HomeMy WebLinkAboutNC0034452_Permit (Issuance)_20040402 NPDES DOCUWENT SCANNING COVER SHEET
NPDES Permit: NC0034452
Willow Creek WWTP
Document Type: ^Permit Issuance Q
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Speculative Limits
Report
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: Aril 12, 2004
Thies document is printed on reuse paper-ignore maws'
contest oa the reverse side
F WA TF,q Michael F. Easley
/U^,^\\ Governor
"� William G. Ross, Jr., Secretary
1t1t1t IIIVVViii"'WWW IIIWWWAAA�`��/VVV� 111 � North Carolina Department of Environment and Natural Resources
O Y Alan W. Klimek, P.E., Director
Division of Water Quality
Apra 12, 2004
Mr. George W. Lyles,Jr.
Willow Creek Holdings,l.LC
1730 North Main Strect
High Point, North Carolina 27262
Subject.Issuance of NPDES Permit NCO034452
Willow Creek%XI\GTP
Davidson County
Dear Mr. Lyles:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly,we are forwarding 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. Envitonmental Protection Agency dated May 9, 1994 (or as subsequently amended).
This final permit includes no major changes from the draft permit sent to you on February 18,2004.
This permit includes a TRC limit that will take effect on November 1, 2005.
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) daps following receipt of
this letter. This request trust be in the form of a written peution, 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.
Plcase note that this permit is not transferable except after notice to the Division. The Division may require
modification or revocation and reissuance of the perurut. This permit does not affect the legal requirements to obtain
other permits which may be required by the Division of eater Quality or permits required by the Division of Land
Resources, the Coastal Area Management Act or any other Federal or Local governmental permit that may be
required. If you have any questions concerning this permit, please contact Dawn Jeffries at telephone number(919)
733-5083, extension 595.
Sincerely,
ORIGINAL SIGNED BY-
Mark McIntire
Alan W. Klimek, P.E.
cc: CentrAl hltes
VlinstomSvlcm Regional Office/Water Quality Section
NBp�i,
N.C.Division of Water Quality/NPDES Unit Phone:(919)733-5083
1617 Mail Service Center,Raleigh,NC 27699-1617 fav(919)733-0719
Internet h2o.enr.state.nc.us DENR Customer Service Center. 1 800 623-7748
Permit No. NCO034452
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
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,
Willow Creek Builders, Inc.
is hereby authorized to discharge wastewater from a facility located at
Willow Creek Builders Wastewater Treatment Plant
Southwest of Willow Creek Country Club
High Point
Davidson County
to receiving waters designated as Abbotts Creek in the Yadkin —Pee Dee River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts 1, II, III and IV hereof.
This permit shall become effective May 1, 2004.
This permit and authorization to discharge shall expire at midnight on April 30, 2009.
Signed this day April 12, 2004.
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit No. NC0034452
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked.
As of this permit 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 included herein.
Willow Creek Builders, Inc.
is hereby authorized to:
I. Continue to operate an existing 0.080 MGD wastewater treatment system consisting
of the following:
• Influent pump station
• Bar screens
• Two aeration basins
• Two secondary clarifiers
• Gravity sand filters
• Chlorine contact chamber
• Effluent flow measurement
The facility is located at Willow Creek Builders Wastewater Treatment plant,
southwest of Willow Creek Country Club, High Point in Davidson County, and
2. Discharge from said treatment works at the location specified on the attached map
into Abbotts Creek, which is classified WS-III waters in the Yadkin-Pee Dee River
Basin.
9,10r.1oi , 41riA
' 1
BEY
1741 u
46
i r�A �/ a .• _ � .�� a � � v / � ti
\��I I�\\ �y/a . �ill� �� �'✓ � I l� i� 11,J Cl/�-B��'titi � �(J�� _:��i�f�
yV J�,��/�j
d10W CreekeeM -
�`
-��-' ' -ice /✓ � ( JAI `� 8P� — � i i o°d-� _J; I II��G
Ili r ��) .� � / , db (.� � �� �� / �'✓N ,�: 1 `i ,:�.r n• eft �.�� 11_
(37
_/� Q\P � f r i uw ]1���<lslf' , il(1��,�} \�I`1 ' ��UI ✓ \+,� CJ 1G
J is1 '> uHM-
J�as
r7/4
a, Ins �i
al
NI
Latitude:35°58' 04" Willow Creek Builders
Longitude:80°06'02"
USGS Quad #:D18NE NCO034452
River Basin #:030707 Davidson County
Receiving Stream:Abbots Creek
Stream Class:WS-111
Permit No.NO0034452
A. (1). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is .
authorized to discharge from outfall(s) serial number 001. Such discharges shall be limited and monitored
by the Permittee as specified below.
