NC0034452_Permit (Issuance)_20140205

i
NPDES DOCUMENT SCANNING COVER SHEET
NPDES Permit: NC0034452
Willow Creek WWTP e
Document Type: !PerFmitIssuance
Waste-load Allocation ■
Authorization to Construct (AtC)
Permit Modification
Speculative Limits
Report
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: February 5, 2014
This document is prfazted on reuBc paper-ignore any
coateat on the reverse side

rs�®
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
February 5, 2014
Mr. Thomas J. Roberts
Aqua North Carolina, Inc.
202 Mackenan Court
Cary,North Carolina 27511
Subject: NPDES PERMIT ISSUANCE
Permit Number NCO034452
Willow Creek W WTP - Class II
Davidson County
Dear Mr. Roberts:
Division personnel have reviewed and approved your application for renewal of the subject
permit. Accordingly, we are forwarding the attached final 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).
Please note that 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). Therefore, a requirement to begin reporting discharge monitoring data electronically using the
NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application has been added to this
final permit. [See Special Condition A. (4.)] For information on eDMR, registering for eDMR and
obtaining an eDMR user account, please visit the following web page:
http•//portal ncdenr org/web/wq/adinin/booipL/edmr.
For information on EPA's proposed NPDES Electronic Reporting Rule, please visit the following
web site: bttp://www2 epa gov/compliance/proposed-npdes-electronie-reporting rule.
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 permit shall be final and binding.
Please take notice that this permit is not transferable. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Resources or
permits required by the Division of Land Resources, Coastal Area Management Act, or any other
Federal or Local governmental permits which may be required.
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:91M07-63001 Fax:[phone]
Internet:waw.ncwaterguattv.org
An Equal OpportunityVdfrmative Action Employer

Aqua North Carolina, Inc.
NC0034452
Page 2
If you have any questions or need additional information, please do not hesitate to contact
Maureen Kinney of my staff at [phone].
S-de/ere l ,
I"homas A. Reeder
cc: Central Files
NPDES Unit Files
Winston-Salem Regional Office, Surface Water Protection Section

Permit NCO034452
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
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,
Aqua North Carolina, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Willow Creek WWTP
SW of Willow Creek Country Club
High Point
Davidson County
to receiving waters designated as the Abbots Creek in the Yadkin-Pee Dee River Basin, in
accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, I1, 11I and IV hereof.
This permit shall become effective May 1,2014.
This permit and authorization to discharge shall expire at midnight on April 30,2019.
Signed this day February 5, 2014.
c
Thomas A. Reeder, Director
Di iv sion of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit 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.
Aqua North Carolina, Inc. is hereby authorized to:
1. Continue to operate an existing 0.080 MGD wastewater treatment system with the following
components:
♦ Influent pump station
♦ Bar screens
♦ Flow equalization tank
♦ Two aeration basins
♦ Two secondary clarifiers
♦ Gravity sand filters
♦ Chlorine contact chamber
♦ Dechlorination
♦ Effluent flow measurement
The facility is located southwest of the Willow Creek Country Club near High Point in
Davidson County.
2. Discharge from said treatment works at the location specified on the attached map into the
Abbotts Creek, currently classified WS-III waters in sub-basin 03-07-07 of the Yadkin-Pee
Dee River Basin.
Page 2 of 6

Permit NCO034452
PART
A. (1) 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 treated wastewater from outfall 001. Such discharges shall
be limited and monitored' by the Permittee as specified below:
EFFLUENT LIMITS MONITORING REQUIREMENTS
CHARACTERISTICS
Monthly Daily Measurement Sample Sample
Parameter Code Average Maximum Frequency Type Z
g 9 Y YP Location
Flow 0.08 MGD Continuous Recording I or E
50050
HOD, 5-day,20°C—Summer* 9.0 mg/L 13.5 mg/L Weekly Composite E
C0310
BOD, 5-day,20°C— Winter* 15.0 mgh 22.5 mg/L Weekly Composite E
C0310
Total Suspended Solids 30.0 mg/L 45.0 mg/L Weekly Composite E
C0530
NH3 as N—Summer* 5.5 mg/L 27.5 mg/L Weekly Grab E
C0610
NH3 as N—Winter* 11.0 mg/L 35.0 mg/L Weekly Grab E
C0610
Fecal Coliform(geometric mean) 200/100 ml 400/100 ml Weekly Grab E
31616
Dissolved Oxygen Daily Average>5.0 mg/L Weekly Grab E
00300 —
Temperature Weekly Grab E
00010
pH Between 6.0-9.0 S.U. Weekly Grab E
00400
Total Residual Chlorine 28 µg/L 2/Week Grab E
50060
Total Nitrogen(NO2,NO3, TKN Monthly Composite E
C0600
Total Phosphorus Monthly Composite E
C0665
Dissolved Oxygen Weekly Grab U& D,
00300
Temperature Weekly Grab U&D
00010
*Summer: April 1 —October 31
*Winter: November 1 —March 31
Footnotes:
1. No later than January 26,2015 begin submitting discharge monitoring reports electronically
using NC DWR's eDMR application system. See Special Condition A.(3.).
2. L Influent, E: Effluent, U: upstream at NCSR 1743,D: downstream at NCSR 1744.
3. The Division shall consider all effluent TRC values reported below 50 µg/1 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 µg/l.
All samples collected should be from a representative discharge event.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
Page 3 of 6

