HomeMy WebLinkAboutNC0064599_Permit Issuance_20100414NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
April 14, 2010
Ms. Halina Genaro
Lake Norman Motel
4491 Slanting Bridge Road
Sherrills Ford, North Carolina 28673
Subject: NPDES PERMIT ISSUANCE
Permit Number NC0064599
Lake Norman Motel WWTP
Catawba County
Dear Ms. Genaro:
Division personnel have reviewed and approved your application for renewal of the subject
permit. Accordingly, we are forwarding the attached final 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).
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 permit shall be final and binding.
Please take notice that this permit is not transferable. 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, Coastal Area Management Act, or any other Federal or
Local governmental permits which may be required.
If you have any questions or need additional information, please do not hesitate to contact
Maureen Scardina of my staff at (919) 807-6388.
Sin -rely,
leen H. Sullins
Director, Division of Water Quality
cc: Central Files
NPDES Unit Files
Mooresville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N: Salisbury St. Raleigh, North Carolina 27604
Phone: 919-807-63001 FAX: 919-807-64921 Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
NorthCarolina
,Naturally
An Equal Opportunity \ Affirmative Action Employer
Permit NC0064599
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,
Halina Genaro
is hereby authorized to discharge wastewater from a facility located at
The Lake Norman Motel
4491 Slanting Bridge Road, near Sherrills Ford
Catawba County
to receiving waters designated as the Mountain Creek arm of Lake Norman in the Catawba 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 May 1, 2010.
This permit and authorization to discharge shall expire at midnight on April 30, 2015.
Signed this day April 14, 2010.
4._ . en H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit NC0064599
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.
Halina Genaro is hereby authorized to:
1. Continue to operate an existing 0.0075 MGD wastewater treatment system with the following
components:
➢ Manual bar screen
➢ .Diffused -air activated sludge aeration basin
> Rectangular single -hopper clarifier with air lift sludge return and skimmer
> Tablet chlorination and chlorine contact chamber
> Dechlorination (tablet)
➢ 1,500-gallon sludge holding tank
This wastewater treatment system is located at The Lake Norman Motel WWTP on Slanting Bridge
Road near Sherrills Ford in Catawba County.
2. Discharge from said treatment works at the location specified on the attached map into the
Mountain Creek arm of Lake Norman, currently classified WS-IV & B CA waters in the Catawba
River Basin.
NC0064599 - Lake Norman Motel WWTP
County: Catawba Stream Class: WS-IV, B, CA
Sub -Basin: 030832 Grid/Ouad: E15SW
Latitude: 35° 34' 10" Longitude: 80° 59' 30"
Receiving Stream: Mountain Creek Arm of Lake Norman
Owner (2010): Halina Genaro
Permit NC0064599
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on May 1, 2010 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
0.0075 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
Weekly
Grab
Effluent
Fecal Coliform
(geometric mean)
200 / 100 ml
400 / 100 ml
Weekly
Grab
Effluent
Total Residual Chlorines
28 µg/L
. 2/Week
Grab
Effluent
Temperature
Weekly
Grab
Effluent
Oil and Grease
30.0 mg/L
60.0 mg/L
Weekly
Grab
Effluent
pH
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Footnotes:
1. The Division shall consider all effluent TRC values reported below 50 pg/L to be in compliance with the
permit. However, the Permittee shall continue to record and submit all values reported by a North Carolina
certified laboratory (including field certified), even if these values fall below 50 µg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE AMOUNTS.
•
Permit NC0064599
A. (2) SPECIAL CONDITION — Spill Notification
(a) Contacting Public Health Directors
The Permittee must notify the Catawba, Iredell, Lincoln and Mecklenburg County Public Health Directors
within 12 hours of first knowledge by the owner/operator of any discharge of untreated wastewater to waters of
the State or a discharge from the wastewater treatment plant that has not received adequate disinfection due to a
malfunctioning treatment unit.
