NC0058815_Fact Sheet_20190312

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not require
full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile
home parks, etc) that can be administratively renewed with minor changes, but can include
facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing,
instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date
Emily DelDuco 12/11/2018
Permit Number
NCO058815
Facility Name
Hope Valley WWTP
Basin Name/Sub-basin number
03-07-02
Receiving Stream
Fisher River
Stream Classification in Permit
C
Does permit need Daily Max NH3 limits?
N / A
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired (on 303(d) list)?
For whatparameter?
No
Any obvious compliance concerns?
No enforcements since 2007. Five NOVs
since 2014.
Any permit modifications since lastpermit?
No
New expiration date
12/31/2023
Comments on Draft Permit
➢ Added HUC to site description (p.2)
➢ Added regulatory citations.
➢ Updated eDMR language
➢ Updated outfall map.
DMR Summary Jan 2014 — Nov 2018
Analysis Variable: Value
Parameter
I Meanj
Minimuml
Maxj
N
00010 - Temperature, Water Deg. Centigrade
17.672
5.00
29.00
271
00400 - pH
7.373
7.30
7.50
115
31616 - Coliform, Fecal MF, MFC Broth, 44.5 C
57.991
1.00
2420.0
114
50050 - Flow, in conduit or thru treatment plant
0.003
0.001
0.003
463
50060 - Chlorine, Total Residual
18.371
7.00
28.00
854
C0310 - BOD, 5-Day (20 Deg. C) - Concentration
12.659
2.00
92.80
114
C0530 - Solids, Total Suspended - Concentration
6.476
1.00
21.20
114
C0600 - Nitrogen, Total - Concentration
16.481
4.17
43.70
20
C0610 - Nitrogen, Ammonia Total (as N) - Concentration
11.451
0.10
48.40
57
C0665 - Phosphorus, Total (as P) - Concentration
1.849
0.05
3.40
26

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
t.
I-i®PE V±&-LJLEi, IJLN
LINDA AMBURN, Executive Director
TERRY GLASCOCK, Board of Directors Chair
Men's Division
P. O. Box 467
Dobson, NC 27017
[phone]
[phone]
FAX [phone]
Women's Division
151 Hope Valley Road
Pilot Mountain, NC27041
[phone]
[phone]
FAX [phone]
August 1, 2018
Residential Services
Emily Phillips
P.O. Box 2682
Hickory, NC28602
NC DEQ/ DWR/ NPDES
[phone]
[phone]
1617 Mail Service Center
FA X '[phone]
Raleigh, NC 27699-1617
Subject. Renewal of NPDES Permit NCO058815
Dear Ms. Phillips,
Hope Valley, Incorporated requests that our NPDES Permit NCO058815 be
renewed. All information requested for the renewal package is enclosed.
If you should have any questions or comments, please contact me at
[phone] or our ORC Martin Semones at [phone].
Sincerely,
Malinda Amburn
Executive Director
— PRIVATE NON-PROFIT CORPORATION —
ESTABLISHED 1968

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
NC DEQ / DWR / NPDES
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCOO 6-B8
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
Facility Name Le 'Oe V /lam V /n car Do,'a -leal
Mailing Address / O S Covr� v ,�la r,-�e, r2aac�
City -h-0 Z5 on "
State / Zip Code -/VC- 2 701 7-
Telephone Number (3 3-)
�-Ax umber
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road c-sp- { +5
City -ZASo n
State / Zip Code 27612
Coi truly
vrrt
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name
Se.rn orle_
Mailing Address 2 rr erY ' Spree.
City Air
ti
State /Zip Code 61 C Z `7 0 3O
Telephone Number (336 ) _75:5 - 78 4' (Ce f/)
Pax Number (336) 786 - 817D
e-mail Address MSe n-1 o Ae_�E_ @ +r r a d . r- r . Gony7
100 3 Form-D 612017

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating
Wastewater (check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/ Staff
Other
[
Explain: 4 Ag, VAZ I may, 14 C-'
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): A ! eoho I d r�
y ' de-Pe-ndenGe. !'�lia�i �r'-�R-r�iarJ Ce,)�er',
b!.sC4ar9e- 15 Comp4r•a6le 4c re.side-r14 is/.
Number of persons served: LJ •,_ (Varies)
110 i.
5. ' T—yppe of collection system
Ivry Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points ore. X�
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes R"'No
7. lame of receiving streams) (NEW applicants: Provide a map showing the exact location of each
outfall):
FisXer ki ✓er a e
S. Frequency of Discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper. _ b va / Grease, Tra S
� 1, Soo gallons eOV-4
- Dva( eompar�! rn f
b" i bet( s; pho i
dosing C_,,016er - boo �QEjonS
Sur4ac-e- r n e4' lrt i't Gn-1'
14' 4 ea_{l ���� %ed
eu
a-Morjne C&AIA 7 C%awtWer -
bee h fa, -ire c o^4oc � a L n4r- _
INasl+e4 San 3 J, 4
rot
Ws A'ad
�4 �� ( iF
rl/e [� v s+ogre-
3eD ejAba5
Sa 9 4110.cs
2 of 3 Form-D 6/2017

