NCG590030_Fact Sheet_20190430

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Fact Sheet
NPDES Permit No. COC NCG590030 (formerly NC0088625)

Permit Writer/Email Contact: Derek Denard, [e-mail]
Date: 30Apr2019
Division/Branch: NC Division of Water Resources/Water Quality Permitting Section
Compliance & Expediated Permitting Branch
Fact Sheet Template: Version 28Mar2019

Permitting Action:
☒ Renewal
☐ Renewal with Expansion
☐ New Discharge
☐ Modification (Fact Sheet should be tailored to mod request)

Note: See Attachment A: NC0088625 Renewal Application, FORM C-WTP

Complete applicable sections below. If not applicable, enter NA.

1. Basic Facility Information

Facility Information
Applicant/Facility Name: Aqua North Carolina, Inc. / The Hollows Subdivision – Well # 1 WTP
Applicant Address: 202 Mackenan Ct, Cary, NC 27511
Facility Address: Lois Lane, Mt. Airy 27030
Permitted Flow: Not limited
Facility Type/Waste: MINOR; 100% industrial/ Water Plants and Water Conditioning
Discharge –filter-backwash - Greensand WTP System
Facility Class: Physical Chemical Not Classified
Treatment Units: greensand filters, chemical usage consisting of: Potassium
permanganate, Chlorine and caustic soda
Pretreatment Program (Y/N) No
County: Surry
Region Winston-Salem

Briefly describe the proposed permitting action and facility background: This facility is a greensand
water treatment plant with discharge of wastewaters from media filter backwash, with a design potable
flowrate of 0.018 MGD, a design backwash/reject flow of 0.002 and a maximum, monthly average
wastewater discharge of 0.0014 MGD. The facility consists of the following water and wastewater
treatment units: greensand filters, chemical usage consisting of: Potassium permanganate, Chlorine and
caustic soda. [See Attachment A: NC0088625 Renewal Application, FORM C-WTP]
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This facility is eligible for coverage under General Permit NCG590000 for the of discharge backwash
wastewaters from greensand and conventional type water treatment facilities. Eligibility is based on the
following (See Attachment B: General Permit NCG590000 Section A. Coverage, p. 2 of 26).
• The facility is a greensand technology water treatment system.
• There are no toxicity issues (monitoring is not applicable under WTP strategy for greensands).
• There are no WQBELs required for toxicants such as Zinc.
• The discharge is not mixed with other process wastewaters.
• The discharge is not to waters classified as High Quality Waters (HQW) or Outstanding Resource
Waters (ORW).
• The discharge is not from water purification systems using Membrane Treatment (Reverse
Osmosis) or Ion Exchange.
• The discharge would not adversely affect a Federal or State listed endangered or threatened
species or its critical habitat. The discharge is not of pollutants to an impaired waterbody in
excess of the wasteload allocation specified in an EPA-Approved TMDL (Total Maximum Daily
Load).

2. Receiving Waterbody Information:
Receiving Waterbody Information
Outfalls/Receiving Stream(s): Outfall 001- UT to Stewarks Creek
Stream Segment: 12-72-9-(4)
Stream Classification: WS-IV
Drainage Area (mi2): --
Summer 7Q10 (cfs) 0
Winter 7Q10 (cfs): 0
30Q2 (cfs): 0
Average Flow (cfs): 0
IWC (% effluent): 100%
303(d) listed/parameter: No – See Attachment D: 2016 Final Integrated Report, p.1188
Subject to TMDL/parameter: No – 2011 Turbidity TMDLs in the Yadkin River Basin:
Muddy Creek and the Yadkin River. The Mitchell River is
not impaired for Turbidity.
Basin/Subbasin/HUC: Yadkin-Pee Dee; 03-07-03 [HUC 030401010806]
USGS Topo Quad: Copland, NC

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3. Effluent Data Summary
Effluent data is summarized below for the period May2014 through Oct2018.
Table. Effluent Data Summary

Table. Data Entry Errors

4. Instream Data Summary
Instream monitoring may be required in certain situations, for example: 1) to verify model predictions
when model results for instream DO are within 1 mg/l of instream standard at full permitted flow; 2) to
verify model predictions for outfall diffuser; 3) to provide data for future TMDL; 4) based on other
instream concerns. Instream monitoring may be conducted by the Permittee, and there are also
Monitoring Coalitions established in several basins that conduct instream sampling for the Permittee (in
which case instream monitoring is waived in the permit as long as coalition membership is maintained).
If applicable, summarize any instream data and what instream monitoring will be proposed for this
permit action: NA.
Is this facility a member of a Monitoring Coalition with waived instream monitoring (Y/N): NO.
Name of Monitoring Coalition: NA.

