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HomeMy WebLinkAboutNC0060461_Permit Issuance_20020703State 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 July 3. 2002 Mr. Jim Highley Carolina Water Service, Inc. of NC P.O. Box 240908 Charlotte. North Carolina 28224 1 • AV NCDENR NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Subject: Issuance of NPDES Permit NCO060461 Abington Subdivision WWTP Forsyth County Dear Mr. Highley: 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). Please note that the following language has been substituted in part 3, D. of this permit: "in the event that the wastewater treatment facility is in substantial non-compliance for three consecutive months with the effluent discharge conditions of this NPDES Permit, the permittee shall, upon demand of the Division, conduct a study evaluating all available wastewater disposal alternatives and the permittee shall, within sixty days of notification by the Division, submit a report in such form and detail as required by the Division evaluating these alternatives with respect to environmental soundness and cost effectiveness." 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 (,duality 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 Christie Jackson at telephone number (919) 733-5083, extension 538. Sincerely, ORIGINAL SIGNED BY K,'SAN A. WILSON Alan W. Klimek, P. E. cc: Central Files Winston-Salem Regional Office/Water 9uaht3r Section NPDES Unit _ 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone (919) 733-5083 FAX (919) 733-0719 An Equal Opportunity Affirmative Action Employer VISIT US ON THE INTERNET @ httpJlh2o.enr.state.nc.us/NPDES Permit NCO060461 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 5 In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations pro;Zlgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, Carolina Water Service, Inc. of 'NC is hereby authorized to discharge wastewater from a facility located at the Abington Subdivision WWTP q 0 Bainburgh Circle North of Kernersville Forsyth County to receiving waters designated as Belews Creek 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 August 1, 2002. This permit and authorization to discharge shall expire at midnight on February 28, 2007. Signed this day July 3, 2002. ORIGINAL SIGNEI) By SUS Alan W. Klimek, P.E., Director Division of Water Quality By Authority of the Environmental Management Commission Permit NCO060461 SUPPLEMENT TO PERMIT COVER SHEET Carolina Water Service, Inc. of NC is hereby authorized to: 1. Continue to operate an existing 0.200 MGD (wastewater treatment syst with the following components: ♦ Equalization basin with dual pumps ♦ Bar screen ♦ Flow splitter box ♦ Dual aeration basins ♦ Dual clarifiers ♦ Tablet chlorinators ♦ Chlorine contact tank ICY�i6w ♦ Dechlorination unit 0 ��'�' D�'�%' � aWCN ♦ Post aeration chamber �'G s��° ae � ♦ Stevens flow recorder � p ♦ Stand -byre ao Fed �� �Y 7�j( The facility'is located north of Kerriersville at Abington Subdivision on Bainburgh Circle in Forsyth County. 2. After receiving an Authorization to Construct from the Division of Water Quality, construct additional facilities for a total treatment capacity not to exceed 0.385 MGD, and 3. Discharge from said treatment works at the location specified on the .attached map into Belews Creek, classified C waters in the Roanoke River Basin. N Facility Information Facility Location MOM, Latitude: 36*10'09" Sub -Basin: 03-02-01 LA)ngitude: 80'05'48- Ouad Name: Belews Creek Strewn Class: C Receiving Stream: Belews Creek tor����CWForsyth S - Abington Subdivision VPMTP NCO060461 County Permit NC0060461 A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - FINAL During the period beginning on the effective date of this permit and lasting until expansion above 