NC0056201_Renewal Application_20180716

ROY COOPER
Governor
MICHAEL S_REGAN
Secretary
Water Resources LINDA CULPEPPER
ENVIRONNIEiNTAL QUALITY Interim Director
July 16, 2018
James Radford
NC Land Lease LLC
PO Box 2533
Christiansburg, VA 24068
Subject: Permit Renewal
Application No. NC0056201
Countryside Mobile Home Park WWTP
Randolph County
Dear Applicant:
The Water Quality Permitting Section acknowledges the July 16, 2018 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit.
The permit writer will contact you if additional information is required to complete your permit renewal. Please respond
in a timely manner to requests for additional information necessary to allow a complete review of the application and
renewal of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/perm its-regulations/perm it-g uida nce/envi ronmenta I-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
.3101'g a
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application(WSRO)
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300

1V 7 f
NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number NC0056201
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 NC Land Lease, LLC
Facility Name Countryside MHP
Mailing Address PO BOX 5529
City Cary
State / Zip Code NC / 27512
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road 3571 Roy Farlow Road RECEIVED/DENR/DWR
City Sophia J U L 16 2018
State / Zip Code NC / 27350 Water Resources
County Randolph County Permitting Section
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to
the Operator in Responsible Charge or ORO
Name Paul Smith
Mailing Address PO BOX 269
City Reidsville
State / Zip Code NC / 27323
Telephone Number [phone]
Fax Number ( )
4. Ownership Status:
Federal ❑ State ❑ Private X Public ❑
Page 1 of 3 Version 5/2012

x
NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
5. Type of treatment plant:
X Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
❑ Green Sand Filter (No sodium recharge)
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
6. Description of source water(s) (i.e. groundwater, surface water)
County water system (Davidson Water Company)
7. Describe the treatment process(es) for the raw water:
8. Describe the wastewater and the treatment process(es) for wastewater generated by the facility:
The raw sewage dumps into a pump station, it is then lifted into the treatment plant and is
treated by an aeration basin. The wastewater then goes through a clarifier and then through
the sand filter and then through the chlorination tank and then goes through a dichlorination
process. It is metered and then discharged.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous X Intermittent ❑
If intermittent:
Days per week discharge occurs: Duration:
11. Plant design potable flowrate .015 MGD
Backwash or reject flow 0 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Unnamed tributary to Caraway Creek
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate Yes No X
Iron sulfate / ferrous sulfate Yes No X
Page 2 of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Fluoride Yes No X
Ammonia nitrogen / Chloramines Yes X No
Zinc-orthophosphate or sweetwater CP1236 Yes No X
List any other additives below:
Sodium Thiosulfate
14. Is this facility located on Indian country? (check one)
Yes El No X
15. Additional Information:
➢ Provide a schematic of flow through the facility, include flow volumes at all points in the
water treatment process. The plan should show the point[s] of addition for chemicals and
all discharges routed to an outfall [including stormwater].
➢ Solids Handling Plan-We have Carolina Septic pump and haul the solids away as
needed.
16. NEW Applicants
Information needed in addition to items 1-15:
➢ New applicants are highly encouraged to contact a permit coordinator with the NCDENR
Customer Service Center.
Was the Customer Service Center contacted? El Yes ❑ No
➢ Analyses of source water collected
➢ Engineering Alternative Analysis
➢ Discharges from Ion Exchange and Reverse Osmosis plants shall be evaluated using a
water quality model.
17. Applicant Certification
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.
James Radford Owner
Printed name of Person Si ing Title
S.• ature of Applicant Date
North Carolina General Statute 143-215.6(b)(2)provides that.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.0 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)
Page 3 of 3 Version 5/2012

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AGC Greensboro,LLC NPDES Permit
Facility ,, )
Countryside MHP NC0056201
Location - z=� `••
Lat.:35°50'32"
USGS Quad Name:Glenola $ `'
Receiving Stream:UT to Caraway Creek Long.:79°54'48"
Stream Class:C North Randolph County
Subbasin:Yadkin-Pee Dee -030709
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