NC0040045_Permit Issuance_20040713

NPDES DOCUMENT :SCANNING% COVER SHEET
NPDES Permit:
NC0040045
Bill's Truck Stop WWTP
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
Staff Report
Instream Assessment (67b)
Speculative Limits
Environmental Assessment (EA)
Document Date:
July 13, 2004
'Miss document its printed on reuase paper - ignore any
content on the reYerBe aside

Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
July 13, 2004
Mr. Robert Walser
BiIl's Truck Stop
1210 Snider Kines Road
Linwood, North Carolina 27299
Subject: NPDES Permit Issuance
Permit Number NC0040045
Bill's Truck Stop
Davidson County
Dear Mr. Walser:
Division personnel have reviewed and approved your application for renewal of the subject
permit. Accordingly, we are forwarding the attached final 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 May 9,
1994 (or as subsequently amended).
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty
(30) days following receipt of this letter. This request must be in the form of a written petition,
conforming to Chapter 150B of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings (6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such
demand is made, this permit shall be final and binding.
Please take notice that this permit is not transferable. 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, Coastal Area Management Act, or any other Federal or
Local governmental permits which may be required.
If you have any questions or need additional information, please do not hesitate to contact Dave
Goodrich of my staff at [phone], extension 517.
Sincerely,
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E.
cc: Central Files
NPDES Unit Files 8
Winston-Salem Regional Office
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1617 - TELEPHONE [phone]/FAX [phone]
VISIT US ON THE WEB AT http://h2o.enr.stote.nc.us/NPDES

Permit NC0040045
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
it
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
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,
Robert Walser
is hereby authorized to discharge wastewater from a facility located at
Bill's Truck Stop
1210 Snider Kines Road
Linwood
Davidson County
to receiving waters designated as South Potts Creek in the Yadkin -Pee Dee River Basin in accordance
with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, and
IV hereof.
The permit shall ibecome effective August 1, 2004.
This permit andthe authorization to discharge shall expire at midnight on May 31, 2009.
Signed this day July 13, 2004.
ORIGINAL SIGNED BY
Mark McIntire
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0040045
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.
Robert Walser
is hereby authorized to:
1. Continue to operate an existing 0.006 MGD wastewater treatment plant consisting of:
• grease traps
• 15,680 gallon septic tank
• a 4,000 gallon recirculating dosing tank with dual 88.5 GPM pumps
• a 40 foot by 50 foot recirculating surface sand filter
• tablet chlorinator
• contact chamber
• flow measure device
located at Bill's Truck Stop, 1210 Snider Kines Road, Davidson County, and
2. Discharge from said treatment works at the location specified on the attached map into the South
Potts Creek, which is classified C waters in the Yadkin -Pee Dee River Basin.

Lynwood—Southmont Road
Bill's Truck
Latitude: 35° 44' 59" N Longitude: 80° 21' 12" W
Stream Class: C Receiving Stream South Potts Creek
Sub -Basin: 03-07-04 State Grid/ USGS Quad: E 17 NE/Southmont, N.C.
Drainage Basin: Yadkin -- Pee Dee Permitted Flow: 0.006 MGD
Facility
Location
not to scale
x
North
NPDES Permit NC 004004,5
Davidson County

Permit NC0040045
Part 1. Section A
1. EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until permit expiration, the Permittee is authorized to discharge from
Outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below:
PARAMETER
EFFLUENT LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Weekly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location'
Flow (MGD)
0.006
Continuous
Recording
I or E
BODS
30.0 mg/L
45.0 mg/L
2/month
Grab
E
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/month
Grab
E
NH9 N
Monitor & Report
2/month
Grab
E
Oil and Grease
Fecal Coliform
Monitor
& Report
400/100 ml
Quarterly
2/month
Grab
E
E
200/100 ml
Grab
Total Residual Chlorine2
Temperature
Monitor
28 ug/L
E j
& Report
2/Week
Daily
Grab
E
Grab
E
Total Nitrogen
(TKN + NO, + NO,)
Monitor & Report
Quarterly
Grab
E
Total Phosphorus
Monitor & Report
Quarterly
Grab
E
pH
Between 6.0 and 9.0 Standard Units
2/month
Grab
E
Notes:
1 E - Effluent, I — Influent
2 The limit for total residual chlorine will take effect 18 months after the effective date of the final permit.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.