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow D, 04 4 MGD
Annual Average daily flow O. DD 27 MGD (for the previous 3 years)
Maximum daily flow O, o 03! MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes 02-No
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
relport daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters currentlu in dour permit. Mark other parameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
4o, S
2
T
Fecal Coliform
2 42 O
'-786. 42
oleo tA4r'rc,
Total Suspended Solids
2
lr
Temperature (Summer)
2 9
o C
-Temperature (Winter)
PH
7' `�
andard nr
list all permits, construction approvals and/or applications:
Type' Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
Ocean Dumping (MPRSA)
IJ0005�'AI5 Dredge or fill (Section 404 or CWA)
Other
14. APPLICANT CERTIFICATION
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
1441; a A&bu
r T��� Ee---o);Z
Printed name of Person
Signature of Applicant
Title
Noah Carolina General Statute 143-215,6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (118 U,S.C. Section 1001
provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3 of 3 Form-D 6/2017

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
Men's Division
P. 0. Box 467
Dobson, NC 27017
[phone]
[phone]
FAX [phone]
Women's Division
152 Hope Valley Road
'ilot Mountain, NC 27041
[phone]
[phone]
FAX [phone]
.,esidential Services
ti tRO' Box, 2682.
Hickory; NC 28602
�(828), 324-8767
[phone]
FAX [phone]
HOPE VALLEY, INC.
LINDAAMBURN, Executive Director
TERRY GLASCOCK, Board of Directors Chair
August 1, 2018
Emily Phillips
NC DEC1/ DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Sludge Management Plan for Hope Valley, Inc Permit NCO058815
Dear'Ms. Phillips,
The Sludge Management Plan for Hope Valley, Incorporated is for the tank to
be pumped semi-annually and additionally as needed, Due to the flow being
dependent upon the number of clients, the above plan has been working well
for us,
if you should have any questions or comments, please contact me at
[phone] or our ORC Martin Semones at [phone].
Sincerely,
—Aj,;A, UAk-,
Malinda Amburn
Executive Director
— PRIVATE NON PROFIT CORPORATION —
ESTABLISHED i968

DocuSign Envelope ID: 64C9695E-8F3F-4294- BEE-616379D6B7_87,
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Dobson Faciiiw

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
NORTH CAROLINA
SURRY COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified and authorized by law to administer oaths,
personally appeared Sandra Hurley who being first duly
sworn, deposes and says: that he (she) is Regional Publisher
(Publisher or other officer or employee authorized to make affidavit) of
ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a
newspaper known as MOUNT AIRY NEWS, published, issued, and
entered as periodicals class mail in the city of Mount Airy in said County
and Stale; that he (she) is authorized to make this affidavit and sworn
statement; that the notice or other legal advertisement, a true copy of which
is attached hereto, was published in MOUNT AIRY NEWS on the
following dates:
and that the said newspaper in which such notice, paper, document or
legal advertisement was published was, at the time of each and every such
publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina,
This 10 day of
Signature of person making
2019
Sworn to and subscribed before me, this e/a day of
20I9
f 4
Notary Public
My Commission expires: January 18, 2023
=.SIMPSONSLIC
NOT
CLIPPING OF
LEGAL
ADVERTISEMENT
ATTACHED HERE
Public Notice
North Carolina
Environmental
Management
Commission/NPDES Unit
1617 Mall Service Center
Raleigh, NC 27699-1617
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Wrinen comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public hear-
ing should there be a signifio-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
htip:lldeq. nc.gov/about/d ivi-
sions/water-resources/water-
resources-perm its/wastewater-
branch/npdes-wastewater/pub-
lic-notices,or by calling (919)
707-3601. NCO058815: Hope
Valley, Inc, requested renewal
permit for Hope Valley
WWTP/Surry County. Facility
discharges to the Fisher
RiverNadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water quality limited.
NCO038822: Central Care, Ina
requested renewal of_permit fc
Central Care WWTPISurry
County. Facility discharges to
an unnamed tributary to Stew -
arts CreekNadkin-Pee Dee
River Basin. Currently ammo-
nia nitrogen, fecal coliform ano
total residual chlorine are wa-
ter quality limited.
Publish. I212t/2o18

