NC0086959_Permit Issuance_20030908

AV
*A
:= -
Mr. Eddie Coltrain
Northwestern Wayne Sanitary District
P.O. Box 1583
Goldsboro, North Carolina 27533
Dear Mr. Coltrain:
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
September 8, 2003
Subject: Issuance of NPDES Permit NC0086959
Memorial Church Road WTP
Wayne 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 May 9, 1994 (or as subsequently amended).
This final permit includes one major change from the draft permit sent to you on July 16, 2003:
➢ The monitoring frequencies for Total Nitrogen (TN), TN components and Total Phosphorus have been reduced to
semi-annually, based on your request dated August 18, 2003.
This reduction in sampling frequency makes it imperative that representative samples are collected. Collect the
TN and TP samples on days when flow is monitored.
• Data from the semi-annual samples wi0 be used to calculate the 'IN load for the facility. The Permittee should
maintain accurate estimates of the total discharge each month (total monthly flow, or TMF). The TMF values
will be multiplied by the TN values for the semi-annual samples to calculate a TN load for the facility.
This permit includes a TRC limit that will take effect on April 1, 2005. If you wish to install dechlorination equipment,
the Division has promulgated a simplified approval process for such projects. Guidance for approval of dechlorination projects
is attached.
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 [phone], extension 511.
Sincerely,
ORIGINAL SIGNED BY
061
TOMFV. mk k, P.E.
cc: Central Files
Washington Regional Office/Water Quality Section
NPDES Unit
N. C. Division of Water Quality / NPDES Unit Phone:[phone]
1617 Mail Service Center, Raleigh, NC 27699-1617 fax: [phone]
Internet: h2o.encstate.nc.us DENR Customer Service Center. 1 800 623-7748

Permit NCO086959
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, the
Northwestern Wayne Sanitary District
is hereby authorized to discharge wastewater from a facility located at the
Memorial Church Road WTP
NCSR 1342 at NC Highway 581
Wayne County
to receiving waters designated as Great Swamp in the Neuse 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 October 1, 2003.
This permit and authorization to discharge shall expire at midnight on January 31, 2008.
Signed this day September 8, 2003.
ORIGINAL SIGNED BY
Tom Belnick
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0086959
SUPPLEMENT TO PERMIT COVER SHEET
All preyicros N I'UI:S PCI'I111tS issued to this facility, whether for operation or discharge arc hcrcbt rcyc►ked. A, O
this permit i•suancc, any preyiousiV issued permit hcaring this number is no longer effective. 'Therefore, the
esclusire authority to operate and discharge from this facility arises under the permit ccinditions, reyuircments,
turns, and provisions InCludcd herein.
The Northwestern Wayne Sanitary District is hereby authorized to:
1. Continue to operate a drinking -water treatment plant with a discharge of filter -
backwash wastewater. This facility is located at the Memorial Church Road WTP
off NCSR 1342 at NC Highway 581 in Wayne County.
2. Discharge from said treatment works at the location specified on the attached
map into Great Swamp, classified C-Swamp NSW waters in the Neuse River
Basin.

57
A
:'Cem
rf so-)
)y
Jr
Gyms,
134
q
Al
A
2,&
Aycock 13
147
C3 j. ----------
13
4�
N
Qutfa11140L�11-
e,"il-
t
-W
L\
RI
130
V�
14.1
VA.
Cem::
It it
5
a M
1'. 34"
Cem
Ketnorid
C;h
C
7-XibmOnal',
-1
341
Te f.T a Punten-
-W
149
N
%
14
0
1541 mon Grove U
t56
N.,., (Cem-
;Cern
Memorial Church Road WTP Facility
Northwestern Wayne Sanitary district Location x not to scale
Latitude: 35" 33' 06- N State Grid/Ouad: Kenly East. N.C.
Loneitude: 77' 03' 10** W Permitted Flow. Not Limited
Receivina Stream: Great S,.%amp River Basin: Neuse River Basin No rthPDES Permit NCO086959
Stream Class: C-Swamp NSW Sub -Basin: 03-04-07 T] L---� Wayne County