NORTH CAROLINA
FORSYTH COUNTY
This 19th day of April, 2004
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified, and authorized by law to administer oaths, personally
appeared D.H. Stanfield, who being duly sworn, deposes and says: that he is
Controller of the Winston-Salem Journal, engaged in the publishing of a newspaper
known as Winston-Salem Journal, published, issued and entered. as second class mail
in the City of Winston-Salem, 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 Winston-Salem Journal on
the following dates:
April 17, 2004
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 the requirements and qualifications of Section 1-597 of the
General Statues of North Carolina and was a qualified newspaper within the meaning
of Section 1-597 of the general statues of North Carolina.
its►-tta
(signature of perso
1
aking affidavit)
Sworn to and subscribed before me, this 19th day of Apt 2004
Sorry County
1. The Yoce, Inc (P.O. Box 78, White PLains, NC 27031) has applied for re-
newal of NPOES permit N00061808 for the Neighbors Fuel Cerrter #12
in Suny County. This permitted facility dischtarges treated wastewater to
the Lille Fisher River in theYadldn-Pee Dee River Bash. Currently BOD,
total suspended solids, oil and grease, and total residual chlorine are
water quaky limited. This discharge may affect future afocations in this
portion of the Yadkin -Pee Dee River Basin. -y
NC Department of Transportation (1557 MiI Service Center, Raleigh.
NC 27699) has applied for renewal of NPDES permit NC0029190 for the
the Sony County Rest Area. This permitted facility discharges 0.030
MGD of heated wasewater to Naked Run in the Yadkin -Pee Dee River
Baser. Currently B00 and total residual chlorine are waterquaity lirnitpd.
This discharge may affect future afiocatior in this portion of the Yadkin -
Pee Dee River Basin. G{}W
The Surry County Board of Education [P.O. tax 364, Dobson, NC
27017] has applied for renewal of NPDES permit NC0041947 for the
North Stay High School WWTP. This permitted facifttyy discharges treat-
ed domestic wastewater to Stewarts Creek in the Yadk n-Pee Dee River
Baser. Currently fecal conform and Iota! residual chlorine eremite( quail-
ty limited. This discharge may affect future Nlocations in this portion of
awaits Creek. !
Virginia DOT (1401 East road'btreet, Richmond VA, 23219) has ap-'
peed for renewal of NPDES permit NC0t339420 for the 1-77 Rest Area
WWTP in Forsyth County. This permitted facility discharges 0.020 MGD
of treated wastewater to Naked Run in the Yadkin -Pee Dee Fever Basin.
Currently BOD, ammonia nitrogen and total residual chlorine are water
quality limited. This discharge may affect future allocations in this portion
of the Yadkirr-Pee Dee River Basin. /� �r�/
The Sony County Board of EducoHglf P.O. Box 364, Dobson, NC
27017] has applied for renewal of NPDES permit NC0041904 for the Flat
Rock Elementary School WWTP. This permitted facility discharges treat-
ed domestic wastewater to an unnamed tributary to Champ Creek in Ilia
Yadkin -Pee Dee River Basin. Currently fecal conform is water quality lim-
ited. This discharge may affect haute allocations in this portion of Champ
Creek.
Wilkes County
The Roaring Gap Club, Inc (P.O. Box 129, Roaring Gap, NC 28668) has
applied for renewal of NPDES permit NC0098991 for the Roaring Gap
Club in Wilkes County. This permitted facility discharges treated waste -
Water to Doe unnamed tributary to the Mitchell River in the Yadkin -Pee
Dee River Basin. Currently BOD, total suspended solids, and total resid-
ual chlorite are water quality limited. This discharge may affect future al-
tocatiorts in this portion of the Yadkin -Pee Dee River Basin.
