WQ0042784_Permit (Issuance)_20210928

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
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ROY COOPER
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Governor
ELIZABETH BISER
Secretary
ft
S. DANIEL SMITH
NORTH CARCLINA
en Orvnmerdal Quorrty
Director
September 28, 2021
Haddon Clark, President
Sampson Bladen Oil Company Inc
PO Box 469
Clinton, NC 28329-0469
Subject: Permit No. WQ0042784
Sampson Bladen Oil Company Inc
Handee Hugo Number 2 Private Pump Station
Wastewater Collection System Extension
Brunswick County
Dear Mr. Clark:
In accordance with your application received August 23, 2021, we are forwarding herewith Permit No.
WQ0042784 dated September 28, 2021 to Sampson Bladen Oil Company Inc (Permittee) for the
construction and operation upon certification of the subject wastewater collection system extension. This
permit shall be effective from the date of issuance until rescinded, and shall be subject to the conditions
and limitations as specified therein. This cover letter shall be considered a part of this permit and is
therefore incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Special Conditions:
Condition 1.1: This permit shall become voidable unless the agreement between the Sampson Bladen
Oil Company Inc and Brunswick County for the collection and final treatment of
wastewater is in full force and effect. [15A NCAC 02T.0304(h)]
Condition 1.2: Each pump station shall be clearly and conspicuously posted using a weatherproof sign
with the address, a pump station identifying name/number, 24-Hour Emergency
telephone number, and name of the owner/operator of the sewer system/pump station
and instructions to call the number in the event of alarm activation or other emergency.
Simplex pump stations or vacuum sewer pits serving a single-family residence may have
a placard or sticker without the address placed on the control panel in lieu of a sign. [15A
NCAC 02T .0305(h)(2)]
Standard Conditions:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
D q5
Division of Water Resources —Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405
Phone: [phone]\ Internet: www.deg.nc.gov

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
t-onamon 11.4: Kequires inat the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 2T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. [15A NCAC 02T.0116]
Condition 11.13: If the Permittee/Applicant holds a system -side collection system operation,
maintenance and management permit (WQCS-prefix) from the Division, then the
following applies: For all newly constructed, modified and rehabilitated pump stations,
all equipment and components shall be sealed within a corrosion -resistant coating or
encasement to the extent practicable and equivalent to the minimum design criteria
unless the permittee can demonstrate it is not practicable or another form of corrosion
resistance is employed. [15A NCAC 02T .0108 (b)]
It shall be responsibility of the Permittee to ensure that the as -constructed project meets the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Tyler Benson at [phone]
or via e-mail at Tyler. [e-mail].
Sincerely,
DocuSigned by:
SOµ l Y�wt'f��On.
7F141E73B6F3456...
Tom Tharrington, Assistant Regional Supervisor
Water Quality Regional Operations Section
Wilmington Regional Office
Division of Water Resources, NCDEQ
Cc: David Menius, Stroud Engineering
Brunswick County
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Permit No. WQ0042784 September 28, 2021 Page 2 of 9

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
NORTH �:AgO_IN.4
Envrrortmcrtruf Quality
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
SAMPSON BLADEN OIL COMPANY INC
BRUNSWICK COUNTY
for the construction and operation upon certification of a 29—gallon per minute grinder pump station with
duplex pumps, on -site audible and visual high water alarms, telemetry, and a portable generator
receptacle with manual transfer switch, as well as approximately 460 linear feet of 2-inch force main to
serve a 6-fixture convenience store without food preparation (1,500 gallons per day) and a 32-seat
restaurant with single service articles (640 gallons per day) as part of the Handee Hugo Number 2 Private
Pump Station project, and the discharge of 2,140 gallons per day of collected commercial wastewater into
Brunswick County's existing sewerage system, pursuant to the application received August 23, 2021 and
in conformity with 15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February
12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting data subsequently
filed and approved by the Department of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
Permit Number: WQ0042784
Issued Today: September 28, 2021
DocuSigned by:
-To-
�na r) OA,
7F141E73B6F3456...
Tom Tharrington, Assistant Regional Supervisor
Wilmington Regional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By Authority of the Director and The Environmental Management Commission
Permit No. WQ0042784 September 28, 2021 Page 3 of 9

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
SUPPLEMENT TO PERMIT COVER SHEET
SAMPSON BLADEN OIL COMPANY INC is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the West Brunswick Wastewater
Treatment Facility in accordance with Permit Number WQ0023693.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T; the Division of Water Resources' (Division) Gravity Sewer Minimum Design Criteria adopted
February 12, 1996 as applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless specifically mentioned
herein. Division approval is based on acceptance of the certification provided by a North Carolina -licensed
Professional Engineer in the application. It shall be the Permittee's responsibility to ensure that the as -
constructed project meets the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
1. This permit shall become voidable unless the agreement between the Sampson Bladen Oil Company
Inc and Brunswick County for the collection and final treatment of wastewater is in full force and
effect. [15A NCAC 02T.0304(h)]
2. Each pump station shall be clearly and conspicuously posted using a weatherproof sign with the
address, a pump station identifying name/number, 24-Hour Emergency telephone number, and name
of the owner/operator of the sewer system/pump station and instructions to call the number in the
event of alarm activation or other emergency. Simplex pump stations or vacuum sewer pits serving a
single-family residence may have a placard or sticker without the address placed on the control panel
in lieu of a sign. [15A NCAC 02T .0305(h)(2)]
II. STANDARD CONDITIONS
This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be considered
on its merits and may or may not be approved. [15A NCAC 02T.0104; G.S 143-215.1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.0110]
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
Permit No. WQ0042784 September 28, 2021 Page 4 of 9

