NC0045471_Permit (Issuance)_20090310

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NPDES DOCUMENT SCANNIMS COVER SHEET
NPDES Permit: NC0045471
Barium Springs WWTP
Document Type: "Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Staff Report
201 Facilities Plan
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: March 10, 2009
This document is printed oa reuse paper-ignore any
coateat oa the reverse aside

AT
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor Coleen H.Sullins, Director Dee Freeman, Secretary
March 10, 2009
Mr. Don S.Kelly
Barium Springs Home for Children
P.O. Box 1
Barium Springs, N.C. 28010-0001
Subject: Issuance of NPDES Permit NCO045471
Barium Springs Home for Children
Iredell County
Dear Mr. Kelly:
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 no major changes from the draft permit sent to you on
January 14,2009.
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
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 Charles Weaver at telephone number(919) 807-6391..
Sin�erMely,
V' tZ��7
Teen H. Sullins
cc: Central Files /
Mooresville Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One
512 North Salisbury Street,Raleigh,North Carolina 27604 NorthCarolina
Phone: [phone]/FAX [phone]/Internet:www.ncwaterquality.org Naturally
a ura l y
An Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper `KL `[

Permit NC0045471
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 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, the
Barium Springs Home for Children
is hereby authorized to discharge wastewater from a facility located at the:
Barium Springs Home for Children
156 Frazier Loop
Barium Springs
Iredell County
to receiving waters designated as an unnamed tributary to Duck Creek in subbasin 03-07-06 of
the Yadkin-Pee Dee River Basin in accordance with effluent limitations, monitoring requirements,
and other conditions set forth in Parts I, 11, I1I and IV hereof.
This permit shall become effective April 1, 2009.
This permit and authorization to discharge shall expire at midnight on March 31, 2014.
Signed this day March 10, 2009
kenH"Su_ffins,Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO045471
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.
The Barium Springs Home for Children is hereby authorized to:
1. Continue operating an existing 0.03 MGD wastewater treatment system that
includes the following components:
➢ Bar screen
➢ Imhoff tank
➢ Sludge holding tank
➢ Dual surface-sand filter beds
➢ Tablet chlorination and dechlorination
This facility is located in Iredell County at the Barium Springs Home for Children,
off NC Highway 21/115 south of Statesville, 0.6 miles north of the junction of Old
Mountain Road.
2. Discharge of treated domestic wastewater from said treatment works at the location
specified on the attached map through Outfall No. 001 into an unnamed
tributary to Duck Creek, currently classified C waters in subbasin 03-07-06 of
the Yadkin-Pee Dee River Basin.

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Barium Springs Home for Children Facility '��
I Location V ,
Latitude: 35°43'28" Sub-Basin: 03-07-06
Lon dtude� 80053'15" Basin:Yadkin-Pee Dee not to scale
Stream Class: C State Grid/Ouad#: E15NW/Troutman
Permitted Flow: 0.03 MGD NPDES Permit NCO041471 Iredell Count
Receiving Stream: Unnamed tributary to Duck Creek North

Permit NCO045471
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning with the issuance date of the final permit and lasting until expiration, the Permittee is
authorized to discharge treated domestic wastewater from Outfall No. 001. Such discharges
shall be limited and monitored by the Permittee as specified below:
4Parameters s Limits': {�` 4Y ,4'`.::"MomtoringRequirements ¢ rA
r Monthl fis Dail Measureriient« 'Sam I T e " ism '
Y Y r: P rYP k r Sample Location
re uencY -
Average', Maximdini iF
Flow 0.03 MGD Weekly Instantaneous Influent or Effluent
BOD5,5-day,200C 5.0 mg/L 7.5 mg/L 2/Month Grab Effluent
(April 1 to October 31
BOD5,5-day, 200C 10.0 mg/L 15.0 mg/L 2/Month Grab Effluent
November 1 to March 31
Total Suspended Solids 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent
NH3 as N 2.0 mg/L 10.0 mg/L 2/Month Grab Effluent
(April 1 to October3l
NH3 as N 4.0 mg/L 20.0 mg/L 2/Month Grab Effluent
November 1 to March 31
pH - >6.0 and<9.0 standard units 2/Month Grab Effluent
Fecal Coliform 200/100 ml 400/100 ml 2/Month Grab Effluent
(geometric mean
Total Residual Chlorine(TRC)z 17 µg/L 2/Week Grab Effluent
Total Phosphorus Quarterly Grab Effluent
Total Nitrogen Quarterly Grab Effluent
Dissolved Oxygen Daily average>6.0 mg/L Weekly Grab Effluent
Dissolved Oxygen Weekly Grab U&D
Temperature(°C) Weekly Grab Effluent, U&D
Footnotes:
1. U; at least 50 feet upstream from the outfall. D: 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/L will be treated as zero for compliance purposes.
Discharge shall not contain floating solids nor visible foam in other than trace amounts.

