NC0055336_Permit issuance_20110719

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 19, 2011
Mr. Alfred Thompson
Camp Carolina
P.O. Box 919
Brevard, North Carolina 28712
Dee Freeman
Secretary
Subject: Issuance of NPDES PERMIT NCO055336
Camp Carolina WWTP, Class 1
Transylvania County
Dear Mr. Thompson:
The Division of Water Quality (the Division) hereby issues the attached NPDES permit for the
subject facility. We issue this permit pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.
Environmental Protection Agency dated October 15, 2007, or as subsequently amended.
We note that you have made no significant changes to your wastewater treatment system since last
renewal. Therefore the Division has made only minor changes to your permit. We have updated
your facility description, your facility map, and added analytical parameters codes to the effluent -
monitoring page for your convenience [see Section A. (I.)].
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable, you have the right to an adjudicatory hearing, upon written request submitted within
thirty (30) days after receiving this letter. Your request must take the form of a written petition
conforming to Chapter 150B of the North Carolina General Statutes, and you must file it with the
office of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699-
6714. Unless such a demand is made, this permit shall be final and binding.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877-623-6748 North Carohna
Internet: www.ncwaterquality.org ���irr�11�
An Equal Opportunity, Affirmative Action Employer

This permit is not transferable except after notifying the Division of Water Quality. The Division
may require permit modification, or revocation and re -issuance. Please note that this permit does
not affect your legal obligation to obtain other permits required by the Division of Water Quality,
the Division of Land Resources, the Coastal Area Management Act, or other federal or local
governments.
If you have questions, or if we can further assist you, please contact Joe Cozporon at
[ o� e.corporon�a;ncdenr.ov] or call [phone].
espectfiilly,
j 2
' oleen H. Sullins �.
Enclosure: NPDES Permit NCO055336 (FINAL)
hc: Central Files
NPDES Program Files
ARO/SWPS, Attn: Roger Edwards
ec: CG&L Attn: Kim Colson
Aquatic Toxicology Unit, Attn: Susan Meadows
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] t Customer Service: 1-877-623-6748
Internet: www.ncwaterquality,org
An Equal Opportunity's Affirmative Action Employer
NorthCarolina
AIMUMll11

Permit NCO055336
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPRES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended,
Alfred Thompson
is hereby authorized to discharge wastewater from a facility located at the
Camp Carolina WWTP
Lambs Creek Road, north of Brevard
Transylvania County
to receiving waters designated as Lambs Creek in the French Broad River Basin in accordance with
effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV
hereof.
This permit shall become effective September 1, 2011.
This permit and authorization to discharge shall expire at midnight on September 30, 2015.
Signed this day July19, 2011.
r
H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO055336
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
Alfred Thompson
is hereby authorized to:
1. continue to operate an existing 0.020 MGD wastewater treatment facility with the following
components:
♦ 25 Septic Tanks / 31,250 gallon capacity
♦ dual dosing tanks
♦ surface sand filter / 15,000 GPD
♦ chlorination/Dechlorination System
♦ cascade aeration
located north of B7evard at the Camp Carolina WWTP on Lambs Creek Road in Transylvania
County, and
2. discharge from said treatment works via Outfall 001, a location specified on the attached map,
into Lambs Creek [stream segment 6-31], a waterbody currently classified C; Trout within
Subbasin 04-03-01 of the French Broad River Basin.

Alfred Thompson -4y -��
Facility
Camp Carolina WWTP Location M
Latitude: N 35' 16' 03" Longitude: W 82° 43' 50" not to scale
Receiving Stream: Lambs Creek [6-31 J Permitted Flow: 0.020 MGD
Drainage Basin: French Broad River Basin Sub -Basin: 04-03-0I NPDESPermitNCO055336
State Grid/USGSQuad: F8SW/ Pisgah Forest Stream Class: C; Trout North
mir. 06010105 Transylvania County

Permit NCO055336
A. (L) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until expiration, the
Permittee is authorized to discharge from Outfall 001. Such discharges shall be limited and monitored
by the Permittee as specified below:
EFFLUENT LIMITS
MONITORING
REQUIREMENTS
Measurement
Sample
Sample
CHARACTERISTICS Monthly Daily
[Parameter Code] Average Maximum
Frequency
Type
Location �
Flow 0.02 MGD
50050
Weekly
Instantaneous
I or E
Total Residual Chlorine
28 µg/L
2/Week
Grab
E
50060
Temperature (°C)
[00010]
Weekly
Grab
E
pH Not < 6.0 nor > 9.0
2/Month
Grab
E
00400 standard units
BOD, 5-day (20°C) 30.0 mg/L
C0310
45.0 mg/L
2/Month
Grab
E
Total Suspended Solids 30.0 mg/L
C0530
45.0 mg/L
2/Month
Grab
E
NH3 as N (Apr 1 — Oct 31) 19.0 mg/L
C0610]
35.0 mg/L
2/Month
Grab
E
NH3 as N (Nov 1 — Mar 31)
C0610
2/Month
Grab
E
Fecal Coliform (geometric mean) 200 / 100 ml
400 / 100 nil
2/Month
Grab
E
31616
Footnotes:
1) E= Effluent; I = Influent
2) Total Residual Chlorine (TRC) - The Division shall consider all effluent TRC values
reported below 501Ag/L to be compliant with this permit. However, the Permittee shall
continue to record and submit all values reported by a North Carolina -certified laboratory
(including field certified), even if these values fall below 50µg/L.
Condition: The Permittee shall discharge no floating solids or foam.

AFFIDAVIT OF PUBLICATION
CLIPPING OF LEGAL ADVERTISING
ATTACHED .HERE ;,.
PUBLIC NOTICE
NORTH CAROLINA
ENVIRONMENTAL
MANAGEMENT
COMMISSION/NPDES
UNIT 1617 MAIL
SERVICE CENTER
RALEIGH, NC
27699-1617
NOTICE OF INTENT
TO ISSUE A NPDES
WASTEWATER
PERMIT
The North Carolina
Environmental Management
Commission proposes to
issue a NPDES wastewater
discharge permit to the per-
son(s) listed below.
Written comments regarding
the proposed permit will be
accepted until 30 days after
the publish date of this
,,cti,e. The Director «#' 0?e
NC Division of Water
Quality (DWQ) may hold a
rublic-hearing should. there
be a significant degree of
public interest. Please mail,
comments and/or informa-
tion requests to DWQ at the
above address. Interested
:,rsons may visit the DWQ
at 512 N. Salisbury Street,
Raleigh, NC to review infor-
mation on file. Additional
information on NPDES per-
mits and this notice may be
found on our website:
iittp://portal .ncdear.org, v v ,
wq/swp/ps/npdes/calendar,
or by calling (919) 807-
A. Dale Owen,15 Adventure
Road, Brevard, Transylvania
County applied to renew per-
mit NCO086223 (Adventure
Village WWTP) discharging
trc,ated wastewater to Peter
Weaver Creek, French
Broad River Basin.
Alfied Thompson, P.O. Box
919, Brevard, Transylvania
County applied to renew per-
mit NCO055336 (Camp
Carolina) discharging treated
domestic wastewater to
Lambs Creek, French Broad
River Basin.
NORTH CAROLINA
TRANSYLVANIA COUNTY
Before the undersigned, a Notary Public of said
County and State, duly commissioned, qualified, and
authorized by law to administer oaths, personally
appeared Sean A. Trapp, who being first duly sworn,
deposes and says: that he is Operations Managger
(Owner, partner, publisher, or other officer or
employee authorized to make this affidavit) of The
Transylvania Times, published, issued, and entered
as second class mail in the Town of Brevard in said
County and State; that he is authorized to make this
affidavit and sworn statement; that the notice or
other legal advertisement, a true copy of which is
attached hereto, was published in The Transylvania
Times on the following dates:
May 30, 2011
and that the said newspaper in which such notice,
paper, document, or legal advertisement was
published was, at the time of each and every such
publication, a newspaper meeting all of the
requirements and qualifications of Section I-597 of
the General Statutes of North Carolina and was
qualified newspaper within the meaning of Section
I-597 of the General Statutes of North Carolina.
This � day of J myte 72011.
" L G T4 '-'
(Signature of person making affidavit)
Sworn to a subscribed before me, this
day of ,GvX�� , 2011.
r
Notary Public
ELINDA M. MCCANTSTARYPUBLIC
lvania County, NCsion Expires 4/27/2013
M05/30/1TC

Ao d�� � �
Corporort, Joe
From: Haynes, Keith
Sent: Tuesday, May 24, 2011 8:43 AM C/
To: Corporon, Joe
Cc: Edwards, Roger
Subject: NC0055336
The subject DRAFT permit appears to be good.
Keith Haynes - Keith. HaynesPncdenr.gov
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Surface Water Protection
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Notice: E-mail correspondence to and from this address may be subject to the NC Public Records Law and may be
disclosed to third parties.

Transylvania County, NC -- Printable Map
Page 1 of 1
Vicinity Map
Transylvania County, NC
Map Legend
❑
Parcels
Parcel Lines
❑
City Limits
13
ETJ
Precincts
Bammo Grove
O
Boyd
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O!Brevar62
finivard
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cedar mou ntain
t)efln`S Rock
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DGJOUG&Ster
OLam
Tomway
OLithe
River
oP*ab
Forest
o
QUONE
ORora
-Ea"oe
$spph w-w h de,.",
Ow
Cmek
Labels: Parcels
Labels: Precincts
DISCLAIMER: The information contained on this page is NOT to be construed or used as a 'legal
description". Map information is believed to be accurate but accuracy is not guaranteed.
Parcels
Pin: 8587-51-4953-000
Deed Book: 142
Owner:
Deed Page: 316
THOMPSON FAMILY INVESTMENTS
LP Sale Inst: WD
PO BOX 919
Sale Imp: I
BREVARD,NC 28712
Zoning:
Sale Date: 200301
Land Value: $1,713,280
Sale Price: $0
Bldg Value: $2,029,880
Acres: 49.469
Year Built: 1990
Heated Sq.Ft.: 7156
XFOB Value: $17,790
Township: 2
Assessed Value: $3,760,950
Legal Address: END OF HIGHWAY # 1359
Other Attributes
at point 885636, 573874
Brevard Zoning:
Zone: General Residential (4)
Brevard Zoning: Map Grid:
Zone: General Residential (4) Tile Name: 858715
http://www.webais.net Anderson & Associates, Inc. http://www.andassoc.com
http://arcims.web9is.net/ne/tansylvania/printable2.asp 7/15/2011

FACT SHEET
FOR COMPLEX -EXPEDITED PE NEWAL
Basic Information
Permit Writer/Date
Joe R. Co G. / 18May2011
Permit Number
NC00
Permittee / Facility
va"ompson
Ca Carolina WWTP, Class I [sand filter]
Tran lvania County
Flow = 0.020 MGD
Regional Office / Contact
ARO / Roger Edwards, Supervisor
no Staff Report to date]
Basin Name/Sub-basin number
French Broad / 04-03-01
Receiving Stream
Lambs Creek [segment 6-33] See note below; see
attached documentation.
Stream Classification in Permit/Verified
C - Trout / Confirmed
Does permit need Daily Max NH3 limits?
No [NH3 is limited; monitored summer & winter.]
Does permit need TRC limits/language?
Yes (updated)
Does permit have toxicity testing?
No
Does permit have Special Conditions?
No
Does permit have instream monitoring?
No
Is the stream impaired [303(d) listed]?
No
Any obvious compliance concerns?
No — see attached BIMS Report
Any permit mods since last permit?
No
Current expiration date
September 30, 2010
New expiration date
September 30, 2015
Comments received on Draft Permit?
BIMS Downloads and Review Results:
• Compliance generally good - BIMS records indicate two frequency violations (NOVs); no limit
violations / no monitoring violations (see attached BIMS compliance database Jan2006-Mar2011).
Frequency NOV occurred first in July 2007 and the second in July 2010. Several other frequency
violations were rendered by DWQ "no action — BPJ."
• Effluent Data — Limit Compliance within the bounds of the permit — no exceedences Jan2006 —
Mar2011 for TRC, TSS, Fecal, NH3 summer, or BOD.
• TOX Summary — WET testing not required — no changes recommended.
• "Lambs vs. Lambo" — Receiving Stream. The USGS Quad Map shows "Camp Carolina" on
Lambo Creek [downstream from Deer Lake; a minor French Broad tributary to the south,
segment 6-33-(2)]. The Permittee confirmed they are located on "Lambs" Creek [plural]
downstream from Simpson Lake, (consistent with DWQ's previous permit); drafted this
renewal using "Lambs Creek," stream segment 6-33.
0 For renewal: updated map; corrected LAT/LONG; added parameter codes to Effluent Table, A. (L).

