NC0078158_Permit Issuance_20160620

Water Resources
ENVIRONMENTAL QUALITY
June 20, 2016
Mr. Thomas J. Roberts
Aqua North Carolina, Inc.
202 Mackenan Court
Cary, NC 27511
PAT MCCRORY
Go, error
DONALD R. VAN DER VAART
Sec, el
S. JAY ZIMMERMAN
Dheclu,'
Subject: Issuance of NPDES Permit NCO078158
Olde Beau Golf Club WWTP
Class WW-2
Allegheny County
Dear Mr. Roberts:
The Division of Water Resources (the Division) hereby issues the attached NPDES permit for the
subject facility. 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.
We have made the following updates to your previous permit:
➢ Section A. (2) has been added to require electronic submission of effluent data. Federal
regulations require electronic submittal of all discharge monitoring reports (DMRs), effective
December 21, 2016.
➢ Regulatory citations have been added to the permit.
➢ An updated outfall map has been included.
We have made the following updates since the draft permit:
➢. A correction in section A. (1) has been made for the daily average dissolved oxygen effluent
concentration. The daily average for effluent concentration of dissolved oxygen shall not be
less than 5.0 mg/L.
➢ In section A. (1) upstream and downstream monitoring for fecal coliform has been removed
as requested by Ms. Laurie Ison on June 3, 2016. However, monitoring for temperature and
dissolved oxygen for effluent, upstream, and downstream sample locations remains
unchanged [per 15A NCAC 02B .0508(d)].
Starting on December 21, 2016, federal regulations require electronic submittal of all discharge
monitoring reports (DMRs) and specify that, if a state does not establish a system to receive such
submittals, then permittees must submit DMRs electronically to the Environmental Protection
Agency (EPA). The final NPDES Electronic Reporting Rule was adopted and became effective on
December 21, 2015.
The requirement to begin reporting discharge monitoring data electronically using the NC DWR's
Electronic Discharge Monitoring Report (eDMR) internet application has been added to your final
NPDES permit. [See A. (2)] For information on eDMR, registering for eDMR and obtaining an
eDMR user account, please visit the following web page:
htti3://deQ.ne.gov/about/divisions/water-resources/edmr.
Stale of North Carolina I Environmental Quality I Water Resources
1617 Mail service Center I Raleigh, North Carolina 27699-1617
919 807 6300

For more information on EPA's final NPDES Electronic Reporting Rule, please visit the following
web site:
http•//www2 ens gov/compliance/final-national-pollutant discharge elimination system npdes
electronic -reporting -rule.
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable, you have the right to an adjudicatory hearing, upon written request submitted within
thirty (30) days after receiving this letter. Your request must take the form of a written petition
conforming to Chapter 150B of North Carolina General Statutes, and you must file it.with the Office
of Administrative Hearings, 6714 Mail Service Center, Raleigh, North Carolina 27699.6714. Unless
such a demand is made, this permit shall remain 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 Resources or
any other Federal, State, or Local governmental permits that may be required.
If you have questions, or if we can be of further service, please contact Jennifer Busam at
[e-mail]] or call [phone].
�x
S. Jay Zimmerman, P. ector
Division of Water Res ces, NCDEQ
Enclosure: NPDES Permit NC0078158 (Issuance Final)
hc: Central Files
NPDES Program Files
WSRO Files

Permit NCO078158
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,
Aqua North Carolina, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Olde Beau Golf Club WWTP
Near 917 Country Downs Avenue
Glade Valley
Alleghany County
to receiving waters designated as an unnamed tributary to Laurel Branch (Laurel Creek) in
subbasin 05-07-03 of the New 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 August 1, 2016.
This permit and authorization to discharge shall expire at midnight on March 31, 2021.
Signed this day June 20, 2016.
VX22t4-w
S. J immerman, P.G., Direct
D' "sion of Water Resources
By Authority of the Environmental Management Commission
Page 1 of 6

Permit NCO078158
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are
hereby revoked, and as of this 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.
Aqua North Carolina, Inc.
is hereby authorized to:
1. Continue to operate an existing 0.02 MGD extended aeration wastewater
treatment system with the following components:
♦ Bar screen
♦ Flow splitter box
♦ Equalization basin
♦ Dual Aeration basins
♦ Dual secondary clarifiers
♦ Dual aerated sludge holding tanks
♦ Single tablet chlorinator
♦ Chlorine contact chamber
♦ Tablet dechlorination unit
♦ Stevens flow meter
♦ Effluent pumps, and
♦ On -site generator
This facility is located at the Olde Beau Golf Club, (near 917 County Downs
Avenue, Glade Valley) in Alleghany County.
2. Discharge from said treatment works via Outfall 001, at the location specified
on the attached map into an unnamed tributary to Laurel Branch (Laurel
Creek) [10-9-10-2)] currently classified C-Trout waters in subbasin 05-07-03
[HUC: 0505000104] of the New River Basin.
Page 2 of 6

