NC0088536_Permit (Issuance)_20140404

NPDES DOC /WENT SCANNING COVER :SKEET
NC0088536
Bannertown Hills WTP
NPDES Permit:
Document Type: /
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Staff Report
Instream Assessment (67b)
Speculative Limits
Environmental Assessment (EA)
Permit
History
Document Date:
April 4, 2014
This document is printed on reuse paper - ignore any
content on the row -erne side

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
April 4, 2014
Thomas J. Roberts, President & CEO
Aqua North Carolina, Inc.
202 Mackenan Court
Cary, North Carolina 27511
Subject: Issuance of NPDES Permit NC0088536
Bannertown Hills Subdivision, Well #2 WTP
Town Lane, 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 - Changes to the Permit Draft. 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. For the final, we have removed
monitoring for Total Copper inadvertently included in the permit draft. Please note that monitoring for
Total Fluoride and Total Zinc is required only if these additives are included 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
directly to EPA. For more information on eDMRs, registering for eDMR submittal, and obtaining an
eDMR user account, please visit DWR's webpage:
http://portal.ncdenr.org/web/wq/admin/bog/ipu/edmr.
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: www.ncwaterquality.org
An Equal Opportunity l Affirmative Action Employer

For information on EPA's proposed NPDES Electronic Reporting Rule, please visit EPA's website:
http://www2.epa.gov/compliance/proposed-npdes-electronic-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 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 this permit. This permit does not affect the legal requirements to obtain
other permits required by the Division of Water Resources or permits required by the Division of Land
Resources, the Coastal Area Management Act or any other Federal or Local government. If you have
any questions concerning this permit, please contact Joe Corporon [[e-mail]] or call
his direct line [phone].
Thomas -A. Reeder, Dire or
Division of Water Resources
Enclosure: NPDES Permit NC0088536 (issuance final)
hc: Central Files
WSRO/WQPS Supervisor, Corey Basinger
NPDES Program Files
ec: WSRO/WQPS, Corey Basinger
Aqua North Carolina, Inc., Thomas J. Roberts [[e-mail]]
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 www.ncwaterquality.org
An Equal opportunity 1 Affirmative Action Employer

NPDES Permit NC0088536
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
Bannertown Hills Subdivision — Well #2 Water Treatment Plant (WTP)
Town Lane, Mt Airy 27030
Surry County
to receiving waters designated as unnamed tributary to Faulkner Creek in the Yadkin -Pee Dee River
Basin, in accordance with effluent limitations, monitoring requirements, and other conditions set forth in
Parts I, II, III, and IV hereof.
The permit shall become effective May 1, 2014.
This permit and the authorization to discharge shall expire at midnight on December 31, 2018.
Signed this day April 4, 2014.
Tho
s A. Reeder, Director
ision of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 5

NPDES Permit NC0088536
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, located at the Bannertown Hills Subdivision, Well #2
WTP, Town Lane, 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 Faulkner Creek [Stream Segment 12-72-6], a waterbody currently classified
C waters within Subbasin 03-07-03 of the Yadkin -Pee Dee River Basin.
Page 2 of 5

NPDES PermitNC0088536
PART I
A. (1.) EFFLUENT LIMIITATIONS 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:
EFFLUENT
CHARACTERISTIC
[PARAMETER CODES]
LIMITS
MONITORING REQUIREMENTS 1
Monthly
Average
Dai ly
Maximum
Measurement
Frequency
Sample
Type
Sample
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
28 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. No later than January 1, 2015, 270 days from the permit effective date, begin submitting
discharge Monitoring Reports electronically using NCDWR's eDMR application system, or
apply for a waiver [See Special Condition A. (2.)].
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 detected by North Carolina -certified
test methods (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.
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.
Page 3 of 5

NPDES Permit NC0088536
NOTE: This special condition supplements or supersedes the following sections within Part II of this
permit (Standard Conditions for NPDES Permits):
• Section B. (11.)
• Section D. (2.)
• Section D. (6.)
• Section E. (5.)
Signatory Requirements
Reporting
Records Retention
Monitoring Reports
1. Reporting [Supersedes Section D. (2.) and Section E. (5.) (a)1
Beginning on January 1, 2015 (no later than 270 days from the permit effective date), the Permittee
shall report discharge monitoring data electronically using the NCDWR'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, 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
Page 4 of 5

