NC0088617_Permit (Issuance)_20090312

6
NPDES DOCYNENT SCANNING COVER SHEET
NPDES Permit: NC0088617
Snow Hill WTP
Document ape: Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Correspondence
201 Facilities Plan
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: March 12, 2009
This aocameat is Priatea oa reuse Paper-ignore aay
coateat on the reverse 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
March 12, 2009
Thomas Roberts, President
Aqua North Carolina, Inc.
4163 Sinclair Street
Denver, North Carolina 28037
Subject: Issuance of NPDES
Permit NCO088617
Snow Hill Subdivision Well#1 WTP
Surry County
Dear Mr. Roberts:
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 permit contains no changes from the
draft permit mailed to you on January 14, 2009 ease a advised-that-Permit-Condition-is-due- fiirtlT(30rdays
rm1 171ss
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 150E of the North Carolina General Statutes, and
fled with the Office of Administrative Hearings (6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless
such demand is made, this decision shall be final and binding.
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 Bob Guerra at telephone number(919)807-6387.
Sincerely
Is ilk
�}3Y` f/ Coleen H. Sullins
Enclosure: NPDES Permit NCO088536
cc: Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
Central Files
Aquatic Toxicology Unit
1617 Mail Service Center,Ralegh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleyh,North Carolina 27604 7.�One.1. 1
Phone:91 M07-63871 FAX:[phone] Customer Service:1-877 623-6748 1 V OI u 1CarOlina.
Internet:Equal
eA natityeA9 Naturally
M Equal Opportunity 1 Affirmative Action Employer

Permit NCO088617
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 with 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, the
Aqua North Carolina, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Snow Hill Subdivision - Well #1 (WTP)
Snow Hill Drive
Dobson
Surry County
to receiving waters designated as an unnamed tributary to Cody Creek in the Yadkin-Pee Dee
River
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 April 1, 2009.
This permit and authorization to discharge shall expire at midnight on February 28, 2014.
Signed this day March 12, 2009.
„— Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO088617
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.
Aqua North Carolina, Inc. is hereby authorized to:
1. Continue to operate an existing greensand water treatment system utilizing greensand
filters in series with a 0.00252 MGD discharge of filter backwash wastewater. Chemicals
utilized during the process consist of:
• Potassium Permanganate
• Chlorine and
Caustic soda
2. This facility is located at the The Snow Hill Subdivision Well #1 located on Snow Hill Drive,
Dobson in Surry County.
3. Discharge from said treatment works at the location specified on the attached map into an
unnamed tributary to Cody Creek, classified C waters in the Yadkin-Pee Dee River Basin.

7 � €Lr / t r'r •
/ cry
Outfall 001 • ��` , -� t,r �.
,x
1 s �2224
Lk
*� � ,�� `�♦ �\S�). '- i. if • � \ A\ ,�.- f \ ✓ F
t
r \0, c 7 � s
♦ \ ) i �` r .`
S
s ro 4
°( a +l �..,• {. J.a
vs� _ ♦♦ l J_ � li°: i A�t
Aqua North Carolina, Inc. Facility , x
Snow Hill Subdivision Well # 1 WTP J
Location
?F_(,- 1z-(f, - r¢
Latitude: 36°21'06" N State Grid: Copeland not to scale
Longitude: 80'42'37" W Permitted Flow: 0,00252 MGD
Receiving Stream: UT to Cody Creek Stream Class: C %K r NPDES Permit No. NCO088617
Drainage Basin: Yadkin-Pee Dee River Basin Sub-Basin: 03 02 North Sorry County

