NC0088625_Renewal Application_20181005

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S_REGAN
Secretary
LINDA CULPEPPER
Interim Director
October 05, 2018
Thomas Roberts
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: Permit Renewal
Application No. NC0088625
The Hollows Subdivision
Surry County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 5, 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. 1506-3 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/permits-regulations/permit-guidance/environmental-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,
.36, Pw
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
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North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300

October 4, 2018
Mr.Wren Thedford _ "
NDPES Unit
DWR, NCDEQ
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Application for Permit Renewal
Aqua North Carolina, Inc.
The Hollows,Well #1 - WTP
NPDES Permit NC0088625
Dear Mr. Thedford:
Enclosed are three (3) copies of the completed application Short Form C -WTP.
This submittal includes necessary attachments for your office to renew the subject
permit.
Aqua North Carolina, Inc (AQUA) has reviewed the Division of Water Resource's
General Permit NCG5900000 for Greensand WTP Effluent Limitations and
Monitoring Requirements - Discharging to Freshwater, and AQUA hereby requests
that treated discharge from The Hollows -Well #1 be considered for coverage
under this General Permit. AQUA understands that if coverage under a general
permit is granted,the Division will rescind individual NPDES Permit NC0088625. If
coverage is not granted under the general permit,AQUA is requesting that the Total
Manganese requirement be changed to reflect a quarterly monitoring frequency
such as AQUA's"other WTP permitted discharge facilities.
Best Regards,
RECEIVED/DENR/DWR
AlkaAdA, 6ar
OCT:e52018
Amanda Berger
Manager, Environmental Compliance r sources
Permitting Section
cc: Laurie Ison
Joseph Pearce
Shannon Becker
202 MacKenan Court,Cary, NC,27511 • 919.467.8712 • AquaAmerica.com

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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 NC0088625
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 Aqua North Carolina, Inc.
Facility Name The Hollows Subdivision-Well #1 - WTP
Mailing Address 202 Mackenan Ct
City Cary
State / Zip Code NC/27511
Telephone Number [phone]
Fax Number [e-mail]
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same as above El
Street Address or State Road Lois Lane
City Mt. Airy
State / Zip Code NC/ 27030
County Surry
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 ORC)
Name Aqua North Carolina, Inc.
Mailing Address 4163 Sinclair Street
City Denver
State / Zip Code NC / 28037
Telephone Number [phone]
Fax Number [e-mail]
Page 1 of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FO •M C - WTP
For discharges associated with water treatment plants
4. Ownership Status: _-. . �____ ,. -
•
Federal ❑ State ❑ Private ►t Public El
5. Type of treatment plant:
❑ Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
El Ion Exchange (Sodium Cycle Cationic ion exchange)
Green Sand Filter (No sodium recharge)
El 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)
Groundwater Well
7. Describe the treatment process(es) for the raw water:
Raw water is treated by utilizing green sand filters with a 0.002 MGD discharge of filter
backwash wastewater. Chemicals utilized during the treatment process consists of
potassium permanganate, caustic, and chlorine.
S. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge is the backwash of the greensand filters. Discharge rate is
approximately 400 gallons per day. Wastewater is discharged at the location specified on
the attached map into an unnamed tributary to Stewarts Creek.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous El Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Approx. 20 minutes
11. Plant design potable flowrate 0.02736 MGD
Backwash or reject flow 0.00040 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Unnamed Tributary to Stewarts Creek (Yadkin Pee Dee Basin)
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments,-that have the potential to be-discharged. -- - - - -
Page 2 of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Alum / aluminum sulfate .,-- -- -.- Yes No X _,_ - - -- - --..
Iron
-
Iron sulfate / ferrous sulfate Yes No X
Fluoride Yes No X
Ammonia nitrogen / Chloramines Yes No X
Zinc-orthophosphate or sweetwater CP1236 Yes No X
List any other additives below:
Potassium Permanganate, Caustic-Soda, Chlorine 2-
14. Is this facility located on Indian country? (check one)
Yes ❑ No
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
o N/A
16. NEW Applicants
Information needed in addition to items 1-15:
• New applicants must contact a permit coordinator with the NCDENR Customer
Service Center.
Was the Customer Service Center contacted? ❑ 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.
Amanda Berger Manager Environmental Compliance, Aqua North Carolina, Inc.
Fri ted name of Person Signin - Title
_ " ---
4_,
-_. __ /0 _20-.1 =--- _- - . , ,.. . F„._. .
Si ature of A plicant Date
P
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.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) _
Page 3 of 3 Version 5/2012

