NC0088528_Permit (Issuance)_20140404

NPDES DOCIMENT SCANNING: COVER :SHEET
NC0088528
Hillcrest Subdivision, Well #3
NPDES Permit:
Document Type: \
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Correspondence
Instream Assessment
(67b)
Speculative Limits
Environmental Assessment (EA)
Permit
History
Document Date:
April 4, 2014
This document is printed on reuse paper - igriore any
content on the re‘rerse aside

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 NC0088528
Hillcrest Subdivision, Well #3 WTP
Lynnwood Drive, 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 Carolina27699-1617
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 \ Affirmative Action Employer

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.
For information on EPA's proposed NPDES Electronic Reporting Rule, please visit EPA's website:
http://www2.epa. gov/compliance/propo sed-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 150E 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
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water 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 Joe Corporon [[e-mail]] or call his direct line [phone].
Thomas A. Reeder, Director
Division of Water Resources
Enclosure: NPDES Permit NC0088528 (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 \ Affirmative Action Employer

NPDES Permit NC0088528
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
Hillcrest Subdivision — Well #3 Water Treatment Plant (WTP)
Lynnwood Road, Mt Airy 27030
Surry County
to receiving waters designated as unnamed tributary to Champ 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.
Th mhs'A. Reeder, Director
4 igi n of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 5

NPDES Permit NC0088528
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 Hillcrest Subdivision Well #3 WTP,
Lynnwood 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 Champ Creek [Stream Segment 12-72-5], a waterbody currently classified C
waters within Subbasin 03-07-03 of the Yadkin -Pee Dee River Basin.
Page 2 of 5

NPDES Permit NC0088528
PART I
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 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
Daily
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. Beginning no later than January 1, 2015, 270 days from the permit effective date, submit discharge
Monitoring Reports electronically using NCDWR's eDMR application system [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 is required only if this parameter is added to finish water used to backwash filters, thereby
creating their 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 NC0088528
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 no later than January 1, 2015, 270 days from the effective date of this permit, 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 NC0088528
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:
"1 certiji, 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 f nes and imprisonment for knowing violations."
3. Records Retention [Supplements Section D. (61
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

UT to Champ Creek
[flows SW]
Aqua North Carolina, Inc.
Hillcrest Subdivision - Well #3 WTP
Latitude:
State Grid / Ouad:
Receiving Stream:
Drainage Basin:
HUC:
36° 31' 50" N Longitude:
A16SE / Mt. Airy N, NC Stream Class:
UT to Champ Creek Stream Segment:
Yadkin -Pee Dee River Basin Sub -Basin:
03040101
80° 34' 12" W
C
12-72-5
03-07-03
Champ Creek
[flows S & W]
North
.
NPDES Permit NCOO88528
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:
4. rl,co/T
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 ,--e.4/Lt.t-Ft/1.�� 2014
Signature of person making affidavit
Swop to and subscribed before me, this 7
k `d ,1_1
Notary P4ic
, 2014
My Commission expires: January 15. 2018
BRIDGE_T HENDERSON
NOTARY PUBLIC
Yadkin County
North Carolina
My Commission Expires January 15, 2018
day of
— Raleigh, NC 27699-1617 —
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
(NC0088609)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 #S,
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 NC0088528
Joe R. Corporon, L.G., Expedited Permitting and Compliance Unit
Revised 03Apr2014
Facihty:Information
Facility Name
Hillcrest Subdivision — Well #3
Applicant
AQUA North Carolina, Inc.
Contact
Thomas J. Roberts, President &CEO
[[e-mail]]
Applicant Address
202Mckenan Court, Cary 27511
Facility Address
Lynnwood Dr. @ Crosswinds Dr., Mt Airy 27030
Permitted Flow (MGD)
Not limited
Type of Waste
potable WTP filter backwash (green sand filter Technology).
Facility Class;
County
Surry
Facility Statu
Renewal
Regional Office
WSRO
Stream Characteristics
Receiving Stream / Basin
UT to Champ Creek
Stream Classification
C
Stream Segment
12-72-5
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 Flov4 (cfs)
—
State Grid
A 16 SE
IWC (%)
100 %
USGS Topo Quad
Mt Airy North, NC
Facility Summary — This WTP employs greensand filter technology to generate potable water at a rate of
0.019 MGD while generating wastewater (filter -backwash) at a rate consistently reported as 0.001 MGD for
discharge to Waters of the State. According to the application, this facility does not add fluoride or zinc
orthophosphate. Monitoring required by WTP strategy for Fluoride and Zinc therefore is required only if
these parameters are added in finish -water used to backwash filters, thereby creating the potential to
concentrate them 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. 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] ; updated Vicinity Map, Lat. / Long;
3. added parameter codes to effluent table, Section A. (1.);
No other changes to the permit.
Fact Shot
Renewal 2013 -- NPDES Permit NC0(}88528
Pa<,c 1 oil

Detail: street view
Aqua NC, Inc., Hillcrest Subdivision Well #3
NC0088528

Aqua NC, Inc., Hillcrest Subdivision Well #3
NC0088528
Lynnwood Dr [where it turns 90°] @ Crosswinds Dr.
Well #3 appears to be within a chain -link fence enclosure [see next photo].
C)
Pn_ 6-Cod- tics
1(rl
L -S ;`)' r/2`(

