NC0088501_Renewal Application_20181005

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S_REGAN
Secretor
LINDA CULPEPPER
Interim Director
October 05, 2018
Thomas Roberts
Aqua North Carolina Inc
202 Mackenan Ct
Cary, NC 27511
Subject: Permit Renewal
Application No. NC0088501
Stonington Subdivision -Well #1
Forsyth 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,
itintiit,ge-cIPM
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
11-57----EQ�)
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300

L
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.
Stonington Subdivison,Well #1 -WTP
NPDES Permit NC0088501
Dear Mr. Thedford:
Enclosed are three (3) copies of the completed application Form C-WWTP. 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 Stonington-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 NC0088501.
Best Regards,
AAA, RECE9VED/DENR/DWR
a"t( OCT 0 5 2018
Amanda Berger Water Resources
Manager, Environmental Compliance Permitting Section
cc: Laurie Ison
Joseph Pearce =
Shannon Becker
202 MacKenan Court,Cary,NC,27511 • 919.467.8712 • AquaAmerica.com

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 NC0088501
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 Stonington 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 ❑
Street Address or State Road Stonington Way Court
City Kernersville
State / Zip Code NC/ 27284
County Forsyth
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 4 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - HTTP
For discharges associated with water treatment plants
4. Ownership Status:
Federal ❑ State ❑ Private ® Public ❑
5. Type of treatment plant:
❑ Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtrationand disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
® Green Sand Filter (No sodium recharge)
LI 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 greensand filters in series with a 0.0021 MGD discharge of filter
backwash wastewater. Chemicals utilized during this process consist of:
• Potassium Permanganate
• Chlorine
• Caustic soda
S. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge from said treatment works at the location specified on the attached
map into an unnamed tributary to Abbotts Creek, classified WS-III waters in the Yadkin-
Pee Dee River Basin.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous ❑ Intermittent
r
If intermittent:
Days per week discharge occurs: 7 Duration: 75 minutes (average)
11. Plant design potable flow rate 0.02088 MGD
Backwash or reject flow 0.00075 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Unnamed Tributary to Abbotts Creek (Yadkin Pee Dee Basin) -- -- -
Page 2 of 4
Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
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
Fluoride Yes No X
__ Ammonia nitrogen_/_ChloraminesYes No X
Zinc-orthophosphate or sweetwater CP1236 Yes No X
List any other additives below:
Chlorine
Potassium Permanganate
Caustic Soda
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
Printed name of Person Signing Title
A1/vt,Cv CtA- D ( i-4 12(0(
Signature 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 iecoiding oT monitoring de"vice br"method'required lb 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
Page 3 of 4 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
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 4 of 4 Version 5/2012

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NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Wel1-#1— _CLASS:PCNC__ - COUNTY:Forsyt - _ „_
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-I ORC HAS CHANGED:No
eDMR PERIOD:09-2017(September 2017) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
t 50050 00400 50067 C0530 01045 01055 00070 01092 I
03
o` L
0t E a F 2 T Weekly 2 X month 2 X-ion:^ '2 X month Quarterly Monthly 2 X month 0t•erterly
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ti @ G & e. Estimate 'Groh Grab Grab Grab Grab I Grab Grab
7. z k
c u F D o no i FLOW OH I CHLORINS TSS-Gene IRON 102ANGNFSE TJtOIDTY 1 ZINC
:400 don Ho 2400 51ert. ISirs WIWI I mei S0 a;fi mg!! utll 'aeiI situ Inv/I
I
I
2 f
3 - I
4
5
6 700 I 00 Y 0.00036 7.5 I 8 <25 50 28 0.65 693
7
8
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>> I 1
12 j
12 I 1730 1.50 Y 0.0005
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16
