NC0038822_Permit Issuance_20090305

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue, Governor
Mr. David Payne
Central Care
139 Apex Lane
Mount Airy, N.C. 27030
Dear Mr. Payne:
Coleen H. Sullins, Director
March 5, 2009
Dee Freeman, Secretary
Subject: Issuance of NPDES Permit NCO038822
Central Care WWTP
Surry County
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge permit. This permit is issued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between
North Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently
amended).
This final permit includes no major changes from the draft permit sent to you on January
14, 2009.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative Hearings
(6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this
decision shall be final and binding.
Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division of Water Quality or permits
required by the Division of Land Resources, the Coastal Area Management Act or any other Federal or Local
governmental permit that may be required. If you have any questions concerning this permit, please
contact Charles Weaver at telephone number [phone].
Sin rely,
f doleen H. Sullins
cc: Central Files
Winston-Salem Regional Office/Surface Water Protection
NPDES Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
512 North Salisbury Street, Raleigh, North Carolina 27604 NorthCarolina
Phone: [phone] / FAX [phone] / Internet: www.ncwaterquality.org Naturally
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper `

Permit NCO038822
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Central Care, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Central Care WWTP
139 Apex Lane
Mount Airy
Surry County
to receiving waters designated as an unnamed tributary to Stewarts Creek in subbasin
03-07-03 of the Yadkin -Pee Dee River Basin in accordance with effluent limitations,
monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective April 1, 2009.
This permit and authorization to discharge shall expire at midnight on February 28, 2014.
Signed this day March 5, 2009.
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO038822
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are
hereby revoked. As of this permit issuance, any previously issued permit bearing this number is .
no longer effective. Therefore, the exclusive authority to operate and discharge from this facility
arises under the permit conditions, requirements, terms, and provisions included herein.
Central Care, Inc. is hereby authorized to:
1. Continue to operate an existing 0.010 MGD wastewater treatment system with the
following components:
♦ Septic tank
♦ Dosing chamber
♦ Surface sandfilter
♦ Tablet chlorinator
The facility is located off Apex Lane, south of Mount Airy in Surry County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Stewarts Creek, currently classified C waters in .
subbasin 03-07-03 of the Yadkin -Pee Dee River Basin.

10
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Discharge Location 91
NCO038822 Central Care, Inc
tude: 36027'11" Sub -Basin: 03-07-03
aitude: 80038'52" River Basin: Yadkin -Pee Di
d Name: Dobson Stream Class: C
)ivine Stream: UT to Stewarts Creek
rAMM
4.
00 tit
af
Facility
i kl'
Location
�%� Not to Scale

Permit NCO038822
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning on the effective date of this permit and lasting until expiration, the
Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and
monitored by the Permittee as specified below:
PARAMETER
LIMITS
MONITORING REQUIREMENTS
Monthly Average.
Daily Maximum
Measurement
Sample Type
Sample Location'
Frequency
Flow
0.010 MGD
Weekly
Instantaneous -
Influent or Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
NH3 as N
2.0 mg/L
10.0 mg/L
Monthly
Grab
Effluent
(April 1- October 31
NH3 as N
4.0 mg/L
20.0 mg/L
Monthly
Grab
Effluent
November 1- March 31
Dissolved Oxygen
Weekly
Grab
Effluent,
U&D
Fecal Coliform
200/100 ml
400/100 ml
2/Month
Grab
Effluent
(geometric mean
Total Residual Chlorine
17 pg/L
2/Week
Grab
Effluent
TRC 2
Temperature (°C)
Daily
Grab
Effluent
Temperature (°C)
Weekly
Grab
U & D
Total Nitrogen
Quarterly
Grab
Effluent
(NO2+NO3+TKN)
Total Phosphorus
Effluent
Quarterly
Grab .
pH
> 6.0 and < 9.0 standard units
_ _
2/Month
Grab
Effluent
Footnotes:
1. U: at least 100 feet upstream from the outfall. D: at least 300 feet downstream from the outfall.
2. The facility shall report all effluent TRC values reported by a NC certified laboratory including field
certified. However, effluent values below 50 µg/L will be treated as zero for compliance purposes.
There shall be no discharge of floating solids or visible foam in other than trace amounts.

