NCG500291_HISTORICAL

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director . Secretary
alb; \Ill'
CERTIFIED MAIL ITEM 7007 0710 0000 5376 8997 — RETURN RECEIPT REQUESTED
Mr. K. Talbot
Robetex, Inc.
P.O. Box 1225
Lumberton, N.C.
Dear Mr. Talbot:
28359-1225
September 29, 2009•
Subject: Termination of NPDES Certificate of Coverage
NCG500291 — Robetex, Inc.
Robeson County
The subject Certificates of Coverage (CoCs) expired on July 31, 2007. You no longer
have a permit to discharge wastewater.
Based on recent information supplied by the Fayetteville Regional Office, the Division has
concluded that you no,longer need this CoC and will not renew it in the future.
If in the future you wish! to discharge wastewater to the State's surface waters, you must first
apply for and receive a new NPDES permit. Discharge of wastewater without a valid NPDES
permit could subject you to a civil penalty of up to $25,000 per day.
If you have questions about this matter, please contact Charles Weaver of my staff at the
telephone number or address listed below.
Sincerely
f Coleen H. Sullins
cc: Central Files , !
Fayetteville Regional O1 ce / Date Lopez i
NPDES -Permif file
Fran McPherson, DWQ 'Budget Office
efie7
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Internet: www.ncwaterquality.org
Phone: [phone] /'FAX [phone]
[e-mail]
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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph:D., Acting Director
4/23/2002
CERTIFIED MAIL
RETURN RECEIPT REQUES 1ED
ATTN: K TALBOT
ROBETEX, INC.
P O BOX 1225
LUMBERTON, NC 28359
NCDENR
NORTH CAROLINA DEPARTMENT OF
E rVIRONMENT AND NATURAL RESOURCES
WAY 6 2002 I
Subject: NOTICE OF VIOLATION
FAILURE TO SUBMIT RENEWAL APPLICATION
ROBETEX, INC.
NCG500000
COC NUMBER NCG500291
ROBESON COUNTY
Dear Permittee:
This letter is to inform you that, as of the date of this letter, the Division of Water Quality has not received a
renewal request for the subject permit certificate of coverage. This is a violation of NCGS §143.215.1 (c)(1) which
states "All applications shall be filed with the commission at least 180 days in advance of the date on which it is
desired to commence the discharge of wastes or the date on which an existing permit expires, as the case may be".
Any permittee that has not requested renewal at least 180 days prior to expiration or permittee that does not have a
permit after the expiration and has not requested renewal at least 180 days prior to expiration, will be subjected to
enforcement procedures as provided in NCGS §143-215.6 and 33 USC 1251 et. seq.
In order to prevent continued, escalated action, including the assessment of civil penalties you must submit a
completed permit coverage renewal application to the attention of the "Stormwater and General Permits Unit" at
the letterhead address within ten (10) days of your receipt of this letter (renewal application enclosed).
If the subject discharge has been terminated, please complete the enclosed rescission request form. Mailing
instructions are listed on the bottom of the rescission request form. You will be notified when the rescission
process has been completed.
Thank you for your prompt attention to this situation. If you have any questions regarding this matter, please
contact Delonda Alexander of the central office Stormwater and General Permits Unit at 919-733-5083, ext. 584.
Sincerely,
for Gregory J. Thorpe, Ph.D.
Acting Director, Division of Water Quality
cc: Stormwater and General Permits Unit Files
Central Files
Fayetteville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG500000
CERTIFICATE OF COVERAGE NO. NCG500291
TO DISCHARGE NON -CONTACT COOLING WATER, COOLING TOWER AND BOILER
BLOWDOWN, CONDENSATE, EXEMPT STORMWATER, COOLING WATERS ASSOCIATED WITH
HYDROELECTRIC OPERATIONS, AND SIMILIAR WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
i '
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,
Robetex, Inc.
is hereby authorized to discharge
non -contact cooling water, condensate and other similar wastewaters
from a facility located at
to receiving waters designated as
Robetex, Inc.
300 Robetex Drive
Lumberton
Robeson County
ubbasin 30757 in the Lumber River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, II, III and IV of General Permit No. NCG500000 as attached.
This certificate of coverage shall become effective August 1, 1997.
This certificate of coverage shall remain in effect for the duration of the General Permit.
Signed this day July 24,1997.
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph:D., Acting Director
11/26/2001
K TALBOT
ROBEI1X INCORPORATED
P O BOX 1225
LUMBERTON, NC 28359
A7A
NCDENR
NORTH CAROLINA DEPARTMENT OF
IRONI ENT AND NATURAL RESOURCES
ta 3 7.001
Subject: NPDES Wastewater Permit Coverage Renewal
Robetex Incorporated
COC Number NCG500291
Robeson County
Dear Permittee:
Your facility is currently covered for wastewater discharge under General Permit NCG500000. This permit expires
on July 31, 2002. Division of Water Quality (DWQ) staff is in the process of rewriting this permit with a
scheduled reissue in the summer of 2002. Once the permit is reissued, your facility would be eligible for continued
coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the DWQ for renewal of
your permit coverage. To make this renewal process easier, we are informing you in advance that your permit
coverage will be expiring. Enclosed you will find a general permit coverage renewal application form. This
will serve as your application, for renewal of your permit coverage. The application must be completed and
returned with the required information by February 01, 2002 in order to assure continued coverage under the
general permit. There is no renewal fee associated with this process. Your facility will be invoiced for the annual
permit fee at a later date.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of wastewater from your facility
without coverage under a valid wastewater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,000 per day.
If the subject wastewater discharge to waters of the state has been terminated, please complete the enclosed
rescission request form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit coverage renewal procedures please contact the Fayetteville
Regional Office at 910-486-1541 or Delonda Alexander of the Central Office Stormwater Unit at [phone],
ext. 584
Sincerely,
& tL
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater and General Permits Unit Files
Fayetteville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Jim Bunyard
Robetex, Inc.
P.O. Box 1225
Lumberton, NC 28359
Dear Permittee:
.13
1998
A"'A.
�EHN1=1.
July 24,1997
Subject: Certificate of Coverage No. NCG500291
Renewal of General Permit
Robetex, Inc.
Robeson County
In accordance with your application for renewal of the subject Certificate of Coverage, the Division is forwarding
the enclosed General Permit. This renewal is valid until July 31, 2002. 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 December 6, 1983. If any parts, measurement
frequencies or sampling requirements contained in this permit are unacceptable to you, you have the right to request
an individual permit by submitting an individual permit application. Unless such demand is made, this certificate
of coverage shall be final and binding.
The Certificate of Coverage for your facility is not transferable except after notice to the Division. Use the enclosed
Permit Name/Ownership Change form to notify the Division if you sell or otherwise transfer ownership of the
subject facility. The Division may require modificationor revocation and reissuance of the Certificate of Coverage.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the Regional
Office listed below at [phone]. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division of
Water Quality, the Division of Land Resources, 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 the NPDES Group at the address below.
Sincerely,
i)if,ft.L 4.
cc:
A. Preston Howard, Jr., P.E.
Central Files
Fayetteville Regional Office;l
NPDES File
Facility Assessment Unit
P.O. Box 29535, Raleigh, North Carolina 27626-0535 [phone] FAX [phone] p&[e-mail]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND. NATURAL RESOURCES
DIVISION OF. ENVIRONMENTAL MANAGEMENT -
GENERAL PERMIT NO. NCG500000
CERTIFICATE OF COVERAGE No. NCG500291
TO DISCHARGE NON -CONTACT COOLING WATER, COOLING TOWER AND BOILER BLOWDOWN,
CONDENSATE AND SIMILIAR WASTEWATERS 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,
Robetex, Inc.
is hereby authorized to continue operation of a treatment system for the generation of non -contact cooling water with
the discharge of the water from a facility located at
off of NC Highway 211
Lumberton
Robeson County
to receiving waters designated as an unnamed tributary to Jacob's Swamp in the Lumber River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV of General. Permit No. NCG500000 as attached.
i
This certificate of coverage shalt become effective December 9,1994
i
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day, December 9,1994
Original Signed By
David /4. Goodrich
A. Preston Howard, Jr., P.E.,Director
Division of Environmental Management
By Authority of the Environmental Management Commission