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7.0
29 I
30 1 I
Monthly Avenge Llm:t. 30 1
7.6mthl>A,- 0.000462 55 2 50 .28 1J25 1693
. __ -_ ---_ _ __. ___ -0.11501sxlmum, 0,00053 7.5 -- --8'- - --4— -- 50 - --- 28 --- 1.6 695 -- - --- - -
0.11>nnmmam 0.00036 73 3 0 SO 28 055 693
""No Reporting Reason.ENFRUSE=No Flow-Reuse/Recycle. ENV WTIIR=No Visitation-Adverse Weather, NOFLOW-No Flow. HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC00SS501 PERMIT VERSION:3.0 PERMIT STATUS:Active
- FACILITY NAME:Stonington Subdivision-Well?`'1 --CLASS:PCNL _, COUNTY:Forsyth--_--
OWNER NAME:Aqua North Carolina inc ORC:Peter Ray Dealing ORC CERT NUMBER:994041
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:09-2017(September 2017) VERSION:1.0 STATUS:Processed
COMPLIANC ST_ US:Co' •:•_it CONTACT PHONE#:[phone] SUBMISSION DATE:10/29/2017
ORC/Certifier Signature Peter y Dealing E-Mail:PRDealingeaquaamerica.com Phone #'336-992-9000 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 Reg:onal 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
0as—r C
1 0/29/20 17
Permittee/Submitter Signature:*** Dave McDaniel E-Mail'dtmcdaniel(a3aquaamerica corn Phone 4:336-992-9000 Date
Permittee Address'Stontngton Way Ct Kemersville NC 27284 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 Tee Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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.- ' _— • _` - ---__- - ' - - - ----- -
__-- ' RC-on.Site7;_OR-Gmust visii:facili-ty-andsloc meni_visitation-. facility_assequired,per_1Sf,NCAC B.G,_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.:NC00S8501 PERMIT VERSION•3 0 PERMIT STATUS:Actrve
- FACILITY NAME:Stonirigton Subd.vision-WeII'#I-"•CLASS:?CNC- ----- - - '' '—COUNTY:-Forsvth ..-- " -
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE.PC-1 ORC HAS CHANGED•No
eDMR PERIOD:10-2017(October 2017) VERSION:1 0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
`s -
50055 05425 50060 IC0530 01045 01050 011070 01092a `
iz
'- - o`
— 1 _ a 17reek1y 12 X moth 2 X month 12 X rnn'o:h Q.a-rcrly Monthly 3 X mo-lb Qustrly
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4 730 I09 Y I 0.33247 7.5 3 <2.5 209 54 2,3 1292
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______ _ _ __ `,ionlhl7 Arerogc• y - t __ ___ -
00047B - _2 05 209 - 54 2.05• - 1290
Dailynirulmum 41 209 54 2.3 12_0
0_01151_: _ .7 7 5-
111.x7 Minimum 0L09.04 75 3 0 294 54 1..8 1290
**'*No Reporting Reason.ENFIWSE-No Flow-Rcusc/Rec}cic, ENVWTHR No Visitation-Adverse Weather, NOFLOW=No Flow, HOLIDAY-No Visitation-Holiday

NPDES PERMIT NO.:N00088501 PERMIT t•ERSION:3 0 PERMIT STATUS:Active
-"FACILITY-NAME:-Stoningtor.Subdivision-Well#1- CLASS:PCNC - - - COUNTY:Forsyth _ - - _.
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:10-2017(October 2017) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:11/28/2017
-12
_11/2-2./2017_1,
ORC/Certifier Signax re; Peter Ray Dealing llvfail-PRDealingaaquaamerica.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 tune 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
c'Li 11/28/2017
Permittee/Submitter Signature•**'` Dave McDaniel E-Mail:[e-mail] Phone #:336:992-9000 Date
Permittee Address:Stomngton Way Ct Kemersville NC 27284 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 Tee Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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. - - - - - - - -
__ ----,--. :fSf_OR-6-ori=Site7-nQRC-mustwisit facility-and doeument.visitation-of facility assequired 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.:NC0088501 PERMIT VERSION•3 0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Well#1 CLASS:PCNL COUNTY:Forsyth -
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-] ORC HAS CHANGED:No
eDMR PERIOD:12-2017(December 2017) VERSION:1 0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
S00S0 00400 %060 C0530 0164S 01055 06076 01092
1.E
P Ve
D
e a I Weekly 2 X month 2 X month [2 X month Quarterly Monthly 2 X montr Quarterly
y < F r
i. u - c 8
a
Estimate Grab Grab Grab Grab Grab Grab Grab
a
C :.i t; o ., o z 01.0W 7111 outman TCS-Cont IRON oiANGNESE TUILBIDTY ZINC
2460 clnck 11r7 24.111 dock 111-4 Y/6M Imad 5u uo'l mg/1 ug/I act, ntu ugrl
0 I - _ I
0
. }II
6 + I 735 1 1.110 Y I a 00046 7.118 I 1 <2.5 30 1440 0,6 <10
7 I I I
a I I
9 I .
10
11 I
12.
