NC0038822_Renewal (Application)_20130905

RESEARCh & ANA[yTICAL
r LAhORATWES, INC.
Analytical/Process Consultations
September 5, 2013
Mr. Charles H. Weaver, Jr.
NPDES Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Renewal of NPDES Permit No. NCO038822
Central Cato W 4V IT
Dear Mr. Weaver,
In response to your request for NPDES Permit Renewal concerning Central Care WWTP
(NPDES Permit No. NC0038822), Research & Analytical Laboratories, Inc. (RAL) has prepared
the enclosed required renewal package information for your review. The signed application form
in triplicate and a description of the method of sludge disposal are all attached.
Sincerely,
Research & Analytical Labs
James M. Cheshire
Authorized Agent
JMC/js
Cc William Payne, Central Care Inc
R 0 Box 473 • 106 Short Street • Kernersvdle, North Carolina 27264
www randalabs com
I

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 Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permitl NCO038822
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
Central Care, Inc.
Facility Name
Central Care WWTP
Mailing Address
139 Apex Lane
City
Mount Airy
State/ Zip Code
NC / 27030
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above
Street Address or State Road
City
State / Zip Code
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 Research & Analytical Laboratories, Inc.
Mailing Address 106 Short Street
City Kernersville
State / Zip Code NC / 27284
Telephone Number [phone]
Fax Number [phone]
1 of 3 Form -D 05/08

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
11,
Number of Employees
Commercial
®
Number of Employees 5-10
Residential
®
Number of Homes 5
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Nursing Home
Population served: 10 - 20
S. Type of collection system
® 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) (Provide a map showing the exact location of each outfall):
Unnamed Tributary to Stewarts Creek
S. Frequency of Discharge: ❑ Continuous ® Intermittent
If intermittent.
Days per week discharge occurs: Random Duration: Random
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.
0.010 Wastewater Facility consisting of the following:
• Septic Tank
• Dosing Chamber
• Surface Sandfilter
• Tablet Chlorination
Tablet Dechlorination
2 of 3 Form -D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.010 MGD
Annual Average daily flow 0 002 MGD (for the previous 3 years)
Maximum daily flow 0.006 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
.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 analysts is reported, report daily maximum
and monthly average. If only one analysts is reported, report as daily maximum
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
207
9 7
MG/L
Fecal Coliform
188
3 5
Col/ 100ml
Total Suspended Solids
25
8.2
MG/L
Temperature (Summer)
26
20.4
oC
Temperature (Winter)
20
10.1
oC
pH
7.1
6.51
SU
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) -- NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
NCO038822
Non -attainment program (CAA) --
14. APPLICANT CERTIFICATION
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
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.
Printed ndme of Person
M�'Iair
of
Title
09/05
Date
1
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 05/08

SLUDGE MANAGEMENT PLAN
CENTRAL CARE, INC.
WASTEWATER TREATMENT PLANT
NPDES PERMIT NO. NCO038822
Sludge from the Central Care wastewater treatment plant (WWTP) is disposed of in the
following way:
Central Care WWTP consists of a documented sludge hauling subcontractor
(V&S Septic, Inc.) who periodically removes digested sludge from septic tank and
delivers waste sludge to a documented or approved wastewater treatment
facility. Information found in documented log includes date, time, volume of
sludge removed and location, date and time sludge transported to final
destination. The designated ORC coordinates the frequency in which digested
sludge is removed.

Weaver, Charles
From: Joe baskin <joe_baskin@yahoo com>
Sent: Tuesday, August 13, 2013 10:49 AM
To: Weaver, Charles
Subject: Re- renewal notice for NPDES permit NCO038822
Dear Mr. Weaver
I am no longer the WWTP operator at Central Care. I believe the operator now is Morgan
Turner with R&A Labs. 336-996-2841. Hope this helps. Thanks Joe
From: "Weaver, Charles" <charles weaver(a)-ncdenr qov>
To: "Ioe baskin(aD-yahoo com" <loe baskin(a).yahoo com>
Sent: Tuesday, August 13, 2013 10 38 AM
Subject: renewal notice for NPDES permit NCO038822
The NPDES permit for the Central Care WWTP in Surry County expires on February 28, 2014. This notice is
being sent to explain the requirements for the permit renewal application.
Federal (40 CFR 122) and state (15A NCAC 2H.0105 (e)) regulations require that permit renewal applications
be filed at least 180 days prior to expiration of the current permit. Your renewal application is due to the
Division no later than September 1, 2013. Failure to apply for renewal by the regulatory deadline would deny
this facility the automatic permit extension described in NCGS 150-B.
Use the attached checklist to complete your renewal package. The checklist identifies the items you must
submit with the permit renewal application.
If all wastewater discharge has ceased at this facility and you wish to rescind this permit, simply reply to this
message.
Charles H. Weaver
NPDES Unit
Messages to and from this address are subject to the NC Public Records Law and may be released to third
parties.