I 7
` E Permit NCO088617
✓ = C;tl�ee��t s�'1 d
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 filter backwash from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified
below:
EFFLUENT. 'vr R# : LIMITS,; k a 'd Xt_ MONITORING REQUIREMENTS$'#
T CHARACTERISTICS 4 v - - -
"y W ��+r1 `. ' Monthly r_r� ,DailyMaxtmum ``Measurement; W 4Samplenfo ""'-Sample--,.
',Frequency:., ?.r„ Type �:.,� -� Locationl
Flow' 0.00252 MGD 2/Month Instantaneous E
Total Suspended Solids 30.0 mg/L 45.0 mg/L 2/Month Grab E
Total Residual Chlorine3d 17 ug/L 2/Month Grab E
K / Total Iron Monthly Grab E
✓ �/ Total Manganese Monthly Grab E
pH 6.0-9.0 s.u. 2/Month Grab E, U, D
�( Temperature Monthly Grab E, U, D
Salinity Monthly Grab E, U, D
Conductivity Monthly Grab E, U, D
X Dissolved Oxygen Monthly Grab E, U, D
x Total Dissolved Solids Monthly Grab E
Total Copper Monthly Grab E ."
Y Total Chloride Monthly Grab E
X Total Lead Monthly Grab - E
Ammonia Nitrogen Monthly Grab E
Total Zincs Monthly Grab E
Fluoride Monthly Grab E
1` x Total Nitrogen Quarterly Composite E
Total Phosphorus Quarterly Composite E
x Whole Effluent Toxicity Quarterly Grab E
1� Monitoring
Footnotes:
1. Effluent=E,Upstream=U,Downstream=D
2. For instantaneous flow monitoring,the duration of the discharge must be reported in addition to the total flow.
3. The TRC monitoring requirement applies only if the Permittee backwashes with chlorine or chlorine derivatives. This limit will
become effective on September 1,2009.
4. The Division shall consider all effluent TRC values reported below 50 ug/I to be in compliance with the
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 50 ugll.
5. Zinc shall be monitored if the Permittee uses any zinc-based additive in the water treatment process.
6. Fluoride should be monitored if the permittee backwashes with fluoridated finished water
7. See Attachment A. (2).
All samples collected should be from a representative discharge event.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NCO088617
A. (2.) CHRONIC TOXICITY MONITORING (QRTRLY)
The permittee shall conduct quarterly chronic toxicity tests using test procedures outlined in the"North
Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or subsequent
versions.
The effluent concentration defined as treatment two in the procedure document is 90%. The testing shall be
performed as a Ceriodaphnia dubia 7day pass/fail test. 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.
All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge
Monitoring Form (MR-1)for the month in which it was performed, using the parameter code TGP36.
'Additionally, DWQ Form AT-1 (original) is to be sent to the following address:
Attention: North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, N.C. 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later
than 30 days after the end of the reporting period for which the report is made.
Test data shall be complete and accurate and include all supporting chemical/physical measurements performed
in association with the toxicity tests, as well as all dose/response data. 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
permittee 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 Flow" in the
comment area of the form. The report shall be submitted to the Environmental Sciences Section at the address
cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required, then monthly
monitoring will begin immediately. Upon submission of a valid test, this monthly test requirement will revert to
quarterly in the months specified above.
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 monitors any pollutant more frequently then required by this permit, the results of such monitoring
shall be included in the calculation & reporting of the data submitted on the DMR & 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.

