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HomeMy WebLinkAboutNC0086436_Issuance of Permit_20110104 • • A • .A NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary January 4, 2011 Mr. R. Belvin Hall • Asst Director— Maintenance Buncombe County Public Schools 175 Bingham Road Asheville, North Carolina 28806 Subject: Issuance of NPDES Permit No. NC0086436 Cane Creek Middle School WWTP Buncombe County Dear Mr. Hall: 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 October 15, 2007 (or as subsequently amended). The following modifications in the November 10, 2010 draft permit remain in the final permit: • Footnote #1 has been modified to include new Total Residual language. Please note that Cane Creek is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List. Addressing impaired waters is a high priority for the Division, and instream data will continue to be evaluated. If there is continual noncompliance with your effluent limits, or if stream impairment can be attributed to your facility's discharge, mitigative measures may be required. 1617 Mail Service Center,Raleigh,North Carolina 27699-1617 • Location:512 N.Salisbury St.Raleigh.North Carolina 27604 • Phone.919-807-63871 FAX 919 07-64951 Customer Service:1-877-623-6748 One North Carolina Internet:http://portal.ncdenr.org/web/wq/home An Equal Opportunity\Affirmative Action Employer Nil/urn/if/ 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 or 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 (919) 807-6387 or email at (bob.ouerrata ncdenr.gov). Sincerely, Coleen H. Sullins • Enclosure: NPDES Permit NC0086436 cc: Asheville Regional Office / Surface Water Protection NPDES Unit Central Files • 1617 Mail Service Center,Raleigh,North Carolina 27699-1617 • Location:512 N.Salisbury St.Raleigh,North Carolina 27604 One Phone:919-807.63871 FAX:919.807.64951 Customer Service:1-877-623-6748 NorthCarolina Internet:http;//portal.ncdenr.orglweblwgmome I si An Equal Opportunity I Affirmative Action Employer Naturally Permit NC0086436 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, Buncombe County Board of Education is hereby authorized to discharge wastewater from a facility located at the Cane Creek Middle School WWTP 570 Lower Brush Creek Road Fletcher, NC Buncombe County to receiving waters designated as Cane Creek in the French Broad 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 February 01, 2011. This permit and authorization to discharge shall expire at-midnight on December 31, 2015. Signed this day January 4, 2011. • Coleen H. Sullins,Director fv1 Division of Water Quality By Authority of the Environmental Management Commission • Permit NC0086436 SUPPLEMENT TO PERMIT COVER SHEET All previous NPDES Permits issued to this facility, whether for operation or discharge, are hereby superseded and, as of this issuance, any previously issued permit describing this treatment facility o'r bearing this number is no longer effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements, terms, and provisions described herein. The Buncombe County Board of Education is hereby authorized to: 1. Continue to operate an existing 0.012 MGD extended aeration wastewater treatment plant utilizing the following treatment components: • Manual bar screen • Flow equalization with audible and visual alarms • Aeration basin with blowers providing diffused air • Clarifier with sludge return • Aerobic digestor • Tablet chlorinator • Chlorine contact chamber • Dechlorination unit • Post aeration • V-notched weir with flow recorder • Standby natural gas generator 2. This facility is located at the Cane Creek Middle School WWTP, 570 Lower Brush Creek Road, in Buncombe County. 