NCG500198_Renewal application_20200713

A74LA.
NCDENR
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 NCAC 02H .0127(d)]; [term definition see 15A NCAC 02H .0103(19)]
Application for renewal of existing coverage under General Permit NCG500000
Existing Certificate of Coverage (CoQ: NCG500000
(Press Tab to navigate form)
1) Mailing address of facility owner/operator: (address to which all correspondence should be mailed)
Company Name
Owner Name Holston Environmental Services, Inc.
Street Address 1000 Business Park Drive
City Chattanooga State TN ZIP Code 37419 -
Telephone # 423 - 899 - 7300 Fax # 423 - 899 - 7373
Email Address [e-mail]
2) Location of facility producing discharge:
Facility Name Holston Environmental Services, Inc.
Facility Contact Effrem Creasman
Street Address 19119 Great Smoky Mountain Expressway
City Waynesville State NC
County Haywood
Telephone # 828 - 452 - 2836 Fax # 0 - -
Email Address @
3) Description of Discharge:
a) Is the discharge directly to the receiving stream?
ZIP Code 28786 -
® 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): 3
Page 1 of 3

NCG500000 Renewal Application
c) What type of wastewater is discharged? Indicate which discharge points, if more than one.
® Non -contact cooling water
❑ Boiler Blowdown
❑ Cooling Tower Blowdown
❑ Condensate
❑ Other
(Please describe "Other"): _
Outfall (s) #: I
Outfall (s) #:
Outfall (s) #:
OutfalI (s) #:
Outfall (s) #:
d) Volume of discharge per each discharge point (in GPD):
#001: 175000 GPD #002: GPD #003: 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 gLny 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,
settlingponds, 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? 5
c) Please check the days discharge occurs: ❑ Sat. ❑ Sun. ® Mon. ® Tue. ® Wed. ® Thu. ® Fri.
Page 2 of 3

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)(1.1.
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: John Williams Title: President
(Please review 15A NCAC 02H .0106(e) for authorized signing officials)
of Applicant
North Carolina General Statute & 143-215.613 provides that:
July 13, 2020
Date Signed
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). 18 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 pays 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
Page 3 of 3