NC0030996_Permit Issuance_20091215

WDES DOCYNEm,r SCANNING COVER SHEET
NPDES
Permit:
NC0030996
The Switzerland Inn WWTP
Permit Issuance
Document
Type:
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Correspondence
Instream Assessment (67b)
Speculative Limits
Environmental Assessment (EA)
Docu
ent Date:
December 15, 2009
This dociiinexxt is printed on reuse paper - ignore a l y
content on the resrerse side

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 15, 2009
Mr. Gary Jensen
The Switzerland Inn
P.O. Box 399
Little Switzerland, N.C. 28749-0399
Subject: Issuance of NPDES Permit NCO030996
The Switzerland Inn WWTP
McDowell County
Dear Mr. Jensen:
Division personnel have reviewed and approved your application for renewal of the
subject permit. Accordingly, we are forwarding the attached NPDES discharge permit.
This permit is issued 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).
This !final permit includes the following changes from the draft permit sent
to you on October 7, 2009:
➢ As you requested, Temperature monitoring has been changed to 2/Week.
The Division cannot grant your request to remove the whole effluent toxicity (WET)
test from the permit. In 1991, WET testing was chosen by your facility instead of effluent
ammonia limits. Given the seasonal nature of your facility's operation, your sampling and
analysis cosis may be lower with the WET test.
If an'r parts, measurement frequencies or sampling requirements contained in this
permit are acceptable to you, you have the right to an adjudicatory hearing upon written
request witl in thirty (30) days following receipt of this letter. This request must be in the
form of a itten petition, conforming to Chapter 150B of the North Carolina General
Statutes, ar d filed with the Office of Administrative Hearings (6714 Mail Service Center,
Raleigh, No h Carolina 27699-6714). Unless such demand is made, this decision shall be
final and binding.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer — 50% Recycledh0% Post Consumer Paper
N�orthCarolina
Natjiiiilt�

Please note that this permit is not transferable except after notice to the Division.
The Division may require modification or revocation and reissuance of the permit. This
permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Water Quality or permits required by the Division of Land
Resources, the Coastal Area Management Act or any other Federal or Local governmental
permit that may be required.
If you have any questions concerning this permit, please contact Charles Weaver at
telephone number [phone].
Si erely,
een H. Sullins
cc: Central Files
Asheville Regional Office/Surface Water Protection
NPDES Unit

Permit NCO030996
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
In compliance witl�I the provision 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,
Gary Jensen
is hereby authorized to discharge treated domestic wastewater from a facility located at
The Switzerland Inn
86 High Ridge Road
Little Switzerland
McDowell County
to receiving waters designated as an unnamed tributary to Buchanan Creek in the Catawba 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 January 1, 2010.
i
This permit and authorization to discharge shall expire at midnight on December 31, 2014.
Signed this day E ecember 15, 2009
i/� i�MlsaVi�Y� V� Y�V L�«�iL VLiL11VLf VNi 1.aNafM�ValfVf�Y VVilYiiaV VaVaf

Permit NCO030996
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked. As of this
permit 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.
Gary Jensen is hereby authorized to:
1. Continue operation of a 0.01 MGD wastewater treatment plant consisting of the following
treatment units:
• Two grease traps [2500 gallons each]
• Septic tank [10,000 gallons]
• Dosing tank [2500 gallons]
• Surface sand filter
• Tablet chlorination & dechlorination
The facility is located near Little Switzerland on High Ridge Road at The Switzerland Inn in
McDowell County.
2. Discharge treated wastewater from said treatment works at the location specified on the attached
map through outfall 001 into an unnamed tributary to Buchanan Creek, currently classified C-HQW
waters in Hydrologic Unit 03050101 in the Catawba River Basin.

