NC0088633_Permit (Issuance)_20040411

NPDES DOCUMENT SCANNIMS COVER SHEET
NPDES Permit: NC0088633
Reeves Woods Well #2 WTP
Document Type: 'Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Correspondence
201 Facilities Plan
Instream Assessment (6713)
Environmental Assessment (EA)
Permit
History .
Document Date: Aril 11, 2004
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AA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory John Skvarla, III
Governor Secretary
April 11, 2014
Thomas J. Roberts, President& CEO
Aqua North Carolina, Inc.
202 Mackenan Court
Cary, North Carolina 27511
Subject: Issuance of NPDES Permit NCO088633
Reeves Woods Subdivision - Well 92 WTP
Reeves Mill Road, Mt Airy 27030
Surry County
Dear Mr. Roberts:
The Division of Water Resources (DWR of the Division) has approved your application to renew the
subject permit. Accordingly, we hereby forward the attached NPDES discharge permit. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection Agency
dated October 15, 2007 (or as subsequently amended).
Changes for Renewal. The Division updated your permit in accord with permitting strategies (amended
in 2009) for potable water treatment plants (WTPs) consistent with similar permits statewide. We have
also has updated your facility description and site map, adding parameter codes to permit Section A.
(1.) for your convenience. We have removed monitoring for Total Copper inadvertently added to the
permit draft. Please note that monitoring for Total Fluoride and Total Zinc is required only if these
additives are present in finish-water used to backwash filters, thereby creating their potential to
concentrate in the wastestream [see Footnote 4, Section A (1.)].
Implementing Electronic Discharge Monitoring Reports (eDMRs). Please be advised that the Division
will implement an electronic Discharge Monitoring Report(eDMR) program, in accord with pending
requirements by the Environmental Protection Agency (EPA). We have included the details required
to implement the eDMR program in this permit [see permit Special Condition A. (2.)].
Proposed federal regulations require electronic submittal of all DMRs and specify that, if North
Carolina does not establish a program to receive such submittals, Permittees must then submit eDMRs
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748
Internet:v .ncwaterquality.oig
An Equal Opportunity 1 Atfrma0ve Action Employer

directly to EPA. I or more information on cDMRs, registering for cDMR submittal, and obtaining an
cDMR user account, please visit DWR's webpage:
h�:Hportal.nedenr.org/web/wq/adm iidbop/ipu/edmr.
For information on EPA's proposed NPDES Electronic Reporting Rule, please visit EPA's website:
lnttp://www2.eya.gov/compliance/proposed-npdes-electronic-reporting rule
Following the mandatory 45-day public comment period,the Division will review all pertinent
comments, if any, and take appropriate action prior to issuing an NPDES permit final. If you have
questions concerning this draft, please e-mail me [e-mail]], or call my direct line
[phone].
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty
(30) days following receipt of this letter. This request must be in the form of a written petition,
conforming to Chapter 150B of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings (6714 Mail Service Center, Raleigh,North Carolina 27699-6714). Unless
such demand is made, this decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
modify or revoke and reissue of this permit. This permit does not affect your legal requirements to
obtain other permits required by the Division of Water Resources, the Division of Land Resources, the
Coastal Area Management Act, or any other Federal or Local government. If you have questions
concerning this permit, please contact Joe R. Corporon, L.G. [[e-mail]] or call his
direct line [phone].
Sincerely,
�L
Thomas A. Reeder, Director
Division of Water Resources
Enclosure: NPDES Permit NCO088633 (issuance final)
hc: WSRO/SWPS Supervisor, Cory Basinger
NPDES Program Files
Central Files
ec: DWR/WSRO, Cory Basinger
Aqua Norih Carolina, Inc.,Thomas J. Roberts [tjroberts [e-mail]]
1617 Mail Service Center,Ralegh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748
Internet:www.ncwaterquality.org
An Equal Opptunity I Affirmative Acton Employer

