NC0076147_Renewal (Application)_20150522

In August 2010 Charles Weaver sent you an email with information about renewing your permit.
Hopefully you made a copy of that application for yourself and can find it in your files so you can take
a look at it for reference when filling this one out. These permits are to be renewed every five years,
hence Charles getting in touch with you in 2010. There is no money due with this renewal process; it is
not your permit annual fee notice. That is sent out separately; looks like probably around August or
September you get that bill.
See the attached form, fill it out and send it the address noted at the top of the application by the end
of June. Your permit number is NC0076147. Fill out as much on the NPDES Application — Form D as
you can. There will be several items you can't fill out since your system has not been built yet. Make
sure you note that the your system/development has not been built yet. Hopefully you can find the last
one of these you submitted in 2010 to help you fill this one out.
Have a nice day,
Linda Wiggs
Environmental Senior Specialist
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Resources -Water Quality Regional Operations
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Link to Division of Water Resources Home Page
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and therefore may be disclosed to third parties.
RECEIVED/DENR/DWR
MAY 222015
Water Quality
Permitting

Mail the complete application to:
N.C.DENR/Division of Water Quality/NPDES Unit
1617 Mail Service Center,Raleigh,NC 27699-1617 /-I
NPDES Permit NC00 FORMTEXT fie 'T
0 0 CO 1 -q
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 Doriana Atkinson
Facility Name San Giusto
Mailing Address 1596 Lancaster Terrace
City Jacksonville
State/Zip Code FL/32204
Telephone Number [phone]
Fax Number
e-mail Address [e-mail]
Location of facility producing discharge:
Check here if same address as above FORMCHECKBOX RECEIVED/DENR/DWR
Street Address or State Road Cane Creek Road
City Fletcher MAY 2 2 2015
State/Zip Code NC Water Quality
Permitting Section
County Bumcomb
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 Doriana Atkinson
Mailing Address 1596 Lancaster Terrace
City Jacksonville
State/Zip Code FL/32204
Telephone Number [phone]
Fax Number (FORMTEXT )FORMTEXT
e-mail Address [e-mail]

4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial FORMCHECKBO Number of FORMTEXT
X Employees
Commercial FORMCHECKBO Number of FORMTEXT
X Employees
Residential X none FORMTEXT
School FORMCHECKBO Number of FORMTEXT
X Students/Staff
Other FORMCHECKBO Explain: FORMTEXT
X
Describe the source(s)of wastewater(example: subdivision,mobile home park,shopping centers,
restaurants,etc.):
FORMTEXT
Number of persons served: none
Type of collection system
FORMCHECKBOX Separate(sanitary sewer only) FORMCHECKBOX Combined (storm
sewer and sanitary sewer)
Outfall Information:
Number of separate discharge points none
Outfall Identification number(s) none
Is the outfall equipped with a diffuser? FORMCHECKBOX Yes FORMCHECKBOX
No
7. Name of receiving stream(s) (NEW a icants:Provide a map showing the exact location of each
outfall):
FORMTEXT
Frequency of Discharge: FORMCHECKBOX Continuous
FORMCHECKBOX Intermittent
If intermittent:
Days per week discharge occurs: unknown Duration:

FORMTEXT
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.
FORMTEXT
RECENEDIDENRIDWR
MAY 222015

Flow Information:
Treatment Plant Design flow unknown MGD
Annual Average daily flow unknown MGD (for the previous 3 years)
Maximum daily flow unknown MGD(for the previous 3 years)
11. Is this facility located on Indian country?
FORMCHECKBOX Yes FORMCHECKBOX 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 Maximum, MonthlyAverage Units of Measurement
g
Biochemical Oxygen
Demand(BODS) FORMTEXT FORMTEXT FORMTEXT
< Fecal Coliform FORMTEXT FORMTEXT FORMTEXT
� cr�� Total Suspended
NpSolids FORMTEXT FORMTEXT FORMTEXT
Temperature(Summer) FORMTEXT FORMTEXT FORMTEXT
Temperature(Winter) FORMTEXT FORMTEXT FORMTEXT
pH FORMTEXT FORMTEXT FORMTEXT
List all permits,construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste
FORMTEXT NESHAPS(CAA) FORMTEXT
(Rte►)
t:� UIC(SDWA) FORMTEXT Ocean Dumping PORMI,
TI
14e<
NPDFS FORMTEXT Dredge or fill(Section FORMTEXT 404 or CWA)
�( ) PSD(CAA) PORMTI I Other FORMTEXT
- f Non-attainment program FO ,
(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.

Doriana Atkinson Owner
FORMTEXT
Printed name of Person ': "ng Title
lrt illhb
• ' pelican Date 144
' • 1 , Q
North Carolina General Statute 143-215.6(bX2)states: Any person • 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,fora similar offense.)
NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100%domestic wastewaters<1.0 MGD
PAGE 1 of NUMPAGES 3
Form-D 11112

Av.
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 27,2015
Doriana Atkinson
San Giusto
1596 Lancaster Terrance
Jacksonville, FL 32204
Subject: Acknowledgement of Permit Renewal
Permit NC0076147
Buncombe County
Dear Permittee:
The NPDES Unit received your permit renewal application on May 22, 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 (919)
807-6333.
Sincerely,
W rem.Tkzobforot,
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.orq
An Equal Opportunity1Affirmative Action Employer