13 730 1.50 Y 0 00244 I 1 I
14 I
IS I
-
16 ( I I
17
1€ I I I I
19
20 730 r 00 Y 0.00044 7.96 19 <25 0.75
21
22
23 I
34
35
2E I I
37 715 30 Y 0.00041 I
26 I I
29 1
30 I I I
31
Monthly Ar4rrir 131411. 39
- _ ____r_,. _
91461111y A7'44"5.1 0.000439 10 0 30 1410 0675 0
I1.0y minima, 0.00041
7.88 1 0 y 30 1 1440 06 0
•"•No Reporting Reason.ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Well#1 CLASS:PCNC COUNTY:Forsyth -
OWNER NAME:Aqua North Carolina Inc ORC:Pete:Ray Deaimg ORC CERT NUMBER:994048
GRADE:PC-I ORC HAS CHANGED:No
eDIVIR PERIOD:12-2017(December 2017) VERSION:1 0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:01/12/2018
r
_ i �_, / i _ _ - -- _, 01/12/20.18_=
ORC/Certifier Signature• Peter Ray Dealing E -Mai1:PRDealing®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 proviaed 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 peann'
c____GL. 4
/1004/re ill
01/12/2018
Permittee/Submitter Signature:*** Dave McDaoie1 E-Mail:dtrncdaniel®aquaamerica.com Phone #:[phone] Date
Permittee Address:Stonington Way Ct Kemersville NC 2725 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 evaluatehe information submitted.Based on my inquiry of the person or persons who managed the
system,or those persons directly responsible for gathering the nfornation,the information submitted is,to the best of my knowledge and belief,true,
accurate,and complete.I am aware that there are significant p nalties for submitting false information,including the possibility of fines and imprisonment for
knowing violations.
ERTIFIED LABORATORIES
LAB NAME:Water Tec Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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/svrp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting faci`ity'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 penod. - •- •
�"•__="IOREnnte?
SiFORi✓riiust-visit facility,and=documehtwisitatioti of facility as required-ptr-15A-NCAC 8G.0204:---,,--.-.7'-',---- -:,-.---
***Signature of Permittee:If signed by other than the pea-mitt 1 e,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).
l
i
1

NPDES PERMIT NO.:NC00088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME-Storington Subdivision-Well Ol CLASS:PCNC " COUNTY:Foisyth •
OWNER NAME:Aqua North Carolina Inc ORC'Peter Ray Dealing ORC CERT NUMBER 994048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:01-2018(January 2018) VERSION:10 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
j1j Fear 00000 50060 ICOc70 01040 0105S 00070 01072
i.
e F = i
E v.
,-°o 31lz
x la Montnl 2 X month Qoarin;ly
R: !E r.
`c o pn 1 Estimate, I Grab Gran Grab I Grao 'Grab Graft Grab
C•
c E. S• e FLOs4 pHCHLORINE ITSS•Conc IRON MAR055SE TLnumaTY EINC
G
2400 cluck Or, 2400 dock lir. (1111P. I mad 00 11V1MOu,/l ue/1 010 ono
11 1 - 1
2 I I I
(4 1 1735 0,50 Y 0.00354
f
1 -
a 1
t7 1
is 1 f
9
110 I 640 1.25 Y 0,00331 17.45 16 <2.5 1 101 3/.4 L4 ,
1f1 -
12
13
141
IS
l6
I7 ,50.1 3 75 T' 0 00054 1
Ili I 1 1
Iv 1 -
20 1
21
22
25 1 _
14 730 1 Y 000034 5 3 <2,5 0,45
25 .
26
27 1 .