NPDES Permit NCO088633
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended, the
Aqua North Carolina, Inc.
is hereby authorized to discharge treated wastewater from a facility known as
Reeves Woods Subdivision - Well #2 WTP
Reeves Mill Road, Mt. Airy
Surry County
to receiving waters designated as unnamed tributary to Rutledge Creek in the Yadkin-Pee Dee River
Basin, in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts 1, 11,III, and IV hereof.
The permit shall become effective May 1, 2014.
This permit and the authorization to discharge shall expire at midnight on February 28, 2019.
Signed this day April 11, 2014.
oo/m
'
TIh s A. Reeder, D a irector —
vision of Water Resources
By Authority of the,Environmental Management Commission
Page 1 of 5

NPDES Permit NCOOSS633
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this issuance, any previously issued permit bearing this number is no longer effective.
Therefore, the exclusive authority to operate and discharge from this facility arises under the permit
conditions, requirements, terms, and provisions described herein.
Aqua North Carolina, Inc.
is hereby authorized to:
1. continue to operate a filter-backwash treatment system in support of potable water production
utilizing green sand treatment technology, including use of the chemicals
o chlorine
• potassium permanganate
• caustic soda
located at Reeves Woods Subdivision - Well #1 WTP, Reeves Mill Road, Mt Airy, Surry County;
and
2. discharge from said treatment works via Outfall 001 at a location specified on the attached map, into
an unnamed tributary to Rutledge Creek [Stream Segment 12-72-10], a waterbody currently
classified C waters within Subbasin 03-07-03 of the Yadkin-Pee Dee River Basin.
Page 2 of 5

NPDES Permit NCO088633
PART
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is'
authorized to discharge filter backwash via Outfall 001. Such discharges shall be limited and monitored 1 by
the Permittee as specified below:
fi x t'� -T'•.--r-i-" ^�-a J i'kfi'� �.. l ,� .. -r-�''r-•J'fir"'^ ti':�5'If'..'�r�.5..� R9.`�.
IFFLUENT
LIMITS' l M'(DNITORING REQUIRFMENiTS.'lt
'CHARACTERISTIC, I� - 11 -� i �
[PARAMEThR CODES] ! Monthly. t Daily 11 Measurement 'Sa] le; Sample
i Iti Average Maximum (I F.requ�cy. e Type y Location,
Flow 50050 Weekly Estimate Effluent
Total Suspended Solids C0530 30.0 mg/L 45.0 mg/L 2/month Grab Effluent
Total Residual Chlorine 2 50060 17 µg/L 2 2/month Grab Effluent
pH [standard units] 00400 Not< 6.0 or> 9.0 2/month Grab Effluent
Turbidity 3 00070 2/month Grab Effluent
Total Manganese 01055 Quarterly Grab Effluent
Total Iron 01045 Quarterly Grab Effluent
Total Fluoride 4 00951 Quarterly Grab Effluent
Total Zinc 4 01092 Quarterly Grab Effluent
Footnotes:
1. Beginning no later than 270 days from the effective date of this permit, the Permittee shall begin
reporting discharge monitoring data electronically using the NC DWR's Electronic Discharge
Monitoring Report (eDMR) internet application. [See Special Condition A. (2.) for eDMR submittal
requirements.]
2. The Division shall consider compliant all TRC effluent values reported below 50µg/L. However,the
Permittee shall continue to record and submit all values reported by a North Carolina-certified test
method (including field certified), even if these values fall below 50µg/L.
3. Discharge from this facility shall not cause receiving-stream turbidity to exceed 50 NTU. If
instream background conditions exceed 50 NTU, this discharge shall not cause instream turbidity
to increase.
4. Monitoring required only if this parameter is added to finish-water used as filter-backwash,
thereby creating its potential to concentrate in the wastestream.
Page 3 of 5