NPUES PERMIT NO.:NC0088625 PERMIT VERSION:3M PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Suny
OWNER NAME:Aqua North Carolina Inc ORC;Not Required ORC CERT NUMBER.995491
GRADE.PCNC ORC RAS CHANGED:No
eDMR PERIOD:06-2018(June2018) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
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••••No Repotting Reason,ENI'RUSE=No Flow-Reuse/Recycle; ENYWTHR=No Visitation-Adverse Weather,NGFLGW=Wo Flow. HOLIDAY=No Visitauo'1-Hchday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS'Active
- - - _ _ - FACILITY NAME:The Hollows Subdivision CLASS:PCNC. -- - COUNTY:Sorry- - - - --
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:06-2018(lune 2018) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:07/23/2018
j . - ---0-7/20/2018-
ORC/Certifier signature: William Young E-Mail:btyoungaaquaamerica.com Phone #:7C4-507-3303 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 ofthe 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 II.E 6 of
the NPDES permit.
(...°\ en, 07/23/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mati.dtmcdaniel©aquaamerica.com Phone # [phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date.02/28/2019
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 ofthe person or persons who managed the
system,or those persons directly responsible for gathenng 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:Water Tech INC,Aqua NC
CERTIFIED LAB#:50 5035
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/psrnpdes/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 occurs 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.
- - - ----------- ---------— - - -- --- - --- - - - - -- -----
***Signaturem
of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per ISA NCAC 2B
0506(b)(2)(D). - -

NPDES PERMIT NO.:N00089625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME-The Hollows Suhdtvtston CLASS:PCNC _ - COUNTY:Surly
OWNER NAME:Aqua North Caro toe Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CIIANGED:No
eDMR PERIOD:05-2018(May 2018) VERSION.1 0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:NO
0000 05402 00060 CONS 00001 01040 011155 00010 51091
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•""No Reporting Reason ENFRUSE=

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:10 PERMIT STATUS:Active
— FACILITY NAME;The Hollows Subdivision CLASS.PCNC - COUNTY:Satry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER.995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:05-2018(May 2018) VERSION:1 0 STATUS:Processed
COMPLIANCE STATUS:Non-Compliant CONTACT PHONE N:3369929000 SUBMISSION DATE:06/26/2018
06/26-12018ORC/Certtfie Signature• William Young E-Mail•btyoung@aquaamerica,com 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 nf 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 II E 6 of
the NPDES permit ,/d
r `Cj 06/26/2018
Permittee/Submitter Signature *** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica cam Phone 1#.336-992-9000 Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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 ofthe 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.1 am aware that there are significant penalties for submitting false information,including the possibility of fines and bnpnsonment for
knowing violations.
CERT li•tbD LABORATORI
LAB NAME:Water Tech/Aqua North Carolina
CERTIFIED LAB 4:50/5035
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER e METER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://pottal.ncdenr.org/web/wq/swp/ps/npdes/forms
FOOTNOTES
Use only units of measurement designated in the ui facility's NPDES permit for reporting data.
*No Flow/Discharge 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 entire monitoring period
**ORC on Site?:ORC must visit facility and document visitation of facility as required per I5A NCAC 8G.0204.
***Signature ofPermittee:'Ifsigned by other than the permittee,then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
0506(b)(2)(D). -

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3,0 PERMIT STATUS:Active
_ FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Sorry
OWNER NAME:Aqua North Carolina Inc ORC:Not Rogutred ORC CIsai NUMBER:94549l
GRADE:PCNC ORC HAS CHANGED:No
cDMR PERIOD:05-2018(May 2018) VERSION:1.0 STATUS:Processed
Report Comments:
Mn exceeded the limit will extend the back wash to try and lower Imola - _ .. - . . _._, _... ._. _.,_ ____ -__. _
_.

