WQ0000267_Renewal Application_20220330

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0000267
Applicant/Permittee Gates County
Applicant/Permittee Address 115 Court Street
Is the owner in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
County
Gates County WWTFs
Gates
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Is the facility in BIMS? Yes No
Fee Amount $0
Complete App Date 03/30/2022
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Michael McAllister
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
252-289-0781
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
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.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Perm it Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number: *
WQ0000267
Has Current Existing permit number
Applicant/Permittee*
Gates County
Applicant/Permittee Address*
115 Court Street
Facility Name*
Gates County WWTFs
Please provide comments/notes on your current submittal below.
Renewal and change out gas chlorine to hypochlorite at old site.
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 Plans, Specifications, Calculations, Etc.)
Gates County WQ0000267 Spray Field Renewal.pdf 10.42MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* 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
,e� wat

Submission Date 3/30/2022

aflAA MUNICIPAL tNUINF.LH
�.rSiceeruc� f�e!l�ue.•/.rhovative A�+'�/�er/Sustau�a�le S�lutio�cs
March 30, 2022
Mr. Nathaniel D. Thornburg
Branch Chief
Non -Discharge Branch
NCDEQ
512 N. Salisbury Street
Raleigh, NC 27644-1617
RE: WQ0000267
Gates County Spray Field
Permit Renewal
Gates County
Dear Nathaniel,
I have attached the following data related to the Gates County Wastewater Treatment Facility permit
renewal near Gatesville, NC. In addition to the permit renewal, Gates County desires to convert the
existing gas chlorine disinfection system at the old facility to sodium hypochlorite.
® Signed application form
® Mapping of the site located near Will Ln, and the older facility near Honey Pot Road
® Construction and Demolition Plan of existing disinfection facility.
® Specifications for the diaphragm metering pump and day tank.
® Chemical Feed Calculations
® Updated O & M plan
If you need additional information, please don't hesitate to contact me.
Sincerely,
Ml1NICOPAL ENGNEFMNG, INC.
Michael, L. McAllister, M-ASCE
Principal Project Manager
i iESL1'0.00M
Licenses: F-0812 & C-586

GATES COUNTY
NORTH CAROLINA
SPRAY FIELD PERMIT RENEWAL
SUPPLEMENTAL INFORMATION
March 2022
YnG
Municipal Engineering, Inc.
68 Shipwash Drive, Garner, NC 27529
Phone:[phone] Fax:[phone]
Corporate License No. F-0812 & C-586
CArQt}�%''ter
Q� SEAL
r 0 710O

Gates County Permit Renewal
Supplemental Information
Table of Contents:
Chlorine Dosage Calculations
Chemical Storage & Feed System Specification
3. Updated Operations & Maintenance Manual

Old Gates Correctional Facility
Permitted Flow (GPD)
Irrigation Pump Rate (GPM)
Run Time Req'd to apply Permitted Flow
Hours Run Time
Disinfection Required NaOCL
Flow (GPM)
CI-2 Dosage Requirement (mg/L)
Solution Strength (%)
Dosage (m/L/minute)
Gallons/Hour
Gallons Per Day
30-day storage requirement
Gates County WWTP
CL2 Dosing Requirements
Gates Correctional Field
March 9, 2022
15,000
GPD
45
GPM
333n?:^
Min.
5",,
Hours
45
GPM
Mg/L
mg/L/min.
GPH
GPD
GAL
2
12.5
2.7
0.042121
1.01088
30.3264

Page No -1
PROJECT SPECIFICATION NO. 11
CHEMICAL STORAGE AND FEED SYSTEMS
PART 1 - GENERAL
1.1 Description of Work:
This section describes materials and methods to furnish and install the following:
a. (1) Metering pump (sodium hypochlorite)
b. (1) 50-gallon day tank and mixer (sodium hypochlorite)
c. Piping and appurtenances as shown on the drawings and herein specified.
PART 2 - MATERIALS
2.1 Metering Pump:
A. Pump shall be a simplex positive displacement diaphragm type comprised of the following
materials:
Sodium
Hypochlorite
Head
PVC
Fittings
PVC
Diaphragm
Hypalon
Valve Balls
PTFE
Valve Seats
PVC
B. Metering pump shall be furnished with manual adjustment so as to adjust the feed rate over a
10:1 range.
C. Motor shall be TEFC, 115 V, single phase, 60 Hertz, maximum 1750 RPM, minimum 1/4 HP.
D. Each metering pump shall be furnished with accessories as indicated on the plans and with
pressure relief valves factory set at 10 psi below pump rating. The pump to be furnished with
back pressure valve set at 35 psi. All actuating parts shall be of an approved corrosion -
resistant material or isolated from the pumped fluid.
E. Acceptable manufacturers include:
a. Wallace & Tiernan
b. Neptune
c. Walchem
d. or equal.
2.2 Pipe and Fittings:
Pipe and fittings shall be solvent -welded schedule 80 PVC conforming to ASTM D-1785, D-2464, and
March, 2022 PROJECT SPECIFICATION NO. 11