EFFLUENT LIMITS MONITORING REQUIREMENTS
CHARACTERISTICS
Monthly Weekly Daily Measurement Samplg Sample
Average Average Maximum Frequency __ Type Location'
Flow 0.080 MGD Continuous Recording I or E
BOD5 9.0 mg/I 13.5 mg/I Weekly Composite E
(April-October 31
BOD5 15.0 mg/1 22.5 mg/I Weekly Composite E
November 1—March 31
Total Suspended Solids 30.0 m /I 45.0 m /I Weekly Composite E
NH3 as N 5.5 mg/I 27.5 mg/I Weekly Grab E
(April 1—October 31
NH3 as N 11.0 mg/I 35.0 mg/I Weekly Grab E
November 1—March 31
Dissolved Oxygen2 Weekly Grab E,U,D
Fecal Coliform 200/100 ml 4001100 ml Weekly Grab E
(geometric mean
H 3 Weekly Grab E
Total Residual Chlorine4 28 N /I 2/week Grab I E
Temperature °C Weekly Grab
Total Nitrogen Monthl Composite E
Total Phosphorus Monthly _Composite E
Notes:
1. Sample Locations: E- Effluent, I- Influent, U —Upstream at NCSR 1743, D—Downstream at NCSR 1744
2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/I.
3. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
4. Monitoring requirement applies only if chlorine is added for disinfection. Limit takes effect November 1,2005.
Until the limit takes effect, the permittee shall monitor TRC (with no effluent limit).
There shall be no discharge of floating solids or visible foam in other than trace amount.
WAT�.c� Michael F. Easley,Governor
O�� 'rpG State of North Carolina
6U
William G.Ross,Jr.,Secretary
rDepartment of Environment and Natural Resources
7 y Alan W.Klimek, P.E., Director
Division of Water Quality
February 18, 2004
MEMORANDUM N.C.RECEIVED
To: Lee Spencer NC Dept. of EHNR
NC DFNR / DEH / Regional I ngineer
Winston-Salem Regional Office FEB 2 0 2004
I
1
From: Dawn Jeffries I Winston-Salem
NpDE.S unit Regional Office,
Subject: Review of Draft NPDES Permit NCO034452
Willow Creek WWTP
please indicate below your agency's position or viewpoint on the draft permit and return this form by March
26, 2004. if you have any questions on the draft permit, please contact me at telephone number (919) 733-
5083, extension 595 or via c-mail at dawti.jeffries@ncinqil.net.
ncmail.net.
ItFSPONSI-': (Check one)
�recur with the issuance of this permit provided the facility is operated and maintained properly, the stated
u -ffl icnt limits are met prior to discharge, and the discharge does not cunuavenc the designated seater quality
standards.
❑ Concurs with issuance of the above permit,provided the following conditions are met
❑ Opposes the issuance of the above permit,based on reasons stated below,or attached:
Signed Date 2 2
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-161 7 -TELEPHONE 919-733-5083/FAX 919-733-071 9
VISIT US ON THE WEB AT http://h2o.enr.state.nc.us/NPDES
Written comments re-ed The City*ofCenter
Lexington,
permit the proposed (28-.West Center Street,
permit will be accepted .,Lexington, :.NC27292)
--- until 30 days after the has applied
PUBLIC publish date of this no- for NPDES permit I
NOTICE tice. All. comments:re-. NCO055786'f6r the.Lex-I
ceived . prior to .that ington Regional WWFP
STATE.I OF date are considered. in in Davidson ,Count
NORTH CAROLINA the final determinations This permitted facility'
ENVIRONMENTAL regarding the proposed discharges . treated
MANAGEMENT'S 'permit The Director.of wastewater to the .Ab-
COMMISSION/NRDES the'NC-Division of Wa- botts Creek in the Yad
UNIT ' ter Quality may decide kin .Pee-Dee River Ba-
1617 MAIL SERVICE. to hold a public meet- sin. Currently'BOD, am-
CENTER ing for, the proposed .monia, .nitrogen, total!
'RALEIGH,NC"' permit,should the'Divi-; phosphorus, . cyanide,
son receive a signifi`: �.mercury, phenols 'and
27699-1617 cant degree of .public total,;residual .chlonnel
NOTIFICATION OF interest... - -are via[er quality'limit-!
