NC0040045_Renewal (Application)_20140922

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Robert Walser, Owner
Bill's Truck Stop, Inc.
1210 Snider Kines Rd
Linwood, NC 27299
Dear Mr. Walser:
John E. Skvarla, III
Secretary
September 29, 2014
Subject: Acknowledgement of Permit Renewal
Permit NCO040045
Davidson County
The NPDES Unit received your permit renewal application on September 22, 2014. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30 -45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Bob
Sledge (919) 807 -6398.
Sincerely,
W re *x,, Tkt4f owY
Wren Thedford
Wastewater Branch
cc: Central Files
Winston -Salem Regional Office
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699 -1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]/Customer Service: 1-877-623-6748
Internet:: www rimater.oro
An Equal OpportunitylAffirmative Action Employer

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 C0040045
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
Robert Walser
Facility Name
Bill's Truck Stop, Inc
Mailing Address
1210 Snider Kines Rd
City
Linwood
State / Zip Code
NC 27299
Telephone Number
(336)956 -4494
Fax Number
(336)956 -6057
e -mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above Xlll�
Street Address or State Road
City
State / Zip Code
County
3. Operator Information:
Name of the firm, public organization or other entity that operates the facility. (Note that this is not
refer-ring to the Operator in Responsible Charge or ORC)
Name Luther Leoard
Mailing Address 502 Northside Drive
City Lexington
State / Zip Code NC 27295
Telephone Number ((336)239 -0842) P;:rE1VED /DENR /DWR
Fax Number ( ) p 9, 9, 2014
e -mail Address
VVaE)t194V
Permitting Section
1 of 4 Form -D 11/12

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
❑
Commercial
x'®
Residential
❑
School
❑
Other
❑
Number of Employees
Number of Employees
Number of Homes
Number of Students /Staff
Explain:
35 -40
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
restaurant
Number of persons served: 100 per day
5. Type of collection system
Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Out fall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes No
7. Name of receiving stream(s) (MW applicants: Provide a map showing the exact location of each
outfall):
South Potts Creek in the Yadkin Pee Dee River Basin
8. Frequency of Discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 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.
1. Septic Tank, grease trap
2. Filter bed, sand filter
3. Chlorine Chamber
4. Dechlorine Chamber
5. Discharge
2 of 4 Form -D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
3 of 4 Form -D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design now 0.006 MGD
Annual Average daily flow 0.0047-MGD (for the previous 3 years)
Maximum daily flow 0.0056 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X No
12. Effluent Data
NEW APPLICANTS: 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.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
rho .,", f qr, mnnfhc F'nr nryrnmPtPrc rurrPntlu in unur hermit. Mark other parameters "N /A ".
y
jr_ w v _ - - - - - 1
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
6.9
4.9
Mg /L
Fecal Coliform
86.8
43
Ug /L
Total Suspended Solids
5.92
12.3
Mg /L
Temperature (Summer)
22.5
24
oC
Temperature (Winter)
12
15
oC
PH
6.5
6.6
units
13. List all permits, construction approvals and /or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO040045
PSD (CAA)
Non - attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
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.
Sherry Freeman Secre
Printed name of Person Signing Title
9/17/2014
Signature oVApplicant 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.)
4 of 4 Form -D 11/12