NC0083470_Renewal Application_20160321

Town of Jefferson Wa -ex Re4ource*
P.O. Box 67 1233 NC Highway 16 South Jefferson, NC 28640 [phone]
"PmVectfw.g,dw.1New Rover13a4Cv
Cathy Howell,Town Manager Tim Church, Director
March 17, 2016
Wren Thedford
NC DENR/ DWQ NPDES Unit RECEIVED/NCDEWWR
1617 Mail Service Center
Raleigh, NC 27699-1617 MAR 21 2016
Water Quality
SUBJECT: Renewal Application for Town of Jefferson WTP Permitting Section
NPDES Permit NCO083470 Ashe County
Wren;
Enclosed please find a signed original and two copies of the permit renewal application
for the filter backwash lagoons at the Town of Jefferson Water Treatment Facility.
If you have any questions or require additional information please call me at (336) 246-
2165 or contact me by e-mail at ieffwns@cen•turylink.net.
Thank you for your assistance in our permit renewal.
Respectfully,
­�'ckmtL
Tim Church
Water Resources Director
Town of Jefferson
[e-mail]

NPDES APPLICATION FOR PERMIT RENEWAL - FORM A
For Publicly Owned Treatment Works (POTW) or other treatment systems treating
domestic wastes < 0.1 MGD with no pretreatment program.
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Vnit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INCO08,3470
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 Town of Jefferson RECEIVED/NCDEUDWR
Facility Name Jefferson WTP MAR 21 2016
Mailing Address P.O. Box 67 Water Quality
City Jefferson nn 'ng Section
State / Zip Code North Carolina 28640
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 879 Don Walters Road
City Jefferson
State / Zip Code North Carolina 28640
County Ashe
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 Town of Jefferson
Mailing Address P.O. Box 67
City Jefferson
State / Zip Code North Carolina 28640
Telephone Number [phone]
Fax Number [phone]
4. Population served: 1,470
1 of 3 Form-A 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM A
For Publicly Owned Treatment Works (POTW) or other treatment systems treating
domestic wastes < 0.1 MGD with no pretreatment program.
5. Do you receive industrial waste?
® No ❑ Yes (if you have an approved pre-treatment program, must complete Form 2A)
6. Type of collection system
® Separate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
?. Outfall Information:
Number of separate discharge points 1
Outfall Identification number(s) 001
Is the outfall equipped with a diffuser? ❑ Yes ® No
8. Name of receiving stream(s) (Provide a map showing the exact location of each outfall):
UT of Naked Creek
9. Frequency of Discharge: ❑ Continuous ® Intermittent
If intermittent:
Days per week discharge occurs: 1 Duration: 1 hour
10.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.
This facility consists of dual lagoons for the purpose of treating the discharge from the
filters at the Jefferson Water Treatment Plant. The lagoons allow for the settling of
solids from filter backwashing.
11. Flow Information:
Treatment Plant Design flow N/A (no flow limits are on this permit MGD
Annual Average daily flow 0.010 per batch MGD (for the previous 3 years)
Maximum daily flow 0.020 MGD (for the previous 3 years)
12. Is this facility located on Indian country?
❑ Yes ® No
2 of 3 Form-A 1/06

NPDES APPLICATION FOR PERMIT RENEWAL - FORM A
For Publicly Owned Treatment Works (POTW) or other treatment systems treating
domestic wastes < 0.1 MGD with no pretreatment program.
13. Effluent Data
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. Effluent testing data must be based on at least three samples
and must be no more than four and one half years old.
Parameter Daily Monthly Units of Number of
Maximum Average Measurement Samples
Biochemical Oxygen Demand Measurement
(BODS) not required
Fecal Coliform Not required
Total Suspended Solids 10. <5 mg/1 24
Temperature (Summer) Not required
Temperature (Winter) Not required
pH 7.9 su 24
14. List all permits, construction approvals and/or applications: A/
Type Permit Number Type ( /p.
Permit Number
Hazardous Waste (RCRA) NESHAPS (CAA)
UIC (SDWA) Ocean Dumping (MPRSA)
NPDES Dredge or fill (Section 404 or CWA)
PSD (CAA) Special Order of Consent (SOC)
Non-attainment program (CAA) Other
15. 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.
Tim Church Water Resources Director
Printed name of Person Signing Title
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 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
$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.)
3 of 3 Form-A 1/06

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Town of Jefferson
Facility -$ =zL� � 19---
Jefferson WTP y 'rd' _.
Location -
r,
Latitude: 35,25'00" N State Grid: Jefferson not to scale
Lonaitude: 81°25'44" W Permitted Flow: N/A
Receivina Stream:UT to Naked Creek Drainage Basin: New River Basin NPDES Permit No. NC0083411
Stream Class: C Sub-Basin: 05-07-01 North
Ashe County

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
" Secretary
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL DUALITY
Dn ector
March 22,2016
Tim Church,
Town of Jefferson
PO Box 67
Jefferson,NC 28640
Subject: Acknowledgement of Permit Renewal
Application No.NCO083470
Jefferson WTP
Ashe County
Dear Permittee:
The Water Quality Permitting Section has received your permit renewal application on March 21,
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 Derek
Denard at 919-807-6304 or [e-mail].
Sincerely,
W{�Q�vv T I�•Q-D�YD�
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
I
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919-807-6300