NPDES Permit NCO088633
A. (2.) ELECTRONIC REPORTING - DISCHARGE MONITORING REPORTS
Proposed federal regulations require electronic submittal of all discharge monitoring reports (DMRs)
and specify that, if a state does not establish a system to receive such submittals, then Permittees must
submit DMRs electronically to the Environmental Protection Agency (EPA). The Division anticipates
that these regulations will be adopted and will begin implementing this program in 2013.
NOTE: This special condition supplements or supersedes the following sections within Part II of this
permit (Standard Conditions for NPDES Permits):
• Section E. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section G. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)I
Beginning no later than 270 days from the effective date of this permit, the Permittee shall begin
reporting discharge monitoring data electronically using the NC DWR's Electronic Discharge
Monitoring Report(eDMR) internet application.
Monitoring results obtained during the previous month(s) shall be summarized for each month and
submitted electronically using eDMR. The eDMR system allows permitted facilities to enter
monitoring data and submit DMRs electronically using the internet. Until such time that the state's
eDMR application is compliant with EPA's Cross-Media Electronic Reporting Regulation
(CROMERR), Permittees will be required to submit all discharge monitoring data to the state
electronically using eDMR and will be required to complete the eDMR submission by printing,
signing, and submitting one signed original and a copy of the computer printed eDMR to the
following address:
NC DENR/DW R/Information Processing Unit
ATTENTION: Central Files/ eDMR
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If a Permittee is unable to use the eDMR system due to a demonstrated hardship, or due to the
facility being physically located in an area where less than 10 percent of the households have
broadband access, then a temporary waiver.from the NPDES electronic reporting requirements may
be granted and discharge monitoring data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3)
or alternative forms approved by the Director. Duplicate signed copies shall be submitted to the
mailing address above.
Requests for temporary waivers from the NPDES electronic reporting requirements must be
submitted in writing to the Division for written approval at least sixty (60) days prior to the date the
facility would be required under this permit to begin using eDMR. Temporary waivers shall be valid
for twelve (12) months and shall thereupon expire. At such time, DMRs shall be submitted
electronically to the Division unless the Permittee re-applies for and is granted a new temporary
waiver by the Division.
Page 4 of 5

NPDES Permit NC0088633
Information on eDMR and application for a temporary waiver from the NPDES electronic reporting
requirements is found on the following web page:
http://portal.nedenr.org/web/n/admin/boglipu/edin
Regardless of the submission method,the first DMR is due on the last day of the month following
the issuance of the permit or in the case of a new facility, on the last day of the month following the
commencement of discharge.
2. Signatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B. (11.) (d)l
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part 11,
Section B. (I 1.)(a), or by a duly authorized representative of that person as described in Part II,
Section B. (I 1.)(b). A person, not an assigned position, must be delegated signatory authority for
eDMR reporting purposes.
For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user
account and login credentials to access the eDMR system. For more information on North
Carolina's eDMR system, registering for eDMR and obtaining an eDMR user account, please visit
the following web page:
http://portal.ncdenr.or web/wq/admin/bogjipu/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall make
the following certification [40 CPR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION
WILL BE ACCEPTED:
V 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 manage 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 significantpenallies.for submiltingfcrlse information, including the
possibility offines and imprisonment for knowing violations."
3. Records Retention ISupplements Section D. (6.)l
The Pennittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions. 'these
records or copies shall be maintained for a period of at least 3 years from the date of the report. This period
may be extended by request of the Director at any time [40 CFR 122.41].
Page 5 of 5

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Aqua North Carolina, Inc. Facility
Bannertown Hills Subdivision - Well #2 WTP Location .-.^
not to scale
Latitude: 36'29'57" N Longitude; 80'33' 14"W Fli
State Grid/Quad: A I 6SE I Mt.Airy N,NC Stream Class; C
Receiving Stream: UT to Faulkner Creek stream Segment: 12-72-6 is
Drainage Basin: Yadkin River Basin Sub-Basin: 03-07-03
HUC: 03040101 NPDES Permit NCO0885
North
Mt Airy, Sorry County

