NC0059218_Permit (Issuance)_20040713

NPDES DOCUMENT SCANNING. COVER SHEET
NC0059218
Captain Stevens Seafood WWTP
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:
July 13, 2004
This document is printed on reuse paper - ignore any
content on the reverse side

Michael F. Easley, Govemor
State of North Carolina
O IDWQ -i
Y
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Mr. Steve Pappas
Captain Stevens Seafood Restaurant
4577 NC Highway 150
Lexington, North Carolina 27292
July 13, 2004
Subject: NPDES Permit Issuance
Permit Number NC0059218
Captain Stevens Seafood Restaurant
Davidson County
Dear Mr. Pappas:
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 May 9, 1994 (or as subsequently amended).
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
Quality 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.
If you have any questions or need additional information, please do not hesitate to
contact Dave Goodrich of my staff at [phone], extension 517.
Sincerely,
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E.
cc: Central Files
NPDES Unit Files
Winston-Salem Regional Office
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1617 - TELEPHONE [phone]/FAX [phone]
VISIT US ON THE WEB AT htfp://h20.enr.stote.nc.us/NPDES

Permit NC0059218
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,
Steve Pappas
is hereby authorized to discharge wastewater from a facility located at
Captain Stevens Seafood Restaurant
4577 North Highway 150
Lexington
Davidson County
to receiving waters designated as an unnamed tributary to Reedy 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 August 1, 2004.
This permit and the authorization to discharge shall expire at midnight on May 31, 2009.
Signed this day July 13, 2004.
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0059218
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 included herein.
Steve Pappas
is authorized to:
1. Continue to operate an existing 0.0025 MGD wastewater treatment plant consisting of:
• a grease trap
• septic tank
• dosing tank
• distribution box
• subsurface sandfilter lined with plastic
• chlorinator with baffled contact tank
• step aeration
located at Captain Stevens Seafood Restaurant, 4577 North Highway 150, Lexington, Davidson County, and
2. Discharge from said treatment works at the location specified on the attached map into an unnamed tributary
to Reedy Creek, which is classified WS-IV waters in the Yadkin -Pee Dee River Basin.

Cap't Stevens Seafood Restaurant
Latitude- 35° 54' 38" N Longitude: 80° 19' 37" W
Stream Class: WS-IV Receiving Stream IPI' of Reedy Creek
Sub -Basin: 03-07-04 State Grid/ USCG Chad: G 17 NE / WeIcome, N.C.
Drainage Basin: Yadkin — Pee Dee Permitted Flow: 0.0025 MGD
Facility
Fac
Loca
tion Location
not to scale
North
x
NPDES Permit No. NC0059218
Davidson County

Permit NC0059218
Part I. Section A
1. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized to
discharge from Outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
PARAMETER
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Weekly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location'
Flow (MGD)
0.0025
Weekly
Instantaneous
I or E
BOD5
30.0 mg/L
45.0 mg/L
2/month
Grab
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/month
2/month
Grab
Grab _.._ __..._....___.__.
E
E
NH3-N
Dissolved Oxygen2
Daily Average > 5.0 mg/L
Weekly
Grab
E, U, D
Fecal Coliform
(geometric mean)
200/100 ml
400/100 ml
2/month
Grab
E
Total Residual Chlorine
28 µg/L
2/week
Grab
E
Temperature
Daily
Grab
Grab
E
Temperature
Weekly
U, D
Oil and Grease
30.0 mg/L
60.0 mg/L
2/month
Grab
E
Total Nitrogen
(TKN + NO2 + NO3)
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
pH4
Between 6.0 and 9.0 Standard Units
2/month
Grab
E
NOTES:
1 E - Effluent, U — Upstream 20 feet from the discharge point, D — Downstream 0.2 miles below the discharge
point at the mouth of the unnamed tributary.
2 The daily average concentration of dissolved oxygen in effluent shall not fall below 5.0 mg/L.
3 The limit for total residual chlorine will take effect 18 months after the effective date of the final permit.
4 The pH shall not fall below 6.0 nor exceed 9.0 standard units.
Units: mg/L = milligrams per liter
ml = milliliters
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
April 14, 2004
MEMORANDUM
To: Lee Spencer
NC DENR / DEH / Regional Engineer
Winston-Salem Regional Office
From: Dave Goodrich0
NPDES Unit
Subject:
Review of Draft NPDES Permit NC0059218
Captain Stevens Seafood Restaurant
Davidson County
AtrA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
RECEIVED
N.C. Dept. of EHNR
APR 1 9 2004
Winston-Salem
Regional Office
Please indicate below your agency's position or viewpoint on the draft permit and return this form by May 10, 2004.
If you have any questions on the draft permit, please contact me at the telephone number or e-mail address listed at
the bottom of this page.
RESPONSE: (Check one)
R/6
oncur with the issuance of this permit provided the facility is operated and maintained properly, the stated effluent lunits
are met prior to discharge, and the discharge does not contravene the designated water quality standards.
Signed
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:
Date: C
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 517 (fax) 919 733-0719
VISIT US ON THE INTERNET @ http://h2o.enr.state.nc.us/NPDES dave.goodrich@ ncmail.net