PUBLIC NOTICE
STATE OF NORTH
CAROLINA
ENVIRONMENTAL
MANAGEMENT COM-
MISSION/NPDES UNIT
1617 MAII .4FRVICF
CENTER
NORTH CAROLINA
RALEIGH, NC
SURRY COUNTY
27699-1617
NOTIFICATION OF
A INTENT TO ISSUE A
AFFIDAVIT OF PUBLICATION
NPDES WASTEWATER
A
PERMIT
Before the undersigned, a Notary Public of said County and State, duly
On the basis of thorough
staff review and applica-
commissioned, qualified and authorized by law to administer oaths,
tion of NC General Stat-
personally appeared Ferris W. Simpson who being first duly
ute 143.215.1 and 15A
NCAC 02H.0109 and
sworn, deposes and says: that he (she) is Business Manager
other lawful standards
(Publisher or other officer or employee authorized to make affidavit) of
and regulations, the
North Carolina Environ-
HEARTLAND PUBLICATIONS, LLC, engaged in the publication of a
mental Management
newspaper known as MOUNT AIRY NEWS, published, issued, and
"ommission proposes to
ssue a National Pollut.
entered as periodicals class mail in the city of Mount Airy in said County
ant Discharge Elimina.
and State; that he (she) is authorized to make this affidavit and sworn
tion System (NPDES)
wastewater discharge
statement; that the notice or other legal advertisement, a true copy of
permit to the person(s)
which is attached hereto, was published in MOUNT AIRY NEWS on the
listed below effective 45
days from the lublish
following dates:
date of this notice.
n
Written comments
mnoo(/Jt 11
r/� o
ardin the Proposed
g
permit will be accepted
until 30 days after the
Publish date of this no-
tice. All comments re-
ceived prior to that date
are considered in the fi-
nd that the said newspaper in which such notice, paper, document or
nal determinations re-
legal advertisement was published was, at the time of each and every
garding the proposed
permit. The Director of
such publication, a newspaper meeting all of the requirements and
the NC Division of Water
Quality may decide to
qualifications of Section 1-597 of the General Statutes of North Carolina
hold a public meeting for
and was a qualified newspaper within the meaning of Section 1-597 of
qg
the proposed permit.
should the Division re -
the General Statutes of North Carolina.
ceive a significant de-
gree of public interest.
This / day of �� fU I✓ i 2009
Copies of the draft permit
`
and other supporting in-
+
formation on file used to
determine conditicrs
present in the draft per -
mit are available upon
—
Signature of person making affidavit
request and payment of
Sworn to and subscribed before me, this IO day of
the costs of reproduction.
Mail comments and/or
FPbt(,eart/ 2009
requests for information
to the NC Division of Wa-
ter Quality at the above
address or call Dina
Sprinkle [phone]
Notary Public
at the Point Source
Branch. Please include
the NPDES permit num-
ber (below) in any com-
My Commission expires: November 27, 2012
municatiom Interested
persons may also visit
the Division of Water
Quality at 512 N. Salis-
bury Street, Raleigh, NC
Notary Public
27604-1148 between the
hours of 8:00 a.m.
ounty, North Carolina
F6MSVucomTl
and
5:00 P.M. to review infor-
Sandra F. Boles
oration on file,
mission Expires._,_

