NC0044962_Permit Issuance_20070614

NPDES DOCUMENT SCANNING COVER SHEET
NPDES Permit:
NC0044962
North Stokes High School
Document hype: "�
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Correspondence
Owner Name Change
Staff Report
Instream Assessment (67b)
Speculative Limits
Environmental Assessment (EA)
Document Date:
June 14, 2007
This document is printed oa reuse paper - ignore any
content on the re -sr -erne side

Michael F. Easley, Governor
William G. Ross Ir., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
June 14, 2007
Mr. Ricky Goins
Maintenance Director
Stokes County Schools
PO Box 50
Danbury, North Carolina 27016
Subject: Issuance of NPDES Permit NC0044962
North Stokes Jr./Sr. High School WWTP
Stokes County
Dear Mr. Goins:
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to the
requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North
Carolina and the U.S. Environmental Protection Agency dated May 9,1994 (or as subsequently amended).
2007.
This final permit includes no major changes from the draft permit sent to you on March 28,
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
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
Karen Rust at telephone number [phone], extension 361.
Sincerely,
Coleen H. Sullins
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection Section
I +TPDES Files
Aquatic Toxicology Unit
Nam` Carolina
,Naturally
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Phone: [phone] Customer Service
Internet httpi/h2o.enr.state.nc.us 512 N. Salisbury St Raleigh, NC 27604 Fax: [phone]
An Equal Opportunity/Affirmative Action Employer

Permit NC0044962
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 provision 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
Stokes County Board of Education
is hereby authorized to discharge wastewater from a facility located at the
North Stokes Jr./Sr. High School
On NCSR 1499
Southwest of Lawsonville
Stokes County
to receiving waters designated as an unnamed tributary to the Dan River in the Roanoke River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I,
II, III and IV hereof.
This permit shall become effective July1, 2007.
This permit and authorization to discharge shall expire at midnight on February 29, 2012.
Signed this day June 14, 2007.
Coleen H. Sullins, Director /
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0044962
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.
The Stokes County Board of Education is hereby authorized to:
1. Continue to operate an existing 0.0115 MGD wastewater treatment facility with the following
components:
• Septic tank
♦ Dosing chamber
♦ Surface sandfilter
• Tablet chlorination
• Chlorine contact tank
• Tablet dechlorination
The facility is located at North Stokes Jr./Sr. High School on NCSR 1499, Southwest of
Lawsonville in Stokes County.
2. Discharge from said treatment works at the location specified on the attached map into an
unnamed tributary to the Dan River, classified C-Trout waters in the Roanoke River Basin.

Facility Information
Latitude:
Longitude:
Quad Name:
Stream Class: C
Receiving Stream: Little Neatman Creek
36°19'26"
80°14'18"
Walnut Cove
Sub -Basin:
03-02-01
Facility
Location
North
Stokes County Schools — South Stokes High School
NC0044954
Stokes County

Permit NC0044962
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee
is authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as
specified below:
Effluent
Characteristics
LimitS
Monitoring Requirements
Monthly
Average
Weekly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample Location
Flow
0.0115 MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5 day (20°C)
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
Total Suspended Residue
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NH3 as N
2/Month
Grab
Effluent
Fecal Coliform
(geometric mean)
200/100 ml
400/100 ml
2/Month
Grab
Effluent
Total Residual Chlorine
1714/L
2/Week
Grab
Effluent
Temperature (°C)
Weekly
Grab
Effluent
Chronic Toxicity1
Quarterly
Grab
Effluent
pH2
2/Month
Grab
Effluent
Footnotes:
1. Chronic Toxicity (Ceriodaphnia) P/F at 23%; February, May, August, and November; (See Part A (2)).
2. The pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NC0044962
A (2). CHRONIC TOXICITY PERMIT LIMIT (QRTRLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to Ceriodaphnia dubia at
an effluent concentration of 23.0 %.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the "North Carolina
Ceriodapbnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent versions or "North Carolina Phase II
Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or subsequent versions. The tests will be performed
during the months of February, May, August, and November. Effluent sampling for this testing shall be performed at the
NPDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV below the permit limit,
then multiple -concentration testing shall be performed at a minimum, in each of the two following months as
described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or
subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the highest concentration
having no detectable impairment of reproduction or survival and the lowest concentration that does have a detectable impairment
of reproduction or survival. The definition of "detectable impairment," collection methods, exposure regimes, and further
statistical methods are specified in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -
February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge Monitoring Form
(MR-1) for the months in which tests were performed, using the parameter code TGP3B for the pass/fail results and THP3B for
the Chronic Value. Additionally, DWQ Form AT-3 (original) is to be sent to the following address:
Attention: Environmental Sciences Section
North Carolina Division of Water Quality
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later than 30 days after the end
of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all concentration/response data,
and be certified by laboratory supervisor and ORC or approved designate signature. Total residual chlorine of the effluent toxicity
sample must be measured and reported if chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is required, the permittee will
complete the information located at the top of the aquatic toxicity (AT) test form indicating the facility name, permit number, pipe
number, county, and the month/year of the report with the notation of "No Flow" in the comment area of the form. The report
shall be submitted to the Environmental Sciences Section at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required, monitoring will be required during
the following month. Should any test data from this monitoring requirement or tests performed by the North Carolina Division
of Water Quality indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include
alternate monitoring requirements or limits.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism
survival, minimum control organism reproduction, and appropriate environmental controls, shall constitute an invalid
test and will require immediate follow-up testing to be completed no later than the last day of the month following the
month of the initial monitoring.