26 I 1
19 1 1
30
31
_. "- _ Monthly/.43,Re Umlt 30
Monihy Menne 00,0432 95 0 101 - -- 364 _ --0925___. - _ ___
_ .._. -,-"..4.7::---,,,,,-_ n.olht::10000: -- - - - ---- -_ - -_- - _i01___s_.. _164._..-_ _.A
,..1..!"-;-.-n- s,...:-.. __.__ *..,--�.�--,.�_,..__ _ �-..._._0n005Q sr�'�__8- - 16 0-- —• —_ -
nay Mlnlm"m 000031 703 ` 13 0 - 101 36,4 0,45
""No Reporting Reason ENFRUSE=No Flow-Reuse/Recycle,ENVWTHR=No Visitation—Adverse Wedther,NOFLOW=No Flow, HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO:NC0088501 PERMIT VERSION:3 0 PERMIT STATUS.Active
FACILITY NAME:Stoningion Subdivision-Well el CLASS:PCNC COUNTY:-Forsyth. . . . -
OWNER NAME.Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:01-2018(January 2018) VERSION:1 0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:02/27/2018
- 02/02/2018
ORC/Certifier Signature: Peter ay Dealing E-Mail:PRDealingaaquaamerica.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 environnfent.
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.
, CD_ 02/27/2018
Permittee/Submitter Signature *** Dave McDaniel [e-mail] aquaamerica.com Phone #.[phone] Date
Permittee Address.Stonington Way Ct Kernersville NC 27284 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.Bascd 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 Tec Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
PARAMETER CODES
Parameter Code assistance maybe obtained by calling the NPDES Unit(919)807-6300 or by visiting http•//portal ncdenr org/web/wq/swp/psinpdes/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-facile nd-documentwisitation=of facility-as.required-per 1.5A-NCAC.8G
***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.:NC0088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdtvis,on-Well Rt CLASS:PCNC COUNTY.Forsyth
OWNER NAME:Aoua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER;9940d8
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:02.2018(February 2018) VERSION:1.0 STATUS.Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
40050 00400 000W C0030 1 CIOas Olson 01070 01592
U °s ,
G e
v 2 s •Weal, 2 X month 2 X month 2 X month I0031401l0 I Monthly 2 X month Outman),
E J
u_` _ o E Estimate I Grab Grab I Grab I Grab Grab Grab Grab
S.6 E t C C
V {= o o e Z F:.ow VH CHLORINE TSS-Gene IRON KANGnESE I7U/21110TV ZINC
2400 deck I II 2400 clock 11n 901059 Brae 1a 4/1 mgr' JO yost Iota u-C{t I
1 I 000 0 0 Y 0.5 t
0230 1
2 l I I I I I
5 I I 1 I I 1
z
i' 1 1
J _ _
7 1730 1,57 Y 0.03039 796 3 <2.5 262 47 I 045 922
F
I9 I I
110
I2 I I
17 I I v
2 I
14 I730 0.6E Y [ 0,0004 I
I 15 I I. -
16
17 I I I l
F I I I I
19
20 I 1 I
21 700 t 00 Y 0,00036 7 25 9 <2 5 10 4
22
77 I 1
24
24 I
26 I , 1 I
27 1 1 I I
20 I I 1600 0,90 Y I 3.00041 I I
r
Monthly Arernke LImIL 30 I
Monthly Avcn F4- 0000306 4 0 26.2 47.1 10,425 92.2
Dolly Maximum.
000041 796 9 0 262 471 045 92,2
Dilly l:tlnlmam 0 00036 7,25 3 0 26 2 '47 I 0 4 92 2
eir No Reporting Reason ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC00885C1 PERMIT VERSION.3 0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Writ#1 CLASS:PCNC COUNTY:Forsyth
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:02-2018(Pebruaty 2018) VERSION:1 0 STATUS:Processed
COMPLIANCES STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:03/27/2018
03/26/2018
ORC/Certifier Signatu>e: Peter Ray Dealing E-Mail.' [e-mail] Phone #,336-992-9000 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.
