NC0040070_Application_19810715

FPNORTH CAROLINA DEPT. OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT
P.O. BOX 27687, RALEIGH, NC 27611
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM APPLICATION NUMBER
APPLICATION FOR PEPMTT TO DISCHARGE - SHORT FORM D AGENCY
USE DATE RECEIVED
To be filed only by services, wholesale and retail trade,
and other commercial establishments including vessels YEAR MO. DAY
Do not attempt to complete this form without reading the accompanying instructions 1�
Please print or type
1. Name, address, and telephone number of facility producing discharge
A. Name Citia of Gastonia - Wa1-ar Treatment Far-;L, ty
B. Street address 313
C. City Gastonia D. Stated_
E. County
Gastonia F. ZIP 28052
G. Telephone No. 704 866-6827—
Area
Code
2. SIC
(Leave blank)
3. Number of employees
4. Nature of business
RECEIVED DEC 1 9'98'
16
Water Treatment Facilit
V5y ��
CI'Q'
3�3L 5 �aRt
5. (a) Check here if discharge occurs all year o , or
(b) Check the month(s) discharge occurs: -
1, o January 2. o February 3, o March 4. a April 5, o May
6, a June 7, o July 8. o August 9.o September 10. o October
11, a November. 12.0 December
(c) How many days per week:
1.131 2, o 2-3 3.0 4-5 4. 96-7
6. Types of waste water discharged to surface waters only (check as applicable)
Flow, gallons per operating day
Volume treated before
discharging (percent)
Discharge per
operating day
0.1-999
1000-4999
5000-9999
10,000-
49,999
50,000
or more
None
0.1-
29.9
30-
64.9
65-
94.9
9 -
100
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(B)
(9)
(10)
A. Sanitary, daily
average
B. Cooling water, etc.,
daily average
HX
C. Other discharge(s),
daily average;
Specify Alum q711dqe
X
D. Maximum per operat-
ing day for combined
discharge (all types)
PREVIOUS EDITION MAY BE USED

7. If any of the typeF of waste identified in item 6, either treated or un-
treated, are discharged to places other than surface waters, check below N/A
as applicable.
AVERAGE FLOW, GALLONS PER OPERATING DA-
Waste water is discharged to:
0.1-999
(1)
1000-4999
(2)
5000-9999
(3)
10,000-49,999
(4)
50,000 or more.
(5)
A. Municipal sewer system
b. Underground well
C. Septic tank
ti
U. Evaporation lagoon or pond
E. Other, specify:
8. Number of separate discharge points:
AJV 1 B. 02-3 C.o 4-5 D.Ll 6 or more
9. Name of receiving water or waters Long Creek — Tributary of South Fork River
10. 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: ammonia, cyanide, aluminum, beryllium, cadmium,
chromium, copper, lead, mercury, nickel, selenium, zinc, phenols, oil and
grease, and chlorine (residual).
A.X] yes B. o no
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.
E. G. Wilson
Printed Name of Person Signing
Director of Public Utilities
Title
7-13-81
Date Application Signed
.e6gy&6 r
Signature or Applicant
North Carolina General Statute 143-215.6(b)(2) 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 knowly 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 provide:
a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
411 14