3. Discharge from said treatment works at the location specified on the attached map into Cane Creek, classified C waters in the French Broad River Basin. -- 4 40 1 3138 J' Buncombe County Schools Cane Creek Middle School WWTP Latitude: 35' 28' 53" N State Grid: Fruitland Longitude: 82° 26' 04" W Permitted Flow: 0.012 MGD Receiving Stream: Cane Creek. Drainage Basin: French Broad Basin Stream Class: C Sub -Basin: 04-03-02 0601 105 1 � � t 3ve Ch Outfall 001 9101r7ml I Facility 1 Location not to scale NPDES Permit No. NCO086436 North11 Buncombe County • • Permit NC0086436 A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below: EFFLUENT LIMITS MONITORING REQUIREMENTS CHARACTERISTICS Monthly Daily Measurement Sample Type Sample Location Average Maximum. Frequency 50050-Flow 0.012 MGD Weekly Instantaneous Influent or Effluent 00310-BOD,5-day,20°C 30.0 mg/L 45.0 mg/L Weekly Grab Effluent 00530-Total Suspended 30.0 mg/L 45.0 mg/L Weekly Grab Effluent Solids 31616-Fecal Coliform 200/100 ml 400/100m1 Weekly Grab Effluent (geometric mean) 00010-Temperature(°C) Weekly Grab Effluent 00400—pH 6.0—9.0 Standard Units Weekly Grab Effluent 00610-NH3 as N 2/Month Grab Effluent 50060-Total Residual 28 pg/L 2/Month Grab Effluent Chlorine Footnotes: 1. The Division shall consider all effluent TRC values reported below 50 ug/L to be in compliance with the permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory(including field certified),even if these values fall below 50 ug/L. There shall be no discharge of floating solids or visible foam in other than trace amounts. Guerra, Bob From: Price, Don Sent: Wednesday, November 17,2010 8:13 AM To: DENR.DWQ.SWPAR0@lists.ncmail.net Cc: Edwards, Roger;Guerra, Bob Subject: RE: Draft permit for 11-10-10 Attachments: image003.gif; image004.gif All, I've reviewed the'draft' permit for Cane Creek Ele. In Buncombe County. Looks fine to me, let me know if you have comments,questions,or have additional comments.Thanks, Don. Don Price,CET- Don.PricePncdenr.gov North Carolina Dept.of Environment and Natural Resources Asheville Regional Office Division of Water Quality-Surface Water Protection Section 2090 U.S.70 Highway Swannanoa, NC 28778 Tel:828-296-4500 Fax:828-299-7043 Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and therefore may be disclosed to third parties. From: Edwards, Roger jmailto:roger.edwardsOncdenr.govl Sent: Monday, November 15, 2010 4:10 PM To: DENR.DWQ.SWPARO@lists.ncmail.net Subject: FW: Draft permit for 11-10-10 FYI review and respond to the draft permits. One Henderson and one Buncombe East and West teams each have one. Roger Edwards-Roger.Edwards@ncdenr.gov North Carolina Dept.of Environment and Natural Resources Asheville Regional Office Division of Water Quality-Surface Water Protection 2090 U.S.70 Highway Swannanoa, NC 28778 Tel: 828-296-4500 Fax:828-299-7043 Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and therefore may be disclosed to third parties. From: Guerra, Bob Sent: Monday, November 15, 2010 11:12 AM To: Edwards, Roger Cc: Pugh,James L. Subject: Draft permit for 11-10-10 1 ASHEVILLE CITIZEN TTIVIES VOICE OF THE MOUNTAINS•CITIzEN-TIMES.com AFFIDAVIT OF PUBLICATION BUNCOMBE COUNTY Nee,oe SS. Norlh Ca� rtuM�rey�n�" 161I7Mall Service Center NORTH CAROLINA NoticreIfnMit to 71tsue a NPDES Wastewater Permit The North Carolina Environmental Managemen Commission proposes to issue a NPDES . Before the undersigned, a Notary Public of said County and below,discharge permit to the person(s) I . Witten comments regardin the proposed State, duly commissioned, qualified and authorized by law mm it will be accepted untill 38 d ys after the puy to administer oaths,personally appeared Elyse Giannetti, if date of this notice. The Director of th N• Divi Ion of Water Qualityt(DWQ) /bar hold . public hearing Should ther bbee ar s gn significant de who, being first duly sworn, deposes and says: that she is gree of public nterest. P ease mail comme is and/or information In rest e9is to DWQ at l the Legal Billing Clerk of The Asheville Citizen-Times, and/o anf rma Interegted petoons Q v l the DWQ at 512 N.Salisbury Street Ralerh N to review Information on file. AdditionaP Info fnati n on NPDES permits andh thiiss notice ma engaged in publication of a newspaper known as The re web/wqq%sw�ppu//TDps%npdes%calenda�Po ofncd tail rw(919)A07.63p4, Asheville Citizen-Times,published, issued, and entered as Buncombe County Board of Education re aed renewal of permit NC0086436 for Cane C first class mail in the City of Asheville, in said County and ddle School In Buncombe County; this mltted discharrgge is t eated d mestic waste State; that she is authorized to make this affidavit and �terto Cane CreeK French Broad River Basin. The Town of Spruce Pine requested renewal o sworn statement; that the notice or other legal pgrtnK N00021423 for Spruce Pine WWiP i eMditchell Coouunty; this facility dNo hth ioelis River' advertisement, a true copy of which is attached hereto, was F municipal wastewater to TT fiver Tench Broad River Basin. Pilot Travel Centers Inc. requ sted renewal • published in The Asheville Citizen-Times on the NPDES permit NC00136053 for Pilot Travel Cen #393/Haywood County. Facilitydlscha.