Draft NPDES Permit NCO045471
Subject: Re: Draft NPDES Permit NCO045471
From: Charles Weaver<[e-mail]>
Date: Tue, 17 Feb 2009 10:25:15 -0500
To: Don Kelly<[e-mail]>
Don - while we sympathize with the operational issues you describe, the Division
cannot change the ammonia or BOD limits for your facility.
Your facility's WWTP Kelly discharges to a "zero-flow" stream. The Division's policy
for facilities like yours is described in an attached memo from 2002.
Also, once a stringent limit has been set, we cannot give relaxed limits unless there
is a change in wastewater composition at the facility. EPA prohibits relaxation of
limits as an "anti-backsliding" measure.
CHW
ZEROFLOW POLICY.doc Content-Type: application/msword j
Content-Encoding: base64
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Draft NPDES Permit NCO045471
Subject: Draft NPDES Permit NC0045471
From: "Don Kelly" <[e-mail]>
Date: Fri, 13 Feb 2009 12:20:04 -0500
To: <[e-mail]>
Mr. Weaver,
I have reviewed the draft permit and would like to request that you considering changing the limits for BOD and
ammonia. I have discussed the draft permit with our contract operator and we feel that those limits—both daily
maximum and monthly average-are very low for a system of this type. We have limited opportunity to impact
these measures other than pumping sludge and raking the sand filter beds, which we do on a regular basis.
We would like to request that you consider raising those limits for the entire year, but especially for the summer
months.
Thanks for your consideration!
Don Kelly
Chief Financial Officer
Barium Springs Home for Children
vi „i�;;nno in•na ann