CL. CZ-0j 03/27/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica,com Phone #.[phone] Date
Permittee Address.Stonington Way Ci Kernersville NC 27284 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 impnsonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Water Tec lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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. - -
**OR—C-on ORC—mustvisit facility and document visitation of facility as required per 15A NCAC 8G,0204
***Signature of Permittee:If signed by other than the perrnittee,then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3.0 PERMIT STATUS•a.cttvc
FACILITY NAME:Stontrgton Subdil talon-Well fit CLASS:PCNC COUNTY'Forsyth
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048 -.. -
GRADE:PC-1 ORC HAS CHANGED:No
eD)47R PERIOD:03-2018(March 2018) VERSION:1 0 STATUS.Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
-' 50010 OMB 159960 cavo 01044 - 9109 nrt
anot ale
E _
I
: s ? V,eridy 2 X month 2 X month 2 X month 10ucterty Monthly 12 X month Ouartrly
a I:I'- - - c S Estimate Gmo 1 Grab Grab 1 Grab Grab 1 Grab Gab
2 0 a c e
Z iJ O o z FLOIt pit CHLORINE (SS•Com IRON MANGNESE TURNIP CY ZINC
2400 Hoek Era 2400 dark Ors l'BN I mgd jso =II ,mJ WIoils nlu WI
1 I Ifo 1
I
4 I I I — I
5 1 III
6 1
-
7 I 703 -1.92 Y 0 00037 111117 79 3 '2_5 <5 4.53 0-9 163
8 1
9 1
10 1
11 1
Il
13
44 926 8.5 Y 000046 •
I5 1
116 1 -
17 I 1 1 •
L
I In
-
19 I 1 ,
Ila
21 730 1 00 Y 0.00037 7.94 1 <2 5 1.i
-
t2 1
123 I . .
125 _ I I I -
26 1
17
28 1713 0 5 Y 0.00043 I 1
29 I
30 I
31 - 1 _
NIonihh Averuac Lnot'v no
Konlhty Avernge 0.000408 2 0 0 4.52 I :63
HMI}MP API oro. D 90946 7.94 3 0 0 4 52 __1.1 163 _ - -
Noll.Nanlmnn• 1779.-_ 1._ - _ ..,. 0 _ _ _ _- 0 - 432 0 9 _ _ 163--_— -_i.__.
"*#NoReporting Reason ENFRUSE=NoFlow-Reuse/Recycle, ENh'WTFIR No Visitation-Adverse Weather NOFLOW-No Flow, HOLIDAY=No Visitation-Holteay-

NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Well rl CLASS:12CNC COUNTY:Forsyth
'OWNER NAME:Aqua North Carolina Lnc ORC:Peter Ray Dealing ORC CERT NUMPER:99404
GRADE:
- -
GRADE:PC-i ORC HAS CHANGED:No
eDMR PERIOD:03-2018(March 2018) VERSION:1 0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:04127/201804/26/2018
ORC/Certifier Signature- Peter Ray Dealing E-Mail:PRDealing®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 corrective actions being taken and a time-table for improvements to be made as required by part II E.6 of
the NPDES permit.
04/27/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Marl:dtmcdaniel®aquaamerica.com Phone # [phone] Date
Permittee Address:Stonington Way Ct Kemersville NC 27284 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 LABS INC.
CERTIFIED LAB 0:50
PERSON(s)COLLECTING SAMPLES:PETER DEALING
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/sv,p/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.— --
***Sienalui e of Permittee:If signed by other than-the peril ittae;theirdeiegatimroftht-Ef itatoiyauthonty-musrbe-on-file with-the-state per-1-5A NCAC 2B- —---•___ _.
.0506(b)(2)(D).

NPDES PERMIT NO'NC008850I PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:Sinninglon Subdivision-Well 41 CLASS:PCNC COUNTY.Forsyth
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED:No
T
eDMR PERIOD,04-2018(April 2018) VERSION: 1_0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
: MO 150450 4060 col1as 01545 ai05c 00070 101092
ey E e s. y
F F_ o° 0
-
e W eekl. 12 X month 2 X manta 2 X month I Quatturiy ivlorlhly 2 X month I Ouartc v
