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HomeMy WebLinkAboutNC0044962_fact sheet_20220831DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 FACT SHEET FOR EXPEDITED PERMIT RENEWALS This form must be completed by Permit Writers for all expedited permits which do not require full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile home parks, etc.) that can be administratively renewed with minor changes but can include facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing, instream monitoring, compliance concerns). Basic Information for Ex edited Permit Renewals Permit Writer/Date Charles Weaver — 8/31/2022 Permit Number NC0044962 Facility Name North Stokes High School Basin Name/Sub-basin number Roanoke / 03-02-01 Receiving Stream an unnamed tributary to the Dan River Stream Classification in Permit C-Trout Does permit need Daily Maximum NH3 limits? N/A Does permit need TRC limits/language? No — already present Does permit have toxicity testing? Yes. All tests passed since 2016. Does permit have Special Conditions? No Does permit have instream monitoring? No Is the stream impaired (on 303(d) list)? Yes- added for Turbidity in 2018. Any obvious compliance concerns? No enforcements since 2010, one NOD in this permit cycle Any permit mods since last permit? No New expiration date 2/28/2027 Changes to Draft Permit? > Installed ammonia limits and removed tox test as per 2016 NH3 guidance. Gave compliance schedule until January 2027 to allow for treatment upgrades. ➢ Added instream monitoring for turbidity to determine compliance with 15A NCAC 02B.0211 (21). > Added instream monitoring for dissolved oxygen to determine compliance with 15A NCAC 02B.0211 (6). > Added instream monitoring for temperature and footnote regarding temperature increase as per 15A NCAC 02B.0211 (18). Most Commonly Used Expedited Language: • 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List. Addressing impaired waters is a high priority with the Division, and instream data will continue to be evaluated. If there is noncompliance with this permit's effluent limits and stream impairment can be attributed to your facility, then mitigative measures may be required". DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 North Stokes High School N C0044962 Prepared By: Charles Weaver Enter Design Flow (MGD): Enter s7Q10(cfs): Enter w7Q10 (cfs): IWC Calculations 0.0115 0.06 0.07 Residual Chlorine 7Q10 (cfs) DESIGN FLOW (MGD) DESIGN FLOW (cfs) STREAM STD (ug/L) UPS BACKGROUND LEVEL (l IWC (%) Allowable Conc. (ug/I) Fecal Limit (If DF >331; Monitor) (If DF <331; Limit) Dilution Factor (DF) NPDES Servor/Current Versions/IWC 0.06 0.0115 0.017825 17.0 0 22.90 74 200/100m1 4.37 Ammonia (NH3 as N) (summer) 7Q10 (CFS) DESIGN FLOW (MGD) DESIGN FLOW (cfs) STREAM STD (mg/L) UPS BACKGROUND LEVEL (mg/L) IWC (%) Allowable Conc. (mg/I) Ammonia (NH3 as N) (winter) 7Q10 (CFS) DESIGN FLOW (MGD) DESIGN FLOW (cfs) STREAM STD (mg/L) UPS BACKGROUND LEVEL (mg/L) IWC (%) Allowable Conc. (mg/I) 0.06 0.0115 0.01783 1.0 0.22 22.90 3.6 0.07 0.0115 0.01783 1.8 0.22 20.30 8.0 8/31/2022 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 NORTH CAROLINA STOKES COUNTY AFFIDAVIT OF PUBLICATION Before the undersigned, a Notary Public of said County and State, duly commissioned, qualified and authorized by law to administer oaths, personally appeared Sandra Hurley who being first duly sworn, deposes and says: that he (she) is Regional Publisher (Publisher or other officer or employee authorized to make affidavit) of ADAMS PUBLISHING GROUP, LLC, engaged in the publication of a newspaper known as THE STOKES NEWS, published, issued, and entered as periodicals class mail in the city of King in said County and State; that he (she) is authorized to make this affidavit and sworn statement; that the notice or other legal advertisement, a true copy of which is attached hereto, was published in THE STOKES NEWS on the following dates: and that the said newspaper in which such notice, paper, document or legal advertisement was published was, at the time of each and every such publication, a newspaper meeting all of the requirements and qualifications of Section 1-597 of the General Statutes of North Carolina and was a qualified newspaper within the meaning of Section 1-597 of the General Statutes of North Carolina. This «4� day of �1. Signature of person making affidavit , 2022 Sworn to and subscribed before me, this )9 day of , 2022 Pu blic My Commission expires: r"-RAS-- JENNA JOHNSON Notary Public - North Carolina Surly County My Commission Expires September 13, 2026 Public Notice North Carolina Environmental Management Commission/NPDES Unit 1617 Mail Service Center Raleigh, NC 27699-1617 Notice of Intent to Issue a NPDES Wastewater Permit NC0044962 North Stokes High School me North Carolina Environ- mental Management Commis- sion proposes to issue a NP- DES wastewater discharge permit to the person(s) listed below. Written comments re- garding the proposed permit will be accepted until 30 days after the publish date of this notice. The Director of the NC Division