Statesville Record & Landmark
' Account Number
Advertising Affidavit
. _ 3142720
North Carolina Community Newspapers
Date
PO Box 968
Hickory, NC 28603 January 23,2009
NC DENR/DWO
BUDGET OFFICE
1617 MAIL SERVICE CENTER
RALEIGH,NC 27699
PUBLIC NOTICE
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT
COMMISSION/NPDES UNIT
1617 MAIL SERVICE CENTER
RALEIGH.NC Z7699-1617
NOTIFICATION OF INTENT TO ISSUE A NPDES Descri lion Ad Number Ad Size
WASTEWATER PERMIT P
On the basis of thorough staff review and applica- PUBLIC NOTICE STATE OF NORTH CAROLINA EN 0001248091 2 x 144 L
tion of NC General Statute 143.215.1 and 15A NCAC
02H.0109 and other lawful standards and regula-
tions,the North Carolina Environmental Manage-
ment Commission proposes to issue a National Media General Operations, Inc.
Pollutant Discharge Elimination System (NPDES)
wastewater discharge permit to the person(s)list-
ed below effective 45 days from the publish date Publisher of
of this notice.
Written comments regarding the proposed permit Statesville Record & Landmark
will be accepted until 30 days after the publish
date of this notice. All comments received prior to
that date are considered in the final determina-
tions regarding the Proposed permit The Director
of the NC Division of Water Quality may decide 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 in-
formation on file used to determine conditions Before the undersigned,a Notary Public of Catawba County,North
present in the draft permit are available upon re-
quest and payment of the costs of reproduction. Carolina,duly commissioned,qualified,and authorized by law to
Mail comments and/or requests for information to
the NC Division of Water Quality at the above ad- administer oaths,in said County and Slate;that he/she is authorized to
dress or call Dina Sprinkle(919) 807-6304 at the make this affidavit and sworn statement:that the notice or other legal
Point Source Branch. Please include the NPDES
permit number(below)in any,communication. In- advertisement,a copy of which is attached hereto,was published in the
terested persons may also visit the Division of Wa-
ter Quality at 512 N.Salisbury Street,Raleigh,NC Statesville Record&Landmark on the following dates:
27604-1148 between the hours of 8:00 a.m. and
5:00 p.m.to review information on file.
The NC Department of Transportation (P.O. Box 01/23/2009
250,North Wilkesboro,NC 28659)has applied for
renewal of NPDE5 permit NCO028606 for the 1.77
Rest Area in Iredell County.This permitted facility
discharges created wastewater to the Camel
Branch in the Yadkin-Pee Dee River Basin. Cur- and that the said newspaper in which such notice,or legal advertisement
rently fecal conform,ammonia nitrogen and total
residual chlorine are water quality limited. This was published,was a newspaper meeting all the requirements and
discharge may affect future allocations in this
portion of the Yadkin-Pee Dee River Basin. qualifications of Section 1-597 of the General Statutes of North Carolina
David L.Millsaps has applied for renewal of NPDES
permit NCO023191 for the Seven Cedars Mobile
Home Park WWTP in Iredell County.This permit- „O
ted facility discharges.010 MGD of treated waste-
water to Third Creek in the Yadkin-Pee Dee River
Basin. Currently, total residual chlorine is water As ' ant Bookkeepe
quality limited. This discharge may affect future
allocations in this portion of the Yadkin-Pee Dee
River Basin. P PE 110\ews a r reference: 01248091
Hill Haven Residential Care. Inc (114 Hill Haven
Road, Statesville. INC 28677) has applied for re-
newal of NPDES permit NCO045012 for the Hill Ha- Sworn to and subscribed before me,thisaz�day of 11 2009
ven Residential Care WWTP in Iredell County.This
permitted facility discharges treated wastewater
to an unnamed tributary to Third Creek in the
Yadkin-Pee Dee River Basin. Currently fecal ,-
coliform, ammonia nitrogen and total residual
chlorine are water quality limited.This discharge 41rolatublic O
_
may affect future allocations this portion of the _ !'
Yatlkin-Pee Dee River Basin.
The Barium Springs Home for Children[P.O.Box 1, Z
Barium Springs,NC 280101 has applied for renewal
Of NPDES permit NCOD45471 for its WWTP in
Iredell County. This permitted faciliW discharges
treated wastewater into an unnamed tributary to My Commission expires: J, t
Duck Creek in the Yadkin-Pee Dee River Basin.
Currently,BOD,ammonia nitrogen,dissolved oxy-
gen,fecal coldorm and total residual chlorine are
water quality limited. This discharge may affect THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU-
future allocations in this portion of the watershed.
Mr.mi Homer 7615Prevettefor has applied for renewal W per-
in I NCOedell County.
for the Herein Truck Stop WWTP // ./L
eIredell County. This permitted facility Di in tar-
es treated wastewater a Third Creek in the PIS le
Yadkin-Pee Dee River Basin. Currently, fecal
coliform and total residual chlorine are water
quality limited. This discharge otThird
may affect future
m allocations :hL portion of L,hd Creek. -