North Carolina Wildlife Resources Commission
MEMORANDUM
TO:
FROM:
DATE:
SUBJECT:
Richard B. Hamilton, Executive Director
S - an Wilson, NPDES Unit
ivision of Water Quality
Ron Linville, Regional Coordinator
Habitat Conservation Program
April 19, 2007
Wastewater Treatment Plant (WWTP) Permits — Dan/Roanoke River Basin
APR 2 0 2007
DEUR -
POINT
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) have reviewed
NC Division of Water Quality (DWQ) notices for the proposed issuance of WWTP permits for
potential impacts to fish and wildlife. Biologists with the NCWRC are familiar with habitat
values in the area. The NCWRC is authorized to comment and make recommendations which
relate to the impacts of this permit or project to fish and wildlife pursuant to Clean Water Act of
1977, North Carolina Environmental Policy Act, US National Environmental Policy Act,
Endangered Species Act (16 U. S. C. 1531-1543; 87 Stat 884), the Fish and Wildlife
Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and/or Federal License of
Water Resource Project Act (Federal Power Act-16 U.S.C. 791a et seq.) as applicable.
DWQ is in the process of issuing and/or re -issuing National Pollutant Discharge Elimination
System (NPDES) permits for several WWTPs that discharge into the Dan/Roanoke River basin.
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) have reviewed
the location of these sites and have determined that additional scrutiny is appropriate for
ammonia, chlorine, and copper. The specific NPDES permits we have reviewed are:
• Cains Way Homeowners Association (NC0075027)
• Horizons Residential Care Center (NC0056791)
• Kobe Wieland Copper Products, Inc. (NC0035173)
• Stokes County Board of Education (NC0044954, NC0044962, NC0087980)
• Town of Danbury (NC0043290)
• Twin Lakes Mobile Home Park (NC0057720)
Chlorine & Ammonia Concerns -
Chlorine is acutely toxic to aquatic organisms and forms secondary compounds that are also
detrimental to aquatic life, especially eggs and juveniles. We also have concerns regarding daily
ammonia concentrations. Freshwater mussels are among the most sensitive aquatic organisms
tested for impacts from ammonia, and ammonia may be a significant limiting factor for unionids
Mailing Address: Division of Inland Fisheries • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]

