NC0074110_LV20170263_20170906

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT (File)
Violator: Mizpah Healthcare Inc
Facility Name: Mountain View Assisted Living WWTP - - RECEIVED/NCM
Permit Number: NCO074110 6' % ®WR
County: Henderson SEP 2 5 2017
Case Number: LV -2017-0263 Permitting aueyn
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;
Four Daily Max BODS exceeded the permit limit by 126%,138%, 98% & 257%
One Monthly Average exceeded the permit limit by 223%.
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 five civil penalty enforcements in the twelve months prior to this violation.
8) The cost to the State of the enforcement procedures.
$118.68
Date
G. Landon Davidson, P.G., Region--al-Supervisor
Water Quality Regional Operations Section
Asheville Regional Office
Division of Water Resources, NCDEQ

WoOrkeso rces
WRONNWAC91,KITY
Certified Mail # 70161370 0001 6571 7457
Return Receipt Requested
September 06, 2017
Robert Crummie
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 -2017-0263
Henderson County
Dear Permittee
ROY COOPER
00"Mor
MICHAEL S. REGAN
sitemw
Se JAY Itw MERMA
Dhre r
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $1,743 68 ($1,625 00 civil penalty
+ $118 68 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 June 2017 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 June 2017, 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

$1,000.00 4 of the 4 violations of 143-215.1(a)(6) and Permit No NC0074110, by discharging wastewater mto
the waters of the State in violation of the Permit Daily Maximum for BOD - Conc
$625.0.0. _ _ 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 - Conc
$1,625.00 TOTAL CIVIL PENALTY
$118.68 Enforcement Costs
$1,743.68 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 properly
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
f
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 thg-ty (30) dys 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 in and 5.00 p.m, except for official state
holidays. The petition may be filed by facsnmle (fax) or electronic mail by an attached file (with restrictions) - provided
the signed original, one (1) copy and a filing fee (--f a filing fee is required by NCGS §150B-23 2) is received in the
Office of Administrative Hearings within seven (;') 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:
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 (3 0) 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 - Enforcer -lent File
NPDES Compliance/Enforcement Unit - Enforcement File
G \17JR\tiVQ,Hendei son\%k 3lteW ntee\'i% inorntMoUnt81n N tew Msidted Ln ung 7411 d LV -2017-02a t rtf

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV -2017-0263 County: Henderson
Assessed Party: Mizpah Healthcare Inc/ Mountain View Assisted Living
Permit No.: NC0074110 Amount Assessed: $1,743.68
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 unavoidahle 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 -2017-0263
Having been assessed civil penalties totaling $1,743.68 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated September 06, 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 , 20
SIGNATURE
ADDRESS
TELEPHONE

ATTACHMENT A
Mizpah Healthcare Inc
CASE NUMBER: LV -2017-0263
PERMIT: NCO074110
REGION:
Asheville
FACILITY: Mountain View Assisted Living
COUNTY:
Henderson
LIMIT VIOLATION(S)
Maximum
SAMPLE LOCATION: Outfall 001 - Effluent
Exceeded
Violation Report
Unit of Limit Calculated % Over
Violation Penalty
Date Month/Yr Parameter Frequency
Measure Value Value Limit
Type Amount
6/2/2017 6-2017 BOD, 5 -Day (20 Deg Weekly
mg/1 750 17 1267
Daily $25000
C) - Concentration
Maximum
6/21/2017 6-2017 BOD, 5 -Day (20 Deg
Weekly
Exceeded
6/6/2017 6-2017 BOD, 5 -Day (20 Deg
Weekly
mg/I
750 1790 1387 Daily $25000
C) - Concentration
Maximum
Exceeded
6/13/2017 6-2017 BOD, 5 -Day (20 Deg
Weekly
mg/1
750 1490 987 Daily $25000
C) - Concentration
Maximum
Exceeded
6/21/2017 6-2017 BOD, 5 -Day (20 Deg
Weekly
mg/l
750 2680 2573 Daily $25000
C) - Concentration
Maximum
Exceeded
6/30/2017 6-2017 BOD, 5 -Day (20 Deg Weekly mg/I 5 1620 2232 Monthly $62500
C) - Concentration Average
Exceeded