Page No -2
all applicable ASTM testing standards.
2.3 Isolation Valves:
Isolation valves shall be true union PVC ball valves rated to 100 psi at 73 degrees F.
2.4 Day Tanks and Mixer:
The day tanks shall be 50-gallon self-supporting polyethylene approximately 24 inches in diameter.
Each tank shall be furnished with a cover suitable for accessing and supporting a mixer and tubing.
Each tank shall also be furnished with a bottom drain spigot.
The mixers furnished shall be suitable for application with sodium hydroxide, sodium hypochlorite and
ferric chloride. Mixer shall be single speed, heavy duty portable type with clamp type mounting bracket.
Motor shall be totally enclosed, 115 volt, single phase, 60 Hertz. Shaft and propeller shall be stainless
steel with shaft length suitable for the depth of the solution tank.
PART 3 - CONSTRUCTION METHODS
3.1 Installation:
The metering pump(s) shall be installed at the location(s) indicated on the drawings. The pump shall
be affixed to a support stand (or shelf) which shall be anchored to the floor (or wall) in the manner
shown on the drawings.
The support shall be of welded steel construction and shall be field -coated in accordance with Project
Specification No. 7 Painting. The support will be sized so that the pump head centerline is no more
than 2'-0" above finished floor. The top surface shall be smooth, level, and drilled for pump base plate
mounting.
3.2 Testing:
Upon completion of installation the pump(s) shall be tested at maximum rate and head, as well as
several points over its range of delivery at operating pressures. Results of this test shall be used to
determine acceptance of the pump. In addition, a pressure test of the piping installation, including
appurtenances, shall be made at a pressure of 100 psi. The system shall be checked for visible leaks
and loss of pressure. There shall be no allowable leakage. Upon determination that the system is
acceptable, the line pressure shall be varied to test the functioning of the pressure relief valve and
back -pressure valves. Acceptance shall be based upon the successful candidate of all the foregoing
tests.
PART4-PAYMENT
The cost for all chemical feed system shall be included in the lump sum price, therefore no separate payment
shall be made.
END OF SECTION
March, 2022 PROJECT SPECIFICATION NO. 11

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(RevNed March 21, 2022)

1.0 System Description
New Facility (Merchants Commerce Park)
Sanitary sewage is conveyed to the site via the Honey Pot Road Pump Station via an 8-
inch force main. A new valve is installed on the new force main. This valve aims to allow
the operator the flexibility to send sewage from the Merchants Commerce Park to either
the existing spray field behind the old Gates Correctional Institute or to the new facility
located on Will Lane. The new facility consists of the following:
• Modifications to Honey Pot Road Pump Station
• Aerated Pre -Equalization Tank
• Sequential Batch Reactor
• Lined Facultative Lagoon
• Chlorine Contact Basin
• Irrigation Pump Station
• Spray Irrigation Fields (5 Zones)
Old Facility (Old Gates Correctional System)
2.0 System Disinfection (Old Facility)
The existing gas chlorine (150# cylinders) have been removed and replaced with a new
sodium hypochlorite system, consisting of a new 50-gallon solution tank with mixer,
diaphragm metering pump, and associated piping.
The new hypochlorite system will need to be based upon a dry chemical mixed with water
and fed at 0.042 GPH. Using a 12.5% solution. The metering pump is interlocked to the
existing spray irrigation pumps only to provide solution injection when the irrigation
pump is running.
K

3.0 Honey Pot Road Pump Station
The pump station will continue to operate much as it does now, except for the new trash
baskets that will need to be monitored and emptied as needed. The flow meter will
remain in place; however, it will be necessary to subtract the flow at the pump station
from the flow meter total at the new facility when the new facility is in operation.
4.0 Aerated Pre -Equalization Tank
The purpose of the Pre -Equalization tank is to buffer the flow from the Honey Pot Road
Pump Station. A floating aerator keeps both the sanitary sewer from becoming septic due
to the long residence time in the force main and to control odors. The sewage enters the
tank via an 8-inch force main. There is a 1-HP floating aerator located at the center of the
tank and two (2) submersible pumps that convey sewage to the Sequential Batch Reactor
(SBR).
The floating aerator is held in place with three vertical pipes, which allow the unit to float
up and down with the level within the tank. Typically, these units only require occasional
service, which can be accomplished by either using a boom truck to remove the unit or a
boat. In either case, the unit should be maintained in accordance with the manufacturer's
instructions.
The two (2) submersible pumps operate on level control via a level transducer and
programmable logic controller (PLC). Should the transducer fail, a high water alarm float
is provided as a failsafe. A cell phone auto -dialer is integrated into the PLC to notify the
operator of problems. The pumps are removable via a slide rail and hoist, much like the
Honey Pot Road pump station system.
5.0 Sequential Batch Reactor
Flow enters the SBR via a 3-inch force main from the aerated pre -equalization tank. The
SBR generally operates in seven (7) phases:
1. Mixed Fill: The floating mixer is operating during the filling of the basin via the pumps
located in the aerated pre -equalization basin.
3