0.200 MGD or expiration, the Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below: EFFLUENT.: MONITORING REQUIREMENTS CHARACTERISTICS . - Withly Week[ _ ilY . Measurement Sample Type Sample Locatio n _ AVerage; ". _ Average: ',. ;. Maximum,.. ._.; Frequency Flow 0.200 MGD Continuous Recording Influent or Effluent BOD, 5-day (209C) 30.0 mg/L 45.0 mg/L Weekly Composite Effluent Total Suspended Residue 30.0 mg/L 45.0 mg/L Weekly Composite Effluent NH3 as N 2.0 mg/L Weekly Composite Effluent (April 1— October 31 NH3 as N 4.0 mg/L /G Weekly Composite Effluent November 1 — March 31 / Dissolved Oxygen2 Weekly Grab Effluent, Upstream & Downstream Fecal Coliform (geometric mean) 200/100 ml 4001100 ml Weekly Grab Effluent Total Residual Chlorine 28 µg/L 2/Week Grab Effluent Temperature (2C) Daily Grab Effluent Temperature (°C) Weekly Grab Upstream & Downstream Total Nitrogen (NO2+NO3+TKN) Quarterly Composite Effluent Total Phosphorus Quarterly Composite Effluent pHs ,DD Kv p Weekly Grab Effluent 1p Footnotes: I. Upstream - at least 100 feet above the outfall; Downstream = at NCSR 2014 2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/L. 3. 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 NCO060461 A. (2.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - FINAL During the period beginning upon expansion to 0.385 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 Avera a Weekly, Average - Daily Maximum' Measurement Frequency Sample Type Sample Location? Flow 0.385 MGD Continuous Recording Influent or Effluent BOD, 5-day (20°C) 30.0 mg/L 45.0 mg/L Weekly Composite Effluent Total Suspended Residue 30.0 mg/L 45. - Weekly Composite Effluent NH3 as N 1- October 31 2.0 mg/L /�Weekly Composite Effluent -(April NH3 as N November 1- March 31 4.0 mg/L L Weekly Composite Effluent Dissolved Oxygen2 Weekly Grab Effluent, Upstream & Downstream Fecal Coliform (geometric mean) 200/100 ml 400/100 ml Weekly Grab Effluent Total Residual Chlorine 25 µg/L 2/Week Grab Effluent Temperature (2C) Daily Grab Effluent Temperature (°C) Weekly Grab Upstream & Downstream Total Nitrogen (NO2+NO3+TKN) Quarterly Composite Effluent Total Phosphorus Quarterly Composite Effluent pH3 Weekly Grab Effluent l� ZS L L �Vy fi� 0-S. Footnotes: 1. Upstream - at least 100 feet above the outfall; Downstream = at NCSR 2014 2. The daily average dissolved oxygen effluent concentration shall not be less than 5.0 mg/L. 3. 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 INTEROFFICE MEMORANDUM TO: FILE FROM: CI-IRISTIE R. JACKSON SUBJECT: CAROLINA WATER SERVICE - BOILER PLATE LANGUAGE DATE: 06/20/02 CC: ADJUDICATION FILE Bruce Haas. with Carolina Water Service has requested to have the boiler plate language (part 3, D) substituted in several of their permits with the following language: "If the facility is in substantial non-compliance with the terms and conditions of the NPDES permit or governing rules, regulations or laws for 3 consecutive months, the permittee shall submit a report in such form and detail as required by the Division evaluating these alternatives and a plan of action within sixty (60) days of notification by the Division." According to a letter from Preston Howard dated July 29, 1992, the following language should be substituted: "In the event that the wastewater treatment facility is in substantial non-compliance for three consecutive months with the effluent discharge conditions of this NPDES Permit, the permittee shall, upon demand of the Division, conduct a study evaluating all available wastewater disposal alternatives and the permittee shall, within sixty days of notification by the Division, submit a report in such form and detail as required by the Division evaluating these alternatives with respect to environmental soundness and cost effectiveness." After