WQ0005603_STFRPT_19960417

4_
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
April 17, 1996
MEMORANDUM
TO: Brian Wagner
THROUGH: Don Link AV-,
,
FROM: Kay Dechant j5,e.
SUBJECT: Coats American - Sevier Plant
Permit Renewal
GW- 96063 WQ - 0005603
McDowell County
Renewal of the subject permit is recommended. Coats American is currently required to
conduct groundwater monitoring under the subject permit and also NPDES Permit No.
NC0004243. The lagoons associated with the NPDES permit are in the same vicinity as the
subject recycle lagoon. For consistency, the groundwater monitoring requirements should
continue to reference all wells.
Please refer to the attached GW-48 with suggested modification to the existing permit.
Please call me at [phone] if you have comments or questions.

.
ak u. ,.ai�ri... kamirsa .b... .sai +a ess:;AeYz'10.9.$*+ "Cw
. J 7. The facilities shall be effectively maintained and operated as a non-discharge system to
,/ /- prevent the discharge of any wastewater resulting from the operation of this facility.
,ski"
, 8. Diversion or bypassing of untreated wastewater from the treatment facilities is prohibited.
i
i .9. Freeboard in the ash settling pond shall not be less than two feet at any time.
f f 10. Any monitoring deemed necessary by the Division of Environmental Management to insure
/ surface and groundwater protection will be established and an acceptable sampling
reporting schedule shall be followed. The Division will attempt to coordinate any
additional requirements with Coats American.
11. Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to
insure proper operation of the subject facilities.
12. The Permittee.or his designee shall inspect the wastewater recycle facilities to prevent
malfunctions and deterioration, operator errors and discharges which may cause or lead to
the release of wastes to the environment, a threat to human health, or a nuisance. The
Permittee shall keep an inspection log or summary including at least the date and time of
inspection, observations made, and any maintenance, repairs, or corrective actions taken
by the Permittee. This log of inspections shall be maintained by the Permittee for a period
of three years from the date of the inspection and shall be made available upon request to
the Division of Environmental Management or other permitting authority.
13. Any duly authorized officer, employee, or representative of the Division of Environmental
Management may, upon presentation of credentials, enter and inspect any property,
premises or place on or related to the recycle system at any reasonable time for the purpose
of determining compliance with this permit; may inspect or copy any records that must be
( kept under the terms and conditions of this permit; or may obtain samples of groundwater,
surface water, or leachate.
1 Within 90 days of permit issuance, two (2) monitor well
Revi dary and Compliance Bou e meated on the attached site map, to
monitor groundwa lit . s shall be constructed such that the water level in the
well is never abo ow ened (open)portion of the Well at any time during the
year. ver, the location and construe
sheville Regional Office, from which a well construction st bee wells must be obproedd by
oblaincci.
irrealak
shall be sampled every April, August, and December for the following parameters: tr
COD TDS
TOC pH .
Selenium Chloride
Water Level ' Total Suspended Solids
3 SO4 Magnesium
Calcium
Volatile Organic Compounds - In December only (by Method I or Methcxl 2 below)
Method 1: Method 6230D- ( Capillary - Column), "Standard Methods for the
Examination of Water and Wastewater", 17th edition, 1989
Method 2: Method 502.2 " Methods for the Determination of Organic Compounds in
Drinking Water", United States Environmental Protection Agency - 600/4-
88/039

GROUNDWATER SECTION GW # 196 IJ 6,3 I
DIVISION OF ENVIRONMENTAL MANAGEMENT
RECORD OF WASTE DISPOSAL PERMIT APPLICATION REVIEW
EVIEW BY _ N �Pe�ia DATE 4r/ 7 //796 FIELD INVESTIGATION? (YIN) y
AGILITY NAME / a�c �jP/i�o�=�sP-i�ie tk.71- COUNTY
DCATION l/Jr L 2/ nr &'Zc r fi S.Q /.-1F.