Permit NCO078158
Part I
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
[15A NCAC 02B.0400 et seq., 15A NCAC 02B.0500 et seq.]
Beginning with the permit effective date and lasting until expiration, the Permittee is
authorized to discharge treated domestic wastewater from Outfall 001. Such
discharges shall be limited and monitored' by'the Permittee as specified below:
- :� t
.y^,•�.sr:.;,es�..+;,;.;�a:'�°�+S�cvei-1
ELENTs�LI
T,�,OS
L
Zc .:esr 1�.
, p iTORI{CR QREMEN� �S� '
�-,-
EFFLUENT CAR►CERISTIS�
��'- ,1T'�.��•:_l.
µ,.
= Dail r
Parame%r Code
on ly�
Mew as`u"�enen� ' Sa p!e jSample
AeYa a
Max'`'�
Fre Qc'YRe, . Location
Flow 50050
0.020 MGD
Continuous
Recording
Influent or
Effluent
BOD, 5-day, (20°C) *Summer C0310
20.0 mg/L
30.0 mg/L
Weekly
Grab
Effluent
BOD, 5-day, (20*C) *Wnfer C0310
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids C0530
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
NHa as N - *Summer C0610
3.0 mg/L
15.0 mg/L
Weekly
Grab
Effluent
NHs as N - *Wnfer C0610
6.9 mg/L
34.5 mg/L
Weekly
Grab
Effluent
Fecal Coliform 31616
200/100 ml
4001100 ml
Weekly
Grab
Effluent
(geometric mean)
Total Residual Chlorine 3 50060
28 Ng/L
2/Week
Grab
Effluent
pH 00400
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Oil and Grease 00556
30.0 mg/L
60.0 mg/L
Weekly
Grab
Effluent
Temperature (°C) 00010
Daily
Grab
Effluent
Temperature (°C) 00010
Weekly
Grab
Upstream &2
Downstream
Dissolved Oxygen 00300
Daily average > 5.0 mg/L
Weekly
Grab
Effluent
Dissolved Oxygen 00300
Weekly
Grab
Upstream & 2
Downstream
-Summer. • April 1- Uctoner ;i1
*Winter November 1- March 31
Footnotes:
1. No later than December 21, 2016, the permittee shall begin submitting discharge monitoring
reports electronically using the NC DWR's eDMR application system [see A. (2)].
2. Upstream= approximately 50 feet upstream from the outfall. Downstream= at the mouth of
the unnamed tributary.
3. 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 pg/L.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN
TRACE AMOUNTS.
Page 3 of 6

Permit NCO078158
A. (2) ELECTRONIC REPORTING OF MONITORING REPORTS
[NCGS 143-215.1 (b)]
Federal regulations require electronic submittal of all discharge monitoring reports
(DMRs) and program reports and specify that, if a state does not establish a system
to receive such submittals, then permittees must submit monitoring data and reports
electronically to the Environmental Protection Agency (EPA) . 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. 15.) (a)]
Effective December 21, 2016, 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 DEQ / 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 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.
Page 4 of 6

Permit NCO078158
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 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.
Page 5 of 6

Permit NC0078158
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.) (dfl
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: / /deg. 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:
"T certify "
ertt; f j, 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. MAI
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 6 of 6

INK
�� --
E
I
YA
--�, � � • me r.
..ua North
Carolina, Inc. Nl*��i�.�■■�r■1��1
Olde Beau
Golf Club WWTP
Facility LocationStream
Segment: 10-9-10-2
River Basin: New
Receiving Stream: Laurel Branch
Stream Class: C-Trout sole not shown
Sub -Basin #: ,,,
,,. USGS Quad: Roaring Gap
(Laurel Creek)

