NC0087840_Permit Issuance_20080812

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August 12, 2008
Mr. Luther H. Lewis Jr. Mayor
Town of Middlesex
P.O. Box 69
Middlesex, NC 27557
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleco H. Sullins, Director
Division of Water Quality
Subject: Issuance of NPDES Permit
Permit NCO087840
Well #4WTP
Nash County
Dear Mr. Lewis:
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).
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable
to you, you have the right to an adjudicatcry 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 permit 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 Agyeman Adu-Poke at telephone
number [phone], extension 508.
Sincerely,
r/ 0/`v leen H. Sullins
cc: Central Files
NPDES File
Raleigh Regional Office / Surface Water Protection
North Carohna Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone]
Internet; www.ncwatercuality.org Location: 512 N. Salisbury St. Raleigh, NC 27604 Fax [phone]
CarVolina Nye
Customer service
1-877-623-6748
An Equal Opportunity/Affirmative Action Employer —50% Recyded/10°h Post Consumer Paper

Permit NCO087840
STATE OF NORTH CAROLINA .
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provisions 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,
Town of Middlesex
is hereby authorized to discharge wastewater and stormwater from a facility located at
Middlesex Water Well No. 4
Nash Street
Middlesex
Nash County
to receiving waters designated as an unnamed tributary to Turkey Creek in the Neuse River Basin in
accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I,
II, III, and IV hereof.
The permit shall become effective September 1, 2008.
This permit and the authorization to discharge shall expire at midnight on May 31, 2013.
Signed this day August 12, 2008.
f
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO087840
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked, and as of this 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 described herein.
Town of Middlesex is hereby authorized to:
I. Operate a greensand filtration system located at the Town of Middlesex Well No. 4, Nash
Street, Middlesex in Nash County; and
2. Discharge grecnsand filter backwash from the treatment works described in item one at _
the location specified on the attached map into an unnamed tributary to Turkey Creek, a
class C-NSW water in the Neuse River Baste. ,_

I Outfall 001 1
Q
Town of Middlesex - NCO087840
USGS Quad Name: Middlesex Lat.: 35047'20"
Receiving Stream: UT to Turkey Creek Long.:
Stream Class: C-NSW 78012'02.97"
Subbasin: Neuse - 030407 1
Facility
Location
North]l Not to SCALE

Permit NCO087840
Part 1 Section A
1. EFFLUENT LEWTATIONS Arm MONITORING REQUIREMENTS
Beginning on the effective date of this permit 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:
'�.r't�'y}�;� ,�„yfi� • a�°��`r -
� k ...
,'' y,t'
s <,:��u � � 1 ^ � ,a �'• ,��r,R f • � '` "���
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iw � z.�.��`"�"'
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,e,e
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577.�C. j
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ti� „y3 e'
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era a 3� �:<< :era e,���' `•1?my'
,�e en r�;.,
5G , R...an
Flow (MGD)
0.0034
Instantaneous
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/Month _
Grab
Effluent
Iron
-
Monthly
Grab
Effluent
Manganese
Monthly
Grab
Effluent
Fluoride
Monthly
Grab
Effluent
pH---
Between 6.0 and 9.0 Standard Units
Monthly
Grab
Effluent
Total Residual Chlorine
28 µg/L
2/Month
Grab
Effluent
Zincl
Monthly
Grab
Effluent
Notes:
1 Zinc shall be monitored if the permittee uses any zinc -based additive in the water treatment process.
THERE SHALL BE NO DISCHARGE OF FLOATING SOLIDS OR VISIBLE FOAM IN OTHER THAN TRACE
AMOUNTS:

April 23, 2008
NCDENR/DWQ
FACT SHEET FOR NPDES PERMIT DEVELOPMENT
Town of Middlesex
Greensand Filter for Well No. 4
NPDES Permit Number NCO087840
Facility
Information
(1.) Facility Name:
(2.) Permitted Floc (NIGD):
(3.) Facility Class:
(4.) Pretreatment Pro;;ram:
(5.) Permit Status:
_ _! Town of 'Middlesex - Water Well No. 4
0.003-1 (6.) County:
1 (7.) Regional Office:
j NA (3.) USGS Topo Quad:
Renewal (9.) USGS Quad Name:
_
_ Nash
Relcioh
D-Ios\x
Stream Characteristics
(1.) Recen ing Stream:
UI' m Turkey Crcck
(7.) Drainage Area (mi'-�
(8.) Summer 7Q10 (cfs):
(9.) Winter 7Q10 (cfs)-:
10.) 30Q2 (cfs):
40,4
i 0.-'0_
NA.._
5.252
2. Sub -basin: N_euse-030407
_
3.) Stream Index Number:
(4.) Stream Classification: C NSW
5. 303 d Status:
Not Listed
11.) Average Flow (cfs):
12.) IWC %:
NA
2.3%
(6.) 305(b) Status: Su ortin
1.0 BACKGROUND
This is a renewal permit for a greensand filtration system for a groundwater well. The system generates
approximately 0.0034 MGD of backwash water.
2.0 PERMIT DEVELOPMENT
This permit was drafted accorded to the NPDES Permitting Strategies for Potable Water Treatment Plants, September
2007.
The pemrittee requested for flow limit increase but the request was not granted at this time because the permittee did
not provide any justification for the request.
3.0 PROPOSED SCHEDULE FOR PERMIT ISSUANCE
Draft Permit to Public Notice: April 23, 2008.
Permit Scheduled to Issue: June 16, 2008.
4.0 NPDES Unit Contact
If you have questions regarding any of the above information or on the attached permit, please contact
Agyeman Adu-Poke at [phone] ext. 508.

NPDES Permit Fact Sheet - April 23, 2008
NCO087840
4

= -i
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleco H. Sullins, Director
Division of Water Quality
May 27, 2008
To: Agyeman Adu-Poke �—
Western NPDES Program " MAY 3 0 2008
i
Through: Danny Smith
Regional Wate ality Supervisor, RRO
From: Stephanie Brixey
Senior Environmental Specialist, RRO
Subject: Draft Permit Comments
Middlesex WTP Well #4
NPDES # NCO087840
Nash County
After reviewing the draft permit and Middlesex WTP file at the RRO, there are questions/comments.
a I found nowhere in the permit that the Town is required to put in a de -chlorination system except in the
cover letter. The Region feels that there should be a deadline for this to be installed due to the TRC
violations and the fact they have a low level limit in the current permit.
a The cover letter states that the facility should designate an ORC and BORC as soon as possible. The
facility fulfilled this requirement January 28, 2008. This information was determined through BIMS.
a The cover letter states that there is no change from the current permit. The draft permit contains a
change that no stream monitoring is required. Is there a reason that stream monitoring is no longer
required?
The comments page is attached.
If you have questions or comments please contact me.
wcs Caro ina
Vtura27b,
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Intemet h2o.enr.state.nc.us 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/l0% Post Consumer Paper

I -D, Permit Fact Sheet — April 23, 2008
NCO087840
Regional Office Comments
Zz
Met y Z -// 2Oa�l
5
REGIONAL
NPDES SUPERVISOR: DATE:

Rocky Mount
TELEGRAM
NCDENR/N C DIV WATER QUALITY
NON -DISCHARGE BRANCH
1650 MAIL SERVICE CENTER
RALEIGH, NC 27699-1650
CopyLine: =NORTHCAROLINAENVIRONM
Lines: 94
Total Price: $141.00
PUBLISHER'S AFFIDAVIT
NORTH CAROLINA
NASH COUNTY:
JUANITA COOPER -FORD affirms that she is clerk of the Rocky Mount Telegram, a newspaper
published daily at Rocky
Mount, Nash County, North Carolina, and that the advertisement, a true copy of which is hereto attached, entitled
PUBLICNOTICESTATEOFNORTHCAROLINAENVIRONM was published in said the Rocky Mount Telegram on the
following dates:
Friday, June 13, 2008 Page: D2
PUBLIC NOTICE
and that the said newspaper in which such notice,
paper, document or legal advertisement was published,
STATE OFVINORTHCAROIINA
ENVIRONMENTAL
was at the time of each and every publication, a
MANAGEMENT
COMMISSIONMPOES UNIT
newspaper meeting all of the requirements and
1617 MAIL SERVICE CENTER
qualifications of Chapter 1, Section 597 of the General
RALEIGH, NC 27699.1617
NOTIFICATION OF INTENT
Statutes of North Carolina and was a qualified
9
TO ISSUE A NPOES
WASTEWATER PERMIT
newspaper within the meaning o Chapter 1, Section
9 of the General Statutes ofMph Carolina.
On the bassofthoragh
staff review and application
of NC General Statute
143.215.1 and 15A NCAC
02H.0109 and other lawful
standards aM regulations.
the North Carolina Environ-
firmed and subscribed before me this 13 day
mental Management Com-
mhsbn prapoxzm have a
Nations Pdl IutantDis-
of June 2008
charge Elimination System
(NPDES) wastewater dis
charge permit to the
person(s) listed below effec-
tive 4S days from the pub-
('O(�O
lish date of this notice.
l�� �., �1y-��� i
,j, (Notary Public Signature )
Written commentsregard-
ing the oromsed permit will
beaccepte unti130clays
after the Wblish date of this
ments
received prior to that date
in the
are considered in the final
arenotice.considered
(Notary Public Printed NM
t�,'�f [ np^f! ®
V V. Y i•ii-aKE
determinationsregarding
the proposed permit. The
Director of the NC Division
Y lray;,t pC
of Water Quality may decide
to hold a public meeting for
My commission expires. \\ — — CC-iiJ iic
the proposed pert should
-WORTH Cn5`vinlA
the Division receive a signifi-
cant degree of public inter-
est.
Copies of the draft permit
and other supporting infor-
mation on file used to
determine conclitions
present in the draft permit
are available upon request
and payment of the costsof
reproduction. Mailcon-
ments andbr requests for
information to the NC Diw
sion of Water Quality at the
AD ID: 337250

above address or call Dina
Sprinkle (919) 733-SD83,
extension 363 at the Point
Same Branch. Please
include the NPDES permit
number (below) in any
communication. Interested
perms may also visit the
Division of Water Quality at
S12 N. Salisixy Street,
Raleigh, NC 27604-1148
between the hoursof &OD
a.m. and 5:00 p.m. to review
information on file.
The Town of Middlesex
(10921 East Finch Avenue,
Middlesex NC 27557) has
applied for a renewal of the
NPDES discharge permit
(NC0087840) for the back-
wash from a greensand fil-
tration water treatment sys
tem. The facility discharges
0.0034 MGD ofgreensand
backwash water to an
unnamed tributary of Tur-
key Creek, a class C NSW
water in the Neuse River
gqBasin. No parameter iswater
thomited at Oils time,
ugh thisdisd arge may
impact future allocation of
the receiving stream.
611108

10232 5" Na 514<
P"z%ag�"61
K.�, NC 2xSP
7S2-23S-961(" 23S-P62
Tart of Mw4lfyu
Luther H. Lewis, Jr., Mayor
March 13, 2008
Mr. Gil Vinzani, Supervisor
Eastern NPDES Program
NC Division of Water Quality —�
1617 Mail Service Center ! MAR 2
Raleigh, NC 27699-1617 i
RE: Request for Permit Flow Adjustment
NPDES Permit- #NC0087840--Water Supply Well # 4
Dear Mr. Vinzani,
The Town of Middlesex does hereby formally request that the approved flow value (3400 gallons
per month) as contained in the Town of Middlesex NPDES Permit # NCO087840 for the
backwash discharge from Well # 4 be increased to 11000 gallons per month. Because of the
necessity to backwash longer to clean the pressure filters at the well, we have found that we
discharge more than the originally authorized discharge flow value and we are receiving fines for
the overage. No changes are proposed to the well, pressure filters or discharge filters.
If there are any questions, or if additional information is needed, please do not hesitate to contact
me at 252-235-5671.
SlOcerely,
P1issette,
Town Administrator
cc: Jeff Waddell