December 6, 1983.
State of North Carolina!
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor.
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E.,I, Director
Mr. Tom Smith
P. O. Box 1225
Lumberton, NC 28359
December 9, 1994
A • A
EHNFl
r 1 iDEC 12 1994
ENV.
q�
Subject: General Permit No. NCG500000
Cert. of Coverage NCG500291
Robetex, Inc.
Robeson County
Dear Mr. Smith:
In accordance with your application for discharge permit received on October, 19, 1994, we are
forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general
permit. This permit is issuedOursuant to the requirements of North Carolina General Statute 143-215 .1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have' the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management or permits required by the Division of Land Resources, 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 Susan Robson at telephone number 919r733-
5083.
On i Erthrted By
David k Goodrich
A. Preston Howard, Jr., P. E.
cc: Fran McPherson
Faye t ville-Regiona1TOffce
P.O. Box 29535, Raleigh, North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
Telephone [phone] FAX [phone]
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DIVISION OF ENVIRONMENTAL MANAGEMENT
November 23, 1994
MEMORANDUM
TO: Dave Goodrich, NPDES Group Supervisor
Permiltt1ing and Engineering Unit
FROM: Kitty A.K. Kramer le: itItc,
Fayetteville Regional Offi e
SUBJECT: NPDES Permit Issuance - New
aRobetexi,_ _Inc.
NPDES Permit No.LNCG590291
Robe ion County
Please find 'enclosed the staff report and recommendations of the
Fayetteville Regional Office concerning the issuance of subject new NPDES
General Permit.
If you haveany questions or require any further information, please
advise.
AKK/AKK/akk
1
Enclosure
cc: Technical Support Branch

