NC0040070_Application_19771003

v'
NORTH CAROLINA DEPT. OF NATURAL & ECONOMIC RESOURCES
/ ENVIRONMENTAL MANAGEMENT COMMISSION
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM A
FOR
To be filed only by municipal wastewater dischargers AGENCY
USE
Do not attempt to complete this form before reading the accompanying instructions
Please print or type
1. Name of organization responsible for facility City of Gastonia
2. Address, location, and telephone number of facility producing discharge:
A. Name City of Gastonia Water Treatment Plant
APPLICATION NUMBER
W1010W4
DATE RECEIVED
771/
Q
YEAR MD. DAY
B. Mailing address:
1. Street address P. 0• Box 1748
2. City Gastonia 3. County Gaston
2
4. State North Carolina 5. ZIP 0 22
C. Location:
1. Street 313 North Fall Street
2. City Gastonia 3. County Gast : on
4. State North Carolina
0. Telephone No. 704 R64u3211 FY+. 281
Area v
Code
If all your waste is discharged into a publicly owned waste treatment facility and
to the best of your knowledge you are not required to obtain a discharge permit,
proceed to item 3. Otherwise proceed directly to item 4. r
3. If you meet the condition stated above, check here O and supply the information
asked for below. After completing these items, please complete the date, title, and
signature blocks below and return this form to the proper reviewing office without
completing the remainder of the form.
A. Name of organization responsible for receiving waste
B. Facility receiving waste:
1. Name
2. Street address
3. City 4. County
5. State 6. ZIP
4. Type of treatment:
A.0 None B. 0 Primary C. o Intermediate D.0 Secondary E.0 Advanced
5. Design flow (average daily) of facility mgd.
6. Percent BOD removal (actual):
A.0 0-29.9 B.0 30-64.9 C.0 65-84.9 D. 0 85-94.9 E.0 95 or more
7. Population served:
A.0 1-199 B.0 200-499 C.0 500-999 D.0 1,000-4,999
E. o 5,000-9,999 F. 0 10,000 or more
8. Number of separate discharge points:
A. o f B. o 2 C. o 3 D.0 4 E.0 5 F.0 6 or more

9. Description of waste water discharged to surface waters only (check as applicable).
-A
Flow, MGD (million gallons per operating day)
Discharge per _
operating day 0- 0,01- 0.05- 0.1- 0.5- 1.0- 5 or None
0,0099 0.Od9 0.099 0.49 0.99 4.9 f more
(1) J (2) i (3) (4) (5) (6) i (7) 1 (B)
Volume treated before
discharging (percent)
0.1- 35- 65- 95-
34.9 64.9 I 94.9 100
(9) (10) 1 (11) (12.)
A. Average X I.
7
B. Maximum ��� ) X It
10. 11 any --Wiste w,, ee, ^ranted nr untrnated. is discharged to Places other than
surface w�tors, check bFlnw an applicable. -1
Flow, MGD (million gallons Per operating day)
wait^ utter is ' 0-0.0m
discharcnrl to i
0,ol-O,n4Q
0.05-D,099
0.1-0.49 0.5-0.99 1.0-4.9 5 or more
(4) (5) (6) (7}
A. Deep well
--.—.—
C. Suhsur;°acr_ pQrcc:'ation >yr.t f4m�
D. Other, specify'
11. Ir; any 110de ultimately returned to a waterway? .
4.X yes 3.0no Alum sludge from settling basins plus filter wash water
12. a. Do you receive industrial waste?
1. r.. yes 2.39 no
b. if wes, enter nvDr•oximate number of industrial dischargers into system
13. Type of collection sewer syste^s:
4.z3 Seoar•ate sanitary
B.FxCombined sanitary and storm Sludge plus wash water goes into storm drain
C. ❑ Both separate and combined sewer systems
14. Name of receiving water or waters Tributary of Long Creek
15. Dees your discharge contain or is it possible for your discharge to contain
one or nx;re of the followinc substances: ammonia, cyanide, aluminum beryllium,
cadmium, chromium, copper. Lead, mercury, nickel, selenium, z- int�p�Pools.
4.3C yes B.O no
I certify that I am fanilinr with the information contained in the application and
that to the hest of my knowledge and belief such information is true, complete, and
accurate.
Donald E. Osborne
Printed Name of Person Signing
Chemist
Title
Sept. 22, 1977
Date Aoolication Signed
;igna.ur•e of Abplica t
rt_ Carolina General Statute 143-215.6(b)(2) provides that: Any person who knowingly makes
false statement representation, or certification in any application, record, report, plan,...,,
,other document files or required to be maintained under Article 21 or regulations of the
ronmental Management Commission implementing that Article, or who falsifies, tampers with
or ,
renders inaccurate any recording or monitoring device or method required to be
ted or maintained under Article 21 or regulations of the Environmental Management Commission
beating that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed
or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides
ent by a fine of not more than 810,000 or imprisonment not more than 5 years, or both,
milar offense.)