NC0034703_Permit (Issuance)_20090617

NPDES DOCUMENT SCANNINS COVER SHEET
NPDES Permit: NC0034703
Knollwood Elementary School WWTP
Document Type: ' Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Speculative Limits
Complete File - Historical
Instream Assessment (67B)
Environmental Assessment (EA)
Permit
History
Document Date: June 17, 2009
Whig document is printed oa reuWe paper-igazore*UM'Y
ooateiat on the reiaex-ae bide

Chapter7V.B: Wastewater Dischargers DRAFT
RP.] Estimated Costs/Savings—Wastewater Dischargers (Metals)
Table IV.13-6. POTWs Evaluatedl
League of Municipalities Study Division of Water Quality Study
Ansonville Boone Moore County
Brevard Burlington-South Mooresville(Rocky River)
Fayetteville(RFC) Burnsville MSD Buncombe
Fayetteville(CC) Cape Fear PUA-Northside Neuse River(Raleigh)
Goldsboro Cape Fear PUA-Southside New Bern
Greensboro-N.Buffalo Creek Cary-North North Wilkesboro
Greensboro-T.Z.Osborne Chadbourn Northeast Brunswick RWWTF
Greenville CMU-McAlpine Creek Pembroke
Havelock Columbus Pilot Mountain
Hendersonville Durham-South Pittsboro
Laurinburg East Side Randleman
Lincolnton Forest City Red Springs
Louisburg Goldsboro Rockingham
Maggie Valley Greensboro-N. Buffalo Creek Rutherfordton
Mebane Greensboro-T.Z.Osborne Salisbury
Raleigh Gunpowder Creek Sanford
Randleman Hamlet Sparta
Roanoke Rapids Hickory Stanley
Rose Hill Hickory-Northeast Statesville-3rd Creek
Rutherfordton High Point-West Statesville-4th Creek
Spindale - Kinston RWRF Tar River RWWTP(Rocky Mount)
Spring Lake Laurinburg-Maxton Airport Commission Thomasville
Valdese Lexington Tryon
Wilson Lumberton _ Union County-Twelve Mile Creek
Windsor Maiden Washington
Yadkinville Marion Whiteville
Mayodan Wilson
Mebane Winston-Salem-Muddy Creek
Mocksville Yadkinville
Footnote:
Facilities in bold were evaluated in both studies.
The RPAs for these freshwater permits indicate that the new metals standards will likely result in the following
changes in permit requirements:
7 of 7 with oo requirements for affected metals will continue to have no requirements (100%)
20 of 25 with 'Monitoring Only' for affected metals will continue to monitor only(80% of subset)
5 of 25 with 'Monitoring Only' for affected metals will receive new limit(s) for Cd, Pb, &/or Ni (20%)
17 of 25 with existing limits for Cd, Pb, &/or Ni or Action Level metals Cu, Ag. &/or Zn ('target' metals)
will still have one or more limits for those metals(68%)
8 of 25 with existing limits for target metals will drop those limits and revert to 'Monitoring Only' (32%)
57
These proportions can be applied to the larger population of freshwater POTW perniits in order to estimate the
standards' impacts. The 7/l/2011 list of permits indicates that, of all the freshwater POTWs,
37 2011 tri_rev fiscal note-WW-draft 20120830.docx
Printed 812 412 01 2 3:08 PM

� r
C®ER
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
June 17, 2009
Mr.J. H. Bivens
Rowan-Salisbury Schools
515 North Clay St
Salisbury, N.C. 28144
Subject: Issuance of NPDES Permit NCO034703
Knollwood Elementary School WWTP
Rowan County
Dear Mr. Bivens:
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 changes from the draft permit sent to you on April 22, 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 [phone].
S' rely, � n
- leer H.4SUllin
cc: Central File's
Mooresville Regional Office/Surface Water Protection
NPDES Unit i
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 One L
512 North Salisbury Street,Raleigh,North Carolina 27604 NOI tI1C81 Ohlla
Phone: [phone]W/FAX [phone]/Internet:www.ncwaterquality.org �aturao��
An Equal Opportunity/Affirmative Action Employer-50%Recycled/10%Post Consumer Paper