SOC PRIORITY PROJECT: Yes
If yes, SOC No.
To: Attention: Susan Robeson
Permits andl Engineering Unit
Water Quality; Section
November 23, 1994
NPDES STAFF REPORT AND RECOMMENDATIONS
County Robeson
Permit No. NCG500291
PART I. GENERAL INFORMATION
1. Facility ands Address: Robetex, Inc.
P.D. -Box -1225 -- ------
Lumberton, N.C. 28359
2. Date of Investigation: November 22, 1994
3. Report Prepared By: Kitty Kramer, Environmental Technician V
4. Persons Contacted and Telephone Number: Tom Smith, Plant Engineer
[phone]
5. Directions to Site: The Plant is located off of Highway 211
approximately 1.4 miles, southeast of the intersection of Hwys 211 and
72.
6. Discharge'Point(s), List for all points:
Outfall 001,- Latitude: 34 36' 30" Longitude: 78 58' 50"
Attach a USGS map extract and indicate treatment facility .site and
discharge point on map.
USGS Quad No.: I 23 SW USGS Quad Name: SE Lumberton, N.C.
7. Site size and expansion area consistent with application?
X Yes! No If no, explain:
8. Topography (relationship to flood plain included): Flat.
9. Location of,nearest dwelling: None within 1,000 feet.
10. Receiving stream or affected surface waters: UT to Jacob's Swp
I
a. Classification: "C-Swamp"
b. River Basin and Subbasin No.: 030757
c. Desc'ribe receiving stream features and pertinent down stream use:
Subjects discharges enter storm drainage ditches which pass through
a large wooded area.

Page 2
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater to be permitted: 0.069 MGD from outfall 001
(located adjacent to the plant) and 0.034 MGD from outfall 002
(located in the back of the plant).
b. What is. the current permitted capacity of the Wastewater Treatment.
facility? N/A
c. Actual treatment capacity of the current facility (current design
capacity): N/A
d. Date(s),and construction activities allowed by previous
Authorizations to Construct issued in the previous two (2) years.
N/A 1
e. Please provide a description of existing or substantially
constructed wastewater treatment facilities:
This iis' a non -contact cooling water discharge which is not
treated.
f. Pleasle 'provide a description of proposed wastewater treatment
facilities: N/A
I
g. PossiIllb1;e toxic impacts to surface waters:
None 'ex:pected.
h. Pret iea'tment Program (POTWs only):
In development Approved
Should be required Not Needed X
2. Residuals handling and utilization/disposal scheme: N/A
I
a. If residuals are being land applied, please specify DEM Permit No.:
Residual Contractor:
Telephone No.:
b. Residuals stabilization: PSRP PFRP Other
c. Landf; i 11:
i
d. Othei disposal/utilization scheme (Specify): N/A
1

Page 3
3. Treatment ipl'ant classification: (attach completed rating sheet):
N/A.
4. SIC Code(s):. 2392
Wastewater codes) of actual wastewater, not particular facilities;
Primary f4 Secondary
,
Main Treatment Unit Codes: N/A
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grants Funds or. are
any public ironies involved (municipals only)? N/A
2. Special monitoring or limitations (including Toxicity) requests:
None requested.
3. ImportantjSOC, JOC, or Compliance Schedule dates (please indicate): None
Date
Submission of Plans and Specification
Begin Construction
Complete Construction
4. AlternativelAnalysis Evaluation: Has the facility evaluated all of the
nondischarge options available. Please provide regional perspective for
each option' evaluated.
The onlyOption this facility mayhave other than direct discharge is to
P 9
go to thelCity of Lumberton's WWTP. However, the Fayetteville Regional -
Office does:not recommend that this kind of discharge go to the City's
wastewater treatment facility.
Sray Irrigation: N/A
Connection to Regional Sewer System: N/A
Subsurface:' N/A
Other Disosal Options: N/A
5. Other Special Items: None
II