Permit NCOO86959
cp4f ?-i
0-.1
W -:?
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 filler backwash from outfall 001. Such dischai;es shall be limited and monitored by
the Permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIMITS
MONITORING REQUIREMENTS
Monthly
Daily
Maximum
Measurement
Frequency
Sample Type
Sample Location'
Flow
c9. O 3
G
9
-Estimate_
V;JL 9
Effluent
s
Total Suspended Solids
30.0 m
. mg/L
2/Month
Grab
Effluent
Settlenhe
Effluent
Iron
y
Grab
Effluent
Total Residual Chlorine2
17 Ng/L
Weeklyr
Grab
Effluent
Tuflsidity-'
Weekly
Grab
m rea
Total Monthly Flow 4
Monitor & Report
milliongallons/month)
Monthly
Calculated
Effluent
Total Nitrogen (TN) 4
Monitor & Report (mg/L)
Semi-annually
Grab
Effluent
Nitrate/Nitrite Nitrogen^
(NO2 + NO3)
Monitor & Report (mg/L)
Semi-annually
Grab
Effluent
Total Kjeldahl Nitrogen (TKN)4
Monitor & Report (mg/L)
Semi-annually
Grab
Effluent
TN load (pounds/month)'
Monitor & Report
ounds er month)
Monthly
Calculated
Effluent
TN load (pounds/year)'
Monitor & Report
(pounds per ear
Annually
Calculated
Effluent
Total Phosphorus
Monitor & Report (mg/L)
Semi-annually
Grab
Effluent
Footnotes: (t`Y► mfti
J
1. Upstream = at least 50 feet upstream from the outfall. Downstream = at least 50 feet downstream from the
outfall.
2. Limit takes effect April 1, 2005. Limits and monitoring apply only if chlorinated water is used to backwash
filters.
3. The discharge from this facility shall not cause turbidity in the receiving stream to exceed 50 NTU. If the
instream turbidity exceeds 50 NTU due to natural background conditions, the discharge cannot cause
turbidity to increase in the receiving stream.
y4. See A. (�2)) for Total Nitrogen monitoring and reporting requirements.
"All samples co11V shod uld be from a representative discharge event.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
Add. ! .J.>�„a ribcrt.�

Permit NC0086959
A. (2) CALCULATION OF TOTAL NITROGEN LOADS
a. The Permittee shall calculate monthly and annual TN Loads as follows:
i. Monthly TN Load (pounds/month) = TN x TMF x 8.34
where:
TN = TN concentration (mg/L) of the sample collected during the semi-annual monitoring event. Use the
TN value for the month in which the sample was taken and successive months until another TN
sample is collected.
TMF = Total Monthly Flow of wastewater discharged during the month (MG/month). If all discharges are not
recorded at the facility, document the calculation(s) used to determine total monthly flow.
8.34 = conversion factor, from (mg/L x MG) to pounds
ii. Annual TN Load (pounds/year) = Sum of the 12 Monthly TN Loads for the
calendar year
b. The Permittee shall report the semi-annual Total Nitrogen results in the discharge
monitoring report (DMR) for that month. The calculated pounds of TN load per month
will be reported on each month's DMR. The Permittee shall report each year's annual
results (pounds per year) on the December DMR.

NORTHWESTERN WAYNE SANITARY DISTRICT
P.O. Box 1583
Goldsboro, N.C. 27533
[phone]
_, eevitwty iv1116e T
August 18, 2003
— �I/6 /�%usc 155Ue5 �r
Charles Weaver, Jr. Moz 5,0461 /, —)"s
NPDES Permit Unit
NC Division of Water Quality
1617 Mail Service Center /Ve 5tA/­f,14y41 AM1 ly�
Raleigh, NC 27699-1617 C, 7-AI17P
SUBJECT: Monitoring Requirements
Draft NPDES Permit No. NCO086959
Northwestern Wayne Sanitary District
Wayne County, NC
Dear Mr. Weaver:
Monitoring requirements for nutrients appear excessive in subject draft NPDES Permit inasmuch
as the effluent is treated filter backwash from a potable water treatment plant with groundwater
supply. Numerous wells are in the area with a history of data indicating low nitrogen levels (see
attached sample reports). There are no additives involving nitrogen in the water treatment process.
A polyphosphate is added in the treatment process (maintained less than 1 mg/1) and is monitored
daily with field test kits. A written record of phosphate levels is maintained by the Sanitary District.
Inasmuch as nitrogen is present only at low background levels it is recommended the frequency
be revised to once per year. More frequent monitoring of phosphorous maybe justified due to the
addition of phosphate in the treatment process; however, semi-annual sampling of phosphorous is
believed adequate since daily sampling and records are maintained for the addition of phosphate.
Your consideration and approval of this request will be appreciated. If you have any questions,
please do not hesitate to contact me.
Sincerely,
NORTHWESTERN WAYNE SANITARY DISTRICT
Eddie Coltrain
District Manager
Attachments
cc: McDavid Associates, Goldsboro (w/attach)
\\G-PCI\D805\FrL\2003\NWWMREQ.LTR 1
NW WSD-MONITORING-REQ-NPDES. LTR 030818