DRAFTS-NC0070033 & NC0059218
Subject: DRAFTS-NC0070033 & NC0059218
From: Steve Mauney <Steve.Mauney @ ncmail.net>
Date: Wed, 28 Apr 2004 09:40:32 -0400
To: Dave Goodrich <Dave.Goodrich @ ncmail.net>
DAVE-I have reviewed the draft permits listed above and had no
questions on Quail Run MHP. Regarding Captain Stevens Seafood
Restaurant, could we list the DO limit as >/ = 5.0 mg/1 ? I am
afraid that the operator may end up rounding off the readings and
will often write down just 5 and we will have to NOV them for it.
Small beans, but NOV's can be a real annoyance. Thanks -Steve
Steve Mauney
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone] ext 262
FAX: [phone]
1 of 1 5/3/2004 6:48 AM

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 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 Winston-Salem Journal on
the following dates:
April 17, 2004
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 Statues of North Carolina and was a qualified newspaper within the meaning
of Section 1-597 of the general statues of North Carolina.
This 19th day of April, 2004
(signature of persoaking affidavit)
Sworn to and subscribed before me, this 19th day of AppJ 2004
County
1 The Yoca, Inc (P.O. Box 78, White PLains, NC 27031) has applied for re -
meal of NPDES permit NC0p61808 for the Neighbors Fuel Center *12
in Surry County. This permitted facility discharges treated wastewater to
the Little Fisher River in the Yadkin -Pee Dee River Basin. Currently DOD,
total suspended seeds, oil and grease, and total residual chlorine are
water quality limited. This discharge may affect future akocations in this
portion of the Yadkin -Pee Dee River Basin.
NC Department o1 Transportation (155714511 Service Center, Raleigh,
NC 27699) has applied for renewal of NPDES permit NC0028190 for the
the Surry County Rest Area This permitted facility discharges 0.030
MGD of treated wastewater to Naked Run in the Yadkin -Pee Dee River
Basin. Currently BOD and total residual chlorine are water quality limited
This discharge may affect future alocations,in this portion of the Yadkin -
Pee Dee River Basin • C CAW
The Suny County Board Of Edutidn [P.O. Box 354,' Dobson, NC
27017j has applied for renewal of NPDES permit N00041947 for the
North Surly High School VW7P. This permitted facility discharges treat-
ed domestic wastewater to Steweris Creek in the Yadkin -Pee Dee River
Basin. Currently fecal colitorrn and total residual chlorine are water qua 1.
lay rn'eeed. This discharge may affect future allocations in this portion at
Ste Creek. -{{��
Virginia DOT (1401 East rrooadStreet, Richmond VA, 23219) has ap-
plied for renewal of NPDES permit NC0039420 for the 1.77 Rest Area
WWTP in Forsyth County. This permitted facilely discharges 0.020 MGD
of treated wastewater to Naked Run in the Yadkin -Pee Dee River Basin.
Currently BCD, ammonia nitrogen and total residual chlorine are water
quality limited. This discharge may affect allocations in Ihis porton
of the Yadkin -Pee Dee River Basch. r�" W
The Suny County Board of Educatidtf (P.O. Box 364, Dobson, NC
270171 has applied for renewal of NPOES permit NCA041004 for the Flat
Rock Elementary School WWTP. This permitted facBiy discharges treat-
ed domestic wastewater to an unnamed tributary to Champ Creek in the
Yadkin -Pee Dee River Basin. Currently fecal coliform is water quality
ited. This discharge may affeu future allocations in ten portion of Champ
Creek.
Wilkes County
The Roaring Gap Club, Inc P.O. Box 129, Roaring Gap, NC 26668) has
applied for renewal of NPDES permit N00088997 for the Roaring Gap
Club in Wilkes County . This permitted taclity discharges treated waste-
water to the unnamed tributary to the Mitchell River in the Yadkin -Pee
Dee River Basin. Currently B0D. total suspended solids, and total resid-
ual chlorine are water quality limited. This discharmay affect future al-
locations in this portion of tie Yadkin -Pee Dee River Basin.
G
Notary) I Colic
Head Mobile Home Park, has a liedw enewal of its NPDES permit
NC0057223. The permitted facility discharges treated wastewater to an
2
R unnamed tebutary to Little Creek in the Yadkin -Pee Dee River Basin. 8, ' Currerely 8005, Ammonia as Nitrogen, Total Residual Chlorine, Total
Suspended Solids and Fecal Colifomh are water quality limited This dis-
charge may affect future allocations in this portion of little Creek
The Heater Utilities, Inc (P.O. Drawer 4889, Cary, NC 2751.9
peed for renewal of NPDES permit N00084409 for the Wellesley Place
WWTP in Forsyth County. This permitted facility discharges treated
wastewater to tfie Mill Creek in the Yadkin -Pee Dee River Basch. Current-
ly 600, total suspended solids, ammonia nitrogen and total residual
chlorine are water quality limited. This discharge may affect future alloca-
tions in this portion of the Yadkin -Pee Dee River Basin, wee,..u� Scarlet Acres Mobile Home Subdision, has applied for�rerfewlli of its
NPDES permit N00061204. The permitted facility discharges treated
AL si wastewater to an unnamed tributary to Mill Creek in the Yadkin -Pee Dee
River Basin. Currently 8005, Ammonia as Nitrogen, Total Residual
Nort Chlorine, Total Suspended Solids, and Fecal Coliform are water quality
F FO limited. This discharge may affect future allocations in this portion of
OH High Poini Heatth"('aie Center, has applied for renewal of es NPDES
,. permit NC0046035. The permitted facility discharges treated wastewater
to Rich Fork in the Yadkin -Pee Dee River Basin. Currently BOD5, Ammo-
rea as Nitrogen and total residual chlorine are water quality limited. This
discharge may affect future aaocatiors in this panto of Rich Fork.
Lucent Technologies (3370 Lexington Rd, Winston-Salem, NC 271071
has applied for renewal of NPDES permit NC0080853 for thhe Saler&
Business Park groundwater remediation site in Forsyth County. This per-
