
11. 1
II 1
®, ,
11 11
__■--�
��®►7i1d17i1�
1 1
��■■■��-
����
1 11
NUMB ml
Emmm11
®
'®m©
1 11■___■__■■■■■�
®■
1 11
1 11
_-_�_■,■-■,■■■■-■
Emm©
1 11■___■__■■■■■�
Emmm
�■
1 11
1 11
■■_�_■__■1■��r'1taTiGf•�
DWQ Form M R -I (11/04) I®

Facility Status: (Please check one of the following) a
All monitoring data and sampling frequencies meet permit requirement
(including weekly averages, if applicable) FX
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirem nts �__1
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 made as required by Part H.E.6
of the NPDES permit.
"I certify, under penalty of law, 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
persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
MOUNTAIN VIEW REST HOME
Permittee (Please print or type)
11!28/2016
ignatute of Penn a*** Date
(Required unless submitted electronically)
NC 28739 828-697-0063
ADDITIONAL CERTIFIED LABORATORIES
11/30/2015
Certified Laboratory (2)
Certification No.
Certified Laboratory (3)
Certification No.
Certified Laboratory (4)
Certification No.
Certified Laboratory (�5)
Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Mc6arge Fir m Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered foi all of the parameters on the, DNM for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
*** Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 213 .0506(b)(2)(D).

JAMES & JAMES ENVIRONMENTAL MANAGEMENT, INC
PO BOX 1354, MOUNTAIN HOME, NC 28758
[phone] OFFICE
[phone] FAX
October, 2016
Client: Mountain View Assisted Living
NPDES PERMIT NUMBER: NCO074110
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 17.5 mg/l on the 5t`
8.2 mg/1 Monthly Average
This gave a daily maximum violation on one day and did give a monthly violation for BOD. We
determined that the cause of the violation was probably due a couple different issues. (1) Grease has been
entering the facility from the establishment. I have spoken with Mr. Crummie regarding the grease issues
and checking the chemicals that are entering the facility. The facility was wasted to the digester and is on
the mend.
You may receive a monetary fine far this month. Thank you for your understanding in this matter.
Thank you for choosing James & James as your service company.
Juanita James

Owner: Mizpah Healthcare Inc
Facility : Mountain View Assisted Living
Permit: NCO074110
Region: Asheville County
Permit Enforcement History Details by Owner
Henderson
(Z��4/5/2017
1
LV -2007-0398
Penalty
10/12/07 $350.00
„Remission
Enf
Enf EMC EMC
OAH Collection
Has
$0.00 No
Case
Assessment Penalty
MR
Enforcement
Request
Conf
Remission Hearing. Remission
Remission MemoSent Total
Balance . Pmt
Case
Number
q roved
pP Amount
Costs
Damages Received
Held
Amount Held Amount
Amount To AGO Paid
Due Plan
Closed
LV -1998-0218
11/6/98 $1,000.00
$150.83
12/7/98
2/3/99
$1,150.83
$67.00
$0.00 No
3/11/99
LV -1999-0431
10/22/99 $1,000.00
$120.98
12/1/99
2/2/00
$0.00
$1,120.98
$0.00 No
3/22/00
LV -2003-0326
1-2003 3/31/03 $250.00
$100.00
LM -2012-0010
10-2011
$350.00
$0.00 No
8/4/05
LV -2007-0398
4-2007
10/12/07 $350.00
$208.57
$113.93
1.0/31/16 $563.93 No
LV -2016-0164
1558.56
$0.00 No
10/31/07
LM -2010-0024
1-2010
6/9/10 $350.00
$67.00
7/13/10
3/25/11
$0.00
.$417.00
$0.00 No
5/26/11
LV -2010-0270
4-2010
8/20/10 $550.00
$67.00
9/23/10
5/12/11
$0.00
$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
$0.00 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
$60.00
$277.00 No
LM -2012-0010
10-2011
3/26/12 $450.00
$137.00
$0.00 $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
$225.00
$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 _
10/31/16
$508.22 No
LV -2016-0102
12-2015
5/31/16
$450.00
$113.93
1.0/31/16 $563.93 No
LV -2016-0164
1-2016
8/25/16
$350.00
$112.94
- 3/15/17 $462.94 No
LV -2016-0199
5-2016
9/28/16
$350.00
$116.62
$466.62 No

4/5/2017
2
LV -2016-0238 7-2016 11/15/16 $450.00 $116.62 $566.62 No
LV -2017-0023 8-2016 1/20/17 $812.50 $116.62 2/20/17 3/7/17 $0.00 $929.12 No
LV -2017-0109 10-2016 3/31/17 $875.00 $116.62 $991.62 No
Total Cases: 19 Total Penalty Amount: $8,938 Total Enforcement Cost: $2,317.95 Sum Of Total Paid: $4,154.54 Total Balance Due: $5,665.07
Sum of Total Case Penalties: $11,255.45 Total Penalties After Remissions $9,819.61
a