NC0088579_Permit Issuance_20120615

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
June 15, 2012
Mr. David F. Ramsey
R&S Engineering & Construction Corporation
61 The Glens Blvd
Banner Elk, N.C. 28604
Subject: Issuance of NPDES Permit NC0088579
Stone Bridge WWTP
Watauga County
Dear Mr. Ramsey:
Dee Freeman
Secretary
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).
This final permit includes no major changes from the draft permit sent to you on April 25,
2012:
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 Charles Weaver at telephone number [phone].
nicer ly,
Charles Wakild, P.E.
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604 Noi thCarofina
Phone: [phone] / FAX [phone] / http://portal.nGdenr.org[web/wq fi/�/ a aAMa l y
An Equal Opportunity/Aflumative Action Employer - 50% Recycled/1 0% Post Consumer Paper "

Permit NCO088579
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PRR MTT
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 Water Quality
Commission, and the Federal Water Pollution Control Act, as amended,
Albert Gersing & David F. Ramsey
are hereby authorized to discharge wastewater from a facility located at the
Stone Bridge WWTP
950 Shulls Mill Road
Boone
Watauga County
to receiving waters designated as Lance Creek in the Watauga River Basin in
accordance with the discharge limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, and IV hereof.
This permit shall become effective October 1, 2012.
This permit and the authorization to discharge shall expire at midnight on September 30, 2017.
Signed this day June 15, 2012
Ch a akild, P.E., Director
D" ' ion of Water Quality
4011"-
By the Authority of the Environmental Management Commission

Permit NCO088579
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.
Albert Gersing & David F. Ramsey are hereby authorized to:
1. Upon receipt of an Authorization to Construct permit from the Division, construct wastewater
treatment facilities not to exceed 0.05 MGD. This permitted facility will be located at the Stone
Bridge WWTP, off Shulls Mill Road near Boone in Watauga County.
2. After submitting an Engineer's Certification, discharge wastewater from said treatment works
at the location specified on the attached map into Lance Creek, currently classified C-Trout
waters in the Watauga River Basin.

Stone Bridge WWTP - NCO088579
USGS Quad: Boone, N.C.
Latitude:
Receiving Stream: Lance Creek
36°09'58"
Stream Class: C-Trout
Longitude:
Subbasin: Watauga — 04-02-01
81°44'06"
Facility
Location
✓V"&
Watauga County
Map not to scale

Permit NCO088579
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning upon receipt of an Engineer's Certification for a 0.05 MGD facility and
lasting until permit expiration, the Permittee is authorized to discharge treated domestic wastewater from
outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
PARAMETER
LIMITS
MONTTORIIVG 1ZEQJIRE1VIENTS
Monthly
Daily
Measurement
Sample
Sample
[PCS Code]_
Avera a
Maximum
Fre uen
T e
Location'
Flow
50050
0.05 MGD
Continuous
Recording
Effluent
BOD, 5 day, 20°C
00310
30 mg/L
45 mg/L
Weekly
Grab
Effluent
Total Suspended Solids
[00530]
30 mg/L
45 mg/L
Weekly
Grab
Effluent
NH3 as N (April 1— October 31)
2.0 mg/L
10.0 mg/L
Weekly
Grab
Effluent
00610
NH3 as N (November 1— March 31)
4.0 mg/L
20.0 mg/L
Weekly
Grab
Effluent
00610
Fecal Coliform (geometric mean)
200/100 mL
400/100 mL
Weekly
Grab
Effluent
31616
pH
00400]
> 6.0 and < 9.0 standard units
— —
Weekly
Grab
Effluent
Temperature
Weekly
Grab
Effluent,
00010
U & D
Dissolved Oxygen
Weekly
Grab
Effluent,
00300
U & D
Total Residual Chlorine (TRC)2
28 pg/L
2/Week
Grab
Effluent
50060
Total Nitrogen (NO2 + NO3 + TKN)
Semi-annually
Grab
Effluent
00600
Total Phosphorus
00665]
Semi-annually
Grab
Effluent
Notes:
1. U: at least 50 feet upstream from the outfall. D: at least 100 feet downstream from the outfall.
2. TRC limit and monitoring requirements apply only if chlorine is used for disinfection. The facility
shall report all effluent TRC values reported by a NC certified laboratory (including field certified
laboratories). However effluent values < 50 µg/L will be treated as zero for compliance purposes.
There shall be no discharge of floating solids or foam visible in other than trace amounts.

