WQ0041789_Pump and Haul Permit Application_20200714

i
Pilgrims Staley WQ0005681
On the evening of June 111h, the Pilgrims Hatchery and Feed Mill facility located in Staley received an
excessive amount of rainfall in a short amount of time that overwhelmed our waste water treatment
system. In addition, we experienced an electrical system outage caused by the storm event system that
kicked our wastewater treatment works offline. Our weather station was part of the system that was
shut down due to the power outage. Prior to shutting down the weather station recorded 3.1 inches of
rain In a vPry chnrt nprind Prinr to the ctnrm event Mir irrigAtinn rPIIC tree hnnrrl mine 1 S' The
excessive storm water that entered our treatment system reduced our lagoon level free board to.7 on
June 12"'.
Looking at the forecast and our saturated soils, we realized that the only way to prevent a lagoon over
topping event and potential berm failure was to pump and haul the water in these cells to another
permitted facility. We discussed our situation with Jim Gonsiewsl<i and Patrick Mitchell and upon
receiving their email we initiated hauling waste water with our contractor Total.Environmental, the
evening of June 12th and by the afternoon of June 13 soil conditions had improved well enough to
permit limited land application activities. By June At' both lagoons again had a foot of freeboard.
However, with more rainfall expected on June 15-18 we have decided it best to bring the lagoon levels
to 2 feet of freeboard.
We appreciate the help of Jim Gonsiewski and Patrick Mitchell in our emergency situation by allowing to
begin hauling immediately. Their decisive action helped us to reduce the possibility of a lagoon breach
and potential berm failure. We have determined that the fastest and best way to prevent this from
reoccurring is to eliminate as much inflow and infiltration of storm water into our system as possible.
We are in the process of re -engineering the infiltration of storm water away from any wastewater
collection system. We feel this analysis of our system and acting on those findings now will prepare us
as we enter the 2020 hurricane system.
We thank you and your teams help during our recent emergency. Should you have any questions please
feel free to contact me at [e-mail] or 919-498-4471.

State of North Carolifia
Department of Environmental Quality
DWR_
_Water-Resounes
15A NCAC 02T .0200 - WASTEWATER PUMP AND HAUL SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM P&H 01.16 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100. i5A NCAC 02T.0200, and Division policies. Failure to submit
all required items will necessitate additional processing and review time. For more information, visit the Wastewater Branch's
website or contact the Regional Office serving your county.
General —This permit application applies to all pump and haul activities of wastewater under the authority of the Division on Water
Resources. Permit coverage is required for the system producing the wastewater. This permit does not apply to the transport of
animal waste from an animal waste management systems, not the transport of wastewater residuals or biosolids.
NOTE: Pump and haul permits are not acceptable long term domestic wastewater treatment alternatives and shall only be issued
in cases of environmental emergencies, nuisance conditions, health problems, or for unavoidable delays in construction of system
previously permitted by the Division.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Pre -submittal Contact & Cover Letter
❑ Contact the appropriate Regional Office prior to submittal
❑ Submit a cover letter explaining the circumstances associated with this pump and haul permit request
B. Application Fee (Domestic Wastewater Only)
❑ Submit a check made payable to: North Carolina Department of Environmental Quality (NCDEQ)
The appropriate application fee is: $810.00 for flows < 10,000 GPD and $1,310.00 for flows > 10,000 GPD
C. Wastewater Pump and Haul (FORM: P&H 01-16) Application:
❑ Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H 01-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or
due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to
correspond to the section and item to which they refer
D. Receiving Facility Letter:
❑ Submit a letter from the owner/authority of the receiving wastewater treatment facility, as required by 15A NCAC 02T .0204
(b), stating thatthe pumped and hauled wastewater will be accepted and specifying the volume and type of wastewaterthat
will be accepted. The letter should be signed by an authorized signing official in accordance with 15A NCAC 02T.0106(b)
E. Contract Hauler Letter:
❑ Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
❑ Letter shall include: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:
❑ The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T.0106(b). Per 15A
NCAC 02T .0106(c) an alternate person may designated as the signing official if a delegation letter is provided from a
person who meets the criteria in 15A NCAC 02T .0106(b)
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer (if required)
G. Plans and Specifications (Required for activities that result in the Practice of Engineering per G.S. 89C-3):
❑ Submit two sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional Engineer)
❑ Plans must include:
A general location map
Diagram of the components associated with the pump and haul activity (drains, piping, tanks, pumps, etc)
Tank Details that indicate high water alarm
Other items as required
INSTRUCTIONS FOR APPLICATION P&H 01-16 Page I of 5