• PUBLIC NO rTICECE r :r)
• t xj
-- :���STATE OF_.NORTH�
, .%u•�a,CAROLINA k Y
ENVIRONMENTALhy;
1«.MANAGEMENT COM;t
'JMISSIONMPDE3 UNIL
_`761Zb1All`SF VICF_•:
A3�y-CENTEER rt5 )
NORTH CAROLINA
SURRY COUNTY „rtn�Elct ,'Nc '
' C'r. NOTIFICATION OF,.s't
A�'NPDES WASTEWATER
AFFIDAVIT OF PUBLICATION A/2ti
Before the undersigned, a Notary Public of said County and State, duly �n the Da'sis of.tno ough
g , ry tY y stagireview;and appIt
commissioned, qualified and authorized by law to administer oaths, `'tio of NC',General'Stat-i
eta 1
personally appeared Ferris W. Simpson who being first duly 43215:1and ,l5Ai
,";Ncnc o2H otost and'
sworn, deposes and says: that he(she) is Business Manager gtner lawfuly3tandsrds!
'and r;regulahoris:>the2
(Publisher or other officer or employee authorized to make affidavit) of Nonh'carogna Envmn=(
HEARTLAND PUBLICATIONS, LLC, engaged in the publication of a inantalg Managernent;<
�Comrrussion proposes to
newspaper, known as MOUNT AIRY NEWS, published, issued, and issue a National Pollut��}�
entered as periodicals class mail in the city of Mount Airy in said County a"!, Dscha ge' Eumma yJ
lion, System,r,(NPDES).,
and State; that he (she) is authorized to make this affidavit and sworn wastewaterr,y discharge
statement; that the notice or other legal advertisement, a true copy of Permit t9 tha Pbrson(s)
t listed below effective_45._
which is attached hereto, was published in MOUNT AIRY NEWS on the Ldays1ff o Lheypublish',
following dates: >dale of this notrde: t g„
�( )y / nOO� rg ruing comrtients�yre-.
IP/ t9ardmg ithe .proposed
pegiirt will be iaccepted;'
1 until°•Oot days�r after the=
?publish'date`of this;no`3
roehred" Lcomrnents re
t'peiyed'pgor.to that date'
ere considered"in the it')
and that the said newspaper in which such notice paper, document or net determination's "re
P P `gardlny ahe;7prpposed:
legal advertisement was published was, at the time of each and every :eermq:r',Tie_ioirecrorot
such publication, a newspaper meetin all of the requirements andNcovs`iod_or Water:
Pg q Quail t rnay"declda,ro.qua '
s of North
andlifications of Section was a qualified newspaper with7 of in the meaning General teof Section 1-5971of na hu PPopo ierrmiublic ot ,
q P Pshould 1neiDivision:re--
the General Statutes of North Carolina. �Jvera3signif,:ant di I
9ree of public interest faj;
This / day of `e r(l I 2009 ( Copies of the draft permit
k^.and.dttief,'supportingt in-j
r I�formation'on.file usedto
-•deterinln 4,condul6ns1
Present In
Signature of ersonmakn affidavit the draft per=
available
upon'
requesGand payment;ot`�
Sworn to and subscribed before me, this day of the costs of rep oduc on.
pp Mad(,comments grid/or
12009 requests' for mforrnation
. to the NC Dmsfon of Wa
' <ter quality at thelahove
address o a`,&i '-ofne
SpnnMi) 607 6304 f
Notary Public •`-.r✓,� at.•�;a"r-he -point
87t6 ucm"mce?Please+4incldde-yO/S'
StheNPDEmrtnu
ber(below) n any`c
My '
Commission expires: November 27,2012 y))mumcatron ,Interested 1
2 Persons".may also`visjt.'i
the�Di'{vis'lon ofrGWateri
��Ouality,at 512 N Salis==�-
�hury Sheet Raleigh NCB
+ 27604 1t48 between e�,i
Notary Pit th
blic ( hours of 8 W a m'andt
Sorry County,NO Carolina 5 oo'p m ao review midi'.
Sandra F.B0Is
. My Commission Expires__