The County Public Health Directors can be contacted using the following information:
Catawba County Health Director
3070 Eleventh Avenue Drive SE
Hickory, NC 28602
828 695-5800
Lincoln County Health Director
151 Sigmon Road
Lincolnton, NC 28092
704 736-8634'
(b) Public Notification
Iredell County Health Director
318 Turnersburg Highway
Statesville, NC 28625
704 878-5300
Mecklenburg County Health Director
700 North Tryon Street
Charlotte, NC 28202
704 336-5102
The Permittee must notify the public of untreated wastewater spills. Wastewater facility owners or operators
must issue a press release after a discharge to surface waters of 1,000 gallons within 48 hours of first
knowledge of the spill by the owner/operator. The press release must be issued to "all electronic and print news
media outlets that provide general coverage in the counties (Catawba, Iredell, Lincoln and Mecklenburg) where
the discharge occurred." A copy of the press release must be maintained for one year by the Permittee. This
press release is required in addition to the permit requirement of contacting the North Carolina Division of
Water Quality (DWQ).
If a discharge of 15,000 gallons or more reaches surface water, a public notice is required in addition to the
press release. The public notice must be placed in a newspaper having general circulation in the County in
which the discharge occurred and the county immediately downstream. At a minimum the notice should be
published in the newspaper of general circulation in Catawba, Iredell, Lincoln and Mecklenburg Counties. If a
discharge of 1,000,000 gallons of wastewater or more reaches surface waters, the DWQ regional office must be
contacted to determine in what additional counties, if any, a public notice must be published. A copy of these
public notices and proof of publication must be sent to the DWQ to the attention of "Non Discharge
Compliance Enforcement Unit" at the letterhead address within 30 days of publication. The minimum content
of the notice is the location of the discharge, estimated volume, water body affected and steps taken to prevent
future discharges.
Michael F. Easley, Governor
State of North Carolina
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
MEMORANDUM
To:
From:
February 17, 2010
Britt Setzer
NC DENR / DEH / Regional Engineer
Mooresville Regional Office
Maureen Scardina
919-807-6388
NPDES Unit
Subject: 'Review of Draft NPDES Permit NC0064599
Lake Norman Motel WWTP
Catawba County
Please indicate below your agency's position or viewpoint on the draft permit and return this form by March 25,
2010. If you have any questions on the draft permit, please feel free to contact me at the telephone number shown
above.
RESPONSE: (Check one)
Concur with the issuance of this permit provided the facility is operated and maintained properly, the stated
effluent limits are met prior to discharge, and the discharge does not contravene the designated water quality
standards.
r1 Concurs with issuance of the above permit, provided the following conditions are met:
Opposes the issuance of the above permit, based on reasons stated below, or attached:
i Date: / / 2//c .
Signed / r �,�
1617 MAIL SERVICE CENTER, RALEIGH, NORTH CAROLINA 27699-1617 - TELEPHONE 919-733-5083/FAX 919-733-0719
VISIT US ON THE WEB AT http://h2o.enr.state.nc.us/NPDES
North Carolina ) ss
Mecklenburg County)
The Charlotte Observer Publishing Co.
Charlotte, NC
Affidavit of Publication
THE CHARLOTTE OBSERVER
DINA SPRINKLE
NCDENR/DWQ/POINT SOURCE BRANCH
1617 MAIL SERVICE CENTER
RALEIGH NC 27699
REFERENCE: 30063432
6439333 npdes w-water permit
Before the undersigned, a Notary Public of said
County and State, duly authorized to administer
oaths affirmations, etc., personally appeared,
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
Charlotte Observer in the city of Charlotte,
County of Mecklenburg, and State of North Carolina
and that as such he/she is familiar with the
books, records, files, and business of said
Corporation and by reference to the files of said
publication, the attached advertisement was
inserted. The following is correctly copied from
the books and files of the aforesaid Corporation
and Publication.
?UBLISHED ON: 02/21
AD SPACE:
FILED ON:
94 LINE
02/25/10
/i-ArP
•� " *-t.mttlLt: (7,1447��, -t c7
DATE: FEIA �j 2 �v
Pu ,Iic 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 Envronmental Management Commission
proposes to issue a NPDES wastewater discharge permit to the
person(s) listed below. ' •
Written comments regarding the proposed permit will' be
accepted until. 30 days after the publish date of this notice. The
Director of the NC Division of Water Qualify (DM) may hold a
public hearing should there be a significant degree of public
interest. Please mail comments and/or information requests to
DWO at the above address. Interested persons may visit the DWO
al 512 N. Salisbury Street, Raleigh, NC to review information on
tile. Additional information on NPDES permits and this notice may
be found on our website: www.ncwaterquality.org,: or by calling
(919) 807-6304.