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 S.A. Bragman, who being duly sworn, deposes and says: that she is
Assistant Controller of the Winston-Salem Journal, engaged in the publishing of a
newspaper known as the Winston-Salem Journal, published, issued and entered as
second class mail in the City of Winston-Salem, in said County and State: that she
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 the
Winston-Salem Journal on the following dates:
April 27, 2012
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 27th day of April, 2012 -�
(signature o person making affidavit)
Sworn to and subscribed before me, this 27tt day of April, 2012
sm" / ralp".i� �
rr0 r
My Commission expires: September 28, 2015
---------------------
KIMALEY JOHNSO'
NOTARY PUBLIC
FORSYTH COUNTY
STATE OF NORTH CAR LI Ji
MY COMMISSION EXPIRE
PUBLIC NOTICE
North Carolina Environmental
Management Commission/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-i617
Notice of Intent to Issue a
NPDES Wastewater Permi t
The North Carolina Environmental Management
Commission proposes to Issue a NPDES wastewa-
ter discharge permit to the person(s) listed below.
Written comments regarding the proposed permit
will be accepted until 30 days after the publish
date of this notice. The Director of the NC Divislon
o review Intormation on tile.
n on NPDES permits and this
on our website: http://portal.
rwD/Ds/nodes/calendar. or
Stokes County Public Works applied to renew
NPDES permit NCO043290 for the Town of Danbury
WTP discharging to a LIT to Scott Branch, Roanoke
River Basin.
Wieland Copper Products, LLC Pine Hall, 3990 Hwy
333N, Stokes County, has appplied to renew permit
NCO035173 discharging to a 11T of Dan River, Roa-
noke River Basin.'
Mill Ridge PDA requested renewal of NCO030473
for their WWTP/Watauga, Countv. Facility dis-
charges to the Watauga River/Watauga River Ba-
sin. Currently BOD, ammonia nitrogen, dissolved
oxygen and fecal coliform are water quality limit-
ed.
Albert Gaining $ David Ramsey requested re-
newal of NC0088579/Stone Bridge WWTP/ Watau-
ga County. Proposed facility will discharge to.
Lnce Creek/Watauga: River Basin. Currently fecal
coliform, ammonia nitrogen, and total residual
chlorine are water quality limited.
Valle Landing Property Owners Association re-
quested renewal of permit NCO072559 /Valle land-
ing Shopping Center WWTP/Watauga County. Fa-
cility discharges to Dutch Creek/Watauga River
Basin. Currently fecal coliform is water quality
limited.
Clevon Woods Association requested renewal of
permit .N00070408/Art Plaza WWTP/Watauga
County. Proposed facility would discharge to the
Watauga River/Watauga River Basin. The follow-
ing parameters are currently water quality limited:
BOD5, TSS, ammonia nitrogen, fecal coliform, total
residual chlorine, dissolved oxygen..
Smoketree Lodge requested renewal of permit
NC0049174 for its WWTP in Watauga County.
Facility discharges to an unnamed tributary to the
Watauga River/Watauga River Basin. Currently
BOD, ammonia nitrogen, total suspended solids,
dissolved oxygen, fecal coliform, and total residu-
al chlorine are water quality limited.
PSI Properties, Inc requested renewal of permit
NC0038041/Laurel Seasons WWTP/Watauga Coun-
ty.
rBaasin! Currentlyy, fecal collform and total residu-
al chlorine are water quality limited.
WSJ: April 27, 2012

Weaver, Charles
From: White, Sue
Sent: Monday, April 16, 2012 2:00 PM
To: Weaver, Charles
Subject: RE: DRAFT permit renewal for NCO988579
Hi Charles. No comments. Nothing really to comment on! O
Please note that my email address has
changed to [e-mail]
Sue White
NCDENR-DWQ Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-S000
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.
From: Weaver, Charles
Sent: Monday, April 16, 20121:53 PM
To: White, Sue
Subject: DRAFT permit renewal for NCO088579
Importance: High
This is an unbuilt facility in Watauga County. The permit will go to Notice on 4/25/2012.
Send me any comments by May 141h
Thanks,
CHW