Winston-Salem Journal
Advertising Affidavit
P.O Box 3159
Winston-Salem, NC 27102
NCDENR/DWO/POINT SOURCE BRANCH
ATTN: WREN THEDFORD
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617
Account Number
3376309
Date
May 06, 2016
Date Category Description Ad Size Total Cost
05/06/2016 Legal Notices PUBLIC NOTICE North Carolina Environmental Management C 1 x 53 L 326.99
PUBLIC NOTICE
North Carolina Environmental
Publisher of the
Management Commission/
NPDES Unit
Winston-Salem Journal
1617 Mail Service Center
Raleigh, NC 27699.1617
Forsyth County
Notice of Intent to Issue a
NPDES Wastewater Permit
The North Carolina Environmental
Before the undersigned, a Notary Public of Forsyth County, North Carolina, duly
Management Commission proposes
commissioned, qualified, and authorized by law to administer oaths, personally appeared D.
to issue a Nt to t wastewater tied
charge permit to the persons) listed
H. Stanfield, who b being duly sworn deposes and says: that he is the Controller of the
Y g Y Po Y
below. Written comments regarding
Winston-Salem Journal, engaged in the publishing of a newspaper known as
accept-
the proposed permit will be accept-
ed until 30 days after the publish
Winston-Salem Joumal, published, issued and entered as second class mail in the City of
P ty
date of this notice. The Director of
Winston-Salem, in said County and State: that he is authorized to make this affidavit and
the Division of Water Resources
may hold a public hearing
(DWR)may
swom statement: that the notice or other legal advertisement, a true co of which is
g PY
should there be a significant degree
attached hereto, was published in the Winston-Salem Journal on the following dates:
of public interest. Please mail com-
ments and/or information requests
to DWR at the above address. Inter-
05/06/2016
ested persons may visit the DWR at
512 N. Salisbury Street, Raleigh, NC
to review information on file. Addi-
and that the said newspaper in which such notice, paper document, or legal advertisement
permits
Donal information on NPOESbe
and this notice may be found on our
our
was published was, at the time of each and every such publication, a newspaper meetin all
P m'Y Pg
website: httpJ/deq.na.gov/aboutt
the requirements and qualifications of Section 1-597 of the General Statutes of North
divisions/water-resources/water-
resources-permits/wastewater-
Carolina and was a qualified newspaper within the meaning of Section 1-597 of the General
9g
branch/npdes-wastewater/public-
Statutes of North Carolina.
notices, or by calling [phone].
Nikola's Restaurant has requested
This 6th day of May, 2016
renewal of permit NCO084932 for
Nikolas Restaurant & High Meadows
Inn WWTP/ Alleghany County; Fa-
cility discharges to Laurel Branch/
(signature o ens n ma ing rdavit)
New River Basin. Three parameters
are water quality limited.
Aqua North Carolina, Inc. has re-
Swom to and subscribed before me, this 6th day of May, 20 6
quested renewal of permit NC00
,
78158 for Olde Beau Golf Club
WWTP in Allegheny County; this
permitted facility discharges to an
unnamed tributary to Laurel Branch/
(No A ry Public)
New River Basin. Five parameters
are water quality limited.
e
WSJ: May 6,zot6
My Commission expires J 4 10Z4 KIMALEY 15AMN
NOTARY PUBLIC
FORSYTH COUNTY
THIS IS NOT A BILL. PLEASE PAY FROM INV9➢AQFxfftJl#rfl9 KN4CMPIKE

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
Jennifer D. Busam — 4/27/2016
Permit Number
NCO078158
Facility Name
Olde Beau Golf Club W WTP
Basin Name/Sub-basin number
New / 05-07-03
Receiving Stream
Laurel Branch (Laurel Creek)
Stream Classification in Permit
C; Tr I Stream Index: 10-9-10-2
Does permit need Daily Max NH3 limits?
No — already resent
Does permit need TRC limits/Ian ua e?
No — already resent
Does permit have toxicity testing?
No
Does permit have S ecial Conditions?
No
Does permit have instream monitoring?
Yes, for DO, fecal coliform and temperature
Is the stream impaired (on 303(d) list)?
No
Any obvious compliance concerns?
No. No enforcements during the current
permit cycle. Few NOV and NOD from TSS
and flow exceedances.
Any permit mods since lastpermit?
No
New expiration date
03/31/2021
Changes to 2011 Permit?
Added eDMR requirements
Added regulatory citations
Latitude and longitude coordinates updated
for outfall location, not facility
Created a new outfall ma
Changes to Draft Permit? %
7 iil jechn A. U) -* pQ Siwu (d he
Most Commonly Used Expedited Languagek%'XI1 U ? V ft' DFke &-wq Hudsm
• 303(d) laneuaee for Draft/Final Cover Letters: "Please note that the receiving stream w�f5� tiUl(P
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 MS. I SaAi
continue to be evaluated. If there is noncompliance with permitted effluent limits and W gl tol to 44
stream impairment can be attributed to your facility, then mitigative measures may be
required".
• TRC language for Compliance Level for Cover Letters/Effluent Sheet Footnote:
"The facility shall report all effluent TRC values reported by a NC certified laboratory
including field certified. However, effluent values below 50 µg/L will be treated as zero
for compliance purposes."