Permit NCO034703 a
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
Rowan / Salisbury Schools
are hereby authorized to discharge wastewater from a facility located at the
Knollwood Elementary School WWTP
3075 Shue Road, north of Salisbury
Rowan County
to Little Creek in subbasin 03-07-04 of 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.
This permit shall become effective July 1, 2009.
This permit and authorization to discharge shall expire at midnight on June 30, 2014.
Signed this day June 17, 2009
1/7 6AFA4j
een H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO034703
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDFS 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 Rowan-Salisbury Schools are hereby authorized to:
1. Continue to operate an existing 0.011 MGD wastewater treatment system with
the'following components:
♦ Grease trap
♦ Bar screen
♦ Equalization basin
♦ Aeration basin
♦ Clarifier
♦ Dosing tank
♦ Distribution box
o Surface sand filter
♦ Chlorine contact tank with tablet chlorinator and tablet dechlorination
♦ Ultrasonic flow meter
The facility is located at the Knollwood Elementary School VJVJTP off Shue Road
north of Salisbury in Rowan County.
2. Discharge from said treatment works at the location specified on the attached
map into Little Creek, currently classified C waters in subbasin 03-07-04 of the
Yadkin-Pee Dee River Basin. -

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Latitude.35"37'29'• Facility , q"'
Longitude:8(r34'22•• NCO034703 4,:.rr"f<„F -i
� "�
Quad: E16SE Location.
Receiving Stream: Little Creek KnOUWOOd Elementary '`WQ`,.
Stream(lass:C School
Snbbasiq: 30704 - Rowan County IF SCALE 1:24000
North

Permit NCO034703
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 from outfall 001. Such discharges shall be limited
and monitored by the Permittee as specified below:
PARAMETER LIMITS MONITORING REQUIREMENTS
Monthly Daily Measurement Sample Type Sample Location
Avera a Maximum Frequency
Flow 0.011 MGD Weekly Instantaneous Influent or Effluent
BOD,5-day(20°C) 30.0 mg/L 45.0 mg/L Weekly Grab Effluent
Total Suspended Solids 30.0 mg/L 45.0 mg/L Weekly Grab Effluent
NH3 as N 28.4 mg/L 35.0 mg/L Weekly Grab Effluent
April 1-October 31
NH3 as N Weekly Grab Effluent
November 1-March 31
Fecal Colifonn 200/100 ml 400/100 ml Weekly Grab Effluent
(geometric mean
Total Residual Chlorine(TRC)l 28 µg/L 2/Week Grab Effluent
Temperature(°C) Daily Grab Effluent
pH >6.0 and<9.0 standard units Weekly Grab Effluent
Total Nitrogen Quarterly Grab Effluent
NO2+NO3+TKN
Total Phosphorus Quarterly Grab Effluent
Footnotes:
1. The Permittee shall report all effluent TRC values reported by a NC-certified laboratory [including
field-certified). Effluent values below 50 µg/L will be treated as zero for compliance purposes.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Weaver, Charles
From: Belnick, Tom [[e-mail]]
Sent: Tuesday, June 16, 2009 3:12 PM
To: [e-mail]
Cc: Krebs, Rob; Tedder, Steve; Poupart, Jeff
Subject: Public Hearing Determination-Yadkin Basin
Attachments: ATT00001.c
The Yadkin Riverkeeper recently requested public hearings for 8 draft NPDES permits. Following a compliance review,
Colleen directed NPDES to hold one combined public hearing for 4 of the facilities,and to proceed to permit finalization
for the others.
Proceed to Public Hearing:
• NC0036561-United Church Retirement Center(Bob Sledge permit)
• NC0059536-Hilltop Living Center(Bob Sledge permit)
• NC0024112-Thomasville Hamby Creek(Sergei Chernikov permit)
• NC0051713-Shoreline LLC/La keview MHP(Bob Sledge permit)
Proceed to Permit Finalization:
• NC0029947-Churchland Elementary School(Bob Sledge permit)
• NC0024228- Highpoint Westside(Sergei Chernikov permit)
• NC0024878- Davie County/Cooleemee(Sergei Chernikov permit)
• NC0034703- Rowan-Salisbury Schools/Knollwood Elementary (Charles Weaver permit)
For the public hearing, looks like Bob Sledge is the big winner! Bob and I will coordinate hearing logistics with WSRO
down the road.
Tom Belnick
Supervisor, NPDES West Program
NC DENR/Division of Water Quality
1617 Mail Service Center, Raleigh, NC 27699-1617
[phone];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.
Email correspondence to and from this sender is subject to the N.C.Public Records Law and may be disclosed to third parties.
1