NPDES REGIONAL WATER QUALITY
STAFF REPORT AND RECOMMENDATIONS
(This form is best filled out on computer, rather than hard copy. Then unprotect to
highlight in light blue as needed to make your comments more visible in the fmal printing.)
[But DON'T protect document again, or Word wipes out all you have entered.]
Date: 18 December 20M County:
To: NPDES Discharge Permitting Unit Permitee:
Atm. NPDES Reviewer: Agveman Adu-Poku;Application/ Permit No.
Staff Report Prepared Y.
Project Name: Permit Renewal Review
SOC Priority Project? (Y/N) N If Yes, SOC No.
A. GENERAL INFORMATION
1. This application is (chmk an that apply): ❑ New ® Renewal
❑ Modification
2. Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 27 March 2007
b. Person contacted and telephone number: Jeff Waddell
c. Site visit conducted by: Ron Boone
d. Inspection Report Attached: ® Yes or ❑ No.
3. Keeping BIMS Accurate: Is the following BIMS information (a. through e. below) correct?
❑ Yes or ❑ No. If No, please either indicate that it is correct on the current application or the
existing permit or provide the details. If none can be supplied, please explain:
(If there is more than one discharge pipe, put the others on the last page of this form.)
a. Location OK on Existing Permit ®, OR, if not, is
OK on Application ❑, or if neither is right, provide Location: Description on application is
incorrect. Outfall goes to roadside drainage ditch, which goes to unnamed trib to Turkey Creek.
b. Driving Directions OK on Existing Permit ❑, OR, if not, is
OK on Application ❑, or provide Driving Directions (please be accurate): From RRO, take Six
Forks north and merge onto the inner beltline (I-440 east). Take inner beltline to exit 16 (64 east).
Take 64 east for approximately 17.1 miles and merge onto 264 east. Take 264 east less than 1
mile to the first exit. Merge onto 264A east. Proceed east on 264A approximately 6.14 miles.
Facility is on the right side of the street at 10921 East Finch Ave.
c. USGS Quadrangle Map name and number OK on Existing Permit N, OR, if not, is
OK on Application ❑, or provide USGS Quadrangle Map name and number:
d. Latitude/Longitude OK on Existing Permit ❑, (check at http://www.topozone.com These are
often inaccurate) or is OK on Application ❑, or provide Latitude: Longitude:
e. Receiving Stream OK on Existing Permit ®, OR, if not, is
OK on Application ❑, or provide Receiving Stream or affected waters:
a. Stream Classification: C, NSW

NPDES REGIONAL WATER QUALITY
STAFF REPORT AND RECOMMENDATIONS
b. River Basin and Sub basin No.: Neuse, 03-04-07
c. Describe receiving stream features and downstream uses: UT to Turkey Creek, which goes to
Buckhom Reservoir approximately 6 miles downstream. Buckhom is WS-V, NSW.
For NEW FACILITIES Proceed to Section C. Evaluation and Recommendations
(For renewals or modifications continue to section B)
B. DESCRIPTION OF FACILITIES AND WASTE(S) (renewals and modifications only)
1. Describe the existing treatment facility: Facility uses potable water to backwash pressure sand filters
which are used to filter well water to produce the potable water for town residents. After backwashing,
the backwash water is metered and then filtered in two gravity sand filters and is then discharged to the
receiving stream.
2. Are there appropriately certified ORCs for the facilities? ❑ Yes or Z No.
Operator in Charge: Certificate #
Back- Operator in Charge: Certificate #
(Available in BIMS or Certification Website)
3. Does the facility have operational or compliance problems? Please comment: Yes. The facility is
having a difficult time meeting the chlorine residual limit, primarily because they have failed to install a
dechlorination system. Prior to the March 2007 inspection, the operator was performing chlorine
residual testing with a colorimeter (color wheel) and not certified to operate the plant or run the chlorine
tests. Many problems were noted with the DMRs during the inspection which were addressed in the
inspection/NOV letter.
Summarize your BRAS review of monitoring data (Notice(s) of violation within the last permit cycle;
Current enforcement action(s)): According to BIMS, permittee has had six daily max total residual
chlorine violations, five daily max total suspended solids violations, seven monthly average total
suspended solids violations and 2 violations of the monthly average flow limit, for which NOVs or
enforcements were issued. Permittee has also incurred five total residual chlorine monitoring
violations, one total suspended solids monitoring violation and two late/missing DMR reports, for
which NOVs or enforcements were issued. Permittee currently has one pending enforcement case for
total residual chlorine and flow violations.
Are they currently under SOC, ❑ Currently under JOC, ❑ Currently under moratorium ❑? Have
all compliance dates/conditions in the existing permit, SOC, JOC, etc. been complied with? ❑ Yes
or ❑ No. If no, please explain: N/A - Please refer to attachment #1.
4. Residuals Treatment: PSRP ❑ (Process to Significantly Reduce Pathogens, Class B) or
PFRP ❑ (Process to Further Reduce Pathogens, Class A)?
Are they liquid or dewatered to a cake?
FORM: NPDES-RRO 06/03, 9/03, 1/07 2