AOUA-
Thomas J. Roberts, President and Chief Operating Officer
0:919.653.5770 • F:919.460.1788 • [e-mail]
November 16, 2015
NCDENR / DWQ/ NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-0167
Re: Application for Permit Renewal
Aqua North Carolina, Inc., Olde Beau
NPDES NC0078158, Alleghany County
Gentlemen:
RECEIVED/DENR/DWR
DEC 0 2 2015
Water Quality
Permitting Section
Enclosed are three (3) copies of the completed application Form D- WWTP. This submittal
includes the necessary attachments for your office to renew the subject permit.
With this permit renewal application, we are requesting that the upstream/downstream sampling
for dissolved oxygen, temperature and fecal colifonn be eliminated. During the winter months,
there is very little to no flow coming into the plant because of the vacation type community.
Also, our downstream sampling location is below an erosion control pond for the development.
We are concerned that this situation could eventually interfere with our sampling results and thus
not be a representation of our plant effluent.
Should you need any additional information regarding this request, please feel free to contact our
Regional Compliance Manager, Michael A. Melton @ 704-489-9404 ext. 57238 or by e-mail at
Enclosure
202 MacKenan Court Cary, NC 27511 • AquaAmerica.com

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 INCO078158
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 AQUA NORTH CAROLINA, INC.
Facility Name OLDE BEAU WWTP
Mailing Address 202 MACKENAN COURT
City CARY
State / Zip Code NC 27511 FNR/DWR
Telephone Number [phone] DEC ® 2 2015
Fax Number [phone] Water Qu
aijiv
e-mail Address [e-mail]
M for
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road Near 917 County Downs Avenue
City Glade Valley
State / Zip Code NORTH CAROLINA,
County Alleghany
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 AQUA NORTH CAROLINA, INC
Mailing Address 202 MACKENAN COURT
City CARY
State / Zip Code NORTH CAROLINA 27511
Telephone Number [phone]
Fax Number [phone]
1 of 4 Form-0 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
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
®
Number of Homes 149
School
❑
Number of Students/ Staff
Other
®
Explain: club
facilities
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Population served: 149 Single Family Homes, Club House, Pool, & Maintenance Building
5. Type of collection system
® Separate (sanitary sewer only)
6. Outfall Information:
❑ Combined (storm sewer and sanitary sewer)
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
?. Name of receiving stream(s) (Provide a map showing the exact location of each outfallj.
To receiving waters designated as Unnamed Tributary to Laurel Branch, classified C-Trout
waters in the New River Basin (see attached map).
S. Frequency of Discharge: ® Continuous ❑
If intermittent:
Days per week discharge occurs:
Intermittent
Duration:
2 of 4 Form-D 05/08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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.
The 0.020 MGD package plant consist of the following:
•
Bar screen
•
Flow splitter box
•
Equalization basin
•
Dual Aeration basins
•
Dual secondary clarifiers
•
Dual aerated sludge holding tanks
•
Single tablet chlorinator
•
Chlorine contact chamber
•
Tablet dechlor unit
•
Stevens flow meter
•
Effluent pumps
•
On -site generator
10. Flow Information:
Treatment Plant Design flow 0.020 MGD
Annual Average daily flow 0.002 MGD (for the previous 3 years) ENTER DATA IN YELLOW
Maximum daily flow 0.011 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 24hour 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 (BODS)
29.2
10.84
MG/L
Fecal Coliform
145.0
1.9
#/ 100ML
Total Suspended Solids
88.3
15.3
MG/L
Temperature (Summer)
27.0
19.3
*Celsius
Temperature (Winter)
13.0
6.1
° Celsius
pH
8.2
N/A
UNITS
3 of 4 Form-D 05l08

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES NCO078158 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.
r
of
Title
(�� 1Z L�
Signature of App ' ant r1ate
North Carolina Generdf 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.)
4 of 4 Form-D 05108

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Facility
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r
not to scale
NPDES Permit No. NCO078158
.(YOYth
Alleghany County