r
Aqua North Carolina;Inca
• � g169-¢Smclaq reelT�.
Denver,iNCT 2803�hasF�
flappfied°for renewal•.cl
rNPDEST � permnt '
fNCOOB8528 for the�Hill'
t aesl Subdtwslon Well'X3
,�Ay—�a N rth Carolm Inc?'11 r permittedtfaahty will des ,•�
(Town Lane,�Mt, Airy,; chargay,. reated ;;tiller;
`- North Carolina) has'ap;. tbacliwashr
} Pkednfor renewal. of ChampyyCre ek lui,lthe'
NPDES:gg�p ,?ermltl Yadon Pee DeeRrver
NC0068536 forithe Ban Basui�y`,Curtentryy (otel
nertown'Hllls S I I Sion' suspended solids and to
We111A2 s,InSurry-, tel r`esdual chlonue are,
water qualityh!!; d'
4County This_permitted a may at-
`_4aallry discharges�1fi00� Thls''discharg *,
I gallons parrdey of green- }eq}`futur allocauonsryn
sand fitter backwash w This porhontof ttie�Yad-
tter to an unnamed trl6u' kin-Pee Dee Rrver Barn.
s ray., iF'Zabl'y#`
�;tary to F'u'iid�'Creek
c Den rl the Yatlkin Pee Aqya NC Incy(4 tit
�Dea.River Basm,Total dairySVeet Denver-NC f
j Suspended.Solldsr(TSS 2808�°hasGapplteC)for y
sand total r resiCual chlo- ienewal�ot NPDES perk-.
q' rine are ou rehtly,water; it=NCQ088617 for4the
quality limited. This des- Sw #Nill vSubdimswn
.':charge a'y`.affect fua no
m ture;' iWell#t mSuKry�Counryl
allocations in"(hls portion l Tliis�°permi-,- t,tacthry�
;of tha Fnulkrier Creek ) discharges 0 0026 MGD,y
'•,'3'•c��`°' •�5�. r ai t�eatedkw_a�st�ew�a',�Y,r� -
hAquallorthCarlina�lnc. nun ar^ed
r oli une; 'Mt AI , jtnbutary to Cody 4Creek3^
;North Carolina) ha Yadkin-Pee Dee ,
i
f.
NPDESo'�ysa�.+g,r m�t �16 reBduall.ch onnes }
'NC0088625-for the_HW% viaterquahry 61imded it
l'bws Suhowision Welt This`ydischarge may -I .
':C7 m Sur Coun -This �,fecllluture allocations mr�
ermined-facile h des; ;ltiisyportion o1,,the,Yad f)
{;charges 2000 gallons peg kin'Pee Dee Riff,-#Bassi
,relay of greensand filter y' , "5ar `
backwash water,to,'ari Central ",!Inc (139�
tunnamed Vibutaryrfto� ApeT Lane 'Mount Anyyt -
'Stewarts;Creek, wrthln„ sNC j27030) has applied;(
the :a in-Fee ¢Das a.for renewalz,,oF permit'
r Rrver,Basin q'Total Sus- NC0038822s;�for !ts
i.upended Solids(TSS)'anil WWTP in,Su'rry County.
ytotal residual chlorine are f�Th, permittetl t facilityn
,cy twtri.quality }}�dischar es tr
urtentl ae eated �do,�
limded Thi s d? Isctiarge Lmestic was ewaterito�an_�
may,affect future alloca- ,unnamed+-tiibutaryi stow
r.tions in this pomon elf the }r.Stewarts iCreek m vthe$
;Stewarfs Creek., ' tYadWn Pee 'Dee Rrver
e, ik ;r}a1 T33}}T�.., Basm''"Cur rntly
Aqua Nortli Ca{okna`Inc- ma nitrogen fecal coh;,,
t(4163 •SinclairStreet? form andxrotalrres dual'.,
c Denver NC 2803 has chlonne are water gJaliry.
f' Thia disgharge
;'applied for;;iene alyof;
NPDES V-; ,permlt3 kii, afect tut'ure alloca't
1�NC0088552 forrthe Colo-g stionstmpthis;,portion of
'mat Woods Subdmsio tewarts Creek
yWell A2 m burry County - Aqua North Carolina Inc'
r This pennitted'facikrytw I has'�appliedLor renewal-
)'cischarge treated jfilter� of�NPDES.perma�num- -
fiackwash tolUT�to Bull; - 66er NCOOB8633�fordiv
Creek m the'Yadon;Pea )'Reeves N1o0ds Subdn '
1D'ee Rrver Ba'sm"y�Cur ,slon Well, WTP I I
ki as l total_-suspended ik Mount Airy.p. - Surryy
rrco faality d
solids and total resduaP' charges,fllter backwash
.ihlonne are water qualtry-4t water'inta�an'Uri d
?.limited ``Thislydischarge Fri--ary inr7ihe Yadkin
1 may affect future r'alloca , IORlver Basin $Theme-
tbons m this portion of the`i ' �'permlf setspTSS' Total
ykYadkm Peen Dee bRrver�t
Residual��Chlonne ,,ariii
pH aslwatequakry,lim-
k itedparameters*s.Thls
In t i
IIi
(dlsc'ha '- ayaeNect
}lure allocaons� } hs'
/portion of�e ,-a--
6Riv rBasin � �
�t '<P
{PubItsh., �Januaryr;t 62

AO U A.
1
Aqua North Carolina,Inc. Thomas J.Roberts
202 MacKenan Court President and Chief
Cary, NC 27511 Operating Officer
T.919.467.8712 ext.30
F:919.460.1788
Jul 30 2008 tjroberts®aquaamerica.com
y w .aquanorthcarolina.com
Ms. Dina Sprinkle (1 ?
NC DENR/DWQ/Point Source Branch ``7 !;I
1617 Mail Service Center AUG 5 2008
Raleigh, NC 27699-1677
DENn Y'.0.TCR
SUBJECT: NPDES Renewal Application
Snow Hill Subdivision, Well #1 ---
NPDES Permit No. NCO088617
Surry County, NC
Dear Ms. Sprinkle:
Transmitted herewith are the completed/signed original and two copies of the subject NPDES
permit application and two copies of this cover letter. Since this facility does not generate any
Sludge, no sludge management plan is necessary. There have been no modifications since the
last permit was issued.
It is my understanding that no filing fee is required for this renewal.
If you have any questions regarding this application, please do not hesitate to contact me.
Sinfc
Thomas J. /obert�s
President and COO
TJR/rt
Enclosure
An Aqua America Company