3G
AL
,N
)F
Notary lic
• Forsyth County
Head Mob r ome Park, has applied for renewal of its NPDES permit
NC0057223. The permitted facility discharges treated wastewater to an
- untamed tributary to Little Creek in the Yadkin -Pee Dee River Basin.
r Currently 13005, Ammonia as Nitrogen, Total Residual Cteorine, Total
Suspended Solids and Fecal Colifonn are water quaky limited. This Os -
charge may affect future allocations in this portion of Lade Creek
The Healer Utilities, Inc (P.O. Drawer 4889, Cary, NC 275(9,
phed tor renewal o1 NPDES permit NC0084409 for the Wellesley Place
WWTP in Forsyth County'. This permitted facility discharges treated
wastewater to the Mill Creek in the Yadkin -Pee Dee River Basin. Current-
ly BOD, total suspended solids, ammonia nitrogen and total residual
chlorine are water quality limited. This discharge may affect future alloca-
tions in this portion of the Yadkin -Pee Dee River Basin. (�
Scarlet Acres Mobile Home Subdivision, has applied for rreedu of its
NPDES permit NC0061204. The permitted facility discharges treated
SI wastewater to an unnamed tributary to Mill Creek in the Yedkin-Pee Dee
River Basin. Currently BOD5, Ammonia as Nieuwe, Total Residual
Olt Chlorine, Total Suspended Solids, and Fecal Coiitorm are water quaFN
FO limited. This discharge may affect future allocations in this portion of AM1I,
Creek. {{�
OH High Point Healtht3je Center, has applied for -renewal of its NPDES
permit NC0046035. The permitted facility discharges treated wastewater.
to Rich Fork in the Yadkin -Pee Dee River Basic. Currently I8005. Ammo-
ria as Nitrogen and total residual chlorine are water quaky limited. This_
discharge may affect future allocations in this portion of Rich Fork.
Lucent Technologies (3370 Lexington Rd, Winston-Salem, NC 27107Y
has applied for renewal of NPDESSpermit NC0080853 for the Salem
Business Park groundwater rem ediation she in Forsyth County. This per-
muted facility discharges 0.301 MGD of treated wastewater to Salem
Creek in the Yadkin -Pee Dee River Basin. Currently no parameters are
water quaky limited. This discharge may affect futur allocations in the
portion of the Yadkin -Pee Dee River Basin, ^T ,L,--(1401
The Winston-Salem / Forsyth County Board of Education [4897 Lan-
sing Drive, Winston-Salem, NC 271051 has applied for renewal of
NPDES permit NC0034827 for the Old Rot nand Elementary School.
TTtis permitted facility discharges treated domestic wastewater to an un-
named tributary to Fries Creek in the Yadkin -Pee Dee River Basin. Cur-
l' ammonia nitrogen and fecal coirtorm are water quality limited. This
d" 1.W Daviayadfect ffutureallocatio
eCnsouin this portion of Fries Creek.
m1 nty -
The Davie County Board of Education [220 Cherry Street, Mocksville,
NC 27028] has opened for renewal of NPOES permit N00033162 for the
Wilfiam R. Davie Elementary School: This permitted facility dsct es
treated domesticwastewaterlo an unnamed tributary to Greasy in
the Yadkin -Pee Dee River Basin. Currently BOO, ammonia nitrogen and
fecal conform are water quality limited. This discharge may affect future
allocations in this portion of Greasy Creek.
WSJ: April 17, 2004
PUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION/NPDES UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
NOTIFICATION OF INTENT TO ISSUE
A NPDES WASTEWATER PERMIT
0n the basis of th orcugh staff review and application of NC General Stat-
ute 143.21, Public law 92-500 and other lawful standards and regula-
tions, the North Carolina Environmental Management Commisson pro-
poses to issue a National Pollutant Discharge Elimination System
(NPOES) wastewater discharge permit to the person(s) listed below ef-
fective 45 days from the pubfsh date of this notice.