Dan River NPDES Permits
-Page 2 - April 19, 2007
cAugspurger et al., 2003). Recent research by Augspurger et al. (2003) found that ammonia
oncntrtions which may be protective of freshwater mussels range from 0.3 to 1.0 mg/L total
ammonia as N at pH 8.
Copper Concerns -
Treated wastewater from Kobe Wieland Copper Products Inc. is discharged to an unnamed
tributary that flows into the lower portion of the Dan River, a Significant Aquatic Resource as
designated by the North Carolina Natural Heritage Program. The Dan River provides diverse
species habitats and harbors several State and Federally listed mussel and fish species, including
the James (River) Spiny Mussel, Pleurobema collina (State Endangered, Federal Endangered).
There are recent records (2001) for the Green floater, Lasmigona subviridis (State Endangered,
Federal Species of Concern) recorded in the NCWRC Aquatics Database. These records are
directly below the confluence of the aforementioned unnamed tributary to the Dan River.
Although the James (River) Spiny Mussel has not been reported in this lower section of the Dan
River, the possibility strongly exists since the Green Floater is a common species associate of the
James (River) Spiny Mussel in the Dan River. The discharge of copper to the unnamed tributary
is an immediate concern for both mussel species. In a 28-day chronic Copper toxicity
experiment, Wang et al. (in press) demonstrated that as little as 12-21 micrograms of copper per
liter of water (0.012-0.021 milligrams/liter) results in an LC-50 (concentration that kills 50% of
the animals in the sample; i.e., Lethal Concentration) for several species of native juvenile
freshwater mussels. This research suggests that mussels are more sensitive to copper pollutants
than other taxa (e.g., fish and microcrustaceans). Monitoring records indicate that on December
31 st, 2006 Kobe Wieland Copper Products Inc. discharged an average of 136 micrograms of
copper per liter of water (0.136 milligrams/liter) from pipe 001 and 380 micrograms of copper
per liter of water (0.380 milligrams/liter) from pipe 003 (data extracted from E.P.A. Envirobccts
Data Warehouse). Those discharge concentrations are well above detrimental levels for juvenile
freshwater mussels according to recent research (Wang et al. in press).
The following recommendations should be evaluated and incorporated into these and other
NPDES permits as appropriate to avoid and reduce potential impacts to fish and wildlife
resources, especially in areas known to support listed and highly sensitive species:
1. Only non -chemical disinfection like ultraviolet or ozone should be permitted and used.
Chlorine should be expressly prohibited from any use (including emergency operations)
at the WWTP. This should provide the additional benefit of removing hazardous
materials from the environment and the workplace.
2. Ammonia limits should be reduced to the maximum extent practicable. Ammonia and
pH monitoring should be required daily. Daily composite sampling may be appropriate.
3. If not already in place, we recommend provision of automatic stand-by power generation
to prevent plant emergencies and upsets caused by power outages.
4. If publicly owned collection systems and treatment works (POTW) become available,
these facilities should be required to connect to the POTW without delay.
5. Kobe Wieland Copper Products, Inc. and anyother NPDES permits with copper issues
should have reduced copper limits to avoid potential impacts to aquatic species,
especially where federally listed aquatic species are known within the watershed.
Although other factors may also contribute to aquatic habitat degradation, we believe the above
evaluations and prevention measures are appropriate. Limits should protect aquatic habitats

Dan River NPDES Permits -Page 3 - April 19, 2007
(water quality) and preclude acute or chronic issues from WWTP point source discharges. We
are especially concerned about maintaining aquatic habitat values in the Dan/Roanoke River
basin and similar healthy watersheds. These high value habitats are usually undeveloped
watersheds that need proactive management strategies to preclude impairment from development
as well as from point and non -point issues.
Thank you for the opportunity to provide input during the planning stages for this project. If we
can be of further assistance, please contact me at 336-769-9453. Mr. Robert Nichols, Aquatic
Wildlife Diversity Coordinator is very knowledgeable about the Dan/Roanoke basin's listed
aquatic species as well as the diversity of aquatic species present in the watershed. You may
contact Mr. Nichols at 919-786-1789. You may contact Tom Augspurger with the U.S. Fish and
Wildlife Service at 919-856-4520 for additional information concerning toxicity and federally
listed species.
Literature cited:
Augspurger, T., A.E. Keller, M.C. Black, W.G. Cope and F.J. Dwyer. 2003. Water quality
guidance for protection of freshwater mussels (Unionidae) from ammonia exposure.
Environmental Toxicology and Chemistry 22: 2569-2575. (See attached file: Augspurger
et al. Mussel Ammonia Article.ET&C.Nov.2003.pdI)
Wang, N., C.G. Ingersoll, E.I. Greer, D.K. Hardesty, C.D. Ivey, J.L. Kunz, F.J. Dwyer, A.D.
Roberts, T. Auspurger, C.M. Kane, R.J. Neves, and M.C. Barnhart. Assessing
contaminant sensitivity of early life stages of freshwater mussels (Unionidae): Chronic
toxicity testing of juvenile freshwater mussels with copper and ammonia. Environmental
Toxicology and Chemistry. In Press.
Wang, N., C.G. Ingersoll, D.k. Hardesty, C.D. Ivey, J.L. Kunz, T.W. May, F.J. Dwyer, A.D.
Roberts, T. Augspurger, C.M. Kane, R.J. Neves, and M.C. Barnhart. Assessing
contaminant sensitivity of early life stages of freshwater mussels (Unionidae): Acute
toxicity of copper, ammonia, and chlorine to glochidia and juvenile mussels.
Environmental Toxicology and Chemistry. In Press.