E 7 1` 0
v t eo° E Est tome 'Grab Gran 1Grab Grao Grab Grab Grab
° a FLOW 511 CITLOPINE I1 RC•Coo. IRON r�JvN42RE5E TURBID re I ZINC I
C V f O C O L _
12475 clad' I Ura 2404 clad Or, 01001 mid _sit ug/1 Img/ I UFll argil niu I uyll
L I I
2
I �_ I 1
,^ 525 24- 125 I Y 10.00036 17.94 I4 <2.5 <25 <5 1045 997
4
l i ,
I i I
a
10 II .
11 124 1646 071 Y 000046 j
12 I ! I
13 I
I
14I - - I
IS I -
16 j - I I
17 1
i6 al5 24 013 OM Y I 0,00037 764 II <2.5 0.5
19 I
20 1 1
21 I ....
1 '22 I23 I
74
2$ 24 1227 007 I6 0.00045 1 _
76 I '
27 1 I I 1 1 I I -
2R -
29 I
30 I I
Manthlr At treat Llmll 1 311
Morthl.41ernpe 00504 2 6.5 0 0 0 0475 997
t}.d 69n:imus- 000044 7.94 9 IS 0 0 0,5
Pall.a1m'mnm ___10______ _ n 0 I OAS 99.7
""NoRepo-trig Reason.ENFRUSE—No Flew-P.cesc/Recycic' ENVW HR—NoVtcrtauon--AdverseWeathe; NOFLOW=NoFWa, HOLIDAY-NoV1sItatton=Iiolieay

NPDES PERMIT NO.•NC0088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
• - FACILITY NAME:Storni-Con Subd:blston-Well#1 -CLASS:PCNC - - COUNTY:Forsyth--- - -
OWNER NAME:Aqua North Carolina Inc ORC.Peter Ray Dealing ORC CERT NUMBER:99d048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:04-2018(Ap-il 2018) VERSION: 1 0 STATUS:Processed
COMPLIANCE STATUS:Comahart CONTACT PHONE 4:3369929003 SUBMISSION DATE:05/23/2018
05/17,'2018
ORC/Certifier Signature: Peter Ray/Dealing E-Mail.PRDealtngc0aquaan:erica.cem 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
05/23/2018
PermitteeiSubmitter Signature:**" Dave McDaniel E-Mail.dtmcdaniel cr aquaamerica corn Phone #.[phone] Date
Permittee Address:Stonington Way Ct Kemersville NC 27284 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 tnose persons directly responsible for gathering the:nformadon,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 Tec Lab
CERTIrIeD LAB 4:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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 mgnitonng-period_
-'----_-----*-*-ORCo-r-Site9'-ORC-must-visit faciltu-and documentvisitation•o-f-facilit3as-required.per--lS ICAC-$G-,0204.,e«—
**' Signature of Permittee"If signed by other than the pemtiltee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
0506(b)(2)(D)

NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Well#1 CLASSi PCNC -- •"-- COUNTY:Forsyth
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC_I ORC HAS CHANGED:No
eDMR PERIOD:05-2018(May 2018) VERSION.1 0 STATUS•Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
501196
1004D1i 50700 00530 01045 D1095 00070 01092
',i E = e
• G F y
24 O E
T E e e a ;, World, 12 X month 2 X month 2 X month Quanerlr _1 Monthly 2 Y.month Quarterly
= F_ 0
_ s
` Estimate IGrab Grab Grab Grab IGrab Grab 'Grab
c` V F O
E $ x
O Z FLOW 4yI1 ICIILORINF, T55-Cone ]RON IMANGVESC TLRIIIDT• ZINC
O
I 1
:400 clock IDoA 2405 r1bd. lir. 5/nN m,d Isu ALS mdl ug/I inti nhr ,15/I
1 I I I - 64
I {I
0•0705 +a2 13 '-23 1a25 <5 0.'
U I v
4I � I '
s IlI
1
I
6 1
1 I
A _ .
9 1631 0.95 Y I 0,00546 -
Io
1
31 I 1
12 j 13
14 I ,
15 1 ,
16 711 098 Y 0.00036 7.65 ,6 1<2.3 0'25
e
IA —
19 - I
20 1 . . .,.