Written comments regarding the proposed permit will be accepted until
30 days after the publish date of this notice. All comments received prior
to that date areconsidered in the final determinations regarding the pro-
posed permit. The Director of the NC Division of Water Quality may de-
cide to hold a public meeting for the proposed permit should the Division
receive a significant degree of public interest.
Copies of the draft permit and other supporting information on tie used
to determine conditions present in the draft permit are available upon re-
quest and payment of the costs of reproduction. Mad comments and/or 1
requests for information to the NC Division of Water Quality at the above
address or calf lAn. Valery Stephens at [phone], exterstonr520.
Please include the NPDES permit number (attached) in any communica-
tion. Interested persons may also visit the Division of Water Quality at
512 N. Salisbury Street, Raleigh, NC 27604-1148 between the hours of
8:D0 a.m. and 5:00 p.m. to review rdormation on file.. ��
Davidson County
Davidson County Schools, P.O. Box 2057, Lexington, NC has applied
for renewal of NPDES permit N00042145 for its Midway Elementary
School WWTP in Davidson County.'Phis.-permitted facility discharges
treated wastewater to an unnamed tribidar, to Leonard Creek in the Yad-
kin -Pee Dee River Basin. Currrentt, BOD; ammonia nitrogen, arW.total
residual chlorine are -water quality Gmited_Ttis dschargg may affect fu-
ture allocations in this portion of the watershedf
BON Truck -Stop, has appned for renewal -ofiits NPDES perrhit
NC0040045. The permitted facility discharges treated wastewater to
South Potts Creek in the Yadkin -Pee Dee River Basin. Currently B005, ,
Total Residual Chlorine, Total Suspended Solids and Fecal Colithim are
water quality limited. This discharge may affect future allocations in this
portion of South Potts Creek. -
Davidson County Schools, P.O. Brix 2057, Lexington, NC has'appted
for renewal of of NPOES permit NC0041629 fir its EMended Day School
WWTP in Davidson County. This permitted facility discharges treated
wastewater to an unearned tributary to Hamby Creek in the Yadidn-Pee
Dee River Basin. Currently BCD, animoeia nitrogen, and trial residual
chlorine are water quality limited. This discharge may affect fuhre alloca-
tions in this portion of the watershed. - �
Quail Run Mobile Home Perk, has awned for -renewal of his NPDES per-
mit MC0070033. The permitted facility discharges treated wastewater to
Miller Creek in the Yadkin -Pee Dee Rover Basin. Currently 8005, Ammo-
nia as Nitrogen, Total Residual Chlorine,-'jotal Suspended Solids and
Fecal Contemn are.water quaky untried discharge nay affectfuture
ek:
allocations in this portion of Maier Cre' P.:) -
Davidson County Scrods, P.O. Box 2057, Lexington, has applied
for renewal of NPDES permit NC0042129 for its Pilot Elementary School
WWTP in Davidson County. This permitted fadfity discharges treated
wastewater to J'anmys Creek in the Yadkin -Pee Dee River Basin. Cur-
rently ammonia nitrogen and total residual chlorine are water quality lim-
ited. This discharge may affect future allocations in this portion of the wa-
tershed- `
Captain Stevens. Sealoo( Ole rant, has applied for renewal of its
NPDES permit NC09218. The permitted facility discharges treated
wastewater to an unnamed Iributary to Reedy Creek in the Yadkin -Pee
Dee River Basin. Currerdy BOD5, Total Residual Chlorine, Total Sus-
pended Solids and Fecal Conform are water quality limited. This dis-
charge may affect future allocations in this portion of Reedy Creek.
