NC0088153_Renewal (Application)_20150421

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MOD
Mail the complete application to:
N. C. DXNR / Division of Water Quality / NPDRS Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDEB Permit CW88163
If you are completing this form in computer use the TAB key or the up - down arrows to moue 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 Shane 011is
Facility Name Linville Riverbend RV Park LW
Mailing Address 8007 Linville Falls Hwy Newland NC 28657 (THIS IS CHANGE)
City Newland
State / Zip Code NC 28657
Telephone Number (828-387-6688) RECEIVED/DENR/DWR
Fax Number ( ) G K 015
e-mail Address [e-mail]
water-adoty
pArmittinq Section
Z. Location of facility producing discharge:
Check here if same address as above 10
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 THIS FACILITY HAS NOT BEEN CONSTRUCTED
Mailing Address
City
State / Zip Code
Telephone Number ( )
Fax Number ( )
e-mail Address
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NPDES APPLICATION - FORK D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
4. Description of wastewater.
Facility Generating Wastewater(check all that applyr
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/Staff
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Number of persons served:
S. Type of collection system
❑ Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Out&U Information:
Number of separate discharge points
C athE Identification number(s)
Is the outhM equipped with a diffuser? ❑ Yes ❑ No
9. Name of receiving stream(s) (AMW applicants: Provide a reap showing the exact location of each
outfall,t
WHEN CONSTRUCTED - LINVILLE RIVER
B. 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.
2 of 3 Fom[)11112

NPDE8 APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design now MOD
Annual Average daily now MOD (for the previous 3 years)
Mazdmum daily now MOD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ❑ No
12. Effluent Data
1l NW dPPllGllf l't3: Provide data for the parameters listed. Fecal Coliform, Tempemture and pH shall be grab
samples, for art otherparameters 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.
RVXWAL APPLiCANTB: Provide the highest single reading (Daily Maxrnum) and Monthly Average over
the past 36 months for parameters currentlu in uour permit. Mark other parameters 'N/A'_
Parameter
Daft
Masimum
monthly -
A
- - Units of
Measurement
Biochemical Oxygen Demand (BOD5)
Fecal Coliform
Total Suspended Solids
Temperature (Summer)
Temperature (Winter)
pH
13. loft all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
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.
SHANE OLLIS OWNER / MANAGER
Printed name of Person Signing Title
North Carolina General Statute 143-215.6 (bK2) 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 punistment 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 11112

A���
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Shane 011is, Manager
Linville Riverbend RV Park LLC
8007 Linville Falls
Hwy Newland, NC 28657
Dear Permittee:
Donald R. van der Vaart
Secretary
April 29, 2015
Subject: Acknowledgement of Permit Renewal
Permit NCO088153
Avery County
The NPDES Unit received your permit renewal application on April 21, 2015. A member of the
NPDES Unit will review your application. They will contact you if additional information is required to
complete your permit renewal. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Charles
Weaver [phone].
Sincerely,
1AJre vv _rkto(f V&
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] Fax: [phone]Customer Service:1-877-623-6748
Internet:: www.ncwater.org
An Equal OpportunityMmnafive Action Employer