of Water Resources (DWR) may hold a public hear- ing should there be a signific- ant degree of public interest. Please mail comments and/or information requests to DWR at the above address. Inter- ested persons may visit the DWR at 512 N. Salisbury Street, Raleigh, NC to review information on file. Additional information on NPDES per- mits and this notice may be found on our website: http://deq. nc.gov/abouUdivi- sions/water-resou rces/water- resources-permits/wastewater- branch/npdes-wastewater/pub- lic-notices,or by calling (919) 707-3601. The Stokes County Board of Education (P.O. Box 50, Danbury, NC 27016-0050) has requested renewal of NP- DES permit NC0044962 for the North Stokes High School WWTP. This permitted facility discharges treated wastewater to an unnamed tributary to the Dan River in the Roanoke River Basin. Currently, total re- sidual chlorine and fecal coli- form are water quality limited. This discharge may affect fu- ture allocations in this portion of the Roanoke River Basin. Publish: 7-14-22 70062662 107623 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 ROY COOPER corer„or S. JAY ZIMMERMAN Drrecior Water Resources ENVIRONMENTAL QUALITY January 20, 2017 Mr. Ricky D. Goins Stokes County Schools P.O. Box 50 Danbury, N.C. 27016-0050 Subject: Issuance of NPDES Permit NC0044962 North Stokes High School Stokes County Dear Mr. Goins: 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 the following changes from the existing permit: ➢ Section A. (3) has been added to require electronic submission of effluent data. Federal regulations require electronic submittal of all discharge monitoring reports (DMRs). ➢ Regulatory citations have been added to the permit. ➢ The components of the wastewater treatment facility have been updated to include additions to the system. 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. State of North Carolina I Environmental Quality I Water Resources 1617 Mail Service Center I Raleigh, NC 27699-1617 919 807 6300 919-807-6389 FAX https: //deq.nc. gov/about/divi sions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 If you have any questions concerning this permit, please contact Brianna Young at telephone number (919) 807-6388 or email [Brianna.Young@ncdenr.gov]. S. Jay Zimmerman, cc: NPDES Unit Winston-Salem Regional Office Central Files DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF WATER RESOURCES 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 Stokes County Board of Education is hereby authorized to discharge wastewater from a facility located at the North Stokes High School 1350 North Stokes School Rd Danbury Stokes County to receiving waters designated as an unnamed tributary to the Dan River in subbasin 03-02-01 of the Roanoke 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 March 1, 2017. This permit and authorization to discharge shall expire at midnight on February 28, 2022. Signed this day January 20, 2017.. S. y Zimmerman, P.G. Director, Division of Water Resources By Authority of the Environmental Management Commission Page 1 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 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 Stokes County Board of Education is hereby authorized to: 1. Continue to operate an existing 0.0115 MGD wastewater treatment facility with the following components: • Septic tank • Recirculation tank • Dual alternating recirculation pumps • Duplex recirculation time dosing control panel • Effluent bypass ball valve • Two surface sand filters • Tablet chlorination • Chlorine contact tank • Tablet dechlorination The facility is located at North Stokes High School on North Stokes School Rd, near Danbury in Stokes County. 2. Discharge from said treatment works at the location specified on the attached map into an unnamed tributary to the Dan River, currently classified C-Trout waters in hydrologic unit 0301010301 of the Roanoke River Basin. Page 2 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 PART I A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS [15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.] During the period beginning on the effective date of the 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 Average Daily Maximum Measurement Frequency Sample Type Sample Location Flow [50050] 0.0115 MGD Weekly Instantaneous Influent or Effluent BOD, 5 day (20°C) [00310] 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent Total Suspended Solids [00530] 30.0 mg/L 45.0 mg/L 2/Month Grab Effluent NH3 as N [00610] 2/Month Grab Effluent Fecal Coliform (geometric mean) [31616] 200/100 ml 400/100 ml 2/Month Grab Effluent Total Residual Chlorine2 [50060] 17 µg/L 2/Week Grab Effluent Temperature (°C) [00010] WeeklyGrab Effluent Chronic Toxicity3 [TGP3B] QuarterlyGrab Effluent pH [00400] > 6.0 and < 9.0 standard units — — 2/Month Grab Effluent Footnotes: 1. The permittee shall submit discharge monitoring reports electronically using the Division's eDMR system [see A. (3)]. 2. 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. 