NC0079049_Renewal (Application)_20160616

NC DENR / DWR / NPDES Renewal Application Checklist Cover letter.
RH Johnson Construction Co. Is re questing renewal of the permit for privately -owned
treatment systems treating 100% domestic wastewaters <1.0 MGD.
No facility or treatment plant exists or has been started. RH Johnson Construction Co.
only wishes to. keep the permit open .
If you need any further information please let me know.
Thank you,
Chris John;
Presiderifof RH Johnson Construction Co.
Ph. 828-423-2764
Email. [e-mail]
86 Wood ave.
Asheville, NC 28803
RECEIVED/NCDEO jDWR
JUN 16 2016
Water Quality
Permitting Section

NC DENR / DWR / NPDES
Renewal Application Checklist
The following items are REQUIRED for all renewal packages.
A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit Submit one signed original and two copies.
The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, written documentation must be provided showing the authority delegated to the
Authorized Representative (see Part II13.11.b of the existing NPDES permit).
A narrative description of the sludge management plan for the facility. Describe how sludge (or other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following items must be submitted by any Municipal or Industrial facilities discharging
process wastewater:
Industrial facilities classified asPrimary Industries (see Appendices A -D to Title 40 of the Code of
Federal Regulations, Part 122) and AL1. Municipal facilities with a permitted flow >_ 1.0 MGD must
submit a Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21.
The above requirement does NOT apply to non -industrial facilities.
Send the completed renewal package to:
Wren Thedford
NC DENR / DWR / NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR I Division of Water Quality I NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NC00
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 ���nSV lr1 Cc Yds +f -V C.� < 0 n cc,,
Facility Name
Mailing Address !c' W C) GU 61'p– : taaa is
city ���e v ; V e CA -C
State / Zip Code IN C 112- 1,UO3 J -�
Telephone Number (9 2—V 22 C �j
W s
Fax Number
e-mail Address !�r 5"'Yno, 4—P C,\ met-;
2. Location of facility producing discharge: 2 ����
Check here if same address as above L]o� C%
Street Address or State Road 2 gd
City
State / Zip Code
County
3. Operator Information:
Name of the firm, public organization or other entity that operat s the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
1 of 3 Farm -011112

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
❑
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.):
Number of persons served:
5. Type of collection system
❑ Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s)
Is the outfall equipped with a diffuser? ❑ Yes ❑ No
7. Name of receiving stream(s) (NEW applicants. Provide a map showing the exact location of each outfall):
8. Frequency of Discharge: ❑ 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.
2 of 3 Form -D 11112

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow MGD
Annual Average daily Now MGD (for the previous 3 years)
Maximum daily flow MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ❑ 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. !f more than one analysis is reported, report daily maximum
and monthly average. !f only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over the
past 36 months forparameters current) in our ermit. Mark parameters "WA'
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
Hazardous Waste (RCRA)
NES14APS (CAA)
Permit Number
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES Dredge or fill (Section 404Itbion
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained in the applind that to the best of my
knowledge and belief such information is true, complete, and accurate.
Chnv� 7�hr PC P �����
Printed n mpdMerson signing Title
s-�
of A,pplirAnt Date
North Carolina gyral 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.)
3 of 3 Form -D 11112