NC0084832_renewal application_20201030

RESEARCh & ANALyTICA1
LAbORATORIESt INC.
Analytical/Process Consultations
October 28, 2020
N.C. DENR
Division of Water Quality\
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: NPDES Permit Renewal Application
Nikola's Restaurant & High Meadows Inn
Permit No. NC0084832
Allegany County
Enclosed are one (1) signed original and two (2) copies of the NPDES Permit
Application: Form D requested renewal of NPDES Permit No.NO0084832 for the wastewater
treatment plant at Nikola's Restaurant & High Meadows Inn. There have been no significant
changes to the wastewater treatment facility.
If you have any questions concerning this application renewal, please so advise.
Sincerely,
Research & Analytical Laboratories, Inc.
614d) Ov
Jessica A. Mize
Authorized Agent
Cc. Zdenko Peros
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina • 27284 • 336-996-2841 • Fax [phone]
www.randalabs.com

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 OCOOS4832
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
Zdenko Peros
Facility Name
Nikola's Restaurant & High Meadows Inn WWTP
Mailing Address
P.O. Box 222
City
Roaring Gap
State / Zip Code
North Carolina/28668
Telephone Number
[phone]
Fax Number
( )
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 10498 Highway 21 South
City
Roaring Gap
State / Zip Code
NC/ 28668
County
Alleghany
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
Research & Analytical Laboratories, Inc.
Mailing Address
106 Short Street
City
Kernersville
State / Zip Code
NC/27284
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 5
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Restaurant (120 seats)
Hotel (120 rooms)
Number of persons served: 1.000
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (AEW ap
outfall): plicants: Provide a map showing the exact location of each
Laurel Branch in Subbasin of the New River Basin
S. 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.
*0.025 MGD wastewater treatment system
1. Aeration Basin with Diffused Air
2. Secondary Clarifier with Sludge Air Lints and in -plant pumps
3. Chlorination
4. Dechlorination
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 0.025 MGD
Annual Average daily flow 0.003 MGD (for the previous 3 years)
Maximum daily flow 0.020 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 c rrendu in our ermit Mark other pqrnmPtPre "N/A"
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
33.9
10.02
Mg/L
Fecal Coliform
5
1.13
Mg/ L
Total Suspended Solids
15.2
7.6
Mg/ L
Temperature (Summer)
24
19.89
°C
Temperature (Winter)
9.5
7.6
°C
PH
7.6
N/A
Standard Units
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.
Jessica Mize Administrative Assistant R & A Laboratories Inc.
Printed name of Person Signing Title
�� - .n.. 1
Signaftzfg,'X'f Applicant
/6 3�
Date
North CaroVa 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

RESEARCh & ANALYTICAL
LAbORATORIES, INC.
Analytical/Process Consultations
SLUDGE MANAGEMENT PLAN
Nikola's Restaurant & High Meadows Inn
WASTEWATER TREAMENT PLANT
NPDES PERMIT NO. NCO084832
Sludge from the Nikola's Restaurant & High Meadows Inn, wastewater treatment plant is
disposed of in the following way:
I. Sludge generated from High Meadows Inn WWTP through the activated sludge
process is removed periodically.
2. Since there is no on -site digester available for wasting, the plant is cut off and
allowed to settle for 24hrs.
3. Thickened sludge is then removed directly from the bottom of the aeration basin
by septic tank truck. Manifest documents are maintained to verify date of sludge
removal, volume pumped, location of approved facility (i.e. municipal W WTP)
receiving sludge, and cost of sludge hauling/disposal.
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina • 27284 • 336-996-2B41 • Fax [phone]
www.randalabs.com