- following date: November 14th , 2010. And that the said treafd wl oew�ateinto Stle anreneh/Frese1 gaPgeocrmecarwaeroqglitygmitedd total in newspaper in which said notice, paper, document or legal NC DDT requested renewal of NC0024805 for . - advertisement was published was, at the time of each and I.40 Welcome Cen er/Re; Areeaa WWTPs 11411,1% wastewCaterr to i h.the cPig n15Riverr / Frenh every publication, a newspaper meeting all of the Broad River Basin. Currently, no paramete are water quality limited Evergreen FoundatIon requested renewal o requirements and qualifications of Section 1-597 of the NPDES ppermit NC0032361 for The Balsam Cent- WWTP/Haywood County. Facility rgn- General Statues of North Carolina and was a qualified into RICMand Creek /French Broad River Basin, Ammonia nitrogen, fecal c0lifp and total re sidualchlor, Inc. requested x"" andnewspapermeaning of NPDES permit NCOD44199 for the Sams Martg WWTP/Haywood County. Facility discharges General Statues of North Carolina. treated wastewater into the pigeon River French Broad River Basf . Currently no rraa mpeter;are water tali y limited. f PDESapermit NCo072 29CeforgthstMount renewal WWTP/Haywood County Facility dl ha treated wastewater into Pisgah creel`d 'w Signed this 15th day of November,2010 Broad River Basin. Dtyllm��d oxygen and 'we`co�ylmfwonn are wattteyyr quality Ilmfted, NPDES permitnNCW6733551 forr them BetheleSchoo WWTP. Facility discharges treated wastewa. to BIrd Creek/Freench Broad River Bas n l Currently, total relld 1 chlorine and fecal coi _ norare wat eg0a Ity mRed. bei I (Signatur of person making affidavit) Sworn to and subscribed before me the 15th day of Nove i ber 110 , ill ,1AlIrdIII ' tary Pu lic) My Co mission expires the 5th day of October, 2013. joy r\ (828)232-5830 I (828)253-5092 FAX (IOTA) 14 O.HENRY AVE. P.O.BOX 2090 I ASHEVILLE,NC 28802 I (800)800-4204 itGAMER UBL GO • All Waters in NC are in Category 5-303(d)List for Mercury due to statewide fish consumption advice for several fish species AU_Number AU_Name AU_Description LengthArea AU_Units Classification Parameter Reason for Rating Use Category Collection Year 303(d)year Q 6-5Sd Mud Creek From Byers Creek to French Broad River 2.2 FW Miles C 5 EcologicaUbiological Integrity Benthos Fair Bioclassification Aquatic Life 2007 2006 0 6-54-3-(17.5) South Fork Mills River From the upstream side of mouth of Queen 4.2 FW Miles WS- Creek to Mills River II;Tr,HQW 5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2007 2010 Q 6-(47.5)ut23 UT FRENCH BROAD R Source to FRENCH BROAD R 0.6 FW Miles 5 Low Dissolved Oxygen Standard Violation Aquatic Life 2008 2010 French Broad River Basin Hominy Creek Watershed 0601010505 0 6-76d Hominy Creek From Moore Creek to French Broad River 7.8 FW Miles C 5 Turbidity Standard Violation Aquatic Life 2008 2008 French Broad River Basin Swannanoa River Watershed 0601010506 Q 6-78-23b Ross Creek(Lake From 1-240 to backwaters of Lake 1.1 FW Miles B Kenilworth) Kenilworth 5 Ecological/biological Integrity Benthos Poor Bioclassification Aquatic Life 1999 2000 Q 6-78a Swannanoa River From source to North Fork Swannanoa River 7.0 FW Miles C 5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2003 2006 French Broad River Basin Cane Creek-French Broad River Watershed 0601010507 0 6-57-(9)a Cane Creek From Ashworth Creek to Cushion Branch 9.6 FW Miles C 5 Ecological/biological Integrity Benthos Poor Bioclassification Aquatic Life 2007 2006 French Broad River Basin Sandymush Creek-French Broad River Watershed 0601010509 0 6-(54.5)d FRENCH BROAD From Craggy Dam to Fletcher Martin Road 6.4 FW Miles B RIVER 5 Turbidity Standard Violation Aquatic Life 2008 2008 Q 6-(54.5)e FRENCH BROAD From Fletcher Martin Road to Sandymush 3.9 FW Miles B RIVER Creek 5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2002 2006 Q 6-(54.5)f FRENCH BROAD From Sandymush Creek to North Carolina- 33.1 FW Miles B