Aug 18 03 03:18p McDRVID RSSOCIRTES, INC. 919-735-7351 p.3
NORTHWESTERN WAYNE SANITARY DISTRICT
P.O. Box 1583
Goldsboro, N.C. 27533
[phone]
August 18, 2003
Charles Weaver, Jr.
NPDES Permit Unit
NC Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
SUBJECT: Monitoring Requirements
Draft NPDES Permit No. NCO086959
Northwestern Wayne Sanitary District
Wayne County, NC
Dear Mr. Weaver:
Monitoring requirements for nutrients appear excessive in subject draft NPDES Permit inasmuch
as the effluent is treated filter backwash from a potable water treatment plant with groundwater
supply. Numerous wells are in the area with a history of data indicating low nitrogen levels (see
attached sample reports). There are no additives involving nitrogen in the water treatment process.
A polyphosphate is added in the treatment process (maintained less than 1 mg/1) and is monitored
daily with field test kits. A written record of phosphate levels is maintained by the Sanitary District.
Inasmuch as nitrogen is present only at low background levels it is recommended the frequency
be revised to once per year. More frequent monitoring of phosphorous maybe justified due to the
addition of phosphate in the treatment process; however, semi-annual sampling of phosphorous is
believed adequate since daily sampling and records are maintained for the addition of phosphate.
Your consideration and approval of this request will be appreciated. If you have any questions,
please do not hesitate to contact me.
Sincerely,
NORTHWESTERN WAYNE SANITARY DISTRICT
&Zir/
Eddie Coltrain
District Manager
Attachments
cc: McDavid Associates, Goldsboro (w;attach)
\\G-PCI%DBOS%TL\2003\N WwT7REQ.LTR
NWWSD+10Nrr0RING REQ NPD11S.LTR
03(la 18
1

NORTH CAROLINA
WAYNE COUNTY.
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State,
duly commissioned, qualified, and authorized by law to administer oaths,
personally appeared
Cynthia Foye
who being first duly sworn, deposes and says: that he (she) is
Legal Clerk
(Publisher, or other officer or employee authorized to make affidavit)
of WAYNE PRINTING COMPANY, INC., engaged in the publication of
a newspaper known as GOLDSBORO NEWS-ARGUS; published,
issued, and entered as second class mail in the city of Goldsboro in said
County and State; that he (she) is authorized to make this affidavit and
sworn statement; that the notice or other legal advertisement, a true
copy of which is attached hereto, was published in GOLDSBORO
NEWS-ARGUS on the following dates:
2003
and that the said newspaper in which such notice, paper, document, or
legal advertisement was published was, at the time of each, and every
such publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
This 31 day of July 2003
&#ignature of person m6king affidavit)
Sworn to and subscribed before me, this 31 day of
July _ 20 03
My Commission expires:
CLIPPING OF LEGAL
ADVERTISEMENT
ATTACHED HERE
PUBLIC NONCE
STATE OF NORTH CAROLINA
ENVIRONMENTAL
MANAGEMENT
COMMISSION/NPOES UNIT
1617 MAIL SERVICE CENTER
RALEIGH, HC 27699-1617
NOTIFICATION OF INTENT TO
On the basis at thorough stun
review and application of NC
General Statute 143.21, Public
law.92-500 and other lawful
standards and regulations, the
North Carolina Environmental
Management Commission pro-
poses to issue National Pollu-
tant Discharge Elimination Sys-
tem (NPDES) wastewater dis-
charge permit to the persan(s)
listed below effective 45 days
from the publish date of this
notice.
Written comments regarding
the proposed permit will be ac-
cepted until 30 days after the
publish date of this notice. All
comments received prior to
that date are considered in the
final determinations regarding
the proposed permit. The Dlmc-
to,of Water
mwlwhmav decideDivisiomo hold a
Copies of the draft permit and
othersuppordng lnformatlon on
file used to determine Can tlI-I
dons present in the draN permit
are available upon request and
payment of me casts of rep ro-
ductIon. all comments and/or
requests for information to the
NC Division of Water 0ualiry a
the above address or call a.
Valery Stephens at 1919) 733-
50a3, evtensbn 520. Please in-
clude the NPOES permit num-
her lattechedl In any communi-
urs at 5:00 am.
to review infor
,astern we ne
t has applled for
NPOES permit
rr its memorial
Great
or,
aM.
chi,
ad.
valor to an unnamuu u­,
0 the NIUS6 River in the Neuse
Basin.liver
,idua hlorieCurrently
water oquality
limited. This Discharge may a -
feet poreoo ofrthe lHeuer Rivec 1Dcations in this
Legal 9095
July 21, 2003

