Avery Co. Industrial Pump & Haul

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0200 — WASTEWATER PUMP AND HAUL SYSTEMS
DIvlslon of Water Resources INSTRUCTIONS FOR FORM P&II 0146 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A 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
f3. Application Fee (Domestic Wastewater only)
❑ Submit 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 that the pumped and hauled wastewater will be accepted and specifying the volume and type of
wastewater that will be accepted_ The letter should be signed by an authorized signing official in accordance with 15A
NCAC 02T .0106(b)
E. ntract 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 Certifleatlon 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 be 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'(Requlred 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:
D A general location map
l 'd OLS9'ON saia}snpuI o;j[V AVti8:9 8l0Z "Z 'AdV

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:
A 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 (type and quantity) specifically agreeing to accept wastewater From the applicant shall be included.
➢ The wastewater does not contain any human waste.
➢ 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
APPLICATION/DOCUMENTS AND WRITTEN APPROVAL iS STILL REQUIRED FOR INDUSTRIAL PUMP AND HAUL ACTIVITIES
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE
APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
Asheville Regional Office
Water Quality Operations
Fayetteville Regional Office
Water Quality Operations
Mooresville Regional office
Water Quality Operations
ADDRESS
2090 US Highway 70
Swannanoa, North Carollna 28778
[phone]
[phone] Fax
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
610 E. Center Avenue
Mooresville, North Carolina 28115
(7041663-1699
[phone] Fax
COUNTIES SERVED
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
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,
919) 788-7159 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,
(252) 946,6481
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Dupiin, New
Water quality Operations
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office 450 W. Hanes MITI Road Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300 Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105 Stokes, Surry, Watauga, Wilkes, Yadkin
f-1161-776-9Rhn
6 'd OL59 "N saiJjsnpuI oaj[V AVS8:9 8l06 '6 ',dV

1. PRCSUBWTTAL INFORMATION:
1. Contacted representative from regional office (Pre -submittal)?:❑ [] Yes ❑ []No
2. Contact name (For Regional Office):
H. APPLICANT INFORMATION:
1. Applicant's name (Municipality, individual, Corporation, etc):
2. Applicant type: ❑ ❑ Municipal ❑❑ State ❑❑ Privately -Owned Public Utility
❑❑❑ County❑ Other: T
3. Origin of Wastewater:
❑❑❑ Residential Subdivision ❑❑ Retail (Stores, Shopping Centers) Domestic:
[]❑ Apartments/Condominiums ❑❑ Institution Commercial:
❑❑ Mobile Home Park OR Hospital Industrial: %
❑❑ School ❑❑ Church other: %
❑❑ Restaurant ❑❑ Nursing Home
❑❑ Office ❑o Other (specify)
4. Signature authority's name: per 15A NCAC 02T .0106_(b).
Title: J
5. Applicant's mailing address: �J� G"d Yot nj R
City: �r Su'(Iftstate: Zip:2)�
6. Applicant's contact information:
Phone number: ( } G Email: _��exoa� �vI R �1;4 . GQ
III. CONTACT/ONSULT-TA�NT INFORMATION:
1. Contact name: f ► i �r r t" A.0'V`9
Title/Affiliation:
2. Contact's information:
Phone number:Email:
IV. RECEIVING FACILITY INFORMATION:
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:/44+kC 6, r15CCk n
z_ Facility name: Tx1 PIA'"1P' W'�
3_ Facility permit number:
4. WWTF permit number:
5. WWTF contact name:
Title/Affiliation:
8 d OL59'ON Saia}SnpuI 3ajjv WVS8:9 8l06 6 'AdV

v. PROJECT INFORMATION:
1. Location of Project (physical address):
Approximate Coordinates (Decimal Degrees): Latitude:
2. Duration of Pump and Haul Request (Six Months Typical): _
3. Has a prior permit been issued? ❑❑ New
o Longitude: - . o
❑❑ Prior Pump & Haul Permit
Permit No.:
4. Permanent Method of Wastewater Disposal:
S. Date Permanent Disposal will be available:
6. Have permits / approvais for permanent disposal been obtained?
❑❑ Yes 07 No Permit Number:
7. Is there a Pretreatment Program in effect? ❑ ❑❑ Yes ❑ No
8_ Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: Gallons per Day
J.O. 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):
12, Is Tank / Container in place or will it be installed (attach description if necessary):
13. What type of high water alarm does the container have (and/or):
❑❑ Audible and Visual ❑❑ Telemetry (Auto Dialer / SCADA)
vi. CERTIFICATION:
la
Applicant's Certification: (Signature of Signing Official and Project Name)
!, , attest that this application for has been reviewed by me ,and is
.accurate and comple a to the best of my knowledge, 1 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 143-215,6B, 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 $10,001) as
well as civil penalties up to $25,000 per violation.
Signing official Signature
Date
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
SHALL BE INSPECTED AT LEAST DAILY BY THE PERMITTEE OR IT'S REPRESENTATIVE PER 15A NCAC 02T ,0204.(d).
ti 'd OLS9'ON saia}snpuI o;I[V WVSp9 8[06 6 'idV

THE. ENGINEER'S CERTACATION IS REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER G.S. 89C-3,
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL. IF CERTIFICATION By AND ENGINEER IS REQUIRED,
THIS PAGE IS NOT NECESSARY.
Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
I, ,attest that this application for 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_GA and 143-215,GB, 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.
Professional Engineer Name
Engineering Firm
2c. ,
Mailing Address
City State Zip
Telephone Facsimile E-mail _ NC PE Seal, Signature & Date
S 'd 6LS9 "N saia}snpul D;JIV Wb'S�:9 2�0z 'z 'AdV