Industrial Pump and Haul Activities
Per 15A NCAC 02T .0203(A)(2), Industrial pump and haul activities are deemed permitted provided the following criteria is met:
The facility notifies the appropriate Division regional office in writing advising of the type of operation, type and quantity of
wastewater generated, location, and the receiving wastewater treatment facility. A letter from the facility accepting the
wastewater (tjpe and quantity) specifically agreeing to accept wastewater from the applicant shall be included
m.a
> The wastewater does not contain any human waste.
i The waste is collected and discharged into a sewer or treatment system designed and permitted to accept the type of
wastewater being pumped and hauled.
The pump and haul activity is not to alleviate a failing wastewater system.
The Division regional office concurs in writing that the activity meets the criteria in this Rule.
CONTACT THE REGIONAL OFFICE PRIOR TO INITIATING ANY INDUSTRIAL PUMP AND HAUL ACTIVITES. SUBMITTAL OF THIS
APPI IrATIr1N/nnfI IMFNTC ANn IA/RITTFN APPRnVAI K CTII I RFOl11RFn FQR INnI IgTRIAI Pl lMP ANn HAI11 ArTI /ITIFC
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE
APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Operations
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Operations
Fayetteville, North Carolina 28301
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Operations
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Operations
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Operations
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Operations
Wilmington, North Carolina 28405
Hanover, Onslow, Fender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
(336)-776-9800
INSTRUCTIONS FOR APPLICATION P&H 01-16 Page 2 of 5

1. PRESUBMITTAL INFORMATION:
- - T - - —
1. Contacted representative from regional office_(Pre-submittal)? Yes No
2. Contact name (For Regional Office): Jim Gonsiewski and Patrick Mitchell
IL. APPLLCANTANFORMATION:
1. Applicant's name (Municipality, Individual, Corporation, etc): Pilgrims
2. Applicant type: ❑ Municipal ❑ State ❑ Privately -Owned Public Utility
❑ County ® Other: Industr
3. Origin of Wastewater:
❑ Residential Subdiui=inn ❑ Rctoil (Ctnraq Chn Pnina� fa�arQ nnmactir• I6%
❑ Apartments/Condominiums ❑ Institution Commercial: %
❑ Mobile Home Park ❑ Hospital Industrial: 84 %
❑ School ❑ Church Other: %
❑ Restaurant ❑ Nursing Home
❑ Office ® Other (specify)
4. Signature authority's name: Jamal Mohammed per 15A NCAC 02T .0106(b)
Title: Complex Manager
5. Applicant's mailing address: 484 Zimmerman Rd
City: Sanford State: NC Zip: 27330-
6. Applicant's contact information:
Phone number: [phone]
III. CONTACT/CONSULTANT INFORMATION:
1. Contact name:
Title/Affiliation:
2. Contact's information:
Phone number: (_)_ Email:
IV. RECEIVING FACILITY INFORMATION:
Email: [e-mail]
If more than 1 facility has agreed to accept the wastewater, please list all the owners, facility names, and permit
numbers as a separate attachment)
1. Owner: See separate attachment
2. Facility name:
3. Facility permit number:
4. WWTF permit number:
5. WWTF contact name:
Title/Affiliation:
6. WWTF contact information:
Phone number:(_)= Email:
APPLICATION P&H 01-16 Page 3 of 5