NORTH CAROLINA "fPubl'ic Notice `
SURRY COUNTY North Cbfolrna?Environmental
Management
Commission/NPDES Unit
1617 Mail Service Center
9-1617
AFFIDAVIT OF PUBLICATION Raleigh,NO Intent
to Issue
Notice of Intent to Issue a
NPDES Wastewater Permit
Before the undersigned, a Notary Public of said County and State, duly The North Carolina Environ-
mental Management Commis-
commissioned, qualified and authorized by law to administer oaths, Sion proposes to issue a NP-
,r5onall appeared Ferris W. Simpson who being first dui DES wastewater discharge
p' ' y PP p' 6 y permit to the,person(s)listed
sworn, deposes and says: that he (she) is Business Manager below.Written comments re-
garding the proposed permit
-
(Publisher or other officer or employee authorized to make affidavit) of will be accepted until30 days
CIVITAS MEDIA, LLC, engaged in the publication of a newspaper known i after notice. publish date of this
I notice.The Director of the NO
as MOUNT AIRY NEWS, published, issued, and entered as periodicals Division of Water Resources
(DWR)may hold a public hear-
class mail in the city of Mount Airy in said County and Stale; that he (she) ing should there be a signifiq-
is authorized to make this affidavit and sworn statement; that the notice or ant degree of public interest.
Please mail comments and/or
other legal advertisement, a true copy of which is attached hereto, was information requests to DWR
published in MOUNT AIRY NEWS on the following dates: at the above address. Inter-
ested persons may visit the
DWR at 512''N.Salisbury
1Tt/ Street;Raleigh,NO to review ')
�' ttrr IV information on file.Additional
information on-NPDES per-
mits and this notice may be
found on our website:
hftp://portal.ncdenr.org/webAvq
/swp/ps/npdes/calendar,or by
calling(9 19)807-6390.Aqua
and that the said newspaper in which such notice, paper, document Or North Carolina, Inc. (Cary)ap-
plied to renew NPDES Permit
legal advertisement was published was, at the time of each and every NCO088633 for Reeves WoodsSubdivision'WTP,Reeves Mill
such publication, a newspaper meeting all of the requirements and Rd.,Mt.Airy,Surry County,
j qualifications of Section 1-597 of discharging treated filter.back-
the General Statutes of North Carolina wash to UT of Rutledge creek,
and was a qualified newspaper within the meaning of Section 1-597 of Yadkin River Basin.Currently,
Total,Residual Chlorine(TRC)
the General Statutes of North Carolina. is water-quality limited.This
discharge may affect future
? I� wasteload allocations to this
This 3 day of 1 VAAAL ) 2014 portion of the receiving stream.
i
,r a Publish February 28,2014.
Signature of person making affidavit
Sworn to and subscribed before me, this 3 day of
,
1 � 1 (A/ � 2014
Notary P Iic
My Commission expires: January 15, 2018 �� )
BRIDGET HENDERSON
NOTARY PUBLIC
Yadkin county
North Carolina
Tres January 15,2018
My Commission Exp

DENR/ DWR/NPDES
EXPEDITED FACT SHEET - NPDES PERMIT DEVELOPMENT
NPDES Permit NCO088633
Joe R. Corporon, L.G., Expedited Permitting and Compliance Unit 28Jan2014
,„ Facility Information
_Facrhty Naive Reeves Woods Subdivision—Wells #2 WTP
APphcant AQUA North Carolina,Inc.
n . Thomas J. Roberts, President &CEO
Contact
[TJRobers a aquaamerica.com]
Applicant Address 202 Mackenan Court, Cary 27511
Facility Address Reeves Mill Road, Mt Airy 27030
Permitted Flow(MGD) Not limited
Type of Waste potable WTP filter backwash (green sand frher Technology).
Facility Class County Surry
F„acility Status ',. Renewal Regional Office WSRO
StreaC•har tenistics ter,
Receiving Stream/ Basin 4`' UT to Rutledge Creek StreamFClass fc ' ion C
Yadkin-Pee Dee
Stream Segment 12-72-10 Dramag&Bas!n River Basin
t , i
Summer 7Q10 (cfs) _ Sub'"'b_in �, `"' 03-07-03
Winter 7Q10(cfs) Use Sugport Yes
Ai (cfs) _ 303(d) Listed No
Average„Flow (cfs) zero-Flow conditions ,State Gnd� B 16 NE
IWC(%) 100 % kUSG �poQuad„ Mt Airy, South
Facility Summary— This WTP employs greensand filter technology to generate potable water at a rate of
0.024 MGD while generating wastewater(filter-backwash) at a rate consistently reported as 0.00118 MGD
for discharge to Waters of the State. The Permittee has reported that neither potable water nor wastewater at
this facility contains fluoride; therefore fluoride monitoring is not required.
Whole Effluent Toxicity(WET)Testing— In accord with current WTP renewal strategy(revised 2009),
WET testing is not required of facilities employing greensand filter technology. No changes to the
permit.
Summary of Renewal Changes:
I. within 270-days of the permit effective date, renewal requires the Permittee to apply for electronic
submittal of monthly DMRs (eDMRs).
2. updated facility description [Supplement to Cover Sheet] and Vicinity Map;
3. added parameter codes to table, Section A. (1.);
4. Because this greensand facility does not discharge to WS waters,effluent concentrations of Total
Manganese is not permit limited /data do not require RPA.
No other changes to the permit.
Pact Shcc1
Rcnc�rtd 2014 -- N1'1)1'S Pcmw NCUUR8G33
I'oec I of I