3. Chronic Toxicity (Ceriodaphnia) P/ F at 23% with testing in February, May, August, and November (see A. (2)). There shall be no discharge of floating solids or visible foam in other than trace amounts. Page 3 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 A. (2) CHRONIC TOXICITY PERMIT LIMIT (Quarterly) [15A NCAC 02B .0200 et seq.] The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant mortality to Ceriodaphnia dubia at an effluent concentration of 23%. The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in the "North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised December 2010, or subsequent versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised- December 2010) or subsequent versions. The tests will be performed during the months of February, May, August, and November. These months signify the first month of each three-month toxicity testing quarter assigned to the facility. Effluent sampling for this testing must be obtained during representative effluent discharge and shall be performed at the NPDES permitted final effluent discharge below all treatment processes. If the test procedure performed as the first test of any single quarter results in a failure or ChV below the permit limit, then multiple -concentration testing shall be performed at a minimum, in each of the two following months as described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -December 2010) or subsequent versions. All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge Monitoring Form (MR-1) for the months in which tests were performed, using the parameter code TGP3B for the pass/fail results and THP3B for the Chronic Value. Additionally, DWR Form AT- 3 (original) is to be sent to the following address: Attention: North Carolina Division of Water Resources Water Sciences Section/Aquatic Toxicology Branch 1621 Mail Service Center Raleigh, NC 27699-1621 Completed Aquatic Toxicity Test Forms shall be filed with the Water 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, accurate, include all supporting chemical/physical measurements and all concentration/response data, and be certified by laboratory supervisor and ORC or approved designate signature. 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 Water Sciences Section at the address cited above. Should the permittee fail to monitor during a month in which toxicity monitoring is required, monitoring will be required during the following month. Assessment of toxicity compliance is based on the toxicity testing quarter, which is the three month time interval that begins on the first day of the month in which toxicity testing is required by this permit and continues until the final day of the third month. Page 4 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 Should any test data from this monitoring requirement or tests performed by the North Carolina Division of Water Resources indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include alternate monitoring requirements or limits. 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. A. (3) ELECTRONIC REPORTING OF DISCHARGE MONITORING REPORTS [NCGS 143-215.1 (b)] Federal regulations require electronic submittal of all discharge monitoring reports (DMRs) and program reports. The final NPDES Electronic Reporting Rule was adopted and became effective on December 21, 2015. NOTE: This special condition supplements or supersedes the following sections within Part II of this permit (Standard Conditions for NPDES Permits): • Section B. (11.) Signatory Requirements • Section D. (2.) Reporting • Section D. (6.) Records Retention • Section E. (5.) Monitoring Reports 1. Reporting Requirements (Supersedes Section D. (2.) and Section E. (5.) (a)1 The permittee shall report discharge monitoring data electronically using the NC DWR's Electronic Discharge Monitoring Report (eDMR) internet application. Monitoring results obtained during the previous month(s) shall be summarized for each month and submitted electronically using eDMR. The eDMR system allows permitted facilities to enter monitoring data and submit DMRs electronically using the internet. Until such time that the state's eDMR application is compliant with EPA's Cross -Media Electronic Reporting Regulation (CROMERR), permittees will be required to submit all discharge monitoring data to the state electronically using eDMR and will be required to complete the eDMR submission by printing, signing, and submitting one signed original and a copy of the computer printed eDMR to the following address: NC DENR / Division of Water Resources / Water Quality Permitting Section ATTENTION: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 If a permittee is unable to use the eDMR system due to a demonstrated hardship or due to the facility being physically located in an area where less than 10 percent of the households have broadband access, then a temporary waiver from the NPDES electronic reporting requirements may be granted Page 5 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 and discharge monitoring data may be submitted on paper DMR forms (MR 1, 1.1, 2, 3) or alternative forms