WQ0002857_Renewal Application_20210226

Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0002857
Applicant/Permittee Chapel Road Properties, LLC
Applicant/Permittee Address 9683 Kerrs Chapel Rd
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Organization
Facility Name Piedmont Custom Meats WWTF
County Caswell
Fee Category Minor
Is this a complete
application?*
r Yes r No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date 02/26/2021
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by NUB Staff regarding electibnittal, confirmation of receipt, other
.......................................................... electronic surece, aner correspondence.
_ -
Name * Larry Moore
Email Address*
[e-mail]
Project Information
........ ......... .................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
336-628-4949
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WO0002857
Fbs Current Existing permt number
Applicant/Permittee*
Chapel Road Properties, LLC
Applicant/Permittee Address*
9683 Kerrs Chapel Rd
Facility Name *
Piedmont Custom Meats WWTF
Please provide comments/notes
on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Spec'rfications, Calculations, Rc.)
scan0173.pdf 2.21 MB
upload only 1 RCF docurrent (less than 250 M3). IvLtiple documents nest be corrbined into one RJF file unless file is larger than
upload limit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date
2/26/2021

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 01-20
This form is for renewal without modification for all non -discharge system permits, excJpt Residuals Management and Single -
Family Residence Wastewater Irrigation System permits.
For more information, visit the Water Quality Permitting Section's Non -Discharge Branch Website.
I. PERMITTEE INFORMATION:
1. Permittee: Piedmont Custom Meats, Inc.
2. Signature authority's name: Donna M Moore per 15A NCAC 02T .0106(b)Title: President
Primary Telephone number: (336) 6284949 Select
Email Address: [e-mail].
3. Permittee's mailing address: 430 NC Highway 49 S
City: Asheboro State: NC Zip: 27205-_
4. Billing address (if different from above):
City: State: Zip: _-
Secondary number: 7( 24} 619= 3738 Select
5. Contact person's name (if different from signature authority): Larry C Moore Title: CFO
Primary Telephone number: 336 628-4949 Select Secondary number: (704�} 619-3738 Select
Email Address: [e-mail]
H. PERMIT INFORMATION:
1. Existing permit number: WQ0002857
2. Has the facility been constructed? ® Yes or ❑ No
If yes, has the facility been constructed in accordance with the permit and the Division -approved plans and specifications?
15A NCAC 02T .0110 x® Yes or ❑ No
If no, a formal permit modification request shall be submitted to the Division.
3. Has any of the property ownership within the facility and/or disposal area changed from what is indicated in the current permit
(Attachment B — disposal field owner/lessee)? ❑ Yes or x® No
Has the Permittee had a name change or has the permit changed ownership? ❑ Yes or x ® No
If yes to either, a permit modification request shall be submitted to the Division. [ 15A NCAC 02T .0105]
4. Is this facility a Privately -Owned Public Utility? ❑ Yes or x® No
If yes, provide two copies of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission
demonstrating the Applicant is authorized to hold the utility franchise. [15A NCAC 02T .0115(a)(1)]
5. Is the Permittee a Home/Property Owners' Associations or Developers of lots to be sold? ❑ Yes or x® No
If yes, provide the following:
• For Home/Property Owners' Associations — Operational Agreement (FORM: HOA) and a copy of the proposed or
approved Articles of Incorporation, Declarations, and Sy -laws [I 5A NCAC 02T .0115(c)]
■ For Developers of lots to be sold — Operational Agreement (FORM: DEV) [I5A NCAC 02T .0115(b)1
FORM: NDSR 0 1 -20 Page I of

DWR
Division of Water Resources
b. Does the facility treat and dispose of industrial wastewater?
If yes, complete items below. If no, skip to the next section.
Indicate the approximate percentage of wastewater makeup:
Industrial:100% Domestic: % Stormwater: %
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 01-20
For all industrial wastewater sources (excluding those permitted under a pretreatment permit), provide a detailed industrial
process description including:
• An overview of the manufacturing process
• An inventory of all materials used for manufacture, including chemicals and biological matter
• An overview of cleaning and treatment methodology, including an inventory of treatment materials and compounds
Has the nature of wastes (e.g., change in industrial processes, introduction of new materials or chemicals, etc.) described in the
approved permit application(s) changed? ❑ Yes or x® No
If yes, a permit modification request shall be submitted to the Division. [G.S. 141-215.1(d)l
III. SITE MAP:
1. Provide an updated site map in accordance with 15A NCAC 02T .0105(d) that shows the following (i€ applicable):
The site map is not required to be signed or sealed by a Professional Engineer. However, the map must indicate the source of
information. For example, parcel lines taken from a county GIS map should reference the GIS website.
❑ Legend, north arrow, and scale
❑ Topographic contours on all disposal sites
❑ Soil mapping units on all disposal sites
❑ All facility -related structures and fences within the treatment, storage, and disposal areas
❑ All habitable residences and places of assembly within 500 feet of all treatment, storage, and irrigations sites
❑ Location of all wells, streams (ephemeral, intermittent, and perennial), springs, lakes, ponds, ditches, and other surface
drainage features within 500 feet of all waste treatment, storage, and disposal site(s)
❑ Latitude and longitude coordinates of all monitoring wells (decimal degrees to b digits)
❑ Location and identification of major components of the waste disposal system
❑ The wetted perimeter of all irrigation fields with field names (named according to the approved permit)
❑ Location and ownership of property boundaries within 500 feet of the disposal area (including road/rail right-of-ways)
❑ The delineation of compliance and review boundaries
❑ Distance measurements verifying all setbacks are being met
❑ Stormwater drainage controls
❑ 100-year tioodplain
❑ For reclaimed water generation permits, provide a separate map showing all distribution lines and utilization permit
locations that are connected to the water generation facility and are permitted by the Non -Discharge Branch (excludes
Local Program permitted facilities). Include all reclaimed water distribution line and reclaimed water utilization permit
numbers.
FORM: NDSR 01-20 Page 2 of 4