YADKIN RIVER BASIN
Name of Stream Subbasin Stream Index Number Map Nunilrer ,, Class
Roby Creek YAD02 12-85-1 C16SE5 WS-IV
Rock Branch YAD1S 13-25-27-2 F19SES C
Rock Creek YAD01 12-43 C14NE1 C
Rock Creek YAD13 13-17-31-1-3-1 F18SW2 C
Rock Hole Branch YAD12 13-17-24-3 G17NW2 C
Rock Hole Creek YAD12 13-17-24 G17NW2 C
Rockhouse Creek YADO1 12-19-7 C12NE7 C;Tr
Rocky Branch YAD06 12-108-16-6-4 C15SE2 WS-III
Rocky Branch YAD06 12-108-21-3-1-2 E15NE8 C
Rocky Branch YAD14 13-17-40-17 G17SE9 C
Rocky Branch YAD10 13-28-3 (319SE4 WS-IV
Rocky Branch YAD16 13-39-14 H19NES C
Rocky Creek YADOB 13-8-(0.5) F18SE5 WS-IV
Rocky Creek YAD08 13-8-(2) F18SE5 WS-IV;CA
Rocky Creek YAD1S 13-25-6 E19SE5 C
Rocky Creek YAD15 13-25-15-5 F19NE4 C
Rocky Creek YAD15 13-25-30-(0.3) F19SW1 C
Rocky Creek YAD15 13-25-30-(0.5) F19SW5 C;HQW
Rocky Creek (Rocky River) YAD06 12-108-11 C14SW6 C
Rocky Face Branch YAD06 12-108-4 D14NE4 WS-II;HQW
Rocky Ford Creek YAD10 13-20-15-1 H18NE4 C
Rocky Fork Creek (Mill stone Lake) YAD16 13-39-8 G20SW5 WS-III
Rocky Meadow Branch YAD04 12-123-1 E18NW3 C
Rocky River YAD10 13-17 E15SE6 C
Rocky River YAD11 13-17 E15SE6 C
Rocky River YAD12 13-17 E15SEG C
Rocky River YAD14 13-17 E15SE6 C
Rocky Spring Branch YAD07 12-113-6-1 D17SE9 C
Roten Creek YAD01 12-40-2-1 B13SE1 WS-II;Tr,HQW
Running Creek YAD13 13-17-31-5-2 F17SE1 C
Rushing Branch YAD10 13-20-2 H18NW7 C
Rutledge Creek YAD03 12-72-10 A16SE9 C
Saddle Mountain Creek YAD02 12-62-5 B15NW2 B;Tr,ORW
Sage Creek YAD02 12-63-4 B15NE2 WS-II;Tr,HQW
Salem Creek YAD14 13-17-36-15 H17NW3 C
Salem Creek (Middle Fork Muddy Creek) YAD04 12-94-12-(4) C18SW2 C
Salem Creek (Middle Fork Muddy Creek, Salem Lake) YAD04 12-94-12-(1) C18SW3 WS-III;CA
Sam Branch YAD06 12-108-16-2-1 C15NW7 WS-III
Sams Creek YAD15 13-25-23 F19SE1 C
Sand Branch YAD04 12-117-2-1 E17SE4 C
Sand Branch YAD09 13-2-10-2 E19SW4 C
Sand Branch YAD09 13-2-19-1-(1) F19NW4 C
Sand Branch YAD09 13-2-19-1-(2) F19NW4 WS-IV
Sand Branch YAD15 13-25-36-2 G19NE2 C
Sandy Creek YAD01 12-40-3-3 C13NE2 WS-II;Tr,HQW
Sandy Creek YAD04 12-100-2 D17SE4 C
Sandyberry Creek YAD02 12-55 C15NE2 C
Barrett Branch YADO1 12-19-17 C12SE9 C;Tr
Savannah Branch YAD17 13-47-1-1 H17SE6 C
Savannah Creek YAD10 13-26 H19NW1 WS-IV
Sawmill Branch YAD04 12-94-13-2 C18SW6 C
Sawmill Branch YAD05 12-102-7 C16SE7 C
Scaly Bark Creek YAD13 13-17-31-2 F18SW4 C
Page 21 of 28 2013-12-19 11:17:52