V. PROJECT INFORMATION:
- - - -
1. Location of Project physical address] 2607 Old 421 R fBtaley, NC
Approximate Coordinates (Decimal Degrees): Latitude: 35.48'390 Longitude:-79.33'200
2. Duration of Pump and Haul Request (Six Months Typical): 6 months
3. Has a prior permit been issued? ® New ❑ Prior Pump & Haul Permit
Permit No.:
4. Permanent Method of Wastewater Disposal: Spray Irrigation
5. Date Permanent Disposal will be available:
6 Have permits / approvals for permanent disposal been obtained?
® Yes ❑ No Permit Number: W00005681
7. Is there a Pretreatment Program in effect? ❑ Yes ® No
8. Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: 4725 daily average over last 12 month Gallons per Day
10. Explain how the wastewater flow was determined: ® 15A NCAC 02T .0114 or ❑ Representative Data
If representative data, describe:
11. Describe Tank / Container wastewater will be pumped from (attach description if necessary):
204,000 gallon lined lagoon
12. Is Tank / Container in place or will it be installed (attach description if necessary):
in place
13. What type of high water alarm does the container have (and/or):
❑ Audible and Visual ❑ Telemetry (Auto Dialer / SCADA)
VI. CERTIFICATION:
Applicant's Certification: (Signature of Signing Official and Project Name)
Mo - i ( , attest that this application for has been reviewed by me and is
accurate and complete tothe best of my knowledge. I understand that if all required parts of this application are not completed
and that if all required supporting documentation and attachments are not included, this application package is subject to
being returned as incomplete. I understand that issuance of a permit will require pump and haul facilities or activities to be
inspected at least daily by me or a designated representative. Note: In accordance with North Carolina General Statutes 143-
215.6A and.143-215.66 any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties
up to $25,000 per violation.
Date - `.....
i
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
ACTIVITIES SHALL BE INSPECTED AT LEAST DAILY BY THE PERMITTEE OR IT'S REPRESENTATIVE PER 15A NCAC 02T .02041d1.
APPLICATION P&H 01-16 Page 4 of 5

THE ENGINEER'S CERTIFICATION 15 REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER G.S. 89C•3.
---ENGINEERING-DOCUME-NTS MUST -BE -COMPLETED -PRIOR -TO SUBMITTAL --IF-CER-T-IFJCATION-&Y-AND-ENGINEERAS.REQU.IRED,__
THIS PAGE IS NOT NECESSARY.
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
I, ,attest that this application for - y has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation 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 all the applicable regulations. Although other professionals may have developed certain portions
of this submittal package, 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. Note: In accordance with NC General Statutes 143-215.6A and
143-215.6E any person who knowingly makes any false statement, representation, or certification in any application shall be
violation.
2a.
Professional Engineer Name
2b.
Engineering Firm
2c.
Mailing Address
2d. 2e. 2f.
City State Zip
2g. '2h. 2i.
Telephone Facsimile : E-mail NC PE Seal, Signature & Date
APPLICATION P&H 01-16 Page 5 of 5

Pump and Haul Application for Staley, NC Pilgrims WQ0005681
e'Eir.: Ein: a rcfia .tiT. . .::v v i �...... =.r . ..-. ....vy: rc .. _..i• n _. _... e..�, o u�.._ n. v._v_�+ v.. .c. _ems_ - "'.`='e.�gn'
IV. RECEIVING FACILITY INFORMATION:
1. Owner: City of Asheboro
2. Facility name: Asheboro Waste Water Treatment Facility
3. Facility permit number:
4. WWTF permit number: NC0026123
Title/Affiliation: Plant Manager
6. WWTF contact information:
Phone number: [phone] Email: mwiseman Dci.asheboro.nc.us
1. Owner: City of Sanford
2. Facility name: Big Buffalo Wastewater Treatment Plant
3. Facility permit number:
4. WWTF permit number: NC0026123
5. WWTF contact name: Scott Siletzky
Title/Affiliation: Plant Manager
6. WWTF contact information:
Phone number: [phone] Email: [e-mail]

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699 1646
Fee assessments and waste determinations will be required at the discretion of the wastewater
treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream.
I, Michael R. Wiseman, ORC, WW4#987680. City of Asheboro Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1032 Bonkemever Drive Randleman NC 27317 _
® (Address)
336-672-0892 do hereby authorize Zac Scott
(Phone Number) (Owner/Operator of Septage Management Firm)
of Total Enviro and Septic Inc NCS# 01525
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste
grease Septage (grease trap pumpings) _ X commercial/industrial Septage X
of Pilgrim's Pride Corp Staley NC Randolph County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1032 Bonkemever Drive, Randleman NC 27317
(Location)
between the hours of 7:00 a.m. to 5:00 p.m. Monday - Friday Onlv __
Reintroducing partially treated liquid into a grease trap is acceptable _Yes X No
This authorization shall be valid until December 31 2020
(Usually December 31, Year)
Signed , Date 6/9.1102 o
(Facility Operator)
Subscribed and affirmed before me this 16 �'
5-,�--
(Votary Public)
W et t(.,1� -7— S(k W c:1C i
day of 20 Z.o
My Commission expires: Q0,-tj�2
Note: Falsification of this document by the septage management firm shall lead to perr
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2019 Firm Application/WWTP Authorization Form 2019

