NC0022691_Renewal (Application)_20160314

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 Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit C0022691
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 Yes AF Utilities EXP, LLC
Facility Name Autumn Forest WWTP
Mailing Address 2401 I5th Street, Suite 200
City Denver
State / Zip Code Colorado 80202
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 3700 Autumn Forest Drive
City Browns Summit
State / Zip Code North Carolina, 27214
County Guilford
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 ORC)
Name APEX Companies, LLC Attn: Annie Haluska
Mailing Address 10610 Metromont Parkway, Suite 206
City Charlotte
State / Zip Code North Carolina 29269
Telephone Number [phone]
Fax Number { )
e-mail Address [e-mail]
1 o 3 Form-D 11112

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 apply):
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential ® Number of Homes
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobil home park
Number of persons served: 152 units
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
outfalI):
UT to Reedy Fork Creek
8. Frequency of Discharge: ❑ Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: Duration:
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.
BAR SCREEN, FLOW SPLITTER, DUAL AERATION BASINS, DUAL CLARIFIERS, DUAL
EFFLUENT CHLORINATION WITH CHLORINE CONTACT CHAMBER, DECHLORINATION,
SLUDGE DIGESTER, INFLUENT FLOW EQUALIZATION BASIN, ALUMINUM CHLORIDE
CHEMICAL FEED DRIP FOR PHOSOROUS REDUCTION (ATC pending).
2 cf 3 rcrn-D 11112

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.082 MGD
Annual Average daily flow 0.019 MGD (for the previous 3 years)
Maximum daily flow 0.033 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes E No
12. Effluent Data
NEW APPLICANTS:Provide data for the parameters listed. Fecal Cohforrn, 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 currently in your permit. Mark other parameters `N/A'.
Parameter Daily Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BOD;) 18.76 110.39 Mg/1
Fecal Coliform >6000 22.84 ml
Total Suspended Solids 67 10.56 Mg/1 geo. mean
Temperature (Summer) 26.4 20.17 Deg. C
Temperature (Winter) 19 10.45 Deg. C
pH 7.49 6.46 S.U.
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UiC (SDWA) Ocean Dumping(MPRSA)
NPDES NC0022591 Dredge or fill (Section 404 or CWA)
PSD (CAA) Other
Non-attainment program (CAA)
14. 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.
Mr. Andrew D. Luter Authorized Perosn
Printed name of Person Signing Title
Signature 9f Applirnt Date
North Carolina General Statute 143-215,6 (bk2) 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 oe 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 rot 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 cf not more than$25,000 or imprisonment not more than 5 years,or both,for a similar offense.)
3 of 3 Form-D 11/12

11,
January 29, 2016 RECEIVED/NCDEODWR
FEB - 1 2016
NCDEQ/ Division of Water Quality
NPDES Unit Water Quality
1617 Mail Service Center permitting Section
Raleigh, North Carolina 27699-1617
RE: Permit Renewal Request
NPDES Permit No. NC0022691
Autumn Forest Wastewater Treatment Plant
3700 Autumn Forest Drive
Browns Summit, North Carolina 27214
To whom it may concern:
On behalf of Yes! Communities, Apex Companies, LLC is submitting the enclosed NPDES Permit
Renewal application for the Autumn Forest Wastewater Treatment Plant (NPDES Permit No.
NC0022691). Please see attached NPDES Application Form D.
If you have any questions or concenrs regarding this submittal, please do not hesitate to contact the
undersigned at ahaluska u apexcos.com or at 704-799-6390 ext 4804.
Sincerely,
Apex Companies, LLC Apex Companies, LLC
Annie Haluska Adam Motsinger
Project Manager Regional Client Manager
Attachments
cc: Ed Redmond, Yes! Communities

PAT MCCRORY
?�a linrr,u,r
DONALD R. VAN DER VAART
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
February 1, 2016
Andrew D. Luter
Yes AF Utilities EXP, LLC
2401 15th Street, Suite 200
Denver, CO 80202
Subject: Acknowledgement of Permit Renewal
Application No.NC0022691
Autumn Forest WWTP
Guilford County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on February 1,
2016. A member of the NPDES Unit will review your application. They will contact you if additional
information is required to complete your permit renewal. Per G.S. 150B-3 your current permit does not
expire until permit decision on the application is made. Continuation of the current permit is contingent on
timely and sufficient application for renewal of the current permit. Please respond in a timely manner to
requests for additional information necessary to complete the permit application.
If you have any additional questions concerning renewal of the subject permit, please contact Charles
Weaver at 919-807-6391 or [e-mail].
Sincerely,
W re w Tked,'o-rd'
Wren Thedford
Wastewater Branch
cc: Central Files
Winton-Salem Regional Office, Water Quality Regional Operations Section
NPDES Unit
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300