NC0036935_Renewal (Application)_20150113

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
Mail the complete application to:
N. C. DENR / Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
NPDES Permit INC0036935
If you are completing this form in computer use the TAB key or the up- down arrows to move from one
f 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 Pine Mountain Property Owners Association
Facility Name Pine Mountain Lakes
Mailing Address 2885 Pine Mountain Drive
City Connelly Springs
State / Zip Code NC 28612
Telephone Number 828-437-4894
Fax Number 828-438-1583 RECEIVED/DENR/DWR
e-mail Address pinemountainof ce(bellsouth.net JAN j 3 2615
aki
2. Location of faciliproducing discharge: Permitting Sectionter
Check here if same address as above 0
Street Address or State Road Off Wards Gap Road (NCSR 1901)
City Connelly Springs
State / Zip Code NC 28612
County Burke
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 Pine Mountain Property Owners Association
Mailing Address 2885 Pine Mountain Drive
City Connelly Springs
State / Zip Code NC 28612
Telephone Number 828-437-4894
Fax Number 828-438-1583
e-mail Address pinemountainofilcogbeflsouth.net
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Form-D 11/12

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 0 Number of Employees
Commercial 0 Number of Employees
Residential X Number of Homes 30
School Number of Students/Staff
Other X Explain: GOLF 8
COURSE/MAINTENANCE EMPLOYEES
Describe the source(s) of wastewater (example: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Subdivision, Golf Course and Maintenance
Number of persons served: 60
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 numbers) 001,
Is the outfall equipped with a diffuser? ❑ Yes X No
7. Name of receiving streams) (,NEW applicants:Provide a map showing the exact location of each
outfallk
Jacob Fork in the Catawba River Basin
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.
0.020 mgd extended aeration facility with influent pump station, manual bar screen,
equalisation tank w/Geyser Air Lift Pump, flow control box, aeration basin, dual
hoppered clarifiers, aerobic digester, table chlorinator, chlorine contact tank, concrete
junction box and polishing pond.
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Form-D 11/12

NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MOD
10. Flow Information:
Treatment Plant Design flow 0.020 MOD
Annual Average daily flow 0.0044 MOD (for the previous 3 years)
Maximum daily flow 0.018 MOD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes R No
12. Effluent Data
NEW APPIJCANTB: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 X07 Monthly Units of
Maximum Average Measurement
Biochemical Oxygen Demand (BODS) 18.3 7.9 MG/L
Fecal Coliform 450 2.6 CFU/100ML
Total Suspended Solids 34.2 24.7 MO/L
Temperature (Summer) 29.7 20.7 C
Temperature (Winter) 12.6 7.1 C
pH 8.4 7.9 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 NC0036935 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.
N-,.ILA ( ,QJi/ MadtitAlo e / c
Printed nam of Person Signing Title
Alio0- / 9-7o)5
Applicant Date
North Carolina General Statute 143-215.6(bX2) 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 a 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 525,000,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.)
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Form-D 11/12

TwA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
January 13, 2015
Jimmy C.Fredell
Pine Mountain Lakes
2885 Pine Mountain Drive
Connelly Springs,NC 28612
Subject: Acknowledgement of Permit Renewal
Permit NC0036935
Burke County
Dear Mr. Fredell:
The NPDES Unit received your permit renewal application on January 13, 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 Maureen
Kinney(919) 807-6388.
Sincerely,
WreAn..Tnzol f oiro('
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