NPDES Permit NC0088536
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)1
All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part II,
Section B. (11.)(a), or by a duly authorized representative of that person as described in Part II,
Section B. (11.)(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.org/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 of fines and imprisonment for knowing violations."
3. Records Retention [Supplements Section D. (6.)1
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 122.41].
Page 5 of 5

Aqua North Carolina, Inc.
Bannertown Hills Subdivision - Well #2 WTP
Latitude:
State Grid / Ouad:
Receiving Stream:
Drainage Basin:
HUC:
36° 29' 57" N
A16SE / Mt. Airy N, NC
UT to Faulkner Creek
Yadkin River Basin
03040101
Longitude: 80° 33' 14" W
Stream Class: C
Stream Segment: 12-72-6
Sub -Basin: 03-07-03
Facility
Location
not to scale
North
NPDES Permit NC0088536
Mt Airy, Surry County

NORTH CAROLINA
SURRY 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 Ferris W. Simpson who being first duly
sworn, deposes and says: that he (she) is Business Manager
(Publisher or other officer or employee authorized to make affidavit) of
CIVITAS MEDIA, LLC, engaged in the publication of a newspaper known
as MOUNT AIRY NEWS, published, issued, and entered as periodicals
class mail in the city of Mount Airy in said County and State; that he (she)
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 MOUNT AIRY NEWS on the following dates:
ittclt.w
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 of 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 / day of
Signature of person making affidavit
Swo
p toand subscribed before me, this
, s
, 2014
day of
, 2014
My Commission expires: January 15, 2018
BRIDGET HENDERSON
NOTARY PUBLIC
Yadkin County
North Carolina
My Commission Expires January 15, 2018
— Raleigh, NC 27699- 617. —
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environ-
mental Management Commis-
sion proposes to issue a NP-
DES wastewater discharge
permit to the person(s) listed
below. Written comments re-
garding the proposed permit
will be accepted until 30 days
after the publish date of this
notice. The Director of the NC
Division of Water Resources
(DWR) may hold a public hear-
ing should there be a signific-
ant degree of public interest.
Please mail comments and/or
information requests to DWR
at the above address. Inter-
ested persons may visit the
DWR at 512 N. Salisbury
Street, Raleigh, NC to review
information on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
http://portal.ncdenr.org/web/wq
/swp/ps/npdes/calendar, or by
calling [phone]. Cent-
ral Care, Inc. requested renew-
al of permit NC0038822 for its
WWTP/Surry County. Facility
discharges to an unnamed trib-
utary to Stewarts
Creek/Yadkin-Pee Dee River
Basin, Currently ammonia ni-
trogen, fecal coliform and total
residual chlorine are water
quality limited. Aqua North
Carolina, Inc. (of Cary 27511)
applied to renew NPDES per-
mit NC0088536 for the Ban-
nertown Subdivision WTP,
Well #2, Town Lane, Mt Airy
27030, discharging to UT to
Faulkner Creek, Yadkin River
Basin, Surry County. Aqua
North Carolina, Inc., Surry
County, has applied to renew
NPDES permit for the Mitchell
Bluff Subdivision Well #1 WTP
[NC0088498] discharging filter -
backwash wastewater to
Mitchell River, Yadkin -Pee Dee
River Basin. Aqua North Caro-
lina, Inc., Surry County, has
applied to renew NPDES per-
mit for the Windgate Subdivi-
sion Well #1 WTP
(NC0086609) discharging filter
backwash wastewater to Fish-
er River, Yadkin -Pee Dee
River Basin. Aqua North Caro-
lina, Inc. (of Cary) applied to
renew NPDES permit
NC0088528 for the Hillcrest
Subdivision WTP, Well #3,
Lynnwood Dr., Mt Airy 27030,
— discharging to UT to Champ
Creek, Yadkin River Basin,
Surry County. Surry County
Schools requested renewal of
NPDES permit
NC0041947/North Surry High
School WWTP. Facility dis-
charges to Stewarts
Creek/Yadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water quality limited. Surry
County Schools requested re-
newal of NPDES permit
NC0041939/J. Sam Gentry
Middle School WWTP. Facility
discharges to Stewarts
Creek/Yadkin-Pee Dee River
Basin. Currently fecal coliform
and total residual chlorine are
water'quality limited.
Publish February 7, 2014