YPE OF DISPOSAL SYSTEM(LAGOON, ETC.) .a /J' DESIGN CAP. (GPD)
ESCRIPTION OF FACILITY C� 90 `f/FS X 4/. Z b �ciet0 nit�ntoc� �lgsiA-
IZE OF IMPOUNDMENT(FT. SO.) &/OR SIZE OF APPLICATION AREA
TASTE SOURCE: MUM.SLUDGE MUN.W. WATER: PRIMARY —SECONDARY TERTIARY
ND.SLUDGE IND.WELL WATER 'v OTHERS:
(STANCE FROM WASTE SOURCE TO NEAREST:STREAM -3 '2 FT., WELL FT.
OR WELL:TYPE OF USE , DEPTH PUMP RATE (EST.)
/HAT DESIGN CONDITIONS WILL REDUCE. °CHANCE OF GW CONTAMINATION:
Q�Si 1 /S _ 4ro64E'
1HAT NATURAL SITE CONDITIONS WILL )UOE/INCREASE CHANCE OF GW CONTAMINATION:
./uf'On a'- /9 ,P/.'Sio/j
iEPTH TO:BEDROCK " 6 0 FT., SEASONAL HIGH W.T. FT., ANNUAL W.T. FLUX FT.
SURFICIAL AQUIFER I BEDROCK/ARTESIAN AQUIFER
GEN. LITIIOLOGY St% / am Qio7i7c 6.174i71/7;c. _ �o4Pjss
HYD. COND. 44A. FT./DAY U MEASURED FT/DAY Li MEASURED
ESTIMATED ESTIMATED
THICKNESS THICKNESS -�,5-0 FT.
IO.OF MONITER WELLS:PROPOSED:UP D DOWN 0 ;EXISTING:UP / DOWN
'ROM WORKSHEET:SITE NUMERICAL DESCRIPTION= /c./ - 3 & zcio / ij E-
T 1 2 3 4 5 6 6A 60
SITE GRADE(HYDROGEOL.)= SITUATION GRADE=
'ROPOSED SAMPLING SCHEDULE 8 PARAMETER(S): Same e S iii eX/`$Ji
'AVE THERE BEEN ANY EXCEEDANCES OF THE GROUNDWATER STANDARDS? YES NO
iAS ANY ENFORCEMENT ACTION BEEN TAKEN?YES NO DATE OF ACTION:
3RIEF SUMMARY OF ENFORCEMENT ACTION TAKEN:
REMARKS/RECOMMENDATIONS/ (Continue on reverse, II necessary): 6a_y_i a/er` /}/oT;/ /ih�
S4a/( ,2 n.f�a e Rs StA/4779 / /4 the /etrn li-
SP € cc&.l ec/15. r an- Az,4_51cet_to n S,
GW-48 Revised04194 HYD. REGIONAL SUPERVISOR

uopnbo topolo ono to 1 Aq U�o 1OPun eIS a A °topawl tna°roJ Aq 4pp°ptn Dory..„
haw snow/tootop°nPPY*Om Alancamp")/gldop p U4p4Uopoo l°1pnpunco l ptuppu•141
4 N9p1 MOAN•I 'P°Im odlogatp lopnptno9 4 o0 noI°poM.1
DOS)000ga.!IO10Mpuno10 4°ono'°poM•O
tang.Hod ttpyl Jellfal
p010gtIldo'otoupuopoo
auois
(09 tl°I9) (V do 4n°Io C p alpNJ P11118100 4441010314.1100c1104°NS•d wolf tlglOodw to paogl d.JS4°p1nlY0-3
NIIP00
nog paqusupoo°al°nll4AWNS"JO/(°NI ApQ4°91!°Wldgx+aw Pli•W 'sou Oa,Otpund Agiow p uoppud°p J
twat.Q
(V9 d°IS) (°u0*04040) IWIPnO PwllPpy gam
WG 1O3Jm pp,/
p1°Itwpta.e
�9iy miaow/foods.S
Ian Aq loou.M :q worn p oupoopo3 of ocelot qen usoutao p mad
(S dots) V4ahic
°Ju°pyuoJ 0000P9Uoo FAO!lira 3