NPDES PERMIT NO.:NC00S8625 FERMI!'VERSION:3.0 PERMIT STATUS:Active -
PACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua North Carolina Joe ORC No Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:04-2018(April 20:8) VERSION:1.0 STATUS;Processed
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
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:1 I
22
27 WI 0,15 Y 0.0004
24
25 ,
'
26 I
30
Te i29
34 J - 0,0004
61.erhb Mer.s..tn0. J6
tio.tbn Avt+ns= S 0,04 4.5 1.S2 0.S$$ 730 I
1
D•11 R1..Lnuno C 0004 1,5 5 4 5 1
10 1:3 730 L 4
11411• itl a.�a1 0,0004 7 45 4 13 2 10.165 700 66
•'•*No Reporong Reason-ENFRUSE-,No Flow-Reuse/Recycle, ENVWTHE a Nu V auatiun-Adverse Weather; NOFLOW-No Flow,HOLIDAY'.No Viscration-Holiday

- - NPDES PERMIT NO.:NC0088625 PERMITVERSION:3.0 - PERMIT STATUS:Active . ' `
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Suiry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:04.2015{April 2018) VERSION:330 STATUS:Processed
Outfall 001-Effluent Comments;
Reason for revision metals tenoning wrong

_ NPDES PERMIT NO. NC0068625 _ PNRMIT LF.RSION X3,0 PERMIT STATUS;Active - -
FACILITY NAME-The Hollows Subdivision CLASS:PCNC COUNTY:Suny
OWNER NAME:Aqua North Carolina Inc ORC:Not Requited ORC CERT NUMBER:995491
GRADE:?CNC ORC HAS CHANGED:No
eDMR PERIOD:0;1. (April 2015) VERSION.3.0 STATUS:Processed
COMPLIANCE STATUS:Castellani CONTACT PHONE#:[phone] SUBMISSION DATE:06/10/20(8
,F 06/08/2018
ORC/Certifier S gnature: Wil tam Young E-Mail blyoungrtaquaamenca.com 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 pemuttee 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 II,E.6 of
the NPDES permit.
( ( Ct�--� 06/10/20 18
Permittee/Submitter Signature:**', Dave McDaniel [e-mail] Phone 4:336-992-9000 Date
Permittee Address.Lois Ln Mount Airy NC 27030 Permit Expiration Date.02/28/2019
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:Water Tech
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal ncdenr.org/web/wgtswp/ps/npdes/Forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES pentut for reporting data.
*No Flow,Discharge 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 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 l5A NCAC 2B
,0506(b)(2)(D).

NPDES PERMIT NO.:14C0088625 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491- -
GRADE:PCNC ORC HAS CHANGED:No
eDNIR PERIOD:03-2018(:MMQreh 2018) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
52050 470 00060 coma 00951 41035 010.15 00070 01091
a +r L0
•
= _ _ Weakly 2 X month 2 X month 2 X month Quarterly Qautvly Monthly 2 X month plwnerly
a`
u o" L Estimate Giro Grab Grab Grab Grab Grab IGrab Grab
R.
'e l x
3 5 0 0 o 3 FLOW ,.a C1:L01(I1`4E —SS-Cos. n-70TAL IRON I MANCNESE !TUMMY LMC
74110 clerk Rn MO clock lin YAM m54 su unri mg' 421 ug+t 1u0 ntu WI
t I I s 1704 (
i !
3 I I 1 -
4
7 1
a +24 1427 0,02 Y 0 0004 i ,
5 _ -
}
10
it -
13 955 24 N 20324 755 4 1, 27 41 0.55
14
15
In
17
le
19
70 (( ,
21 I 7
31 54 1625 1 5' 0,0004
13
24
15 I I
16 -I
17 1000 24 N 0.0C lawc /, I?s i I 0,75
2.11 I
17 3 1 1
31 ! 1 I ! '
f
Mool6ly Arrreite Lnil 4 I 3}g 1 I
MonthlyAmrngr. 05004
I
125 +a6 27 S! 0.5
DallyMcelmuml 0,0004 8.05 3.4 27 41 0.55
126.111,126.111,Mlnloon 00004, :SS 17.
�2iiS { :7 4t 0.75 I
4•.x Na Reporting Reason•ENFRUSE-No Flow-Reuse/Recycle:ENVWTHR,-No Visitation—Adverse Weather;NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required _ ORC CERT NUMBER:995491 •-
GRADE:PCNC ORC HAS CHANGED:No
eDVIR PERIOD:03-2018(March 2018) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:G4125;2018
04/19/2018
ORC/Certifier gnature. W' am Young E-Mail,btyoung®aquaamerica.com Phone #:[phone]- Date-
By this signature,I certify that this report is aeLurate 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 time-table for improvements to be made as required by part ILE.6 of
the NPDES permit (•—•
(�
i (-Dc: 04/25/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel(ciaquaamerica.com Phone #:[phone] Date
Penruttee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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.Water Tech INC
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Umt(919)807-6300 or by visiting http-1/gc,{,.I_ .orev. 7.4,.. Linsiandforms_
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 occurs and,as a result,there are no data to be-s/e all of the pa-s•e`ers 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).