NC DENR - DIVISON OF WATER QUALITY
.0304 FRENCH BROAD RIVER BASIN
2B .0300
Class
Name of Stream
Description
Class
Date
Index No.
FRENCH BROAD RIVER
From Nicholson Creek to the
B
08/01/02
6-(27)
downstream side of the
mouth of Gash Creek
Nicholson Creek
From source to French Broad
C;Tr
07/01/73
6-28
River
Graham Creek
From source to Nicholson
B;Tr
07/01/73
6-28-1
Creek
Brackens Creek
From source to Graham Creek
C
09/01/74
6-28-1-1
Keystone Camp Branch
From source to Water Supply
C;HQW
08/03/92
6-28-1-2-(1)
Intake
Keystone Camp Branch
From Water Supply Intake to
B
04/01/58
6-28-1-2-(2)
Graham Creek
Norton Creek (Tucker
Creek)
From source to Nicholson
C;Tr
07/01/73
6-28-2
Creek
Brushy Creek (Norton
Creek)
From source to Brevard
C;Tr
08/03/92
6-28-2-1-(1)
Water Supply Intake
Brushy Creek (Norton
Creek)
From Brevard Water Supply
B;Tr
07/01/73
6-28-2-1-(2)
Intake to Norton Creek
Hunts Branch
From source to Norton Creek
C
07/01/73
6-28-2-2
Cateechee Branch
From source to French Broad
B
04/01/58
6-29
River
King Creek
From source to French Broad
C;Tr
08/03/92
6-30
River
Fawn Branch
From source to King Creek
C;Tr
08/03/92
6-30-2
Mine Branch
From source to King Creek
C;Tr
08/03/92
6-30-4
Orchard Branch
From source to King Creek
C;Tr
08/03/92
6-30-5
Long Branch (Tinsley
Creek)
From source to King Creek
C;Tr
07/01/73
6-30-6
(Lake Frances, Siniard Lake)
Lambo Creek
From source to Camp
B;Tr
07/01/73
6-31-(1)
Carolina Dam
�a e�
Williamson Creek From source to French Broad C;Tr,HQW
River
Knob Branch r From source to Williamson C;Tr,HQW
` Creek
Camp Creek ` From source to Williamson C;Tr,HQW
Creek
Lamb Creek (Simpson Lake) From source to French Broad C;Tr
Neil Gap Branch
Soapstone Branch
Allison Creek
Allison Creek
Davidson River
From source to Lamb Creek
From source to Lamb Creek
From source to Camp Straus
Dam
From Camp Straus Dam to
French Broad River
From source to Avery Creek
C;Tr
C;Tr
B;Tr
C;Tr
08/01/90 6-32
08/01/90 6-32-1
08/01/90 6-32-2 /
07/01/73 6-33
07/01/73 6-33-1
07/01/73 6-33-2
07/01/73 6-33-3-(1)
07/01/73 6-33-3-(2)
WS-V,B;Tr,HQW 08/01/02 6-34-(1)
Page 18 of64 2011-05-14 07:18:09