3/29/2018
Pump Haul Agreement.jpg
PUMP AND MAUL AGREEMENT
TMS AGREEMENT is entered into this 28 day of N famb, 2018 by and between bauiel 1`14Mps and
Tt;ple T pumping, a corporation (hereinafi;er referred to as ")jple T").
Triple T provides pump and haul services that are requested and required by Daniel Phillips. The parties have
entered into the following Agreement whereby Tnplc T agrees to provide pump & haul services for Daniel
Phillips and Daniel Phillips agrees to pay for such services -
IT IS THIEREFORlE A,GREM) TRAT:
I - The consideration for this agreement is the mutual promises and covenants contained herein_ This agreement
shall take effect on arch 2$ 201 and shall remain in eflbet until h 28 2023 unless earlier terminated as
provided herein.
2. Triple T shall pump and haul all wastewater from the septic tank at the 835 Ed Young Rd, Burnsville, NC
property that is owned by Daniel Phillips on a regular schedule to be established by the parties w this agreement;
and at such times as may be necessary to insure the continual safe and sanitary operation of the septic teak. All
pump and haul activities by Triple T shall be conducted in a manner that mods with the apptoval of the
Watauga County Health Department. Triple T shall also comply at all times with all applicable federal, state and
local statutes, ordinances, rules and regulations regarding pumping and hauling of wastewater. Triple T will be
taking the wastewater to the Triplo T Pumping Waste Water Plant in Boone, NC,
3. If at any time Triple T becomes aware that the treatment facility is incapable of fully treating the wastewater
generated at 835 Ed young Rd, Triple T shall notify Daniel Phillips of such condition. Triple T shall also report
by telephone to the Water Quality— AshevilIe Division of Water Resources [[phone]) as soon as ..
possible, but in no event mote than 24 houts or on the next working day following first knowledge of the
occurrence. Persons reporting such occurrences by telephone sball file a written report in letter form within 15
days following fast knowledge of the occurrence_ The report must outline the actions taken or proposed to
ensure that the problems does not recur.
4. This agreement shall not be assigned, trarlsferred, or otherwise modified in any way other than by an
instrument in writing, signed and properly executed by both parties.
5. Triple T shall not be rcquirod to pomp and haul any wastewater under this agreement other than that
generated at,
6. Triple T "I be liable for any and all damages and/or injury of any kind caused by any spill, failure of other
accident resulting from this pump and haul operation. Triple T shall maintain sufficient insurance coverage to
MY indemnify and hold Daniel Phillips harmless for such damages, including attorney fees. Failure to maintain -
such insurance coverage shall constitute a dePautt under this agreement_
7. Any employee or representative of the Water Quality — Division of Water Resources or the North Carolina
Division of Environmental Health, DENIZ, may upon proper credentials, at any reasonable time enter and
inspect any property, premises or place related to the pump and haul operation; inspect or copy any record
required by this agreement or applicable law to be kept; and obtain samples, for, the purpose of determining
compliance with this agreement and any applicable law, rule or regulation.
8. Triple T shall maintain accurate and current records of all activities conducted under this agreement,
including:
(a) Date(s) wastewater is removed from the property;
(b) Address of property from which waste is removed;
(c) Name of the facility receiving wastewater;
(d) Volume of wastewater removed, if applicable; and
(e) Any spill, accident or other unforeseen event this agreement. this
in the course of performing services under
9 'd OLS9 'ON
s;1jIsnpuI oa}[H NVS0:9 0[Ol '6 'ady

' 3/2912018
Pump Maul Agreement pg 2.jpg
Invoices waftd paid containing the required information will be considered acceptable records.
9_ Failure by either party to abide by the terms and conditions of this agreement shall constitute a default, and
may subject either party to enforcement of action by the Water Quality -- Division of Water Resourecs, the
Division of Environmental Health or other authorities having jurisdiction over these activWcs.
10. A charge of $ 500 per load removed will be invoiced the following month of each service_ All invoices are
due upon receipt. Any invoices outstanding 30 days will be subject to a 1.5% finance charge. The contract price
can be subject to change each year upon the anniversary date of the Agreement notice will be given to Daniel
Phillips before any final change is made. Failure to pay invoices will be considmvd a default on the Agreement.
11. Default by either party in any maz erial provision of this agreement shall entitle the other party to give notice
of default. Upon failure by the defaulting party to correct its default (if the default is of such a nature that it can
effectively be corrected) within 30 days of written notice, the non -defaulting party shall have the right to
terminate ft Agreement, and may pursue any and all legal remedies available to it, including collection of
attorney fees where authorized by applicable law.
Signed this the rday of U4 rr— 72018,
Daniel Phillips
835 Ed Young Rd
Burnsville, NC 28714
928467-6342
[e-mail]
By: Daniel 'Phillips — Owner of (835 Ed Young Rd)
Triple T pumping
1372 NC Hwy 194 North
Boone, NC 28607
Office: 828-262-5745
Cell: 828-265-9005
Fax: [phone]
M. Atrd�
By: Mike rlock (owner of Triple'1)
L 'd OLS9 "N saialsnpuI 3alld NVS8:9 8106 'Z 'IdV