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME•The Hollows Sadivts.on CLASS:PCNC COUNTY:Sorry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED.No
eDMR PERIOD:02-2018(February 2018) VERSION:1 0 STATUS:Processed
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
52050 - 00400 50060 C0C10 00951 01045 00045 05025 most
z ,9 "- dc
y a F g i
3 WcckIy S X In9Rr0051112 X month 2 X month Quate:ly Quanuty Mon,nly 2 X mnnIn Quarterly
3 ! I 16 Z 1.. Ssolnele Grab Grab Grab Grab Grob Glob Grzb Grab
e ° Z u r
c C4 — O e O z FLOW pll CIII.OIt1NF. r54 rent F.feint. IRON fIANCNESE TUMMY ZINC
2400 dick W. 2400(lock Nn 'MN mgcl su uy./l mppl nit u10 me no ug/1
1 0.004
2
3
II
757 0 Y 0.0004
III I
010 0 43 Y 0,0004 7.54 10 3.4 1070 153 0.55
MI IIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
1111111111111 MIMI lll IIII
I i illill
20 1033 0 A 5.0204
21
22
23
24
25
26
22 806 0 85 y 341004 5.24 1 4.1 OA
25 j
0(000505 nrrrnte rami •0
MonlNr Arargr 01.1X,: Si 3.75 1000 ISS 0.475
nrayn20:Imam 0,0004 754 10 4 t 1090 153 0.55
0.115 fifnlm010ro•.00004 7.24 1 04 1e90 153 0,4
`•"NoReporting Reason ENFRUSE=No Flow-Reuse/Recycle; ENVWIHR=NoVisitation-AdverseWeather; NOFLOW=No Flow;HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3,0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry" - - -' - -
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC IIAS CHANGED:No
cDMR PERIOD:02-2018(February 2018) VERSION;l.0 STATUS.Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSIO)v DATE:03/27/2018
• , _ - . . „ _ _ 03/14/2018
ORC/Certifie ignature: William Young E-Mail:btyoung®aquaamerica.com 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 correchve actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
03/27/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica,com Phone #:[phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date.02128/2019
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.Water Tech
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 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 occurs 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(han the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B.
0506(b)(2)(D). -

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3 0 PERMIT STATUS:Active
3
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry __ ___ _ — .
ii OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:01-201H(January 20191 VERSION:1,0 STATUS:Pmcessed
I.
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
I
G •20050 03400 50060 C0530 00951 01045 0101.2 anon31092
. F B a G A
f
s e < A _ Weekly 2 X month 2 X month 2 X month 061xcter3 Quarterly Monthly 2 X month i Quarterly
Y s` L 8 I Estimate Grab ,Gran Gran Goon Grab Grob Grab Grab
. 3
o 5 5 o 0 ; SLOW IpJf COLORING TSS•Conc F-TOTAL IRON a7A,GNtik TUR0ID7Y TINC
2402 clad/ ION 2405 ciu,k ION YAWN inn 51 ,us/1 m551 ups bill uWl rots us/1
1
t
3
4
y
0 1522 0.02 Y 3.000: _
6
8
5 1005 .0.62 Y 0.0034 7 65 1 3,9 86 31 Ll
to
,
11
'
12
13
.
)4
12
16 I
L7
le 1029 3 Y 040304
19 I Y
20 1 . .1 _
II
22
27 1040 032 Y 0.0004 7.02 7 c 2.5 0 53
20
It
26 ! j a
I7 ` it
' I :I
x8 I I I[
I -1
i j
29 7 1 1
33 2
` I I i
31 1349 i!0 iY 1 ;a:t''
Hcamlr 0nno r
c Lha
,30
trtaut612•.Qaen ugo4 5 1.95 86 31 0 825
Dally Nrsai,aamr 00094 725 7 3.0 66 31 L1
tow h7lMnaml- 004 7.52 3 _0 06 31 055
'""NoReporting Reason.ENFRUSII=NoFlow-Reuse./Recycle, ENVWTHR=NoVisitation-AdverseWeather, NOFLOW=No Flow; HOLIDAY=No Visitation-HDilday•- -