Permit NCO034452
A. (2.) NUTRIENT REOPENER FOR HIGH ROCK LAKE
This permit may be reopened and modified to implement nutrient requirements in accordance with any
future TMDL and/or nutrient management strategy for High Rock Lake.
A. (3.) DISCHARGERS TO 303(D)WATERS:
Please note that the receiving stream is listed as an impaired waterbody on the North Carolina 303(d)
Impaired Waters List. Addressing impaired waters is a high priority with the Division, and instream
data will continue to be evaluated. If there is noncompliance with permitted effluent limits and
stream impairment can be attributed to your facility,then mitigative measures may be required.
A. (4.) ELECTRONIC REPORTING OF 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 is beginning implementation in late 2013.
NOTE: This special condition supplements or supersedes the following sections within Part II of
this permit(Standard Conditions for NPDES Permits):
• Section B. (11.) Signatory Requirements
• Section D. (2.) Reporting
• Section D. (6.) Records Retention
• Section E. (5.) Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning no later than 90 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/DWR/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,
Page 4 of 6

Permit NC0034452
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.
Information on eDMR and application for a temporary waiver from the NPDES electronic
reporting requirements is found on the following web page:
http://portal.ncdenr.org/web/wq/admin/bog/ipu/edmr
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. Siunatory Requirements [Supplements Section B. (11.) (b) and supersedes Section B. (11.)
All eDMRs submitted to the permit issuing authority shall be signed by a person described in
Part II, Section B. (I I.)(a) or by a duly authorized representative of that person as described in
Part 1I, Section B. (I 1.)(b). A person, and not a 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.ora/web/wq/admin/bog/ipu/edmr
Certification. Any person submitting an electronic DMR using the state's eDMR system shall
make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF
CERTIFICATION WILL BE ACCEPTED:
"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 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 significant penalties for submitting false information,
including the possibility offrnes and imprisonment for knowing violations."
3. Records Retention [Supplements Section D. (6.)]
The permittee 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
122.411.
Page 5 of 6

�I741` X
r b; .•Jl�` ,, �1. � ?�f ;� � •,� 0�' / .��. I\ ; •: ; .,, .
IN I
Creeh �._ ✓ .!i . .
�A✓I�v/r�: �5�.� �����/%��_ 11: Jl• yam. ' � \� �r�� t—f � �%�1
FT
'). aSa_. �` � .;1� I .i I R.`� �.v_��� `�:� _ -ea'?43 8c' \V y.. /`( :--�`.� .♦ _ n :I
_ Dl.� I755j,`1.���. \ M,i .: _ ^.\ �� - // � _' ectrJ2efer—' � � l-- � �`'�♦�jL�,
_ - is �. .. '' • ' � /� / ..`\� �/^^•I I /_ _�ppJ '�' --�. �����! A�.i `�i
.11'' . ' � �� �.``� f / r � lam, `•. i�L%�'i l�i�y )i - �J 1 �`_"� �L^f���/�-.
�._ p' �` ;mil ,�'�•`��1�(7;_,�i?i `.�I .��/ :' (ti�1�,,—i" 1 j•�'1'���0 9A• I
(JI`1 :�� ::.'.l ,11) 1 -:
Aqua North Carolina, Inc. Facility
Pine Valley Subdivision WWTP x.
Location
County: Davidson Stream Class: WS-III (not to scale)
Receiving Stream: Abbotts Creek Sub-Basin: 03-07-07
Latitude: 350 58'04" Grid/Quad: High Point A
Longitude: 80o06'02" HUC#: 03040103 North NPDES Permit: NCO034452

