NC0088765_Permit Issuance_20090108

=n
N—CD ENR
Wayne Smith
51 Bridge Street, #B
Sylva, NC 28779
Dear Mr. Smith,
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 8, 2009
Coleen H. Sullins, Director
Division of Water Quality
Subject: Issuance of NPDES Permit NCO088765
Tinsletown RV Park
Jackson 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 October 22, 2008.
The Division recommends that you consider ultraviolet (UV) disinfection for your facility. Chlorine can be
acutely toxic to aquatic organisms and forms secondary compounds that can also be detrimental to aquatic life. UV
disinfection would reduce the chemical load in your facility's effluent and reduce risks to aquatic life instream.
The Division also recommends that the plant will be equipped with emergency generators to operate all
critical pans of the plant during the power outage. The dumping of recreational vehicle holding tanks that contain
formaldehyde or other toxic compounds should be prohibited.
If any pans, 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 pemrit 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 Sergei Chemikov at telephone number
[phone].
Sincere4, �04
Jen H. Sullins
cc: NPDES Permit File ;
Central Files
Asheville Regional Office / Surface Water Protection
Mark Brooks, P.E., Brooks Engineering Associates, PA,
17 Arlington Street, Asheville, NC 28801
N. C. Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Internet: h2o.encstate.nc.us
Phone: [phone]
fax: [phone]
DENR Customer Service Center: 1 800 623-7748

Permit NCO088765
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PFRMTT
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,
Wayne Smith
is hereby authorized to discharge wastewater from a facility located at the
Tinseltown RV Park
80 Wllmont Road
Sylva
Jackson County
to receiving waters designated as Tuckasegee River in Little Tennessee 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 February 1, 2009.
This permit and authorization to discharge shall expire at midnight on November 30, 2012.
Signed this day January 8, 2009.
f4-- Z��K.
'V- Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO088765
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.
Wayne Smith is hereby authorized to:
1. After receiving an Authorization to Construct permit from the Division,
construct wastewater treatment facilities not to exceed 0.0042 MGD design
now.
2. After submitting an Engineer's Certification, operate 0.0042 MGD package
plant located on Wilmont Rd. at Tinseltown RV Park in Jackson County
and discharge from said treatment works at the location specified on the
attached map into Tuckasegee River, a class B water in the Little
Tennessee River Basin.

Latitude:35°24'12" Tinselt:own RV
Longitude: 83°197' WW1 P
Receiving Stream: Tuckasegee River
Stream Class: B NCO08876
Subbasin: 040402
Jackson Coui
Facility
Location
orth

Permit NCO088765
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
During the period beginning upon completion of the construction of WWTP 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 f
MohthN Average
Daily Maximum
Measurement
Fr uenc
Sample Type
Sample Locatlon
;
Flow
0.0042 MGD
Weekly
Instantaneous
Influent or Effluent
BOD, 5-day (20°C)
30.0 mg/L
45.0 mg/L
Weekly
Grab
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg1L
Weekly
Grab
Effluent
Fecal Coliform
(geometric mean
200/100 mL
400/100 mL
Weekly
Grab
Effluent
Total Residual Chlorine
RC '
28 Ng/L
2/Week
Grab
Effluent
Temperature (T)
Weekly
Grab
Effluent
pH
> 6.0 and < 9.0 standard units
Weekly
Grab
Effluent
Footnotes:
1. Limit and monitoring applies only if chlorine is added for disinfection. The Permittee
shall report all effluent TRC values reported by a NC -certified laboratory [including
field -certified]. 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`IM
' STATEO!~NOF"-CAROLINA.� L,
1617=.MAILSERVICE'CENT
�",, ,}'FIALEIGH; NC�27899-i61i
NOTIMATIM ONNTENT'
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effecti!t52d�ys from the publish
''date;o�t�is}riotit:e
,', �r�Wri_ cotptnenss regarding the,
p 'scd 1tWil.be accepted un-
tittays�r the publish date -of
'tills notice ��Al) commentsrecelyed
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'at the Nlnt Source,Branah.
ncluds the NPDES 'permit
(below) in any dOmMunlea
terested persons; may also
'Division of Water Quality"'at
allsbury � Street; Ratelgh, NC -
48 between the hours of 8:00
5:00 p 61; to leview jnforma-
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3 Smith (51•_84dgd:Sbeet, #Bi;
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led for a modification
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p�r<dthe wastewatea
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NORTH CAROLINA
Jackson 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 .......... A...,.xe ........... ...........
who is first duly sworn, deposes and says: that he -she is
.................................................•.....................�� ` ...........................
(Owner, partner, publisher, or other officer or employee authorized to make this affidavit)
of The Sylva Herald and Ruralite, engaged in the publication of a
newspaper known as The Sylva Herald and Ruralite published,
issued, and entered as second class mail in the Town of Sylva, 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 The Sylva
Herald and Ruralite on the following dates;
..........................a�......3 6)r............... ...................................
•
........................................................................................................
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 ................•.. day of ..........................................✓ I .....�:.orJr......
.,$� '45L
....................................................................................:..... ... .. .
(Signature of person making affidavit)
.� �;
Sworn to anal_su� t e before me, is ' / ................. ......../..... ,.
dayof .......�v� ..
. / IE
.... .... ... ... ..... etic............ ...............
N tiCounty, North cBmllm
My CO—MMb" Exp1ms =ebrwq 7413
My Commission expires: .................... 'e". . . ..........................

DENR/DWQ
FACT SHEET FOR NPDES PERMIT DEVELOPMENT
NPDES No. NCO088765
Facility Information
Applicant/Facility Name:
Wayne Smith/Tinsehown RV Park
Applicant Address:
51 Bride Street #B, S lva, North Carolina 286779
Facility Address:
80 Wilmont Rd., S lva, North Carolina 28779
Permitted Flow:
0.0042 MGD
Type of Waste:
100% Domestic.
Other Permit(s):
N/A
Facility / Permit Status:
Class II / New
County:
I Jackson County
BACKGROUND:
Tinseltown RV Park WWTP is a proposed Class 11, 100% domestic wastewater treatment system
that treats waste from an RV Park with 42 RV spaces. The EAA for this facility has been
approved on September 10, 2008. Effluent limitations are based on Level B model conducted on
September 30, 2008.
PROPOSED SCHEDULE FOR PERMIT ISSUANCE
Draft Permit to Public Notice: October 22, 2008 (est.)
Permit Scheduled to Issue: December 18, 2008 (est.)
NPDES CONTACT:
If you have questions regarding any of the above information or On the attached permit, please
contact Sergei Chemikov at [phone]. (j/y
REGIONAL OFFICE COMMENTS:
ARO did not object to the proposed project.
Fact Sheet
NPDES NCO0331 I 1 Renewal
Page 1

Pidiii Ad
® North Carolina Wildlife Resources Commission KN
Gordon Myers, Executive Director
November 18, 2008
Mr. Sergei Chemikov
Division of Water Quality, NPDES Program
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SUBJECT: Mr. Wayne Smith, Tinsletown RV Park
NPDES Permit No. NCO088765
Jackson County
Dear Mr. Chemikov:
Biologists with the North Carolina Wildlife Resources Commission (Commission) reviewed the notice
about the proposed NPDES permit for Mr. Wayne Smith. This permit would allow the discharge of 4,200
gallons per day of treated wastewater from the Tinsletown RV Park into the Tuckasegee River in Jackson
County. Comments from the Commission on this proposal are provided under provisions of the Fish and
Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d), North Carolina General
Statutes (G.S. 113-131 et seq.), and the North Carolina Administrative Code 15A NCAC 101.0102.
The Tuckasegee River is designated an Aquatic Significant Natural Heritage Area of national significance
because of numerous rare aquatic species. It supports the federally endangered Appalachian elktoe
mussel (Alasmidonta raveneliana) and other rare species like the olive darter (Percina squamata, FSC,
NC -SC). However, water quality in the river is deteriorating because of sedimentation and other non -
point and point pollution sources. The river was recently added to the 303d List because of elevated fecal
coliform contamination.
The river has ample assimilative capacity for the proposed wastewater treatment plant (W WTP)
discharge. However, the Commission is concerned that operational upsets would eventually harm rare
aquatic species. Small package plants, as presumably proposed at the Tinseltown RV Park, are
susceptible to treatment efficiency problems because of irregular loading.
Mussel declines have occurred downstream WWTPs, most notably below the Franklin WWTP on the
Little Tennessee River in Macon County and more recently below the Burnsville W WTP on the Cane
Mailing Address: Division of Inland Fisheries • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]

