NC0069892_Renewal (Application)_20230315

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Mail the complete application to:
N. C. Department of Environment and Natural Resour
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit Number INCOO6
If you are completing this form in computer use the TAB key or the up - dou j lri�iieLr-',ES
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 Ac lru)-n,
Facility Name ►1� w 7 2
Mailing Address �+ Sui to is
City A•ndc ! , r
State / Zip Code NC- J ?9U
Telephone Number (� ) f •_ 12 1,
Fax Number ( )
e-mail Address m e_ k' i L o= yj t-n 6w
2. Location of facility producing discharge:
Check here if same as above ❑ /y
Street Address or State Road �����(d'� Cd-
City
State / Zip Code
County
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name / 5WN Dr' I7LA6-i✓s
Mailing Address 101Q,
City n EW
State / Zip Code NC 2f?O
Telephone Number (gag) 39
Fax Number ( )
4. Ownership Status:
Federal ❑ State ❑ Private ❑ Public_�
Page 1 of 4 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
5. Type of treatment plant:
Conventional (Includes coagulation, flocculation, and sedimentation, usually followed by
filtration and disinfection)
❑ Ion Exchange (Sodium Cycle Cationic ion exchange)
❑ Green Sand Filter (No sodium recharge)
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
G. Description of source water(s) (i.e. groundwater, surface water)
7. Describe the treatment process(es) for the raw water:
ccct5,ru�ta�riOA,
F a-
l}rc'on ct\d &s �-
or Nz�- �;e�
S. Describe the wastewater and the treatment process(es) for wastewater generated by the
facility:
R t ter back oc6n tax V er
-Cmm Awo e_ sdi l ors
9. Number of separate discharge points: i
Outfall Identification number(s)
10. Frequency of discharge:
If intermittent:
Days per week discharge occurs:
Continuous ❑ Intermittent 9
`l Duration: 8 - f, hOUC5
11. Plant design potable flowrate a . 0 _MGD
Backwash or reject flow 0 (C)C, MGD
12. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude): U.r`C m-c- �- 4(,1buc �y � �O ��
13. Please list all water treatment additives, including cleaning chemicals or disinfection
treatments, that have the potential to be discharged.
Page 2 of 4 Version 5/2012

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
Alum / aluminum sulfate No
Iron sulfate / ferrous sulfate Yes No
Fluoride Yes No
Ammonia nitrogen / Chloramines Yes No
Zinc -orthophosphate or sweetwater CP1236 Yes No
List any other additives below:
C' U -svic
T�Cf oo10
14. Is this facility located on Indian country? (check one)
Yes ❑ No x
15. Additional Information:
➢ Provide a schematic of flow through the facility, include flow volumes at all points in
the water treatment process. The plan should show the point[s] of addition for
chemicals and all discharges routed to an outfall [including stormwater].
➢ Solids Handlin Plan Ail l 5o i++ 5 �m�� i ii
HandlingPlan [ 4 � �i?�rve '� �1 � 5 '�CaGi � r `1• W.11 i,'1 iC?
-mot , '$ � ` 1©©�:� Ar4�S W W-7 P t,3 r.
16. NEW Applicants
Information needed in addition to items 1-15:
➢ New applicants are highly encouraged to contact a permit coordinator with the
NCDENR Customer Service Center.
Was the Customer Service Center contacted? ❑ Yes ❑ No
➢ Analyses of source water collected
➢ Engineering Alternative Analysis
➢ Discharges from Ion Exchange and Reverse Osmosis plants shall be evaluated using a
water quality model.
17. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge sand belief such information is true, complete, and accurate.
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 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
Page 3 of 4 Version 5/2012

u _-- Permit NCO069892
Quad: Andrews, N.C- Townof
Stream Class. C-Trout
Subbasin:405t72 Andrews WTP
Latitude: 35°12`3$"
Longitude:83°60'12'
Receiving Stream:. UT Dan Holland Creek
Page 7 of 7
NC
offiotfA Cherokee
kee Cou coon;