Aqua North Carolina, Inc.
(Town Lane, Mt. Airy,
North Carolina) has ap-
plied for renewal of
NPDES Permit
NCO088536 for the Ban-
nertown Hills Subdivision
Well #2 in Surry
County. This permitted
racihty discharges 1600
gallons per day of green -
sand filter backwash wa-
ter to ;in innamed tribu-
tary to Faulker Creek
witnin the Yadkin -Pee
Dee River Basin. Total
Suspended Solids (TSS)
and total residual chlo-
rine are currently water
quality limited. This dis-
charge may affect future
allocations r, this portion
of the Faulkner Creek.
Aqua North Carolina, Inc.
(Lois Lane, Mt. Airy,
North Carolina) has ap-
plied for renewal of
NPDES Permit
NCO088625 for the Hol-
lows Subdivision - Well
#1 in Surry County. This
permitted facility dis-
charges 2000 gallons per
day of greensand filter
backwash water to an
unnamed tributary to
Stewarts Creek within
the Yadkin -Pee Dee
River Basin. Total Sus-
pended Solids (TSS) and
total residual chlorine are
currently water quality
limited. This discharge
may affect future alloca-
tions in this portion of the
Stewarts Creek.
Aqua North Carolina, Inc.
(4163 Sinclair Street,
Denver, NC, 28037) has
applied for renewal of
NPDES permit
NC0088552 for the Colo-
nial Woods Subdivision
Well #2 in Surry County.
This permitted facility will
discharge treated filter
backwash to UT to Bull
Creek in the Yadkin -Pee
Dee River Basin. Cur-
rently total suspended
solids and total residual
chlorine are water quality
limited. This discharge
may affect future alloca-
tions in this portion of the
Yadkin -Pee Dee River
Basin.
Aqua North Carolina, Inc.
(4163 Sinclair Street,
Denver, NC, 28037) has
applied for renewal of
NPDES permit
NC0088528 for the Hill -
crest Subdivision Well #3
in Surry County. This
permitted facility will dis-
charge treated filter
beckwaah to UT t'
Champ Creek in the
Yadkin -Pee Dee River
Basin. Currently total
suspended solids and to-
tal res;dual chlorine are
water quality
This discharge may af-
fect future allocations in
this portion of the Yad-
kin -Pee Dee River Basin.
Aqua NC, Inc. (4163 Sin-
clair Street, Denver, NC,
28037) has applied for
renewal of NPDES per-
mit NCO088617 for the
Snow Hill Subdivision
Well #1 in Surry County.
This permitted facility
discharges 0.0026 N4GD
of treated wastewater to
an unnamed
tributary to Cody Creek
in the Yadkin -Pee Dee
River Basin. Currently
total residual chlorine is
water quality limited.
This discharge may af-
fect future allocations in
this portion of the Yad-
kin -Pee Dee River Basin.
Central Care, Inc. 1139
Apex Lane, Mount Airy,
NC, 270301 has applied
for renewal of permit
NCO038822 for its
WWTP in Surry County.
This permitted facility
discharges treated do-
mestic wastewater to an
unnamed tributary to
Stewarts Creek in the
Yadkin -Pee Dee River
Basin. Currently ammo-
nia nitrogen, fecal coli-
form and total residual
chlorine are water quality
limited. This discharge
may affect future alloca-
tions in this portion of
Stewarts Creek
Aqua North Carolina, Inc.
has applied for renewal
of NPDES permit, num-
ber NC0088633, for the
Reeves Woods Subdivi-
sion Well #2 WTP near
Mount Airy in Surry
r.n,inty. The.. facility dis-
charges filter backwash
water into an unnamed
tributary in the Yadkin
River Basin. The new
permit sets TSS, Total
Residual Chlorine, and
pH as water quality lim-
ited parameters. This
discharge may effect fu-
ture allocations in this
portion of the Yadkin
River Basin.
Publish: January 16,
Anna

Re: NCO038822 compliance problems
Subject: Re: NCO038822 compliance problems
From: Steve Tedder <[e-mail]>
Date: Mon, 01 Dec 2008 12:19:17 -0500
To: Charles Weaver <[e-mail]>, Sue White <[e-mail]>
CC: Gary Hudson <[e-mail]>, [e-mail]
Glad we can give Dean some business. Where was he when we re -issued Louisiana Pacific a couple
months back.
The first three are small facilities with not a bad history. If thats the best he can do then all is well.
Now Central Care is a different beast.
Septic tank single pass sand filter. was a 30/30 and we switched to 5/2 some time back.
Will never meat NH3 as designed. I hit them pretty hard last month and I think it sunk in. They have
had certification staff out for TA and have contacted three consultants to evaluate options. Looking at
some new technology for bugs as well as recirculating Sand filter and on site possibilities.
They would prefer to tie onto the city of Mount Airy but they are on the wrong side of US 74. They have
been hoping the city would run lines under the interstate, but that does not look like it will happen in the
near future.
Their history does look bad and they have been assessed about every month for the past two years. they
have paid them all.
Now that tie to city is out of the question, they know they will have to travel a different path. If they can
make a decision and have a timeline, I'd be willing to do SOC.
Tedder
Steve Tedder
[e-mail]
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336)-771-4950
Fax [phone]
On 12/1/2008 8:49 AM, Charles Weaver wrote:
The Yadkin RIVERKEEPERC is already complaining about some small discharges.
He demanded an extended comment period for NC0029599, NCO029602 and NC0058815. His
request was denied. I wouldn't be surprised if he challenges the final permits in court.
NCO038822 is ready to be sent to Public Notice, and he's sure to squeal in outrage about it.
Should I put any special conditions in the draft, given their continuuing problems?
Should they be considered for an SOC?
Let me know
I CHW
Steve Tedder <Steve.Tedder(a),NCmail.net>
WSRO
NC DENR
1
1 of 1 1/6/2009 7:17 AM