t Wopyuoo Am 0
9/ poppuoo Mon.V loop.to AOUI000o ul POUOrryUOJ to°OJB°Q
(p(WS) •
AloOop3 U°HN.PIIda om d)e4 o1"1.000len
PUq p>fJoP°9 H:°Tory .ITS
Yrit 26.11'29.1:°copra Puol IO 1I30p9e
01 wog;tool d6 16 46 )IL 36 N9 86 09 Oo OC 99 el CUd41wo1 N9p°1UI°tl
p AaO
LC-ol 00 N6 30 rL (]e In Di 09 eL 3L 09 el 0-C 6, h°VIl4w
Z ->fJolp°q. tulryoJ u(p)sv-ez_ d6 re oe I 3L 19 09 3V e9 CZSet
i3 eV 30 VI•dl
6S-9V co le 99 HI QL 119 09 3b OP it VC 00 OI-SI o O
ai
Vy OL 1p
II-09 I40 116 a9[ >9 V9 39 OP 31 OL OO 2 o iscod
tg`
pp 3: MJooy- wgo rJ 1(C)
WO JO 30 AL 39 19 'JV 3C k al JI GO OL-Sy f
II I II I II I II I II .1 9g Jn
964041=VI V6 V9 V9 (V�1 (C)1 ° Rq
W VO 0C PUI W°VI pups CZ7 t_ Mgoq poi
PUON A01p S CC- putt ADD WI <NJod- Mot1V(L)woo 411n lo Ott uIxJIM01 7(CC"91 % ttoyi
in;ono g9MpuoS qYn PUo9 wow Oil
upon qw.AqJ .°Ny I0'p 10J tklPgltlld
1 „ ' 'ANIlgpowl
Jo°µwe
J Jo rant
A'oll to OOROW
UNp.IP P°pd o Mop mop
139100113140 114oW1 so uplpWp Iotgpolp
0q19 P.O PU Pq P0I04M1110 P14p40I10
pddns Hddro. WI IJ pua OW IOU UOlout
wpn. MOM *Idol IOW Alddn. C031 UWI
porno; 111o4ao1 !°pm 1°p m 16143 WO
Iuoolta P0OIO4 poo o; piano; Pql 4411ddn
L map ytl pooped pooped P9 wpn1p U41O.NP y Md °Yt U4IO
ul
(C dais) topoaO Jo IODIC UDII1 nN I wog N ppwP o9 A0M0 Pto pitapat) - - uol olJ uo9
'W lU°Pu19 PNP019 P°P0t9 PNPoIO P P Ngl t°IOM IOIOM PO
oP010 P° ol9 P9PO19 pP Ngpl
OWUII9
EGA o4I
J0%900141 wow
031110i g
(C aolS) '1'M 0 C 0 PC 91.0 9yy1 SC9C 099C -0 3 0 ouiq uptol
txyon•yJ qj1J 00-19 WC-10 ♦Wy loss
J WW1 Mgoq
°O 0 1.9 CLSI PC L-9 lit dy-yl 6y0C 09OC ♦o) oo°i ;dopopin°4143
0 9 L 9 9 V C stop
W 41doP B1(1°1u1>ip3
V-°rion•W C I 0 °40A 14Od Z--O{TS
Mo01P°q Mgowu°d Allood 4:9.°nqa'Id YpdiP°q Nglwunod 4 019p1+°IOAn 0 'Him
(NZ-0 WI.19 096-191 0001.109 OOe9-001C 1°W
(1 dW� 09-IC 091-101 CO2-19C WIC-1W1 ♦COW 4°pu01 'OUo°I
p
1>1°A'W °OuOpp 0.0 O1-01 �•� VL•09 6eL-09I OWL•OWI u°IaU 1°N°N/Odra l.J6n
_� do en•9L 066-000 ♦CCIOL 40000piO Ptow+wl UOIIOUALOI
0 O /!- 9 L 9 9 P C C 1 0 °nnoA 14od "�Ib;1n°p oq;Ptnob to
IqP WI°41uIW°0
#//iL THIS
AFC :ojnp
.,(i'°.. • •toMe1Ao•
S tl M
Munoz,
-, Ad/misc.- l/b?//c/ �S T AHIIJpi •
133HSNUOM M3IA3EI N011vollddb 1IWti3d 1VSOdSIG 31SVM
r`

•
WASTE DISPOSAL PERMIT APPLICATION REVIEW WORKSHEET (CONT.)
