NC0080659_Renewal (Application)_20150330

Madison County Schools
5738 US Hwy. 25/70
Marshall, NC, 28753-9006
March 30, 2015
Wren Thedford
NC DENR/DWR/NPDES Unit
1617 Mail Service Center
Raleigh, NC, 27699-1617
Dear Mr. Thedford:
The Madison County Schools is requesting renewal of their
permit for Madison Middle School and Laurel Elementary
School. There have been no changes since the permit was
issued in 2010.
If we can be of further assistance, please contact Dr. Ron
Wilcox, Madison Co. Schools Superintendent or Joe Davis,
Madison Co. Schools Maintenance Director.
Respectfully Submitted,

Madison County Schools
5738 US Hwy. 25/70
Marshall, NC, 28753 — 9006
March, 30, 2015
Wren Thedford
NC DENR/DWR/NPDES Unit
1617 Mail Service Center
Raleigh, NC, 27699 — 1617
Dear Mr. Thedford:
In regards to the Sludge Mgt. Plan, The Madison County Schools
disposes of the sludge from Madison Middle School & Laurel
Elementary School on an "As Needed Basis".
We are currently using Mike's Septic Tank Service, PO Box 968,
Leicester, NC, 28748.
If we can be of further assistance on this matter, please
contact, Ron Wilcox, Madison County Schools Superintendent
or Joe Davis, Madison County Schools Maintenance Director.
Respectfully Submitted,

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 Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NCOO r (o sq
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 IOC)(5
Facility Name 0 )5�,n l(i �i Sthoo I
Mailing Address ft r lush Gk %R
City 5
State / Zip Code ' .2R153
Telephone Number (82) (0(4 C - 0=9
Fax Number (&)8) co- q - 010 15
e-mail Address rL i;lcnx(G 1' c d istiA k►a .i let C rice 1c, e Iie±
2. Location of facility producing discharge:
Check here if same address as above Lg'
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)
Name u n A Jo S'e
Mailing Address lg..Ci /..i-1- ;5 1v- S f.
City got SO-- ;. 1115 1 /VC
State / Zip Code /VC- I 7L( 3
Telephone Number (27-g ) 5-c/ - -7 z
Fax Number (( 6M1— 10/ 5.
e-mail Address CS`t' L1 S ry16 + 1 . co Yn
•1 of 3 Form-D 9/2013

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
School Number of Students/Staff I I e,
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): jyl u • SG h n G[a (12 S�6cc I / VI-L( 5 t C re`e 1Z. ken
Number of persons served:
5. Type of collection system
[ ' Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points ON E
Outfall Identification number(s) Oo
Is the outfall equipped with a diffuser? ® Yes ❑ No
7. Name of receiving stream(s) (NEW a licant :Provide a map showing the
e exact location of each
outfalls G( P c Y .2C-u S Ll Cv Y., ►1 n 1 r .5 o h .l�►
8. Frequency of Discharge: I2( 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.
fc N G �►a r, S ri'l r �� c� p n }u ? -2 i •�
Form-D 9/2013

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow C,CC 7 MOD
Annual Average daily flow (',CCG MOD (for the previous 3 years)
Maximum daily flow C.'', C ' MOD (for the previous 3 years)
11. Is this facility located on Indian country?
D 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) /10 7 5 rrn
Fecal Coliform 5p Z 3 �r wit
Total Suspended SolidsL j ( 5 ��,y� q/(19
Temperature (Summer) .'Ljr 3 / . G
Temperature (Winter) /0,0 °C B
pH 7 6 , 7 "Sorel
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 /(/L rj 1 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.
e.gei.
c e 42 ix
Printed name of:7Person Signi g Title
Si gr ture of ' Date
North Carolina General Stu 143-215.6 (b)(2) states: Any person who knowingly makes any false statement representation, or certification in any
application, record, report, pan, 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 912013