Data Limits
Parameter Max Min Average Count MA DM PQL UoM Errors
00070 - Turbidity 30 0.15 2.01 104 ntu no
00076 - Turbidity, HCH Turbidimiter 15 0.55 6.44 4 ntu no
00400 - pH 8.68 6.9 7.52 108 su no
01045 - Iron, Total (as Fe)1090 0.019 62 31 ug/l yes
01055 - Manganese, Total (as Mn)730 0.012 68 51 ug/l yes
50050 - Flow, in conduit or thru treatment plant 0.001 0.0004 0.00040 963 mgd no
50060 - Chlorine, Total Residual 21 0 8.28 108 17 20 ug/l yes
CO530 - Solids, Total Suspended - Concentration 34 2.5 4.7 108 30 45 2.5 mg/l no
MA = monthly average; DM = daily maximum; PQL = practical quantitation limit; UoM = Unit of Measure
Not < 6.0 or > 9.0
Date Parameter UoM Value Coments
10/28/2015 01055 - Manganese, Total (as Mn)ug/l 0.016 UoM mg/L?
8/9/2016 01045 - Iron, Total (as Fe)ug/l 3.6 UoM mg/L?
8/9/2016 01055 - Manganese, Total (as Mn)ug/l 1.63 UoM mg/L?
9/28/2016 01055 - Manganese, Total (as Mn)ug/l 0.036 UoM mg/L?
10/12/2016 01055 - Manganese, Total (as Mn)ug/l 0.166 UoM mg/L?
11/15/2016 01055 - Manganese, Total (as Mn)ug/l 0.078 UoM mg/L?
2/22/2017 01045 - Iron, Total (as Fe)ug/l 0.0675 UoM mg/L?
2/22/2017 01055 - Manganese, Total (as Mn)ug/l 0.497 UoM mg/L?
2/7/2017 50060 - Chlorine, Total Residual ug/l 0 PQL?
4/12/2017 01045 - Iron, Total (as Fe)ug/l 0.163 UoM mg/L?
4/12/2017 01055 - Manganese, Total (as Mn)ug/l 0.392 UoM mg/L?
5/10/2017 01045 - Iron, Total (as Fe)ug/l 0.208 UoM mg/L?
5/10/2017 01055 - Manganese, Total (as Mn)ug/l 0.309 UoM mg/L?
11/21/2017 01055 - Manganese, Total (as Mn)ug/l 7 UoM?
12/12/2017 01045 - Iron, Total (as Fe)ug/l 0.282 UoM mg/L?
12/12/2017 01055 - Manganese, Total (as Mn)ug/l 0.313 UoM mg/L?
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5. Compliance Summary
Summarize the compliance record with permit effluent limits (past 5 years): See Attachment E:
Monitoring Report Violations Nov2013 to Oct2018, 1 page. One NOD was noted for a Manganese
frequency violation in May2014. Three (3) NOVs were noted for Manganese frequency violations in
Jun2014, Jul2014, and Aug2014.
Summarize the compliance record with aquatic toxicity test limits and any second species test results
(past 5 years): NA.
Summarize the results from the most recent compliance inspection: The last facility inspection conducted
on 11/06/2018 reported that the facility appeared to be clean and well maintained. See Attachment F:
Inspection Report 11/06/2018, 5 pages.
6. Water Quality-Based Effluent Limitations (WQBELs)
Dilution and Mixing Zones
In accordance with 15A NCAC 2B.0206, the following streamflows are used for dilution considerations
for development of WQBELs: 1Q10 streamflow (acute Aquatic Life); 7Q10 streamflow (chronic Aquatic
Life; non-carcinogen HH); 30Q2 streamflow (aesthetics); annual average flow (carcinogen, HH).
If applicable, describe any other dilution factors considered (e.g., based on CORMIX model results): NA.
If applicable, describe any mixing zones established in accordance with 15A NCAC 2B.0204(b): NA.
Oxygen-Consuming Waste Limitations
Limitations for oxygen-consuming waste (e.g., BOD) are generally based on water quality modeling to
ensure protection of the instream dissolved oxygen (DO) water quality standard. Secondary TBEL limits
(e.g., BOD= 30 mg/l for Municipals) may be appropriate if deemed more stringent based on dilution and
model results.
If permit limits are more stringent than TBELs, describe how limits were developed: NA.
Ammonia and Total Residual Chlorine Limitations
Limitations for ammonia are based on protection of aquatic life utilizing an ammonia chronic criterion of
1.0 mg/l (summer) and 1.8 mg/l (winter). Acute ammonia limits are derived from chronic criteria,
utilizing a multiplication factor of 3 for Municipals and a multiplication factor of 5 for Non-Municipals.
Limitations for Total Residual Chlorine (TRC) are based on the NC water quality standard for protection
of aquatic life (17 µg/l) and capped at 28 µg/l (acute impacts). Due to analytical issues, all TRC values
reported below 50 ug/l are considered compliant with their permit limit.
Describe any proposed changes to ammonia and/or TRC limits for this permit renewal: There are no
proposed changes. NCG59000 sets the daily maximum limit for TRC at 17 µg/l.
Reasonable Potential Analysis (RPA) for Toxicants – NA.
Toxicity Testing Limitations
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Permit limits and monitoring requirements for Whole Effluent Toxicity (WET) have been established in
accordance with Division guidance (per WET Memo, 8/2/1999). Per WET guidance, all NPDES permits
issued to Major facilities or any facility discharging “complex” wastewater (contains anything other than
domestic waste) will contain appropriate WET limits and monitoring requirements, with several
exceptions. The State has received prior EPA approval to use an Alternative WET Test Procedure in
NPDES permits, using single concentration screening tests, with multiple dilution follow-up upon a test
failure.
Describe proposed toxicity test requirement: NA.
Mercury Statewide TMDL Evaluation