Permit Enforcement History
Permit: NC0038822
Region: Winston-Salem
Penalty
Assessment
Case Number Approved
Penalty
Amount
Facility: Central Care VWWP
County: Surry
Remission
Enforcement Request
Costs Damages Received
Owner: Central Care Inc
Enforcement Collection
Conference EMC Memo Sent
Held Hearing Held to AGO Total Paid Balance Due
Has
Payment
Plan
Case Closed
MV-1988-0005
01/01/88
No
05/06/88
MV-1988-0027
06/20/88
$300.00
$.00
$.00
$300.00
.00
No
07/18/88
LR-1990-0083
01/24/90
$150.00
$.00
$.00
$150.00
.00
No
03/30/90
LR-1990-0244
04/23/90
$300.00
$.00
$.00
$300.00
.00
No
07/14/90
LR-1990-0363
08/27/90
$600.00
$.00
$.00
$600.00
.00
No
11/06/90
LV-1991-0014
07/26/91
$6,000.00
$282.00
$.00
08/29/91
10/02/91 $1,649.01
4,632.99
No
11/06/93
LV-1999-0228
06/15/99
$1,750.00
$31.00
$.00
$1,781.00
.00
No
07/23/99
LM-1999-0073
11/01/99
$950.00
$52.00
$.00
$1,002.00
.00
No
05/25/00
LV-2002-0459
09/26/02
$1,000.00
$75.64
$1,075.64
.00
No
11/19/02
LV-2002-0624
12/09/02
$1,000.00
$76.00
$1,076.00
.00
No
01/21/03
LV-2003-0252
05/06/03
$250.00
$76.00
$326.00
.00
No
07/02/03
LV-2003-0405
05/23/03
$250.00
$86.00
$336.00
.00
No
07/02/03
LM-2004-0011
05/14/04
$400.00
$94.00
$494.00
.00
No
06/16/04
LM-2004-0036
08/20/04
$350.00
$94.00
$444.00
.00
No
09/16/04
LV-2004-0468
09/14/04
$250.00
$94.00
$344.00
.00
No
10/19/04
LV-2004-0504
10/08/04
$312.00
$94.00
$406.00
.00
No
12/16/04
LM-2004-0044
11/09/04
$437.50
$94.00
$531.50
.00
No
01/06/05
LV-2005-0017
01/10/05
$312.50
$94.00
$406.50
.00
No
02/28/05
RV-2005-0002
03/09/05
$500.00
$500.00
.00
No
05/05/05