a discussion with Bruce Haas, this language is accepted by Carolina Water Service and will be inserted into all of their new and renewed permits. Ar -MA-1 TIMC FP co State of North Carolina Department of Environment, Health and Natural Resources Division of Environmental Management 512 North Salisbury Street • Raleigh, North Carolina 27611 James G. Martin, Governor William W. Cobey, Jr., Secretary July 29, 1992 Mr. Samuel H. Long, III Long, Cloer and Elliott Attorneys and Counselors at Law P. O. Box 3827 Hickory, NC 28603-3827 A. Preston Howard, Jr., P.E. Acting Director M SGJs Subject: Modifications to the NPDES Permits NCO063789 Mecklenburg County NCO060593 Catawba County NCO065587 Forsyth County NCO065773 Mecklenburg County NCO056154 Iredell County NCO065684 Union County Dear Mr. Long: The Division of Environmental Management has modified the subject permits in accordance with the agreement outlined in our letter to you dated May 28, 1992. The modification for each permit is the deletion of the language: "the permittee shall promptly connect to an operational publicly owned wastewater collection system within 180 days of its availability to this site, if the facility is in non-compliance with its effluent limitations for three consecutive months." Subsequently, the following language was subsituted: "in the event that the wastewater treatment facility is in substantial non-compliance for three consecutive months with the effluent discharge conditions of this NPDES Permit, the permittee shall, upon demand of the Division, conduct a study evaluating all available wastewater disposal alternatives and the permittee shall, within sixty days of notification by the Division, submit a report in such form and detail as required by the Division evaluating these alternatives with respect to environmental soundness and cost effectiveness." Regional Offices Asheville Fayetteville Mooresville Raleigh Washington — Wilmington Winston-Salem 704/251-6208 919/486-1541 704/663-1699 919/571-4700 919/946-6481 919/395-3900 919/896-7007 Pollution Prevention Pays P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone 919-733-7015 An Equal Opportunity Affumative Action Employer s Mr. Samuel H. Long, III Page 2 F. July 29, 1992 Attached please find the corrected pages for the subject NPDES permits. The original special conditions which contained the old language should be discarded and replaced with the attached pages for each permit. All other conditions, limits, and requirements of these NPDES permits will remain the same. This action should resolve the contested case No. 91EHNR0174. If you have questions regarding this correction, please contact me at (919) 733-7015. X , IL A. Preston Howar , ., P.E. Acting Director cc: Mid South Water Systems, Inc. Mooresville Regional Office Winston-Salem Regional Office Permits and Engineering Cental Files Residual Chlorine and Ammonia Toxicity Assessment Residual Chlorine ............................. ............................. ............................. s7Q10 (CFS) Q<;>>' DESIGN FLOW (MGD) 5' DESIGN FLOW (CFS) 0.31....... STREAM STD (UG/L) 17.0 UPS BACKGROUND LEVEL ( 0 IWC (%) 51.67 Allowable Concentration (ug 32.90 Ammonia as NH3 (summer) s7Q10 (CFS) 0.29 DESIGN FLOW (MGD) 0.2 DESIGN FLOW (CFS) 0.31 STREAM STD (MG/L) 1.0 UPS BACKGROUND LEVEL 0.22 IWC (%) 51.67 Allowable Concentration (rr 1.73 Ammonia as NIi3 (winter) ....................... ....................... ....................... w7Q10 (CFS) (#8; Fecal Limit 200/100mi DESIGN FLOW (MGD) 0.2 Ratio of 0.9 :1 DESIGN FLOW (CFS) 0.31 STREAM STD (MG/L) 1.8 UPS BACKGROUND LEVEL 0.22 IWC (%) 24.03 Allowable Concentration (rr 6.79 3/13/02 CRJ NCO060461 Residual Chlorine and Ammonia Toxicity Assessment Residual Chlorine Ammonia as NIi3 (summer) s7Q10 (CFS) E}; s7Q10 (CFS) 0.29 