NC0038997_Final Permit_20040607 (37)

June 09, 2003
Mrs. Valery Stephens
NC DENR
Water Quality
Point Source Branch
Dear Mrs. Stephens,
This application is being submitted to request permit renewal for Roaring Gap Club,
Incorporated, NPDES Permit NC0038997. A UV disinfection system has been added
since last permit issuance.
Sincerely,
Jay Manner
JUN
DENR-WATER QUALITY
POINT SOURCE BRANCH

N
NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water (Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
http://h2o.enr.state.ne.us/NPDES/
North Carolina NPDES Permit Number I NC00379 9 %
Please print or type
1. Contact Information:
Facility Name
Owner Name
Street Address
City
State / Zip Code
Telephone Number
(-'04 ) 363 _ Pa l�
Fax Number
( )
e-mail Address
Operator Name
L -%%2A�f So c,
Street Address
7( RC 4CUd
' naD i_2.
City
.�7� P<O W, A(C
State / Zip Code
e 9&7, .
County
IVIZ eas
Telephone Number
(33 6 ) $'7 SL_
2. Location of facility producing discharge:
Check here if same as above
Facility Name (If different from above)
Street Address or State Road
City
State / Zip Code
County
3. Reason for application:
Expansion/Modification *
Existing Unpermitted Discharge
Renewal New Facility
* Please provide a description of the expansion/modification.
Page 1 of 3
Version 12102

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
4. Description of the existing treatment facilities (List all installed components with
capacities):
T�,c Ovate 54AIV � r��s, vu _DI6EAhq;r7r,,0 A/
�b/3 MCA
5. Description of wastewater (check all that apply):
Time of Facilitv Generating Wastewater
Industrial
Number of Employees
Commercial
Number of Employees
Residential
✓ Number of Homes
School
Number of Students/Staff
Other
3q
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
Sr'j fj s' 4MES
6. List all permits, construction approvals and/or applications (check all that apply):
Type
RCRA
UIC
NPDES
PSD
NESHAPS
Permit Number
Type
Non -Attainment
Ocean Dumping
Dredge/Fill Permits
Other
Permit Number
7. Number of separate wastewater discharge pipes (wastewater outfalls):
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall:
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Version 12102

r
NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
9. Name of receiving stream(s) (Provide a map shounng the exact location of each outfaU):
U7- -ra /"); 7-CWCZL 12%v�2
10. Is this facility located on Native American lands? (check one)
YES ❑ NO
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.
Printed Name of Person Signing
Title
Signature of Applicant
Date Signed
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 $10,000, 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 $10,000 or
imprisonment not more than 5 years, or both for a similar offense )
Page 3 of 3
Version 12102

The sludge management plan for this system is as follows:
Some sludge is removed on an annual basis. An approved septic
hauler is contacted, the tank is pumped, and disposed of at a
wastewater treatment plant.