®U " "" Aqua North Carolina,Inc. www.aquanorthcarolina.com
4163 Sinclair Street
Denver, NC 28037
September 18, 2013
N.0 Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-0167
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Reeves Woods Subdivision Well #2 WTP
NPDES No. NC0088633
Surry County
Gentlemen:
Enclosed are three (3) copies of the completed application Short Form C- WTP.
This submittal includes the necessary attachments for your office to renew the
subject permit.
If you need any additional information or assistance, please feel free to
contact our Regional Compliance Manager, Michael A. Melton @ 704-489-9404
ext. 57238 or by e-mail at [e-mail].
Sincerely,
oberts- - -
President & COO
Enc
An Aqua America Company

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 NC0088633
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 Reeves Woods Subdivision -Well #2 WTP
Mailing Address 202 Mackenan Ct
City Cary
State / Zip Code NC/27511
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road Reeves Mill Road
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
Denver _.. _.
State / Zip Code NC / 28037
Telephone Number [phone]
Fax Number [phone]
Page I of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
4. Ownership Status:
Federal ❑ State ❑ Private ® Public ❑
5. Type of treatment plant:
❑ Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
® Green Sand Filter (No sodium recharge)
❑ 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 two (2) Greensand filters operated in parallel, two (2)
Potassium Permanganate feed tanks, Caustic soda and Chlorine.
8. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge is the backwash of greensand water treatment system. Average
discharge rate is approximately 1,180 gallons per day.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Average Backwash Duration = 100 minutes
11. Plant design potable flowrate .024 MGD
Backwash or reject flow 0.0011$ MGD
12. Name,of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Unamed Tributary to Rutledge Creek (Yadkin Pee Dee Basin)
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i
NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate Yes No X
Iron sulfate / ferrous sulfate Yes No X
Fluoride Yes No X
Ammonia nitrogen / Chloramines Yes No X
Zinc-orthophosphate or sweetwater CP1236 Yes No X
List any other additives below:
Potassium,Permanganate
Caustic Soda
Chlorine
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
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 ofmy knowledge and belief such information is true, complete, and accurate.
&IyE2TS
Pri e n e of P so gn g Tit
Signature of plicant Date
North Carolina General Statute 143-215.6(b)(2)provides that:Any person who knowingly makes any false statement representation,or certification in any application,
record,report,plan,or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that
Article,or who falsifies,tampers with,or knowingly renders inamorata 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. (16 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.)
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AOUA
Aqua North Carolina,Inc. r:70I F89.9+01
North CalY o I I n a. +109 Sinclair Street F: 701.489.9+09
Denver,NC 28097 v�vw.aquanorthcarollna.corn
SLUDGE MANAGEMENT PLAN
For
Aqua North Carolina, Inc.
No sludge will be treated on any wastewater treatment plant site operated
by Aqua N.C., Western Division
Where practical, sludge removed from a Aqua N.C., Western Division
facility will be transported via a contract hauler to another Aqua N.C.,
Western Division facility for the purpose of"seeding" a new or under
loaded plant.
Unusable (or "dead") sludge will be removed by a contract hauler and
properly disposed of in accordance with NCGS 1+3-215.1. Contract
haulers used by Aqua N.C., Western Division will be required to report the
quantity of sludge transported and identify the location of the proposed
disposal site if the sludge is not taken to an existing plant operated by Aqua
N.C., Western Division. Aqua N.C., Western Division has not entered into
any agreement to accept sludge into its facilities fi-om plants not owned by
them.
Aqua N.C., Western Division will keep records on the quantity of sludge
removed from each facility, the name of the contract hauler, and the
destination of the sludge (whether used in another plant or disposed of).
The information will be kept on file and will be made available to any
regulatory agency havingjurisdiction over sludge treatment or disposal.
Aqua N.C., Western Division includes all of the facilities under the
Jurisdiction of the Winston-Salem Regional Office: