NC0039187_Renewal (Application)_20150311

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 ItC0039187
If you are completing this form in computer use the TAB key or the up -down arrows to mouse 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 Charles W. Burkett, W- Burkett Corp.
Facility Name Valley View Shopping Center
Mailing Address 1332 Biscaya Drive
RECEIVEDIDENRIMR
City Surieide LIAR i. 2015
State / Zip Code Florida 33154 Water Cluallly
Permirtino Section
Telephone Number 305-534-0102
Fax Number 305-673-2075
e-mail Address charles(urkettcompanies.com
2. Location of facility producing discharge:
Check here if same address as above 0
Street Address or State Road US Highway 19/23
City Candler
State / Zip Code NC 28715
County Buncombe
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 Charles W. Burkett, IV - Burkett Corp
Mailing Address 1332 Biscay*Drive
City Surfside
State / Zip Code Florida 33154
Telephone Number 305-534-0102
Fax Number 305-673-2075
e-mail Address [e-mail]
1 of 3 Forrn-D 11112

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 R Number of Employees '
Residential Number of Homes
School Number of Students/Staff
Other ❑ Explain:
Describe the source(s) of wastewater ( ple: subdivision, mobile home park, shopping centers,
restaurants, etc.):
Shopping Center Sl'l'1)1)
)1) `1 Ce
S—Le '111
Number of persons served:
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? 0 Yes X No
7. Name of receiving stream(s) (NEW applicants;Provide a map showing the exact location of each
outfallk
Unnamed tributary to Hominy Creek in the French Broad River Basin
8. Frequency of Discharge: X Continuous 0 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.
A 0.01 MOD facility with manual bar screen, aeration basin with dual blowers, clarifier
with skimmer and sludge returns, tablet chlorinator, chlorine contact chamber, tablet
dechlorinator.
2 of 3 form-D 11112

• NPDES APPLICATION - FORM D
For privately-owned treatment systems treating 100% domestic wastewaters <1.0 MGD
10. Flow Information:
Treatment Plant Design flow 0.01 MGD
Annual Average daily flow NO FLOW MGD (for the previous 3 years)
Maximum daily flow NO FLOW MOD (for the previous 3 years)
11. Is this facility located on Indian country?
❑ Yes X No
12. Effluent Data
NSW LTCAIVTS: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 WA'.
Parameter Daily Monthly Units of
Msucimum Average Measurement
Biochemical Oxygen Demand (BODS) NO FLOW NO FLOW MO/L
Fecal Coliform NO FLOW NO FLOW CFO/100bIL
Total Suspended Solids NO FLOW NO FLOW MG/L
Temperature (Summer) NO FLOW NO FLOW C
Temperature (Winter) NO FLOW NO FLOW C
pH NO FLOW NO FLOW UNITS
13. List all permits, construction approvals and/or applications:
Type Permit Number Type Permit Number
Hazardous Waste(RCRA) NESHAPS(CAA)
UTC (SDWA) Ocean Dumping(MPRSA)
NPDES NC0039187 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 knowle a an belief such information is true, complete a te.
t itr--3;
r11[(--
Printed name of Pe :•n Signing Titlek.L.Lato (J t,, 1, S ✓
/—C1/
Signature of
•li�: t Date
North Carolina = Statute 143-215.6 (bX2) states:Any person who knowingly makes any false statement representation, or certification In any
application,) •. report, plan,.or other document files or required to be maintained under Article 21 or regulations of the Environmental Management
COMM/�implementing that Article, or who falsifies, tampers with, or knowingly renders Inaccurate any recording or-monitoring device or method
required be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article,shall be
PRY of a misdemeanor punishable by a fine not to exceed$25,000,or by imprisonment not to exceed six months,or by both. (1811.S.C.Section 1001
provides a punishment by a fine of not more than$25,000 or Imprisonment not we than 5 years,or both,for a similar ,)
3 of 3 Form-D 11112

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
March 17,2015
Charles W.Burkett,IV
Valley View Shopping Center
1332 Biscaya Drive
Surfside,FL 33154
Subject: Acknowledgement of Permit Renewal
Permit NC0039187
Buncombe County
Dear Mr. Burkett:
The NPDES Unit received your permit renewal application on March 11, 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 Bob
Sledge(919) 807-6398.
Sincerely,
W re. .Tlh-e oVo-ro('
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.org
An Equal OpportunitylAffirmative Action Employer