DESIGN FLOW (MGD)338 DESIGN FLOW (MGD) 0.385 DESIGN FLOW (CFS) 0.59675 DESIGN FLOW (CFS) 0.59675 STREAM STD (UG/L) 17.0 STREAM STD (MG/L) 1.0 UPS BACKGROUND LEVEL ( 0 UPS BACKGROUND LEVEL 0.22 IWC (%) 67.30 IWC (%) 67.30 Allowable Concentration (ug 25.26 Allowable Concentration (rr 1.38 Ammonia as NH3 (winter) ....................... ....................... ....................... w7Q10 (CFS) Fecal Limit 200/100ml DESIGN FLOW (MGD) 0.385 Ratio of 0.5 :1 DESIGN FLOW (CFS) 0.59675 STREAM STD (MG/L) 1.8 UPS BACKGROUND LEVEL 0.22 IWC (%) 37.85 Allowable Concentration (rr 4.39 3/13/02 CRJ NCO060461 Re: NPDES DRAFT-NCO060461 Subject: Re: NPDES DRAFT-NCO060461 Date: Wed, 19 Jun 2002 15:19:11 -0400 From: Christie Jackson <christie.jackson@ncmail.net> Organization: NC DENR DWQ To: Steve Mauney <steve.mauney@ncmai1.net> Hi Steve Sorry it's take me FOREVER to respond .... but I wanted to give you an update. I'm going to go ahead and issue the Abington permit ASAP. If CWS wants to increase the flow for Abington, they'll have to do the flow justification and EAA, just as any other permit would. We will assign that stuff to an engineer and consider issuing a permit mod to increase the flow. I'll add "sludge holding tank" to the supplement page, per your request. Please let me know if you have questions. I hope to issue this permit this week. Thanks, Christie Steve Mauney wrote: > CHRISTIE-I spoke with Bruce Haas of CWS and there are two issues, the > easy one first. > #I --On the supplement page please add, "sludge holding tank" > #II--CWS'may want to increase the permit flow for this plant by > 72,000gpd to allow us to void Kynwood > (NC0046752 ). I told Bruce that a flow increase for Abbington (to 0.457 > MGD) may change his limit for BOD at the higher flow. I would support > that permit change if CWS is agreeable. CWS will likely be objecting to > the Kynwood permit and if necessary we could wait until that occurs > before we initiate any changes to Abbington. > CALL OR e-mail IF ANY QUESTIONS.-STEVE > Steve Mauney > NC DENR Winston-Salem Regional Office > Division of Water Quality, Water Quality Section > 585 Waughtown Street > Winston-Salem, NC 27107 > Voice: (336) 771-4608 ext 262 > FAX: (336) 771-4630 1 of 1 6/19/02 3:19 PM NOWf 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 23, 2002 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 A Section 1-597 of the general statues of North Carolina. ` PUBLIC NOTIC Phis 25th day of March, 2002 STATE: OF NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION/NPDES UNIT (signature of pers n aking affidavit) 1617 M G SERVICE CENTER R.4LEIGH, NO 2769a1617 ;worn to and subscribed before me, this 25th day of h, 2002 a Nota ublic Ay Commission expires: September 28, 2005 "tea OFFICIAL SEAL s Notary Public North Carolina COUNTY OF FORSYTH t�T r KIMALEY OH SOWWN,, \ My Commission Expires�,•_.±�— NOTIFICAT ION OF INTENT TO ISSUE A NPDES WASTEWATER PERMIT Stn the at- ute 14321, Pubsis lic Law 92--500�and of erlawfuullfion ofNC General 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 persons) listed below ef- 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 Qua! ably may de - receive to hold a public meetirg far 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 corndlbons present in the draft permit are available upon re- quest and payment of the costs of reproduction. Mail commerts and(or requests for information to the NC Division of Water Quality at the above address or call Ms. Christie Jackson at (919) 733.5083, exte son 538. Please include the NPDES permit number (attached) in arty communica- tion. Interested persons 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. NPDES Permit Number NC0037311, Creekside Manor Rest Home, 6206 Reidsville Road, Kemersville, NC 27284 has applied for a permit