INTENT TO ISSUE ' ed. This discharge mays
NPDES WASTEWATER 'Copies of the draft Per- affect future'allocations t
PERMIT mit and 'other,support-. in this, portion of the
ing 'information:on .file Yadkin .Pee-Dee River
On the basis of thor- used to determine.con Basin. -
ough staff, review and ditions present .in -the ,
application of NC.Gen- draft permit are availa- 'Willow Creek Hgldings,
.ble upon:request and LLC in High'.Point, NC - R
Prat Statute 143.nd '(
Public Law_l,standards
and payment p the costsCs of has'applied-iDE5 renewal ,^.l
re roduc[ion.•'Mail com- of NPDES.
other lawful,standards p l permit
and regulations,- the men[s and/or..requests. -NC0034452 for its Wil-
North'Carolina Environ- for information to .the low Creek wastewater mental Management NC Division ".of-Water treatment plant,in. Do- ���e�npD 2004 IJ
Commission proposes Quality at the above vidson County. -This �U'll` _ 3
Ito issue a National Pol- address or call Ms. Va-I rpermitted facility dis-.
i lutant Discharge Elimi- levryy Stephens at (919), .charges treated waste-
nation System (NPDES) 733-5083, extension,' water to.Abbotts Creek 115Y
wastewater dischar a 520. Please included -in the Yadkin Pee-Dee AIR(lft c.
ermi[ to the persons) the NPDES permit.num- river Basin. Currently, g OGET 0�fICE____`.�
fisted below effective ber (attached) in any1 ammonia, nitrogen'
45 days from the pub- communication. Inter BOD, and total residual
lish date of this notice. ested persons may also chlorine are water qual- I
visit'the-Division of Wa' ity '-limited_ ;This .dis- I
- .ter Quality at 512, N.' charge 'may .affect;fu-.
.Salisbury Street, Ra-i ture-allocations' in;this
leigh, NC 27604-1148.1 portion .of the water-
. - between the hours ofj shed.
8i00 a.m. and 5:00 p.m.1 to review- information February 20,2004
on file.
AFFIDAVIT OF PUBLICATION Z 1 � ZU 2004
STATE OF NORTH CAROLINA Lexington,N-C. `.J(R W
DAVIDSON COUNTY
a f I i sl & of THE DISPATCH, a newspaper published in the city of
Lexington, County and Slate aforesaid, being duly sworn, says the foregoing legal
of
which the attached is a true copy, was published in said newspaper once the
day of F-tbiyulaVl l 2004.
-Publication Fee $ /13b. 45
(Seal)
Sworn to and subscribed before me, this 2V ' 'I` day of - "�-�� W L'�- 20
Oq
W,,,pxwuiulp� '
�e#,N Cq"�N Q
a Q 10
My commission expires
3�:• '°UB LlG ;2VF�
COUN
Fier
PUBLIC NOTICE P 1 '. 1/I/N'
STATE OF NORTH CAROLINA 00— (n/
ENVIRONMENTAL MANAGEMENT C CENTER
IONINPDES UNIT
1617 RAMAILSERVICECEMEN
RATION NCTENTTOI
NOTIFICATION T INTENT TOISSUEA
NPOFst WASTEWATER A PERMIT
Onthe basis Public
law staffrevid otheapp whit end rdOaeralStat-
tio ,the N Public law 92-500 and ether anagl ant Commission
and regula-
tions,the North Carolina Environmental Management Commission System
pro-
poses to issue a National Popermit Discharge Elirtdlisted System
I cove I wastewater discharge permit to the persons)fisted below at-
active a5 days from se publish pdate roposed
eis erica.
Written mmmets regarding ea pmpo ce.permit will nd accepted until
3o days attar thepublishconsidered
r d in th this notke.All carnmeofs received prior
e eat date are he Director
in final tlelemtinof Watergunitythepro-
posed permit.The Director of the NC Division pt Water Ouatry may di,
title to tnd a public meeting for the proposed parent should the Divksion
receive of
draft permit
degree of Minor interest.
Copies of the draft permit and other eu raft er information on ufilep nused
re-
quest wMdiof t present o the drodu permit are available upon/or
quest and payment of the gistsof Division
of
Mail comments above
requests for information to me NC Division of Water B3,exte the above
addressPlease i cl call Me.Vale Stephens at rfia n3&SOfi3 extension 52n.
Please include the NPDES permit numbere Division in Water Quality at
fiat.N.