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NCO030996 - The Switzerland Inn
Latitude: 350 50' 56" Longitude: 820 05' 23"
uad #: Little Switzerland, N.C.
Stream Class: C-HQW
Receiving Stream: Unnamed Tributary to Buchanan Creek
Sub -Basin: 03-08-30 Hydrologic Unit Code: 03050101
Facility
Location =:,w i,
• � r���,l/� McDowell County
[map not to scale]

Permit NCO030996
A. (1) 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 treated wastewater from outfall 001. Such discharges shall be limited and monitored by the
Permittee as specified below:
Parameter
Limits
Monitoring R
uirements
Monthly Average
Daily Maximum
Measurement
Frequencl
Sample Type
Sample Locationl
Flow
0.01 MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5-day, 200C
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NHA
2/Month
Grab
Effluent
Fecal Coliform
200/ 100ml
400/ 100ml
2/Month
Grab
Effluent
Dissolved Oxygen
Minimum daily average > 5.0 mg/L
Weekly
Grab
Effluent
Dissolved Oxygen
Weekly
Grab
Upstream & Downstream
Temperature
2/Week
Grab
Effluent
Temperature
Weekly
Grab
Upstream & Downstream
Total Residual Chlorine
TRC 2
17 jrg/L
2/Week
Grab
Effluent
Chronic Toxicity3
Quarterly
Grab
Effluent
pH
> 6.0 and < 9.0 standard units
2/Month
Grab
Effluent
Footnotes:
1. Upstream = at least 100 feet upstream from the outfall. Downstream = at least 300 feet downstream from the
outfall.
2. The facility shall report all effluent TRC values reported by a NC certified laboratory including field certified.
However, effluent values below 50 µg/1 will be treated as zero for compliance purposes.
3. Chronic Toxicity (Ceriodaphnia) at 90%: March, June, September, December (see A. (2)).
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NC0030996
A. (2) CHRONIC TOXICITY PERMIT LIMIT (Quarterly)
The effluent disch' ge shall at no time exhibit observable inhibition of reproduction or significant mortality
to Ceriodaphnia dbia at an effluent concentration of 90%.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the
"North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent
versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February
1998) or subsequent versions. The tests will be performed during the months of March, June, September and
December. Effluent sampling for this testing shall be performed at the NPDES permitted final effluent
discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a -failure or ChV below the
permit limit, then! multiple -concentration testing shall be performed at a minimum, in each of the two
following months as described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure"
(Revised -February 1998) or subsequent versions.
The chronic value ' for multiple concentration tests will be determined using the geometric mean of the
highest concentration having no detectable impairment of reproduction or survival and the lowest
concentration that does have a detectable impairment of reproduction or survival. The definition of
"detectable impai�ment," collection methods, exposure regimes, and further statistical methods are specified
in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998) or
subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge
Monitoring Form (MR-1) for the months in which tests were performed, using the parameter code TGP3B for
the pass/fail results and THP3B for the Chronic Value. Additionally, DWQ Form AT-3 (original) is to be sent
to the following address:
Attention: NC DENR / DWQ / Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Branch no later than
30 days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all
concentration/response data, and be certified by laboratory supervisor and ORC or approved designate
signature. Total residual chlorine of the effluent toxicity sample must be measured and reported if chlorine
is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is
required, the perinittee will complete the information located at the top of the aquatic toxicity (AT) test form
indicating the facility name, permit number, pipe number, county, and the month/year of the report with the
notation of "No F}ow" in the comment area of the form. The report shall be submitted to the Environmental
Sciences Branch at the address cited above.
Should the permi,ttee fail to monitor during a month in which toxicity monitoring is required, monitoring
will be required during the following month.
Should any test data from this monitoring requirement or tests performed by the North Carolina Division of
Water Quality indicate potential impacts to the receiving stream, this permit may be re -opened and modified
to include alternate monitoring requirements or limits:
If the Permittee onitors any pollutant more frequently than required by this permit, the results of such
monitoring shall a included in the calculation and reporting of the data submitted on the DMR and all AT
Forms submitted.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism
survival, minimum control organism reproduction, and appropriate environmental controls, shall constitute an invalid
test and will require immediate follow-up testing to be completed no later than the last day of the month following the
month of the initial monitoring.

Weaver, Charles
From:
Giorgino, John
Sent:
Friday, November 20, 2009 10:43 AM
To:
Meadows, Susan; Weaver, Charles
Cc:
Moore, Cindy
Subject:
RE: NC0030996 - Switzerland Inn
I don't understand how it will save the facility money? If there is no flow, they simply report as such on their DMR and
AT form. What if there is flow at some point? No, I think the permit requirements should remain. We have had a lot of
reporting issues with them in the past, and it took some time for them to get the message.
-john
John Giorgino
Environmental Biologist
North Carolina Division of Water Quality
Environmental Sciences Section
Aquatic Toxicology Unit
Mailing Address:
1621 MSC
Raleigh, NC 27699-1621
Office: 919 743-8441
Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
From: Meadows, Susan
Sent: Friday, November 20, 2009 10:31 AM
To: Giorgino, John
Subject: FW: NC0030996 - Switzerland Inn
Hey John,
What's your thought on this?
Susie
Susan Meadows, Environmental Biologist
Aquatic Toxicology Unit
DWQ/Environmental Sciences Section
4401 Reedy Creek Road Raleigh, NC 27607
[e-mail]
t: [phone]
f: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.