Invoices/permit status
From: Charles \Veaver <Charlc s.A\'eavcr a)neniail.net> 8:21 AM
Subject: Invoices( permit scatus
To: F ran McPherson <'raaNlcPhcrson tt ncmail.nct>, Robert I armer <Robert Iarmcr (Of ncmail.net>
CC: Dave Goodnch <Dave.GoodnchQncnuil.net>, Mike Templeton <Mike.Tenipleton®ncmail.net>
Fran - I received a call from Landis Davis, the contact for permit
NC0086967. He received an annual fee invoice for the permit; he wishes
to return the invoice because the Wayne County government has decided
not to use that facility. He will return that invoice.
He also said that no invoice had yet been received for permit
NC0086959. I told him that the billing month may not have been reached
yet, but that I would let you know. That permit will remain active, so
if the annual fee is due please send an invoice to the permittee.
Robert - when the invoice for NCO086967 is returned we can use it to
start the rescission process.
Dave/Mike - this is FYI, as these are both Neuse facilities... and both
assigned to me.
CHW
1 of 1 6/25/2003 8:25 AM

Printer Information
Serial Number: USBK141567
Formatter Number: JA32KX
Firmware Datecode: 19961220 v9 7
Processor Revision: 29040 E40d
Page Count: 123110
Pages Since Last Power Cycle: 0
Pages Since Last Maintenance: 123110
Installed Personalities and Options
PCL (19961220)
POSTSCRIPT (19960724)
• Adobe. PostScript. and the PostScript Logo are trademarks of Adobe
Systems Incorporated ehieh may be registered in certain jurisdictions.
SIMM Slot 1: Empty
SIMM Slot 2: Empty
SIMM Slot 3: 8 MByte RAM SIMM
SIMM Slot 4: 1 MByte ROM SIMM
Error Log
Number of Entries in Use: 50
Maximum Number of Entries: 50
Last Three Entries:
Number Error Page Count
50 42.06.01 123111
49 13.01.02 123111
48 42.06.01 123110
HP MIO 1
HP JETOIRECT
J255M IPX/SPX STATUS: INITIALIZING
SNIP SET CMTY WE:
NONE
FIMAAE REVISION:
A.08.32 TRYING TO CONNECT TO
SERVER
— ----
-
LAN NJ ADDRESS: 0060B0374155 NODE: QUEUE
SERVER
TCP/IP STATUS
READY
PORT SELECT:
RJ45 NODE MANE:
MFG 10: 3704XXXXXX0503 NO NPOES 5SINX
I/O CARD READY
'IPX/SPX RETPANS:
0
HOST WE:
NOT
SPECIFIED
NETWORK FRANE TYPE
RCVO
CONFIG BY:
USER
SPECIFIED
99580208 EN 802.3
6B
IP ADDRESS:
149.168.123.82
UNKNOWN IN_802.2
2
SUBMIT MASK:
255.255.255.0
NETWORK STATISTICS
DEF. GATEWAY:
149.16B.123.1
UNICAST PACKETS RCVD:
ld----------------------
SYSLOG SERVER:
NOT
SPECIFIED
TOTAL PACKETS RCVD:
96 APPIETPLK STATUS: INITTAL
I27NG
TO E TIMEOUT (SECOIDs): 120
BAD PACKETS RCVD:
0 ETALK NET: 65281 NODE:
130 P2
FRAMING ERRORS RCVD:
0 LTALK NET: 0 RODE:
181
PACKETS TRANSMITTED:
54 APPLETALK WE:
U16ENDABLE PACKETS:
0
------------
MMIT COLLISIONS:
0 ETALK ZONE:
!OLC/LLC STATUS:
READY
XMIT LATE COLLISIONS:
0
Memory
Total Memory: 12 MBytes
Available Memory: 8.9 MBytes
I/O Buffering:
0 KBytes Allocated of 100 KBytes Available
Resource Saving:
Not Enabled - Need: 1 MBytes More Memory
Security
Control Panel Lock: DISABLED
Control Panel Password: DISABLED
Paper Handling Options
None
HP MIO 2
Not Installed