Page 4
PART IV - EVALUATION AND RECOMMENDATION
It is the recommendation of the Fayetteville Regional Office that
a General NPDES Permit (No. NCG500291) be issued to Robertex, Inc.
Signature of Report Preparer
�SL& W.
Water Quality Regional Supervisor
\l(z; (cV-1 ..
Date

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State of North; Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr.,. P.E., Director
October 31, 1994
Tom Snnith
Robetex, Inc.
P. O. Box 1225
Lumberton, NC 28359
Dear Mr. Smith: 1
This letter'is to acknowledge receipt of your application dated October 14, 1994 for
coverage under General Permit for non -contact cooling water and similar discharges. The
permit number highlighted above has been assigned to the subject facility. By copy of this
letter, we are requesting that our Regional Office Supervisor. prepare a staff report and
recommendationsregarding this discharge.
17:7A wivr
ED, F3,
ENV. MANAGEMENT
r FAYETTEVILLE REG. OFFICE
Subject: NOI Application
NPDES: NCG500291
Robetex, Inc.
Robeson County
If you have questions regarding this matter, please contact Susan Robson at (919)
733-5083.
cc:
Sincerely,
r.
c1,zc R
David Goodrich
Supervisor, NPDES Group
day^" ettevill�e�Regronal Off ce'(With-attachnierits)'
Permits and Engineering Unit
Central Files
P.O. Box 29535, Raleigh,'North Carolina 27626-0535
An Equal Opportunity Affirmative Action Employer
Telephone [phone] FAX [phone]
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James G. Martin, Governor
William W. Cobey, Jr., Secretary
State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
A. Preston Howard, Jr., P.E.
Acting Director
NOTICE OF INTENT
National Pollutant Discharge Elimination System
Application for Coverage under General Permit NCG500000; Non -contact cooling water, boiler blowdown,
cooling tower blowdown, condensate, and similar point source discharges.
1. Name, Address , location, and telephone number of facility requesting Pczmit.
A. Official Name:
B. Mailing Address:
(1)Street Address;
(2)City;
(3)State;
(4)Zip;
(5)County;
C. Location. (Attach map delineating
(1)Street Address;
(2)City;
(3)State;
(4)County;
D. Telephone Number,
2. Facility Contact:
A. Name;
B. Title;
C. Company Name;
D. Phone Number, .(
Z4
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1-St�e SUN(
general facility location)
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(Cl'T) (nil - 87B7
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G I 0 ) (07L-17 f37
3. Application type (check appropriate selection):
A. New or Proposed;
B. Existing; If previously permitted, provide permit number -
and issue date
C. Modification;
(Describe the nature of the modification):
R.z nT o
OCT 1 1994
4. Description of discharge
A. P1e state the number of separate discharge points.
1,[] ; 2,[91 3,[ ] ;, 4,[ 1 ; —,[ ]•
B. Please describe the amount of wastewater being discharged per each separate discharge point 1: (0)000
gallons per day (gpd) 2;_ (gpd) 3: (gPd) 4' igPd)
Page 1

C. Check the duration and frequency of the discharge, per each separate discharge point
1. Continuous:
2. Intermittent (please describe):
3. Seasoyial .(chec montt,t(s) the die occurs): January [ ]; February [ ]; March [ ]; April [
[
May'[ ;June [ , July [vj',August agmber [ ]; October [ ];November [ ]; December [ ].
4. How many days per week is there a discharge?(check the days the discharge occurs)
Monday [v]; Tuesday [,]!Wednesday [Thursday [Friday [Saturday [ ], Sunday [].
5. How much of the volume discharged is treated? (state in percent) 0 %
D. What type of wastewater is discharged, per separate discjiarge point. (place check next to correct type):
1. Non -contact cooling water,✓/
2. Boiler blowdown;
3. Cooling tower blowdown;
4. Condensate;
5. Other(please describe);
Please list any known pollutants that are present in the discharge, per each separate discharge point (if
applicable):
E. Please describe the type of process the cooling water is being discharged from, per separate discharge point
(i.e. compressor, boiler blowdown, cooling tower blowdown,`air conditiong unit etc.):
F. Please check the type of chemical added to the wastewater for treatment or other, per separate discharge
point
1. Biocides;
2. Corrosion inhibitors;
3. Chlorine;
4. Algae control;
5. Other(please describe);
6. None;
If 1,2,3,4, or 5 was checked, please state the name and manufacturer of the chemical additive. Also include
a completed Biocide 101 form, and manufacturers' information on the additive with the application for the
Division's review.
G. Is there any type of treatment being provided to the wastewater before discharge (i.e. retention ponds,
settling ponds, etc.); if yes, please describe. Give design specifics (i.e. design volume, retention time,
surface area, etc.). Existing treatment facilities should be described in detail and design criteria or
operational data should be provided(including calculations) to ensure that the facility can comply with
requirements of the General Permit. N A
NOTE: Construction of any wastewater treatment facilities require submission of three (3) sets of plans and
specifications along with their application. Design of treatment facilities must comply with requirement,
15A NCAC 2H .0138. If construction applies to the discharge, include the three sets of plans and
specifications with the application.
5. What is the nature of the business applying for this permit? 'Pe..QbU C.E e C3 i* WOVE P
6. Name of receiving water. -VY�(-', it "Ki-�1 t R. Classification:
(Attach a USGS topographical map with all discharge points) clearly marked)
U
Page 2