DENR / DWR / NPDES
EXPEDITED FACT SHEET - NPDES PERMIT DEVELOPMENT
NPDES Permit NC0088536
Joe R. Corporon, L.G., Expedited Permitting and Compliance Unit
Updated 03Apr2014
Facility Information
Facility Name
Bannertown Hills Subdivision WTP — Well #2
Applicant
AQUA North Carolina, Inc.
Contact
Thomas J. Roberts, President &CEO
[tj [e-mail]]
Applicant Address
202 Mackenan Court, Cary 27511
Facility Address
Town Lane, Mt Airy 27030
Permitted Flow (MGD)
Not limited
Type of Waste
potable WTP filter backwash (green sand filter technology).
Facility Class
County
Surry
Facility Status
Renewal
Regional Office
WSRO
Stream Characteristics
Receiving Stream / Basin
UT to Faulkner Creek
Stream Classification
C
Stream Segment
12-72-6
Drainage Basin
Yadkin -Pee Dee
River Basin
Summer 7Q10 (cfs)
—
Subbasin
03-07-03
Winter 7Q10 (cfs)
...
Use Support
Yes
30Q2 (cfs)
—
303(d) Listed
No
Average Flow (cfs)
—
State Grid
B 16NE
IWC (%)
100%
USGS Topo Quad
Mt Airy North, NC
Facility Summary / Renewal Strategy — This WTP employs greensand filter technology to generate
potable water at a rate of 0.005472 MGD while generating wastewater (filter -backwash) at a rate
consistently reported as 0.0008 MGD for discharge to Waters of the State. According to the application,
this facility does not add fluoride or zinc orthophosphate (corrosion inhibitor). Therefore, monitoring in
accord with WTP strategy shall be required only if Fluoride and Zinc are added to finish -water used as
filter -backwash, thereby creating their potential to concentrate in the wastewater [see added Footnote 4,
Section A (1.)].
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:
1. By January 1, 2015 (within 270-days of the permit effective date), the Permittee shall begin
electronic submittal of monthly DMRs (eDMRs), or apply for a variance.
2. Updated facility description [Supplement to Cover Sheet] and Vicinity Map.
3. Added parameter codes to table, Section A. (1.).
4. Discontinued in BIMS monitoring for Fluoride and Zinc [appears in permit as "only if."].
Fact Sheet
Renewal 2014 -- NPDES Permit NC0088536
Page 1 of 1