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surly " "' • '`-
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:01-2018(January 2018) VERSION:l 0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE if:3369929000 SUBMISSION DATE:02/27/2018
Lr 4".., • 02/15/2018-
ORC/Certifier Si nature: William Young E-Mail:[e-mail] Phone #•704-507-3303 Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
Tne 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 S 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 II.E.6 of
the NPDES permit.
A
gli-42 [C02/27/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail"[e-mail] Phone #:[phone]. Date
Pennittce Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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.l am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for
knowing violations
CERTIFIED IED LABORATORIES
LAB NAME:Water Tech INC
CERTIFIED LAB 4:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMEIEK CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(91 r)807-6300 or by vibituig litip.//portal.nedenr.org/web/wq/swp/ps/npdes/forms.
FOi NOTES
Use only units of measurement designated in the reporting facility's N-PDES permit for...Ira,ono data.
*No Flow/Discharge From Site:Check this box if no discharge occur and,as a result,there are no dais 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).

i
NPDES PERMIT NO.:NC0088625 PERMIT VERSION.3.0 PERMIT STATUS.Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE PCNC ORC HAS CHANGED:No
eDMR PERIOD 12-2017(December 2017) VERSION:1 0 STA rUS:Processed
1
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
Ii
.- 2 R 0090 sorter 00069 0052lean)
5 - urs` 01044- ' = souuart MEM
L 9 a
' . I a t3 a
12.a 0 a 2 r Weekly 2 Xmonth 2 X month 2 X month Quarterly Quarterly Monti) 2 X mouth Quarterly
8 v it t o` �. Eshrualo Grab Grab Grab Grab Grab Grab Grab Grab
q u
a 'f„
s
4 o O g Z FLAW 0n fill 00114E TSS-Corr y.1.01,t1. 1n00i 61ANGNES'E TURDIDTY TMC
240001.4, IIn 2400 clam I41 Y'9I14 mgd Su 41 mrJA uel uar KA rain u5;1
I 0.0004_
2
3
4
5
6 24 943 0 Y 0 0004
7
R
4
19
11
12 24 944 025 Y 011004 8.14 5 3.t 0.282 0313 0_7
I1 ,
14 a
1S
16
17
IR
19 24 1540 n e 0.0544
20 L--
21
aa
23 -
24 1
25 I
26 I
27 1 ( I 1
28 24 1033 0.09 Y 0.0504 793 5 1,--29 1 I J 0,6
29 t
l
30 1 1
31 0 0004
41on161y ArrnRuLimlt• 13R 1
Monitor Arenaa, 00704 5 ISS :1.=2 123)3 OFS
Dn1lyMnlmuml 5,0004 8.14 5 3.1 0212 0313 0.2
12,112 Slblmumn 00004 7.96 5 0 0282 0.313 Ob
"}4NoReporting Reason.ENFRL'SE=No Flow-Reuse/Recycle; ENVWTHR—NoVlsItallon—AdverscWeathcr, NOFLOW=No Flow; HOLIDAY=NoVEsilalion—Elnhday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3 0 PERMIT STATUS:Active
- FACILITY NAME:The Hollows Subdivision ('LASS.PCNC - - - -COUNTY:Surry - ' _ -" "
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:12-2017(December2017) VERSION:1.00 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:01/12/2018
/7'
01/10/2018_
ORC/Certifi Signature: William Young E-Mail:[e-mail] 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 time-table for improvements to be made as required by part II E.6 of
the NPDES permit.
( (1 S.,04J 01/12/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica corn Phone #:[phone] Date
Pm-mitt=Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
I certify,under penalty of law,that this document and ail 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:Water Tech INC
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/wcb/wq/swp/ps/npdcs/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 occurs 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 ihe signatory authority must be on file with the state per I5A NCAC 2B -
.0506(b)(2)(D). -