Statesville Record & Landmark
Account Number
Advertising Affidavit
3142720
North Carolina Community Newspapers
Data
PO Box 968
Hickory, NC 28603 January 23,2009
NC DENR/DWO
BUDGET OFFICE
1617 MAIL SERVICE CENTER
RALEIGH,INC 27699
Date Category Description Ad Number Ad Size
01/23/2009 Legal Notices PUBLIC NOTICE STATE OF NORTH CAROLINA EN 0001248091 2 x 144 L
Media General Operations, Inc.
Publisher of
Lowe's Home Centers, Inc. [711 Tomlin Mill Road,
Statesville. NC 286251 has anglied for renewal of Statesville Record & Landmark
NPDES permit NCOOSS120 for Its Iredell County
Distribution Center W WTP.This Permitted facility
discharges treated wastewater to an unnamed Iredell County
tributary to Rocky Creek in the Yadkin-Pee Dee
River Basin. Currently,ammonia nitrogen and fe-
cal coliform are water quality limited. This dis-
charge may affect future allocations in this por-
tion of the watershed.
Hampton Capital Partners.LLC dba Gulistan Carpet Before the undersigned,a Notary Public of Catawba County,North
[P.O.Box 10,Turnersburg,NC 28688-00101 has ap-
plied for renewal of NPDES permit N00004898 for Carolina,duly commissioned,qualified,and authorized by law to
its Turnersburg Plant in Iredell County. This per-
mitted facility discharges to Rocky Creek in the administer oaths,in said County and Stale;that he/she is authorized to
Yadkin Pee-Dee River Basin.This facility has four
curtails:outtalls 001,003,and 004 discharge cool- make this affidavit and sworn statement;that the notice or other legal
ing tower blowdown, air washer water, boiler
blowdown, and stormwater. Treated domestic advertisement,a copy of which is attached hereto,was published in the
wastewater is discharged through outfall 002. Statesville Record&Landmark on the following dates:
Currently total residual chlorine is the only water
quality limited parameter.This discharge may af-
fect future allocations In this portion of the Yadkin
Pee-Dee River Basin. 01/23/2009
Manheim Statesville(P.O. Box 749, Statesville, NC
28687) has applied for renewal of permit
NCO076333 for its Statesville Auto Auction WWTP
in Iredell County. This permitted facility discharg-
es treated domestic wastewater to Fifth Creek in and that the said newspaper in which such notice,or legal advertisement
the Yadkin-Pee Dee River Basin. Currently ammo-
nia nitrogen,fecal coliform,oil&grease and total was published,was a newspaper meeting all the requirements and
residual chlorine are water quality limited. This discharge may affect future allocations in this qualifications of Section 1-597af the General Statutes of North Carolina.
portion of Fifth Creek.
Southern States Cooperative.Inc.[6606 West broad
St,Richmond,VA 232301 has applied for renewal
. . of NPDES permit N00082821 for its Statesville Fer.
tilizer Plant in Iredell County. This permitted fa- Ass am Bookkeep
cility discharges remediated groundwater to
Fourth Creek in the Yadkin-Pee Dee River Basin.
Currently,ammonia nitrogen is water quality lim- Newspaper reference:0001248091
ited. This discharge may affect future allocations
in this portion of the watershed.
PUBLISH:January 23.2009 4
Sworn to and subscribed before me,this�y"'day of�y.r.r12009
=CPMA Mck�v' ,
Notary tublic O Tq ;,
My Commission expires: �" !'� AV B L`'TG `
°:
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE"Tk�t N ` sv`
r/nnut tsx

SOC PRIORITY PROJECT: Yes_Nox
If Yes. SOC No.
To: Western N.PDES Program Unit
Water Quality Section
Attention: Dina Sprinkle
Date: October 30, 2008
NPDES STAFF REPORT AND RECOMMENDATION
County: Iredell r
Permit No. NCO045471 f�� E C E �VJ E ; j y
PART I - GENERAL INFORMATION NOV 2008 '�
1. Facility and address: Barium Springs Home for Children
UALID
P.O. Box 1 POT SOURCE E MCH
Barium Springs,NC 28010
2. Date of investigation: October 29, 2008
3. Report prepared by: Samar Bou-Ghazale, Env. Engineer II
4. Persons contacted and telephone number: Mr. Jerry Rogers, ORC; telephone number (704)
437-2922
5. Directions to site: The entrance to the wastewater treatment plant site is on the right (east)
side of Highway 115 approximately 0.6 mile north of the junction of Highway 115 and S.R.
1005 (Old Mountain Road)just north of the Town of Troutman.
6. Discharge point(s). List for all discharge points:
Latitude: 35o 43'28" Longitude: 80° 53' 15"
Attach a U.S.G.S. map extract and indicate treatment facility site and discharge point on
map.
U.S.G.S. Quad No.: E 15 NW U.S.G.S. Name: Troutman, N.C.
7. Site size and expansion are consistent with application?
Yes-x-No_ If No, explain:
8. Topography (relationship to flood plain included): Gently rolling, 2-8% slopes; wastewater
treatment plant is not located in a flood plain area.