iL 6 14s I ,
YADKIN RIVER BASIN
Name of Stream
Subbasin Stream Index Number Map Number Class
Faulkner Creek
YADO3 12-72-6 A16SE8 C
Featherbed Branch YAD17 13-42-2-3 H18NE8 C
Ferreltown Creek (Ferreltown Lake) YAD11 13-17-4-3 F15NE8 C
Fiddlers Creek YADO4 12-94-13-3 C18SE4 C
Fifth Creek (Five Mile Branch) YADO6 12-108-13 D15SW3 C
Fish Dam Creek (Fishtrap Creek) YADO1 12-35 C13NE6 WS-IV
Fisher Creek YADO2 12-84-2-4 C16SW5 WS-III
Fisher River YADO2 12-63-(1) A15SE4 WS-II;Tr,HQW
Fisher River YADO2 12-63-(7) B15NE6 WS-II;HQW
Fisher River YADO2 12-63-(8.5) B16NW7 WS-II;HQW,CA
Fisher River YADO2 12-63-(9) B16NW7 C
Fishers Branch YADO4 12-94-12-2-2-(1) C18SE1 WS-III
Fishers Branch YADO4 12-94-12-2-2-(2) C18SW3 WS-III;CA
Fishing Creek YAD01 12-44 C14NE7 C
Fivemile Branch YADO4 12-94-7-1 C18NW4 C
Flag Branch YAD14 13-17-36-8-2 H17NW4 C
Flag Branch YAD14 13-17-40-18-1 G17SE6 C
Flag Branch (Tobacco Branch) YAD14 13-17-36-9-5-1-(1) G16SE6 WS-III
Flag Branch (Tobacco Branch) YAD14 13-17-36-9-5-1-(2) G17SW4 WS-III;CA
Flat Branch YAD01 12-11-1 C12SE5 C;Tr
Flat Branch YADO1 12-19-3 C12NE7 C;Tr
Flat Branch YAD01 12-24-8-4 C12NE9 C;Tr,ORW
Flat Branch YADO2 12-62-13-3 B15SE1 C
Flat Creek YADO8 12-128-(1) E17SE6 WS-IV
Flat Creek YADO8 12-128-(2) E18SW4 WS-IV;CA
Flat Fork YAD10 13-20-18 G18SE8 C
Flat Lick Branch YAD15 13-25-36-8 G19NW6 C
Flat Rock Branch YADO6 12-108-16-6-6 C15SE3 WS-III
Flat Rock Branch (South Branch Grants Creek) YADO4 12-110-1-(1) E165W6 WS-IV
Flat Rock Branch (South Branch Grants Creek) YADO4 12-110-1-(2) E16SW6 WS-IV;CA
(Lake Corriher)
Flat Rock Creek YAD15 13-25-20-8-0.3 F19NW8 C;HQW
Flat Shoal Creek YADO3 12-72-13 B16NE6 C
Flat Swamp Creek YADO4 12-123 D18SW9 C
Fletcher Creek YADO1 12-31-2-3 C13NW3 C;Tr
Forbush Creek YADO2 12-83-(0.3) C16NW6 C
Forbush Creek YADO2 12-83-(1.5) C16NE7 WS-IV
Fourmile Branch YADO4 12-124 D18SW8 C
Fourth Creek YADO6 12-108-20 D14SE3 C
Fox Branch YADO1 12-26-4 C13NW8 C;Tr
Frazier Creek (Winston Lake) YADO4 12-94-12-6-1 C18NW8 C
Fries Creek YADO2 12-80 C17NW5 WS-IV
Frost Creek YADO4 12-106-1 D17SW8 WS-IV
Frost Mill Creek YADO5 12-102-11 D16NE1 C
Fryes Creek YADO4 12-94-15 D18NW4 C
Fuda Creek YAD11 13-17-7-1 F16SW6 C
Fulton Creek (Carter Creek) YADO4 12-97-(1) D17NW8 C
Fulton Creek (Carter Creek) YADO4 12-97-(2) D17NW5 WS-IV
Funderburks Lake YAD12 13-17-9-3 F16NE4 C
Gaddys Goose Ponds YAD10 13-20-16-1-2 G18SE1 C
Gambill Creek YAD01 12-46-1-7 B14SW2 C
Garden Creek YAD01 12-46-4-6 B14NE4 C;Tr,HQW
Garr Creek YADO8 12-131-(1) E18SW9 WS-IV
Page 9 of 28
2013-12-19 11:17:52

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
,NC0088536
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 Bannertown Hills 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 Town Lane
City
State / Zip Code
County
Mt. Airy
NC/ 27030
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
City Denver
State / Zip Code NC / 28037
Telephone Number [phone]
Fax Number [phone]
Page 1 of 4 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:
El Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
Cl 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) (Le. groundwater, surface water)
Groundwater Well
7. Describe the treatment process(es) for the raw water:
Raw water is treated by greensand filters in series with a 0.0016 MGD discharge of filter
backwash wastewater. Chemicals utilized during this process consist of:
• Potassium Permanganate
• Chlorine
• Caustic soda
8. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge from said treatment works at the location specified on the
attached map into an unnamed tributary to Faulkner Creek, classified C waters in the
Yadkin -Pee Dee River.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge:
Continuous ❑ Intermittent CE
If intermittent:
Days per week discharge occurs: 7 Duration: 80 minutes
-- _11: -- Plant -design iotable-'flow rate` "0:0t 54`72 '..1VIGI?
Backwash or reject flow 0.00080 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfalI, including
latitude and longitude):
Unnamed Tributary to Faulkner Creek (Yadkin Pee Dee Basin)
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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:
Chlorine
Potassium Permanganate
Caustic Soda
14. Is this facility located on Indian country? (check one)
Yes ❑ No Eg
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].
z 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 of my knowledge and belief such information is true, complete, and accurate.
Tho
berts
e:,of Person..
President, Aqua North Carolina, Inc.
Title
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Signature of Applicap D
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 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
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Version 5/2012