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:
March 31, 2007
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 2nd day of April, 2007
Abk
♦
(signature o pers a g affidavit)
Sworn to and subscribed before me, this 2nd day of April, 2007
Nota '' blic
My Commission expires: September 28, 2010
KIMALEY JOHNSON
NOTARY PUBLIC
FORSYTH COUNTY
STATE OF NORTH CAR ! t
MY COMMISSION EXPIRES '-• v
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STATE NORTH CAROLINA
ENVIRONMENTAL MANAl BEEPff COMMISSION/
NPDES UNIT
1$17 MAIL SERVICE CENTER
NC 27699-1617
NOTIRCATI�ON"OF DITENT•TO ISSUE
ANDS WASTEWATlliL PERMIT .
Op the basis of thorough staff revJr�gwr ond a.pplicatioq
of NC General Statute 14321, Pubiia law 9z-500 and
other lawful standards and•.regutatio the North
Carolina Environmental I I lanagement Comms n •
p�r�ooposes to Issue aNational Pollutant Disch�EliminationSystem �te) ee
IePubhd�atess) lst�dbeawdv45 days
•
Wr` n oomm u �l'e3ar.dina e publish date off
mis no �me .ed pri r to that date
a�rree cons in the final determinations regarding
the ropos mil. The DI or• 1 the NC aivis on
v� t�yr a � tit
�f ater Qual may Cecihde 4• ! � gttbt a met ng
e proposed perm s ou d e Division rege ve a
stgnl ant degree of public interest.
Co ofthe draft perrttit and hear su ons infor-
on on 1tb seed io determ ne oon ors PPre�sent
n the draft it are available uponrrequest and
payment
of
et pts ermit
information ror�Qrl�ticn.o Mail ent of
• Water p/or at the above address or call
Source B� at [phone], exte Ion 363. Com-
me is can also be emalled to . i,. • . • i 1,:.,
re�aasneylnctude a r It pe
ma also vlslt the�p vn W Q: ity at 512 N.
Sal Street, RNet NC 27604.1i48 n e
hou%of8.:00 s.m. and p ntto review t an
Stokes
1 apple (oBPOESAerra
t�tt.0 % South Alt.
. . of WwT in
Stokes + permttl� • t ? discharges
0.0173 D treated waste - . to , e Neatman
sidu in :�' Roenoke River arge.
RoRoanokke Basin. • yY
St I ofEdue�OO Q�
ryry NC 2701!� applied for renewal of NPO permit
Nt30044962 for a North Stokes !r./ Sr. High School
rgin Stokes County. This permitted facility dls-
es 0.0115 MGD treated wastewater to an un-
, • nnBasin. Curbre�.to thelesDlduiiver iu Roanoke River
—ty� Eim This Isch mayal ne is fuwaturelions quail -
in this portion of the Roanoke. ieurtBasin.
lobo (PO Sox lOns NC
NQ00�has appl or renewal � laDE5 permit
720 iqr the Twin takes Mobile dome Park
WVirf^ti Pes 0 00101)Ctreated w stewaterrttod i uinnaamed
too Timmons Creek in the RoanokegRiver Ba-
�chlortflq aar0e waterw�ual ty limited. and total
di�s-
affect future allocations in this portion of

RESEARCH & ANALyTICAI
LABORATORIES, INC.
Analytical/Process Consultations
September 1, 2006
Mr. Charles H. Weaver, Jr.
NPDES Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Renewal of NPDES Permit No. NC0044962
North Stokes High School WWTP
Stokes County
Dear Mr. Weaver,
ECEllyE
OCT - 9 2006
- A'ATER QUALITY
'�"r SOURCE
DE'�R BRANCH
Please renew NPDES Permit No.NC0044962 for the wastewater treatment plant at North Stokes
High School. The signed application form in triplicate, a description of the method of sludge
disposal and a map of the location of the discharge are all attached.
Sincerely,
Research & Analytical Labs
James M. Cheshire
Authorized Agent
JMC/sl
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.researchandanalyttcal.com

