NC0030325_Renewal (Application)_20151202

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NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
Mall the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INC0030325
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 A &D Water Service, Inc.
Facility Name Buffalo Meadows WWTP
Mailing Address P O Box 1407
City Pisgah Forest
State / Zip Code NC / 28768
Telephone Number [phone]
Fax Number [phone]
e-mail Address ,[e-mail]
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road NCSR 1131
City West Jefferson
State / Zip Code NC / 28694
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 A 8s D Water Service, Inc
Mailing Address P 0 Box 1407
City Pisgah Forest
State / Zip Code NC / 28768
Telephone Number [phone]
Fax Number [phone]
e-mail Address [e-mail]
1 of 3 Form-011/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
4. Description of wastewater:
Facility Generating Wastewater(check all that apply):
Industrial ❑ Number of Employees
Commercial ❑ Number of Employees
Residential X Number of Homes 45
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Subdivision
Number of persons served: 100
5. Type of collection system
X Separate (sanitary sewer only) 0 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 . X No
7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall):
Buffalo Creek
8. Frequency of Discharge: X 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.
Grit chamber, Aeration basin, Clarifier, Tablet feed chlorinator, Tablet dechlorination,
Post aeration, Flow meter, Sludge holding basin.
2 of 3 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 0.010 MGD
Annual Average daily flow 0.0047 MGD (for the previous 3 years)
Maximum daily flow 0.0201 MGD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X 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 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 (BODS) 26 7.03 mg/L
Fecal Coliform >600 4.33 100 ml
Total Suspended Solids 46 8.38 mg/L
Temperature (Summer) 22.5 14.8 C
Temperature (Winter) C
pH 8.83 7.47 su
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 NC0030325 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.
Aubrey Deaver President
Printed name of Person Signing Title
42a , 17 1
Signat e 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 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.)
3 of 3 Form-D 11/12

•
PAT MCCRORY
!,n (iorernor
DONALD R. VAN DER VAART
secrelao,
Water Resources • S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
December 02, 2015
Aubrey Deaver, President •
A & D Water Service, Inc.
PO Box 1407
Pisgah Forest,NC 28758
•
Subject: Acknowledgement of Permit Renewal
Application No.NC0030325
Buffalo Meadows WWTP
Ashe County
Dear Permittee:
•
The Water Quality Permitting Section has received your permit renewal application on December
02, 2015. 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 Wren
Thedford at 919-807-6304 or [e-mail]. -
Sincerely,
W re v'fli eof f oi,
Wren Thedford •
Wastewater Branch
cc: Central Files
,VU,I isfon:5_alenl 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