9. Location of nearest dwelling: None within 1000 feet of the site.
10. Receiving stream or affected surface waters: Unnamed tributary to Duck Creek
a. Classification: C
b. River Basin and Subbasin No.: Yadkin 030708
C. Describe receiving stream features and pertinent downstream uses: Flow was
observed in the receiving stream that was approximately 2' wide and 1-3 inches
deep. No other discharges and/or water intakes exist in this area. A flood control
structure (35 feet high) and a lake, estimated at 2 acres, are located approximately
500 feet downstream of the discharge point.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater to be permitted: 0.03 MGD (Ultimate Design Capacity)
b. What is the current permitted capacity of the wastewater treatment facility? 0.03
MGD
C. Actual treatment capacity of the current facility (current design capacity)? 0.03
MGD
d. Date(s) and construction activities allowed by previous Authorizations to Construct
issued in the previous two years: N/A
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: The existing facility consist of a bar screen, an Imhoff tank, a
sludge holding tank (primarily used for bar screen scrapings), dual surface sand
filter beds, chlorine tablet disinfection, de-chlorination tablet and a dosing counter.
f Please provide a description of proposed wastewater treatment facilities: N/A
g. Possible toxic impacts to surface waters: None other than chlorine.
h. Pretreatment Program (POTWs only): N/A
2. Residuals handling and utilization/disposal scheme: Sludge is removed as necessary by
Lentz Septic "rank Service and disposed of at a septage land application site approved by the
DWM(SLAS-49-01).
3. Treatment plant classification : Class I (no change from previous rating)
4. SIC Code(s): 8361

Primary: II Secondary:
Main Treatment Unit Code: 46017
PART HI - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public monies
involved (municipals only)? N/A
2. Special monitoring or limitations (including toxicity) requests: N/A
3. Important SOC, JOC or Compliance Schedule dates: (please indicate): N/A
4. Alternative Analysis Evaluation:_N/A
5. Air Quality and/or Groundwater concerns or hazardous materials utilized at this facility that
may impact water quality, air quality, or groundwater: No AQ or GW concerns nor are
hazardous materials utilized at this facility.
PART IV - EVALUATION AND RECOMMENDATIONS
The permittee, Barium Springs Home for Children, is applying to renew the permit to
discharge treated domestic wastewater. The wastewater treatment facility was in good operating
condition at the time of the site inspection. No detrimental effect on the stream was observed by
the discharge. The only change from the last permit renewal was the addition of a de-chlorination
system. The nearest sewer line is approximately 2 miles from the facility.
Pending review and approval by the Western NPDES Program Unit, it is recommended
that the permit be renewed as requested
Signature of Report Preparer
Water Quality Regional Supervisor
/'/y
Date

Serving North Carolina's children and families now;
making a difference for the future.
Post Office Box 1
a a i v 5 P 2i GS Barium Springs, NC 28010
ch
n home for 1-800.320.4157-704-872-4157
ROM -1T FAX [phone]
Q�JG www.bariumsprings.org
September 30, 2005
C1
111 t
i
Mrs. Dana Sprinkle , Wi t
NC DENR / DWO / Point Source Branch DOj 1 2008
1617 Mail Service Center
Raleigh, NC 27699-1617 0E14R wAtER OJRJ Y
r_._---4.,4CH
PC�hS p^UgCE_ ._
Dear Mrs. SpinKle,
Lam writing to request the renewal of NPDES permit:#NC0045471 .for our wastewater treatment
plant, i he following information is enclosed:
A completed application
A letter describing our sludge management plan
.Since our last permit renewal, we have installed a,dc-cnlorination tcharnber•at our facility. Just
before the,outfall.
Please contact me or Statesville Analytical,(our current operator) if you have any questions.
Sincerely,
Don S. Keliv
Chief Financial Officer
cc: Dena Myers. Statesville .Anaiviical
f 1111''CW6A h'
m }VV{{ V M I tl

