NC0044164_Renewal (Application)_20150610

•- NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. DENR / Division of Water Resources / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number NC00164-
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 'JY-Q L. Thovnas
Facility Name L2nol Y- Lake_ R4h15s W ri 1pnent GUtIT)i
Mailing Address . Box 951?
City Lenoir RECEIVED/pE
State / Zip Code NIL X64NR/DWR
P.
Telephone Number Vg JUN 1 0 2015
Fax Number vs) 394,-1,044
Water Qdallity
e-mail Address r 1 4hornIts 1enoir. hC.US Per I g Section
2. Location of facility producing discharge:
Check here if same as above El
Street Address or State Road 5474- �Wederoorks Rd.
City &mat. Foals
State / Zip Code N (3O
County ejektih1ELL
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name CI p-f Lenoir
Mailing Address P. . goy 15$'
City j enol r
State / Zip Code NC 628145
Telephone Number (gig') 330- /006
Fax Number ) 3%--/O'
4. Ownership Status:
Federal ❑ State ❑ Private ❑ Public (27
5. Type of treatment plant:
Page 1 of 3 Version 3/2014

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
❑ Green Sand Filter (No sodium recharge)
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
6. Description of source water(s) (i.e. groundwater, surface water)
5urfuee kkier, Like- gkoci .i'ss
7. Describe the treatment process(es) for the raw water:
water i54trct. w.. Lake- Rated-kiss r►,ix�d wt�'G.
Alumni Inikm. -to setNeA, -t!'i 14- ed, a.j knlY,cd
wi Sod.ittw. lh P l,ori k. r dtsi r.{'t iohn �2.St �r �' upr esti ort, A•tid
WON �+-p b� ' ri��++qq. vucll��yy Ac n�shcd Wwkr s cbs«I with zir+e ��P)'°sP)'�
for Corrosion lotht(fi ion 1r� �l a dts 1.tion sys+ew1.
8. Describe the wastewater and the treatment process(es) forC -wastewater generated
-by the�,e
facility: W - ..�r. d0 A5 t6i6 oç ri ww �
ri tPack WAS k r �'"p i°'`� `"" Mi)(
VA eat c. `�1'krs, and 5 P `FYo rm - r�ac. S s-(e i - h H r*-
�amerr{ o� r . (fie_ have- o eyIi►tdr►'a0.t eonert .
kOtdirr5 -1-anIS, . OM Mer backloask Ler +nk awl R 0.5'At& 4444.1 5
SA.perr+ctdant i5 c115cAna et �Yovn + -tartkS i n-o a. Io�o�oov )
once_ deci►1orina wet& 4. -wee
ere. Wcs'�µa'(er eg ut * is vi schuly�
irk oat oi.ct-4,lk pi Rjwdhtss.
9. Number of separate discharge points: I Outfall Identification number(s) CO(
10. Frequency of discharge: Continuous ❑ Intermittent 27
If intermittent: /.intermittent: -
Days per week discharge occurs: 7 Duration: (O 1'loµ�
11. Plant design potable flowrate lz MGD
Backwash or reject flow , MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitudes Lake_ plQbti5S- CA
b River
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate el* No
Iron sulfate / ferrous sulfate es
Fluoride Yes No
Page 2 of 3 Version 3/2014

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Ammonia nitrogen / Chloramines Yes No
ni via
Zinc- phosphate or sweetwater CP1236 dip No
List any other additives below:
ScrLurn WPoch1or;fe- , SocL &v 13150tife, are .AP2a3<r(y»ur\
14(Ave- ectieljtij add 04 nat. curd e' rbort 1)(4.1- hot hot n eecleA -to
tat eT4r since Our new raw-W,oker i raAke aoto+L. i W10 Services i n 20 t(
14. Is this facility located on Indian country? (check one)
Yes ❑ No V
15. Additional Information:
Provide a schematic of flow through the facility, include flow volumes at all points in
the water treatment process. The plan should show the point[s] of addition for
chemicals and all discharges routed to an outfall [including stormwater].
• Solids Handling Plan
16. NEW Applicants
Information needed in addition to items 1-15:
• New applicants are strongly recommended to contact a permit coordinator with the
NCDENR Customer Service Center.
Was the Customer Service Center contacted? ❑ Yes ❑ No
• Analyses of source water collected
• Engineering Alternative Analysis
• Discharges from Ion Exchange and Reverse Osmosis plants shall be evaluated using a
water quality model.
17. 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.
1oc4rcI L • 1 elovvvi5 if'es Pi rector
Printed n e of Person Signing Title
(0/2./ f
2015
Signat of Applicant Date
North Carolina General Statute 143-215.6(b)(2)provides that Any person who knowingly makes any false statement representation,or certification in any application,
record,report,plan,or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that
Article,or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21
or regulations of the Environmental Management Commission implementing that Article,shall be guilty of a misdemeanor punishable by a fine not to exceed$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.)
Page 3 of 3 Version 3/2014