luau
F/ • NI.nut desap
—(2._ a3z. if5ss _
Total Step 1 Slop 2 Stop) Step 4 Step 6 Step 6A Step 6B
(Add Steps l•4(Omit letters))
Site Grade Based on Hyd lopeologic Parameters .
21.111
Hcztard Potential Main Wenner•(IFM) .
(Choose One)
D G I
B E II •
A O- F gg'
IBMdI
nal
(1)Nuneilcol VW Desaptlon(from Step 7) Told Porrn/Sorp• Ii7N
Q)PAR VALUE(Stage S) Z
SITUATION RATING:(I)-Q) I_ hJ 1 S _U
(table below) �
SITUATION GRADE • ' ^ f
m em ro 1 T 1
(fee table below)
Kin SIIUAR� - I I
(f49 fable below)
•
SITUATION RATING TABLE
To be reed for Step v(Nahrr01)and Step 10(Modified)
SITUATION RATING PROBABILITY OF (Step 10)
(Combined Value) CONfAhYNATION SITUATION
•
DEGREE OF ACCEF'fA&L1IY GRADE
8 a leehipobo1M
ProbabV acceptable A
•7bd 7
I'rababfyacceptable or B
ar Jbwl 7 at >afy r"OQeptable
Acceptance rrtagloh C
M b+7 Probably
Probably unacceptable D
4 amare VW Probable ofr*y acceptable
Ahwft certain to be .F
unacceptable
The proboWIty of contamarnkratlan Dam situation haying values between 17 and-
satkfaclaly. Therefore.INf range of values repreaentW7 Y d onlyf to a question
Try wades B and C.Y designed only by a question mark.
Acceptance
m or refection of as slse for the Mended purpose Y a refponfpyryy of me particular agency
rghsPa requirements of Sfe agency a on feoslbAlty and execution of approved
a eerhgp n on(Stage

•
DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
May 17, 1996
MEMORANDUM
To: Carolyn McCaskill UHT ®'
D
Though: Bob Cheek I's c.. MAY 2 31996 I_ ,
From: Brian Wagner/L,—
Groundwater Section
Asheville Regional Office
Subject: Coats American-Sevier Plant
Recycle System
McDowell County
WQ0005603/GW96063
(Rick Moore : DEM SERG Review Engineer)
The Groundwater Section has reviewed the subject permit renewal application. The facility conducts
groundwater monitoring both for this permit and an NPDES permit. Monitoring data indicates an increasing
trend and sporadic exceedences of TDS,TOC, Chloride, Sulfate,Magnesium, Calcium and VOC. Please note
that we are dropping TSS, COD and Selenium from the sampling requirements. The NPDES permit should be
changed to reflect these monitoring changes. We recommend reissuance of the permit with the following
conditions:
*1. The Groundwater Section's computerized compliance monitoring system requires numerical
monitoring well names. Therefore,the following monitoring well(s) shall,in the future,be
designated with the following sequential name(s):
Old Name New Name
K80L-2 MW-2
KSOL-10 MW-10
K80L-11 MW-11
KSOL-12 MW-12
K80L-13 MW-13
K80L-I4 MW-14
This(ese) name(s) shall be used in all future correspondences with the Groundwater Section
regarding this nondischarge permit.