RIVER Tennessee State Line 5 Turbidity Standard Violation Aquatic Life 2(108 2008 Q 6-84a Newfound Creek From source to SR 1296 3.9 FW Miles C 5 EcologicaUbiological Integrity Benthos Fair Bioclassification Aquatic Life 2002 2006 Q 6-84b Newfound Creek From State Route 1296 to SR 1297 1.3 FW Miles C 5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2002 1998 Q 6-84c Newfound Creek From State Route 1297to State Route 1378 2.3 FW Miles C 5 Ecological/biological Integrity Benthos Fair Bioclassification Aquatic Life 2002 1998 NC 2010 Integrated Report Category 5-303(d)List EPA Submittal 20100329 Monday,March 29,2010 Page 25 of 115 I •s BUNCOMBE COUNTY PUBLIC a 02 a, SCHOOLS � ; MAINTENANCE DEPARTMENT \lb 4Z 175 Bingham Rd. ASHEVILLE,NC 28806 '�:HCA� TELEPHONE (828) 232-4244 FAX (828) 232-4249 May 18,2010 Mrs.Dina Sprinkle NCDEHNR/Water Quality/NPDES Unit 1617 Mail Service Center Raleigh,NC 27699-1617 RE: NPDES Permit Applications Buncombe County Schools Please find enclosed applications for permit renewals concerning Buncombe County Board of Education WWTP's. The BOE would formally like to request renewal of the following permits: North Buncombe High School NC0061182 North Buncombe Elementary School NC0073814 Fairview Elementary NC0066796 Leicester Elementary NC0066788 Cane Creek Middle School NC0086436 Also enclosed is the sludge handling procedures as specified by our contractor operator,RPB Systems. Please contact me at the above numbers if you have questions or concerns. Respectfully, R. Belvin Hall—Assistant Director Maintenance Enc. (6) Cc: Mr. Gregg Fox Mr.Clark Wyatt Mr.Bob Barr—RPB Systems File /0-11-/0 FleA. .A-keivaiC eue1 106L """::1...- RPB Systemswww.rpbsystems.com P.O.Box 1325•Asheville,NC 28802 (828)251-1900•(828)251-1945 Fax Construction Services•Contract Operations•Maintenance May 12, 2010 Mr. Belvin Hall Buncombe Schools 175 Bingham Road Asheville, NC 28806 Re: Sludge Hauling for Buncombe County School Treatment Plants Belvin, This letter is per our discussion to clarify your sludge management plan for your schools treatment plants as required for your permit renewals. Currently we utilize Mikes Lusk Septic Hauling who has an agreement with MSD of Buncombe County to dispose of stabilized sludge at the receiving station located at the MSD facility in Asheville. Mike hauls sludge for the following facilities: Buncombe County Schools-North Buncombe High School NC0061182 Buncombe County Schools-North Buncombe Elementary School NC0073814 Buncombe County Schools-Fairview Elementary School NC0066796 Buncombe County Schools-Leicester Elementary School NC0066788 Buncombe County Schools-Cane Creek Elementary School NC0086436 I trust this will be sufficient for regulatory review of your permit renewals. If you have any questions or concerns, please contact us anytime. Sincerely, VV1.) • Robert Barr Cc: File FACT SHEET FOR EXPEDITED PERMIT RENEWALS This form must be completed by Permit Writers for all expedited permits which do not require full Fact Sheets. Expedited permits are generally simple 100%domestics(e.g., schools,mobile home parks,etc)that can be administratively renewed with minor changes,but can include facilities with more complex issues(Special Conditions, 303(d)listed water,toxicity testing, instream monitoring,compliance concerns). Basic Information for Expedited Permit Renewals Permit Writer/Date Bob Guerra/ 11-10-2010 Permit Number NC0086436 Facility Name Cane Creek Middle School WWTP Basin Name/Sub-basin number French Broad—04-03-02 Receiving Stream Cane Creek Stream Classification in Permit C Does permit need Daily Max NH3 limits? No Does permit need TRC limits/language? Yes Does permit have toxicity testing? No Does permit have Special Conditions? No Does permit have instream monitoring? No Is the stream impaired(on 303(d)list)?For Yes what parameter? Any obvious compliance concerns? Attach BIMS Report;discuss with Region Any permit mods since last permit? No Current expiration date 12-31-10 New expiration date 12-13-15 Comments received on Draft Permit? Yes No If Yes,discuss response with Supervisor Most Commonly Used Expedited Language: • 303(d)language for Draft/Final Cover Letters: "Please note that the receiving stream is listed as an impaired waterbody on the North Carolina 