Hilltop Living Center, has applied for renewal. of is NPDES permit
NC0059536. The permitted facility discharges treated wastewater to an
unnamed tributary to Yadkin River in the Yadkin•Pee Dee River Basin,
Currently BOD5, Ammonia as Nitrogen, Total Residual Chlorine; Total •
Suspended Solids, Total Phosphorus and fecal Conform are water qual-
ity limited. This discharge may affect future allocations in this portion of
Yadkin Rivera. g7(

PUBLIC
NOTICE
STATE OF NORTH
CAROLINA
ENVIRONMENTAL
MANAGEMENT
COMMISSION
NPDES UNIT
1617 MAIL
SERVICE CENTER
RALEIGH, NC
27699-1617
NOTIFICATION
OF INTENT TO
ISSUE A •
NPDES
WASTEWATER
PERMIT
0n the basis of thor-
ough staff review and
application of NC Gen-
eral Statute 143.21,
Public law 92-500 and
other lawful standards
and regulations, the
North Carolina Environ-
mental Management
Commission proposes
to issue a National Pol-
lutant Discharge Elimi-
nation System (NPDES)
wastewater discharge
permit to the person(s)
listed below effective
45 days from the pub-
lish date of this notice.
Written comments re-
garding the proposed
permit will be accepted
until 30 days after the
publish date of this no-
tice. All comments re-
ceived prior to that
date are considered in
the final determinations
regarding the proposed
permit. The Director of
the NC Division of Wa-
ter Quality may decide
to hold a public meet-
ing for the proposed
permit should the Divi-
sion receive a signifi-
cant degree of public
interest.
Copies of the draft per-
mit and other support-
ing information on file
used to determine con,
ditions present in the
draft permit are availa-
ble upon request and
payment of the costs of
reproduction. Mail com-
ments and/or requests
for information to the
NC Division of Water
Quality at the above
address or call Ms. Va-
lery Stevens at (919)
733-5083, extension
520. Please include the
NPDES permit number
(attached) in any com-
munication. Interested
persons may also visit
the Division of Water
Quality at 512 N. Salis-
bury Street, Raleigh, NC
27604-1148 between
the hours of 8:00 a.m.
and 5:00 p.m. to review
information on file.
Bill's Truck Stop has ap-
plied for renewal of its
NPDES permit
NC0040045. The per-
mitted facility discharg-
es treated wastewater
to South Potts Creek in
the Yadkin -Pee Dee Riv-
er Basin. Currently
BOD5, Total Residual
Chlorine, Total Sus-
pended .591ids , and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of South Potts
Creek.
Davidson County
Schools P.O.. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0041629 for its Ex -
Quail Run Mobile Home
Park, has applied for re-
newal of its NPDES per-
mit NC0070033. The
permitted facility dis-
charges treated waste-
water to Miller Creek in
the Yadkin -Pee Dee Riv-
er Basin. Currently
BODS, Ammonia as Ni-
trogen, Total Residual
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Miller Creek.
Davidson County
Schools, P.O. Box 2057
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042129 for its Pilot
Elementary School
WWTP in Davidson
County. This permitted
facility discharges
treated wastewater to
tended Day School Jimmy's Creek in the
WWTP in Davidson l Yadkin -Pee Dee River
County. This permitted Basin. Currently Ammo -
facility discharges nia Nitrogen and Total
treated wastewater to Residual Chlorine are
an unnamed tributary
to Hamby Creek in the
Yadkin -Pee Dee River
Basin. Currently 80D,
Ammonia Nitrogen, and
Total Residual Chlorine
are water quality limit-
ed. This discharge may
affect future allocations
in this portion of the
watershed.
STATE OF NORTH CAROLINA
DAVIDSON COUNTY
water quality limited.
This discharge may af-
fect future allocations
in this portion of the
watershed.