mitted facility discharges 0.301 MGD of treated wastewater to Salem
Creek in the Yadkin -Pee Dee River Basin. Curenty no parameters are
water quality limited. This discharge may atfed allocations in this
porton o1 the Yadkin -Pee Dee River Basin. e!HIV
The Winston-Salem / Forsyth County Boa of Education [44897 Lan-
sing Drive, WinstonSalem, NC 271051 has applied for renewal of
NPDES permit NC0034827 for the Old Aideanond Elementary School.
This permitted facility discharges treated domestic wastewater to an un-
named tributary to Creek in the Yadkhn-Pee Dee River Basin. Cur-
rently ammorna nitrogen and fecal cofiform are water quality limited. This
discharge may affect future allocations in this portion of Fries Creek.
Davie The Davie County Board of Education 220 Cherry Street, Mocksvrf e,
NC 270281 has applied for renewal of NPDES permit NC0033162 for the
Miriam R. Davie Elementary School: This permitted facility discharges
treated domestic wastewater to an uxhnamed tribtemyto Greasy Creek in
the Yadkin -Pee Dee River Basin. Currently BOD, ammonia nitrogen and
fecal cultorm are water quaMy limited. This discharge may affect future
allocations in this portion of Greasy Creek.
WSJ: April 17, 2004
PUBLIC NOTICE
STATE OF NORTH CAROUNA
ENVIRONMENTAL MANAGEMENT COMMISSION/NPDES UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617 •
NOTIFICATION OF INTENT TO ISSUE
A NPDES WASTEWATER PERMIT •
On the basis of thorough staff review and apptcatien of NC General Stat-
ute 143.21, Public taw 92-500 and other Ilawtut standards and regula-
tions, the North Carolina Environmental Management Commission pro-
poses to issue a National Pollutant Discharge Elimination System
(NPDES) wastewater discharge permit to the person(s) listed below el-
fective 45 days from the publish date of this notice.
Written comments regarding the proposed permit will be accepted until
30 days after the publish date of this notice. All comments received prior
to that date are considered in the final determinations regarding the pro-
posed permit. The Director of the NC Division of Water Quality may de-
cide to hold a public meeting for the proposed permit should the Division
receive a significant degree of public interest
Copies of the draft permit and other supporting intomtafion on file used
to determine conditions present in the draft permit are available upon re-
quest and payment of the costs of reproduction. Mail comments andlor
requests for irtformation to the NC Division of Water Quality at the above .
address or call Ms. Velery Stephens 2t (91199)� 733-5083, extension:520.
Please irhdude the NPDES permit number (attached) in any communica-
tion Interested persons may also visit the Division of Water Quality at
512 N: Salisbury Street Raleigh, NC 27604-1148 between the7hours of
8:00 a.m. and 5:00 p.m. to review information on file. • re Davidson County /
Davidson County Schools, P.O. Box 2057, Lexington, NC has applied
for renewal of. NPDES permit NC0012145.for its Midway Elementary
School WWTP in Davidson County. Tuns permitted facility dschargges
treated wastewater to an unnamed tributary. to Leonard Creek in the Yad- '
kirePee Dee River Basin. Currientr BCD: ammonia nitrogen, and toter
residual chlorine are water quality Iyhnlited..ibis discharog may affect fu-
ture akwatershed,
in this portion of the watershet f
BIIfs Trtrde Stop, has applied lor • renewal. of its NPDES permit
NC0040045: The permitted facility discharges treated west:wafer fo
South Potts Creek in the Yadkin -Pee Dee River Basin. Currently 80D5,
Total Residual Chlorine, Total Suspended Solids and Fecal Ccliform are
water quality limited. This discharge may affect future allocations in this
portion of South Pots Creek.
Davidson County Schools, P.O. Brix 2057, Lexington, NC lhes applied
for renewal old NPDES permit N00041629 for its Eedended Day School
WWTP- in Davidson County. This permitted facility discharges treated
wastewater to an unrarned tributary to Hamby Creek in the Yadkin -Pee
Dee River Basic. Currently BOO, ammonia nitrogen. and total residual I
chlorine are water quality limited. This discharge may affect future ;Rica- ,
eons in this portion ate watershed..-. �
Quail Run bile Home Park, has applied for rcrrtewal of its NPDES per-
mit N00070033. The permitted facility discharges heated wastewater to
Miller Creek in the Yadkin -Pee Dee Rrvei Basin. Currently BOD5, Ammo-
nia as Nfiogen, Total Residual Gllorine, Total Swperded Solids and
Fecal Coliform are water quality livtecbeet edischargeplayaffectfuhae
allocations in this portion of Miller Creek.' A
Davidson Count, Schools, P.O. Box 2057, LeiggtortlIC has applied
for renewal of NPDES permit NC0042129 for its Pilot Elementary School
WWTP in Davidson County. This permitted facility discharges treated
wastewater to Jimmys Creek in the Yadkin -Pee Dee River Basin. Cur-
rently ammonia nitrogen and total residual chlorine are water quality lim-
ited. This discharge may affect future allocations in this portion of the wa-
tershed.
Captain Stevens Seatoo( rant, has applied for renewal 0f its
NPOES permit N00059218. The permitted facility discharges healed
wastewater to an unnamed tributary to Reedy Creek in the Yadkin -Pee
Dee River Basin, Currently 13005, Total Residual Chlorine, Total- Sus-
pended Solids and Fecal Coliform are water quality limited. This dis-
charge may ateC future allocations in this portion of Reedy Creek.
Hilltop Living Center, has applied for renewal of its NPDES permit
NC0059536. The permitted facility discharges treated wastewater to an
unnamed tributary to Yadkin River in the Yadkin -Pee Dee Rorer Basin.
Currently BOD5, Ammonia as Nitrogen, Total Residual Chlorine, Total
Suspended Solids, Total Phosphorus and fecal Coliform are water qual-
ity limited This dscharge may affect future allocations in this portion of
Yadkin River.-9eri