NPDES REGIONAL WATER QUALITY
STAFF REPORT AND RECOMMENDATIONS
Land Applied? Yes ❑ No ❑ If so, list Non -Discharge Permit No.
Contractor Used:
Landfilled? Yes ❑ No❑ If yes, where?
Other?
Adequate Digester Capacity? Yes ❑ No ❑ Sludge Storage Capacity? Yes ❑ No ❑
Please comment on current operational practices: N/A - Used sand from sand filters is replaced every
few years. Old sand is landfilled.
5. Are there any issues related to compliance/enforcement that should be resolved before issuing this
permit? ® Yes or ❑ No. If yes, please explain: Permittee needs to appoint ORC and BORC for the
facility and install a dechlorination system.
C. E VAL UA TION AND RECOMMENDATIONS
1. Alternative Analysis Evaluation: has the facility evaluated the non -discharge options available? Give
regional perspective for each option evaluated:
Spray Irrigation:
Connect to Regional Sewer System: According to current operator, Mr. Jeff Waddell, the permittee is
currently considering and investigating tying the waste stream into the sanitary sewer for conveyance to
the town of Zebulon for treatment. Official status of this effort is unknown, but was highly encouraged.
Subsurface:
Other Disposal Options:
2. Provide any additional narrative regarding your review of the application:
3. List any items that you would like NPDES Unit to obtain through an additional information
request. Make sure that you provide a reason for each item:
Recommended Additional Information
Reason
What they plan to do to stop TRC violations and
start meeting the TRC limit.
Violations are too many.
Status of tying waste stream into sanitary sewer.
Eliminate the discharge.
4. List specific Permit requirements that you recommend to be removed from the permit when
issued. Make sure that you provide a reason for each condition:
Recommended Removal Reason
Flow, Monthly Average Monthly average limit should be increased.
Operator currently backwashes usually only
once or twice per month, placing them in
FORM: NPDES-RRO 06/03, 9/03, 1/07

NPDES REGIONAL WATER QUALITY
STAFF REPORT AND RECOMMENDATIONS
violation of the monthly average permit limit
for flow. The monthly average should be
increased to be more comparable to monthly
average flows. The waste stream is still
somewhat negligible.
5. List specific special requirements or compliance schedules that you recommend to be included in
the permit when issued. Make sure that you provide a reason for each special condition:
Recommended Addition
Reason
Install a dechlorination system within three months.
Needed to prevent TRC exceedances.
Appoint ORCBORC immediately.
Need an ORCBORC.
6. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office;
® Hold, pending review and approval of required additional information by NPDES permitting
office; ❑ Issue; ❑ Deny. If deny, please state reasons:
Reminder: attach inspection report ' Was checked for 2 d.
7. Signature of report preparer: - 2
Signature o`f�WQ egiona su erv}sor:
Date: D / r r
D. ADDITIONAL REGIONAL STAFF REVIEW ITEMS
If next page is not used, PLEASE set printer for pages 1 through 3 to avoid wasting paper.
Use this page for facilities with more than one Discharge Pipe
Discharge Point: (Fill this section only if BIMS or Application Info is incorrect or missini, )
a. Location OK on Application ❑,
OK on Existing Permit ❑, or provide Location:
b. Driving Directions OK on Application ❑,
OK on Existing Permit Ellor provide Driving Directions (please be accurate):
c. USGS Quadrangle Map name and number OK on Application ❑,
OK on Existing Permit ❑, or provide USGS Quadrangle Map name and number:
FORM: NPDES-RRO 06/03, 9/03, 1/07

ATTACHMENT #1
A(3d). Approximately lat/long is 35°, 47', 20.11" North by 78°, 12', 02.97" West. This
is a measurement of where the discharge meets the drainage ditch that it initially
drains into, which then goes to a UT to Turkey Creek and then eventually to
Turkey Creek. This lat/long is quite different than that which is currently listed in
the permit (in BIMS), which locates the outfall close to what appears to be the
approximate origin of the UT that goes to Turkey Creek.
B3. Permittee has apparently taken no action to enable it to meet the total residual
chlorine (TRC) limit of 28 41. No dechlorination system has been installed and
repeat TRC violations are occurring.