2. React Fill: The PLC will generally command the mixer to stop and the aerator to begin
operation during the filling stage.
3. React: During this phase, the pumps at the pre -equalization basin shut off, and the
aerator continues the provide treatment.
4. Settle: During this phase, the mixing and aeration are cut off, and the solids are
allowed to settle to the bottom.
5. Decant: Clear liquid is removed from the top of the basin and allowed to flow into the
facultative lagoon.
6. Sludge Waste: The submersible pump at the bottom of the basin is turned on during
this phase. Settled sludge is pumped to the sludge de -watering box.
7. Idle: The SBR is waiting for the next fill phase to begin.
The floating aerator/mixer/decanter is held in place by vertical steel pipes, which allow
the unit to move up and down with the water level in the tank. The PLC controls the
functionality of the equipment, including the electric valve and sludge pump.
The SBR basin is equipped with a 6-inch overflow which will direct the partially decanted
wastewater to the facultative lagoon in case of failure.
6.0 Facultative Lagoon
The new facultative lagoon is lined with High -Density Polyethylene (HDPE) with an
effective storage volume of 2,598,292-gallons with 2-feet of freeboard. The lagoon is 10-
feet deep from the bottom to the toe of the top slope with a 2:1 interior slope and a 3:1
exterior slope. The HDPE liner was chosen for its durability, permeability, and protection
of the lagoon side slopes from wave action erosion.
Decant flow from the SBR enters the lagoon from the westerly end and exists through the
chlorine contact basin and self -priming pumps on the eastern end. The HDPE liner anchors
to the top of the dike through a series of buried folds located within a trench 2-feet from
the edge of the top slope. The trench is 2-feet deep x 2-feet wide around the lagoon's
perimeter.
4

The lagoon should maintain 2-feet of freeboard or greater at all times to comply with
NCDEQ regulations. Due diligence should be taken to prevent the liquid freeboard from
decreasing to a point less than the 2-feet requirement through careful management of
the facility.
It is imperative great care should be used when cutting grass or weed -eating around the
lagoon linerto avoid tears. Should a tear occur, the operator should take immediate steps
to patch the opening in accordance with the manufacturer's directions.
7.0 Chlorine Contact Basin
The cast -in -place concrete chlorine basin is sized to provide a minimum of 30-minutes of
detention time at 229-GPM. The basin contains concrete baffle walls within the basin to
direct the flow in a serpentine pattern to maximize the efficiency of the unit.
The basin is equipped with a 15-inch diameter self-cleaning intake screen where the flow
enters the basin. The cleaning process is initiated each time the spray irrigation pumps
are turned on and timed to run approximately 3-minutes. The screen is cleaned by a water
jet of approximately 10-GPM @ 75-psi. The water supply for the screen is taken from the
irrigation pump discharge, and a booster pump located within the pump building is
designed to supply the difference between the irrigation pump discharge pressure and
the 75-psi pressure needed to adequately clean the screen. The screen is mounted at the
end of a pipe with has a swivel fitting and portable hoist to allow the operator to inspect
and maintain the screen from the top of the chlorine contact basin.
The system is designed to utilize sodium hypochlorite (NaOCI) or bleach. A new metering
pump, day tank, and mixer will be located inside the irrigation pump station building and
then piped to the influent end of the chlorine contact basin. The metering pump shall be
interlocked to the pump controls so it will only operate during spray irrigation. Generally,
the agent is purchased in a dry form and then mixed with water on an as -needed basis.
Great care should be used when mixing and using sodium hypochlorite, and the
manufacturer's instructions and safety precautions found in the Material Data Safety
Sheet (MSDS) (Appendix A) must be followed.
5