FRENCH BROAD RIVER BASIN
Name of Stream Subbasin Stream Index Number Map Number Class
Kuykendall Branch
FRB02
6-91
E08NW3
C
Kuykendall Creek
FRB01
6-16-9-(0.5)
G07NE3
WS-II;Tr,HQW
Kuykendall Creek
FRB01
6-16-9-(1.5)
G07NE3
WS-II;Tr,HQW,CA
Kyles Creek
Lake Coma
FRB02
FRB02
6-55-11-8
6-61
F09NW9
F08NE2
C;Tr
C
Lake Louise
FRB02
6-87-11
E08NE5
C
Lake McCrady
�f \
FRB02
6-55-4-1
F08SE9
B
Lake Palcoy
G� /
FRB05
5-16-18
E07SW8
C
Lamance Creek
FRB01
6-3-12
G07NW6
C;Tr
Creek (Simpson Lake)
FRB01
6-33 _
F08SW7
C;Tr
_amb
Lambo Creek
FRB01
6-31-(1)
FOBSW7��—T�
ettd5o R-reele
FRB01
6-31- (2)
FOSSWT
L F
Langford Branch
FRB07
7-3-24
D09NE4
C;Tr
Lanning Branch
FRB03
6-34-2-1
F07SE4
B;Tr,HQW
Lanning Mill Creek
FRB02
6-55-11-8-1
F09NW8
C
Laurel Branch
FRB05
5-2-9
F07NWS
WS-III;Tr
Laurel Branch
FRB05
5-27
E06NE9
C
Laurel Branch
FRB05
5-36
E06NE6
C
Laurel Branch
FRB05
5-39
E06NE5
C
Laurel Branch
FRB01
6-3-9
G07NE1
C;Tr
Laurel Branch
FRB02
6-55-11-10
F09SW3
C
Laurel Branch
FRB02
6-57-5
E09SW6
C;Tr
Laurel Branch
FRB02
6-67-4
F08NW3
C;Tr
Laurel Branch
FRB02
6-78-8-(1)
E09SE1
WS-I;HQW
Laurel Branch
FRB02
6-7B-11-16
E09NE7
C
Laurel Branch
FRB04
6-96-16-7
D08SWG
C
Laurel Branch
FRB04
6-101-1
DOBSWB
C
Laurel Branch
FRB06
7-2-52-14
D105W7
C;ORW
Laurel Branch
FRB06
7-2-59-4
C10SE7
C;Tr
Laurel Branch
FRB07
7-3-7
D09SE5
WS-II;HQW
Laurel Branch
FRB07
7-3-10
D09SE2
WS-II;Tr,HQW
Laurel Branch (Laurel Lake)
FRB02
6-78-8-(2)
E09SE1
B;Tr
Laurel Branch (Murr Creek)
FRB01
6-6-6
G08SW1
C;Tr,HQW
Laurel Brook
FRE03
6-54-3-11
FOBSWI
WS-II;Tr,ORW
Laurel Creek
FRB05
5-59-23
E06NE1
C;HQW
Laurel Creek
FRB01
6-38-17
GOSNW6
C;Tr,HQW
Laurel Creek
FRB03
6-54-3-17-5
F08SW2
WS-II;ORW
Laurel Creek
FRB06
7-2-30
D11NW4
C;Tr
Laurel Creek
FRB06
7-2-64-13-5
C10SW3
C;Tr
Laurel Fork
FRB03
6-34-4
F07SE7
B;Tr,HQW
Laurel Fork
FRB02
6-55-11-2
F09NE4
C;Tr
Laurel Fork
FRB02
6-87-4-(1)
E09NW5
WS-I;HQW
Laurel Fork
FRB02
6-67-4-(2)
E09NW5
B;Tr
Leathermans Fork
FRB06
7-2-69-2-1
C09SE3
C;Tr
Leatherwood Branch
FRB05
5-33
E07NW7
C
Leatherwood Branch
FRB05
5-55-3
E06NE1
C;Tr
Leatherwood Branch
FRB05
5-59-21
D06SE7
C;HQW
Ledford Branch
FRE02
6-67-8
FOBNW3
B
Lee Creek
FRB02
6-83
E08SW3
C
Left Fork Beans Creek
FRB06
7-2-64-12-2
C1oSW1
C;Tr
Left Fork Beetree Creek
FRB02
6-78-15-5
E09NW9
WS-I;HQW
Left Fork Cane Creek
FRB06
7-2-59-2
C10SE7
C;Tr
Left Fork North Fork Swannanoa
River
FRB02
6-78-11-6
E09NE4
WS-I;HQW
Page 17 of 34 2011-05-14 07:21:28