There is a statewide TMDL for mercury approved by EPA in 2012. The TMDL target was to comply with
EPA’s mercury fish tissue criteria (0.3 mg/kg) for human health protection. The TMDL established a
wasteload allocation for point sources of 37 kg/year (81 lb/year), and is applicable to municipals and
industrial facilities with known mercury discharges. Given the small contribution of mercury from point
sources (~2% of total load), the TMDL emphasizes mercury minimization plans (MMPs) for point source
control. Municipal facilities > 2 MGD and discharging quantifiable levels of mercury (>1 ng/l) will
receive an MMP requirement. Industrials are evaluated on a case-by-case basis, depending if mercury is a
pollutant of concern. Effluent limits may also be added if annual average effluent concentrations exceed
the WQBEL value (based on the NC WQS of 12 ng/l) and/or if any individual value exceeds a TBEL
value of 47 ng/l.
Describe proposed permit actions based on mercury evaluation: NA.
Other TMDL/Nutrient Management Strategy Considerations
If applicable, describe any other TMDLs/Nutrient Management Strategies and their implementation
within this permit: Under the current general permit NCG590000 nutrient monitoring is not required for
Greensand technology that discharges to freshwater.
Other WQBEL Considerations
If applicable, describe any other parameters of concern evaluated for WQBELs: NA.
If applicable, describe any special actions (HQW or ORW) this receiving stream and classification shall
comply with in order to protect the designated waterbody: NA.
If applicable, describe any compliance schedules proposed for this permit renewal in accordance with
15A NCAC 2H.0107( c)(2)(B), 40CFR 122.47, and EPA May 2007 Memo: NA.
If applicable, describe any water quality standards variances proposed in accordance with NCGS 143-
215.3(e) and 15A NCAC 2B.0226 for this permit renewal: NA.
7. Technology-Based Effluent Limitations (TBELs) – NA.
8. Antidegradation Review (New/Expanding Discharge):
The objective of an antidegradation review is to ensure that a new or increased pollutant loading will not
degrade water quality. Permitting actions for new or expanding discharges require an antidegradation
review in accordance with 15A NCAC 2B.0201. Each applicant for a new/expanding NPDES permit must
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document an effort to consider non-discharge alternatives per 15A NCAC 2H.0105(c)(2). In all cases,
existing instream water uses and the level of water quality necessary to protect the existing use is
maintained and protected.
If applicable, describe the results of the antidegradation review, including the Engineering Alternatives
Analysis (EAA) and any water quality modeling results: NA.
9. Antibacksliding Review:
Sections 402(o)(2) and 303(d)(4) of the CWA and federal regulations at 40 CFR 122.44(l) prohibit
backsliding of effluent limitations in NPDES permits. These provisions require effluent limitations in a
reissued permit to be as stringent as those in the previous permit, with some exceptions where limitations
may be relaxed (e.g., based on new information, increases in production may warrant less stringent TBEL
limits, or WQBELs may be less stringent based on updated RPA or dilution).
Are any effluent limitations less stringent than previous permit (YES/NO): NO.
If YES, confirm that antibacksliding provisions are not violated: NA.
10. Monitoring Requirements
Monitoring frequencies for NPDES permitting are established in accordance with the following
regulations and guidance: 1) State Regulation for Surface Water Monitoring, 15A NCAC 2B.0500; 2)
NPDES Guidance, Monitoring Frequency for Toxic Substances (7/15/2010 Memo); 3) NPDES Guidance,
Reduced Monitoring Frequencies for Facilities with Superior Compliance (10/22/2012 Memo); 4) Best
Professional Judgement (BPJ). Per US EPA (Interim Guidance, 1996), monitoring requirements are not
considered effluent limitations under Section 402(o) of the Clean Water Act, and therefore anti-
backsliding prohibitions would not be triggered by reductions in monitoring frequencies.
For instream monitoring, refer to Section 4.
11. Electronic Reporting Requirements
The US EPA NPDES Electronic Reporting Rule was finalized on December 21, 2015. Effective
December 21, 2016, NPDES regulated facilities are required to submit Discharge Monitoring Reports
(DMRs) electronically. Effective December 21, 2020, NPDES regulated facilities will be required to
submit additional NPDES reports electronically. This permit contains the requirements for electronic
reporting, consistent with Federal requirements.
12. Summary of Proposed Permitting Actions:
NC0088625 is to be converted to COC NCG590030. The applicable effluent page is found in Section B.
(1.) Greensand WTP Effluent Limitations and Monitoring Requirements – Discharging to Freshwater.
[See Attachment C: General Permit NCG590000, Section B. (1.), page 3 of 26.]
Latitude and Longitude were corrected to 36º 29’ 47” and -80º 41’ 21” [36.496389º N, -80.689167º W],
respectively. See Attachment G: Map pages from EAA 04-04-2007.

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13. Public Notice Schedule:
Not Applicable for Certificates of Coverage (COCs) Under General Permit NCG590000. The general
permit was submitted to public notice.
14. Fact Sheet Addendum (if applicable): NA.
See Attachments H, I, J & K for comments and correspondence.
See Attachment K for The Public Water Supply Memo review.
15. Fact Sheet Attachments (if applicable):
A. NC0088625 Renewal Application, FORM C-WTP, 20181005, 34 pages.
B. General Permit NCG590000 Section A. Coverage, p. 2 of 26.
C. General Permit NCG590000 Section B. (1.), p. 3 of 26.
D. 2016 Final Integrated Report, p.1188.
E. NC0088625 Monitoring Report Violations Nov2013 to Oct2018, 1 page.
F. NC0088625 Inspection Report, 11/06/2018, 5 pages.
G. Map pages from EAA 04-04-2007, 2 pages.
H. Email to WSRO, 20181206, 2 pages.
I. Email Charles Weaver for conversion to NCG59000, 20190222, 2 pages.
J. Email DRAFT NCG590030-Permitttee_WSRO_Maureen Kinney, 20190412, 1 page
K. NPDES PWSS memo NCG590030 Hollows SD 042019, 1 page.

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ROY COOPER NORTH CAROLINA
Governor Environmental Quality
MICHAEL S_REGAN
Secret
LINDA CULPEPPER
Interim Director
October 05, 2018
Shannon V. Becker, President
c/o Amanda Owens
Aqua North Carolina, Inc.
202 Mackenan Court
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. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
httos://deq.nc.gov/permits-regulations/permit-guidance/environmental-aoolication-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,
31/144-4/4141
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
DEQ
0
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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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
DEC)--?)
OryNrtw9 d EmYOweeltl OWdE\
North Carolina Department of Environmental Quality I Division of Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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/DWRAlkaAdA, 6ar OCT:
e52018
Amanda Berger
Manager, Environmental Compliance r sourcesPermittingSection
cc: Laurie Ison
Joseph Pearce
Shannon Becker
202 MacKenan Court,Cary, NC,27511 • 919.467.8712 • AquaAmerica.com
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DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 919) 653-6965
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 704)489-9404
Fax Number [e-mail]
Page 1 of 3 Version 5/2012
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 DateP
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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
1:gosn • 054U0, 52o60 CONN u095t 0104,, 010cs - 00070 111092
1- : F ,f+ is
h Y
a o'
R m W«hry 2 X month 2 X month 2 X month Quarterly Quailctiy Month'y 2 X month Ouanny
E < F' -
o° A rsamalc Grab Grab Crab Grab Gmb Gmb Grab Grab
mAIa
o e z`P,011' i,2[CHLORINE TES•Crnc F.TOTAL IRON A'1L40NEJC TURQ!QTt' 7,INC
2409 dock un 2430 Ciller( Nn rrurr. j regd su 1144 rue a.))tie u0,5 n•u u2,7
10.0004
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0_0004 73 i f 2 1.4 105 0.45
No Repotting Reason,ENI'RUSE=No Flow-Reuse/Recycle; ENYWTHR=No Visitation-Adverse Weather,NGFLGW=Wo Flow. HOLIDAY=No Visitauo'1-Hchday
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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.
SignaturemofPermittee: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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
e !E ;z
F i
w 8 d wce.117• 2 X month 2 X moan 2 X mo•Ith Qua teny Qifnttaty Monthly 2 X month Quartcrty
E
I uC3
8 Esnmate Grab Grab Crab Grab Crab Gras CrGrab ah
SIV' f o o, O i CLOW' pit C11LORtoY TSS-Cone F--TOTAL IRON htoscsecE TURDIII Y ZINC
141.61 sleek 110 1400 clerk ;Us //DIN n-g6 :61 4'k'
01 me WI ottgl owl nitt uzl
1 tots 0 N 0.9004 2.4" 15 5.7 24C 0.9
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thtny n1.amum
cacao 75R 15 4,9 240 09
II.tlyativlmum•0,0004 1741 113 L^ 240 _ —A1
No Reporting Reason ENFRUSE=
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
dr `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
PARAMETEReMETER 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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
wuw 34400 51541 Cosh ^0951 0104, 010., o0c10 Moos
C !
R
a
e` 1Weekly 2 X month 2 X month 2 X month Qonn is 4unneriv Monthly 2 X month 0,2,1-1402,
e A 1t
v c' E:dmale. Gtsb Grob Grob Grab drag Grab Canto Grsb
a E 10 E x`
C : 1-` O O O A now pit CIIL0AItte TMs,Gone %.'rolAt. 11106 nsuGtn SL 111Rn101Y c1',C
1400 dock 112i 2450 morn 11r. SOlO mod no ul;/l ',1011 cr51 ItrcS coil mu VI
r
1
1 1010 0 4 0.0604 76 5 4.5 06
1
II
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17
16
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24
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tio.tbn Avt+ns= S 0,04 4.5 1.S2 0.S$$ 730 I
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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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 I16 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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 i3
WcckIy S X 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
IIII 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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 Af
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 j29711
33
2
I Ii
31 1349 i!0 iY 1 a:t''
Hcamlr 0nno rcLha
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•- -
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
CERTIFIEDIED 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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 ua 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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
l23
r5I 1
3
ii1201I1155€ 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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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 Quarterlyc55
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
A6I
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,
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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' CnTSS- nc 5-TOTAL IRON MTUMIDTUTY 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 II
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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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.,
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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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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
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F
e`
Y
E u Weekly 2 X month 2 X moth, 2 X mannl Quarterly Quanex4 Moat41y 2 X 1010th Quadcrly
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v j n Eshrmic Grab G-ab Grab Grab Grab Crab Grab UrnE3xa
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
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0004t I
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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
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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).
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7

Permit No. NCG590000
Page 2 of 26

PART 1
A. Coverage

(1.) Eligibility of Coverage
a. Existing Greensand Water Treatment Plants (WTPs) with individual NPDES permits and new facilities seeking a
NPDES permit for a greensand water purification system utilizing Iron and/or Manganese removal systems are
eligible for coverage under this general permit. Backwash wastewaters from similar activities such as sand filtration
or systems utilizing calcite filtration are eligible and covered under the Greensand WTP effluent requirements section
in this general permit.

b. Existing Conventional WTPs with a wastewater discharge resulting from water purification facilities with filter
backwash, sedimentation basin washdown, and decant from water treatment facilities are eligible for coverage under
this general permit.