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403. If an individual
permit is not required, the following performance criteria shall be met: [15A NCAC 02T .0108(b)]
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected everyday (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High -priority sewer lines shall be inspected at least once per every six -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to control grease entering the system from other public and private satellite
sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three
years with exception of the map, which shall be maintained for the life of the system.
5. Noncompliance Notification:
The Permittee shall report by telephone to a water resources staff member at the Wilmington
Regional Office, telephone number [phone], as soon as possible, but in no case more than 24
hours or on the next working day, following the occurrence or first knowledge of the occurrence of
either of the following:
Permit No. WQ0042784 September 28, 2021 Page 5 of 9

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part 11 of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G.S. 143-215.1C(a1)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or in accepted electronic format and are defined as the design drawings that are marked
up or annotated with after construction information and show required buffers, separation
distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing, velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection, detention time in the wet well, and force main, ability to flush low points in force
mains with a pump cycle, and downstream sewer capacity analysis. If a portable power source or
pump is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities
and the rotation schedule of the portable power source or pump, include travel timeframes, shall
be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form.
Permit No. WQ0042784 September 28, 2021 Page 6 of 9

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Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting in
non-compliance with this permit (including pipe length changes of 10% or greater by type & size,
increased flow, pump station design capacity design increases of 5% or greater, and increases in the
number/type of connections), regulations, or the Minimum Design Criteria. Requested modifications
or variances to the Minimum Design Criteria will be reviewed on a case -by -case basis and each on its
own merit. Please note that variances to the Minimum Design Criteria should be requested and
approved during the permitting process prior to construction. After -construction requests are
discouraged by the Division and may not be approved, thus requiring replacement or repair prior to
certification & activation. [15A NCAC 02T .0116]
8. Gravity sewers installed greaterthan ten percent below the minimum required slope perthe Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the Division's
Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials may subject the Permittee to an enforcement action by
the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-215.6C,
construction of additional or replacement wastewater collection facilities, and/or referral of the North
Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by
the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
13. If the Permittee/Applicant holds a system -side collection system operation, maintenance and
management permit (WQCS-prefix) from the Division, then the following applies: For all newly
constructed, modified and rehabilitated pump stations, all equipment and components shall be sealed
within a corrosion -resistant coating or encasement to the extent practicable and equivalent to the
minimum design criteria unless the permittee can demonstrate it is not practicable or another form
of corrosion resistance is employed. [15A NCAC 02T .0108 (b)]
Permit No. WQ0042784 September 28, 2021 Page 7 of 9

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE:
Sampson Bladen Oil Company Inc
PERMIT #:
WQ0042784
PROJECT:
Handee Hugo Number 2 Private Pump Station
ISSUE DATE:
September 28, 2021
COUNTY:
Brunswick
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of this permit until
the Division has received this Certification and all required supporting documentation. Consequently, it should be
submitted in a manner that documents the Division's receipt. Send the required documentation to the Wilmington
Regional Supervisor, Water Quality Section at the address at the bottom.
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Certifications
shall include Phase/Section covered, line size & lengths installed, and listing of lots/connections to be served and pump
station design, if applicable. A Final Certification shall be a complete set of record drawings and design calculations
regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant to the applicable
standards & requirements, the Professional Engineer below has provided applicable design/construction information to
the Permittee, and the Permittee is prepared to operate & maintain the wastewater collection system permitted herein
or portions thereof.
Printed Name, Title Signature Date
ENGINEERS CERTIFICATION
I, , as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to (❑ periodically, ❑ weekly, ❑ full time) observe the construction of the project name and location as
referenced above for the above Permittee hereby state that, to the best of my abilities, due care and diligence was used
in the observation of the following construction:
of a 29—aallon Der minute arinder DumD station with duplex Dumps, on -site audible and visual hiah water alarms
telemetry, and a portable generator receptacle with manual transfer switch, as well as approximately 460 linear feet
of 2-inch force main to serve a 6-fixture convenience store without food preparation (1,500 gallons per day) and a 32-
seat restaurant with sinale service articles (640 aallons Der dav) as Dart of the Handee Huao Number 2 Private PumD
Station proiect, and the discharge of 2,140 gallons per day;
such that the construction was observed to be built in compliance of this permit; 15A NCAC 2T; the Division of Water
Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials.
............................................................
North Carolina Professional Engineer's Seal w/signature & date
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 127 Cardinal Drive Extension Wilmington, NC 28405
Wilmington Regional Office Phone: [phone] FAX: [phone]

DocuSign Envelope ID: B57F9543-ABCO-486E-86EA-BF06FD1305A8
SEWER ENGINEERING CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project Name:
W Q00
Project County:
1) Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. ❑ Yes ❑ No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3) Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
• Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5) Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDC) for the permitting of Gravity Sewers (latest version), and MDC
for the Permitting of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including pipe
length difference of 10% or greater, change in flow, pump station design capacity design change of 5% or greater, and
change in the number/type of connections)? ❑ Yes ❑ No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.