NC 0088765 Page 2 November 18, 2008
Jackson County
River in Yancey County. Chlorine is acutely toxic to aquatic life and freshwater mussels are extremely
sensitive to ammonia. Therefore, ultraviolet light or ozone systems are recommended instead of chlorine
and de -chlorination systems. Ambient concentrations in the range of 0.3 to 1.0 mg/L total ammonia as N
at pH 8 do not appear toxic to freshwater mussels (Augspurger et al. 2003). WWTPs should employ
technology that achieves these low ammonia concentrations.
Because of sensitive aquatic life in the receiving stream, the Commission recommends that alternatives to
surface water disposal be evaluated before issuing a permit. Land application may be possible depending
in part upon land availability and soil suitability. Another option, possibly in the near future, would be
connection with an existing collection system like the Whittier Sanitary District, which was approved in
2001. The Whittier Sanitary District may extend close to the Tinseltown RV Park or extensions may
already be anticipated.
If the NPDES permit is issued, then the Commission recommends that it be conditioned as follows to help
protect sensitive aquatic resources in the river:
1. Ultraviolet light will be used for disinfection of effluent instead of chlorine.
2. The dumping of recreational vehicle holding tanks that contain formaldehyde or other toxic
compounds, which can harm treatment efficiency, will be prohibited. A quality assurance system
needs to be developed to prevent violation of this condition.
3. The treatment plant will be equipped with emergency generators to operate all critical parts of the
plant during a power outage.
4. The permittee will contact Commission representatives and the U.S. Fish and Wildlife Service in
Asheville immediately in the event that treatment problems arise. This would facilitate our
assessment of any aquatic resource damages, assist the Division of Water Quality with remedial
actions, and help assure the safety of our field staff who routinely survey the Tuckasegee River.
Contact information has been or will soon be provided to Mr. Roger Edwards with the Division
of Water Quality's Asheville Office.
5. The facility will connect with a central waste collection system should service become available.
The Commission also wishes to take this opportunity to remind the Division of Water Quality of the need
for a site specific management strategy for the Tuckasegee River watershed as required by 15A NCAC
02B .0110. This rule, which became effective on August 1, 2001, requires the development of strategies
for maintaining water quality in watersheds that harbor federally -listed aquatic species. The strategy for
the Tuckasegee River was supposed to be finished in March 2007, which is when the first full 5-year
basin planning cycle was completed after rule implementation. Specific mitigative measures for new
NPDES discharges in the Tuckaseegee River should be addressed in such a strategy.
Thank you for the opportunity to review and comment on this permit action. If there are any questions
regarding these comments, please contact me at [phone] extension 24.

NC 0088765 Page 3
Jackson County
Sincerely,
-;,//g .
Dave McHenry
Mountain Region Coordinator, Habitat Conservation Program
ec: Allen Ratzlaff, USFWS
Angie Rodgers, Natural Heritage Program
References:
November 18, 2008
Augspurger, T., A. E. Keller, M. C. Black, W. G. Cope, and F. J. Dwyer (2003) Water quality guidance
for protection of freshwater mussels (Unionidae) from ammonia exposure. Environmental
Toxicology and Chemistry 22:2569-2575.

