NC0067008_Renewal (Application)_20170907

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 000067008
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
Watauga County Board of Commissioners
Facility Name
Old Cove Creek School WWTP
Mailing Address
814 West King Street, Suite 205
City
Boone
State / Zip Code
NC 28607
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
robert marsh a watgov org
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 207 Dale Adams Rd
City Sugar Grove
State / Zip Code NC 28679
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 ORC)
Name Water Quality Lab and Operations
Mailing Address P O Box 1167
City Banner Elk
State / Zip Code NC 28604
Telephone Number [phone]
Fax Number [phone] ;
i
e-mail Address waterqualitylabsuyahoo com
I
1 of 3 Form -D 11112

4
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 2
Residential
❑
Number of Homes
School
®
Number of Students/Staff 51
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc )• Businesses located within the Old Cove Creek School Building include a daycare
facility and a woodworking shop.
Number of persons served. apx. 65
5. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall 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) (NEW applicants: Provide a map showing the exact location of each
outfall):
Cove Creek, Classified C waters in the Watauga River Basin
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If mtermittent.
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
Grit Chamber, Aeration Basin, Clarifier, Chlorination, Dechlorination, Return Sludge
Holding Tank
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 .01 MGD
Annual Average daily flow .0024 MGD (for the previous 3 years)
Maximum daily flow 004 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 If more than one analysis is reported,
report daily maximum and monthly average If only one analysts is reported, report as daily maximum
RENEWAL APPLICANTS: Prolnde the highest single reading (Daily Maximum) and Monthly Average over
+Z,- -f Q9 .,,—fl— C- nnrnmoforc r irronfht to ivnvr normit Unrlr nth Pr nnrnmPtonc 'IVIA"
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
23.4
12 2
mg/L
Fecal Coliform
194
35
cuf/ 100mL
Total Suspended Solids
41
21
mg/L
Temperature (Summer)
26
23
Degrees Celsius
Temperature (Winter)
18
147
Degrees Celsius
pH
7 7
74
S/u
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES NCO067008
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
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.
Jadd Brewer Signatory
Printed name of Person Signing Title
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 (1 B 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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Form -D 11/12

Water Quality Lab & Operations, Inc.
P O Box 1167/ 1522 Tynecastle Highway
Banner Elk, NC 28604
Ph. 828-898-6277 Fax [phone]
I, the undersigned, do hereby give my permission and grant my authority as the
Maintenance Director of Watauga County to Jadd Brewer, Co-Owner/Operator of Water
Quality Lab and Operations, Inc. to complete, sign and submit the Wastewater Permit
Renewal Application for The Old Cove Creek School WWTP for 2017
This is the /VK day of Qrll4YU , 2017.
Printed Name and Title: Robert Marsh, Maintenance Director, Watauea County
Signature: