NC0058815_Application_20180801

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t.�
HOPE VALLEY, INC.
LINDA AMBURN, Executive Director
TERRY GLASCOCY, Board of Directors Chair
Men's Division
P. O. Box 467
Dobson, NC 27017
[phone]
[phone]
FAX [phone]
Women's Division
_ l52 Hope Valley Road
Pilot Mountain, NC 27041
[phone]
[phone]
FAX [phone]
August 1, 2018
Residential Services
Emily Phillips
P.O. Box 2682
Hickory, NC 28602
NC DEQ/ DWR/ NPDES
[phone]
[phone]
1617 Mail Service Center
FAX [phone]
Raleigh, NC 27699-1617
Subject: Renewal of NPDES Permit N00058815
Dear Ms. Phillips,
Hope Valley, Incorporated requests that our NPDES Permit NCO058815 be
renewed. All information requested for the renewal package is enclosed.
If you should have any questions or comments, please contact me at
[phone] or our ORC Martin Semones at [phone].
Sincerely,
Malinda Amburn
Executive Director
— PRIVATE NON-PROFIT CORPORATION —
ESTABLISHED 1968

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
NC DEQ / DWR / NPDES
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCOO 58B S
If you are completing this form in computer use the TAB key or the up - down arrows to moue 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
1-612__ U�� /fin o ra fed
Facility Name Oe. ✓a A V 14 C-,,- De r4 ka/
Mailing Address /05- Co�� go ME kc"gw
City 0 6S on
State / Zip Code /V C 2 7 0/ 7
Telephone Number (g 36)
1,ax'Number ( )
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road (s+5
City
DASon
State / Zip Code t�C 27012
Couniq
S vrr\/
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 A,, , /
�LSaL�in K
Mailing Address 27i %lerrinj S4reef
City
MOunf ,4ir�/
State /Zip Code !✓C 2-7030
Telephone Number
Fax Number
e-mail Address
(331-) 755-7$i6- (Ce./l)
(336) 78�- 8170
mSevyioneS 7 @ +bad rr. c-or✓1
100
Form-D 6/2017

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
❑v
Explain: N' lnC-,
r�
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): AIeoAoi) dru' dependence
D%sC4ar9g %s Cos» para6/e 4a re_Sideq 4 %al.
Number of persons served: L, A (Varies)
11i �
5. 'Type of collection system
Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points one Z)
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).
F;Sler i2i ✓e r (yad Eln - P be I ✓ r &Sm
S. 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. _ D va ( GreaSe, Tra S
P I, Soo 9q/10ps each
- Dval C'oMpar�rrt�}-f
bo41e61 vcpkc, 4-an4 2, 000 9q/lops
2)" l bell Siphon
dosing c_am6er- Goo ja oe15
+W'jA Sur4ace
Sand-{-'ilferS— II,rXIbr`f''eac 9 30 "
WaSk Sand 3 Washed Pea
11 f / cj rat/eli to o 1/4''- I�/7- s+VAed
Ch1orjnC COAlAd Cken<6er- goo CjAbn5
bee Aforjae Ce^Yacf e,(aw4o,- - So 9a.11e,ts
2 of 3 Form-D 6/2017

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.00 4 MGD
Annual Average daily flow 0. 007-7 MGD (for the previous 3 years)
Maximum daily flow 0,008/ 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 analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters currentlu in uour permit. Mark other parameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
410, S
32.4
M
Fecal Coliform
2 42 D
' 7B0.Y2
%piA46c.
'Total Suspended Solids
, z
15. g57
M1,
Temperature (Summer)
2 9
o C
'Temperature (Winter)
/
pH
7,
F4,%dard ni
13.E List all permits, construction approvals and/or applications:
Type" Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES �I00058B15 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
.Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
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.
yj1?AIln�a ffn,�iL�/Ti l 1/Rce-7-0R
name of Person
Signature
Title
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.)
3 of 3 Form-D 6/2017

HOPE VALLEY, INC.
LINDA AMBURN, Executive Director
TERRY GLASCOCK, Board of Directors Chair
Men's Division
P. O. Box 467
Dobson, NC 27017
[phone]
[phone]
FAX [phone]
Women's Division
152 Hope Valley Road
'ilot Mountain, NC 27041
[phone]
[phone]
FAX [phone]
August 1, 2018
2esidential Services
Emily Phillips
..vT0 -Box 2682.:
Hickory, NC 28602
NC DEQ/ DWR/ NPDES
_�[phone]
[phone]
1617 Mail Service Center
FAX [phone]
Raleigh, NC 27699-1617
Subject: Sludge Management Plan for Hope Valley, Inc Permit NCO058815
Dear'Ms. Phillips,
The Sludge Management Plan for Hope Valley, Incorporated is for the tank to
be pumped semi-annually and additionally as needed. Due to the flow being
Zt ,A:::i::' :-,
dependent upon the number of clients, the above plan has been working well
"
for us.
If you should have any questions or comments, please contact me at
[phone] or our ORC Martin Semones at [phone].
Sincerely,
(�
Malinda Amburn
Executive Director
— PRIVATE NON-PROFIT CORPORATION —
ESTABLISHED 1968

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I
Ahea ler ' 1 21,
i SCALE 1:24000
` Facility
a1 t,de' 36`25'06" Sub -Basin: 03-07.02
qr �qd 80'42'43" Location `
B16W
iL-±ini Cass: WS-11 CA i
,`�ygsivinc Strcam Fishcr River v/-/� f/� Hop. Vnliry, Inc
olmitted Flow 0.004 MGD ./ �U,LL/L NCO058815 J
Dobson F.dkv