NC0022454_Renewal (Application)_20150505

lo' . James & James Environmental Management, Inc.
3801 Ashes ille Hwy., Henderson ille. N.C. 28791
OFFICE: [phone] FAX: [phone]
RECEIVEDIDENRIDWR
MAY 5 201
April 29,2015
Water Quality
Permitting Section
N. C. Department of Environment and Natural Resources
Division of Water Quality/NPDES Unit
1617 Mail Service Center
Raleigh,N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt.. Inc
To Whom It May Concern:
This letter is to request the renewal of the permit for the waste water treatment facility of Midway
Medical Center WWTP, NPDES number NC0022454.
Sincerely
4MA4y)( 4*lier
Juanita James
James and James Environmental Mgt., Inc.
j.j emi rdbel l south.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 INC0022454
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 Midway Medical Center
Facility Name Midway Medical Center
Mailing Address 6750 Carolina Boulevard
RECEIVEDIDENRIDWR
City Clyde
State / Zip Code NC 28721 MAY 5 2015
Telephone Number 828-627-2211 Water Quality
Fax Number 828-627-2216 Permitting Secton
e-mail Address Schulz. Qtr. �lrr , COM
2. Location of facility producing discharge:
Check here if same address as above X
Street Address or State Road
City
State / Zip Code
County Haywood
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 Midway Medical Center
Mailing Address 6750 Carolina Boulevard
City Clyde
State / Zip Code NC 28721
Telephone Number 828-627-2211
Fax Number 828-627-2216
e-mail Address SClciv i S 6%m%cl LciGiy irn C .Cam
1 of 3 Forth-011/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
4. Description of wastewater:
Facility Generatina Wastewater(check all that apply):
Industrial Number of Employees
Commercial Number of Employees
Residential Number of Homes
School Number of Students/Staff
Other R Explain: Physician's Office
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Physician's Office
Number of persons served: ir7i3 t c i I H C{.1i
5. Type of collection system
X Separate (sanitary sewer only) 0 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? 0 Yes X No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Sally Haynes Branch
8. Frequency of Discharge: X Continuous 0 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.
0.005 MOD facility with aeration chamber with diffused air, clarification with return
sludge, chlorine disinfection, chlorine contact chamber, dechlorination.
2 o(3 Form-011112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.005 MOD
Annual Average daily flow 0.0006 MOD (for the previous 3 years) RECEIVED/DENR/DWR
Maximum daily flow 0.003 MOD (for the previous 3 years) MAY 5
2015
11. Is this facility located on Indian country? Water Qua)l'�r
❑ Yes ][ No Permitting Section
12. Effluent Data shall be
NEW APPLICANTS:Provide data for the parameters listed.Fecal Coliform, Temperature and pHgrab
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'.
Daily • Monthly Units of
Parameter Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 22.3 12.8 Md/L
Fecal Coliform 260 3.5 CFU/100ML
Total Suspended Solids 33.3 14.9 MG/L
Temperature (Summer) 22.6 21.7 C
Temperature (Winter) 10.5 5.6 C
pH 7.7 7.6 UNITS
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 11C0022454 Dredge or fill(Section 404 or CWA)
PSD(CM) 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.
v((tilt C _ c['a rv.v...ctk. I rr ) �(_QS I
�� t `T'
Printed name oPPerson Signing Title
16NUAA/U--
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Signature of Appiit D to 1
North Carolina General Statute 143-215.6 (bX2) 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 Artide, 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

James & James Environmental Management. Inc.
_ 3801 Ashe%itle HHS.,Hendersonville. X.C. 28791
OFFICE: [phone] FAX: [phone]
April 29,2015
N. C. Department of Environment and Natural Resources
Division of Water QualityINPDES Unit
1617 Mail Service Center
Raleigh,N. C. 27699-1617
Regarding All Waste Water Facilities Operated by James & James Environmental Mgt., Inc.
To Whom It May Concern:
Sludge from this facility ( Midway Medical Center WWTP NC0022454) is pumped by Mike's Septic
Tank Service and is permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
Cle/Wer—
/ l
Juanita Ja es
James and James Environmental Mgt.. Inc.
hemi a bellsouth.net