NC0089931_Application_20200506

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit RW
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
Wallace Loft, LLC.
Facility Name
The Cottages of Boone WWTP
Mailing Address
2711 Centerville Road, Suite 400
City
Wilmington
State / Zip Code
Delaware, 19808
Telephone Number
[phone] RECEIVED
Fax Number
[phone] MAY 0 "20
e-mail Address
[e-mail]
„ Nrnrn,rsW ""NPDES
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 615 Fallview Lane
City
Boone
State / Zip Code
NC, 28607
County
Watauga
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Wallace Loft, LLC.
Mailing Address 2711 Centerville Road, Suite 400
City Wilmington
State / Zip Code Delaware, 19808
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: Apartment Complex 894 Br
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Apartment complex serving 894 bedrooms, five administrative/clubhouse employees, a fitness center
and a pool.
Number of persons served: 900
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1 Pro _osedl
Outfall Identification number(s) # 1
Is the outfall equipped with a diffuser? ® Yes (Proposed) ❑ No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Laurel Fork (Watauga River Basin) - See Attached Map showing proposed outfall location
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
See attached WWTP Permit
2 of 3 Form-D 11l12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.1085 MGD
Annual Average daily flow 0.036 MGD (for the previous 3 years)
Maximum daily flow 0.073 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average
over the past 36 months for parameters rrently in our ermit. Mark otherparameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
31.1
2.07
Mg/L
Fecal Coliform
< 1
<1
#/ 100 ml
Total Suspended Solids
<2.5
<2.5
Mg/L
Temperature (Summer)
N/A
N/A
N/A
Temperature (Winter)
N/A
N/A
N/A
pH
8.94
7.1
su
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
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.
Printed name of Person Signing
Signature of i\ pjilicant
Title
�4
Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (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.)
3 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit JNC00
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Wallace Loft, LLC.
The Cottages of Boone WWTP
2711 Centerville Road, Suite 400
Wilmington
Delaware, 19808
[phone]
[phone]
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 615 Fallview Lane
City Boone
State / Zip Code NC, 28607
County Watauga
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Wallace Loft, LLC.
Mailing Address 2711 Centerville Road, Suite 400
City
State / Zip Code
Telephone Number
Fax Number
Wilmington
Delaware, 19808
[phone]
e-mail Address [e-mail]
1 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: Apartment Complex 894 Br
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Apartment complex serving 894 bedrooms, five administrative/clubhouse employees, a fitness center
and a pool.
Number of persons served: 900
S. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1 Wroposed]
Outfall Identification number(s) # 1
Is the outfall equipped with a diffuser? ® Yes (Proposed) ❑ No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Laurel Fork (Watauga River Basin) - See Attached Map showing proposed outfall location
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration: _
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
See attached WWTP Permit
2 of 3 Form-D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.1085 MGD
Annual Average daily flow 0.036 _ .MGD (for the previous 3 years)
Maximum daily flow 0.073 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes
►1
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average
over the past 36 months 16rjjarameters current l in . our >>ermit. Mark other arameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD.5)
31.1
2.07
Mg/ L
Fecal Coliform
< 1
< 1
# / 100 ml
Total Suspended Solids
<2.5
<2.5
Mg/L
Temperature (Summer)
N/A
N/A
N/A
Temperature (Winter)
N/A
N/A
N/A
pH
8.94
7.1
su
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
I certify that I am familiar with the information contained in the application and
best of my knowledge and belief such information is true, complete, and accurate.
6( r 0(01 j t'-7'
Printed name of Person
that to the
a �i
Signature of A ant Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (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.)
3 of 3 Form-D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCOO
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
Wallace Loft, LLC.
Facility Name
The Cottages of Boone WWTP
Mailing Address
2711 Centerville Road, Suite 400
City
Wilmington
State / Zip Code
Delaware, 19808
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 615 Fallview Lane
City Boone
State / Zip Code NC, 28607
County Watauga
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
referring to the Operator in Responsible Charge or ORC)
Name Wallace Loft, LLC.
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
2711 Centerville Road, Suite 400
Wilmington
Delaware, 19808
[phone]
[phone]
[e-mail]
1 of 3 Form-D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
®
Explain: Apartment Complex 894 Br
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Apartment complex serving 894 bedrooms, five administrative/clubhouse employees, a fitness center
and a pool.
Number of persons served: 900
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points _ 1 Proposed)
Outfall Identification number(s) # 1
Is the outfall equipped with a diffuser? ® Yes (Proposed) ❑ No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
Laurel Fork (Watauga River Basin) - See Attached Map showing proposed outfall location
8. Frequency of Discharge:
If intermittent:
Days per week discharge occurs:
Continuous ❑ Intermittent
Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
See attached WWTP Permit
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.1085 MGD
Annual Average daily flow 0.036 MGD (for the previous 3 years)
Maximum daily flow 0.073 _MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes
12. Effluent Data
NEW APPLICANTS: Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab
samples, for all other parameters 24-hour composite sampling shall be used. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average
over the east 36 months for parameters currentlil in your j_)ermit. Mark otherparameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
31.1
2.07
Mg/L
Fecal Coliform
< 1
< 1
# / 100 ml
Total Suspended Solids
<2.5
<2.5
Mg/L
Temperature (Summer)
N/A
N/A
N/A
Temperature (Winter)
N/A
8.94
N/A
N/A
pH
7.1
su
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, mplete, and accurate.
Printed name of Person Signing'rifle
Signadt Applicant
Date
North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be
guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (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.)
3 of 3 Form-D 11/12