-------.®�, ----532?{rsrrFurnaee�
Sanford, NC 27331-3729 Sanford, NC 27330
CITY Of ANFO D
Scon Siletzt,v WASTEWATER MANAGEMENT FACUTV
Phone: (919)775-$305
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
Fee assessnients and Waste dMerminations will e required at the discretion of the wastewater treatment facility. The
facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream.
(Plant Operator and Name of Plant)
5327 Iron Furnace Rd- Sanford NC 27330
(Address)
[phone] do hereby authorize Zac Scott
(Phone Number) (Owner/Operator of Septage Management Firm)
Of Total Enviro Septic & Waste LLC NCS - 01525
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage x , portable toilet waste x
grease septage (grease trap pumpings) commercial/industrial septage x , from
Pilgrim's Pride ( Lee County "Only'
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of 8am-5pm Monday -Friday
Reintroducing partially treated liquid into a grease trap is acceptable _Yes X No
This authorization shall be valid until
=4
Date
Sworn to and subscribed before me this _ --1—A 1 day of �n , 20 2n
4 41, n &'Z My Commission expires: (D2-(YI-2b21
L,/ (tytaryPublic)
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shalt lead to permit revocation.

NORTH CAROLINA
Environmental Quality
Permit and Registration
Total Enviro
is hereby issued a Septage Management Firm Pentut,
Permit Number NCS-01525
And by virtue of completing the annual training
requirements is hereby registered as a
Septage Management Firm
in the State of North Carolina.
o.pammem or umm�momel numlty
This permit to operate a Sepmgc tALanagemem Pirm is issued to the abucL named person, business nr 11Mn- alums and is not ttansFcmblu to I,% other person, business ur entity',
Lima operation .:hall bL in accordance „ith the provisions of N .General 5mtum 1311.A-291.1 - 131i A-2913,'1'ide 15 V of N.C. A dminisn'atice 1,ndL 13B .1IHIIII d..eq.,
conditions of the permit, and represenmtiunn mad, in the appkation and 'Co umpanrigq docunents tina pamrc.
I I, permit hnldcr a vudnalaed tit disehntgc scpmgc oah 'at tha La-adons(s) liacd bcln,e
1. Big Buffalo AC'1G" TP, Sanford NC
This permit dues nn1 cntitic the permit hnldcr, to operate a �,ptagc I and Application 1I[C, n Sepragw Detention or'I reanncnt Pnellin', or amother solid ,taste mnnagcmcnt Pneilin,
not staclfrd hcrufn.
I�ailure to operate as permitted mac result in the Dcpartmcnt' suspending nr r, ok.,,g the pwm ,, tool.ning nehon to cnh iin the unP,,aatt,,d operatov, imposing adminiilrativc
penalties, ur invoking nnc other remedy as padded in Chaprcr 131 LA, AI lid, I. part 2 of ds Noah Carulim Gencrnl Jnntres. 'Phis purmrc and registration expires on
December 31, 2020,
Digitally signed by Adam
Adam Ulishneypai1eZ 20.05.1115:56:13-04'00
Adam Ulislmec, Environmental Compliance Branch Head

-5
-----POBox29O3-- — -919. 708 056-----
Sanford, NC 27330 Tota1env1roseFA1c.nc@gm
Truck Information
2000 Mack Septic Hauler
FAVATiTIA Irbe
• License Tag #: YA154564
• Tank Capacity: 4,000 Gallon
2.) 2000 International Vactor 2100
* VIN#: IHTGMADR4YH321461
9 License Tag #: JZ5012
9 Tank Capacity: 1,000 Gallon
3.) 2013 International Vactor 2100+
• VIN#: IHTGRSJT3DJ35167/4
• License Tag #: YA154563
• Tank Capacity: 1,300 Gallons