AQUA.
SLUDGE MANAGEMENT PLAN
For RECEIVED/DENR/DWR
Aqua North Carolina, Inc.
DEC 0 2 2015
Water Quality
No sludge will be treated on any wastewater treatment plant sitepft§ection
by Aqua N.C., Western Division
Where practical, sludge removed from a Aqua N.C., Western Division
facility will be transported via a contract hauler to another Aqua N.C.,
Western Division facility for the purpose of "seeding" a new or under
loaded plant.
Unusable (or "dead") sludge will be removed by a contract hauler and
properly disposed of in accordance with NCGS 143-215.1. Contract
haulers used by Aqua N.C., Western Division will be required to
report the quantity of sludge transported and identify the location of
the proposed disposal site if the sludge is not taken to an existing
plant operated by Aqua N.C., Western Division. Aqua N.C., Western
Division has not entered into any agreement to accept sludge into its
facilities from plants not owned by them.
Aqua N.C., Western Division will keep records on the quantity of sludge
removed from each facility, the name of the contract hauler, and the
destination of the sludge (whether used in another plant or disposed of).
The information will be kept on file and will be made available to any
regulatory agency having jurisdiction over sludge treatment or disposal.
Aqua N.C., Western Division includes all of the facilities under the
jurisdiction of the Winston-Salem Regional Office.
202 MacKenan Court, Cary, NC, 27511 • 919.467.8712 • AquaAmerica.com

Upstream
NPDES Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau Golf Club
Stream: UT to Laurel Branch
Location: 100' above discharge and po
Ills
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NPABS Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau -Golf Club
Stream: UT to Laurel Branch
Location: 100' above discharge and po
Print Stream Sheet: Yes
Downstream
001 Month:
August Year. 2015
County:
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Stream:
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Location:
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Upstream
NPDES Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau Golf Club
Stream: UT to Laurel Branch
Location: 100' above discharge and Po
Print Stream Sheet Yes
•
Downstream
001 Month:
July Year: 2015
County:
Alleghany
Stream:
UT to Laurel Branch
Location:
200' Below the discharge
RECEIVED/DENR/DWR
DEC 0 2 2015
Water Quality
Permitting Section

Upstream
NPDES Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau Golf Club
Stream: UT to Laurel Branch
Location: 100' above discharge and po
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Downstream
001 Month:
June Year: 2015
County:
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NPDES Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau Golf Club
Stream: UT to Laurel Branch
Location: 100' above discharge and'po
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May Year: 2015
County:
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NPDES Permit No.: NC 0078158 Discharge No.:
Facility Name: Olde Beau Golf Club
Stream: LIT to Laurel Branch
Location: 100' above discharge and po
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Downstream
001 Month:
April Year: 2015
County:
Alleghany
Stream:
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Location:
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i NPDES NO: NC 0078158 DISCHARGE NO: 001 MONTH: March YEAR: 2015
FACILITY NAME: Olde Beau Golf Club COUNTY: Allegheny
s
STREAM: UT to Laurel Branch STREAM: UT to Laurel Branch
LOCATION: 100' ft. Above Discharge & Pond LOCATION: 200' ft. Below Discharge
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NPDES NO: NC 0078158 • DISeHARGE NO: 001 MONTH: Febninry YEAR: 2015
FACILITY NAME: Olde Beau Golf Club COUNTY: Allerfhenv
STREAM: UT to Laurel Branch STREAM: UT to Laurel Branch
LOCATION: 100' ft. Above Discharge & Pond LOCATION: 200' ft. Below Discharge
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Copy DEM Form MR-3 (11/84)

NPDES NO: NC 0078158 DISCHARGENO: 001 MONTH: January YEAR: 2015
FACILITY NAME: Olde Beau Golf CIub COUNTY: Allegheny
STREAM: UT to Laurel Branch STREAM: UT to Laurel Branch
LOCATION: 100' ft. Above Discharge &Pond LOCATION: 200' ft. Below Discharge
Upstream
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11
Copy DEM Form MR-3 (11/84)

NPDES NO: NC 0078158 DISCHARGE NO: 001 MONTH: December YEAR: 2014
FACILITY NAME: Olde Beau Golf Club COUNTY: Allegheny
STREAM: UT to Laurel Branch STREAM: UT to Laurel Branch
LOCATION: _ _ 100' ft. Above Discharge & Pond LOCATION: 200' ft. Below Discharge
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Copy DEM Form MR-3 (11184)

NPDES NO: NC 0078158 DISCHARGE NO: 001 MONTH: October YEAR: 2014
FACILITY NAME: Olde Beau Golf Club COUNTY: Allegheny
STREAM: UT to Laurel Branch STREAM: UT to Laurel Branch
LOCATION: 100' ft. Above Discharge & Pond LOCATION: 200' ft. Below Discharge
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Copy DEM Form MR-3 (11184)