NC0042439_Renewal (Application)_20231018

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ROY COOPER Governorli
ELIZABETH S.BISER �� °
Secretary -»; v,,,..er'f
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
October 18, 2023
Westside Swim & Racquet Club
Attn: Timothy Smith, President
PO Box 895
Salisbury, NC 28145
Subject: Permit Renewal
Application No. NC0042439
Westside Swim & Racquet Club
Rowan County
Dear Applicant:
The Water Quality Permitting Section acknowledges the October 18, 2023, receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
ictlitc63
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Madelyn Mills-Envirolink, Inc
ec: WQPS Laserfiche File w/application
D E North Carolina Department of Environmental Quality Division of Water Resources
Mooresville Regional Office 610 East Center Avenue.Suite 301 Mooresville.North Carolina 28115
�� ^ter► 704.663.1699

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
Form NC Department of Environmental Quality-Application for NPDES Permit to Discharge Wastewater
MINOR SEWAGE FACILITIES(Before completing this form,please read the instructions.Failure to follow
NPDES the instructions may result in denial of the application.
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and (9))
1.1 Facility name
Westside Swim&Racquet Club
Mailing address(street or P.O.box)
P.O.Box 895
City or town State ZIP code
o Salisbury NC 28145
Contact name(first and last) Title Phone number Email address
Laura Shaffer [phone] [e-mail]
Location address(street, route number,or other specific identifier) ❑ Same as mailing address
630 Neel Road
w
City or town State ZIP code
Salisbury NC 28145
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑ No 4 SKIP to Item 1.4.
Applicant name
Madelyn Mills,Envirolink,Inc.
a Applicant address(street or P.O.box)
773 Sanford Avenue
City or town State ZIP code
Mocksville NC 27028
co Contact name(first and last) Title Phone number Email address
T Madelyn Mills Compliance Coordinator [phone] [e-mail]
1.4 Is the applicant the facility's owner.operator,or both?(Check only one response.)
❑ Owner ❑✓ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
Facility and applicant
❑✓ Facility ❑ Applicant ❑ (they are one and the same)
1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
NC0042439
o ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
rn
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑ Other(specify)
404)
Page 1

North Carolina
Department of Environmental Quality Modified Application Form 2A
Division of Water Resources Revised March 2021
Modified Application
Form 2A
Minor Sewage Facilities < 0. 1 MGD
and No Pretreatment Program
NPDES Permitting Program
RECEIVED
u C r 0 6
NCDEQ/DWR/NP2023DES
Note: Complete this form if your facility is a MINOR new or existing publicly owned treatment works.

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
N/A 250 100 %separate sanitary sewer 0 Own 0 Maintain
Z %combined storm and sanitary sewer 0 Own 0 Maintain
a) 0 Unknown 0 Own 0 Maintain
co %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own 0 Maintain
0 Unknown 0 Own 0 Maintain
a %separate sanitary sewer 0 Own 0 Maintain
c %combined storm and sanitary sewer 0 Own 0 Maintain
'° ❑ Unknown 0 Own 0 Maintain
E %separate sanitary sewer 0 Own 0 Maintain
rn %combined storm and sanitary sewer 0 Own 0 Maintain
c ❑ Unknown 0 Own ❑ Maintain
'0. Total 250
d Population
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of
sewer line(in miles) 100 o°
C
1.8 Is the treatment works located in Indian Country?
o ❑ Yes 0 No
U
0 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
0 ❑ Yes 0 No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
0.003 mgd
= Annual Average Flow Rates(Actual)
a R Two Years Ago Last Year This Year
C• o 0 mgd 0 mgd 0 mgd
7 " Maximum Daily Flow Rates(Actual)
a Two Years Ago Last Year This Year
° mgd 0 mgd ° mgd
w 1.11 Provide the total number of effluent discharge points to waters of the State of North Carolina by type.
.o Total Number of Effluent Discharge Points by Type
0 cD
Q• " Combined Sewer Constructed
FT T Treated Effluent Untreated Effluent Overflows Bypasses Emergency
co 0 -0 Overflows
3
1 1
'-'age 2
,

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
Outfalls Other Than to Waters of the State of North Carolina
1.12 Does the POTW discharge wastewater to basins,ponds,or other surface impoundments that do not have outlets
for discharge to waters of the State of North Carolina?
❑ Yes El No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface
Impoundment (check one)
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
0 Continuous
gpd 0 Intermittent
y 1.14 Is wastewater applied to land?
❑ Yes No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
0 Land Application Site and Discharge Data
Continuous or
Location Size Average Daily Volume Intermittent
a, Applied (check one)
acres gpd 0 Continuous
o 0 Intermittent
acres d ❑ Continuous
ij gp 0 Intermittent
acresgpd 0 Continuous
0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
❑✓ Yes ❑ No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
The wastewater treatment facility serving the Westside Swim&Racquet Club is a seasonal facility that only operates in
the summer months.As solids accumulate,they are periodically pumped by a local septic tank company. This process
takes place one to two times annually.
1.18 Is the effluent transported by a party other than the applicant?
E Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
Myers Septic Service 1882 Briggs Rd
City or town State ZIP code
Salisbury NC 28147
Contact name(first and last) Title
Shelby Office Administrator
Phone number Email address
[phone] [e-mail]
Page 3

