NC0072061_Renewal (Application)_20150302

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AO UA
March 2, 201 5
Wren Thedford
NC DENR / DWR/ NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-0167
Re: Application for Permit Renewal
Aqua North Carolina, Inc.
Fox Run Subdivision Well #3 WTP
NPDES No. NC0072061
Gaston County
Gentlemen:
Enclosed are three (3) copies of the completed application Short Form C- WTP.
This submittal includes the necessary attachments for your office to renew the
subject permit.
If you need any additional information or assistance, please feel free to contact
our Regional Compliance Manager, Michael A. Melton @ 704-489-9404 ext.
57238 or by e-mail at [e-mail].
Since ,
Thomas J. oberts
President & COO
Enc
202 MacKenan Court,Cary,NC,27511 • 919.467.8712 • AquaAmerica.com

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number NC0072061
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 Fox Run-Well #3 WTP
Mailing Address 202 Mackenan Ct
City Cary
State / Zip Code NC/27511
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same as above 0
Street Address or State Road NCSR 2722
City Gastonia
State / Zip Code North Carolina / 28056
County Gaston
3. Operator Information:
Name of the firm, consultant 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 4163 Sinclair Street
City Denver
State / Zip Code NC / 28037
Telephone Number [phone]
Fax Number [phone]
Page 1 of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
4. Ownership Status:
Federal ❑ State ❑ Private ® Public ❑
5. Type of treatment plant:
❑ Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
• Ion Exchange (Sodium Cycle Cationic ion exchange)
® Green Sand Filter (No sodium recharge)
O Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener El
6. Description of source water(s) (i.e. groundwater, surface water)
Groundwater Well
7. Describe the treatment process(es) for the raw water:
Raw water is treated by greensand filters in series with a 0.0017 MGD discharge of filter
backwash wastewater. Chemicals utilized during this process consist of:
• NaOH injection
• KMnO4 Injection for Iron removal
• Filtering through three (2) green sand filters
• Backwashing of Filters using finished water
• Discharging of backwash each day to two (2) buried settling tanks
• Chlorination / De-chlorination of effluent
8. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
Wastewater discharge from said treatment works at the location specified on the attached
map into an unnamed tributary to Crowders Creek, classified C waters in the Catawba
River Basin.
9. Number of separate discharge points: 1
Outfall Identification number(s) 001
10. Frequency of discharge: Continuous 0 Intermittent IZ
If intermittent:
Days per week discharge occurs: 1 Duration: 24 minutes (average)
11. Plant design potable flow rate 0.0252 MGD
Backwash or reject flow 0.0017 MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Page 2 of 3 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Unnamed Tributary to Crowders Creek (Catawba River Basin)
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Alum / aluminum sulfate Yes No
Iron sulfate / ferrous sulfate Yes No
Fluoride Yes No
Ammonia nitrogen / Chloramines Yes No X
Zinc-orthophosphate or sweetwater CP1236 Yes No g
List any other additives below:
Chlorine, Caustic, Potassium Permanganate
14. Is this facility located on Indian country? (check one)
Yes 0 No
15. Additional Information:
• Provide a schematic of flow through the facility, include flow volumes at all points in
the water treatment process. The plan should show the point[s] of addition for
chemicals and all discharges routed to an outfall [including stormwater].
• Solids Handling Plan
16. NEW Applicants
Information needed in addition to items 1-15:
• New applicants must contact a permit coordinator with the NCDENR Customer
Service Center.
Was the Customer Service Center contacted? 0 Yes ❑ No
• Analyses of source water collected
• Engineering Alternative Analysis
• Discharges from Ion Exchange and Reverse Osmosis plants shall be evaluated using a
water quality model.
17. 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.
Tho • J,'oberts President, Aqua North Carolina, Inc.
tea jF e of P: .onn __,i._ Title
,4LdL_ - �
Signature of `..'.licant r ate
North Carolina Ge -ral Statute 143-215.6(b)(2)provides that: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.)
Page 3 of 3 Version 5/2012

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Aqua North Carolina, Inc. Facility
.
Fox Ruu WTP Location
Latitude: 35°(1'19" N State,Grid: Gastonia South not to scale
Lomritude: 81°09'25" W Permitted Flow: N/A
Receiving Strewn: UT toCrawdersCreek Stream Class: CNorthNPDES Permit No.NC007206 1
utnlon eBasin: Catawba Rivu•Basin lob-flnsin: 0308-37 �O�� Gaston County
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