The Charlotte Observer Publishing Co.
Charlotte, NC
North Carolina ) ss Affidavit of Publication
Mecklenburg County) -THE CHARLOTTE OBSERVER
__________________________________________________ __________
NCDENR/DUO/NPDES
FRANCIS CANDELARIA
1617 MAIL SERVICE CTR
RALEIGH NC 27699-1617
REFERENCE: 30045571
6336267 npdes - amaral
Before the undersigned, a Notary Public of said
County and State, duly authorized to administer
oaths affirmations, etc., personally appeared, I . . .
being duly sworn or affirmed according to law,
doth depose and say that he/she is a
representative of The Charlotte Observer
Publishing Company, a corporation organized and _
doing business under the laws of the State of
Delaware, and publishing a newspaper known as The - - we eN
Charlotte Observer in the city of Charlotte, a� 7--Z '0 emem�
Y NoM Gamma Em'�,mrD�Un "
Count of Mecklenburg, and State of North CarolinaAD
and that as such he/she is familiar with the �1-. .. TA'AnW95 a,fis sweauenwas �',j n
books, records, files, and business of said +#N°'^LB ,o ere�Eroi,'unnn-POEMaa gt ey
Corporation and b reference to the files of said The•INhM ssuea NPDE,,S�y�,w,.�a1L[L�t n�K 4.'.'M
P Y pe(s sl llt atlC°n�_,9a`?,dog.inubis I dataadt tiano,bolo
publication, the attached advertisement was ���°m p^ro°e ztea.,.D° N , at-,
inserted. The fallowing is correctly copied from - Pup%'citu9?b°Ula:tn° ^�anewcupl '^
the books and files of the aforesaid Corporation ;merest Please me'dtla pFeeee9� �t i o�n n.may
pW�2 Nh Salabury.5�r. non NPDCSPe ual tYo 9:i oreby
and Publication. mates Na
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PUBLISHED ON: 04/24 —
AD SPACE: 68 LINE
FILED ONjjFlFl�: O5/01/O9
NAME:--U�'I yJ1 QL� ____
/U"lA�l _- TITLE:
DATE: qAy 9 1 2onq
In Testimony Whereof I have hereunto set my haald-affixed my-seal;-the
day and or aforesaid. -
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Note z ission Expires:
My Commission Expires May 27, 2011

Permit Enforcement History
Permit:NCO034703 Facility:Knollwood Elementary School Owner:Rowan-Salisbury Schools
Region:Mooresville County:Rowan
Penalty Remission Enforcement Collection Has
Assessment Penalty Enforcement Request Conference EMC Memo Sent Payment
Case Number Approved Amount Costs Damages Received Held Hearing Held to AGO Total Paid Balance Due Plan Case Closed
LR-1990-0012 01/24/90 $150.00 $.00 $.00 0211MO 04/04/90 $150.00 .00 No 05/24/90
LV-2000-0259 06/30/00 $250.00 $82.17 $332.17 .00 No 07/31/00
LV-2002-0371 08/29/02 $250.00 $85.45 $335.45 .00 No 09/13/02
Total Cases: 3 $650.00 $167.62 817.62 $.00
Total Penaltes: $817.62 Total Penalties after remission s): $817.62

SOC PRIORITY PROJECT: No
To: Western NPDES Unit
Surface Water Protection Section
Attention: Charles Weaver
Date: December 3, 2008
NPDES STAFF REPORT AND RECOMMENDATION 5�;, —T—
County: Rowan 7 I - -'
;
Permit No. NC0034703
j t` NOV 4 POOn
PART I - GENERAL INFORMATION f I
DEMO.. -YJATFi'10U^.n
1. Facility and address: Knollwood Elementary School P3Jg' SOU",
Rowan-Salisbury Schools Maintenance Department
515 North Clay Street
Salisbury, North Carolina 28144
2. Date of investigation: November 13, 2008
3. Report prepared by: Michael L. Parker, Environmental Engineer II
4. Persons contacted and telephone number: Mr. Jerry Rogers, ORC: 704/872-4697.
5. Directions to site: From the junction of US Hwy 29 and SR1506 (Shue Road) in China Grove,
Rowan County, travel north on SR 1506 approximately 2.9 miles. The school is on the left(west)
side of the road. However,the wastewater treatment plant is located approximately 600 feet north
of the school.
6. Discharge point(s). List for all discharge points:
Latitude: 35' 37' 29" Longitude: 80' 34'22"
USGS Quad No.: E 16 SE USGS Name: China Grove, NC
10. Receiving stream or affected surface waters: Little Creek.
a. Classification: C
b. River Basin and Subbasin No.: Yadkin-Pee Dee & 03-07-04
C. Describe receiving stream features and pertinent downstream uses: The receiving stream is
approximately 25 feet wide with sandy bottom. Downstream uses are typical for class C
waters.
Page 1

PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater: 0.011 MGD (Design Capacity)
b. What is the current permitted capacity of the wastewater treatment facility? 0.011 MGD
C. Please provide a description of existing or substantially constructed wastewater treatment
facilities: The existing facility consists of a grease trap, bar screen, equalization basin.
aeration basin, clarifier, dosing tank, distribution box, surface sand filter with six 80-foot
long distribution pipes, followed by a chlorine contact tank with tablet chlorinator and a
tablet dechlorination unit. Flow is measured by a flume/ultrasonic flow meter.
d. Please provide a description of proposed wastewater treatment facilities: There are no
additional WWT facilities proposed at this time.
e. Possible toxic impacts to surface waters: None other than chlorine.
2. Residuals handling and utilization/disposal scheme: Sludge is transported by Myers Septic
Company to a City of Salisbury wastewater treatment plant for final disposal.
3. Treatment plant classification (no change in rating since last inspection): Class II
4. Compliance information: Facility was last inspected on October 12, 2007 and was found to be in
good operational condition and only one effluent violation was noted during the preceding 12
months.
PART III - OTHER PERTINENT INFORMATION
i. Special monitoring or limitations (including toxicity) requests: None at this time.
2. Alternative Analysis Evaluation: There are no known alternatives to a discharge at this time.
PART IV - EVALUATION AND RECOMMENDATIONS
The Permittee, Rowan-Salisbury Schools, is applying for renewal of its NPDES permit to
discharge treated domestic wastewater from the wastewater treatment system serving Knollwood
Elementary School. There have been no changes to the permit since it was last renewed, however, the
school has added an equalization basin, flow meter and a tablet dechlorination unit.
Pending a final technical review and approval by the Western NPDES Unit, it is recommended
that the permit be renewed as requested.
AK'��100 iz��
Signature of Report Preparer D to
Water Q i y Regional Supervi r ate
H Adsrr\dsr08Umollwood.dm
Page 2

PLISBUljt.
Rowan-Salisbury Schools Maintenance Department
z' 1 prr
C'
U
t 515 North Clay Street • Salisbury,North Carolina 28144
Telephone: [phone] • Fax: [phone]
DANCE DVV
November 4, 2008
Ms. Dina Sprinkle
NC DENWDWQ/Point Source Branch
1617 Mail Service Center
Raleigh NC 27699-1617
Ms. Sprinkle:
In accordance with NPDES permit regulations; we are making application for renewal of
NPDES Permit NC0034703.
As requested, we are documenting any changes to the facility. The first change was the
addition of a tablet dechlorination system constructed under A to C No. 034703A01,
issued October 27, 2005. The second change was the installation of an effluent v-notch
flow meter and recorder and a 7,500-gallon capacity flow equalization basin with
necessary appurtenances constructed under A to C No. 034703A02, issued February 5,
2007. Please see all constructed changes on attached drawing.
If you nee any questions answered or additional information, please do not hesitate to
contact Mr. Jody Blythe at 704-639-3017 ext. 102.
Sincerely,
-a-W.
NOV - 7 2008 l
J. H. Bivens
Director of Maintenance ----._.
"Maximizing Learning for Maximized Success"

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Date:October 25 2007 I_
Knollwood
Elementary
School
1 - Wastewater
Treatment Plant
Improvements
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NOV - 7 2008
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515 North Clay
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=t - Salisbury, NC 28144
NnroSele �' '
NEW 4'X 6'CONCRETE
PAD FOR BLOWER
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,�S�l.1SBURllCy0
Rowan-Salisbury Schools Maintenance Department
s toff
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s 515 North Clay Street • Salisbury, North Carolina 28144
Telephone: [phone] • Fax: [phone]
November 4, 2008
Sludge Management Plan
Ref: NPDES Permit NC0034703
Knollwood Elementary School
Rowan County, NC
The above permitted facility generates enough solids to have pumped and hauled by local
pump/haul businesses. Our grease interceptor is pumped once a year in June/July after school
recesses for summer. Our aeration basin/clarifier is generally pumped 3-4 times a year as
needed. Because we are still in a learning curve on the equalization basin, we have pumped
solids from it two times. As a class 2 facility, we are on-site 5 days per week and closely
monitor for any additional pumping needs. Our surface sand filter is raked weekly, weather
permitting.
$d1-6weroo
J. H. Bivens
Director of Maintenance
"Maximizing Learning for Maximized Success"