Davidson County
Schools, P.O. Box 2057,
Lexington, NC has ap-
plied for renewal of
NPDES permit
NC0042145 for its Mid-
way Elementary School
WWTP in Davidson
County. This permitted
facility discharges
wastewater to an un-
named tributary to Leo-
nard Creek in the Yad-
kin -Pee Dee River Ba-
sin. Currently Ammonia
Nitrogen and Total Re-
sidual Chlorine are wa-
ter quality limited. This
discharge may affect
future allocations in this
portion of the water-
shed.
Captain Stevens Sea-
food Restaurant, has
applied for renewal of
its NPDES permit
NC0059218. This per-
mitted facility discharg-
es treated wastewater
to an unnamed tributa-
ry to Reedy Creek in
the Yadkin -Pe Dee-Riv-
er . Basin. Currently.
B005, Total Residual
C,Ei--4 •
AFFIDAVIT OF PUBLICATION
-�-, Ls AJorrrs
Lexington,N.C.
Chlorine, Total Sus-
pended Solids and Fe-
cal Coliform are water
quality limited. This dis-
charge may affect fu-
ture allocations in this
portion of Reedy Creek.
Hilltop Living Center,
has applied for renewal
of its NPDES permit
NC0059536. The per-
mitted facility discharg-
es treated wastewater
to an unnamed tributa-
ry to Yadkin -Pee Dee
Basin. Currently 80D5,
Ammonia as Nitrogen,
Total Residual Chlorine,
Total Suspended Solids,
Total Phosphorus and
Fecal Coliform are wa-
ter quality limited. This
discharge may affect
future allocations in this
portion of the Yadkin
River.
April 19, 2004. ,
MAY 1 1 2004
UTLITYH
pE�RWAjER p OA.jr
QpINY Sit
2004
of THE DISPATCH, a newspaper published in the city of
Lexington, County and State aforesaid, being
which
day of
attached is a true copy,
Sworn to and subscribed before me, this
oTAq
•
duly sworn,
says the
foregoing legal of
was published in said newspaper once the
2004.
2N�
Publication Fee $
da
My commission expires
200c1
fr
)zikod
(Seal)

FACT SHEET FOR EXPEDITED RENEWAL
Permit Number
l'OZ-4-47
Facility Name
Z3.(LLS '(12_�Ct— S'ro p
Reviewer]
Basin/Sub-basin
Receiving Stream
5t)3POTPOTTS C % (a-r f
Is the stream impaired (listed on 303(d))?
00
Is stream ,monitoring required?
• Do they need NH3 limit(s)?
KO
Do they need TRC limit(s)?
f.-
Do they have whole -effluent toxicity testing?
W v
Are there special conditions?
��•
Any obvious compliance concerns?P
Existing Expiration Date
/ r iAciecf
Proposed (Expiration Date
at MAY
Miscellaneous Comments:
Ato6:‘ /e-lef-tovria- /1,4cc
£_ •
•
V
Circle one:
DO NOT EXPEDITE
If expedited, is this simpler permit o a more difficult one?
c-P)

NPDES APPLICATION FOR PERMIT RENEWAL- SHORT FORM D
To be filed only by privately -owned dischargers of 100% domestic wastewater (<1 MGD flow)
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit _
1617 Mail Service Center, Raleigh, NC 276 9-16 f c; n
http://h2o.enr.state.nc.us/NPDES/ r�_ ?� y
North Carolina NPDES Permit Number
1. Contact Information:
Facility Name
Owner Name
Street Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Operator Name
Street Address
City
State / Zip Code
County
Telephone Number
2003
Please print or type
O1 `rs 1r u,ck
P o ex 1AJ EA -
L_
DENR•WATER QUALITY
POINT SOURCE MANCH
121Cs 'Smidt.-- inedS
Li t\wood
ill C. 2 ''1 a °t
(330) qS6-44c4
(33S) q 510 - 10 b 5 /
Py+Yu,_1�5t-op ao\.co
LLA.A r L-c:0 A.1/4"-d
IVe rirks,ae 0,f
(3 ) L4`( -7431
2. Location of facility producing discharge:
Check here if same as above
Facility Name (If different from above)
Street Address or State Road
City
State / Zip Code
County
3. Reason for application:
Expansion/Modification * Existing Unpermitted Discharge
Renewal
New Facility
* Provide a description of the expansion/modification:
Page 1 of 3 Version 12/02

ES•CATION lFOl'=PERMIT RENEWAL-• SHORT FORMD
�To' ire fed oniy `by `p • r "t l Owned' disc1iargers of 11004 domestic (wastewater (<1 MGD'flow)
4. Description of theesktreatmen'facilities (listed! tnsta led components with
capacities): � _ �� t t a; )1: �i ; �' ;.: . " u � : ' , :2 -. .