YADKIN RIVER BASIN
4-07+ (-4 vk e6.-f
-if
Name of Stream
Subbasin Stream Index Number
Map Number Class
Cane Creek YAD11 13-17-4-2-1 F15NE8 C
Canebreak Branch YAD14 13-17-40-19 G18SW4 C
Cape Fear Branch YAD16 13-40-2 H19NE8 C
Capples Pond and Gibsons Millpond YAD16 13-39-6-2 H2ONW2 WS-III
Caraway Creek YAD09 13-2-3 D19NW8 C
Carolina Creek YAD14 13-17-40-5 H17SW3 WS-V
Carroll Branch YADO1 12-24-8-1-3 C12NE5 C;Tr,ORW
Carter Creek YAD02 12-93 D17NW3 C
Cartledge Creek YAD16 13-35 G19SE8 C
Cattail Creek YAD09 13-2-19-2 F19NW7 WS-IV
Cattail Creek YADO8 13-8-1 F18SE5 WS-IV
Caudill Branch YAD01 12-46-2-2-2 B14NW9 C;Tr,ORW
Caudle Branch YAD14 13-17-40-16-2 G17SE9 C
Cedar Branch YAD14 13-17-35 G17NE6 C
Cedar Branch YAD14 13-17-40-7 H17NW9 WS-V
Cedar Branch YAD14 13-17-40-20 G18SW8 C
Cedar Branch YAD15 13-25-31-1 F19SW9 C
Cedar Branch YAD15 13-25-32-1 G19NW2 C
Cedar Creek YAD05 12-102-13-(2) C16SE9 C
Cedar Creek YAD08 12-125-(1) E18SW4 WS-IV
Cedar Creek YADO8 12-125-(2) E18SW4 WS-IV;CA
Cedar Creek YADO9 13-2-23 F19NW7 WS-IV
Cedar Creek YAD08 13-12-(1) G18NW3 WS-IV
Cedar Creek YAD08 13-12-(2) G18NW3 WS-IV;CA
Cedar Creek YAD10 13-21 H18NE3 C
Cedar Creek YAD15 13-25-22 F19SE2 C
Cedar Creek YAD17 13-47-3 H18SW6 C
Cedar Creek, including proposed reservoir YAD05 12-102-13-(1) C16SE4 B
Cedar Fork Creek YAD09 13-2-3-3-2 E19NE1 C
Chadric Creek YAD02 12-62-5-1 B15NW6 B;Tr,ORW
Champ Creek YAD03 12-72-5 A16SE8 C
Cheatwood Branch YADO1 12-46-4-10-1-2 S14SE3 C
Cheek Creek YAD15 13-25-36 F19SE9 C
Chestnut Branch YAD01 12-24-7 C12NE6 B;Tr,ORW
Childs Branch YAD17 13-42-2-2-1 H18NW9 C
Chinkapin Creek YAD14 13-17-36-9-5-(0.3) G16SE3 WS-III
Chinkapin Creek YAD14 13-17-36-9-5-(0.7) G17SW4 WS-III;CA
Chinquapin Creek YAD03 12-72-14-3 B17NW7 WS-II;HQW
Chinquapin Creek YAD05 12-102-6 C16SE7 C
Chock Creek (Gibson Pond) YAD16 13-39-6 H2ONE4 WS-III
Christian Creek (North Fork Mitchell River) YAD02 12-62-8 B15NW3 B;Tr,ORW
Church Barnch YAD01 12-42-4 B14SW4 C
Church Branch YAD01 12-17 C12SE9 C;Tr
Church Creek YAD04 12-115.5 E17SW3 C
Clarke Creek YAD11 13-17-4 F15NE9 C
Clarks Creek YAD10 13-16 F18SE6 C
Clarks Creek YAD11 13-17-5-2 F15SE3 C
Clay Creek YAD17 13-47-1 H17SE5 C
Clear Branch YADO1 12-24-5 C12NE2 B;Tr,ORW
Clear Branch YADO1 12-40-2-3 B135E4 WS-II;Tr,HQW
Clear Creek YAD11 13-17-8-4-1 F16SW9 C
Clear Creek YAD12 13-17-17 G16NW6 C
Clercy Branch YAD06 12-108-16-2-3 C15NW7 WS-III
Page 5 of 28
2013-12-19 11:17:52

AQUA
September 18, 2013
Aqua North Carolina, Inc.
4163 Sinclair Street
Denver, NC 28037
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.
Hillcrest Subdivision Well #3 WTP
NPDES No. NC0088528
Surry County
Gentlemen:
www.aquanorthcarolina.com
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].
Since
r
Thomas j. 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
NC0088528
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 Hillcrest Subdivision - Well #3 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
City
State / Zip Code
County
Lynnewood Drive
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
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
Aqua North Carolina, Inc.
4163 Sinclair Street
Denver
NC / 28037
[phone]
[phone]
Page 1 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 0
5. Type of treatment plant:
0 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
ID
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 utilizing three (3) Greensand filters operated in parallel. Chemical
usage consisting of potassium permanganate, 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. Discharge
rate is approximately 1,000 gallons per day.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge:
Continuous 0 Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Approx. 100 minutes
11. Plant design potable flowrate .019 MGD
Backwash or reject flow 0.00100 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Unamed Tributary to Champ Creek (Yadkin Pee Dee Basin)
Page 2 of 3 Version 5/2012

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 El
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 of my knowledge and belief such information is true, complete, and accurate.
15 C"---'/1-75- tag:5, eoo
Prin.. i a ,-'of Person .'nin� / 1�
9' /7 (}
Signature of Applic t Da
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
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.)
Page 3 of 3
Version 5/2012

AQUA
North Carolina.
Aqua North Carolina, Inc. T: 704.489.9401
4163 Sinclair Street F: 704.489.9409
Denver, NC 28037 www.aquanorthcarolina.com
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 of).
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.