4
SOC PRIORITY PROJECT: YES_NO_X_
IF YES, SOC NO
To: Permits and Engineering Unit
Water Quality Section
Attn: Charles Weaver
Date: August 19, 2002
NPDES STAFF REPORT AND RECOMMENDATION
Northwestern Wayne Sanitary District
Memorial Church Road Water Treatment Plant
Permit No. NCO086959
PART I — GENERAL INFORMATION
1. Facility and Address: Northwestern Wayne Sanitary District
Memorial Church Road Water Treatment Plant
Wayne County
P.O.Box 1583
Goldsboro, NC 27533
2. Date of Investigation: July 31, 2002
3. Report Prepared by: Kristin Jarman
4. Person(s) contacted and telephone number(s):
Joey Threewitts - Operations Manager
919-731-2310
5.
9
7
1)JI
0
.; EP - 4 2002 �l
DEi;R - WATER QUALITY
HINT SOVC,E FRANCA
Directions to Site: Located on the West side of NC Hwy 581 at its intersection
with SR 1342
Discharge Point:
001-- Latitude: 35' 33' 06" N Longitude: 78°03'10" W
Attach a USGS map extract and indicate treatment facility site and discharge
point on map.
USGS Quad. No.
USGS Quad Name: Kenley East
Site size and expansion area consistent with application?
X_ Yes No If No, explain:

8. Topography (relationship to flood plain Included) : Flat with elevation of approx.
140 feet
9. Location of nearest dwelling: Approximately 200 feet
10. Receiving stream or affected surface waters: Great Swamp
a. Classification: C-SWP-NSW
b. River Basin and Subbasin No.: 03-04-07
C. Describe receiving stream features and pertinent downstream uses:
Drainage, fishing
PART II —DESCRIPTION OF DISCARGE AND TREATMENT WORKS
l . a. Volume of Wastewater to be permitted: NA
b. What is the current permitted capacity of the Wastewater Treatment
facility? NA
C. Actual treatment capacity of the current facility (current design capacity)?
NA
d. Date(s) and construction activities allowed by previous Authorizations to
Construct issued in the previous two years: NA
e. Please provide a description of existing or substantially constructed
wastewater treatment facilities: NA (Bids are in)
f. Please provide a description of proposed wastewater treatment facilities:
40' x 40' (67,000 gallon) concrete settling basin
g. Possible toxic impacts to surface waters: Chlorine
h. Pretreatment Program (POTWs only): NA
2. Residuals handling and utilization/disposal scheme:
a. If residuals are being land applied, please specify DWQ permit
no.
Residuals Contractor
Telephone No.
b. Residuals stabilization: PSRP PFRP Other
C. Landfill: x
d. Other disposal/utilization scheme (Specify):
Treatment plant classification (attach completed rating sheet): Grade 1

4. SIC Code: 4941
Wastewater Code of actual wastewater, not particular facilities.
001-- Primary_22_ Secondary
Main Treatment Unit Code: 5 0 0 1
PART III —OTHER PERTINTENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are any public
monies involved? (municipals only) No
2. Special monitoring or limitations (including toxicity) requests: NA
Additional effluent limits requested: None
4. Other: None
PART IV —EVALUATION AND RECOMMENDATION
This proposed discharge will result from the backwash of filters for iron removal.
Softeners are not proposed therefore chlorides are not expected to be a problem The
Washington Regional Office recommends that this permit be reissued at the same
location.
oSigna of Rep
h- /,k::. 5;�
,;—Water Quality Regional Supervisor
x 9�zz-
Date

