NC0074233_Application_20200415

NPDES APPLICATION FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mail the complete application to:
N. C. DENR / Division of Water Resources / NPDES Program
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit 000074233
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
Catawba County Schools
Facility Name
Blackburn Elementary
Mailing Address
PO BOX 1010
City
Newton
State / Zip Code
NC/28658
Telephone Number
[phone]
Fax Number
[phone]
e-mail Address
[e-mail]
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road 4377 West NC 10 Highway
City Newton
State / Zip Code NC/28658
County Catawba
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 ORQ
Name Catawba County Schools
Mailing Address PO Box 1010
City Newton
State / Zip Code NC/28658
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1 of 4 Form-D 9/2013

NPDES 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 applyft
Industrial
❑
Number of Employees
Commercial
❑
Number of Employees
Residential
❑
Number of Homes
School
®
Number of Students/Staff 560/68
Other
❑
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Elementary School
Number of persons served: 628
5. 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) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfallp.
Potts Creek
S. Frequency of Discharge: ❑ Continuous ® Intermittent
If intermittent:
Days per week discharge occurs: 5 Duration: 10 minutes each time
9. Describe the treatment system
List all installed components, including capacities, 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.
We have a sand filter system that uses a timer to dose the entire surface of the filter
intermittently with wastewater. This system draws oxygen from the atmosphere through
the sand medium area. Physical, chemical and biological processes are ways the effluent
is treated within the system. The treatment occurs through the bacteria that colonize in
the sand grains of the sand filter system. The microorganisms use the organic matter in
the effluent for growth and reproduction to help continually maintain the system
properly.
2 of 4 Form-D 9/2013

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
3of4
Form-D 912013

. .-
NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.015 MGD
Annual Average daily flow 0.000052 MGD (for the previous 3 years)
Maximum daily flow 0.0006 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes ® No
12. Effluent Data
NEW APPLICANTS: 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. If more than one analysis is reported,
report daily maximum and monthly average. If only one analysis is reported, report as daily maximum.
RENEWAL APPLICANTS: Provide the highest single reading (Daily Maximum) and Monthly Average over
the past 36 months for parameters curre tty in your permit. Mark other parameters "SIT/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODs)
28.9
27.15
mg/ L
Fecal Coliform
250
164.5
ml
Total Suspended Solids
31
20.4
mg/ L
Temperature (Summer)
25.9
23.67
°C
Temperature (Winter)
20.1
17.9
°C
pH
7.6
N/A
S.U.
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES NCO074233
PSD (CAA)
Non -attainment program (CAA)
14. APPLICANT CERTIFICATION
NESHAPS (CAA)
Ocean Dumping (MPRSA)
Dredge or fill (Section 404 or CWA)
Other
Permit Number
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.
MorM C. Williams Health & Environmental Coordinator
Printed name of Person Signing Title
Morgan C. Williams 4-15-2020
Signature of Applicant Date
North Carolina General Statute 143-215.6 (b)(2) states: 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 $25,000, 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 $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
4 of 4 Form-D 9/2013