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 INC00 'f 5 71
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 $Praluwl 5r121iJ�,j ifolw_ ,r-or- C0 It-DPE'N%
Facility Name S iNYJ i+jrv, C1-i1c-DRc'--i
Mailing Address P 0 r ua
City Ij AP-1LiM j^t_irJ, -f
State / Zip Code N ` ( ,2 0oI I1I;1 IP P_ F 8 1 E. r�
Telephone Number :3 -7c(7 ) i' j
'f �-�- - -{ li .. 11i � t
Fax Number (joy) 9 3e 15 OCT 1 2008 L .i
e-mail Address
C.r�elf � i,a2iu..,.5o�iac � c,r=n ! I
! DENR - WATER QUALITY
POINT SOURCE P.R/diCH
.2. Location of facility producing disc rge:
Check here if same address as above
Street Address or State Road 1 Sto F!'a Z j t'P
City 1>A(=iam IN4�_V
State / Zip Code N` ,;LD, p
County
L Y-E'17c LE_
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 - 5.- -V it_i. A-A/A�-`�i rC 4L
Mailing Address *F C-X -2 A q
City ST>A'r iVi[
State / Zip Code ti 2-0E gj 7
Telephone Number (700 72 _ q&q-7
Fax Number (701) 67£ — A-7 &-7
1 of 3 Form-D 05108

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow , 03 MGD
Annual Average daily flow , 0 P 8 MGD (for the previous 3 years)
Maximum daily flow 6l MGD (for the previous 3 years)
11. Is this facility located on In an 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 ( Maximu Dailym Monthly I Units of
Average Measurement
Biochemical Oxygen Demand (BOD5)Fecal Coliform 3, 33 CFU 100� C-
Total Suspended Solids �' y S, j r I / L
Temperature (Summer)
Temperature (Winter) ) („ 2 %/, ( Cry, J
pH u3
13. List all permits, construction.approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CA_A)___---.. .----i.
UIC (SDWA) Ocean Dumping M SZ U ,yf 'LEI n,'i
NPDES PIC p0 514 ?/ Dredge or fill(Senction 404 or CWA)
PSD (CAA) Other ��}�� OCT 2nnn
vv _
Non-attainment program (CAA)
r
14. APPLICANT CERTIFICATION OE,hR -WATER QUALITY I
i POINT SOURCE EIJVdCH
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.
2
, Nrc)F FitjA� e. o L of rice
Printed name of Person igning Title
Sig ature of Applicant Date
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, 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 ounishable 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 525,000 or imprisonment not more than 5 years,or both,for a similar offense.)
3 of 3 Form-D 05108

\ / Serving North Carolina's children and families now;
making a difference for the future.
Pos',Office Box 1
B a 2i vn� s P 2 i r�GS Barium Sprinos, NC 28010
41
m home for W 1.800.320.4157- 704-872.4157
Lch i6 ,m FAX.bariu spring
www.bariumsprings.org
September 30, 2008
Mrs. Dana Sprinkle
NC DENR / DWO / Point Source Branch
1617 Mail Service Center
Raleiah. N01.27699-1617
Dear Mrs. SPInkle,
This letter describes our siudae management plan for our wastewater.treatment plant (NPDES
Permh NC0045471).
.Statesville Analytical has been contracted as the operator-of our WWTP. As par of their
regular monitoring, the Operator notifies us when the suspended solids increase beyond the
recommended concentration. We then contract with a,localiseptic:tank-service company who
,pumps out the sludge holding tank and disposes of•the-waste off-site.
Please contact me or Statesville Anaivtical it,you have any questions.
Sincerely,
Don'S: Kelly
Chief Financial Officer
cc: Dena Myers, Statesville Analytical
W
W M 1Y
.�.omr Y! IlY

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Basic Information to determine potential for expedited permit renewal
Reviewer/Date 611 /'h 4N; I 14-tl-OB
Permit Number N C ob q 5147t
Facility Name ar S r; s
Basin Name/Sub-basin number ; H 30,a 6
Receiving Stream T o va!-t Crew
Stream Classification in Permit G
Does permit need NH3 limits? N v
Does permit need TRC limits? /J C2
Does permit have toxicity testing? Ai D
Does permit have Special Conditions? Al O
Does permit have instream monitoring?
Is the stream impaired (on 303 d list)? N
Any obvious compliance concerns? NO
Any permit mods since lastpermit? O
Existing expiration date -
New expiration date
New permit effective date
Miscellaneous Comments
YES This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NE3,
name/ownership changes). Include conventional WTPs in this group.
YES_ 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)