NPpES PERMIT NO.: NCO074110
FACILITY NAME: Mountain View Assisted Living
OWNER NAME: Mizpah Healthcare Inc
GRADE: WW -2
eDMR PERIOD: 06-2017 (June 2017)
PERMIT VERSION: 4 0
CLASS: WW -2
ORC: Shannon D James
ORC HAS CHANGED: No
VERSION: 10
IJ
PERMIT STATUS: Active d�
COUNTY: Henderson
ORC CERT NUMBER: 1002526
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
*** * No Reporting Reason ENFRUSE = No Flow-Reuse/Recycle, ENVWTHR=No Visitation— Adverse Weather, NOFLOW=No Flow, HOLIDAY =NoVisitation —Holiday
> IV49 V - Zx) /::7- - V 0
e
+:
o
F
E
V
P
B
d
y
A
x
iL
50050
Continuous
Recorder
FLOW
00010
5Xweek
Grab
TEMP -C
00400
Weekly
Grab
pH
50060
2Xweek
Grab
CHLORINE
0310
Weekly
Composite
BOD -Cone
C0610
Weekly
Composite
rM-N-Cone
C0530
Weekly
Composite
TSS -Cone
31616
Weekly
Grab
FCOLIBR
00300
Weekly
Grab
DO
2400 clock
Hrs
2400 clack
Hrs
YB/N
mgd
deg c
so
ugR
mg/1
mgll
#/100m1
Mg/1
1
1300
033
Y
00024
20
73
< 15
842
2
0925
05
Y
00024
204
17
0 151
115
< 1
3
0 002
4
0 002
5
1530
033
Y
0 002
1207
69
< 15
946
6
1220
05
Y
0 002
209
179
0185
<26
< 1
7
1320
05--
Y
0 002
208
S
1430
05
Y
0 002
205
< 15
9
1535
033
Y
0 002
212
10
0 002
11
0 002
12
1725
1042
Y
0 002
218
172
< 15
882
13
1010
05
Y
0001
213
149
0166
35
<1
14
1250
05
Y
0 001
222
15
0820
05
Y
0 001
218
16
1035
042
Y
0 002
222
< 15
17
0 002
18
0 002
19
1705
1042
Y
0 002
223
78
< 15
819
20
1725
033
Y
0 001
221
21
1325
05
Y
0001
222
268
015
<258
<I
22
0940
033
Y
0 001
217
< 15
23
1500
033
Y
0 001
231
24
0 001
25
0 001
26
1740
033
Y
0 001
227
76
< 15
826
27
1505
033
Y
0001
214
421
<01
<5.56
<1
28
1
1445
05
Y
0 001
212
29
1
11700
1042
Y
1
0 001
214
< 15
30
1
1500
1033
Y
0 001
211
Monthly Average Lumrt 0 005
5
2
30
200
MonthlyAvenge
000156
215
0
16 162
01304
3
1
863
Dndy Mnnmum
0 0024
23 1
7 8
0
26 8
0 185
115
0
946
Dstly Mlnhnum
0 001
120
169
0
1421
0
0
10
18 19
*** * No Reporting Reason ENFRUSE = No Flow-Reuse/Recycle, ENVWTHR=No Visitation— Adverse Weather, NOFLOW=No Flow, HOLIDAY =NoVisitation —Holiday
> IV49 V - Zx) /::7- - V 0

i
NPDES PERMIT NO.- NCO074110
FACILITY NAME: Mountain View Assisted Li`
OWNER NAME: Mizpah Healthcare Inc
GRADE: WW -2
eDMR PERIOD. 06-2017 (June 2017)
COMPLI ;119 ATUS: Compliant
PERMIT VERSION: 4 0
CLASS: WW -2
ORC: Shannon E James
ORC HAS CHANGED: No
VERSION. 10
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Henderson
ORC CERT NUMBER. 1002526
STATUS: Processed
SUBMISSION DATE: 07/20/2017
07/20/2017
ORC/Certifier Signature- Kevin Bryan E-Nail•JJemi@bellsouth net Phone # [phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
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 tune -table for improvements to be made as required by part H E 6 of
the NPDES permit
07/20/2017
Permittee/Submitter Signature *** Juanita James E -Mail Jjemi@bellsouth net Phone # [phone] Date
Permittee Address- 260 Center Way Dr Hendersonville NC 28792 Permit Expiration Date- 11/30/2020
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
CERTIFIED LABORATORIES
LAB NAME: James & James Environmental Mgt, Inc
CERTIFIED LAB #: 482
PERSON(s) COLLECTING SAMPLES: Shannon James
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal ncdenr org/web/wq/swp/ps/npdes/forms
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data
* No Flow/Discharge From Site. Check this box if no discharge occu: s and, as a result, there are no data to be entered for all of the parameters on the DMR
for 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 delegation of the signatory authority must be on file with the state per 15A NCAC 2B
0506(b)(2)(D)

.NPDIFS EERNUT NO.: NCO074110 PERMIT VERSION: 4 0 PERMIT STATUS: Active ( r1ex 614)t��
FACILITY NAME: Mountain View Assisted Living CLASS: WW-2 COUNTY: Henderson
OWNER NAME: Mizpah Healthcare Inc ORC: Shannon D James ORC CERT NUMBER: 1002526
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 06-2017 (June 2017) VERSION: 10 STATUS. Processed
Report Comments:
On the 6th, BOD data valid, Blank was >0 20mg/L On the 21 st and 27th, BOD data valid, GGA was greater than 228 5mg/L
The system is very clear and has no odor The clarity allows one to see the bottom of the dechlor chamber The facility was pumped for the grease and is beginning to make a
transition