The Town o1 Taylorsville requested renewal al 01 permit
14C0026271
Win for the Town of TaylorsvilleWWTP
oUnty; this
permitted discharge is treated wastewater to the Lower Little River
in the Catawba River Basin. - nested
Lake Norman Woods Homeowners Assoreciation, q
renewal of NPDES Permit No. NC0071528, for Lake Norman
Woods WWTP in Iredell County; this permitted discharge is treat-
ed domestic wastewater to Lake Norman, Catawba River Basin.
Anthony -Genaro [4491 Slanting BridgeiRd, Sherrills Ford, NC
28673] has applied for renewal of permit NC0064599 tor the Lake
Norman Lake Norman Motel WWTP in Catawba County. This
permitted facility discharges treated domestic wastewater to the
Mountain Creek arm of Lake Norman in the Catawba River Basin.
Aqua North Carolina, Inc- (Country Valley Subdivision WWTP),
per MackenanNC0058 Court, cated inNC 27511 Ca Catawba County.
ed renewal of
This permitted
permit NC005gest
facility discharges treated wastewater to Hagan Fork Creek in the
Catawba River Basin.:.. Catawba
NPDES Permit Number NC0024252, City of Conover,
County, has applied tor renewal of its Conover Northeast
Wastewater Treatment Plant (NEWWTP) permit discharging to the
Lyle Creek in the Catawba River Basin.
LP6439333
In Test mony Whereof I have hereunto set my hand and affixed my seal, the
day and //ear aforesaid.
?;otar,
Y6ej:eAA—'
My Commission Expires: _/_/_
My Commission Expires May 27, 2011
SOC Priority Project: No
To: Permits and Engineering Unit
Water Quality Section
Attention: Charles Weaver
Date: November 9, 2009
NPDES STAFF REPORT AND RECOMMENDATION
County: Catawba
Permit No. NC0064599
PART I - GENERAL INFORMATION
1. Facility and address: Lake Norman Motel
4491 Slanting Bridge Road
Sherrills Ford, North Carolina 28673
2. Date of investigation: November 3, 2009
3. Report prepared by: B. Dee Browder, Environmental Engineer I
4. Persons contacted and telephone number: Mr. Tony Genaro, (828) 478-2817.
5. Directions to site: From the junction of NC Hwy 150 and SR 1844 (Slanting Bridge Road)
in southeastern Catawba County, travel south on SR 1844 approximately 1.0 mile. The
motel is on the right (west) side of the road.
6. Discharge point(s), list for all discharge points:
Latitude: 35° 34' 10" Longitude: 80° 59' 30"
U.S.G.S. Quad No.: E 15 SW U.S.G.S. Quad Name: Lake Norman North, NC
7. Site size and expansion area consistent with application? Yes. There is limited area available
for expansion, if necessary.
8. Topography (relationship to flood plain included): Moderately sloping; the WWTP is not
located within the 100 year flood plain or above the high water elevation of nearby Lake
Norman.
9. Location of nearest dwelling: The WWTP is located adjacent to the Lake Norman Motel.
Page Two
10. Receiving stream or affected surface waters: Mountain Creek
a. Classification: WS-IV, B CA
b. River Basin and subbasin no.: Catawba 030832
c. Describe receiving stream features and pertinent downstream uses: The facility
discharges into a small cove adjacent to the Mountain Creek arm of Lake Norman.
Lake Nounuan is used as a water supply and for primary and secondary recreation.
PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of wastewater to be permitted: '0.0075 MGD (ultimate design capacity)
b. Current permitted capacity of the wastewater treatment facility: 0.0075 MGD
c. Actual treatment capacity of the current facility (current design capacity): 0.0075
MGD
d. Date(s) and construction activities allowed by previous Authorizations to Construct
issued in the previous two years: There have been no ATCs issued to this facility in
the past two years (see (f) below).