(2.) Limitations on Coverage
a. Although this general permit does not cover the following types of discharges, other permits such as an
individual NPDES permit, an alternate general permit, or other approval from the Division may be obtained.
This permit does not authorize discharges from Water Treatment Plants with the following:
 Discharges that are mixed with other process wastewaters.
 Discharges to waters classified as High Quality Waters (HQW) or Outstanding Resource
Waters (ORW).
 Discharges from water purification systems using Membrane Treatment (Reverse Osmosis) or
Ion Exchange.
 Discharges that would adversely affect a Federal or State listed endangered or threatened
species or its critical habitat.
 Discharges of pollutants to an impaired waterbody in excess of the wasteload allocation
specified in an EPA-Approved TMDL (Total Maximum Daily Load).
 Discharges from new Conventional WTPs proposing a discharge to surface waters.

b. New Conventional WTPs proposing a discharge to surface waters shall be covered under an individual permit for
at least one permit cycle. Upon permit renewal, if an evaluation of the facility’s wastewaters shows no need for
additional limitations or requirements beyond what is conta ined in this general permit, then the permittee will be
considered for coverage.

c. Conventional WTPs proposing to expand existing facilities shall submit a Notice of Intent (NOI) permit
application with the proposed expansion/treatment details and an Engineering Alternative Analysis for Division
review and approval in order to obtain coverage for the expansion under this permit and receive a revised
Certificate of Coverage (CoC).

d. This permit does not authorize discharges that the Division has determined to be or which may reasonably be
expected to be contributing to a violation of a water quality standard (as defined in the “Red Book” or NC
Administrative Code 15A NCAC 02B .0100, .0200, and .0300).

e. If the Division determines at any time that the discharge is causing or contributing to a violation of water quality
standards or if the Division has any other grounds for modifying or revoking this permit, the Division may require
corrective action or require the discharge be permitted differently in accordance with Part II, Section B of this
permit. The Division may deny coverage under this permit and require submittal of an applica tion for an
individual NPDES permit based on a review of the Notice of Intent (NOI) or other information.

f. Whole Effluent Toxicity (WET) test results for the past three years shall be reviewed for existing or
expanding Conventional WTPs applying for coverage under this general permit. Permittees with WET test
results showing potential for aquatic toxicity may be denied coverage under this general permit which
includes a WET limitation of “Pass”.

(3.) Transfer Coverage from Other Permits
Upon issuance of this general permit, all existing and active individual permits for Greensand and
Conventional type WTPs will automatically be considered for coverage under this general permit as
permit renewal applications are received.

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7

Permit No. NCG590000
Page 3 of 26

B. (1.) Greensand WTP Effluent Limitations and Monitoring Requirements – Discharging to Freshwater

a. During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is authorized to discharge
wastewaters from iron and manganese removal type systems for the purpose of water purification to the receiving waters. Such
discharges shall be limited and monitored1 by the Permittee as specified below:

PARAMETER EFFLUENT LIMITS MONITORING REQUIREMENTS
Monthly Average Daily Maximum2 Measurement
Frequency
Sample
Type
Sample
Location
Flow3 Monitor Only (MGD) Twice per Month Instantaneous
Or Estimate Effluent
Total Suspended Solids4 30.0 mg/l
(Exception:Trout Waters)
45.0 mg/L
(Exception:Trout Waters) Twice per Month Grab Effluent
Total Residual Chlorine5 - 17 µg/L Twice per Month Grab Effluent
pH 6.0 < pH < 9.0 s.u. Monthly Grab Effluent
Turbidity6 50 NTU daily maximum
(Exceptions: Trout Waters, Lakes & Reservoirs) Monthly Grab Effluent
Total Manganese7, 8 Monitor Only µg/L (Exception: WS Waters) Quarterly Grab Effluent
Total Iron7 Monitor Only (µg/L) Quarterly Grab Effluent
Total Zinc9 Monitor Only (µg/L) Quarterly Grab Effluent
Total Fluoride10 Monitor Only (µg/L) Quarterly Grab Effluent

Footnotes:
1. eDMR: No later than 270 days from the effective date listed on the CoC issued with this permit, begin submitting discharge
monitoring reports electronically using NC DWR’s eDMR application system. See Special Condition C.
2. The Daily Maximum limits apply to all permittees. More stringent limitations apply to discharges to Trout and Water Supply (WS)
Waters and Lakes & Reservoirs as noted above and detailed in the footnotes below. Refer to the Certificate of Coverage (CoC) for
receiving stream classifications.
3. For instantaneous flow monitoring, the duration of the discharge must be reported in addition to the total flow.
4. TSS: Permittees discharging to Trout waters shall not exceed a monthly average of 10 mg/L and a daily maximum limit of 15 mg/L.
5. TRC: Limit and monitoring requirements only apply if the facility adds chlorine or chlorine derivatives to water that is eventually
discharged. The Division shall consider all effluent TRC values reported below 50 ug/L to be in compliance with the permit.
However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory (including
field certified), even if these values fall below 50 ug/L.
6. Turbidity: The Turbidity Daily Maximum effluent limit is 10 NTU for Trout waters and 25 NTU for Lakes & R eservoirs not designated
as trout waters.
7. Iron & Manganese: This sampling requirement does not apply to b ackwash from calcite filtration or similar systems which are not
designed for iron or manganese removal and are not blended with other WTP wastewaters.
8. Total Manganese: Permittees discharging to WS waters shall not exceed the manganese water quality standard defined in
Administrative Code 15A NCAC 2B .0100, .0200, and .0300. Currently the water quality standard for manganese is a daily maxim um
limit of 200 µg/L.