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 0000 3 . 'ic 3
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 NameDWA�
Facility Name >`1pLI YJDDl7 EL&1+1, T,,+gy SGHmL-
Mailing Address 515 All CL/I"/ Sj
City
State / Zip Code PVC- A14
Telephone Number (zd ) k j7. q 301 /_ x 1 o6
Fax Number �fIJ`I ) 01 3109
e-mail Address My 7 �f. i I 'r �55 i k_12 a "C a u5
2. Location of facility producing discharge:
Check here if same address as above ❑ nn ..
Street Address or State Road _�,P75 SHv&
city . . SALISd3uRy
State / Zip Code
County
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 S1�1 lZSV1LLf aI� qL yT�CH(_
Mailing Address a 8Ex 7zR
City S1Tf3V1L(E 6
State Zip Code l r'
Telephone Number (��) B-7Z LJI-A
itl�r:
pr �/ ��qq 11
Fax Number tl�IyF ) ��l J (i�7/7 r l�+ Nov - J 2008 ;'1
1 of 3 Form-D 05108

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial ❑ Number of Employees
Commercial
❑ Number of Employees,
Residential ❑ Number of Homes
School Number of Students/Staff
Other ❑ Explain: 670 1DD .
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
SCt�UvL TI M s c L-15S VCOM -slovk5 k)ZMbJ
Population served:
5. Ty e of collection system
Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points _
Outfall Identification number(s) tssG!
Is the outfall equipped with a diffuser? ❑ Yes 2 No
7. Name of.receiving stream(s) (Prouide a map.shounng the exact location of each outfallJ.
G/7JL� GQEE� %iy 7'Hk Y�DJ�in/ /'E�SEE / ►'te A-z5ie4l'
8. Frequency of Discharge: ❑ Continuous 2 Intermittent
If intermittent:
Days per week discharge occurs: Duration: It A? —
9. Describe the treatment system
List all installed components, including capacities,provide design removal forBOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet ofpaper.
Xj
V
t ,� Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design now I LMGD
Annual Average daily flow o D MGD (for the previous 3 years)
Maximum daily flow _MGD (for the previous 3 years)
11. Is this facility located on In an country?
ElYes No
12. Effluent Data
Provide data for the parameters listed. Fecal Coliform, Temperature and pH shall be grab samples,for all other
parameters 24-hour composite sampling shall be used. If more than one analysis is reported,report daily maximum
and monthly average.If only one analysis is reported, report as daily maximum
Parameter Daily -Monthly - -. .Units of
Maximum Avera a I Measurement
Biochemical Oxygen Demand (BODs) L �L
Fecal Coliform /��
Total Suspended Solids
Temperature (Summer)
Temperature (Winter) �� 3, o�
pH J4p
O , .
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
11C X3V 703 Dredge or fill (Section 404`,r CWAl
PSD (CAA) - Other I L(I NOV - I)nno ��i
Non-attainment program (CAA)
14. APPLICANT CERTIFICATION {,
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.
K Ol ✓ETlS - JJ(lLZ,ry,� 0/7'///A-!N�'T/f>`NC�
Printed name of Person Signing Title
0✓ aca
Signature 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 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 Form-D 05/08

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Basic Information to determine potential for ex edited ermit renewal
Reviewer/Date a.t S. Y
Permit Number n1C00 3Y 70 3
Facility Name — 1%.11o..1 El.,,. 5.4, ww P
Basin Name/Sub-basin number o3o?o4- "
Receivin Stream ofl. Cr..k
Stream Classification in Permit C
Does permit need NH3 limits? 04
Does permit need TRC limits? 04
Does permit have toxicity testing? lJo
Does permit have Special Conditions? No
Does permit have instream monitoring? No
Is the stream impaired on 303 d list)? pla
Any obvious compliance concerns? No
Any permit mods since lastpermit? Pa
Existing expiration date 6/16/91
New expiration date
New permit effective date
Miscellaneous Comments /� J
Aaa CS Ip f L— Mau AMJ i6 fAfiAh {..11111 UCS4A JON
YES✓ This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NH3,
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)