NC0073741_Renewal (Application)_20200529

A & D Water Service , Inc.
P.O. Box 1407 Pisgah Forest, NC 28768 828-884-9772 Fax [phone]
RECEIVED
May 25, 2020 MAY 2 9 2020
NCDEQIDWRINPDES
Please find attached NPDES Permit renewal forms for the following;
High Vista Falls : NC0089095
Hunter's Glen : NC0067288
Mountain Valley : NC0073741
Sherwood Forest : NC0048658
No modifications have been made to these facilities.
Thank you,
Aubrey Deaver
President

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 INC0073741
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 A 86 D Water Service, Inc.
Facility Name Mountain Valley ��++ ` '
RE
Mailing Address P. O. Box 1407L.1 E I v E D
City Pisgah Forest MAY 9 2020
State / Zip Code N.C. 28768 NCDEQIDWRINPDES
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road NCSR 1171
City Etowah
State / Zip Code N.C.
County Henderson
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 Vincent Edwards
Mailing Address P.O. Box 1407
City Pisgah Forest
State / Zip Code N.C. 28768
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1 of 3 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 X Number of Homes 66
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Subdivision
Number of persons served: 165
5. Type of collection system
X Separate (sanitary sewer only) El 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? El Yes ® No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
French Broad
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Continuous
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.
Extended air, c12, and dec12
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 0.0020 MGD
Annual Average daily flow 0.010 MGD (for the previous 3 years)
Maximum daily flow 0.024 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 currently in your permit. Mark other parameters "N/A".
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BOD5) 64 12.15 Mg//
Fecal Coliform 600 14.01 #/100m1
Total Suspended Solids 46 16 Mg/1
Temperature (Summer) NA
Temperature (Winter) NA
pH 8.41 6.73 SU
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping(MPRSA)
NPDES NC0073741 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION
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.
Aubrey Deaver President
Printed name of Person Signing Title
May 25, 2020
Signature of scant 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.)
3 of 3 Form-D 6/2017

Revised: 01/01/14
A&D WATER SERVICE
P. O. Box 1407
PISGAH FOREST,NC 28768
SLUDGE MANAGEMENT PLAN
Sludge generated at this facility is pumped and hauled to other facilities for additional treatment
and final disposal.
Sludge haulers include Goldie Associates, Mikes Septage or ACL.
Sludge is hauled to wastewater treatment systems at the City of Hendersonville,the City of
Brevard or Buncombe County's Metropolitan Sewage District(MSD).