STAFF REPORT
TO: Sergei Chernikov
FROM: Roy Davis 0-1.�
DATE: September 4, 2008
SUBJECT: NPDES Permit Application
Tinseltown RV Park
Wastewater Treatment Plant
Jackson County
lf1 SEP 8 2008 L'
1
v; Try r•.7M.ITY
On May 27, 2008 1 looked at the piece of property in Jackson County proposed
for development as the Tinseltown RV Park. The proposed receiving stream is
the Tuckaseigee River. I know of no reason we should not issue the requested
permit. Neither am I aware of any special conditions that should be made a part
of any permit we issue.
I will call your attention to the presence of the elk toe mussel, a federally listed
endangered species, in the Tuckaseigee River below the project site. Also be
aware that segments of the Tuckaseigee River in the project area appear on the
Draft 2008 303(d) list for fecal coliform impairment.
G:\WPDATA\DEMWQ\Jackson\Tinseltown RV Park Staff Report.08.doc

Tinseltown RV Park
Tuckasegee River Class B 040402
Proposed 100% domestic wastewater discharge in the Tuckasegee River.
Design capacity is 0.0042 MGD
Estimated hydrologic info at proposed discharge point
DA —372 mil
QA-856 cfs
Summer 7Q 10 —210.6 cfs
Winter 7Q10 —251.8 cfs
30Q2-376.4 cfs
Predicted IWC 0.003 %
Level B model results (can't print model at this time !)
2 reaches, with no runoff flow included, slope of 12.5 fpm
Reach 2 has trib flow from Bumgarner Branch at head waters
Began with inputs for secondary treatment BOD5 = 30 mg/l, assume eff NH3 of 20 mg/l
CBOD=45 mg/l and NBOD= 90 mg/l, no eff DO limit included
Model results: predicted DO min = 7.72 mg/l at milepoint 0.0
End CBOD =1.95 mg/l
End NBOD = 0.98 mg/l
End DO = 8.20 mg/l
Recommendation:
Summer and winter limits of 0/30 protect instream DO standard.
Effluent DO limit is not need
Effluent NH3 limits not needed.

MODEL INPUTS FOR LEVEL B ANALYSIS
GENERAL INFORMATION
Facility Name: „ /st ✓ IV A
l —
NPDES No.:
Type of Waste:
6C, X cl,"I
Facility Status:
,, osr r,C
Receiving Stream:
u-A./sc
Stream Classification:
Subbasin:
LT/✓0 Z
z
County:
;I#- ck/wl
Regional Office:
A100
Topo Quad:
FSn/Gr
FLOW INFORMATION
USGS #
Date of Flow Estimates:
Drainage Area (m0):
372-ini 7'
Summer 7Q10 (cfs):
r a/o, b ctr
Winter 7Q10 (cfs):
Average Flow (cfs):
r b c>r
30Q2 (cfs):
/' ?76, ycfj
IWC at Point of Discharge RW:
Cummulative IWC (%):
MEMEMEMENINNISM
MODEL INPUT INFORMATION
LENGTH OF REACH (miles) O• %�/'ib i
/, r
INCREMENTAL LENGTH (miles)
WASTE CHARACTERISTICS
FLOW (MGD)
pp Y.7
CBOD (mg/1)
NBOD (mg/1)
D.O. (mg/1)
RUNOFF CHARACTERISTICS
7Q10 (cfs/mf2)
QA (cfs/mil)
CBOD (mg/1)
NBOD (mg/1)
D.O. (mg/1)
TRIBUTARY CHARACTERISTICS /3✓n ✓a/ 8/� w% 06. /,tr n,
7Q1 O (cfs)
QA (cfs)
CBOD (mg/1)
NBOD (mg/1)
D.O. (mg/1)
SLOPE (fpm)
IR'Llk,
ST M
Name of facility

