NC0044199_Renewal (Application)_20150804

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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 f NC0044199
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 Sam's Mart, Inc.
Facility Name Sam's Mart #45
Mailing Address 7935 Council PI, Suite 200
City Matthews RECEIVED/DENR/MR
State / Zip Code NC 28105 AUG 0 4 2015
Telephone Number 701-I 990- 3G12
Wdler Qudiity
Fax Number -704 U — t-+ D5 - 'GOO Permitting Section
e-mail Address ,ty,e pSe e5 a rn Siena 41 rC. Gvn,L
2. Location of facility producing discharge:
Check here if same address as above El
Street Address or State Road 3360 Crab Tree Road @NC Highway 209
City Waynesville
State / Zip Code NC
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 Sam's Mart, Inc.
Mailing Address 7935 Council PI, Suite 200
City Matthews
State / Zip Code NC 28105
Telephone Number 70C4--q40
Fax Number 704- LOS -8640
e-mail Address (`OSGe, Sams h',a✓ef1n • Cork
1 of 3 Form-D 11/12

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 X Number of Employees
Residential Number of Homes
School- -of-Students-/-Staff---- - -- - ----- - ---- -
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Restaurant,bathrooms,showers
Number of persons served:
5. Type of collection system
X Separate (sanitary sewer only) ❑ 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? ❑ Yes X No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfalls
Pigeon River
8. Frequency of Discharge: X 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.
A 0.015 MGD extended aeration facility with two modular grease interceptor units,
influent lift station, manual bar screen, aeration basin with dual blowers providing
diffused air, clarifier with skimmer and sludge return
2 of 3 Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.015 MOD
Annual Average daily flow .0008 MGD (for the previous 3 years)
Maximum daily flow 0.0028 MOD (for the previous 3 years)
----1-1.-Is this facility located-on-Indian-country?.---- - - -- - ------------ —
❑ Yes R 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) 43.7 31.5 MG/L
Fecal Coliform NA NA CFU/100ML
Total Suspended Solids 54.3 27.9 MG/L
Temperature (Summer) 26.3 25.3 C
Temperature (Winter) 17.4 14.2 C
pH 7.9 7.4 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 NC0044199 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.
se\abP.61' m. go 5e., Jr- E►-,vtrmnh,\e-vthq l Vel BnOf .e.e
Printed name of Person Signing Title
R40/t4 VIA Rtle , 5/1/1 c
Signature of Applicant 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 11112

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��� �♦ James & James Environmental Management, Inc.
44 �1r�®�j' 3801 Asheville Hwy.,Hendersonville,N. C. 28791
Y;:JOy 4 I OFFICE: [phone] FAX: [phone]
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:
Sludge from this facility (Sam's Mart#45 WWTP NC0044199 is pumped by Mike's Septic Tank
Service and is permitted to be dumped at Brevard Waste Treatment System and MSD.
Sincerely
l
Juanita Jakes
James and James Environmental Mgt., Inc.
[e-mail]

//fir
4'4 `._4 ��� James & James Environmental Management, Inc.
I. -�1r%$'O1 3801 Asheville Hwy.,Hendersonville,N.C. 28791
f �-� �ri>/� OFFICE:[phone] FAX: [phone]
`lie
RECEIVED/DENR/DWR
N. C. Department of Environment and Natural Resources AUG 0 4 2015
Division of Water Quality/NPDES Unit
1617 Mail Service Center Water Quality
Raleigh, N. C. 27699-1617 Permitting Section
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 Sam's Mart
#45 WWTP, NPDES number NC0044199.
Sincerely
( g1/424/V-(6
#r),
Juanita James
James and James Environmental Mgt., Inc.
[e-mail]

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
August 5,2015
Robert M.Rose,Jr.
Sam's Mart,Inc.
Sam's Mart#45
7935 Council Pl., Suite 200
Matthews,NC 28105
Subject: Acknowledgement of Permit Renewal
Permit NC0044199
Haywood County
Dear Permittee:
The NPDES Unit received your permit renewal application on August 04, 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 Joe
Corporon at(919)807-6394.
Sincerely,
Wre.&,114.eo(fo-rat
Wren Thedford
Wastewater Branch
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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 Opportunity Affirmative Acton Employer