NC0032212_Permit Issuance_20071015

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
October 15, 2007
Mr. Morris Trammel, Jr.
Water Quality Services, Inc.
P.O Box 1102
Banner Elk, NC 28604
Subject: Issuance of NPDES
Permit NC0032212
Yonahlossee WWTP
Watauga County
Dear Mr. Trammel Jr.,
Coleen H. Sullins, Director
Division of Water Quality
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).
This permit includes no major changes from the draft permit sent to you on August 15, 2007.
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 Bob Guerra at telephone number
[phone], extension 539.
Sincerely,
Coleen H. Sullins
Enclosure: NPDES Permit NC0032212
cc: Central Files
Winston-Salem Regional Office / Surface Water Protection
NPDES Unit
lNo t hCarolina
,Naturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone]
Internet: www.ncwaternuali y.org, Location: 512 N. Salisbury St. Raleigh, NC 27604 Fax [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
Customer Service
1-877-623-6748

Permit NC0032212
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
Water Quality Services, Inc., Inc.
is hereby authorized to discharge wastewater from a facility located at the
The Yonahlossee WWTP
1102 Shulls Mill Road
Watauga County
to receiving waters designated as Lance Creek in the Watauga 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 December 1, 2007.
This permit and authorization to discharge shall expire at midnight on September
30, 2012.
Signed this day October 15, 2007.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0032212
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 Yonahlossee WWTP is hereby authorized to:
1. Continue to operate an existing 0.04 MGD wastewater treatment facility with the
following components:
• Aeration flow equalization basin,
• Three-way splitter box,
• Aeration basin,
• Clarifier,
• Aerated sludge holding tank,
• Disinfection / post -aeration chamber with UV disinfection and
• Continuous flow -recording device.
After receiving an Authorization to Construct from the Division, construct and
operate a 0.150 MGD extended -aeration package plant with sludge holding.
This facility is located off NCSR 1102 at 1102 Shulls Mill Road, South of Boone
in Watauga County.
2. Discharge from said treatment works, through Outfall 001, into Lance Creek,
classified C-Trout waters in the Watauga River Basin, at the location_ specified on
the attached map.

Water Quality Services Inc. 1
Yonahlossee WWTP
Latitude:
Longitude:
Receiving Stream:
Stream Class:
36° 10' 12" iV State Grid: Boone
81° 43' 21" W Permitted Flow: 0.04 MGD
Lance Creek Drainage Basin: Watauga River Basin
C - Trout Sub -Basin: 04-02-01
NPDES Permit No. NC0032212
Watauga County