From: Weaver, Charles' -
Sei t: Friday, November 20, 2009 9:39 AM
To: Meadows, Susan
Cc: Cantwell, Janet
Subject: NCO030996 - Switzerland Inn
The permittee is requesting a change in their toxicity monitoring.
The facility is open ca. 6 months each year. The permittee would like to reduce the number of monitoring events in
order to save money.
Would the ESS agree to maintaining the existing tests, with sampling in June and September only?
The facility has passed all tox tests since 2005. Would annual monitoring be considered, given the excellent compliance
record?
Let me know — and thapks for your help.
CHW
Messages to and from this address are subject to the N.C. Public Records law.
2

Weaver, Charles
From: gary [[e-mail]]
Sent: Monday, November 02, 2009 9:14 AM
To: Weaver, Charles
Cc: [e-mail]
Subject: nc 0030996 permit renewal
Charles, following are a few request I have concerning the pennit renewal. Do I need to mail a hard copy of
this?
'ems, Gary
Charles Weaver
1617 Mail Service Center
Raleigh, NC 27604
RE: Switzerland inn Permit Renewal (NC0030996)
Charles,
I have received the renewal permit for the Switzerland Inn and have a few request I
would like you to consider.
1. I am requesting the daily temperature requirement be reduced to two times per
week, since that Is how many times our operator visits and takes samples. This would
eliminate the need for our staff to do this each and every day
2. I am requesting the toxicity testing requirement be removed from our permit, we
have passed all test for three consecutive years at a 90% requirement, and the test is
quite expensive. If this can not be removed completely, maybe one per season would be

adequate. We are only open six months per year, so currently we have two tests during
our operating season.
Thank you for considering these requests, The Inn is closing this week, so I can be
reached via email or cell phone if you have any questions.
Gary Jensen
[e-mail]
800-654-4026 (office)
828-467-0629 (cell)
cc: Ken Deaver (operator)
Kace Environmental
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below.
wrlken
Before the undersigned, a Notary Public of said County and
comments regebb9 the
emit will bn acceptetl until 3o days ektt the p b
Its date of tnis notice The Director of N N°
State, duly commissioned, qualified and authorized by law
ON Sion of'Water Oualily (�w9) andyy Iptdla
public hearinn shoulfBl there a si niRunl de•
gree of pphfiq bterosk Please mat ggmmrnN
to administer oaths, personally appeared Elyse Giannetti,
a Inbrmation requests to DWQ at the
t UWp it 5u „". saIi. °i,5 kph°„�
who, being first duly swom, deposes and says: that she is
b review inbmwtlon on file, A is root inbry
anIm
b on °our °` this rptlee and
the Legal Billing Clerk of The Asheville Citizen -Times,
nE" e"°b'siteand
ryary, or by cdlfirig8gT4tlwwwncwaterqualZ
Doorier
engaged in publication of a newspaper known as The
Mana mark Inc
NCD68)i51 requested renewal of
County. "s "tacility"`'vet, ror 'E¢d�A.;l
Iischame teatM
Asheville Citizen -Times, published, issued, and entered as
wastewater to the LIrAilc Giver in Me Catawba River BasiD Tebl resltlual
chlorine is water quality limkel
first class mail in the City of Asheville, in said County and
Columbia Forest Plvw° protlucts uested
70
renewal of NCDs to for its facility In Mclbw-
ell County. This fadlitvl
State; that she is authorized to make this affidavit and
tlir I es wetdecking
runoff te the CaUwbe River in t e Catawba Riv-
`rc s'D
McDowell Assistetl
sworn statement; that the notice or other legal
LHinu, LLC requested re-
newal 353 br rts WWlp ,n
. Facll McDowell
Daunts. EacDiry dischages treated „astewa-
ter to North
advertisement, a true copy of which is attached hereto, was
Muddy Creek in the Catawba River
u�°hchbdries to v'wliry hmhe4 '°""�'"-
published in The Asheville Citizen -Times on the
NC`W°JSw131"B �Mt Enty lODJer'Ontary°P55'ed I�W`lvTg
Facility dlu�ra!9CS treated wastewa b
following date: October 9th , 2009. And that the said
r an
t a ba fiver BA :° Sheddck Dr M`1 in the
Gtavwba River Bashi, ROD, ammonN
newspaper in which said notice, paper, document or legal
P P g
I ni
I celifonn and total residual chbdlr%-
waterquality limited
advertisement was published was, at the time of each and
McDowell County Adult Care 1, LLC mq ue�sled
renewal of It 36 I15T c"edarbmgk"By;yTPtt
Mcooweil County, Facility discharges tma4d
every publication, a newspaper meeting all of the
eddy m° e � 4� the m� a7yer B1a,le
ROD,
requirements and qualifications of Section 1-597 of the
ammonia nitrogen, feral mlilorm antl to. Ire, on
^ary
General Statues of North Carolina and was a qualified
Jenmsen 'requested renewal of Ictir, ,,,
iThe Switity diS Inn a, treated a waste N ;n
Facility discharges treated wastewater
newspaper within the meaning of Section 1-597 of the
n ,, to
m unnamed tributary to Buchanan Leek In M.
:am a River BasiKK curreMt!y BDD, real rot-
brm and total Id,e� ., _ _
General Statues of North Carolina.
Sworn
2009✓
My
Signed this 9th day of October, 2009
and subscribed before me the 9th day of October,
expires the 5 h day of October, 2013
[phone] 1 [phone] FAX
14 O. HENRY AVE. I P.O. BOX 2090 1 ASHEVILLE, NC 28802 ) [phone]
C)GANWff