Salisbury
persons may also visa the Division of Water hours of
0 N.Salisbury Street,Raleigh,NC 2]600.t1an between the hours of
The a.m.and Lexington on(tc review information on file
The City of Lexington(of West perm Steel,lenlnyytr the
Le 2ngton
has applied for renewal of NPDES permit NCOOSSn88 for the Lexington
Regional IWVTP in Davidson County.This ppermitted facil�'�ryry discharges
treated wastewater M the Manor Creek in the Yadkin Pee-Dee River Ba-
sin.Currently BOD,ammonia nitrogen,total phosphorus,cyanide,met.
wry,phenols and total residual chlorine are water quality tlrrfsd.This
discharge may affect future allocations in this portion of ma Yadkin Pee
Dee River Basin
Willow Creek Holdings,LLC In High Point,NO has applied for renewal of NPDES parent NC0034 52 tar as Willow Creek wastewater treatment
plat in Davidson County.This pamated faalrty discharges Voted
wastewater to Atoms Creek in the Yadkin-Pee nee River 9asin.Cur-
rently,ammonia nitrogen,BOD,and total residual chorine are water
quality limited.This discharge may of act 8rture allocations in this portion
of the watershed.
The FidM Products,Inc.(SO/Meent n,Norwalk,CT 18252)has applied
for renewal of NPDES perma NC0085871 for the Fled Product Remede-
ron Site in Forsyth County.This Permitted faci1ay discharges treatetl
wastewater to the Brushy Fork in the Yatlkin Pee-Dee River ash.Cur-
ren y total suspended solids are water qualay Ivrdecl TNs discharge
may affect future allocations in this portion of the Yadkin Pee-Dee River
Basin.
WSJ:February 21,2004
WINSTON-SALEM JOURNAL PROOF
Customer: NCDENR/DWQ/NPDES Contact: FAX / VALERY Phone: 9197335083
Address: 1617 MAIL SERVICE CENTER ATTN: VALERY STEPHENS
RALEIGH NC 276991617
Ad Number: 480349
Insert Dates: 02/21 004
Price: 294.78
Section: CL Class: 99; LEGALS Size: 2 x 51.00
Printed By: KSAPP Date: 02/19/2004 For: 9999
Signature of Approval: __ _______________ Date:____________________
VAR 004
FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
Facility Name 1,//V1,v t fwkAr/di
Reviewer &evdn ah
Basin/Sub-basin pp7p
Receiving Stream
Is the stream impaired (listed on 303(d))? No-
Is stream monitoring required? Lc�,
Do they need NH3 limit(s)? + ��i>tr wu-el q rcc/7A tR�CiWI'�!'
Do they need TRC limit(s)?
Do they have whole-effluent toxicity testing? V.
Are there special conditions? O ,
Any obvious compliance concerns? p.
Existing Expiration Date
Proposed Expiration Date ty0
Miscellaneous Comments:
/mi 9
Circle one: EXPEDITE DO NOT EXPEDITE
If expedited, is this a simpler permit r a more difficult one?
NC0034452
Facility: Willow Creek Builders, Inc.
Discharge to: Abbots Creek
Stream class and index#: WS-III
Residual Chlorine Ammonia as NH3
(summer)
7010 (CFS) 1.55 7C10 (CFS) 1.55
DESIGN FLOW (MGD) 0.08 DESIGN FLOW (MGD) 0.08
DESIGN FLOW (CFS) 0.124 DESIGN FLOW (CFS) 0.124 .
STREAM STD (UG/L) 17.0 STREAM STD (MG/L) 1.0
UPS BACKGROUND LEVEL (UG/L) 0 UPS BACKGROUND LEVEL (MG/L) 0.22
IWC (%) 7.41 IWC (%) 7:41
Allowable Conc. (ug/1) 229.50 Allowable Concentration (mg/I)'. 10.75,
maximu =28 ugl{ m nimum= 2
CAmmonia as NH3
(winter)
7010 (CFS) 3.3
Fecal Limit 200/100ml DESIGN FLOW (MGD) 0.08
Ratio of 12.5 :1 DESIGN FLOW (CFS) 0.124
STREAM STD (MG/L) 1.8
UPS BACKGROUND LEVEL (MG/L) 0.22
IWC (%) 3.62
Allowable Concentration (mg/1) 43-55-
�miilimum = 4
4t) o-ty"e.. 'A— ,a-4) r1- wily ,�Jax s . sX A.
106 94a-1 CA
6 . 68/I".�/✓LL1G--D�� I/�/ss�l'L�-�r'//��1Gy% �n./��li_c- /i
IaCGeC/? 03-07-07
%oCT-
Q e o�J
�Cnn (it�f/� - 7/PPC� CJni I/�7iJL / (` sC'iWcLo�2e•
o3
N�—Gc�r•� �a-�-P e� -fc�CGX �2IUl�
T)A-iL v 144X
f
U
OGO L-
�
- OQaZ=aGG_3 - -Scr �O
g e5
ROBERSON HAWORTH & REESE, P. L. L. C.