CARD
2
P.O. Box 919
Brevard , North Carolina 28712
D
Phone: [phone]
Fax: [phone]
E-Mail: [e-mail]
Website: campcarolina.com
Private Summer Comp for Boys Since 1924.
April 16, 2010
Mr. Charles H. Weaver Jr.
NCDENR/Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh. NC 27699-1617
RE: Renewal Request—NPDES Permit #NC0055336
Dear Mr. Weaver,
Alfred Thompson
Director
Nath Thompson
Director Emeritus
We are requesting a renewal of the above permit. Please find attached our application
for permit renewal and our sludge management plan. There have not been any
changes at our facility since the last permit was issued.
Sincerely,
�homP s n
Dire or/President
rCldl �r MEatl:6L.f
ACCREDITED aaea�,.EB ��
member y. � CAMP
r
American Red Cross i�11le/�CBR r.811►pIRg'4330dHf1011® Participating Program Provider,

Camp Carolina Sludge Management Plan
All septic tanks and dosing tanks are pumped on a regular basis by Houck Pumping and
are hauled to the City of Brevard's Wastewater Treatment Plant. The sand beds are raked
and sand replaced on a regular basis. Old sands and solids are hauled to the county
landfill by camp personnel.
Printed Name
Title
a �i %-`��
l?
Date

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 INCOO 5
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 kLJF:9-5o 1��" ro - PSC)f-�
Facility Name CAM O
Mailing Address PC) V ( q
city
State / Zip Code t�J C
Telephone Number SO q 14
Fax Number () b ZLk 5
e-mail Address `n-�m or&rn C na , Lc)m
2. Location of facility producing disc rge:
Check here if same address as above
Street Address or State Road
city
State / Zip Code
County
3. Operator Information:
PCLjok
C__D M
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 1�_ E� I 'Q 4 fkv C)
Mailing Address a q H I L j_-, P-p jay
city p6N
State / Zip Code rJ G Z0
Telephone Number () �-1 �56 5
Fax Number ( ) g'�� :J,5�35
1 of Z Fnrm_r) f1F1(1R

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 Explain: 5 ki M Mer G0.rn�2{'k Q$ Z-- 517r:� .3`05
r SI�(� -eirm Vtej ht Marc , �- o - �5
Describe the source(s) of wastewater (example: subdivision, mobile ome pJk, whopping centers,
restaurants, etc.):
Su rn mom' cc�r, P f ur"I nn ,SUM ry)e- r
Sham -term VVe'kbhi'
Population served:
S. Type of collection system
Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
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6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s)
Is the outfall equipped with a diffuser? E<Yes ❑ No
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7. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
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8. Frequency of Discharge: ❑ Continuous V Intermittent
If intermittent:
Days per week discharge occurs: Pts©N AFL Duration:V?'�" f'�PPI�tyC 1 ndPcT�L�
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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 ofpaper.
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NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0• C)W MGD
Annual Average daily flow 0 • Q i , MGD (for the previous 3 years)
Maximum daily flow b.0 9 MGD (for the previous 3 years)
11. Is this facility located on ndian country?
❑ Yes No
12. Effluent Data
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.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
30.8
—7, Q
M C i L.
Fecal Coliform
1-2-0
1
4 Z f OO M
Total Suspended Solids
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C.4, 5
N 6'AL
Temperature (Summer)
2_1
I c9
G
Temperature (Winter)
!�
C. NA
o
C�
pH
-7. 0
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13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES tV 00015V&33b Dredge or fill (Section 404 or
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
I certify that I am familiar with the information contained
the best of my l5nowledge and belief such information is true
Printed name of Person Signing title
Signa
t
Date
Permit Number
in the application and that to
complete, and accurate.
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No Carolin eneral Statute r�'43-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, cord, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
CommissiV implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required t 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.)
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