NC0086983_Renewal (Application)_20160830

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NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
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
NPDES Permit Number INCO086983
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 Informations
Owner Naive
Caswell County BOB
Facility Name
South Elementary WTP
Mailing Address
P.O. Box 160
City
Yanceyville
State / Zip Code
NC / 27379
Telephone Number
[phone]
Fax Number
( )NA
e-mail Address
[e-mail]
2. Location of facility producing discharges
Check here if same as above ❑
Street Address or State Road 8925 NC Hwy 86 South
City
Mebane
State / Zip Code
NC / 27302
County
Caswell
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 ORCJ
Name Research & Analytical Laboratories, Inc.
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
4. Ownership Status:
Federal ❑
106 Short Street
Kernersville
NC / 27284
[phone]
[phone]
State ❑
Private ❑ Public
Page I of 3 ' 'r ^ )1 Version 5/2012
E.._.ii FILL m.

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NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
b. Type of treatment plant:
❑ 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)
Groundwater
7. Describe the treatment process(es) for the raw water:
Groundwater treated with Sodium Hypochlorite for Disinfection and KMn04 for Iron &
Manganese Removal
S. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Backwash wastewater from green sand filtration, followed by dechlorination.
9. Number of separate discharge points: 1
OutfaU Identification number(s) 001
10. Frequency of discharge: Continuous ❑
If intermittent:
Days per week discharge occurs: 2 on average
11. Plant design potable flowrate NA MGD
Backwash or reject flow 0.0007 MGD
Intermittent
Duration: 30 min ea cycle
12. Name of receiving stream(s) (Provide a map shouting the exact location of each outfall, including
latitude and longitudep.
UT to Hyco Creek (Stream Segment 22-58-1)
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate Yes No X
Page 2 of 3 Version 512012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Iron sulfate / ferrous sulfate Yes No X
Fluoride Yes No X
Ammonia nitrogen / Chioramines Yes No X
Zinc -orthophosphate or sweetwater CP1236 Yes No X
List any other additives below:
Sodium Hypochlorite
Postassium Permanganate
14. Is this facility located on Indian country? (check one)
Yes ❑ No 10
its. 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 points] 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 highly encouraged 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.
of
of
Title
riL Z
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 requited to be maintained under Article 21 or regulations of the Environmental Management Commission Implementing that
Article, or who falsiffes, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21
orregufafions 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.monlhs, or by both, (18 U.S.C. Section 1001 provides a punishment by a fine of not more then $25.000 or imprisonment not more than 5
years, or both, for a similar offense.)
Page 3 of 3
Version 5/2012
0

SLUDGE MANAGEMENT PLAN
SOUTH ELEMENTARY
WATER TREATMENT PLANT
NPDES PERMIT NO. NCO086983
Sludge from the South Elementary Water Treatment Plant (WTP) is disposed of in the following way:
No sludge is generated from this facility

CaswelP County Board ofFIEducatn®n
South ERementarry Schm®R WTP
USGS Ound/State Grid: Rid.-eville, B22SW Stream Class: C
Latitude: N 36" 19' 37" Sub -Basin: 03-02-05
Longitude: W 79° 14' 25" Hue: 03010104
PrainnecBmin: Roanoke River Basin
ReceivingStrenm: UT to 1Iyco Creek [stream segment 22-58-1]
North 'DI\TCOO86983
Caswell County
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From Well "�' QFilter
:t Dechlor Tablet
Feder
Storage Tank_ �.a r _
Chem Chem —, ---�
Pump Pump -
Backwash,"0*
Discharge to 001
Dist Line to School
Hydro
Tank
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Pump #1 Pump #2
T 1
Caswell County Schools
South Elementary Well 'House