21 "
22
23 I 640 0.92 -Y 0 00044 ,
24 -
25
27 I I
28 I
29 I
36 711 0.77 ,Y 000C39 -
31 n "
Monthly A•er.Ae Limn 30
h7onihly Avrn0r0.000404 4.5_--- 0 0 0 0.475_- _64 - . __ .. -
Drily M.rlmum 6 0 0 0 07 64 -
y,.,....-__��-,..r --_._; :4.
!UR Minimum: 0.00036 765 3 0 6 0 025 64
"•"No Reporting Reason FNFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Aeserse Weather,NOFLOW=No Flow, HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:'400088501 PERMIT VERSION:3.0 PERMIT STATUS:Active
FACILITY NAME:Stonington Subdivision-Well n1 CLASS•PCNC - COUNTY:Forsyth _ — _ . _ -
OWNER NAME:Aqua North Ca okra Inc ORC:Peter Ray Dealing ORC CERT NUMBER:99,1048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:05-2018(May 2018) VERSION:1 0 STATUS:Processed
COMPLIANCE STATUS:Compliant
CONTACT PHONE#:[phone] SUBMISSION DATE:06/262018
✓,/ / ,1`— . " 06/26120 1 8
ORC/Certifier Signature: Peter Ray Dea`iing E-Mail:[e-mail] Phone 4:336-992-9000 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 ILE 6 of
the NPDES permit.
06/26/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail dtmcdaniel©aquaamerica.com Phone #:[phone] Date
Permittee Address'Stonington Way Ct Kernersville NC 27284 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 Tee Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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/foriris.
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
Y. _ for entire monitoring period. - -. - -- ""
- **-ORC on Site?:ORCMust-visit"facilitrard-docufnent-visitatiem.oi-€aei?rty>as-requited=per 15A NCAC"-$G-,0204--__ -. - __..r _ 3—•..
***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.:NC0088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILITY NAME:StomnglenSu'2divislnn'-Well 4-1 -CLASS.PCNC COUNTY:-Forsyth — - -__. y-__ _
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED.No
eDMR PERIOD:06-2018(June 2018) VERSION: 1 0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE': NO
61x1+0 alwaa 050611 C0,10 1 0104 10100, .- .. --- - -
00I,011ams:
IU i
01
E
F C Weekly 12 X month X month 2 X month Quarterly 1 Monthly 2 X month Qter to!ly
e u _ g E E. Est mate Grab Grab Grab Grab Grab Gran Grab
z
C FLOW phi I(71LORINE TSS-Cent IRON t,ANCJ4EtiE TURa1nTY ITN[
G J F G• c e C G L 1 -
2400 dock I II-. 2400 none III. Y/aM mad ,J ut:'I moll WI ,iia/I aro ug/1
I I
2
I I
4 I I I
3
6
6 705 t Y 000043 7.57 5 <2.5 535 <5 0.75 572
I
7 1
9 1 —
10
71 I
12
:3 1540 005 Y 0,00041 i .
14 JJ
1.5I I 1
16
17
a I
19
211 703 1 Y 0 00039 7 67 4 e 25 0.2
21 I
22
23
129 _ I I.
136
.7 I
28 1530 t-02 Y 003541 I
29
le
MoniMo Averr0e Limit 30
nlonthh A,er.ge 001041 45 e 53s Ie 0475 57.2
- D.R1k1.xlmet,. 000(43 767 5 0 53.5 Io 015 s;z
11.iIyOiIn1m.m 003559. 7..57 4_y - 0 535 — IC 02 57.2
"••No Reporting Reason ENFRUSE=No rlow-Reuse/Recycle; EN V W FI IR=No Visitation—Adverse Weather,,NOFLOW=No Flow, HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
- - _FACILITY NAME:-Stonireton Subdivision-Well#1 CLASS:PCJC COUNTY:Forsyth
OWNER NAME-Aqua North Carolina Inc ORC:Peter Ra;Dealing ORC CERT NUMBER:994048
GRADE:PC-1 ORC HAS CHANGED:No
eDMR PERIOD:06-2018(June 20I8) VERSION:1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:01/01/2018
r
ORC/Certifier Signature- Peter Ray Baling E-Mari:[e-mail] Phone #.[phone] Date
By this signature.I certify that this report is accurate and complete to the best of my knowledge.
