NC0030422_Renewal (Application)_20150730

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NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
• Mail the complete app ation to•
N. C. DENR / Division of Water FSPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit iNC0030422
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 Bill Freeman,James Francis,John Francis
Facility Name Green Valley Mobile Home Park
Mailing Address 201 Freeman Road
City Waynesville
RECENEMENRIDWR
State / Zip Code North Carolina 28786
Telephone Number 828-421-6235 JUL 30 LUI5
Fax Number 282-227-7705 Water Quality
-Permitting Section
e-mail Address [e-mail]
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road 7 Grape Leaf Drive Hyatt Creek •
City Waynesville
State / Zip Code North Carolina
•
County Haywood
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 Environmental Inc.
Mailing Address 2675 Skyland Drive
City Sylva
State / Zip Code North Carolina
Telephone Number 828-586-5588
Fax Number 828-586-0085
e-mail Address [e-mail]
1 of 1 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 ❑ Number of Employees
Commercial ❑ Number of Employees
Residential ® Number of Homes 30
School ❑ Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Mobile Home Park
Number of persons served: 110
5. Type of collection system
® 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 ® No
• 7. Name of receiving stream(s) (NEW applicants:Provide a map showing the exact location of each
outfall)
Hyatt Creek
8. Frequency of Discharge: ® Continuous 0 Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: Continuous
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.
1. 0.009 MGD extended aeration wastewater treatment plant consisting of the following
treatment components:
• Equalization Basin
• Clarifier with sludge return
• Aerobic digestor
• Chlorine Contact Basin
• Tablet chlorinator
• Tablet Dechlorination
• Basin with V notch weir
2 of 2 Form-D 11112

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• NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
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1.0. Flow Information:
Treatment Plant Design flow 0.009 MGD
Annual Average daily flow 0.0083 MGD (for the previous 3 years)
Maximum daily flow 0.0090 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 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) 32 17.6 Mg/1
Fecal Coliform 260 82.2 Ml
Total Suspended Solids 41.7 26 Mg/1
Temperature (Year-Round) 25 22.8
Temperature (Winter)
pH 7.3 7.1 Standard Units •
•
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 )NC00304221 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.
"Tame 5 F"-rotvr cis 5-114-15 Co--a.,reir"
. Printed name of Person Signing Title
ignature 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
rruired to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be
4 of 4 Form-D 11/12

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• NPDE S APPLICATION - FORM D •
For privately-owned treatment systems treating 10016 domestic wastewaters<1.0 MOD . •
• guilty of a ansdern anar punishable by a fine not to exceed$25,000,or by Imprisonment not to exceed sbc months,or by both. (18 U.S.C.Section 1001
provides a punishment by a fine ci not more than$25,000 or imprisonment not more then 5 years,or both,for a similar oifense.)
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545 Fcan-D 11/12

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Latitude; 35°2T'51" N' State Grid: Waynesville not to scale
Lonzitude: 83°0 '36" W permitted Flow: 0.009 MGD
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Receiving S eam: Hyatt Creek Stream Class: C North i•DES Hennit No.NC0030422ywood County
i t••i ,eB.,'1: Franc)Broad R ver Basin Sub-Basin: 04-03-05-06010106
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NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
August 5, 2015
James H.Francis
Green Valley Mobile Home Park
201 Freeman Road
Waynesville,NC 28786
Subject: Acknowledgement of Permit Renewal
Permit NC0030422
Haywood County
Dear Permittee:
The NPDES Unit received your permit renewal application on July 24, 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. You should expect to receive a draft permit approximately 30-45 days
before your existing permit expires.
If you have any additional questions concerning renewal of the subject permit, please contact Sonia
Gregory at(919) 807-6333.
Sincerely,
W re v'T!^zo( rot'
Wren Thedford
Wastewater Branch
cc: Central Files
Asheville Regional Office
NPDES Unit
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone]\Fax:[phone]/Customer Service:1-877-623-6748
Internet::www.ncwater.orq
An Equal OpportunitylAffirmative Action Employer •