2. Monitor wells MW-2 (formally K8OL-2),MW-10 (formally K80L-10), MW-11 (formally KSOL-
11), MW-12 (formally K80L-12), MW-I3 (formally K80L-13), and MW-14 (formally KSOL-14)
shall be sampled every April, August and December for the following parameters:„
TDS TOC
Water Level pH
Chloride Sulfate
Magnesium Calcium
Volatile Organic Compounds -In December Only(by the method below)

... - Method-6230D (Capillary-Column), "Standard Methods For The Examination of Water and...:. . ..':
Wastewater", 17th ed., 1989 - -
2. The measurement of water levels must be made prior to sampling for the remaining parameters.
The depth to water in each well shall be measured from the surveyed point on the top of the casing.
3. The measuring points (top of well casing) of all monitoring wells shall be surveyed to provide the
relative elevation of the measuring point for each monitoring well.
< 1 Jf TOC concentrations greater than 10 mg/1 are detected in any downgradient monitoring well,
additional sampling and analysis must be conducted to identify the individual constituents
comprising this TOC concentration. If the TOC concentration as measured in the background
monitor well exceeds 10 mg/l,this concentration will be taken to represent the naturally occurring
TOC concentration. Any exceedances of this naturally occurring TOC concentration in the
downgradient wells shall be subject to the additional sampling and analysis as described above.
*5. If any volatile organic compounds are detected by method 6230D,then the Asheville Regional
Office groundwater supervisor[phone number: [phone]] must be contacted immediately for
further instructions regarding any additional follow-up analyses required. The results of all initial
and follow-up analyses must be submitted simultaneously.
6. The results of the sampling and analysis shall be sent to the Groundwater Section,Permits and
Compliance Unit, P.O. Box 29578 Raleigh,N.C. 27626-0578 on Form GW-59 [Compliance
Monitoring Report Form] every May, September and January.
*7. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall be
provided. The Division will attempt to coordinate any additional requirements with Coats
American.
8. The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in 15A
NCAC 2L, Groundwater Classifications and Standards. The Compliance Boundary for disposal
systems constructed after December 31, 1983 is established at either(1) 250 feet from the waste
disposal area, or(2) 50 feet within the property boundary,whichever is closest to the waste
disposal area. An exceedance of Groundwater Quality Standards at or beyond the Compliance
Boundary is subject to immediate remediation action in addition to the penalty provisions
applicable under General Statute 143-215.6A(a)(1).
9. In accordance with 15A NCAC 2L, a REVIEW BOUNDARY is established around the disposal
systems midway between the Compliance Boundary and the perimeter of the waste disposal area.
Any exceedance of standards at the Review Boundary shall require remediation action on the part
of the pemuttee.
•
®-arnrtaleiiOt�
Permit Files
baw/96063.doc

[I] ECEIV. 1DI
DIVISION OF ENVIRONMENTAL MANAGEME APR 121996
GROUNDWATER SECTION
�/°^ `( °J 9 q� Asheville Groundwater
Office
MEMORANDUM
TO: -Oa,.) L,L k .
71- S eieuSe Regional Office
FROM: IJ/ZVA k (.VAS tie A-
SUBJECT: Application for l/P.ermit R'enewai)
Permit Amendment
New Permit /
Facility Names C0.1�s AMe2lcAti - SQV /"�ICR 'CIL
County: Mc Dcu.e /1
•
Type of Project : 7ztc/c_/e
APPLICABLE PERMIT NO. s : a'C.O S603' ` C v63
DEH A to C
UIC EPA CUA
• The Groundwater Section has received a copy of the referenced permit
application, a copy of which should have been sent to your Regional
Water Quality Supervisor - IF A COPY HAS NOT BEEN RECEIVED IN THE
REGIONAL OFFICE, PLEASE LET ME KNOW.