9. Zinc: This requirement applies only to wastewater discharges from plants that use water treated with zinc orthophosphate for
backwashing filters.
10. Fluoride: This requirement applies only to wastewater discharges from plants that backwash with fluoridated finished water.
b. SAMPLES SHALL BE TAKEN AT THE OUTFALL BUT PRIOR TO MIXING WITH THE RECEIVING WATERS
c. THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR FOAM IN OTHER THAN TRACE AMOUNTS.

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
Final 2016 Integrated Report-All Assessed Waters
Yadkin River Headwaters Subbasin Yadkin-Pee Dee River Basin
Assessment Unit Name
Assessment Unit Number
Assessment Unit Description
Water Quality Classification Length/Area Units
South Prong Lewis Fork From Wilkes County SR 1155 to a point 1.1 mile upstream of mouth
5.8 FW MilesC12-31-2-(6)
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Good Benthos (Nar, AL, FW)1
Meeting Criteria Good Fish Community (Nar, AL, FW)1
Stewarts Creek From N.C.-Va. State Line to Surry County SR 1622
5.0 FW MilesWS-IV;Tr12-72-9-(1)
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Excellent Fish Community (Nar, AL, FW)1
Stewarts Creek From Surry County SR 1622 to NC89
1.9 FW MilesWS-IV12-72-9-(4)a
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Good-Fair Benthos (Nar, AL, FW)1
Stewarts Creek From NC89 to a point 0.7 mile downstream of mouth of Pauls Creek
1.4 FW MilesWS-IV12-72-9-(4)b
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Good-Fair Benthos (Nar, AL, FW)1
Stewarts Creek From Town of Mount Airy water supply intake to Ararat River
6.8 FW MilesC12-72-9-(8)
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Good-Fair Benthos (Nar, AL, FW)1
Stony Fork From Wilkes County SR 1168 to Yadkin River
5.9 FW MilesC12-26-(7)
Assessment Criteria Status Reason for Rating Parameter of Interest Category
Meeting Criteria Excellent Benthos (Nar, AL, FW)1
Data Inconclusive Not Rated Fish Community (Nar, AL, FW)3a
Page 1188 of 13064/11/2018 2016 Integrated Report -All Assessed Waters
Fish tissue assessments for mercury apply to all waters and are not individually listed
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
MRs Between and Violation Category:Program Category:
Param Name County:Subbasin:%Violation Action:
Major Minor:%
Permit:
Facility Name:
Region:--NC0088625
%%
%
%
%%
%
11 2013 10 2018
MONITORING REPORT(MR) VIOLATIONS for:12/06/18Report Date:1Page:of 1
PERMIT:NC0088625 FACILITY:Aqua North Carolina Inc - The Hollows Subdivision COUNTY:Surry REGION:Winston-Salem
%
Over
UNIT OF
MEASURE VIOLATION ACTIONVIOLATION TYPECALCULATED
VALUELIMITFREQUENCYVIOLATION
DATEPARAMETERLOCATIONOUTFALL/
PPI
MONITORING
REPORT
Limit Violation
05 - 2018 001 Effluent Manganese, Total (as Mn)05/31/18 Monthly Monthly Average
Exceeded
None240200ug/l 20
%
Over
UNIT OF
MEASURE VIOLATION ACTIONVIOLATION TYPECALCULATED
VALUELIMITFREQUENCYVIOLATION
DATEPARAMETERLOCATIONOUTFALL/
PPI
MONITORING
REPORT
Monitoring Violation
05 - 2014 001 Effluent Manganese, Total (as Mn)05/31/14 Monthly Frequency Violation Proceed to NODug/l
06 - 2014 001 Effluent Manganese, Total (as Mn)06/30/14 Monthly Frequency Violation Proceed to NOVug/l
07 - 2014 001 Effluent Manganese, Total (as Mn)07/31/14 Monthly Frequency Violation Proceed to NOVug/l
08 - 2014 001 Effluent Manganese, Total (as Mn)08/31/14 Monthly Frequency Violation Proceed to NOVug/l
08 - 2016 001 Effluent Turbidity 08/31/16 2 X month Frequency Violation No Action, BPJntu
10 - 2016 001 Effluent Turbidity 10/31/16 2 X month Frequency Violation No Action, BPJntu
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
EPA
United States Environmental Protection Agency
Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 N 52 NC0088625 18/11/06 C S31112171819 20
21 66
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA ----------------------Reserved-------------------
N67707172 73 74 75 80
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
The Hollows Subdivision
Lois Ln
Mount Airy NC 27030
Entry Time/Date Permit Effective Date
Exit Time/Date Permit Expiration Date
10:30AM 18/11/06 14/05/01
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
///
Other Facility Data
11:00AM 18/11/06 19/02/28
Name, Address of Responsible Official/Title/Phone and Fax Number
Gary Moseley,4163 Sinclair St Denver NC 28037//704-489-9404/7044899409 Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Other
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s)Agency/Office/Phone and Fax Numbers Date
Gary Hudson Division of Water Quality//336-776-9694/
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page#1
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
NPDES yr/mo/day
18/11/06
Inspection Type
C3111218
1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
November 26, 2018
Shannon V. Becker, President
Aqua NC, Inc.
202 MacKenan Court
Cary, NC 27511
Subject: Compliance Evaluation Inspection
Nine Greensand Filtration Water Treatment Systems
NPDES Permit No. NC0088536, NC0088552, NC0088528, NC0088625, NC0088498, NC0088633,
NC0088617, NC0088609, NC0088854.

