NC0075027_Renewal (Application)_20161228

Water Resources
ENVIRONMENTAL QUALITY
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Director
December 29, 2016
Mr. Bradley Flynt
Cainsway Homeowner's Association
Po Box 846
Walkertown, NC 27051
Subject: Permit Renewal Application
Application No. NCO075027
Cainsway WWTP
Forsyth County
Dear Mr. Flynt:
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on December 28, 2016. The primary reviewer for this_ renewal
application is Brianna Young.
The primary reviewer will review your application, and she 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 Brianna Young at 919-807-6369 or [e-mail].
Sincerely,
?A" ?& 404d
Wren Thedford
Wastewater Branch
cc: Central Files
NPDES
Winston-Salem Regional Office
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807.6300

Subject: NPDES Permit #NC0075027
Cainsway WWTP
Forsyth County
NPDES Renewal Application
12/20/2016
R CEIVEDIMODEQIDV*`
DEC 2 8 2016
Wate,QSec ®n
PermitcIpg
I, Bradley Flynt, Cainsway WWTP ORC, would like to on behalf of the Cainsway
Homeowner's Association, request renewal of the NPDES permit. There have
been not changes to the facility since the issuance of the last permit. Thanks
Bradley Flynt
. 3" P- I A��
ORC, Cainsway WWTP

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 INCOO 75 0
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 �� 115c OCc c 1 l`'C7 n IG Pt � ll f �5 X15iC fir; n �1
Facility Name /1 1X 5A �W:cp
Mailing Address lP U, �Xc�(o t'
City
�_,) cr.l Pcr 0w n
State / Zip Code t4(- '), r7 0 5
Telephone Number ( )
Fax Number ( )
e-mail Address
2. Location of facility producing discharge:
Check here if same address as above ❑
Street Address or State Road . i n e_ka (L
City W Q l L{ e rtow n
State / Zip Code )�i o2 q 0 5 -
County FD
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� ra'd l� �� tit 11
Mailing Address
City 5 �1=�e'Z.,XcC-(P .
State / Zip Code a r) 3 5 r(
Telephone Number (-330 5-9 q- 033 U
Fax Number _(33G) S1 3 - -7 7 X
e-mail Address (tea . F�un� rGert,Sro nC G epi/
1 of Form -D 11/12

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
❑
Commercial
❑
Residential
[✓�
School
❑
Other
❑
Number of Employees
Number of Employees
Number of Homes
Number of Students/Staff
Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.): 5 (A
d �/;6 1*
6 V)
Number of persons served: `75 4
5. Type of collection system
01"S'e-parate (sanitary sewer only) ❑ Combined (storm sewer and sanitary sewer)
6. Outfall Information:
Number of separate discharge points
Outfall Identification number(s)
Is the outfall equipped with a diffuser? ❑ Yes M No
7. Name of receiving stream(s) (NEW applicants: Provide a map showing the exact location of each
outfall):
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.
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2 of 4 Form -D 11/12

CINAIMMiu
OUTFALL 061
A
Cains Way Homeowner's Association
Facility P'S
"T
Cains Way Mobile Home Park WWTP
LocationN�, 845_
County: Forsyth Stream Class: C (not to scale)
Receiving Stream: Ader Creek Sub -Basin: 030201
Latitude: 36' 12' 20" Grid/Quad: Walkertown
Longitude: 80,09,081, HUC: 03010103 IVORTH NPIDES Permit No. NC0075027

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
3 of 4 Form -D 11/12

NPDES APPLICATION - FORM D
For privately -owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0. MGD
Annual Average daily flow MGD (for the previous 3 years)
Maximum daily flow 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
prior tho past .36 mnnths far na.rameters currentlu in uour permit. Mark other parameters "N/A".
Parameter
Daily
Maximum
Monthly
Average
Units of
Measurement
Biochemical Oxygen Demand (BODS)
/�'► �L
Fecal ColiformLy
Total Suspended Solids
Temperature (Summer)
lo
(o
Temperature (Winter)
5/
° C
pH
0nii3
13. List all permits, construction approvals and/or applications:
Type Permit Number Type
Hazardous Waste (RCRA)
UIC (SDWA)
NPDES
PSD (CAA)
Non -attainment program (CAA)
NESHAPS (CAA)
Ocean Dumping (MPRSA)
N ,np'76pd'7 Dredge or fill (Section 404 or CWA)
Other
14. APPLICANT CERTIFICATION
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.
Printed nam of Perslon Signing
Signature
Title
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 11/12