303(d)Impaired Waters List. Addressing impaired waters is a high priority with the Division,and instream data will continue to be evaluated. If there is noncompliance with permitted effluent limits and stream impairment can be attributed to your facility,then mitigative measures may be required". • TRC language for Comuliance Level for Cover Letters/Effluent Sheet Footnote: "The facility shall report all effluent TRC values reported by a NC certified laboratory including field certified. However,effluent values below 50 ug/1 will be treated as zero for compliance purposes." NPDES APPLICATION - FORM D For privately owned treatment systems treating 100% domestic wastewaters<1.0 MGD Mail the complete application to: N. C. DENR/ Division of Water Quality / NPDES Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 NPDES Permit 1NC0086436 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 Buncombe County Board of Education Facility Name Cane Creek Middle School Mailing Address 175 Bingham Road City Asheville State / Zip Code NC 28806 Telephone Number (828)232-4244 Fax Number (828)232-4249 e-mail Address 2. Location of facility producing discharge: 2R@IgOW21) Check here if same address as above 0 Street Address or State Road 570 Lower Brush Creek Road MAY 212010 City Fletcher DENR-WATER QUALITY Pf1IMT CM ion State / Zip Code NC 28732 County Buncombe 3. 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 Buncombe County Board of Education Mailing Address 175 Bingham Road City Asheville State / Zip Code NC 28806 Telephone Number (828)232-4244 Fax Number (828)232-4249 1 of 3 Forth-D 05/08 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 applyk Industrial 0 Number of Employees Commercial ❑ Number of Employees Residential ❑ Number of Homes School X Number of Students/Staff 813 Other ❑ Explain: Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers, restaurants, etc.): Educational Facility Population served: 813 5. Type of collection system X Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer) 6. Outfall Information: Number of separate discharge points 1 Outfall Identification number(s) 001 Is the outfall equipped with a diffuser? ❑ Yes X No T. Name of receiving stream(s) (Provide a map showing the exact location of each outfaIl,: Cane Creek 8. Frequency of Discharge: X Continuous ❑ Intermittent 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. Cane Creek Middle School wastewater treatment system is a Class II 0.012 MGD extended aeration package treatment plant with flow equalization, clarifiers, sludge holding, chlorine contact chamber, chlorination and dechlorination equipment and standby natural gas generator. 2 of 3 Form-D 05/08 NPDES APPLICATION - FORM D For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD 10. Flow Information: Treatment Plant Design flow 0.012 MGD Annual Average daily flow 0.010 MGD (for the previous 3 years) Maximum daily flow 0.010 MGD (for the previous 3 years) 11. Is this facility located on Indian country? ❑ Yes X 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.If more than one analysis is reported, report daily maximum and monthly average.If only one analysis is reported, report as daily maximum. Parameter Daily Monthly Units of Maximum Average Measurement Biochemical Oxygen Demand (BODS) 25.4 13.3 mg/1 Fecal Coliform 49.8 6.3 col/100 ml Total Suspended Solids 19.3 11.7 mg/1 Temperature 18.9 17.0 0C pH 7.2 6.8 standard units 13. List all permits, construction approvals and/or applications: Type Permit Number Type Permit Number Hazardous Waste (RCRA) NESHAPS(CAA) UIC(SDWA) Ocean Dumping(MPRSA) NPDES NC0086436 Dredge or fill(Section 404 or CWA) PSD (CAA) Other Non-attainment program(CAA) 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. / ge /Ts f/ �%rt rC I�,�-t- /iiYPrt✓/G#rnrct_ Printed name of Person Signing Title Z-vt-:- � -- //o Signature of Applicant Date��/p North Carolina General Statute 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, a certification in any application, record,report, plan,or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be guilty of a misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (18 U.S.C.Section 1001 provides a punishment by a fine of not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.) 3 of 3 Form-D 05/08