✓ The Groundwater Section has received_a-copy of th_erreferenced_permit
application. (A_copy of_the app Caton-documents we received sl
-attached:
The Groundwater Section has received a subsurface disposal project
from the Div. Env. Health' s On-Site Wastewater Section. A copy of
the application has been forwarded to DEH' s Regional Soil
Specialist, . Please coordinate your review with
that Soil Specialist .
_ --Please_review the application materials for completeness . If you feel
additional information is necessary, please let me know no later than
(' 4p..&i ,9 ,9 5 C )1. A copy of any formal request for additional information ;
will be= ed to you.
If you do not need any additional--unformati\to complete your review,
please provide your final comments. br i.I/ So 9 .'If you request and/or
receive additional information, your\fi al is are due no later than
14 days after you receive the additional information`?
\TRANS.SHL • .

,« '_,_. .-.Department Environment, Health anc -- `'atural Resources
D'et • ; ion of Environmental ML_::.gement
Non-Discharge,Permit Application Form
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
IC
• RECYCLE FACILITIES -
3.
I. GENERAL INFORMATION: pIECFCIl�IID MAR 2 9 133 .
1. Applicant's name(please specify the name of the municipality, corporation, individual, etc.):
Coats American — Sevier Plant '
2. Print Owners or Signing Official's name and tide (the person who is legally responsible for the facility amPits compliance)
• W. R. Stuckey, V.P. General Engineering & Environmental Services tr K
01
tom-.
3. Mailing address: P. 0. Box 368 r `
c
City: Marion State: NC Zip: 28752A a,3 p
ro
704 756-4111 5 G.p
Telephone Number: ( )
4. Project Name(please specify the name of the facility or establishment- should be consistent on all documents included:
Wastewater recycle system — settling basin
•
.5. Location of Recycle Facility(Street Address): Highway 221 North
City: Marion North Carolina
State: ' Zip: 28757
6. Contact person wbd can answer questions about application:-
Name: Jerry Sisk Telephone number: ( 704 ) 756-4111
7. Latitude: ;Longitude: of recycle facility location
S. Application Date:
9. Fee Submitted: S yo-.00 ()1L7( he permit processing fee should be as specified in 15A NCAC 2H .0205(e)(5).]
10. County where project is located: [
II. PERMIT INFORMATION: pp
1. Application No. (will be completed by DEM): f3 QOU O 5 (`5 . .
2. Specify whether project is:_new; x renewal`; modification
For renewals, complete only sections I, II, and applicant signature(on page 6). Submit only pages 1 and 6 (original and
three copies of each). Engineer's signature not required for renewal without other modifications.
3. If this application is being submitted as a result of a renewal or modification to an existing permit, list the existing permit
number W00005603 and its'issue date 4/16/92
- 4. Specify whether the applicant is public or x private. [TEC E p U
APR 121996 D
FORM: RF 06/94 Page 1 of 6
Asheville Re' ona Office

•
III, INFORMATION ON WASTEWATER:
1. Nature of Wastewater: ' %Domestic; • % Commercial; ' %Industrial; f
% Other waste (specify): •
. . - ..
2. Please provide a one or two word description specifying the origin of the wastewater, such as school, subdivision, hospital,
commercial, industrial, apartments, etc.:
- 3. Volume of recycle water generated by this project: gallons per day -
4. Explanation of how recycle water volume was determined:
•
5. Brief project description:
IV. DESIGN INFORMATION
1. Provide a brief listing of the components of the recycle facilities, including dimensions, capacities, and detention times of
tanks,pumping facilities, high water alarms, filters, ponds, lagoons, etc.: -
•
2. Name of closest downslope surface waters: - -
3. Classification of closest downslope surface waters: (as established by the Environmental Management
Commission & specified on page 4 of this application -This classification must be provided by the appropriate Regional
Office prior to the submittal of the application).
