NC0044253_Renewal (Application)_20150121

CAMP DOGWOOD
P.O.BOX 39
SHERRILLS FORD,NC 28673
January 15, 2015
RECEIVEDIDENRIDWR
Mrs. Wren Thedford .JAN 261;
NCDENR/DWR/NPDES Unit
1617 Mail Service Center Water Quality
Raleigh, NC 27699-1617 Permittina Section
Dear Mrs. Thedford:
Please accept this letter as a request for renewal of the Camp Dogwood Wastewater
Treatment Plant NPDES Permit#NC0044253.
There have been no operational or design changes at the facility since the issuance of the
last permit.
Sincerely,
Steve L. Walker
Executive Director
NC Lions, Inc.

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 INC0044253
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 NC Lions, Inc.
Facility Name Camp Dogwood
Mailing Address P.O. Box 39
City Sherrills Ford
State / Zip Code North Carolina 28673 RECEIVEDIDENRIDWR
Telephone Number [phone] JAN 21 2015
Fax Number [phone] Water Quality
On
e-mail Address [e-mail] rermitGr►g Seat
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road 7050 Camp Dogwood Drive
City Sherrills Ford
State / Zip Code North Carolina 28673
County Catawba
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 Steve L. Walker, Executive Director
Mailing Address P.O. Box 39
City Sherrills Ford
State / Zip Code North Carolina 28673
Telephone Number [phone] Ext 223
Fax Number [phone]
e-mail Address [e-mail]
1 of 3 Form-D 11/12

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 0 Number of Employees
Residential 0 Number of Homes
School ❑ Number of Students/Staff
Other ® Explain: 16 Staff
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Camp for blind and visually impaired.
100% Domestic Waste.
Facility has kitchen/dining.
Number of persons served: 75
5. Type of collection system
►i/ Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Directly into Lake Norman (Catawba River Basin)
8. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
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.
-Manual bar screen
-Activated sludge aeration basins-(10,000 gal)
- Clarifier with skimmer&air lift sludge return(1,000 gal)
- Chlorine contact chamber-200 gal-with tablet feed chlorinator
-In-line tablet feed dechlorination in effluent discharge line
-Design removal estimated to be 90%
2 of 3 Form-D 11112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.010 MGD
Annual Average daily flow 0.003 MOD (for the previous 3 years)
Maximum daily flow 0.007 MOD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
NEW APPLICANTS: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.
RENEWAL APPLICANTS: Provide the highest single reading(Daily Maximum)and Monthly Average
over the past 36 months for parameters currently in your permit. Mark other parameters `N/A".
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 31.5 4.25 mg/L
Fecal Coliform 270 7.3 Colonies/100 mL
Total Suspended Solids 50.4 9.86 mg/L
Temperature (Summer) 28 25 C°
Temperature (Winter) 13 12 C°
pH 7.8 7.0 su's
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 NC0044253 Dredge or fill(Section 404 or CWA)
PSD (CAA) Other
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.
Steve L. Walker Executive Director
Printed name of Person Signing Title
� ‘IP adi
/- 2t - /5
Si at :' A li t 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 11/12

Sludge Management Plan
For: Camp Dogwood Wastewater Treatment Plant
NPDES Permit#NC0044253
Date: January 15, 2015
The waste sludge produced at the treatment facility is removed directly from the aeration
basins by Robert's Septic Service of Hickory,NC (Catawba County—License#NCS00294) and
discharged into the City of Newton(Catawba County) sewage collection system.
By: Steve L. Walker
Executive Director
NC Lions, Inc.
P.O. Box 39
Sherrills Ford,NC 28673