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: The WWT facility consists of a bar screen, a 7,500 gallon
aeration tank, a 1,250 gallon clarifier, a 200 gallon chlorine contact tank, and in -line
declorination.
f. Please provide a description of proposed wastewater treatment facilities: There are
no proposed WWT facilities at this time. Pending the anticipated inclusion of a total
residual chlorine (TRC) limit in the permit at reissuance, dechlonation will be
necessary.
g. Possible toxic impacts to surface waters: Chlorine is added to the waste stream.
Dechlorination is not presently provided.
h. Pretreatment Program (POTWs only): Not required.
2. Residuals handling and utilization/disposal scheme: Residuals are removed as
needed and transported by Roberts Septic Tank Services to the City of Newton=s
Clark Creek WWTP for disposal.
3. Treatment plant classification: Class II (no change from pervious rating).
Page Three
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public monies
involved? N/A
2. Special monitoring or limitations (including toxicity) requests: None.
3. Important SOC, JOC or Compliance Schedule dates (Please indicate): N/A
4. Alternative Analysis Evaluation: Currently there is no access to a sewer collection system.
In the future this option may become more readily available to the permittee.
PART IV - EVALUATION AND RECOMMENDATIONS
The permittee, has requested reissuance of the subject permit. In March 2009, the permittee
requested removal of the daily fecal testing requirement based on good historical date and
prohibitive costs. This Minor Modification was issued in March 2009.
There have been 7 permit violations since the last permit renewal consisting of minor
monitoring violations, a reporting violation, and needed facility repairs. The facility repairs noted in
the April 2009 inspection have been completed.
The ORC for this facility will need to submit a designation form to Raleigh so that
information may be updated in the system.
It is recommended that the permit be renewe s mg a final review and concurrence of the
draft permit when it becomes avail. Q.
gifl
la►
Signature o Re..
H:\dsr\dsr05\LNMote1. sr
// 'a�
Date
I /c/01
Water Quality Regional Supervisor Date
r
rt Preparer
September 29, 2009
Mrs. Dina Sprinkle
NCDENR/DWQ/Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Mrs. Sprinkle,
Please accept this letter as a request for renewal of the Lake Norman Motel
Wastewater Treatment Plant NPDES Permit # NC 0064599, located at 4491 Slanting
Bridge Road Sherrills Ford, NC 28673.
There have been no operational or design changes at the facility since the issuance
of the last permit.
Enclosed, you will find a location map showing the discharge point into Lake
Norman, a completed copy of the application form that is signed and dated, and a
description of sludge management and removal.
Thank you for this consideration,
Halina Genaro, owner
Lake Norman Motel and Landing Restaurant
4491 Slanting Bridge Road
Sherrills Ford, NC 28673
828-478-2817
lakenorman.motel@charterinternet.com
www.lakenonnanrnotel.net
NED
r
DENR • WATER QUALITY
POINT SOURCE BRANCH
Sludge Management Plan
For: Lake Norman Motel Wastewater Treatment Plant
NPDES Permit # NC 0064599
Date: 9/29/09
The waste sludge produced at the treatment facility is removed directly from the digester
and aeration basins by Stanley Septic Service of Stanley, NC (Gaston County - License
Pumping # NCS01132), and discharged into the City of Dallas at Earth Farms - 351 Colt
Thornburg Rd. Dallas, NC 28034 (Disposal Site Permit # SDTF 36-04) sewage collection
system.
Thank ,ou,
Halina Genaro, owti�r
Lake Norman Motel and Landing Restaurant
4491 Slanting Bridge Road
Sherrills Ford, NC 28673
828-478-2817
lakenorman. motel @charterinternet. com
www.lakenormamnotel.net
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
INcoo
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
Facility Name % Ak'L A10 A -I , '1 f e L-
Mailing Address �/9/ _S1 /='T/,ur) 8/-c .