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number NC0088617
ff 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:
�1Owner Name Aqua North Carolina, Inc .---•� � i� ,
Facility Name Snow Hill Subdivision--Well #1
Mailing Address 202 Mackenan
` on(1A
City Cary
State / Zip Code NC/27511
Telephone Number [phone]
Fax Number [phone] y
e-mail Address TRobertsoaaquaamerica.com
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road Snow Hill Drive
City Dobson
State / Zip Code NC/27017
County Surry
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name Aqua North Carolina, Inc
Mailing Address 4163 Sinclair Street
City Denver
State / Zip Code NC/28037
Telephone Number [phone]
Fax Number [phone]
4. Ownership Status:

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Federal ❑ State ❑ Private ® Public ❑
S. Type of treatment plant:
❑ Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
® Green Sand Filter (No sodium recharge)
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
6. Description of source water(s) (i.e. groundwater, surface water)
Groundwater well
7. Describe the treatment process(es) for the raw water:
Green sand filtration using potassium permanganate. Chlorine added for disinfection and
caustic soda added for pH adjustment. Sodium Chloride water softerner.
S. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge is the backwash of the green sand filters. Discharge rate is
approximately 2520 gallons, once every two(2) days.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 3 Duration: Approx. 20 minutes
11. Plant design potable flowrate 0.0648 (Max. well yield) MGD
Backwash or reject flow 0.00252 MGD
12. Name of receiving streams) (Provide a map showing the exact location of each outfall, including
latitude and longitudes
Unnamed tributary to Cody Creek (Yakdin River Basin)

NPDES PERMIT APPLICATION- SHORT FORM C - WTP
For discharges associated with water treatment plants
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Potassium permanganate
Chlorine
Caustic soda
Sodium Chloride
14. Is this facility located on Indian country? (check one)
Yes ❑ No
15. Additional Information:
> Provide a schematic of flow through the facility, include flow volumes at all points in
the treatment process, and point of addition of chemicals.
> Solids Handling Plan
16. NEW Applicants
Information needed in addition to items 1-15:
New applicants must contact a permit coordinator with the NCDENR Customer
Service Center.
Was the Customer Service Center contacted? ❑ Yes ❑ No r: !
> Analyses of source water collected �- 1
s
> Engineering Alternative Analysis
f-
> Discharges from Ion Exchange and Reverse Osmosi tipl`\is sh�{11 be evaluated using a
water quality model. I1 \l
CiJP61h�_ �. ._.
17. Applicant Certification ptihF. Su!1RG` p
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.
Thom Roberts President
Pri n e of Pers Si g Title
Signature of A,pKicant to
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 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

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Basic Information to determine potential for expedited pprmit renewal
Reviewer/Date e4"tA
Permit Number "/✓e, 0 6 t
Facility Name Savo LV FA ! 40 Vi NAN U✓�� '/
Basin Name/Sub-basin number Yad lu`n/ JS— 04—02 .
Receiving Stream UT- fa t� u G((
Stream Classification in Permit el , I
Does permit need NH3 limits? /Vo
Does permit need TRC limits? AN
Does permit have toxicity testing? ,1-M
Does permit have Special Conditions? `1 A10
Does permit have instream monitoring? �1
Is the stream impaired (on 303(d) list)?
Any obvious compliance concerns? AoQ
Any permitmods since lastpermit? UA� o3—R—Dy
Existing expiration date V 0 2
New expiration date -
New permit effective date
Miscellaneous Comments
AVim
a-
YES_ This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC,NH3,
v��j
name/ownership changes). Include conventional WTPs in this group.
YES'k This is a MORE COMPLEX EXPEDITED permit renewal (includes
Special Conditions (such as EAA, Wastewater Management Plan), 303(d)
listed, toxicity testing, instream monitoring, compliance concerns, phased
limits). Basin Coordinator to make case-by-case decision.
YES_ This permit CANNOT BE EXPEDITED for one of the following reasons:
• Major Facility (municipal/industrial)
• Minor Municipals with pretreatment program
• Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS,
etc)
• Limits based on reasonable potential analysis (metals, GW remediation organics)
• Permitted flow>0.5 MGD (requires full Fact Sheet)
• Permits determined by Basin Coordinator to be outside expedited process
TB Version 8/18/2006 (NPDES Server/Current Versions/Expedited Fact Sheet)