4. If a power failure at the facility could impact waters classified as WS, SA, B, or SB, describe which of the measures are
being implemented to prevent such impact, as required in 15A NCAC 2H .0200:
•
- - _;1i
;'�s -�• ipf t -
44
t' i• t' Fine?� t r wA
�FQ�RM: RF 06/94 Page 2 of 6

5. The facilities mustconfoni<<IS the following`buffers(and all other applicable uffers):
•
a) 400 feet between a lagoon and any residence under separate ownership; -
b) 1G0 feet between a surface sand filter and any residence under separate ownership;
d 100 feet between the recycle facilities and any private or public water supply source;.
d1 •100 feet between the recycle facilities and any streams classified as WS or B and any waters classified as SA or Sli.; . :
e) 100 feet between the recycle facilities and any other stream, canal,marsh,coastal waters,lake or impoundment;
• f) 50 feet between the recycle facilities and property lines. . ._
6. If any of the buffers specified in No. 5 above are not being met, please explain how the proposed buffers will provide equal
or better protection of the Waters of the State with no increased potential for nuisance conditions: .
•
•
•
•
7. Are any components of the recycle facility located within the 100-year flood plain? Yes; No. If Yes, briefly
describe the protective measures being taken to protect against flooding.
•
r .
•
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF: -
ENVIRONMENTAL ENVIRONMENTAL MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS. ARE•
. ,
INCLUDED WITH THE SUBMITTAL
a: One original and three copies of the completed and appropriately executed application form.
b. The appropriate permit processing fee,in accordance with 15A NCAC 2H .0205(c)(5). .
c. Five (5) sets of detailed plans and specifications signed and sealed by a North Carolina Professional Engineer. The plans must
include a general location map, a site map which indicates where any borings or hand auger samples were taken, along with
buffers, structures, and property lines. Each sheet of the plans and the first page of the.specifications must be signed and sealed.
d For industrial wastewater, a complete chemical analysis of the typical wastewater must he provided. The analysis may include,
but shall not be limited to, Total Organic Carbon, BOD, COD, Chlorides, Phosphorus, Nitrates, Phenol, Total Trihalomethanes,
TCLP analysis, Total Halogenated Compounds,Total Coliforms, and Total Dissolved-Solids.
e. If lagoons are a part of the facilities and the recycle water is industrial, provide a hydrogeologic description of the subsurface to a
depth of 20 feet or bedrock, whichever is less. The number of borings shall be sufficient to define the following for the area
underlying each major soil type at the site: significant changes in lithology, the vertical permeability of the unsaturated zone, the
hydraulic conductivity of the saturated zone,and the depth of the mean seasonal high water table.
f. Five copies of all reports, evaluations, agreements, supporting calculations, etc., must be submitted as a part of the specifications
. which are signed and sealed by a North Carolina Professional Engineer. Although certain portions of this required submittal must
be developed by other professionals, inclusion of these materials under the signature and seal of a North Carolina Professional
Engineer signifies that he has reviewed this material and has judged it to he consistent with his proposed design.
g. Five(5) copies of the existing permit if a renewal or amodification.
•
FORM: RF 06/94 Page 3 of 6

• . r r Y:
This form must be completed by the appropriate DEM regional office and included as a part of the_project '
submittal information.
•
INSTRUCTIONS TO NC PROFESSIONAL ENGINEER: -
The classification of the downslope surface waters(the surface waters that any overflow from the facility would flow toward)
in which the recycle facility will be constructed must be determined by the appropriate DEM regional office. Therefore,you
are required, prior to submittal of the application package, to submit this form, with items-1 through 7 completed
to the appropriate Division of Environmental Management Regional Water Quality Supervisor(see page 6 of 6). At a
minimum, you must include an 8.5" by 11" copy of the portion of a 7.5 minute USGS Topographic Map which shows the
location of the recycle facility and the downslope surface waters in which they will be located. Identify the closest downslope
surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and
submit the application package.