Weaver, Charles
From:
Cantwell, Janet
Sent:
Monday, September 28, 2009 12:00 PM
To:
Weaver, Charles
Cc:
Edwards, Roger
Subject:
Draft NC0030996: Switzerland Inn, McDowell County
Charles ---I have reviewed the draft permit and see nothing which should prevent reissuance.
Thanks ---Janet
Janet [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 US Highway 70
Swannanoa, NC 28778-8211
Tel: [phone]
Fax: [phone]
Link to "Guidebook to Water Quality Management in North Carolina":
http://h2o.enr.state.nc.us/basinwide/documents/Su pportDocument.pdf
Link to the NC Division of Water Quality:
http://www.ncwaterguality.org/
Link to NPDES Programs & Compliance Info: (DMRs, Annual Report, Etc.):
http://h2o.enr.state.nc.us/NPDES/
Link to Technical Assistance & Compliance Unit, WW Operator Regs, Etc.:
http://h2o.enr.state.nc.us/tacu/index.htmi
Link to Collection Systems (PERCS Unit):
htt : /www.ncwaterguality.org/peres/Collection%20SVstems/CollectionSystemsHome.html
Link to NC Surface Waters & Wetlands Standards ("Redbook"):
http://h2o.enr.state.nc.us/admin/ruies/codes statutes.htm
Link to NC Stream Classifications:
http://h2o.enr.state.nc.us./bims/reports/reportsWB.html
Link to Water Supply Watershed Info:
http://h2o.enr.state.nc.us/wswpZindex.html
Link to booklet "Guidelines for Riparian Buffer Restoration:"
http://www.nceep.net/services/guidancedoc.htm
Link to Stormwater, General Permits, & Runoff Pollution:
http://h2o.enr.state.nc.us/Stormwater.htmi
how://h2o.enr.state.nc.us/su/Forms Documents.htm#stormwaterGP

Weaver, Charles
From: Pugh, James L.
Sent: Tuesday, September 22, 2009 9:14 AM
To: Weaver, Charles
Subject: RE: DRAFT permit NCO030996
Nothing in the draft will cause the classification of the system to change.
James
***Please note new email address: [e-mail]***
James L. Pugh, Ex�ension Education & Training Specialist
NCDWQ, Technical Assistance and Certification Unit
1618 Mail Service Center
Raleigh, NC 27699,1618
[phone] x341
[phone] Fait
[e-mail]
http://h2o.enr.state.nc.us/tacu/
E-mail correspondence to and from this address may be subject to the North Carolina
Public Records Law and may be disclosed to third parties.
From: Weaver, Charles
Sent: Tuesday, September 15, 2009 10:52 AM
To: Meadows, Susan; Haynes, Keith; Pugh, James L.
Subject: DRAFT permit NCO030996
This is a class WW-1 facility in McDowell County.
This permit will be sent to Public Notice on September 30`h; please send me yor comments by that date.
Thanks,
CHW
Messages to and from this address are subject to the N.C. Public Records law.