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
1 L 7
Mail the complete application to:
N. C. Department of Environment and Natural Resourc,
Division of Water Quality . Qu ty / NPDES Unit f iFn_ ,,,r, � • � � ;
1617 Mail Service Center, Raleigh, NC 27699-1617J CC 5
NPDES Permit Number INCOO I 19 4 a
If you are completing this form in computer use the TAB key or the up - down arrows to moue 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
Facility Name
Mailing Address
city
State / Zip Code
M
Telephone Number (As -)I -2. is. S y � /
Fax Number (26�z ) 523S. S- yd 20
e-mail Address 2niddAIaS4 g '
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road
/ opa 1��--
City
State / Zip Code N•C �-
County Ak4k
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
Mailing Address
City
State / Zip Code
Telephone Number
Fax Number
4. Ownership Status:
Federal ❑
- W
NC �7
State ❑ Private ❑ Public [ir
Page 1 of 2 C-WTP 03/05

NPDES PERMITAPPLICATION - 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)
sodi r la
❑ Membrane Technology (RO, nanofiltration)
Check here if the treatment process also uses a water softener ❑
6. Description of source water(s) (i.e. groundwater, surface water)
D&AP Gt/d4L
?. Describe the treatment process(es) for the raw water;
S. Describe the wastewater and the treatment processes for wastewater generated by the
facility:
9. Number of separate discharge points:
Outfall Identification number(s)
10. Frequency of discharge: Continuous Intermittent
If intermittent: r
we urs• Duration: f O
11. Plant design potable flowrate MGD
Backwash or reject flow MGB- =2061
12.. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitudes
Page 2 of 2 C-WTP 03/05

NPDES PERMIT APPLICATION - SHORT FORM C - WTP
For discharges associated with water treatment plants
13. Please list all water treatment additives, including cleaning chemicals, that have the
. potential to. be discharged.
14. Is this, facility located on Indian country? (check one)
Yes ❑ No
15. Additional Information:
Provide a schematic of flow through the facility, include flow volumes at all points in
the treatment process, and point of addition of chemicals.
Solids Handling Plan C/
16. NEW Applicants
Information needed in addition to items 1-15.
New applicants must contact 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 and belief such information is true, complete, and accurate.
L-4ex A teevz--i J�.
Printed name of Person Signing Title
of
ti zs, zo6
Date
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 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.)
Page 3 of 3
C-WTP 03/05

FACT SHEET FOR EXPEDITED PERMIT RENEWALS
QAn�n, TMTAwf4fA�'1A�1 +A runtontial fnr avnarlitPfl nPrmit renewal
Reviewer/Date
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Permit Number
AX 00 k 7,,W0
Facility Name
/Y?J - L&) p
Basin Name/Sub-basin number
w. 0 2) v C/- 6 7
Receiving Stream
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Stream Classification in Permit
Does permit need NH3 limits?
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Does permit need TRC limits?
O ��
Does permit need Enteroccoci limit?.
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Does permit have toxicity testing?
Does permit have Special Conditions?
/
Does permit have instream monitoring?
Is the stream impaired (on 303(d) list)?
O
Any obvious compliance concerns?
Any permit mods since lastpen-nit?
Existing expiration date
SJ 3/ of
New expiration date
5rl 3 /zzJ
New permit effective date
Mi��+ollaran»e inmmante
YES— This is a SIMPLE EXPEDITED permit renewal (administrative
renewal with no changes, or only minor changes such as TRC, NH3, .
name/ownership changes).
YES-K This is a MORE COMPLEX EXPEDITED permit renewal (includes
Special Conditions (such as EAA, Wastewater Management Plan),
Conventional WTP, 303(d) listed, toxicity testing, instream monitoring,
compliance concerns, phased limits). Basin Coordinator to make case -by -
case decision.
YES_ This permit CANNOT BE EXPEDITED .for one of the following reasons:
• Major Facility (municipal/industrial)
• Minor Municipals with pretreatment program
• Minor Industrials subject to Fed Effluent Guidelines (lb/day limits for BOD, TSS, etc)
• Limits based on reasonable potential analysis (metals, GW remediation organics)
• Permitted flow > 0.5 MGD (requires full Fact Sheet)
• Permits determined by Basin Coordinator to be outside expedited process
TR Version 9/7/2007
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