Permit NC0032212
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until expiration or
expansion above 0.04 MGD, the Permittee is authorized to discharge from outfall 001. Such
discharges shall be limited and monitored by the Permittee as specified below:
LIMITS
,� c . z , k .• e , 4
' MONITORING REQUIREMENTS
.. ' r.`•a . ' N ' ! t r., ' • 44:li....a .. ,
EFFLUENT,;:':
CHARACTERISTICS , » {
'' -
4 :
Monthly
Average . -
,Daily
}.,Malcimum-
,Measurement
. Frequency ;
Sample Type
; :
1 Sample
.Locationr` __.
Flow
0.04 MGD
Continuous
Recording
- I or E.
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Composite
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
E
NH3 as N
(April 1-October 31)2
3.0 mg/L
15.0 mg/L
Weekly
Composite
E
NH3 as N
(November 1— March 31)2
6.0 mg/L
30.0 mg/L
Weekly
Composite
E
Dissolved Oxygen4
Monitor and Report
Weekly
Grab
E, U & D
Fecal Coliform (geometric
mean)
200/ 100
mL
400/ 100
mL
Weekly
- Grab
E
Total Residual Chlorines
17 ug/L
Weekly
Grab
E
Temperature °Cs
Monitor and Report
Daily
Grab
E -
Temperature °Cs
Monitor and Report
Weekly
Grab
U & D
PH6 -
Monitor and Report
Weekly
Grab
E
Footnotes:
1. Sampling Locations: E = Effluent, U= Upstream (at least 200 feet from outfall); D = Downstream
(at the hiking trail below the outfall).
2. This permit already contains a monthly average ammonia (NH3-N) limit. In order to comply with
federal regulations, a corresponding daily maximum (or weekly average) ammonia limit has been
added.
3. Limits and monitoring for total residual chlorine will apply only if chlorine is added to the waste
stream during the treatment process.
4. The daily average dissolved oxygen concentration shall not be less than 6.0 mg/L.
5. The temperature for trout waters shall not increase more than 0.5 °C due to the discharge of
heated liquids, but in no case to exceed 20°C.
6. 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 NC00322 12
A. (2.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning after expansion above 0.04 MGD 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
7
` , ; f = LIMITS
P
�5�1�"'.y� .. `i � ,'a'hx `�
Y' 't' '
�., MONITORING REQUIREMENTS
..•, '. _ ` ".. Fy`.....1. -44 . ' < Y r
� ur r';r�' ;�j fei.L � d 4; �^t �ti ,.fir �,:� r !'k3i Ap= yr ..
CHARACTERISTICS > 4�
•
•
i ; =
- j . _ .
Monthly
" Daily z �,
Maximum'
Masu csement
'Frequency ,
, Sample Type a
.. ; , ' :i`
_. x Samnple
_Location=
Average
Flow
0.15 MGD
Continuous
Recording
I or E
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Composite
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
Weekly
Composite
E
NH3 as N
(April 1-October 31)
2.0 mg/L
10.0 mg/L
Weekly
Composite
E
NH3 as N
(November 1- March 31)
4.0 mg/L
20.0 mg/L
Weekly
Composite
E
Dissolved Oxygen
Monitor & Report
Weekly
Grab
E, U 8s D
Fecal Coliform (geometric
mean)
200/ 100
mL
400/ 100
mL
Weekly
Grab
E
,
Total Residual Chlorine3
17 ug/L
Weekly
Grab
E
Total Nitrogen
(NO2+NO3+TKN)
Monitor & Report
Semi -Annually
Composite
E
Total Phosphorus
Monitor & Report
Semi -Annually
Composite
E
Temperature oC4
Monitor & Report
Daily
Grab
E
Temperature 0C4
Monitor & Report
Weekly
Grab
U & D
pHs
Monitor & Report
_ Weekly
Grab
E
Footnotes:
1. Sampling Locations: E = Effluent, U= Upstream (at least 200 feet from outfall); D =
Downstream (at the hiking trail below the outfall).
2. The daily average dissolved oxygen concentration shall not be less than 6.0 mg/L.
3. Limits and monitoring for total residual chlorine will apply only if chlorine is added to the
waste stream during the treatment process.
4. The temperature for trout waters shall not increase more than 0.5 °C due to the discharge of
heated liquids, but in no case to exceed 20°C.
5. 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.