renewal for a facility locked in Forsyth County discharging treated wastewater into an unnamed tributary to Belews Creek in the Roarroke River Basin. Currently amrruxua & fecal corrform are water quality limited. This discharge may affect future allocations in this portion of the receiv- Jstream. NPDES Permit Number NC0079049, R.H. Johnson Construction Com- pany, 7010 Simmons Road, Rural Hall, NC 27045 has applied for a per- mit renewal for a facility located in Forsyth County discharging treated wastewater into Rough Fork in the Roanoke River Basin. Currently am- monia, fecal c0liform & total residual chlorine are water quality limited. This discharge may affect future allocations in this portion of the recav- g stre am. .NPDES Permit Number NC0078115, AquaSource, Inc. - Greystone Subdivision WWTP, 107 Commercial Park Drive SW, Concord, NC 28027 has applied for a permit renewal for a facility located in Forsyth County discharging treated wastewater into an unnamed tributary to Be- lews Creek in the Roanoke River Basin. Currently ammonia & fecal colif- orm are water quality limited This discharge may affect future allocations in this portion of the receiving stream. NPDES Permh Number NC0067091, AquaSource, Inc.- Mikkda Downs Subdivision, 107 Commerexal Park Drive SW, Concord, NC 28027 has applied for a permit renew&, for a facility located in Forsyth County dis- charging treated wastewater into East Belews Creek in the Roanoke Riv- er Basin. Currently ammonia & fecal colitorm are water quality limited. This discharge may affect future allocations in this portion of the receiv- ing stream. NPDES Permit Number NCf1060461, Carolina Water Service, Inc. of NC - Abington Subdivision, PC Drawer 240908, Charlotte, NC 28224 has applied for a permit renews for a facility located in Forsyth County dis- charging treated wastewater into Belews Creek in the Roanoke River Ba- sin. Currently ammonia, fecal coliform & total residual chlorine are water quality limited. This discharge may affect future allocations in this portion of the receiving stream. WSJ: March 23. 2002 a 101105/01 FRI 11:32 FAX 704 525 817 C.AROLINA WATER SVC. U001 CAROLINA WATER SERVICE, INC. P.O. Box, 240908, c/tartafre, NC 28224.0909 [704] 525-7990 • FAX [7041 525-9174 FAX MEMORANDUM Date: October 5, 2001 To: Mike Meyer Cc: Carl Daniel Martin Lashua Bruce Haas From_ Jim Highley Fax #: 919-733-0719 Re: Notice of Violation Failure to Submit Permit Renewal Applications Abington Subdivision - Felvedere Subdivision Number of pages including cover sheet: [ 0 ] Per our telephone conversation today, attached are copies of the "Notice of Renewal intent" information that was sent to Mr. Charles Weaver on July 13, 2001 for the above referenced subdivisions. Apparently these were not received by his office. In the future, application renewals will be sent "Certified Mail", I apologize for any inconvenience this may have caused your office. If you have any questions, please feel free to call me at 704-525-7990 ext. 221. JH/rs 10;05101 FRI 11:32 F11 704 525 817 CAROLINA WATER SVC. im 002 CAROLINA WATER SERVICE, INC. I' IIj j`II' II j AN AFFILI jA�TF O/ �-11I ILLIl�1IFEOIII I Cn Regional office: 5701 We$lparK ❑r., Suite 101 P.O. Sox 240908 Charlotte, NC 26224 Telephone: (704) 525.7990 PAX; (704) 52"174 July 13, 2001 Mr. Charles H. Weaver, Jr. NC DENR / Water Quality / NPDES Unit 1617 Mail Service Centex Raleigh, NC 27699-1617 Re: Notice of Renewal Intent Abington Subdivision VFNU NPDES Permit NCO060461 Forsyth County bear Mr_ Weaver: Carolina Water Service, Inc. of NC is hereby requesting renewal of the aforementioned pennit. Enclosed are one signed original and two copies of this letter, the application, and our sludge management plan. If you should need additional information regarding the permit renewal