approved by the Director. Duplicate signed copies shall be submitted to the mailing address above. See "How to Request a Waiver from Electronic Reporting" section below. Regardless of the submission method, the first DMR is due on the last day of the month following the issuance of the permit or in the case of a new facility, on the last day of the month following the commencement of discharge. Starting on December 21, 2020, the permittee must electronically report the following compliance monitoring data and reports, when applicable: • Sewer Overflow/Bypass Event Reports; • Pretreatment Program Annual Reports; and • Clean Water Act (CWA) Section 316(b) Annual Reports. The permittee may seek an electronic reporting waiver from the Division (see "How to Request a Waiver from Electronic Reporting" section below). 2. Electronic Submissions In accordance with 40 CFR 122.41(1)(9), the permittee must identify the initial recipient at the time of each electronic submission. The permittee should use the EPA's website resources to identify the initial recipient for the electronic submission. Initial recipient of electronic NPDES information from NPDES-regulated facilities means the entity (EPA or the state authorized by EPA to implement the NPDES program) that is the designated entity for receiving electronic NPDES data [see 40 CFR 127.2(b)]. EPA plans to establish a website that will also link to the appropriate electronic reporting tool for each type of electronic submission and for each state. Instructions on how to access and use the appropriate electronic reporting tool will be available as well. Information on EPA's NPDES Electronic Reporting Rule is found at: http://www2.epa.gov/compliance/final-national-pollutant- discharge-elimination-system-npdes-electronic-reporting-rule. Electronic submissions must start by the dates listed in the "Reporting Requirements" section above. 3. How to Request a Waiver from Electronic Reporting The permittee may seek a temporary electronic reporting waiver from the Division. To obtain an electronic reporting waiver, a permittee must first submit an electronic reporting waiver request to the Division. Requests for temporary electronic reporting waivers must be submitted in writing to the Division for written approval at least sixty (60) days prior to the date the facility would be required under this permit to begin submitting monitoring data and reports. The duration of a temporary waiver shall not exceed 5 years and shall thereupon expire. At such time, monitoring data and reports shall be submitted electronically to the Division unless the permittee re -applies for and is granted a new temporary electronic reporting waiver by the Division. Approved electronic reporting Page 6 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 waivers are not transferrable. Only permittees with an approved reporting waiver request may submit monitoring data and reports on paper to the Division for the period that the approved reporting waiver request is effective. Information on eDMR and the application for a temporary electronic reporting waiver are found on the following web page: http://deq.nc.gov/about/divisions/water-resources/edmr 4. Signatory Requirements (Supplements Section B. (11.) (b) and Supersedes Section B. (11.) (d)1 All eDMRs submitted to the permit issuing authority shall be signed by a person described in Part II, Section B. (11.)(a) or by a duly authorized representative of that person as described in Part II, Section B. (11.)(b). A person, and not a position, must be delegated signatory authority for eDMR reporting purposes. For eDMR submissions, the person signing and submitting the DMR must obtain an eDMR user account and login credentials to access the eDMR system. For more information on North Carolina's eDMR system, registering for eDMR and obtaining an eDMR user account, please visit the following web page: http://deq.nc.gov/about/divisions/water-resources/edmr Certification. Any person submitting an electronic DMR using the state's eDMR system shall make the following certification [40 CFR 122.22]. NO OTHER STATEMENTS OF CERTIFICATION WILL BE ACCEPTED: "1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." 5. Records Retention (Supplements Section D. (6.)1 The permittee shall retain records of all Discharge Monitoring Reports, including eDMR submissions. These records or copies shall be maintained for a period of at least 3 years from the date of the report. This period may be extended by request of the Director at any time [40 CFR 122.41]. Page 7 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Permit NC0044962 NC0044962 — North Stokes High School Latitude: 36°2744" Longitude: 80°16'49' USGS Quad : Hanging Rock Stream Class: C-Trout Receiving Stream: UT to Dan River Sub -Basin: 03-02-01 Hydrologic Unit: 0301010301 oa L Location dadafp ac Fa< Fility Stokes County Map not to scale Page 8 of 8 DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 Winston-Salem Journal Advertising Affidavit P.O Box 3159 Winston-Salem, NC 27102 NCDENR/DWQ/POINT SOURCE BRANCH ATTN: WREN THEDFORD 1617 MAIL SERVICE CENTER RALEIGH, NC 27699-1617 Account Number 3376309 Date November 05, 2016 Date Category Description Ad Size Total Cost 11/05/2016 Legal Notices PUBLIC NOTICE North Carolina EnvironmentalManagement C 1 x 53 L 326.99 PUBLIC NOTICE North Carolina Environmental Management Commission/ NPDES Unit 1617 Mail Service Center Raleigh, NC 27699-1617 Notice of Intent to Issue a NPDES Wastewater Permit The North Carolina Environmental Management Commission proposes to issue a NPDES wastewater dis- charge permit to the person(s) listed below. Written comments regarding the proposed permit will be accept- ed until 30 days after the publish date of this notice. The Director of the NC Division of Water Resources (DWR) may hold a public hearing should there be a significant degree of public interest. Please mail com- ments and/or information requests to DWR at the above address. Inter- ested persons may visit the DWR at 512 N. Salisbury Street, Raleigh, NC to review information on file. Addi- tional information on NPDES permits and this notice may be found on our website: http://deq.nc.gov/about/ divisions/water-resources/water- resources-permits/wastewater- branch/npdes-wastewater/public- notices,or by calling (919) 807-6397. Stokes County Schools requested re- newal of permit NC0044962/North Stokes High School WWTP. Facility discharges treated wastewater to an unnamed tributary to the Dan River/ Roanoke River Basin. Currently, total residual chlorine and fecal coliform are water quality limited. Stokes County Schools requested re- newal of NPDES permit NC0044954/ South Stokes High School WWTP. Facility discharges to Little Neatman Creek/Roanoke River Basin. Current- ly, fecal coliform and total residual chlorine are water quality limited. WSJ: November 5,2016 Publisher of the Winston-Salem Journal Forsyth County Before the undersigned, a Notary Public of Forsyth County, North Carolina, duly commissioned, qualified, and authorized by law to administer oaths, personally appeared D. H. Stanfield, who by being duly sworn deposes and says: that he is the Controller of the Winston-Salem Journal, engaged in the publishing of a newspaper known as Winston-Salem Journal, published, issued and entered as second class mail in the City of Winston-Salem, in said County and State: that he is authorized to make this affidavit and sworn statement: that the notice or other legal advertisement, a true copy of which is attached hereto, was published in the Winston-Salem Journal on the following dates: 11/05/2016 and that the said newspaper in which such notice, paper document, or legal advertisement was published was, at the time of each and every such publication, a newspaper meeting all the requirements and qualifications of Section 1-597 of the General Statutes of North Carolina and was a qualified newspaper within the meaning of Section 1-597 of the General Statutes of North Carolina. This 5th day of November, 2016 (signature of p Sworn to and subscribed before me, this 5th day of November, 2016 My Commission expires S • Z i 10L0 THIS IS NOT A BILL. PLEASE PAY FROM IN 4 ng affidavit) N. ' ary ublic) KIMALEY JOHNSON NOTARY PUBLIC FORSYTH COUNTY STATF OF NORTH CARSILJM 0 Aliito' PiRES .?.fika ! DocuSign Envelope ID: 7800031 D-63C0-4055-88CF-ACAA516707B2 FACT SHEET FOR EXPEDITED PERMIT RENEWALS This form must be completed by Permit Writers for all expedited permits which do not require full Fact Sheets. Expedited permits are generally simple 100% domestics (e.g., schools, mobile home parks, etc) that can be administratively renewed with minor changes, but can include facilities with more complex issues (Special Conditions, 303(d) listed water, toxicity testing, instream monitoring, compliance concerns). Basic Information for Expedited Permit Renewals Permit Writer/Date Brianna Young — 10/25/16 Permit Number NC0044962 Facility Name North Stokes High School Basin Name/Sub-basin number Roanoke / 03-02-01 Receiving Stream an unnamed tributary to the Dan River Stream Classification in Permit C-Trout Does permit need Daily Maximum NH3 limits? N/A Does permit need TRC limits/language? No — already present Does permit have toxicity testing? Yes. All tests passed since 2011. Does permit have Special Conditions? No Does permit have instream monitoring? No Is the stream impaired (on 303(d) list)? No Any obvious compliance concerns? Monitoring violations, total chlorine limit violations Any permit mods since last permit? Yes — recirculating sand filter, effluent recirculating system added New expiration date 2/28/2022 Comments received on Draft Permit? No Most Commonly Used Expedited Language: • 303(d) language for Draft/Final Cover Letters: "Please note that Cane Creek is listed as an impaired waterbody on the North Carolina 303(d) Impaired Waters List. Addressing impaired waters is a high priority with the Division, and instream data will continue to be evaluated. If there is noncompliance with this permit's effluent limits and stream impairment can be attributed to your facility, then mitigative measures may be required".