Acct. Name:
NCDENR/DWQ/NPDES
Acct. # 112162
COST OF PUBLICATION
Total $ 154.22
PUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION/NPDES UNIT
4. 1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
NOTIFICATION OF INTENT TO ISSUE A NPDES WASTEWATER
PERMIT
Vn the basis of thorough staff review and application of NC General
:.statue 143.21, Public law 92-500 and other lawful standards and
regulations, the North Carolina Environmental Management Commis-
sion proposes to issue a National Pollutant Discharge Elimination
System (NPDES) wastewater discharge permit to the person(s) listed
below effective 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 re-
ceived prior to that date are considered in the final determinations re-
garding the proposed permit. The Director of the NC Division of Wa-
ter Quality may decide to hold a public meeting for the proposed per-
mit should the Division receive a significant degree of public interest.
Copies of the draft permit and other supporting information on file
used to determine conditions present in the draft permit are available
upon request and payment of the costs of reproduction. Mail com-
ments and/or requests for information to the NC Division of Water
Quality at the above address or call Ms. Frances Candelaria (919)
733-5083, extension 520 at the Point Source Branch. Please include
the NPDES permit number (attached) in any communication. Inter-
ested person may also visit the Division of Water Quality at 512 N.
Salisbury Street, Raleigh, NC 27604-1148 between the hours of 8:00
a.m. And 5:00 p.m. to review information on file.
Mill Ride Property Owners Associatiori Alias applied for
eenewal of a wastewater permit discharging to die tltfati#uga River, a
class B-Trout-HQW stream in the Watauga River Basin.
Hebron Colony Ministries permit number=0.344as applied
for FenewaI- of its permit discharging to the Watauga Aiver in the
Watauga River Basin. ✓ .
Yonahlossee WWTP1 ._. hlis applied forrriffrfe iel of its per-
mit discharging to Lance Creek in the Watauga River Basin.
Bethel Elementary Schoolir as applied for;;enewai,of
its permit discharging to f3eaVerdanr'CY2ek in the Watauga River
Basin.
Old Cove Creek School,' permit numbe► p s applied for
:tenewa, of its permit discharging to Cove Creek in the Watauga River
Basin. • ,'�/
Valle Crucis Elementary SchoottiC13067a24 nos applied forfienew-
t of its permit discharging to`b'ufcft Cretf in the Watauga River
Basin.
The Valle Landing Properly Owners Association, Inc. [P.O. Box 554,
Valle Crucis,t/NC 28691] has applied for :xrenewal of permit
;t4E0932553.tpr its Valle landing Shopping Center WWTP in Watauga
County. This permitted facility discharges treated wastewater to
Dutch Creek in the Watauga River Basin. Currently fecal coliform is
water quality limited. This discharge may affect future allocations in
this portion of Dutch Creek.
AFFIDAVIT OF PUBLICATION
NORTH CAROLINA-WATAUGA COUNTY
Before the undersigned, a Notary Public of said County
and State, duly commissioned, qualified and authorized by the
law to administer oaths, personally appeared:
Who being first duly sworn, deposes and says: that he (she) is
REPRESENTATIVE
of a newspaper known as THE WATAUGA DEMOCRAT, publishe
issued and entered as second class mail in City of Boone,
in said County and State; that he (she) is authorized to make
this affidavit and sworn statement; that the notice of other legal
advertisement, a true copy of which is attached hereto, was
published in THE WATAUGA DEMOCRAT the following dates :
NPDES WASTEWATER PERMIT
08/20/2007
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 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 20th day of August, 2007
Sworfi ar�d sufas�riled before me, this
2QtFi day, of AugL•tst, '2007
US; IC) \=;/1 "44-"r1---d/2-)
•
•
Notary Public
My Commission Expires:
o

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:
August 18, 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 20th day of August, 2007
(signature of per on ing affidavit)
Sworn to and subscribed before me, this 20th day of August, 2007
My Commission expires: September 28, 2010
KIMALEY NOTARY PUBLIC
N
FORSYTH COUNTY
STATE OF NORTH CAR! I
MY COMMISSION EXPIRES'
af♦
PUBUC NOTICE
STATE OF NORTH CAROUNA
ENVIRONMENTAL MANAGEMENT
COMMtSSFON/NPDES UNIT -
1617MAIL SERVICE CENTER-" "-•
RALEIGH, NC 27699-1617
NOTIFICATION OF INTENT TO ISSUE
A NPDES WASTEWATER PERMIT
On the basis of thorough staff review and
application of NC General Statute 143.21, Public law
92-500 and other lawful standards and regulations,
the North Carolina Environmental Management
Commission proposes to Issue a National Pollutant
Discharge Elimination System (NPDES) wastewater
discharge permit to the person(s) listed below
effective 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 proposed permit. The Director of the
NC Division of Water Quality may decide 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
information on file used to determine conditions
present In the . draft permit. are available upon
request and dayment of the costs of reproduction.
Mall comments and/or requests for information
to the NC Division of. Water Quality at the
above address or call Ms:• Frances Candelaria.
(919). 733-5083, extension 520 at the Point Source
Branch. Please include the NPDES permit number
(attached) 'In any' communication. Interested
persons may also visit the Division of Water Quality
at 512 N.. Salisbury. Street, Raleigh, NC 27604-1148
between the hours oi• 8:00 a.m. and 5:00' p.m. to
review1nformatloq onffile.
Creekslde Manor Rest Home [P.O. Box 'ABS, Kerners-
vg1.,, M-27285-0485] has appplied for renewal of
311 for its MVP In Forsyth County.
s permitted facility discharges treated domestic
wastewater to an unnamed tributary..to Belews•
Creek In • the Roanoke River Basin. Currently
dissolved oxygen, ammonia nitrogen, fecal coliform
and total residual chlorine are water quality
limited This discharge may affect future alloca-
tions in this portion pf Belews Creek...
MIB Ridge Property Owners AssociallonMKSIONTIS
has applied for renewal of a wastewater -Permit for'
discharging to the Watauga River, a•class B-Trout-
HQW stream in the Watauga River Basin.
[Hebron . ,Colony MintUksh peMdt number
f1C109 dllicha41has applied for renewal of Its permit,
ln to the Watauga River In .the Watauga
River Basin.. ; ' • : :
Yonahlossee WWTP, has applied for
renewal of its permit di b' •Lance Creek in
the Watauga River Basin.:;` :` :'a,..' ' .., ...
Bethel Elementary School, NC0066991, has applied
for renewal of its permit discharging to Beaverdam
Creek in the Watauga River Basin.'.
Old Cove Creek School; 'permit numberNOODUTO08
has applied for renewal of its permit discharging to
Cove Creek in the Watauga River.Basin.
Valk Cruds Elementary Sehooli. has
applied for renewal of Its permit�scharggiing to
Dutch Creek lrithe
ggWatauga River BaSin..r
Inc. [P.O.The O.Boxd554, Valk Crud 91] has
applied for renewal ogf permit
County.VThie s permitted facility diischarges treatP In ea
wastewater to Dutch Creek in the Watauga River
Basin. Currently fecal coliform is water quality
limited. This discharge may affect future alloca-
tions in this portion of Dutch Creek.
WSJ: August 18, 2007 ..