DAVID L. MAYNARD A PROFESSIONAL LIMITED LIABILITY COMPANY
ROBERT A. BRINSON' ATTORNEYS AND COUNSELLORS AT LAW
ELIZABETH M. KOONCE SUITE 300 HIGH POINT BANK 6 TRUST BLDG.
WILLIAM P. MILLER' 300 N. MAIN ST. WESCOTT ROBERSON
ALAN B. POWELL' (I873-1938)
COLIN 0. MERRITT HIGH POINT, NORTH CAROLINA 2 7 260-5056 HORACE B. HAWORTH
THOMAS F. FOSTER 1169E-I918,
LISAMAILING ADDRESS: OWEN REESE
CHR W. POWELL HRISTOPH ER C. FINAN P.O. BOX C 2 1M. UT
EY,J
HIGH POINT, NC 2J261 ARTHUR M. UTLEv,JR.
JULIAN P. ROBB U923-19BJI
JAMES C. LANIK" TELEPHONE (336)689-8733
'CERTIFIED MEDIATOR FACSIMILE (336)885-I280
"ALSO ADMITTED IN COLORADO
February 2, 2004 �c /]
IECEPI' F
Mrs. Valerie Stephens D �� PIL
NC DENR FE8 - 3 2004
Division of Water Quality
Point Service Branch
1617 Mail Service Center DEINR AVATER ouAU v
F'OIM'SQ.-iRC['.r_-a.tir:CH
Raleigh, NC 27699-1617 --- — -�
RE: Application for Permit Renewal-Short Form D
Permit#NC0034452
Willow Creek Sewer System
Davidson County
Dear Mrs. Stephens:
In connection with the permit renewal for the above referenced, I enclose herewith
the following:
1. Two (2) copies of this cover letter.
2. Original and two (2) copies of the Permit Renewal Form, Short Form D.
Please let me know if you need anything further at this time.
Very truly yours,
ROB RSON, HAWORTH & REESE, P.L.L.C.
David L. Maynard
DLM/dgg
Enclosures
NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately-owned dischargers of 100% domestic wastewater (<I MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit .
1617 Mail Service Center, Raleigh, NC 27699-1617
http://h2o.enr.state.ne.us/NPDES/
North Carolina NPDES Permit Number I NC00 34452
Please print or type
I. Contact Information:
Facility Name Willow Creek Holdings, LLC
Owner Name
Street Address 1730 N. Main Street
City High Point,
State / Zip Code NC 27262
Telephone Number ( 336 ) 881-1422
Fax Number ( )
e-mail Address
Operator Name Willow Creek Holdings, LLC
Street Address 1730 N. Main Street'
City High Point .
State / Zip Code NC 27262
County
- Guilford -
Telephone Number ( 336 ) 881-1422
2. Location of facility producing discharge:
Check here if same as above ❑
Facility Name (If different from above)
Street Address or State Road Dorado Drive, Willow Creek Subdivision
City High Point
State / Zip Code NC 27265
County
Davidson
3. Reason for application:
Expansion/Modification ` Existing Unpermitted Discharge _
Renewal X New Facility
Please provide a description of the expansion/modification:
Page 1 of 3 - Version 12102
NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately-owned dischargers of 100% domestic wastewater (<1 MGD flow)
4. Description of the existing treatment facilities (list all installed components with
capacities):
Wastewater treatment facility consisting of influent pump stations, bar
screens. 2 aeration basis 2 secondary clarifiers gravity sand filters
cholorine contact chamber and effluent flow measurement
5. Description of wastewater (check all that apply):
Type of Facility Generating Wastewater
Industrial Number of Employees
Commercial Number of Employees
Residential Number of Homes
School Number of Students/Staff
Other g
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
Residential, school and country club
6. List all permits, construction approvals and/or applications (check all that apply):
Type Permit Number Type Permit Number
RCRA Non-Attainment
UIC Ocean Dumping
NPDES NCO034452 Dredge/Fill Permits
PSD Other
NESHAPS
7. Number of separate wastewater discharge pipes (wastewater outfalls):
one
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall: -
Page 2 of 3 Version 72102
• NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately-owned dischargers of 100% domestic wastewater (<1 MGD flow)
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
Abbotts Creek
10. Is this facility located on Native American lands? (check one)
YES ❑ NO FA
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.
George W. Lyles, Jr. , Member/Manager
Printed Name of Person Signing
Member/Manager
Title
/,�' /
1 /28/04
Signature of A licant Date Signed
North Carolina General Statue 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$10,000,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$10,000 or
imprisonment not more than 5 years,or both for a similar offense.)
Page 3 of Version 12102