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
-p Facility name Mailing address(street or P.O. box)
N/A-NO DISCHARGE
= City or town State ZIP code
C
o N/A-NO DISCHARGE
U
Contact name(first and last) Title
o N/A-NO DISCHARGE
d Phone number Email address
QNPDES number of receiving facility(if any) ID None Average daily flow rate mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do
8 not have outlets to waters of the State of North Carolina(e.g.,underground percolation,underground injection)?
a)
s ❑ Yes ❑ No-4 SKIP to Item 1.23.
U
0 1.22 Provide information in the table below on these other disposal methods.
cu Information on Other Disposal Methods
oDisposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
❑ Continuous
acres gpd ❑ Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acres gpd 0 Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
Cl) Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
ca
❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
a-
0) Section 301(h)) 302(b)(2))
❑ Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
✓❑ Yes ❑ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name) Envirolink,Inc.
Mailing address
773 Sanford Avenue
(street or P.O.box)
o City,state, and ZIP
code Mocksville, NC,27028
O Contact name(first and Madelyn Mills,Envirolink,Inc.
c.) last)
Phone number [phone]
Email address [e-mail]
Operational and Conduct visits 5x/weekly and
maintenance complete routine reporting
responsibilities of
contractor
Page 4

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and (2))
o Outfalls to Waters of the State of North Carolina
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
.00
❑ Yes ✓❑ No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
o gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
N/A
0
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
� specific requirements.)
0)
0
0 ❑✓ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o (See instructions for specific requirements.)
a,
II co
❑✓ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes El No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1.
E
C)
2.
E
0
3.
C'
Co
4.
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2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
2 Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
1.
-a
cn
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
Page 5

r— NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number o01 Outfall Number Outfall Number
State North Carolina
is
County Rowan
O City or town Salisbury
Distance from shore ft. ft. ft.Q
Depth below surface ft. ft. ft.
a)
Average daily flow rate o mgd mgd mgd
Latitude 35° 40' 06" N
Longitude 80° 33' 41" W
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o El Yes ❑ No 4 SKIP to Item 3.4.
c
ti 3.3 If so, provide the following information for each applicable outfall.
L
cn Outfall Number Outfall Number Outfall Number
Number of times per year
g discharge occurs
o Average duration of each
discharge(specify units)
oAverage flow of each mgd mgd mgd
discharge
coMonths in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
0-
Outfall Number Outfall Number _ Outfall Number
d
CO
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the State of North Carolina from
d one or more discharge points?
Y ❑ Yes r❑ No 4SKIP to Section 6.
Page 6

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
3.7 Provide the receivingwater and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Draft Branch
Name of watershed, river,
0 or stream system Yadkin Pee-Dee River Basin
0- U.S.Soil Conservation
•L
Service 14-digit watershed
o code
Name of state
management/river basin
rn
U.S.Geological Survey
8-digit hydrologic
ce cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number Outfall Number Outfall Number
Highest Level of 0 Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
O Secondary 0 Secondary 0 Secondary
❑ Advanced 0 Advanced 0 Advanced
O Other(specify) 0 Other(specify) 0 Other(specify)
0
0. Design Removal Rates by
Outfall
N
BOD5 or CBOD5
TSS
❑ Not applicable 0 Not applicable 0 Not applicable
Phosphorus
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
ok
Page 7

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below.
0
U
o Outfall Number Outfall Number Outfall Number
Disinfection type
N
0
c Seasons used
Dechlorination used? ❑ Not applicable E Not applicable ❑ Not applicable
❑ Yes ❑ Yes ❑ Yes
❑ No ❑ No ❑ No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
❑ Yes 2 No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number_ Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water
Number of tests of receiving
C, water
d
w
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑ Yes 4 Complete Table B, including chlorine. r❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑ Yes El No
Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
3.18 attached the results to this application package?
❑ Yes 0 No additional sampling required by NPDES
permitting authority.
Page 8

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
❑ Yes ❑ No+ Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑ Yes ❑✓ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MMIDDIYYYY)
v
m
w 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
❑ Yes ❑ No 4 SKIP to Item 3.26.
Ts'
3.23 Describe the cause(s)of the toxicity:
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w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 9 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑ Yes ❑ Not applicable because previously submitted
information to the NPDES .ermittin. authorit .
Page 9

NPDES Permit Number Facility Name Modified Application Form 2A
NC0042439 WESTSIDE SWIM&RACQUET Modified March 2021
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below, mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
▪ Section 1: Basic Application
Information for All Applicants ❑ wl variance request(s) ❑ w/additional attachments
❑ Section 2:Additional El w/topographic map 0 wl process flow diagram
r
Information ❑ w/additional attachments
❑ w/Table A ❑ w/Table D
❑ Section 3:Information on ❑ w/Table B ❑ wl additional attachments
• Effluent Discharges
❑ wl Table C
Section 4:Not Applicable
0
Section 5:Not Applicable
Section 6:Checklist and
U)
El Certification Statement ❑ w/attachments
6.2 Certification Statement
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information,the information submitted is,to the best of my knowledge and belief, true,accurate,and
complete.lam aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Madelyn Mills,Envirolink,Inc. Compliance Coordinator
Signature Date signed
09/26/2023
Page 10
1