(6) TERTIARY OR ADVANCED TREATMENT UNIT
4a) Activated Carbons Bads -
vAthout carbon regeneration .................. 5
with carbon regeneration ......... . . . . . . .:... 15
(b) Powdered or Granular Activated Carbon Feed -
,without carbon regeneration ................. 5
with carbon regeneration .................... 15
•
(c) Air Stripping ............................. 5
(d) DenitrificationProcess (separate process) ..... 10
(e) . Eledrodialysis .............................. 5
(0 Foam Separation ............................. 5
(g) ton Exchange ................................ 5
(h) Lend Application of Treated Effluent
(see definition no. 22b) (not applicable for
sand. gravel. stone and other similar mining
operations)
(i) on agriculturally managed sites (See del.
No.4)................................... 10
(ii) by high rate infiltration on non -agriculturally
managed sites (includes rotary distributors
and similar fixed nozzle systems) ........... 4
(III) by subsurface disposal ('includes low pressure
pipe systems and gravity systems except at
plants consisting of septic tank and nitrifica-
tiontines only) ............................. 4
(I) Microsc Teens .................................. 5
(j) Phosphorus Removal by Biological Processes
(See del. No. 26) ............................ 20
(k) Polishing Ponds - without aeration ....... 2
with aeration .......... 5
(1) Post Aeration - cascade .............. 0
diffused or mechanical ... 5
(m} Reverse Osmosis ............................... 5
(n) Sand or Mixed -Media Filters - low rate ........... 2
high rate ........ 5
(o) Treatment processes for removal of metal or
cyanide.................................... 15
(p) Treatment processes for removal of toxic
materials other than metal or cyanide ......... 15
I SLUDGE TREATMENT
(a) Sludge Digestion Tank - Heated ...............
10
Aerobic....
5
Unheated .............
3
(b) Sludge Stabilization (chemical or thermal) .......
5
(c) Sludge Drying Beds - Gravity .................
2
Vacuum Assisted .......
5
(d) Sludge Elutriation .............................
5
(e) Sludge Conditioner (chemical or thermal) ........
5
(1) Sludge Thickener (gravity)...... - -
5
(g) Dissolved Air Flotation Unit
(not applicable to a unit rates as (3) (i} .........
8
(h) Sludge Gas Utilization (including gas storage) ....
2
(i) Sludge Holding Tank - Aerated .................
5
Non -aerated ............
2
(j) Sludge incinerator - (not including activated
carbon regeneration) .....
10
(k) Vacuum Filter. Centrifuge or Filter Press or other
similar dewalering devices ....................
10
(8) SLUDGE DISPOSAL (including incinerated ash)
(a) Lagoons ....... ..................................
(b) Land Application (surface and subsurface)
2
(see definition 22a)
-where the facility holds the land app. permit ...
10
-by contracting to a land application operator who
holds the land application permit ................
2
-land application of sludge by a contractor who does
not hold the permit for the wastewater treatment
facility where the sludge is generated .........
10
(c) Landfilled (burial) ... .. ................ 00 . . . .. .
5
(9) DISINFECTION
a)
(a) Chlorination ............................ .
5
(b) Dechlorination ........................
5
(c) Ozone ..............................
(10) CHEMICAL ADDITION SYSTEM (S) (See definition No. 9)
(not applicable to chemical additions rated as item
(3) 6). (5) (a) (A). (6) (a). (6) (b). (7) (b). (7) (e)
(9) (a). (9) (b). or 19) (c) 5 points each: List:
5
..... 5
(11) MISCELLANEOUS UNITS
(a) Holding Ponds. Holding Tanks or Settling Ponds
for Organic or Toxic Materials including wastes
from mining operations containing nitrogen and/or
phosphorous compounds in amounts significantly
greater than is common for domestic wastewater .......... 4
(b) Effluent Flow Equalization (not applicable to storage
basins which are inherent In land application systems). 2
(c) Stage Discharge (not applicable to storage basins
inherent in land application systems ..............»....».».......•-».-• 5
(d) Pumps...._...».»..».» 3
(e) Stand -By Power Supply-..»..............»...-»»-._._-w»-•-•••••• 3
(1) Thermal Pollution Control Device:».....»...........»..........•»--•»..•• 3
TOTAL POINTS
CLASSIFICATION
Class L. 5 - 25 Points
Class 11.............. 26- 50 Points
Class Ili 51- 65 Points
Class IV...».... 66- Up Points
Facilities having a rating of one through four points. inclusive.
do not require a certified operator. Classification of all other
facilities requires a comparable grade operator in responsible
charge.
Facilities having an activated sludge process will be assigned
a minimum classification of Class If.
Facilities having treatment processes for the removal of metal
or cyanide will be assigned a minimum classification of Class If.
Facilities having treatment processes for the biological removal
of phosphorus will be assigned a minimum classification of Class
Ill.
In -plant processes and related control equipment which are an
integral part of industrial production shall not be considered waste
treatment. Likewise. discharges of wastewater from residences
having a design flow of 1.000 gpd or less. shall not be subject to
rating.
ADDITIONAL COMMENTS:

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
Charles H. Weaver — 4/11/2012
Permit Number
NC0088579
Facility Name
Stone Bride W WTP
Basin Name/Sub-basin number
Watauga / 04-02-01
Receiving Stream
Lance Creek
Stream Classification in Permit
C-Trout
Does permit need Dailv Maximum NH3 limits?
N / A
Does permit need TRC limits/language?
No — already present
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
Yes
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No
Any permit mods since last permit9
No
New expiration date
9/ 10/2017
Comments on Draft Permit?
Facility has not been constructed yet: no data to
review-.
Most Commonly Used Expedited Language:
• 303(d) lan¢ua2c for Draft/Final Cover Letters: "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 with the Division. and instrea n data will
continue to be evaluated. If there is noncompliance with this permit's effluent limits and
stream impairment can be attributed to your facility, then mitigative measures may be
required".

NPDES PERMIT COPIES GO TO WHOM?
E-Mail addresses for the contacts listed above are:
TACU
➢ Steve Reid [[e-mail]] for Municipal WWTPs
➢ James Pugh [e-mail]] for everything else
Aquatic Toxicology Unit
➢ Susan Meadows [[e-mail]]
➢ Cindy Moore [[e-mail]]
DEH
➢ ARO / Jim Adams [e-mail]]
➢ FRO / Debra Benoy [[e-mail]]
➢ MRO / Britt Setzer [[e-mail]]
➢ RRO / Michael Douglas [[e-mail]]
➢ WaRO / Harry Bailey [[e-mail]]
➢ WiRO / Debra Benoy [[e-mail]]
➢ WSRO / Lisa Edwards [[e-mail]]
DEH / Shellfish Sanitation
J.D. Potts [[e-mail]]
➢ WaRO facilities / Alan Saunders [[e-mail]]
➢ WiRO facilities / Mark Ethridge [[e-mail]]
EPA Region 4
➢ Pam Myers [[e-mail]]
ESS Basin Coalition coordinator
➢ Jennie Atkins [e-mail]] i4'44"` it
Wake County Environmental Services
➢ Ed Duke [[e-mail]]
Mecklenburg County
➢ Erin Hall [[e-mail]]
If you need assistance determining who should get a copy, or of what should they receive copies, see
CHW or your Supervisor
4 January 2011
2of2

David F Ramsey, P E- P S M
R&S Engineering and Construction Corporation
434 Skinner Boulevard 61 The Glens Boulevard
Dunedin, F134698 Banner Elk, NC 28604
webpage: www.ramseven2incerin2.com
727 409-4639 e-mail davidf.ramsev(averizon.net 828 963-5875
Professional Engineer Ohio-Florida-N Carolina-S Carolina -Georgia
Professional Surveyor Ohio-Florida-N Carolina
General Contractor Class A Florida CGC 010310 North Carolina 44555
Please reply to North Carolina Address
March 30, 2012
Charles H Weaver
NC DENR/Divison of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Stone Bridge NPDES Permit #NC0088579
Watauga County
Dear Mr. Weaver:
Enclosed you will find (3) copies of the requested NPDES Application - Form D for the aforementioned project.
Please review and if you have questions, please do not hesitate to call or email.
Sincerely,
J�-
David F Ramsey, PE, PSM
General Contractor
APR _ 2 2012

