NCG500662_Renewal Application_20200521

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NcDEMR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
NOTICE OF RENEWAL INTENT
[Required by 15A NC'AC 02H .01.7(d)]; [term definition see 15A NCAC 02H .010309)]
Application for renewal of existing coverage under General Permit NCG500000
Existing Certificate of Coverag, (CoQ: NCG500662
(Press Tab to navigate form)
1) Mailing address of facility owner/operator: (address to which all correspondence should be mailed)
Company Name
Owner Name
Street Address
City
Telephone #
Email Address
High Shoals, LLC
High Shoals, LLC
670 N. Commercial Street, Suite 204
Manchester
State NH ZIP Code 03101 -
978 - 621- 9489 Fax # - -
[e-mail]
2) Location of facility producing discharge:
Facility Name High Shoals Hydroelectric Project
Facility Contact Jeff Shaffner
Street Address River Street Highway 321
City High Shoals State NC
County Gaston
Telephone # 704 - 735 - 2156 Fax # - -
Email Address @
3) Description of Discharge:
a) Is the discharge directly to the receiving stream?
ZIP Code 28077 -
® Yes
❑ No — Please submit a site map with the pathway to the potential receiving waters clearly marked. This
includes tracing the pathway of the storm sewer to the discharge point, if the storm sewer is the only
viable means of discharge.
b) Number of discharge outfalls (ditches, pipes, channels, etc. that convey wastewater from the property): 1
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NCG500000 Renewal Application
c) What type of wastewater is discharged? Indicate which discharge points, if more than one.
® Non -contact cooling water Outfall (s) #: 1
❑ Boiler Blowdown Outfall (s) #: _
❑ Cooling Tower Blowdown Outfall (s) #: _
❑ Condensate Outfall (s) #: _
❑ Other Outfall (s) #: _
(Please describe "Other"):
d) Volume of discharge per each discharge point (in GPD):
#001: 7200 GPD #002: GPD 4003: GPD #004: GPD
4) Please check the type of chemical[s] added to the wastewater for treatment, per each separate discharge
point (if applicable, use separate sheet):
❑ Chlorine ❑ Biocides ❑ Corrosion inhibitors ❑ Algaecide ❑ Other ® None
If M box other than None is checked, a completed Biocide 101 Form and manufacturers' information on the
additive must be submitted to the following address for approval:
NC DENR / DWR / Environmental Sciences Section
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
5) Is there any type of treatment being provided to the wastewater before discharge? (i.e., retention ponds,
settling ponds, etc.)
❑ Yes - Please include design specifics (i.e., design volume, retention time, surface area, etc.) with submittal
package. Existing treatment facilities should be described in detail.
® No
6) Discharge Frequency:
a) The discharge is: ® Continuous ❑ Intermittent ❑ Seasonal
i) If the discharge is intermittent, describe when the discharge will occur:
ii) If seasonal, check the month(s) the discharge occurs:
❑ Jan ❑ Feb ❑ Mar. ❑ Apr ❑ May ❑ Jun ❑ Jul ❑ Aug. ❑ Sept. ❑ Oct. ❑ Nov. ❑ Dec.
b) How many days per week is there a discharge? 7
c) Please check the days discharge occurs: ® Sat. ® Sun. ® Mon. ® Tue. ® Wed. ® Thu. ® Fri.
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NCG500000 Renewal Application
Additional Application Requirements:
The following information must be included in duplicate [original + 1 copy] with this application or it
will be returned as incomplete.
➢ Site map. If the discharge is not directly to a stream, the pathway to the receiving stream must
be clearly indicated. This includes tracing the pathway of a storm sewer to its discharge point.
➢ Authorization for representatives. If this application will be submitted by a consulting
engineer (or engineering firm), include documentation from the Permittee showing that the
consultant submitting, the application has been designated an Authorized Representative of the
applicant, per 15A NCAC 02H .0138(b)(I }.
CERTIFICATION
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: b A TITOJ STAB ICY Title: (Please review LM NCA 2E4.010 a for authorized signing officials)
Click he to i inter a date.
Signature of Applican Date Signed
North Carolina General Statute 143-215.613 provides that:
Any person who knowingly makes any false statement representation, or certification in any application, record,
report, plan, or other document filed or required to be maintained under this Article or a rule implementing this
Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the Commission implementing this
Article, shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars
($10,000). I8 U.S.C. Section 1001 provides a punishment by a fine or imprisonment not more than 5 years, or both,
for a similar offense.
This Notice of Renewal Intent does NOT require a separate fee.
The permitted facility already nays an annual fee for coverage under NCG500000.
Mail the original and one copy of the entire package to:
NC DENR / DWR / Water Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: Charles Weaver
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