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19 August 2016
Mr. Wren Thedford
NCDENR / DWQ / NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: South Elementary School, Caswell County BOE
NPDES Permit NC0086983 Renewal Application Report
Dear Mr. Thedford:
RECEIVEMCDENWR
AUG 2 3 2015
Water duality
Permitting Section
Enclosed are one (1) signed original and two (2) copies of the NPDES Permit Application — Short
Form C - GW requesting renewal of NPDES Permit No. NC0086983. There have been no significant
changes to wastewater treatment facility.
If you should have any questions concerning this application renewal please so advise.
Best Regards,
Jerry Hatchett
Maintenance Director
Caswell County BOE

NPDES PERMIT APPLICATION - SHORT ]FORM C - GW
For discharges associated with groundwater treatment facilities.
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
NPDES Permit Number NC0086983
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 Caswell County BOE
Facility Name South Elementary WTP
Mailing Address P.O. Box 160
City Yanceyville
State / Zip Code NC, 27379
Telephone Number [phone]
Fax Number ( )NA
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road 8925 NC Hwy 86 South
City Mebane
State / Zip Code NC, 27302
County Caswell
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 Matt Smith, RAL
Mailing Address 106 Short Street
City Kernersville
State / Zip Code NC, 27284
Telephone Number [phone]
Fax Number [phone]
4. Ownership Status:
Federal ❑
State ❑
Private ❑
Q
Page 1 of 3 C -GW 030

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
S. Products recovered:
Gasoline ❑ Diesel fuel ❑ Solvents ❑ Other NA
6. Number of separate discharge points: 001
Outfall Identification number(s) 001
7. Frequency of discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 2 on average Duration: 30 mins each cycle
S. Treatment System Design flow MGD
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
UT to Hyco Creek [stream segment 22-55-1]
10. Please list all additives to the treatment system, including chemicals or nutrients, that have
the potential to be discharged.
Sodium Hypochlorite
Potassium Permanganate
11. Is this facility located on Indian country? (check one)
Yes ❑ No
12. Additional Information
All applicants (including renewalsp
A USGS topographical map (or copy of the relevant portion) which shows all outfalls
A summary of the most recent analytical results (effluent data, if available) containing the
maximum values for each chemical detected
NEW Applicants only:
D Engineering Alternative Analysis
Description of remediation treatment system components, capacities, and removal efficiency
for detected compounds.
If the treatment system will discharge to a storm sewer, written approval from the
municipality responsible for the sewer.
A list of any chemicals found in detectable amounts at the site, with the maximum observed
concentration reported for each chemical (the most recent sample must be collected less
than one year prior to the date of this application)
For petroleum -contaminated sites — Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
For sites contaminated with solvents or other contaminants - EPA Method 624/625
analysis should be performed.
Page 2 of 3 C -GW 03105

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NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
13. 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.
Jerry Hatchett Maintenance Director
Printed name of Person Signing Title
'/Eg.�-
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 C -GW 03105

SLUDGE MANAGEMENT PLAN
SOUTH ELEMENTARY
WA'T'ER TREATMENT PLANT
NPDES PERMIT NO. NCOO86983
Sludge from the South Elementary Water Treatment Plant (WTP) is disposed of in the following way:
No sludge is generated from this facility

Water Resources
ENVIRONMENTAL QUALITY
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Director
August 30, 2016
Mr. Jerry Hatchett, Maintenance Director
Caswell County Board of Education
PO Box 160
Yanceyville, NC 27379
Subject: Permit Renewal
Application No. NCO086983
South Elementary WTP
Caswell County
Dear Mr. Hatchett:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on August 23, 2016. The primary reviewer for this renewal
application is Derek Denard.
The primary reviewer will review your application, and he will contact you if additional
information is required to complete your permit renewal. Per G.S. 150B-3 your current permit
does not expire until permit decision on the application is made. Continuation of the current permit
is contingent on timely and sufficient application for renewal of the current permit.
Please respond in a timely manner to requests for additional information necessary to complete the
permit application. If you have any additional questions concerning renewal of the subject permit,
please contact Derek Denard at 919-807-6307 or [e-mail].
Sincerely,
?am %&*Td
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6300