PUBLIC
NOTICE
STATE OF NORTH
CAROLINA
ENVIRONMENTAL
MANAGEMENT
COMMISSION
NPDES UNIT
1617 MAIL
SERVICE CENTER
RALEIGH, NC
27699-1617
NOTIFICATION
OF INTENT TO
ISSUE A •
NPDES
WASTEWATER
PERMIT
On the basis of thor-
ough staff review and
application of NC Gen-
eral Statute 143.21,
Public law 92-500 and
other lawful standards
and regulations, the
North Carolina Environ-
mental Management
Commission proposes
to issue a National Pol-
lutant Discharge Elimi-
nation System (NPDES)
wastewater discharge
permit to the person(s)
listed below effective
45 days from the pub-
lish date of this notice.
Written comments re-
garding the proposed
permit will be accepted
until 30 days after the
publish date of this no-
tice. All comments re-
ceived prior to that
date are considered in
the final determinations
regarding the proposed
permit. The Director of
the NC Division of Wa-
ter Quality may decide
to hold a public meet-
ing for the proposed
permit should the Divi-
sion receive a signifi-
cant degree of public
interest.
Copies of the draft per-
mit and other support-
ing information on file
used to determine con-
ditions present in the
draft permit are availa-
ble upon request and
payment of the costs of
reproduction. Mail com-
ments andlor requests
for information to the
NC Division of Water
Quality at the above
address or call Ms. Va-
lery Stevens at (919)
733-5083, extension
520. Please include the
NPDES permit number
(attached) in any com-
munication. Interested
persons may also visit
the Division of Water
Quality at 512 N. Salis-
bury Street, Raleigh, NC
27604-1148 between
the hours of 8:00 a.m.
and 5:00 p.m. to review
information on file.
Bill's Truck Stop has ap-
plied for renewal of its
NPDES permit
NC0040045. The per-
mitted facility discharg-
es treated wastewater
to South Potts Creek in
the Yadkin -Pee Dee Riv-
er Basin. Currently
BOD5, Total Residual
Chlorine, Total Sus-
pended.. .and Fe-
cal Coliform are-
re water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of South Potts
Creek.
Davidson County
Schools P.O.. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0041629 for its Ex-
tended Day School
WWTP in Davidson
County. This permitted
facility discharges
treated wastewater to
an unnamed tributary
to Hamby Creek in the
Yadkin -Pee Dee River
Basin. Currently BOD,
Ammonia Nitrogen, and
Total Residual Chlorine
are water quality limit-
ed. This discharge may
affect future allocations
in this portion of the
watershed.
Quail Run Mobile Home
Park, has applied for re-
newal of its NPDES per-
mit NC0070033. The
permitted facility dis-
charges treated waste-
water to Miller Creek in
the Yadkin -Pee Dee Riv-
er Basin. Currently
BOD5, Ammonia as Ni-
trogen, Total Residual
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Miller Creek.
Davidson County
Schools, P.O. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042129 for its Pilot
Elementary School
WWTP in Davidson
County. This permitted
facility discharges
treated wastewater to
Jimmy's Creek in the
Yadkin -Pee Dee River
Basin. Currently Ammo-
nia Nitrogen and Total
Residual Chlorine are
water quality limited.
This discharge may af-
fect future allocations
in this portion of the
watershed.
Davidson County
Schools, P.O. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042145 for its Mid-
way Elementary School
WWTP in Davidson.
County. This permitted
facility discharges
wastewater to an un-
named tributary to Leo-
nard Creek in the Yad-
kin -Pee Dee River Ba-
sin. Currently Ammonia
Nitrogen and Total Re-
sidual Chlorine are wa-
ter quality limited. This
discharge may affect
future allocations in this
portion of the water-
shed.
Captain Stevens Sea-
food Restaurant, has
applied for renewal of
its NPDES permit
NC0059218. This per-
mitted facility discharg-
es treated wastewater
to an unnamed tributa-
ry to Reedy Creek in
the Yadkin -Pee .Dee-Riv
er Bashi.-- Currently.
BOD5, Total Residual
AFFIDAVIT OF PUBLICATION
STATE OF NORTH CAROLINA Lexington,N.C.
DAVIDSON COUNTY
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Reedy Creek.
Hilltop Living Center,'
has applied for renewal
of its NPDES permit
NC0059536. The per-
mitted facility discharg-
es treated wastewater
to an unnamed tributa-
ry to Yadkin -Pee Dee
Basin. Currently BODS,
Ammonia as Nitrogen,
Total Residual Chlorine,
Total Suspended Solids,
Total Phosphorus and
Fecal Coliform are wa-
ter quality limited. This
discharge may affect
future allocations in this
portion of the Yadkin
River.
April 19, 2004.
vitt1/4" } 2004
�-- ER OUnLjY
p ENR GF,Rfitl! ►-1
2004
of THE DISPATCH, a newspaper published in the city of
Lexington, County and State aforesaid, being duly sworn, says the foregoing legal of
which the attached is a true copy, was
day of
Sworn to and subscribed before
tossing Ili%
s
OM
me, this
published
2004.
2Nel
in said newspaper once the
Publication Fee $ LAk�• 7
day o 200
My commission expires
)2_1)2_06
(Seal)

FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
l'I&OZ)",q ( (3
Facility Name
G. kV4 ` 51`- , j SS 557
Reviewer
c
Basin/Sub-basin
ff53----4-
Receiving Stream
U 7 6 F r_.(Doct c LtK
U
Is the stream impaired (listed on 303(d))?
/de
Is stream monitoring required?
(-('
• Do they need NH3 limit(s)?
�� tv o
i
Do they need TRC limit(s)?
t-('s
Do they have whole -effluent toxicity testing?
Are there special conditions?
-
Any obvious compliance concerns?i
Existing Expiration Date
'3 ( �,g
Proposed Expiration DateCF
!J
Miscellaneous Comments:
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Circle one:
If expedited, is this
simpler permit
DO NOT EXPEDITE
more difficult one?
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DEUR - WATER Ott' . TY
POINT SOURCE
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May 18, 2002
AFFIDAVIT OF PUBLICATION ,
STATE OF NORTH CAROLINA Lexington,N.C. / , / b 2002
DAVIDSON COUNTY /1
of THE DISPATCH, a newspaper published in the city of
Lexington, County and State aforesaid, being duly sworn, says the foregoing legal of
which the attached is a true copy, was published in said newspaper once the /k
day of
Sworn to and subscribed before me, this
2002.
Publication Fee $ /0,5 30
day of
&/ l AvV—' (Seal)
eaaeee
PUBLIC
CifJ: -Abef 3 5'