NPDES PERMIT NO..NCOC88625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua Node Carolina Inc ORC:Nol Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eD.MR PERIOD:II-2017(November 2017) VERSION:l 0 STATUS:Processed
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:NO
- -- 30550 004011 - 35010 C0530 05901 01045 01045 40075 01092 "
N 9 F Z d
C I
I;
A F _ Weekly 2 X month 2 X morih 2 X month Qualtrly Quarts/1y Monthly 2 X month Chivied),
LEstnnale Grob Grab Grab Grab IGrab Grab Grab Grab
e 7.7. 0 i
-, U F C C O ty FLOW pll CHLORINE 555-Cone F-TOTAL. I IRON MANGNESE TURBIDTl' ZINC
2400 clod, On 2496 dook Hn V/004 meal on ur/1 meq bull be ug/I nlu °n/]
1 0.0004
2
3 I
a
5
6
7
11 030 C.27 V 00004 7.47 4 21 045
9
10
11
u
13 •
14 1150- 0 V 0.0004 w
u0
16 . - _ -
II -
IF -
19
221 4
21 I 1414 117 V 00504 7.75 4 00.5 0x5 7 03
22 1
23 1 I -
24 l 23
r5I 1
3 } ii
120 1 I 1155€ 10 B 0.5004
1 i I I
1� i r
!X lManlhly Arerap.Llm11 31
I Mon11415 Atga9a
80004 4 1.55 0 7 0 375
0.110 Ma:lmamr 0 0004 7.75 4 J,1 5 7 0.45
Dolly Minimum: 0
.0
004 7,47 4 0 0 7 0,3
CUSS No Reporting Reason.ENFRUSE=NoFlow-Reuse/Recycle;ENVWTHR=No Visitation—Adverse Weather,NOFLOW—No Flow, HOLIDAY=NoVisitation—Holiday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC - COUNTY:Sony - - • -
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:11-2017(November 2017) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PRONE#:3369929000 SUBMISSION DATE:12/22/2017
d-14 � 12/2 l/2I7
C
ORC/Certifier Si ature: Y fliam Young E-Mail:[e-mail] 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 wntten 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 II.E.6 of
the NPDES permit.
r -c- 'M 12/22/2017
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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:Water Tech INC
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may b=c :ie`by ,nigNPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of in a Wit-cit-.-ignared in me-e Iry ing facility's NPDES permit for reporting data.
*No Flow/Discharge 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 entire monitonng period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 80.0204.
***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). - - -

i
NPDES PERMIT NO.:NC0D88625 PERMIT VERSION:3M PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY;Sutry _ _ ._
OWNER NAME;Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:Nc
eDMR PERIOD; 10-2017(October2017) VERSION:1 0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
1 - _ -,.. -,.r MO- -- 99405 -'---s00w- - Cnsm most - 55005 01095
g a y o WroUy 2 X month 2 X month 2 X month Quarterly 04arteslu Monthly 2X month Quarterly
c 55
I u yt h p° !} O,umate Grab Grab Grab 0-ah C-ab Grab GrabCrab
0 2 A 5
n u �. O ; 01AW pH CHLORINE TIS-Cale RTOTAL, noon MAVCN6'S£ TUABID't'1' 051410
i 7450 dont lir, 2405 rinrt. Kra 001N mg(} su roll myll un4 4/1 0055 au :IV
I ,
2
+ 1606 0.'r3 Y 0 0004 7,52 4 n 2.5 56 157 0 b
4 t
.1 5
4
t 7
' y
i 0
9
t
0 ' 929 0.17 Y 0(400 '-
51
> Ix
52
54
t5
to
17 1003 0.03 Y 0,0004 ,
`
IS
19
25 3 I I
25
11
23 _
24 ( I
28 1457 9 87 V 0,0004 739 15 13,7 0 35 1
A6 I III
n
i
29 1 1 I
3 I
30 1429 10'5 0 1 0,0704 ? 8 i -
35 I 1
1114,n/Illy Arnaar Limb `ie j I!
Monthly Avrrogr. 0,0004
195 1.85 I 56 107 0.725
De11y61aalmtm' c,0004
7S9 15 3.7 56 107 0,85
Dolly Minimum,
3.5-44 7 52 I4 a 56 107 0.6
"""No Reporting Reason ENFRUSE=No Flow-Reuse/Recycle. ENVWTHR=No Visitation—Adverse Weather;NOFLOW=No Flow,HOLIDAY=No Visitation—Holtday,

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Surry' - --
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:10-2017(October 2017) VERSION:LOO STATUS:Processed
COMPLIANCE` STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:08/02/2017
- -/ /."--- ,4- ----- . -- .11/20/201.7
ORC/Certift r Signaturre:''William Young E-Mail•btyoungr®taquaamerica.com Phone #:[phone] Date
By this signature,I certify that this report is acc,uate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threater.s public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstance`.A wntten 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 1I.E.6 of
the NPDES permit.
11/28/2017
Permittee/Submitter Signature.*** Dave McDaniel E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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:Water Tech INC
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(9 L9)807-6300 or by visiting http://portal.ncdenr.orgiweb/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit iorrepai.ii.r data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,the-reare:la 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 80 0204
***Signature of Permittee.If signed by other than the pennittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0505(b)(2)(D). -