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
MONITORING REPORT(MR) VIOLATIONS for:
Permit: nc0058815 MRs Between 1 - 2014 and 3 - 2019 Region: %
Facility Name: % Param Name % County: %
Major Minor: %
Report Date: 03/12/19 Page: 1 of 2
Violation Category% Program Category:
Subbasin:% Violation Action: %
PERMIT: NCO058815
FACILITY: Hope Valley Inc -Hope Valley WWTP
COUNTY: Surry
REGION: Winston-Salem
Limit Violation
MONITORING
OUTFALU
VIOLATION
UNIT OF
CALCULATED
%
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
Over
VIOLATION TYPE
VIOLATION ACTION
01 -2014
001
Effluent
BOD, 5-Day (20 Deg. C) -
01/30/14
2 X month
mg/I
45
92.8
106.2
Daily Maximum
Proceed to NOV
Concentration
Exceeded
01 - 2014
001
Effluent
BOD, 5-Day (20 Deg. C) -
01/31/14
2 X month
mg/I
30
57.55
91.8
Monthly Average
Proceed to NOV
Concentration
Exceeded
12 - 2014
001
Effluent
BOD, 5-Day (20 Deg. C) -
12/29/14
2 X month
mg/I
45
45.3
0.7
Daily Maximum
No Action, BPJ
Concentration
Exceeded
02 - 2017
001
Effluent
BOD, 5-Day (20 Deg. C) -
02/28/17
2 X month
mg/I
30
32.6
8.7
Monthly Average
No Action, BPJ
Concentration
Exceeded
02 -2018
001
Effluent
BOD, 5-Day (20 Deg. C) -
02/28/18
2 X month
mg/I
30
30.65
2.2
Monthly Average
No Action, BPJ
Concentration
Exceeded
03 _2015
001
Effluent
Coliform, Fecal MF, MFC
03/25/15
2 X month
#/100ml
400
570
42.5
Daily Maximum
Proceed to NOV
Broth, 44.5 C
Exceeded
07 - 2015
001
Effluent
Coliform, Fecal MF, MFC
07/24/15
2 X month
#/100ml
400
470
17.5
Daily Maximum
Proceed to NOV
Broth, 44.5 C
Exceeded
10 - 2015
001
Effluent
Coliform, Fecal MF, MFC
10/28/15
2 X month
#/100ml
400
2,420
505
Daily Maximum
Proceed to NOV
Broth, 44.5 C
Exceeded
10 - 2015
001
Effluent
Coliform, Fecal MF, MFC
10/31/15
2 X month
#/100ml
200
780.92
290.5
Monthly Geometric Mean
Proceed to NOV
Broth, 44.5 C
Exceeded
02 -2016
001
Effluent
Coliform, Fecal MF, MFC
02/12/16
2 X month
#/100ml
400
2,420
505
Daily Maximum
Proceed to NOV
Broth, 44.5 C
Exceeded
Monitoring Violation
MONITORING
OUTFALL/
VIOLATION
UNIT OF
CALCULATED
%
REPORT
PPI
LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT
VALUE
Over
VIOLATION TYPE
VIOLATION ACTION
11 -2014
001
Effluent
Flow, in conduit or thru
11/01/14
Weekly
mgd
Frequency Violation
No Action, BPJ
treatment plant
12 - 2014
001
Effluent
Nitrogen, Total -
12/31/14
Quarterly
mg/I
Frequency Violation
None
Concentration
12 - 2014
001
Effluent
Phosphorus, Total (as P) -
12/31/14
Quarterly
mg/I
Frequency Violation
None
Concentration

DocuSign Envelope ID: 64C9695E-8F3F-4294-9BEE-616379D6B787
MONITORING REPORT(MR) VIOLATIONS for: Report Date: 03/12/19 Page: 2 of 2
Permit: nc0058815 MRS Between 1 - 2014 and 3 - 2019 Region: % Violation Category:% Program Category:
Facility Name: % Param Name oho County: % Subbasin:% Violation Action: %
Major Minor: %
PERMIT: NCO058815 FACILITY: Hope Valley Inc -Hope Valley WWTP COUNTY: Surry REGION: Winston-Salem
Monitoring Violation
MONITORING OUTFALL/
VIOLATION
UNIT OF
CALCULATED %
REPORT Ppl LOCATION
PARAMETER
DATE
FREQUENCY
MEASURE
LIMIT VALUE Over VIOLATION TYPE VIOLATION ACTION
05 - 2014 001 Effluent
Temperature, Water Deg.
05/03/14
Weekly
deg c
Frequency Violation No Action, BPJ
Centigrade
11 -2014 001 Effluent
Temperature, Water Deg.
11/01/14
Weekly
deg c
Frequency Violation No Action, BPJ
Centigrade