NORTHWESTERN WAYNE SANITARY DISTRICT
P.O. Box 1583
Goldsboro, N.C. 27533
[phone]
June 27, 2002
Mr. Charles H. Weaver, Jr.
NPDES Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
r2 2002
D
ER QUALITY
POINT SOURCE BRANCH
SUBJECT: Request for Permit Renewal
NPDES Permit NC 0086959
Northwestern Wayne Sanitary District
Wayne County, NC
Dear Mr. Weaver:
Attached please find one signed original and two copies of each of the following:
1. Cover Letter
2. Application Form
Wastewater discharged via this Permit is backwash and rinse water from water filters treating
potable water. Solids retained (iron residual) are anticipated to be removed on an annual basis (less
than 3000 Ibs) and be transported to the Wayne County landfill for disposal.
If you have any questions concerning this, please do not hesitate to contact me.
Sincerely,
NORTHWESTERN WAYNE SANITARY DISTRICT
Eddie Coltrain
District Manager
\\G-PC 1\D805\FTL\2002
NW WSD•DWQ-NPDES-PERMIT-RENEWAL.wpd
020627

1
NPDES PERNUT APPLICATION - SHORT FORM C
For manufacturing or commercial facilities with a discharge < 1 MGD (or WTPs)
N. C. Department of Environment and Natural Resources
Division of Water Quality 1 NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
North Carolina NPDES Permit Number NC00 '86959
Please print or type
1. Applicant and facility producing discharge
A. Name Northwestern Wayne Sanitary District
B. Mailing address of applicant:
Street address P..• 0. Box 1583
City Goldsboro , County Wayne
State NC Zip Code 27533
Telephone Number (919 ) 731=23310
Fax Number (919 ) 734-5994
e-mail address N/A
C. LocatIon of facility:
Street .. Memorial Church Road WTP
City Fremont County Wayne
State NC Zip Code 27533
Telephone Number ( ) N/A
2. Standard Industrial Classification (SIC) code(s):
3. Number of employees: 15
4. Principal product(s) produced: Potable water
Principal.raw material(s) consumed: Groundwater
5. Principal process(es): Potable water system
S. Qrnour't of ;+rinr:i;+24.pmd.tict produced or raw material consumed
11 [at ananifir% am' manta nnnciimpd andlnr units of nrnductionl
Product Produced or Raw Material Consumed
AVERAGE
Product Produced or Raw Material Consumed
PEAK
per Day
1 00 0 GPD
per Month
per Year
7. Check here if discharge occurs all year RX , or
Circle the month(s) in which discharge occurs: January February March April
May June July August September October November December
Days per week discharge occurs: 7 days /week
NOTE: If the facility has separate discharge points (outfalls) or multiple industrial processes, include a schematic diagram
of wastewater flow at the facility.
Page 1 of 2 Version-1112OW

NPDES PERMIT APPLICATION - SHORT FORM C
For manufacturing or commercial facilities with a discharge <1 MGD (or WTPs)
8. Types of wastewater discharged to surface waters only (check as applicable). ,
Discharge per operating day
Flow
Volume treated before discharging
GALLONS PER OPERATING DAY
(PERCENT).
Sanitary - daily average
,
Cooling water, etc. - daily average
-
N/A
Process water - daily average
-
.
33,000 GPD
Maximum per operating day for
total discharge (all types)
66 000 GPD
9. If any of the types of wastewater identified in item 8 (either treated or untreated) are discharged to places
other than surface waters, record the amount(s) discharged below:
A.
Municipal sewer system
and
B.
Underground well
and
C.
Septic tank
qpd
D.
Evaporation lagoon or pond
and
E.
Other, specify
and
10. Number of separate discharge points: 1
11. Name of receiving stream(s): Great Swamp
Sanitary wastewater disposed
on —site via septic system
12. Does your discharge contain or is it possible for your discharge to contain one or more of the following
substances added as a result of your operations, activities, or processes? Circle all that apply:
aluminum ammonia beryllium cadmium chromium chlorine (residual
copper cyanide lead mercury nickel oil and grease
' phenols selenium zinc None of the above
1 certify that 1 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.
Eddie Coltrain District Manager
Printed name of Person Signing Title*
Signature of Applicant
Date
North Carolina General Statute 143-215.6E (i) provides that: 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 $10,000, 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 $10,000 or imprisonment not more than 5 years, or both, for a similar offense.)
Page 2 of 2 Version —f 112000