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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
INC0044962
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 Stokes County Schools
Facility Name North Stokes High School
Mailing Address P. O. Box 50
City Danbury
State / Zip Code NC/27016
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 1350 North Stokes School Road
City
State / Zip Code
County
Danbury
NC/27016
Stokes
1. 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 Research And Analytical Laboratories, Inc.
Mailing Address P. O. Box 473
City Kernersville
State / Zip Code NC/27284
Telephone Number [phone]
Fax Number [phone]
1 of 4 Form-D 1/06

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
School ® Number of Students/Staff 703
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Population served:
4. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
4. 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):
unnamed tributary to Dan River
7. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 5 Duration:
7. Describe the treatment system
List all installed components, including capacity, 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 of paper.
0.0115 wastewater facility consisting of the following:
-septic tank
-dosing chamber
-surface sandfilter
-tablet chlorination
-chlorine comtact tank
-tablet dechlorination
2 of 4 Form-D 1/06

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
7. Flow Information:
Treatment Plant Design flow 0.0115 MGD
Annual Average daily flow 0.0044 MGD (for the previous 3 years)
Maximum daily flow 0.008 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. Effluent testing data must be based on at least three samples
and must be no more than four and one half years old.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Number of
Samples
Biochemical Oxygen Demand
(BOD5)
15.8
13.0
mg/1
Fecal Coliform
<1.0
<1.0
col/ 100mis
Total Suspended Solids
12.5
8.88
mg/1
Temperature (Summer)
21.0
17.0
°C
Temperature (Winter)
12.0
10.1
°C
pH
6.60
6.60
SU
12. List all permits, construction approvals and/or applications:
Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
Permit Number
NC0044962
14. APPLICANT CERTIFICATION
Type
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Special Order of Consent (SOC)
Other
Permit Number
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.
James M. Cheshire Authorized Agent
Printed name of Person Signing Title
3 of 4
Form-D 1/06

Sign
NPDES APPLICATION - FORM D
For privately ow ed eatment systems treating 100% domestic wastewaters <1.0 MGD
re of Applicant
�--t—off
Date
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 knowly 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.)
4 of 4 Form-D 1/06

SLUDGE MANAGEMENT PLAN
NORTH STOKES HIGH SCHOOL WASTEWATER TREAMENT
PLANT
NPDES PERMIT NO. NC0044962
Sludge from the North Stokes wastewater treatment plant is disposed of in the
following way:
Solids are collected in the septic tank and digested
anaerobically. The excess solids are periodically pumped and
halved by a licensed septic pumper contractor and disposed
of at the City of Winston Salem wastewater treatment plant.

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Basic Information to determine potential for expedited permit renewal
Reviewer/Date
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Permit Number
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Facility Name
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Basin Name/Sub-basin number
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Receiving Stream
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Stream Classification in Permit
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Does permit need NH3 limits?
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Does permit need TRC limits?
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Does permit have toxicity testing?
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Does.permit have Special Conditions?
Q
Does permit have instream monitoring?
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Is the stream impaired (on 303(d) list)?
A/o
Any obvious compliance concerns?
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Any permit mods since last permit?
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Existing expiration date
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Reissued permit expiration date
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New -proposed permit effective -date
Miscellaneous Comments
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YES! This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NH3,
name/ownership changes). Include conventional WTPs in this group.
YES_ This is a MORE COMPLEX EXPEDITED permit renewal (includes
Special Conditions (such as EAA, Wastewater Management Plan), 303(d)
listed, toxicity testing, instream monitoring, compliance concerns, phased
limits). Basin Coordinator to make case -by -case decision.
YES_ This permit CANNOT BE EXPEDITED for one of the following reasons:
• Major Facility (municipal/industrial)
• Minor Municipals with pretreatment program
• Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS,
etc)
• Limits based on reasonable potential analysis (metals, GW remediation organics)
• Permitted flow > 0.5 MGD (requires full Fact Sheet)
• Permits determined by Basin Coordinator to be outside expedited process
TB Version 8/18/2006 (NPDES Server/Current Versions/Expedited Fact Sheet)