L I "I 'Ll.
Division of Water Resources
IV. GROUNDWATER MONITORING WELLS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 01-20
1. Does the facility have a proposed or existing groundwater monitoring well network? x® Yes or ❑ No
If no, skip to next section.
If yes, complete the following table (NOTE — This table may be expanded for additional wells):
Well Name
Status
Latitude a
Longitude
Gradient
Location
JA
s elect
- °
LJT Select
a!�i �6.elect
el
] ► Select
0
Dpi*) Select
1 1 Select
p Select
-0
DROJSelect
11 Select
Select
- 0
Select
Select
Select
°
-0
Select
Select
Select
-0
Select
Select
Select
-0
Select
Select
Select
- 0
Select
Select
Select
-0
Select
Select
Select
-
Select
Select
a. Coordinates must be in NAD83 and have 6 decimal degrees
V. SETBACK WAIVERS, EASEMENTS, AND LEASES:
1. Does the permit have any setback waivers, easements, or leases? ❑ Yes or x® No
If yes, provide copies of all documents and complete the table below:
Document
Type
Grantor or
Parcel No.
Grantee
Expiration
Date
County
Registered
Deed
gook
Deed Page
Document
Description a
Select
Select
Select
Select
Select
Select
Select
a. The document description shall list any reduced setbacks with distance, etc.
2. For reclaimed water utilization permits:
Is reclaimed water utilized on property not controlled by the generator? ❑ Yes or x® No
A lease, easement, or agreement must be provided allowing for the utilization of reclaimed water on the property or within the
facility. For irrigation of reclaimed water, an easement is required per 15A NCAC 02U .0501(6 . All documents shall be listed
in the table above.
FORM: NDSR 0 1 -20 Page 3 of

DWR
Division of Water Resources
VI. RELATED PERMITS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 01-20
1. If this permit has interactions with other wastewater permits (collection systems, NPDES, etc.), complete the table below
(provide additional pages if necessary):
Permit Type Permit No. Description
2. Does the facility have an approved flow reduction 15A NCAC 02T .0114 ? ❑ Yes or xW No
If yes, attach the measured monthly average amount of wastewater flow contributed per unit for the 12 months prior to permit
renewal. If any of these monthly averages are within 20% of the approved value, the Permittee shall provide a reevaluation of
the reduced flow value using the methodology applied to the original flow reduction application. Also, attach a copy of the
flow reduction approval letter.
APPLICANT'S CERTIFICATION 15A NCAC 02T .0106 Ir
1, Donna M Moore , attest that this renewal application has been reviewed by me, and is accurate and complete to the
best of my knowledge. I understand that any unauthorized discharge of wastewater from this non -discharge system to surface waters or
the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make
no claim against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required
parts of this application are not completed, this application may be returned to me as incomplete. I further certify that the Applicant or
any parent, subsidiary, or other affiliate of the Applicant has not been convicted of an environmental crime, has not abandoned a
wastewater facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or
abandoned, are compliant with any active compliance schedule, and does not have any overdue annual fees.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package 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. The Applicant's Certification shall be signed in accordance with
I3A NCAC 02T .010b b . Per 15A NCAC 02T .010G 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]
Signature:
Date:
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE BRANCH
By U.S. Postal Service: By Courier: By Email:
Non -Discharge Branch Non -Discharge Branch — Archdale 942W N_o_ n-Discharge.Reports@ncdenr goy
1617 Mail Service Center 512 N. Salisbury St.
Raleigh, NC 27699-1617 Raleigh, NC 27604
TELEPHONE NUMBER: [phone]
FORM. NDSR 0 1 -20 Page 4 of

"
f'
r
alol',
FIGURE 1
SPRAY IRRIGATION SYSTEM
CASWELL COUNTY
SITE LOCATION MAP

`� '� _ ram•--- � ��^
y
�l
D.
ow
c