Case Number
Penalty
Assessment
Approved
Penalty
Amount
Enforcement
Costs
Remission Enforcement Collection
Request Conference EMC Memo Sent
Damages Received Held Hearing Held to AGO
Total Paid
Balance Due
Has
Payment
Plan
Case Closed
LM-2005-0013
03/30/05
$525.00
$94.00
$619.00
.00
No
05/05/05
LV-2005-0255
07/28/05
$373.00
$94.00
$467.00
.00
No
08/24/05
LM-2005-0035
09/02/05
$525.00
$94.00
$619.00
.00
No
09/26/05
LM-2005-0041
09/27/05
$450.00
$94.00
$544.00
.00
No
10/20/05
LV-2005-0428
11/01/05
$375.00
$94.00
$469.00
.00
No
11/29/05
LV-2005-0455
11/29/05
$525.00
$94.00
$619.00
.00
No
12/29/05
LV-2006-0002
01/09/06
$525.00
$94.00
$619.00
.00
No
02/23/06
LV-2006-0042
02/20/06
$375.00
$94.00
$469.00
.00
No
04/25/06
LV-2006-0070
03/13/06
$375.00
$94.00
$469.00
.00
No
04/25/06
LM-2006-0016
04/06/06
$1,500.00
$94.00
$1,594.00
.00
No
04/25/06
LM-2006-0025
05/17/06
$600.00
$94.00
$694.00
.00
No
06/22/06
LM-2006-0029
06/01/06
$600.00
$94.00
$694.00
.00
No
09/14/06
LM-2006-0033
07/17/06
$800.00
$94.00
01/05/07
$894.00
.00
No
12/22/06
LM-2006-0039
08/07/06
$1,100.00
$102.00
01/05/07
$1,202.00
.00
No
12/22/06
LM-2006-0043
08/25/06
$800.00
$102.00
01/05/07
$902.00
.00
No
12/22/06
LV-2007-0021
01/16/07
$500.00
$102.00
$602.00
.00
No
01/31/07
LV-2007-0055
02/02/07
$500.00
$102.00
$602.00
.00
No
02/16/07
LV-2007-0093
03/02/07
$500.00
$102.00
$602.00
.00
No
03/30/07
LM-2007-0019
03/30/07
$900.00
$94.00
$.00
$994.00
.00
No
04/17/07
LM-2007-0024
04/30/07
$2,400.00
$102.00
$2,502.00
.00
No
08/20/07
LV-2007-0214
06/07/07
$1,900.00
$102.00
$2,002.00
.00
No
07/26/07
LV-2007-0258
06/29/07
$500.00
$102.00
$602.00
.00
No
07/26/07

Case Number
Penalty
Assessment
Approved
Penalty
Amount
Enforcement
Costs Damages
Remission Enforcement Collection
Request Conference EMC Memo Sent
Received Held Hearing Held to AGO
Total Paid
Balance Due
Has
Payment
Plan
Case Closed
LV-2007-0299
07/25/07
$700.00
$102.00
$802.00
.00
No
08/22/07
LV-2007-0358
09/05/07
$700.00
$102.00
11/15/07
$802.00
.00
No
01/03/08
LV-2007-0382
10/03/07
$700.00
$105.00
$805.00
.00
No
10/17/07
LV-2007-0464
12/05/07
$700.00
$105.00
$805.00
.00
No
01/03/08
LV-2007-0465
12/05/07
$700.00
$105.00
$805.00
.00
No
01/03/08
LV-2008-0016
01/10/08
$500.00
$105.00
$605.00
.00
No
02/15/08
LV-2008-0083
02/25/08
$500.00
$105.00
$605.00
.00
No
03/25/08
LV-2008-0103
03/17/08
$2,000.00
$105.00
$2,105.00
.00
No
04/22/08
LV-2008-0137
04/17/08
$500.00
$105.00
$605.00
.00
No
05/20/08
LV-2008-0169
05/08/08
$500.00
$105.00
$605.00
.00
No
06/20/08
LV-2008-0201
06/05/08
$500.00
$105.00
$605.00
.00
No
07/25/08
LV-2008-0249
07/18/08
$700.00
$105.00
$805.00
.00
No
08/25/08
LV-2008-0264
07/31/08
$1,400.00
$105.00
10/06/08
1,505.00
No
LV-2008-0328
08/28/08
$900.00
$105.00
1,005.00
No
LV-2008-0395
10/27/08
$3,200.00
$105.00
$3,305.00
.00
No
11/20/08
LV-2008-0438
11/25/08
$500.00
$105.00
605.00
No
Total Cases: 57
Total Penalties:
$46,460.00
$5,048.64
$51,508.64
43,760.66
Total Penalties after remission(s):
$7,747.99
$51,608.64