NPDES PERMIT NO.:NC0088525 PERMIT VERSION:10 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CLASS:PCNC COUNTY:Su
ny _ -
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD.09-2017(September 2017) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:NO
50050 03490 S0565 50531 00951 91049 01295 00070 01091
1 F r
s I ° a
e =
w X E Weekly 1X IRtn1111 1X month 2 X month Oharterly Quarterly blench y 2 X month Ouura;rly
g i5 i 9 - Es Ima19 Grab Gras Grab Grab Grab Grab Crab Grab
e ,
7 t: 0 O O s. T PLOW pH CHIORINI' Cn
TSS- nc 5-TOTAL IRON MTUMID TUTY ZINC
`
5400 rink Ws 2400 clock I Firs YRION ntgd Sa 4/1 'tr0';I os/I _ Vet U•I 9Iv ugh
_........._. 0,0004 _ t
011004
11 C
12 1002 095 Y 0.0004 7.411 R '-2.5 01 IRs 1.2
14
IS
17
In
19 1642 0 Y 3.0004
29
1I ,
22
23
'
24
25
26 944 0,42 Y 011304 7,95 4 S 0,75
i.- I
I
20 I
I
in i
1 I
A 1
1 Monthly Avn+ae Limit/ 3C
M4.nr.11 Ater•gr_ 0,0004 6 7.5 71 195 0975
Daily M.[Imu at 00504 7,95 0 5 9' 185 8.2
aunt Minimum: iIo054 7,49 4 0 91 140 _i.75
••"NoReporting Reason.ENFRUSE=NoFlow-Reuse/Recycle; ENVWTHR=NoVisitation—AdverseWeather. NOFLOW No Flaw, HOLIDAY=Nn Visitation—Holiday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:The Itolk`nvE Subdivision CLASS:PCNC COUNTY:Sorry -- - • `
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:09-2017(September 2017) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:10/29/2017
-J J - - - . . . . .10/23/2017 -
'ORC/Certifier S`gnaturet <Mem Young E-Mail:btyoung@aquaamerica coin Phone #•704-507-3303 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 time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
j10/29/2017
Permittee/Submitter Signature*** Dave McDaniel E-Maii•[e-mail] Phone #•336-992-9000 Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
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:Water Tech INC
CERTIFIED LAB t#:50
PERSON(s)WLLECTINGSAMPLES:William Young
PARAMETER CODES
Parameter Coce assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms,
FOOTNOTES
Use only nes of measucc rein designated in the reporting facility's NPDES permit for reporting data
No FloweDtscharge 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 entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
**"Signature-of Permitter: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).

NPDES PERMIT NO:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME.The Hollows Subdivision CLASS:PCNC COUNTY:Surry
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:08-2017(August 2017) VERSION:1 0 STATUS:Processed
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
• - . - `
~ t 50050 00010 50055 CO000 02951 01045 alias - - •'000m 01092-
I r
`e
7 F
A8 e s Weekly 2 X month 2 X month 2 X month Quarterly Quarterly Monthly 2 X month Oua uriy
Y. E L
5 u 0 2 0 $ Ect;mate Cm Grab Gras Grab Grab Grab Grab Grab q u° - D b c A' PLOW pH CHLORINE TSS-Cant- FfOTeL IRON hUNGNESE TURDIOTY MC
2400 clack II., I 00
1400 clad, Sl11, 50111N byr1 W ag/I 'r :roll ail/6 WI 0000 oA
I
I ,5%14 ggg € -
1 I I
s
5
k
7
,
0 744 1.28 Y 0.0504 7.S 8 o2.5 Ll
9
Li
11
t2
t-3
14
15 0 9004
III 11 i
is ,1
21
22 1952 0 8/1 Yt!r11,04 7.4: '2 .3.4 15 127 1.2
23
14
15
15 I i
17
1 { ! -
x5 I ( I
19
r.' I
1a i
11 I r i I
Mrnstkly Art.ace L.-1, ; 130 -
1laarkiy nvt-rv::r00000 la la 15 327 LIS
Dolly Maximum 0,0004 7 8' 12 3 4 15 327 1.2
Deily 4141i4um00034 7.47 8 C 115 277 1.1
''".No-Reporting Reason:ENFRUSE=No Flow-ReuselRP ecycle, ENVWTHR=No Visitation—Adverse Weather,, NOFLOW=No Flow, HOLIDAY;No Visitation—Holiday