application or have questions about the information I have provided, please contact me by calling 704-525- 7990, extension 221. Sincerely ice, Highley Sr. Regional Manager c: Carl Daniel n 101105101 FRI 11:33 FAX. 704 525 817 41 CAROLINA WATER SVC, 9 003 CAROLINA WATER SERVICE, INC. AN Aff[4IArFFOOF U� I li��l� I IILSOIfII Ili a Regional Office; 5701 Westparx Dr., Suite 101 P.O. Box 240908 Charlotte, NC 26224 Tolaphone: (704) 62S-7990 Fax: (704) 625-8174 July 13, 2001 Mr. Charles I-i. Weaver, Jr. NC DENR/Water Quality/NPDES Unit 1617 Mail Service Center Raleigh, NC 27699-1617 Re. Abington Subdivision WWTP NPDES Permit No. NCO060461 Sludge Management Plan Dear Mr. Weaver. Please, be advised that sludge generated at the aforementioned facility is removed and disposed of by: Carolina Septic, Inc. 5709 Old Vallej School Road Kernersville, NC 27284 336-993-5633 If you should need additional information regarding our sludge management Program, please coatact me by calling 704-525-7990, extension 221. Sinc rely, Jim I3igbley Senior Regional Manager .10105/01 FRI 11:33 FAg 704 525 817 CAROLINA WATER SVC. ROQI NPDES PEpNnT APl'IrICATXON - Sg()V t POPIM D To be filed only by dischargers of 100% domestic wastewater (tl MGD flow) s N. C. Department of ]Environment =d Natural Resources ]Division of Water Quality / NPDBS Unit 1617 MaU Soxvice Center, Raleigh. NC 27699-16].7 North Carolina NTDES Permit Number NG001v6VG/ (if known) please print or type 1. Mailing address of applicant/permittee: Facility Name Owner Nance Street Address City State ZIP Code Telephone Number Fax Fumber e-mail Address 2. Location of facility producing discharge: Wnfne (Xf differwn+ from above) Facility'Contact Person Street Address or State Road City J Zip Code County Telephone Number 3, Reason for application: ExpansionJModiftcation * Existing Unpern:1itted Discharge Renewal t New Facility Please provide a description of the expansion/raadification: 4. Description of the existing treat=ent facilities (List all installed Components Witu Ca�ac�txes}: Page i of 2 V10101, 1112000 ' ,10'05/01 FRI 11:33 FAI 704 525 817 CAROLINA WATER SVC. NP]D�S PEYtMIT ApPf Yo9✓o da>na�estiS�LOR'x eORiVMDD flow) To be filed only by dischargers o 1 Y S. Description of wastewater (check all that apply): e of Facili Ge_ne-rating WasteH Industrial Con=ercial ^_ Residential School Other Number of Employees Number of Employees Number of domes Number of Students/Staff Describe the source(s) of wastewater (example, subdivision, mobile home park, etc.): 6. Number of separate wastewatex ci3seha4e pipes (wastewater outfalls): IM 005 V. If the faculty has sn1413p1e discharge outfoUs, reaaxd the sou xee(s) of wastewater for each outfall: g. Name of xeceivi.ng atream(s) (provide a map sho%4ug the -exact locatinn of eaoii outfalA: ed in the application best certify y knowledge and belief such information is truethat X am familiar with the information , complete, � that to the complete, and accurate. Title North Carolina General Statute i43-Z15,fiB (1) provides that Any person who knowingly makes any rake statement representation, or certification in any appllcatior> "A report, plan, or other dooument files or required to ba maintained under Article 21 or regulations of the ers Environmental Management Commission implementing that Article, or who talsltles, amp with or knowingly 9 Y renders inaccurate any recording or monitoring device or msthod.requirad to be operated or maintained under Article 21 or regulations or the envlronmen1W Management Commission implementing that Article, shall be gullty 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_ 5ectibn 1001 provides a punishment by a line of not more than 10, O(10 Or imprisonment not more than 5 years, orboth for a similar offense.) Version 11/2000 Page 2 01 2 •L J