1. Applicant(specify name of the municipality, corporation, individual, etc.):
2. Name&complete address of engineering firm:
Telephone number: ( ) •
3. Project name:
4. Name of closest downslope surface waters:
5. County(ies)where the recycle facility and surface waters are located:
6. Map name and date:
7. NC Professional Engineer's Seal, Signature, and Date:
•
TO: REGIONAL WATER QUALITY SUPERVISOR •
-
Please provide me with the classification of the watershed where these sewers will be constructed, as identified on the attached
map segment
Name of surface waters: •
Classification (as established by the Environmental Management Commission):
Proposed classification, if applicable:
Signature of regional office personnel: Date:
(All attachments must be signed) •
FORM: RF 06/94 . Page 4 of 6

Name and Complete Address of Engineering Firm:
•
_ City: State: Zip:• • • --
• Telephone Number ( • )
Professional Engineer's Certification:
I, ••
, attest that this application for
•
has been reviewed by me and is accurate and complete to the best of my knowledge. I further attest that to the best of my knowledge
the proposed design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal
package may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that-I have
reviewed this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
•
•
•
Applicant's Certification:
•
I, W. R: Stuckey , attest that this application for wastewater. recycle --
system - settling basin
has been reviewed by me and is accurate and complete to the b best of my knowledge. I understand that if all required parts of this -
application are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete.
Signature 'mot// Date 3 1 -94i
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION -AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT •
WATER QUALITY SECTION
PERMITS AND ENGINEERING UNIT
• POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
• TELEPHONE NUMBER: (919) 733-5083
FORM: RF 06/94 Page 5 of 6

DIVISION OF ENVIRONMENTAL MANAGEMENT.::REGIONAL OFFICES (11/93) . ..
I
egrona up trsor Washington Regional WQ Supervisor Raleigh Regional WQ Supervisor
OL9►WWoodfin av . - - Post Office Box 1507 • .Post Office Box 27687
.. hevill--N 88f in Washington, NC 27889 Raleigh, NC 27611
tra04)1251 o - [phone] [phone] t
�Faxt(�7i°, .461 La.: Fax [phone] Fax [phone]
Avery Macon - - - Beaufort Jones • Chatham Nash
Buncombe Madison Bertie Lenoir Durham Northampton
Burke eM iowetl Camden Martin Edgecombe Orange
Caldwell Mitchell Chowan Pamlico Franklin Person
Cherokee Polk Craven Pasquotank Granville Vance
Clay Rutherford Currituck Perquimans Halifax Wake
Graham Swain Dare Pitt Johnston Warren
Haywood Transylvania Gates Tyrell Lee Wilson
Henderson Yancy Greene. Washington
Jackson Hertford Wayne
Hyde
• Fayetteville Regional WQ Supervisor Mooresville Regional WQ Supervisor Wilmington Region. WQ Supervisor
Wachovia Building, Suite 714 919 North Main Street 127 Cardinal Drive Extension
Fayetteville, NC 28301 Mooresville, NC 28115 Wilmington, NC 28405-3845
[phone] [phone] [phone]
Fax [phone] Fax[phone] Fax[phone]
Anson Moore Alexander Mecklenburg . Brunswick . New Hanover
Bladen Robeson Cabarrus Rowan Carteret Onslow
Cumberland Richmond Catawba Stanly Columbus Fender
Hamett Sampson Gaston Union Duplin
Hoke Scotland Iredell Cleveland
Montgomery Lincoln
Winston-Salem Regional WQ Supervisor - .
8025 North Point Boulevard,Suite 400 •
Winston-Salem, NC 27106 .
_ [phone]
' Fax [phone]
Alamance Rockingham' - -
Alleghany Randolph ,
Ashe Stokes
Caswell Surry
Davidson Watauga
Davie Wilkes -
Forsyth Yadkin
Guilford
•
•
FORM: RF 06/94 Page 6 of 6