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME.The Hollows Subdivision CLASS:PCNC COUNTY:Sunt'
OWNER NAME:Aqua North Carolina Inc ORC:Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:08-2017(August 2017) VERSION:1.0 STATUS.P-ocessed
COMPLIANCE7STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:09/252017
i 1,1, --- '' `�• y' 09/19/2017
ORC/Certifier ignature William Young E-Mail•btyounga>aquaamerica corn 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 time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
ccal 09l25/2017
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica corn Phone #:[phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
I certify,under penalty cf 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 or.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:Water Tech INC
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:William Young
PARAMETER CODES •
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visaing;tip:/iipornii.ncdenr.org/web/wgfstvp/ps/npdes/forms
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for rcportirm docs.
*No Flow/Discharge 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 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). - - -

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME.The Hollows Subdivision CLASS:PCNC COUNTY:Surry -_ ._ - .
OWNER NAME:Aqua Nortli Carolina Inc ORC:Not Re.quircd ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDM.R PERIOD:06-2017(June 20 17) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
1
19640 110750 50Lull COME 3 00941 01015 41005 914770 01097
E n ••
1 e
F &
e` Y
E u Weekly 2 X month 2 X moth, 2 X mannl Quarterly Quanex4 Moat41y 2 X 1010th Quadcrly
e f. r. a
v j n Eshrmic Grab G-ab Grab Grab Grab Crab Grab UrnE 3 x a
C L F O O x FLOW pH CHLORINE ISS•Lane F-Tr7TAl IRON \rARCRFSC TIIROI=I.1' ZINC
2400 c1xk lin ,2400 ehnrk 1 Ho YI0/N mad Ill urs/ Ing/1 I U5rl VLT/I 95I Diu spit
€.0004
t I
2
0 ( '
4
0 0 0004
n
1
9
-19
it
12
20 - 1017 .25 Y 0,0004 779 10 4,1 55.9 04.4 c-3.5
14
15
16
17
18
19
10 0 0004
21
22
22
74
29
26
77 1615 25 Y 0.0004 7,50 9 4 2 5 0.0
211
50
NInmiiy Aecr90e LIN, an '
`
Monthly Areeege, 071024 9.5 204 SSA 04,4 0 825
n.nyafnilmum 00004 _7,79 10 4,1 55.9 944 0.95
5911081,10099 00004 7.56 9 0 155.9 944 0.9
"•* HNFKUSIS=NoFlow-Reuse/Recycle,ENVWTHR—NoVisitation—AdverseWeather. NOFLOW=No I•low, HOLIDAY=NoVisitetion--Hotidoy

NPDES PERMIT NO.:NC0088625 PERMIT VERSION:3,0 PERMIT STATUS:Active
FACILITY NAME:The Hollows Subdivision CF.ASS:PCNC - COUNTY:Suny- - - -
OWNER NAME:Aqua North Carolina Inc ORE'Not Required ORC CERT NUMBER:995491
GRADE:PCNC ORC HAS CHANGED:No
eDMR PERIOD:06-2017(June 2017) VERSION:1 0 STATUS:Processed
COMPLIANCE STATICS:Compl'ant CONTACT PHONE 4:3369929000 SUBMISSION DATE:07/26/2017
07/20/20.17
ORC/Certifier ignaturc: William Young E-Mail•btyoung@aquaamerica,com 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 potent:ally threatens public health or the environment.
Any information shall be provided orally within 24 hours from the tune 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 II.E 6 of
the NPDES permit. '
a-G. iII' CI(-0 07/26/2017
Permittee/Submitter Signature:*** Dave McDaniel E-Mail [e-mail] Phone #:[phone] Date
Permittee Address:Lois Ln Mount Airy NC 27030 Permit Expiration Date:02/28/2019
I certify,under penalty of taw,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 ern aware that there are significant penalties for submitting false information,including the possibility of fines and Imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Water Tech INC
CERTIFIED LAB#:50
PERSON(sI COLLECTING SAMPLES:William Young
PARAMETER CODES
?ammeter Code assistance may be obtained by calling the NPDES Unit(91.9)807-6300 or by visiting http://portal ncdenr,org/webiwq/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 occurs 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 penntttee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D). -