hopes leaV 1.4
,& A,-� -=
O.d 69W-Z
OVP W13w
Oid

Tinseltown RV Park
Residual Chlorine Ammonia as NH3
(summer)
7Q10 (CFS)
210.6
7Q10 (CFS)
210.6
DESIGN FLOW (MGD)
0.0042
DESIGN FLOW (MGD)
0.0042
DESIGN FLOW (CFS)
0.00651
DESIGN FLOW (CFS)
0.00651
STREAM STD (UG/L)
17.0
STREAM STD (MG/L)
1.0
UPS BACKGROUND LEVEL (t
0
UPS BACKGROUND LEVEL
0.22
IWC (%)
0.0031
IWC (%)
0.00
Allowable Concentration (ugi
549970.92
Allowable Concentration (m
25234.18
Ammonia as NH3
(winter)
7Q10 (CFS)
261.8
Fecal Limit 2001100mi DESIGN FLOW (MGD)
0.0042
Ratio of 32350.2 :1 DESIGN FLOW (CFS)
0.00651
STREAM STD (MG/L)
1.8
UPS BACKGROUND LEVEL
0.22
IWC (%)
0.00
Allowable Concentration (m
61114.55
9/30/2008

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Facility: Tinseltown RV Park
NPDES#:
Receiving Stream: Tuckasegee River
Comment(s):
Low Flow Record Station Number.
Hydrologic Area Number.
Drainage Area Low Flow Record Station:
Qave Low Flow Record Station:
s7Q10 Low Flow Record Station:
w7Q10 Low Flow Record Station:
30Q2 Low Flow Record Station:
03.5105.0000
HA10
347
763.40 cfs
198.00 cfs
236.00 cfs
353.00 cfs
must be < 400 sq. miles
Drainage Area New Site:
372
MAR New Site:
2.3
Qave per Report Equation:
856 cfs
s7Q10 per Report Equation:
141.88 cfs
w7Q10 per Report Equation:
201.53 cfs
30Q2 per Report Equation:
294.33 cfs
Continue
Drainage Area Ratio: 1.07 :1
[ new DA / Da at gage Continue
Weighted Ratio: 0.98 :1
Over -ride Inappropriate Site ( y ):
Drainage Area New Site:
372
MAR New Site:
2.3
Weighted Qave per Report Equation:
856 cfs
Weighted s7Q10 per Report Equation:
210.57 cfs
Weighted w7Q10 per Report Equation:
261.77 cfs
Weighted 30Q2 per Report Equation:
376.41 cfs

BROOKS
En ineeri
As ociatee
Land Planning Civil Engineering Surveying Environmental Services
August, 18 2007
North Carolina DENR
Department of Water Quality
NPDES Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Attention: Ms. LeToya Fields
Regarding: NPDES Permit Application
Tinseltown RV Park
Jackson County, NC
Dear Ms. LeToya Fields:
Brooks Engineering Associates is pleased to present the enclosed NPDES Permit
Application on behalf of Wayne Smith.
Enclosed are the following items:
■ NPDES Application Form D;
■ A check for the $860 application fee;
■ Engineering Alternative Analysis which includes:
o a site map showing the discharge location;
o flow information from the USGS office in Raleigh; and
o local government review form (as an Attachment).
17 WiirgOon Street
Asheville, INC 28801
P: 828.232.4700
F. 828.2.32.1331
We trust that this application package is complete. However, please contact us (828)
232-4700 if additional information is required. We look forward to working with the
NPDES Unit on this permit application.
Sincerely,
Brooks Engineering Associates, PA
Mark C. Brooks, P.E.

• NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
• Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit NC00
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
Wayne Smith
Facility Name
Tinseltown RV Park
Mailing Address
51 Bridge Street #B
City
Sylva
State / Zip Code
NC/ 28779
Telephone Number
[phone]
Fax Number
( )
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 80 Wilmont Rd
City Sylva
State / Zip Code NC/ 28779
County Jackson
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 Wayne Smith
Mailing Address 51 Bridge Street #B
City Sylva
State / Zip Code NC/ 28779
Telephone Number [phone]
Fax Number ( )
1 of 4 Farm-D 1/06

NPDEB 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 applyr
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
❑
Number of Students/ Staff
Other
®
Explain: RV Park
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Tinseltown RV Park willhave 42 RV spaces that are anticipated to be rented on a daily, weekly, or
monthly basis. The design flow is calculated based on 100 gpd per RV space so the design flow is
4,200 gallons per day
Population served: = 2.5 x 42 = 105
S. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) to be assigned
Is the outfall equipped with a diffuser? ❑ Yes ❑ No
7. Name of receiving stream(s) (Provide a map shouring the exact location of each outfallj:
The receiving stream is the Tuckasegee River. The discharge location is shown on Figure 2 of
the EAA. The discharge location is N 35o 24' 11.9801, W 83o 19' 17.27"
S. Frequency of Discharge: ® Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
9. Describe the treatment system
List all installed components, including capacity, 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.
The proposed treatment technology is a recirculating media filtration unit designed to treat 4,200
gallons per day. The proposed plant is an EZ Treat"m system in which septic tank effluent is
dosed approximately 36 times a day over a high surface area synthetic media for aerobic
biodegradation. The system has a dual treatment train to allow for duplicity in the system and
provide backup treatment in an emergency situation. The system will be equipped with W
disinfection in anticipation of secondary discharge limits being required. Should tighter
discharge limits be required, a different treatment plant technology may be selected. Anticipated
discharge limits are to be designed to meet or exceed monthly average limits of 30 mg/1 five day
BOD, 30 mg/1 TSS,15 mg/l Ammonia, and 200 cfu/ 100 ml fecal coliform.
2 of 4 Form-D 1 /06

9
NPDES APPLICATION - FORM D
For privately owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.0042 MGD
Annual Average daily flow MGD (for the previous 3 years)
Maximum daily flow MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® 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. Effluent testing data must be based on at least three samples
and must be no more than four and one half years old.
Parameter
Daily
Maximum
Monthly
Averse
Units of
Measurement
Number of
Samples
Biochemical Oxygen Demand
(BOD5)
Fecal Coliform
Total Suspended Solids
Temperature (Summer)
Temperature (Winter)
pH
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Special Order of Consent (SOC)
Other
Permit Number
3 of 4 Form-D 1106

r/M C)/ 1I9 LV VV 1. 1y ..... .. .•.• v/v� •• i
• . NPDFB APPLICATION - FORM D
For privately owned treatment systeme treating 100% domestic waetewatere <1.0 MOD
14. APPLICANT CERTIFICATION
I cerft that I am familiar with the information 'contained in the application and that to the
beat of my knowledge and belief such information is true, complete, and accurate.
VMth= smith t 1 t'l a Manager
Printed.=me of Person Signing Title .. ._
Signffure of Applicant bate
North Carolina General &atnte 143-215.6 (b)(2) states: Any person who knowingly melees any false stalamnt
representation, or cation in any a -- record, reps, per, or other dccwnwt Mw or requhvd to be
maintained udder ArMe 21 or regalatiens of the Surlroamentat Mmanwent Commf adore hadmenting that Awe, or
who falst[fee, tmpers wlth, or lmowl� render in=urae any recordiisg or monitoring device ar method mptrod to be
operated or maintained under Article 21 ar regulatiana of the Fnvkorunenwl Mausgemect Comniisaion implemcnting
that Article, shall be guilty of a m#sdemeenor puniahhable by a fine not to exceed $25,000, or by impdootment not to
cured nix months, or by both. (18 U.S.C. SeWou 1001 provides a punishment by a fine of not more th= $25,000 or
imprisonment not more then 5 years, or both, for a simffar offeftm)
4014
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AUG 2 5 2008
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Form-D iM
08-15-2008 13:14 PAGES