Iss;�e •. �/y �►�
NORTH CAROLINA
FORSYTH COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified, and authorized by law to administer oaths, personally
appeared D.H. Stanfield, who being duly sworn, deposes and says: that he is
Controller of the Winston-Salem Journal, engaged in the publishing of a
newspaper known as the Winston-Salem Journal, published, issued and
entered as second class mail in the City of Winston-Salem, in said County and
State: that he is authorized to make this affidavit and sworn statement: that the
notice or other legal advertisement, a true copy of which is attached hereto,
was published in the Winston-Salem Journal on the following dates:
December 21, 2013
and that the said newspaper in which such notice, paper document, or legal
advertisement was published was, at the time of each and every such
publication, a newspaper meeting all the requirements and qualifications of
Section 1-597 of the General Statutes of North Carolina and was a qualified
newspaper within the meaning of Section 1-597 of the General Statutes of
North Carolina.
This 23rd day of December, 2013
(signaiur'e of ers n aking affidavit)
Sworn to and subscribed before me, this 23rd day of Dece ber, 2013
Notary P lic
My Commission expires: September 28, 2015
PUBLIC NOTICE
North Carolina Envhonm."
f Management Commission/NPDES Unit "
1627 Mail Service Center
Raleigh,NC,27699-1617
Notice of Intent to Issme a '
KIMALEY JOHNSON NPDES Wastemiler Permit
NOTARY PUBLIC The North Carolina Environmental Management
- FNOTARY pUBLITY Commission proposes.to issue a NPDES wastewa-
p I ter discharge permit to the person(s) listed below.
STATE OF NORTH CAR Q 10� Written comments regarding the proposed permit
MY COMMISSION EXPIRE will be accepted until 30 days after the publish
date of this notice.The Director of the NC'Diwsion
.of Water Resources(DWR) may hold a,public hear-
ing should there be a significant degree of public
1 interest Please mail comments and/or informa-
tion requests to DWR at the above address.inter-
estedpersons may visit the DWR at 512 N.Salis-
bury Street, Raleigh, NC to review information on
file.Additional information on NPDES permits and
this'notice may be found on our website: http://
portal.ncdenr.org/web/wq/swp/os/npdes/calen
I dar,or by calling [phone].Aqua North Caro-
lina, Inc. requested renewal of permit NCO034452
for Willow Creek WWTP; Davidson County; this
permitted discharge is treated domestic wastewa-
ter to Abbotts Creek;Yadkin-Pee Dee River Basin.
wsl:December 21,2023 '

Kinney, Maureen
From: Kinney, Maureen
Sent: Thursday, January 02, 2014 1:36 PM
To: Carter, Jenifer
Subject: RE: DRAFT Permits: NC0034452 & NC0083941
Thanks Jenifer.
Lisa Edwards is only copied when any of the permits discharge to WS classified waters. She signs off on an approval
memo we need before we can finalize.
Maureen
From: Carter, Jenifer
Sent: Friday, December 20, 2013 4:04 PM
To: Kinney, Maureen
Cc: Reid, Steve
Subject: RE: DRAFT Permits: NCO034452 & NC0083941
As the inspector of these two facilities, I see no problems with the two draft permits. Not sure why Lisa Edwards was
asked to respond... she is the Public Water Supply supervisor and, as far as I know, has nothing to do with wastewater
permits in our regional office. Maybe you meant to cc Corey Basinger?
Thank you.
Have a Merry Christmas and Happy New Year!
Jenifer Carter
Before printing this email, please consider your budget and the environment.
If you must print.please print only what you need and save ink with the free Eco-Font. -
NC DENR Winston-Salem Regional Office
Division of Water Resources
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Kinney, Maureen
Sent: Tuesday, December 17, 2013 11:16 AM
To: Carter, Jenifer; Edwards, Lisa
Cc: Reid, Steve
Subject: DRAFT Permits: NC0034452 & NC0083941
1

By-
� r
NC®ENK
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory, Governor Thomas A. Reeder, Director John E. Skvada, III,Secretary
December 18, 2013
MEMORANDUM
To: Lisa Edwards
NC DENR/DWR/Regional Engineer
Winston-Salem Regional Office
From: Maureen Kinney
Compliance& Expedited Permitting
Subject: Review of Draft NPDES Permit NCO034452
Willow Creek WWTP
Davidson County
Please indicate below your agency's position or viewpoint on the attached draft permit and return this form by
January 15,2013. If you have any questions on the draft permit, please contact me at 919-807-6388 or
Maureen.Kinnevancderineov.
RESPONSE: (Check one)
X❑ Concur with the issuance of this permit provided the facility is operated and maintained properly, the
stated effluent limits are met prior to discharge, and the discharge does not contravene the designated
water 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: 12-17-13
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 919 807-6388 (fax)919 807-6489
VISIT US ON THE INTERNET@HTTP://PORTAL.NCDENR.ORGIW'EB/W0 [e-mail]
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10°/Post Consumer Paper