Dear Mr. Becker:
On November 6, 2018, Gary Hudson of this office met with William Young, ORC of Aqua NC, to
perform a Compliance Evaluation Inspection on the nine NPDES permitted greensand water filtration
plants located throughout Surry County. This type of inspection consists of two basic parts: an
in-office file review and an on-site inspection of the treatment facility. The findings and observations
are outlined below:
Bannertown Hills Subdivision Well # 2 – NC0088536
Location: Town Lane, Mount Airy, NC 27030
Permitted Flow: 0.0016 MGD
Discharge Point: Discharges into a flexible black plastic pipe that runs 100’ downhill to the west of the
plant, and eventually into an unnamed tributary to Faulkner Creek in the Yadkin-Pee Dee River Basin.
Colonial Woods Subdivision – Wells 1 & 2 – NC0088552
Location: Atkins Lane, Mount Airy, NC 27030
Permitted Flow: 0.002 MGD
Discharge Point: Discharges into a drain pipe that runs 100’ downhill to the north of the plant, and
eventually into an unnamed tributary to Bull Creek, a class “C” water in the Yadkin – Pee Dee River
Basin.
Hillcrest Subdivision – Well # 3 – NC0088528
Location: Lynnewood Drive, Mount Airy, NC 27030
Permitted Flow: 0.00168 MGD
Discharge Point: Discharges under pressure into an underground gravel pit approximately 50’
northwest of the water plant, and eventually into an unnamed tributary to Champ Creek, a class “C”
water in the Yadkin-Pee Dee River Basin.
NC0088625 17 (Cont.)
Page#2
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
Permit:NC0088625
Inspection Date:11/06/2018
Owner - Facility:
Inspection Type:
The Hollows Subdivision
Compliance Evaluation
The Hollows Subdivision – Well # 1 – NC0088625
Location: Lois Lane, Mount Airy, NC 27030
Permitted Flow: 0.002 MGD
Discharge Point: Approximately 100’ southwest of water plant, and eventually into an unnamed
tributary to Stewarts Creek, class “C” waters in the Yadkin – Pee Dee River Basin.
Mitchell Bluff Subdivision – Well # 1 – NC0088498
Location: Mitchell Cove Road, Elkin, NC 28621
Permitted Flow: 0.00168MGD
Discharge Point: Into a PVC pipe that runs 100’ to the west of the water plant, and eventually into an
unnamed tributary to the Mitchell River in the Yadkin – Pee Dee River Basin.
Reeves Woods Subdivision – Well # 2 – NC0088633
Location: Reeves Mill Road, Mount Airy, NC 27030
Permitted Flow: 0.002 MGD
Discharge Point: 100’ east of the water plant at the tree line, and eventually into an unnamed tributary
to Rutledge Creek in the Yadkin – Pee Dee River Basin.
Snow Hill Subdivision – Well # 1 – NC0088617
Location: Snow Hill Drive, Dobson, NC 27017
Permitted Flow: 0.00252 MGD
Discharge Point: Approximately 100’ south of the water plant into a field, and eventually into an
unnamed tributary to Cody Creek, class “C” waters in the Yadkin – Pee Dee River Basin.
Windgate Subdivision – Well # 1 – NC0088609
Location: Simmons Road, Dobson, NC 27017
Permitted Flow: 0.00168 MGD
Discharge Point: 100’ southwest of the water plant, and eventually into an unnamed tributary to the
Fisher River, class “C” waters in the Yadkin – Pee Dee River Basin.
Pine Lakes Subdivision – Well # 2 – NC0088854
Location: Gloria Road, Mount Airy, NC 27030
Permitted Flow: 0.002 MGD
Discharge Point: The equipment for the greensand filtration has recently been installed.