cc: Permits and Engineering
Technical Support Branch
County Health Dept.
Central Files
WSRO
SOC PRIORITY PROJECT: Yes No
If Yes, SOC No.
To: Permits and Engineering Unit
Water Quality Section
Attention: Charles Weaver
Date: July 31, 2007
NPDES STAFF REPORT AND RECOMMENDATION
County Watauga
Permit No. NC0030473
3ZZ/ Z-
PART I - GENERAL INFORMATION
1. Facility and Address: Yonahlossee Resort & Club
NCSR 1102 at end of road
Watauga Co
AUG 3 2007
2. Date of Investigation: July 16, 2007
3. Report Prepared by: Sue White
4. Persons Contacted and Telephone Number: Jadd Brewer 828-260-2027
5. Directions to Site: Hwy 321 through Blowing Rock. Yonahlossee is on the left
6. Discharge Points(s), List for all discharge points: One discharge point in Lance Creek
directly behind the WWTP
Latitude: 36d 10' 14"_ Longitude: 81d 43' 15"
U.S.G.S. Quad No. C 11NE_ U.S.G.S. Quad Name _ Boone
7. Site size and expansion area consistent with application? Yes
8. Topography (relationship to flood plain included): Hilly and Rocky

9. Location of nearest dwelling: 100 yards
10. Receiving stream or affected surface waters: Lance Creek
a. Classification C-Trout
b. River Basin Watauga and Subbasin No.: 040201
c. Describe receiving stream features and pertinent downstream uses: General
Useage
Part II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater to be permitted: MGD (Ultimate Design Capacity)
0.04 MGD
b. What is the current permitted capacity of the Waste Water Treatment facility?
0.04 MGD
c. Actual treatment capacity of the current facility (current design capacity)?
0.04 MGD
d. Date(s) of construction activities allowed by previous A/C=s issued in the
previous two years. N/a
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities; existing dual train system
f. Please provide a description of proposed wastewater treatment facilities. N/a
g•
Possible toxic impacts to surface waters: fecal
h. Pretreatment Program (POTWs only): n/a
in development approved
should be required not needed
2. Residuals handling and utilization/disposal scheme:
NPDES Permit Staff Report
Version 10/92
Page 2

Other disposal/utilization scheme (Specify): Solids pumped on as -needed basis and taken
to municipal WWTP
3. Treatment plant classification (attach completed rating sheet).
SIC Code(s):
Primary Secondary
Main Treatment Unit Code:
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public monies
involved. (municipals only)? N/a
2. Special monitoring or limitations (including toxicity) requests: none at this time
3. Important SOC, JOC or Compliance Schedule dates: (Please indicate) n/a
Date
Submission of Plans and Specifications
Begin Construction
Complete Construction
4. Alternative Analysis Evaluation: Has the facility evaluated all of the non -discharge
options available. Please provide regional perspective for each option evaluated.
N/a
5. Other Special Items: N/a
PART IV - EVALUATION AND RECOMMENDATIONS No issues with this plant at this
time.
Signature of report preparer
Water Quality Regional Supervisor
NPDES Permit Staff Report
Version 10/92
Date g*"1?
Page 3