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
This form must be completed by Permit Writers for all expedited permits which do not
require full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g.,
schools, mobile home parks, etc) that can be administratively renewed with minor changes,
but can include facilities with more complex issues (Special Conditions, 303(d) listed water,
toxicity testing, instream monitoring, compliance concerns).
Basic Information for Expedited Permit Renewals
Permit Writer/Date Maureen Kinney 12/17/2013
Permit Number NC0034452
Facility Name Willow Creek Subdivision WWTP
Basin Name/Sub-basin number Yadkin-Pee Dee 03-07-07
Receiving Stream Abbous Creek
Stream Classification in Permit WS-III
Does permit need Daily Max NH3 limits? No
Does permit need TRC limits/language? Yes No
Does permit have toxicity testing? Yes No
Does permit have Special Conditions? Yes No— E-Re orting Reg uirement/Re-o ener
Does permit have instream monitoring? Yes No—Temperature& D.O.
Is the stream impaired (on 303(d) list)? For Yes No
whatparameter?
-Any obvious compliance concerns? No
-Any permit mods since lastpermit? No
Current expiration date 4/30/14
New expiration date 4/30/19
Comments received on Draft Permit?
Please note the following modifications to this draft:
• Parameter codes have been added to Section A.(1.) Effluent Limitations and
Monitoring Requirements.
• A Nutrient Re-opener has been added to all dischargers in sub-basins 03-07-01
thru 03-07-07, see Special Condition A. (2.).
• A requirement to begin reporting discharge monitoring data electronically using
the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet
application has been added to this draft. [See Special Condition A. (3.)] For
information on eDMR, registering for eDMR and obtaining an eDMR user
account, please visit the following web page:
http://portal.ncdenr.ork,/web/wq/admi n/bos/ipu/edm r.

AQUA.
North Carolina
Aqua North Carolina,Inc.
4163 Sinclair Street F:704.489.9409
Denver, NC 28037 vvww.aquanorthcarolina.com
November 14, 2013
NCDENR / Division of Water Quality/ NPDES Unit
1617 Mail Service Center LNOV 20 2013
Raleigh, NC 27699-0167
DENR-WATER QUALITY
POINT SOURCE BRANCH
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Willow Creek WWTP
NPDES No. NCO034452
Davidson County
Gentlemen:
Enclosed are three (3) copies of the completed application Form D- WWTP. 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].
Sin
Thomas J. Rzbertsy___�
President & COO
Enc
An Aqua America Company

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 C0034452
If you are completing this form in computer use the TAB key or the up — down arrows to moue 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 WILLOW CREEK WWTP
Mailing Address 202 MACKENAN COURT
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 address as above ❑
Street Address or State Road SW of WILLOW CREEK COUNTRY CLUB
City HIGH POINT
State / Zip Code NORTH CAROLINA
County DAVIDSON
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 AQUA NORTH CAROLINA, INC
Mailing Address 202 MACKENAN COURT
City CARY
State / Zip Code NORTH CAROLINA 27511
Telephone Number [phone]
Fax Number [phone]
1 of 3 Form-D 05108

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 154
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
This system serves residential customers only.
Population served: 392
5. Type of collection system
® Separate (sanitary server 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) (Provide a map showing the exact location of each outfall):
Abbotts Creek in the Yadkin-Pee Dee River Basin
S. 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 ofpaper.
The 0.080 MGD package plant consist of the following:
• Influent pump station
• Bar Screens
• Flow equalization tank
• Two aeration basins
• Two secondary clarifiers
• Gravity sand filters
• Chlorine contact chamber
• Dechlorination
• Effluent flow measurement
2 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.080 MGD
Annual Average daily flow 0.051 MGD (for the previous 3 years)
Maximum daily flow 0.237 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
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.
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODs) 7.4 2.0 MG/L
Fecal Coliform 300 8.6 #/100ML
Total Suspended Solids 12.3 4.4 MG/L
Temperature (Summer) 25.9 21 'Celsius
Temperature (Winter) 14.8 10.4 ° Celsius
pH 8.1 N/A UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NCO034452 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. 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.
Thomas J. Roberts President & Chief Operating Officer
Prin Zam of Person ign Title
/l /.5 /
Sign lure of Appli nt ate
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 05/08

AQUA
North Carolina_
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 143-215.1. 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 from 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 ol).
The information will be kept on file and will be made available to any
regulatory agency having jurisdiction over sludge treatment or disposal.
Aqua N.C., Western Division includes all of the facilities under the
jurisdiction of the Winston-Salem Regional Office.