All of these sites appeared to be clean and well maintained. No problems or concerns were
noted.Should you have any questions concerning this report, please contact Gary Hudson or me at
[phone].
Sincerely,
Sherri V. Knight, P.E.
Regional Supervisor
Page#3
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
Permit:NC0088625
Inspection Date:11/06/2018
Owner - Facility:
Inspection Type:
The Hollows Subdivision
Compliance Evaluation
Water Quality Regional Operations
Division of Water Resources
cc:Central Files
WSRO
Page#4
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
Permit:NC0088625
Inspection Date:11/06/2018
Owner - Facility:
Inspection Type:
The Hollows Subdivision
Compliance Evaluation
Other Yes No NA NE
See SummaryComment:
Page#5
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DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
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1
Denard, Derek
From:Denard, Derek
Sent:Thursday, December 06, 2018 11:28 AM
To:Hudson, Gary; Boone, Ron
Cc:Knight, Sherri
Subject:Aqua North Carolina Inc. - Greensand WTP Renewals/Transfers to coverage under NCG590000
Gary & Ron, 

The following is a list of Aqua greensand WTP permits that are up for renewal: 

Permit Owner Facility County Expires
NC0088498 Aqua North Carolina, Inc. Mitchell Bluff - Well #1 Surry 12/31/2018
NC0088609 Aqua North Carolina, Inc. Windgate Subdivision Surry 1/31/2019
NC0088528 Aqua North Carolina, Inc. Hillcrest Subdivision - Well #3 Surry 12/31/2018
NC0088536 Aqua North Carolina, Inc. Bannertown Hills Subdivision - Well #2 Surry 12/31/2018
NC0088552 Aqua North Carolina, Inc.
Colonial Woods Subdivision - Wells 1
and 2 Surry 1/31/2019
NC0088854 Aqua North Carolina, Inc. Pine Lakes Subdivision - Well #2 Surry 1/31/2019
NC0088617 Aqua North Carolina, Inc. Snow Hill subdivision Surry 2/28/2019
NC0088625 Aqua North Carolina, Inc. The Hollows subdivision Surry 2/28/2019
NC0088633 Aqua North Carolina, Inc. Reeves Woods Subdivision Well #2 Surry 2/28/2019
NC0088501 Aqua North Carolina, Inc. Stonington Subdivision - Well #1 Forsyth 2/28/2019

Aqua has indicated that they would like to have coverage under the general permit for these. Most likely all of them will 
be converted to General Permit NCG590000. Please note that conversion to the general permit will not require public 
notice. We should be able to process these renewals/conversions in a couple of week instead of months. I would like to 
knock out the 3 that expire this month by December 31. Please let me know if you have any comments or staff reports 
(e‐mail is fine) for any of these facilities. 

Thanks, 

Derek C Denard
Environmental Specialist
Compliance & Expedited Permitting Unit
N.C. Division of Water Resources
N.C. Department of Environmental Quality 

919 707 3618 office
919 707 9000 main DWR
[e-mail]

N. C. Division of Water Resources
Water Quality Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
2

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
1
Denard, Derek
From:Weaver, Charles
Sent:Friday, February 22, 2019 10:28 AM
To:Denard, Derek
Subject:RE: Aqua Greensands to convert to NCG59 in BIMS
See details below 

From: Denard, Derek  
Sent: Thursday, February 21, 2019 12:16 PM 
To: Weaver, Charles <[e-mail]> 
Subject: Aqua Greensands to convert to NCG59 in BIMS 

Charles, 

Below is a list of greensands that can be converted to NCG59. 

NC0088498 Aqua North Carolina, Inc. Mitchell Bluff ‐ Well #1 ‐> NCG590024 
NC0088609 Aqua North Carolina, Inc. Windgate Subdivision ‐> NCG590025 
NC0088528 Aqua North Carolina, Inc. Hillcrest Subdivision ‐ Well #3 ‐> NCG590026 
NC0088536 Aqua North Carolina, Inc. Bannertown Hills Subdivision ‐ Well #2 ‐> NCG590027 
NC0088552 Aqua North Carolina, Inc. Colonial Woods Subdivision ‐ Wells 1 and 2 ‐> NCG590028 
NC0088617 Aqua North Carolina, Inc. Snow Hill subdivision ‐> NCG590029 
NC0088625 Aqua North Carolina, Inc. The Hollows subdivision ‐> NCG590030 
NC0088633 Aqua North Carolina, Inc. Reeves Woods Subdivision Well #2  ‐> NCG590031 

Please let me know what the COC numbers are. 
By the way, I have two others that may end up as individual permits because of a possible Zinc limit. 

Thanks, 

Derek C Denard
Environmental Specialist
Compliance & Expedited Permitting Unit
N.C. Division of Water Resources
N.C. Department of Environmental Quality 

919 707 3618 office
919 707 9000 main DWR
[e-mail]

N. C. Division of Water Resources
Water Quality Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
2

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
1
Denard, Derek
From:Denard, Derek
Sent:Friday, April 12, 2019 5:15 PM
To:[e-mail]
Cc:Kinney, Maureen; Hudson, Gary
Subject:DRAFT NCG590030 (formerly NC0088625) The Hollows Subdivision – Well # 1 WTP
Attachments:NCG590030 Aqua_The Hollows_COC_DRAFT 2019.pdf
Ms. Berger, 

Please find the attached draft of certification of coverage (COC) NCG590030 (formerly NC0088625) for Aqua, Inc.‐ The 
Hollows Subdivision – Well # 1 WTP. Please review this document to assure your understanding of the permit limits and 
monitoring conditions, and to correct errors, if any. Please provide any comments to me via email 
[[e-mail]] or write to my attention care of DEQ / DWR / NPDES Program no later than April 26, 2019. 

Sincerely, 
Derek C Denard
Environmental Specialist
Compliance & Expedited Permitting Unit
N.C. Division of Water Resources
N.C. Department of Environmental Quality 

919 707 3618 office
919 707 9000 main DWR
[e-mail]

N. C. Division of Water Resources
Water Quality Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7
DocuSign Envelope ID: D17F6654-5B03-4127-B4D0-34C6723F7AE7