The pernuttee 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.
r\• 08/01/2018
Permittee/Submitter Signature:*** Dave McDaniel E-Mail:dtmcdaniel@aquaamerica corn Phone #:[phone] Date
Permittee Address:Stonington Way Ct Kernersville NC 27284 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 mforrnation,including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Water Tec Lab
CERTIFIED LAB#:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
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. _ _ — — --- - - -- --- - -- --
_ , µ___ **ORC,on Site?:ORC sust_vasit facilltx and documept visitation offacility 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.:NC008850I PERMIT VERSION':3 0 PERMIT STATUS:Active
--- -- FACILITY NAME:Stoning'on Subdivision--Well-41 CLASS:PCNC - . COUNTY:-Forsyth,__ -. _ -.. - ._
OWNER NAME:Aqua North Carolina Inc ORC:Peter Ray Dealing ORC CERT NUMBER:994041
GRADE'PC-1 ORC HAS CHANGED:No
eDIvIR PERIOD:07-2018(July 2018) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
y- 500519. 100400 roars C0530 01n45 1011155 60170 01091 ------ - --
B 6
E 0.e-J.1y 2 X moolh 2 X month .12 X month Quarterly Months 12 X month I Quancrh•
1 L
u E o Estimate Grab Grab Grab Grab Grao Grab I Grab
a E — i . -
4 y° .E. p' o` 5 i FLOW p11 CHLORINE, TCS-Cane IRON MANCNZSE TUREIOT1 ZINC
12400 rioek Itn 2400 rlr1. nn Mfr. rand so ue'I mp/l tie 1 WFC nor I u,A
1 I 1 I
1 .
3
- j I- I
4 i
s 713 1,2 V I 0,00046 759 2 <2.3 36,3 <0,055 I0,6 22<€ I
6 1 1
7 I I I
F
9
I0
it I
12 707 10_2 Y L.000d1
13 I - .
14 1 I
15 ► I
I6
17 I I - I
II } 915 I Y I CCt102 717 7 1<25 0-5
19 I J I
2n
21
22 I I I
23
I I
24 I I
25 1536 1.52 Y 030041
lu I
27 I I I
28 I I I C I
29 !
3u I I
1.31
.-_.� Average- - - Alonrhlr Average Limit I
30 --- - - _ I - -
--- - --
_ h7mlhly Avonpe 0.0004
4.5 0 $6.3 0 035 _ 226
n.unMaximum 030042 7.07 70 363 0 06 I22E
- _.—_� -' - ---�4'ne➢j nihtm m• 0.00036uJ-- 759 `- -2 - --j0 303 10 -- - CS -- "?'G,E _<—
."'No Reporting Reason L-NCRUSL 'No Flor-Reuse:Recycle, F-NVWTIIR m No Viseanon--Aevcsc Weather, NOFLOW=No Flow, HOLIDAY=No Vlstatton-Holiday
I'

NPDES PERMIT NO.:N00088501 PERMIT VERSION:3 0 PERMIT STATUS:Active
FACILIg1 NAME:Stonmgton Subdivision--Well#1 CLASS:PCNC COUNTY:Forsyth _• _
OWNER NAME:Aqua North Carolina lnc ORC:Peter Ray Dealing ORC CERT NUMBER.99,048
GRADE:PC-1 ORC HAS CHANGED.No
eDMR PERIOD:07-2018(July 2018) VERSION:1 0 STATUS:Processed -
COMPLIANCE STATUS.Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:08/22/2018
_ __.. ` i,val _..��'*� __ __._...—_.....�___ ........�.r.._.__-'______ � - w, -�-._. _ .,•,., .1tF!'1..12 C F-F7 v
ORC/Certifier Signature. Pete Ray Dealing [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 alsc be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncomplianF 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.
t
C 08/22/2018
Permittee/Submitter Signature:*Y* Dave McDaniel E-Mail:[e-mail] Phone #.[phone] Date
Permittee Address:Stonmgton Way Ct Kernersville NC 27284 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 impnsonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Water Tec Lab
CERTIFIED LAB if:50
PERSON(s)COLLECTING SAMPLES:Peter Dealing
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting httpl/portal ncdenr.org/web/wq/swp/ps/npdes/forrns.
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 documentytsdation 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).