I ‘ti.t,:id::;t:41\,11;
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(I) S(12414".---T4VVV: p
(14) JCteet. C:lr•CI-c; 4`r
ejl n �4 Puti-4�c�- (a)rtt
eatfttlficr's(5') r4C01k1-:..4 44 .,,� • �-i. �Lic pc,�,�. es
Rc : r vLtl,v th.‘ 4 -44.x.r S��.o f � (i �• L-'n -1 , ei
5. Description of wastewater (check all that apply):.
Type of Facility Generating Wastewater .. _
Industrial _ T. ..._.� -.- =J 1..__1 . . Number: of Employees
Commercial Number of Employees
Residential .. _ Number of Homes .
School it '_ Number..of Students/Staff
Other
3�1
Describe the source(s) of wastewater (example: subdivision, mobile home park, etc.):
•
• 6. List all permits, construction •approvals, and/or applications. (check all that apply):.
Tie
RCRA
UIC
NPDES
PSD
NESHAPS
Permit Number
NCtook" o045
Non -Attainment
Ocean Dumping
Dredge/Fill Permits
Other
Permit Number
7. Number of separate wastewater discharge pipes (wastewater outfalls): , . .
8. If the facility has multiple discharge outfalls, record the source(s) of wastewater for each
outfall:
Page 2 of 3 Version 12/02

NPDraAPPLICA, ON FOR PERMIT RENEWAL- SHORT FORM D
To � '�"
r be Sled only by privatelyr-owned dischargers of 100% domestic wastewater (<1 MGD flow)
S. Name of receiving street a(s) _(Prrouide.a map showing the exact,iocation of each outfall)r
1'
as ` SO4.4-1. Po 4+1 Cr c k ; Ya tik :rN a ,I Pc-.e bt a
10. Is this facility located on Native American lands? (check one)
YES NO NO El
I certify-that.1 am fj li[as Wvith tie iaMormation contained in the application and that to
the best of my knowledge and belief such information is time, complete., and accurate.
{ •
Ith+.E vt)cilsv-A'
Printed7Vame,of Person Signing
Pre / ,
Title • � ........
‘ z- •c1.• o3
Signature of Applicant
Date Signed
North Carolina General Statute 143-215.6(b)(2) provides that 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
recordlng 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 $10,000, 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 $10,000 or
imprisonment not more than 5 years, or both fora similar offense.)
Page 3 of 3 Version 12/02

BILL'S TRUCK STOP
1210 Snider - Kines Road
Linwood, N.C. 27299
Fuel Desk 704-956-4494 - Office 704-956-2064
Owner
Bob Walser
December 10, 2003
Mrs. Valery Stephens •
NC DENR
•
'''1"`f'1617 Mail Service Center ni_ .:.
:a•Raleigh, NC 2769.9-1617
RE: PERMIT RENEWAL #NC0040045
Dear Mrs. Stephens,
We are requesting the renewal of the permit for our facility. There have
Fax
704-956-3588
• r... , ;•, f
,te
r..
been no changes since the last renewal.
For our sludge removal we use Neal's Septic Tank Service. Their address
is P 0 Box 1272, Thomasville, NC 27361. Their phone number is (336)
472-4115. We use their services every 4 to 6 months.
Sincerely,
hitt t()(14Al
Bob Walser