Water Quality Services, Inc.
P.O. Box 1102
Banner Elk, NC 28604
[phone]
NCDENR/DWQ/Point Source Branch
Mrs. Carolyn Bryant
1617 Mail Service Center
Raleigh, NC 27699-1617
Febr ary 22, 2007
Subj ct: Renewal
NP 1 ES NC0032212
Yon hlossee WWTP
Wat : uga County
Dear Mrs. Bryant,
Water Quality Services' is requesting renewal for the pe
Treatment Plant at Yonahlossee.
The sludge at this plant is removed as needed by the Ope ation's firm.
L' Q
F E B 2 6 2007
DENR . WATER QUALITY
POINT SOURCE BRANCH
it for the Wastewater
rfh ink you,
M rris Trammel, Jr.
0 ner

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
1. Contact Information:
Owner Name
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
NPDES Permit
INC001 Z 2. 12.
Please print or type.
Mc, ram; S M
frormme-L) )r
W& - -r C a_ t .re.v~v c-e s, t kJ c.
o t..c srcEt c,.s(T P
Po (3o a.._ 1 1 0 ;-
13 a--r, { E
G Zatdy
(g'2 & 8 9 8- 2. Li
($2 a) e' $— Z 2- 11 6
K.. cl `� r v v L.
2. Location of facility producing discharge:
Check here if same address. as above ❑
Street Address or State Road
City
State / Zip Code
County
gktktls P-1,
N C.SR_ I I Scs4k o e $oc rJc
I oo tJ t
Nc a8eo-1
1/W A "T l} U Q
3. Operator Information:
Name of the firm, public organisation or other entity that operates the facility. (Note that this is not
referring to the Operator in Respc nsible Charge or ORC) Name A.t2 L4.. - era. 4- i O n
Mailing Address PD 80 .. II C. -1
City Q, h .e r- L l4.
State / Zip Code N G_ a $
Telephone Number (Si ) 43 9 $ - 2 - -1
Fax Number 998— G,ay
Form-D 4/05
1 of 3

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 0 Number of Employees
Residential Er Number of Homes 1 Li 1
School ❑ Number of Students/Staff
Other 0 Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
S c.t a Ls-1
Population served: 1 i "C) m
5. Type of collection system
6711 Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 06 I
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):
L4.NCce. Crezk
8. Frequency of Discharge: [V Continuous ❑ Intermitte nt
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper.
0,04 m G O Ww-r,P
4. e d. 1-0 w 9 u 4.- i Z (1-4- t o 6 a. s. s1
Tti re c - wa. 13 SQ is -tom b IL.
�} e r v. •-4- o r 6 a- S ) rl
C�cLr ; .: of
S r 4.•l-t c r C_)'l 4..r,.. '12 4-k 4 V dr i sr n Pccri=
on--tnu0LA n3 ct..e.v
SO M Go - q.Cra.-4; o n I
2 of 3 s- ,_t n L 0 Form-D 4/05

N
DES APPLICATION - FORM D
For privately owned trea ent systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
oIs
Treatment Plant Design flo ' 0. 1 SMGD
Annual Average daily flow 6 b 9 MGD (for the previous 3 years)
Maximum daily flow 0 2- MGD (for the previous 3 years)
11. Is this facility located on I 1 dian country?
❑ Yes
12. Effluent Data
No
Provide data for the parameters liste•.. Fecal Coliform, Temperature and pH shall be grab samples, for all other
parameters 24-hour composite sampl.' g shall be used. If more than one analysis is reported, report daily maximum
and monthly average. If only one ana ysis is reported, report as daily maximum.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
4 T. 6
3 O r 0
r / 1--
Fecal Coliform
LI 0 () J 1 0 0
2. b C) /10 o
rt% 1
Total Suspended Solids
4 Sr 0
36.0
im 3 / L.
Temperature (Summer)
Temperature (Winter)
pH
�r'q j, 9
q
<4 > I
l
S-` ta-•.A4rd
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES JC) 3 Z 2.. t 2... Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
Permit Number
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Mole -LDS j �A M. r�� �- ,,j >IL._
Printed name of Person Signing)
Signature of Applicant
Title
'_ a-2—o')
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 c r regulations of the Environmental Management Commission implementing that Article, shall be guilty of a
misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a
punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
3 of 3
Form-D 4/05