-
CHALET RESTAURANT
6/9/09
Mrs. Donna Sprinkle
NC DENR / DWQ / Point Source Branch
1617 Mai] Service Center
Raleigh, NC 27699-1617
Jli;; 1 5 "509
DENR - WATER QUALITY
POINT SOURCE BRANCH
Mrs. Sprinkle,
I am requesting renewal of permit member 0030996 for the Switzerland Inn. Our
business, as,asummer resort, has remained the same•as has our wastewater plant since
the last renewal. Enclosed is the application, please let me know if anything further is
needed.
Thanks
Gary s
Owner / Switzerland Inn
P.O. Box 399 • Little Switzerland • North Carolina 28749 828-765-2153 • 1-800-654-4026 • www.switzeriandinn.com

KL 19ii
ell
✓ R�,�.F,
.,' CHALET RESTAURANT
6/9/09
Sludge Management Plan
Switzerland INN
Dear sirs or Madam,
The Switzerland Inn consist of 72 guest rooms, 200 seat restaurant and bar, and.small out
parcel or shopping area. We have been in business since 1910 as a "seasonal summer
resort on the Blue Ridge Parkway. Our sewer facilities are a combination of sub surface
drain fields and small sand filter wastewater plant. Oar sand filter treatment plant does
not produce any sludge; we do have our grease traps pumped monthly and our septic tank
annually.
.. >i # fir.
Thank ypu; y
P.O. Box 399 a Little Switzerland • North Carolina 2874.9 • 828-765-2153 • 1-800-6544026 www.swilzerlandinn.com

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 NC00.joqdj
If you are comp'ng this form in computer use the TAB key or the up - down arrows to move from one
,field to the next. o check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
i
Owner Name
Facility Name
Mailing Address
City U wy t C,," : ne r la IN1
State / Zip Code " `
Telephone Numb r 164:; -
Fax Number (fig) �6� _ Q � Lj C l
e-mail Address t ter i • GOM
I
I
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road
City wQ 2N-7g•r
State / Zip Codei ,N C- ;;La n �g
County M�"t�lowE
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 k&c a En&: f a�MfnV • i
Mailing Address
City
State / Zip Code f\)C �q
Telephone Number 6s t)� 1$
Fax Number I ( j
�� 645+) ON, Lt 6 btu
1 of 3 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Gen_ eratinLy Wastewater(check all that apply):
Industrial !
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students Staff
Other
(
Explain: uo�t
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Population serve
S. Type of colt ction system
[Separate (sanitary sewer only) ❑ Combined � (storm sewer and sanitary sewer
� �'y )
6. Outfall Information:
Number of s parate discharge points
Outfall Iden cation number(s) .I
—
Is the outfaU equipped with a diffuser? ❑ Yes
?. Name of rece
❑ No
stream(s) (Provide a map shouring the exact location of each outfallk.
e
S. Frequency of Discharge: ❑ Continuous 3100 Intermittent
If intermittent:
Days r week discharge occurs:
y per g 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 suffiicient, attach the description of the treatment system in a
separate sheet of paper.
o t J►o �, � rr-�+ �t .. a �� eA � tons
CA CC1o�
�`a�a♦ca 4, -e
2 of 3 Form-D 05/08

OP r
. NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow, • 0 MGD
Annual Average daily flow MGD (for the previous 3 years)
Ma2dmum daily flow - MGD (for the previous 3 years)
11. Is this facili located on ;pNo
an country?
Yes
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.
Biochemical O*en Demand (BODs)
Fecal Coliform
Total Suspended; Solids
Temperature (Summer)
Temperature (Winter)
pH
Daily
Maximum
Monthly
Average
Units of
Measurement
Li5
"%o I %mo M I
�+�► M
M 1
Lis
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 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICA
TION
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.
Printed name q Person Signing
of
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, reporM 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 Farm-D 05108