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT•FORM D
To be filed only by privately -owned dischargers of 100% domestic wastei eater (<1 MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-161,7
http://h2o.enr.state.nc.us/NPDES/
North Carolina NPDES Permit Number
1. Contact Information:
Facility Name
Owner Name
Street Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Operator Name
Street Address.
City
State / Zip Code
County
Telephone Number
OCT - 1 2303
NC00
Please print or type
C CA rtszVA-ks
Slew 7S ��lvv� /?-•f'01Q‘kkt°L+"1--
LI S71 # C Hwy
L ; ti..
N•C. 2.1Z92.
(S%G) - 47
qkkevt ;-0-1 Cot M' b \1
y?y ,e'
tea-4/Ixes-t
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2. Location of facility producing
Check here if same as above
Facility Name (If different from above)
Street Address or State Road
City
State / Zip Code
County
3. Reason for application:
Expansion/Modification *
Renewal
'scharge:
Existing Unpermitted Discharge
New Facility
* Provide a description of the expansion/modification:
Page 1 of 3 Version 12/02

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):
'4. Ok0‘.07kI M W csx 'C d1 T C e `n1 \ w` e t4Noloti t i
vt
C OM&..* i`;' to 4-- GV entS c •t
da-•A)uAkv oL� SO
, SS•Ar
'c• ��� �f��
to s ; C., c l ‘o \, ‘,,, \
C•c::)\-'y(A- Ek-,‘ • di SA P`c-cat 5%.•'*.t e\dce.
5. Description of wastewater (check all that apply):
Type of Facility Generating Wastewater
Industrial
Commercial
Residential
School
Other
Number of Employees
Number of Employees
Number of Homes
Number of Students/Staff
12% C k4CA•A X"'z'-‘
s.s
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
6. List all permits, construction approvals and/or applications (check all that apply):
Type
RCRA
UIC
NPDES
PSD
NESHAPS
Permit Number
NC 0059
Type
Non -Attainment
Ocean Dumping
Dredge/Fill Permits
Other
Permit Number
7. Number of separate wastewater discharge pipes (wastewater outfalls):
©�
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall:
Noc
Page 2 of 3 Version 12/02

a
4
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):
10. Is this facility located on Native American lands? (ct}eck one)
�s ❑
NO
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.
ick
Printed Name of Person Signing
Title
Date Signed
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 $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 3 Version 12/02