Weaver, Charles
From: David F Ramsey [[e-mail]]
Sent: Friday, March 30, 2012 9:21 AM
To: Weaver, Charles
Subject: Re: renewal notice for NPDES permit NC0088579
Attachments: Stone Bridge Form-D-20090518-DWQ-SWP-NPDES (1).docx
Charles: Attached you will find the Form D-20090518-DWQ-SWP-NPDES for the Stone Bridge Project. We have not
completed the design on this project due to the economic condition but wish to keep the permit activity. Since we have not
complete the design do you need any additional information. I am placing the mail today the Original Form with two copies.
Please advise.
David F Ramsey
Professional Engineer
727 4094639
Confidentiality Notice:
This E-Mail transmission (and/or the documents accompanying it)
map contain information belonging to the sender which is
confidential, privileged and/or exempt from disclosure under
applicable law. The information is intended only for the use
of the indvidual(s) or entity named above. If you are not
the intended recipient, you are hereby notified that any
disclosure, copying, distribution or the taldng of any action
in reliance on the contents of this information is strictly
prohibited. If you have received this E-Mail transmission
in error, please immediately notify us by return E-Mail or
telephone to arrange for return of its contents including any
documents.
From: Weaver, Charles
Sent: Friday, March 09, 2012 1:59 PM
To: davidf.ramsev(a)verizon.net
Subject: renewal notice for NPDES permit NC0088579
The NPDES permit for the Stone Bridge WWTP in Watauga County expires on September 30, 2012. This
notice is being sent to explain the requirements for your permit renewal application.
Federal (40 CFR 122) and state (15A NCAC 211.0105 (e)) regulations require that permit renewal applications
be filed at least 180 days prior to expiration of the current permit. Your renewal application is due to the
Division no later than April 3, 2012. Failure to apply for renewal by the appropriate deadline can result in a
civil penalty assessment or other enforcement activity at the discretion of the Director.
If your facility is still discharging any wastewater, this permit must be renewed. Discharge of wastewater
without a valid permit violates North Carolina General Statute 143-215.1 and could result in assessment of civil
penalties of up to $25,000 per day.
Use the attached checklist to complete your renewal package. The checklist identifies the items you must
submit with the permit renewal application. If all wastewater discharge has ceased at this facility and you wish
to rescind this permit, simply reply to this message.
Charles H. Weaver
NPDES Unit
Messages sent to or from this address are subject to the North Carolina Public Records Law

Sledge, Bob
From:
Paul Phillips [[e-mail]]
Sent:
Wednesday, January 25, 2012 11:00 AM
To:
Sledge, Bob
Cc:
King, Larry
Subject:
Question on draft NPDES Permit NC 0036536
Dear Mr. Sledge,
The change on draft permit was adding monitoring, reporting and compliance determination of Total Residual
Chlorine valves in the event that UV disinfection system fails and chlorine compounds are used for disinfection.
I have dual UV protection so if one goes down we can valve off that one and still have disinfection. Power lose
or any other emergency the school will be closed so no usage which in turn means no discharge from
wastewater plant. So I am asking for this to be taken out of requirements in permit.
Thanks
Paul Phillips
Water Quality Director
Person County Schools

1' •
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 CO088579
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
Albert Gersing and David F Ramsey
Facility Name
Stone Bridge WWTP
Mailing Address
61 The Glens Boulevard
City
Banner Elk
State / Zip Code
NC 28604
Telephone Number
[phone]
Fax Number
(None)
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 950 Shulls Mill Road
City Boone
State / Zip Code NC 28607
County Watauga
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 ORQ
Name None at this time Facility has not been completed
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
2 2012
po,t-jT,•.. FQUgl)
1 of 3
Form-D 05108

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
X
Number of Homes
School
❑
Number of Students/ Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Townhouse Project
Population served: 136 Townhouse
S. 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)
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving stream(s) (Provide a map showing the exact location of each outfallp.
Lance Creek
S. 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.
No components installed at this time. Project is under design.
2 of 3 Form-D 05108

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow .06 MGD
Annual Average daily flow MGD (for the previous 3 years)
Maximum daily flow 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
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
Fecal Coliform
Total Suspended Solids
Temperature (Summer)
Temperature (Winter)
pH
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
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.
David F Ramsey Part Owner
Printed name of Person Signing Title
OF
of Applicant
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 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.)
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