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SURFACE WATER PROT �

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 COQ,My �-
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
Facility Name
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
�r ► ,�MAI
2. Location of facility producing discharge: SEP 3 0 .2008
Check here if same address as above
Street Address or State Road nrNn \\/ATCD O1 IA 1 ITV
City POINT SO URCE H
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 ORQ
Name] e_� er�rcJh" c�,dr�1S a� L.a`Do rcr�or i �S
Mailing Address R iD. box. !A ri'3y ©\-Q 3,00f - 3. ,
City Viel'f)•2('k.
State / Zip Code G arl $t{
Telephone Number ('631Q) C1 Ci Lo-. 0g614
Fax Number (13w)
1 of 3 Form-D 05/08

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
Other ❑ Explain: �zy; ��/jt; rF 3 3
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): A J S + S L^ " ; .^ y �- r I + �
Population served: .3 J
5. Zlso:raxate
f collection system
=(sanitarysewer only) . T R❑ Combined (storm sewer and sanitary sewer)
6. Outfall Infoririation:`-
Number of separate discharge points
Outfall Identification number(s)
Is t ir,pVLt.ffL1L-equipped,-yit" TT
f er? ❑ Yes ❑ No
?. Nai3ziecsivizig strea�n((s)8 (Pii1vidk a map shouring the exact location of each outfall):
8. Frequency of Discharge: ❑ Continuous Id Intermittent
If intermittent:
Days per week discharge occurs: Duration:jo
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.
1" �� l (y�l� ���CO �(,( t-� 1�S• 1�y )K,� YN r S�IJ` 1� e�1. SGl•S �',` i �'C' T�r� t
I �
J�����j l c�_'��c,[�} L�r�tl,solO�J^ C'eV1� t��LC� pit UWnt
2 of 3 Form-D 05108

NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow e,, " MGD
Annual Average daily flow a 003 v MGD (for the previous 3 years)
Maximum daily flow o QV. C0 MGD (for the previous 3 years)
11. Is this facility located on Indiacn country?
❑ Yes Q/No
12. Effluent Data
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.
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
L4 5
3 C
Fecal Coliform
14 o
Total Suspended Solids
3
Temperature (Summer)
Temperature (Winter)
PH
���4-"i.G)r-
(.S,iA 11
13. List all permits, construction approvals and/or applications:
Type Permit Number. Type Permit Number
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NESHAPS (CAA)
Ocean Dumping (MPRSA)
%V C 0 G 2 mil- Dredge or fill (Section 404 or CWA)
Other
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.
Printed name of Person Signing Title
Signature of A
I—Ic,
Date
North Carolina General Statute 143-215.6 (b)(2) 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 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 05/08

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
Rnsie Tnfnrmation to determine potential for expedited permit renewal
Reviewer/Date
on1
Permit Number
G epo 3,8 SZ
Facility Name
T L- C44aF, n►c
Basin Name/Sub-basin number
023a le "
Receiving Stream
Ui 5TIW&Q-T
Stream Classification in Permit
G
Does permit need NH3 limits?
o h1 Trie►^a�
Does permit need TRC limits?
Ke-7 0A-5 t"
Does permit have toxicity testing?
O
Does permit have Special Conditions?
�!o
Does permit have instream monitoring?
Is the stream impaired (on 303(d) list)?
NO
Any obvious compliance concerns?
-r-ye Asr 7
Any permit mods since lastpen-nit?
Existing expiration date
2 28 0
New expiration date
2
New permit effective
Miscellaneous Comments
5o�v►E A -Sr eonaD�t�cE t�SuGy ^7 1�F4 tSSu.e'~i
YES V This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NH3,
name/ownership changes). Include conventional WTPs in this group.
YES_ This is a MORE COMPLEX EXPEDITED permit renewal (includes
Special Conditions (such as EAA, Wastewater Management Plan), 303(d)
listed, toxicity testing, instream monitoring, compliance concerns, phased
limits). Basin Coordinator to make case -by -case decision.
YES_ This permit CANNOT BE EXPEDITED for one of the following reasons:
• Major Facility (municipal/industrial)
• Minor Municipals with pretreatment program
• Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS,
etc)
• Limits based on reasonable potential analysis (metals, GW remediation organics)
• Permitted flow > 0.5 MGD (requires full Fact Sheet)
• Permits determined by Basin Coordinator to be outside expedited process
TB Version 8/18/2006 (NPDES Server/Current Versions/Expedited Fact Sheet)