C. Check the duration and frequency of the ciisrharge, per each separate discharge point.
1. Continuous:__
2. Intermittent (please describe):
3. Seaso (chec mon) the discharge occurs): January [ ]; February [ ]; March [ ]; April Dr -
May [ ;June [v1; July [,4; ,August [�]!§eptember [ ]; October [ ];November [ ]; December [ ].
4. How many days per week is there a disc e?(check the days the discharge occurs)
Monday [Tuesday [[Wednesday[ Thursday [Friday [,,r;Saturday [1, Sunday [ ].
5. How much of the volume discharged is treated? (stare in percent) D %
D. What type of wastewater is discharged, per separate discharge point (plan check next to correct type):
1. Non -contact cooling water,
2. Boiler blowdown;
3. Cooling tower blowdown;
4. Condensate;
5. Other(please describe);
Please list any known pollutants that are present in the discharge, per e rh separate discharge point (if
applicable):
E; Please describe the type of process the cooling water is being discharged from, per separate discharge point
(i.e. compressor, boiler blowdown, cooling tower blowdown, air conditioning unit, etc.):
F. Please check the type of chemical added to the wastewater for treatment or other, per separate discharge.
point:
1. Biocides;
2. Corrosion inhibitors;
3. Chlorine;
4. Algae control;
5. Other(please describ>e);
6. None;
If 1,2,3,4, or 5 was checked, please state the name and manufacturer of the chemical additive.. Also include
a completed Biocide 101 form, and manufacturers' information on the additive,with the application for the
Division's review.
G. Is there any type of treatment being provided to the wastewater before discharge (i.e. retention ponds,
settling ponds, etc.); if yes, please describe. Give design specifics (i.e. design, volume, retention time,
surface area, etc.). Existing treatment facilities should be described in detail and design criteria or
operational data should. be provided(including calculations) to ensure that the facility can comply with
requirements of the General Permit. .,1 A
NO1'h: Construction of any wastewater treatment facilities require submission of three (3) sets of plans and
specifications along with their application. Design of treatment facilities must comply with requirement
15A NCAC 2H .0138. If construction applies to the discharge, include the three sets of plans and
specifications with the application.
5. What is• the nature of the business applying for this permit? f 0{ 'JC.—Z' UJ OVE
L t (:.•
6. Name of refPiving water. V c! :'.' i'•:. k. Classification:
(Attach a USGS topographical map with all-dischargepoint(s) clearly.marked)
Page 2

7. Is the discharge directly to the receiving water? (Y,N) Iy
If no, state specifically the discharge point. Mark clearly the pathway to the potential receiving waters on the
site map. (This includes tracing the pathway of the storm sewer to its discharge point, if a storm sewer is the
only viable means of discharge.)
8. Please address possible non -discharge alternatives for the following options:
onnection to a Regional Sewer Collection System;
B. Subsurface Disposal;
C. Spray Irrigation;
9. I certify that I am familiar with the information contained in the application and that to the best of my knowledge
and belief such information is true, complete, and accurate.
Printed Name of Person Signing l-ir) f n R - 1,1\ -1't\
Title, 7Pl_? --i.
Date Application Signed 10
Signature of Applicant 1
NORTH CAROLINA GENERAL STATUTE :143-215.6B (i) PROVIDES THAT:
Any person who knowingly makes any false statement, representation, or certification in any application, record,
report, plan or other document filed 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 $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, for a similar offense.)
Notice of Intent must be accompanied by a check or money order for $400.00 made payable to the North Carolina
Department of Environment; Health, and Natural Resources. Mail three (3) copies of entire package to:
Division of Environmental Management
NPDES Permits Group
Post Office Box 29535
Raleigh, North Carolina 27626-0535
Page 3

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UNITED STATES
DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
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