City SA err///s rOrok /VC YG I3
State / Zip Code
Telephone Number (9 9 / 7
Fax Number ( ) /V/ "i
e-mail Address
X049/ecivokMRNe MC3ZEL. ` ej1CI r ter-/71ye/--n t f s Cr) ill
I-1 AL / nv 6,oNn2h
C 1(i,
2. Location of facility producing discharge:
Check here if same address as above,
Street Address or State Road
City
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)
RECHVED
Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
t?/1-TAbt,110,A- DENR - WATER DUALITY
POINT SOURCE BRANCH
„L. A/tE /JJRfimiN filo teL
g 9/ S%Nt/.vi) dry
5'/-i e rri //s r�..
NC / gb 73
(S,)g) q7'-?s/%
1 of 3 Form-D 05/08
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 ❑
Commercial
Residential ❑
School ❑
Other ❑
Number of Employees
Number of Employees
Number of Homes
Number of Students/Staff
Explain:
9- .7- Sea s o:Je+
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
S-61 Sent RC .5. 1-C c.> rz iyt,7 -
ge) Sett-/- Pr-r!d . > S�i:snn�i
Population. served: Cf — / 60 r f4-?,
e)i8�
L
5. Type 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) 66 /
I the outfall equipped with a diffuser? ❑ Yes %No
7. Name of receiving strea'/m(s) (Provide(P a map showing the exact location of each ou�tfalll))1:n /J
ar"i�l //? 4 el — i C%� t-At..7g14 2IYei- Getc ly �s �,f /� t- NORM11A�'
Frequency of Discharge: Continuous ❑ Intermittent
If intermittent: r '"
Days per week discharge occurs: Duration:
8.
9. Describe the treatment system
List all installed components, including capacities, provide design removal for BOD, TSS, nitrogen and
phosphorus. If the space provided is not sufficient, attach the description of the treatment system in a
separate sheet of paper. floc/4 ye i as rwu.7 e trear /fie/Vr p/4,uT
Sc-reeN m/aNcif 4
_ /4 et/ c .SL vc.4, € i- /3 a sl �.I (7 So o G,a r.)
-4,fit velif #'efv,a.v Pafirs-
c2
-' CLcr,,i2 C',/^_QiJyr/h
o
)
Ch/o,./N e C/ �c�n tcic7' c (/hd er
Tv 4civ e.
FF<v6NT
Re ri2c vcr L C>2/ /e r!
2 of 3
(moo %a L) .. .7' ,�/'et Feec-C
7Lee4 et /=rem U�c%/or;A.iacfio,ti%
i7iscl; -e h ,v e
�o /e) 's `57o
'TS S 9S`%
/lied
/trcrei•eN' -
/ h
=orm-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 flosy}, Ooic MGD
Annual Average daily flow 6.003 MGD (for the previous 3 years)
Maximum daily flow h , 00 S MGD (for the previous 3 years)
11. Is this facility located on Indian 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
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BOD5)
b , 5
6 ,0
Ma/ L
Fecal Coliform
1�/ g 0
/7- 9
// 1 -iL
Total Suspended Solids
r�/9, (9
/ ). v
/ 42 jL
Temperature (Summer)
& o 0
pia z
rd
Temperature (Winter)
A /
/ 0 , 2
C
pH
7.V
7,Z
Sil's
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES N (, (') (, S/5 9 ? Dredge or fill (Section 404 or CWA)
PSD (CAA) ` Other
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
Permit Number
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.
Pl.frn 6-; A ;RC
Printed name of Person Signing
Pres.,,,,e n 21" 65i4i A) i-
Title /
Signature of A t cant 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
az. -1 ~ t �
•
tom',-�r'.r,,;c:
L
1C C.
is .LLiEa 1' i NYF47;
•
ti L
-j '.? .4..Y .7(s61i:{
! rgc.. '..:.v
7.-8 M..75"
•
TOv F-rnniiL•
�.• 1 ��' .
Ett
a t 12 S�Allta
ee5 .445,
•
•
/1
w
.<
•r t
•
Ke NC) AI a wu /v1 Ofe I
0n( i h5 Ze51-ci-Jrc4 f Mari vit2..
THE LANDING MARINA
4491
SLAN
TING BRIDGE RO.
SHERRILS FORD, NC 28673 '
478-2817
+1,JDL1n
E.7
• r
4... - +