7.0 Irrigation Pump Station
The Irrigation Pump Station is located at the easterly end of the lagoon on top of the dike
and is housed in an FRP building. The pumps are a duplex self -priming type, capable of
pumping 229-GPM via a 6-inch force main to each of the five (5) spray zones. (note only
one zone may be sprayed at a time.) The Owner/Operator shall consult the
manufacturer's O&M manuals for operation and service information regarding these
pumps.
A new magnetic flow meter is installed within a concrete vault along with the common
force main leaving the pump station. The 4-20 mA signal from the meter is connected to
a remote chart recorder. The magnetic flow meter should be calibrated by a qualified
person annually.
8.0 Spray Irrigation Fields
The irrigation system contains five zones that are approximately the same size. Each zone
is controlled via a plug valve located at the main feed line for each zone. Each zone
contains 109 impact sprinklers designed to emit 2.10-GPM @ 35-psi. A general guide to
impact sprinkler head maintenance can be found in Appendix B.
The irrigation fields are planted initially with tall fescue applied at a rate of 10-15 Ib./ac.
Once established, fescue grass should be mowed to a height of no less than 3-inches. Re-
seeding may be required during the fall. It is advisable to mow in different directions to
minimize the packing of the soil from the mower wheels. The utilization of heavy
equipment on the spray fields should be avoided.
It is imperative that the irrigation fields and impact sprinklers be monitored upon
beginning to spray each zone. Visually inspect the spray heads to ensure all are in place
and working properly, including the adjustment required to keep the irrigated
wastewater within the established limits. Each zone should be inspected routinely to
ensure no channelization of the soils has occurred, allowing a path for a run-off. Irrigation
C:

activities should be avoided during wet weather or very windy conditions to avoid
contamination of adjacent areas.
The fields are designed for one zone to be utilized each day for approximately 4-hours.
The application rates established and listed in the permit should be adhered to at all
times.
9.0 Residuals Management
Unlike the existing spray irrigation system located behind the old Gates Correctional
Institute, where residuals collect in the bottom of the facultative lagoon, the SBR will
collect the settled sludge in the bottom of the SBR. The amount of wasted sludge will
depend on several factors, including volume of flow, BOD and TSS removed, etc. The
residuals are collected in a mobile de -watering box. The box is a portable device where
wet sludge is deposited for drying, and the filtrate is recycled to the EQ basin via a gravity
drain.
10.0 Site Access
The entire facility includes treatment units, spray fields, and buffers surrounded by a
woven wire fence. Access should be restricted to the site by unauthorized personnel at
all times.
11.0 Spill Control and Response
Generally, land application systems rarely have overflows; however, with the various
treatment units and lagoon, the possibility exists. The EQ and SBR basins have high water
alarms connected to an auto -dialer to notify personnel of a malfunction. The SBR unit is
equipped with an overflow that drains into the lagoon.
In the event of a spill, the permittee shall notify the Washington Regional Office within 24
hours at telephone [phone], fax [phone] during regular business hours. All
other times the permittee shall contact the 800-858-0368 or 919-733-3300.
7

Should the spill occur on the ground, the permittee shall apply lime in an amount
appropriate to the volume spilled and area contaminated. Should the spill reach the
waters of the State, it is recommended a septic hauler be called to remove as much of the
contaminated as possible. It is also suggested to provide some sort of aeration to the
water affected, such as utilizing a mud pump to recirculate the water and let the pump
discharge to the top of the water to create turbulence.
In the event of a high water level in the lagoon, it is advisable to spray irrigate regardless
of the weather conditions or moisture level within the spray fields and report this action
to the Washington Regional Office. It is better to spray treated waste than allow the
lagoon dike to breach, causing a more substantial spill and subsequent expensive repair.
�3

Appendix A
Sodium Hypochlorite MSDS

(545138)
ALLIED UNIVERSAL CORPORATION
Headquarters: 3901 NW 115r" Avenue, Miami, Florida 33178 Phone: (305) 888 - 2K3
MATERIAL SAFETY DATA SHEET
May be used to comply with OSHA's Hazard Communication Standard, 29 CFR § 1910.1200.
TODAY'S DATE: 09/06/07 MSDS NUMBER: 0001
24 HOUR EMERGENCY CHEMICAL SPILL OR RELEASE PHONE NUMBERS:
Allied Universal Corp, at 1-305-483-7732 (Digital Beeper) and/orCHEMTREC at 1-800-424-9300
SECTION 1 CHEMICAL PRODUCT/COMPANY IDENTIFICATION
Sodium Hypochlorite
Product Names: Aqua Guard Chlorinating Sanitizer, Aqua Guard Bleach, Liquid Chlorine Solution, Liquid
Bleach, Hypochlorite, Hypo and Chlorine Bleach.
Listed Strengths: 10.5%, 12.5% and 15% CAS Number: 7681-52-9
Date MSDS Revised: August 2007 (previous revision 11/04)
Product Use: Disinfectant and sanitizer, see product label for all approved uses & instructions.
NSF Approval: Yes. Certified to NSF/ANSI Standard 60. Maximum use in Potable Water is 84 mg/L for 12.5%
bleach and 100 mg/L for 10.5% bleach.
NSF Non -Food Compounds Approval: Yes
SECTION 2 HAZARD INGREDIENTS/IDENTITY INFORMATION
Hazardous Ingredient(s): % (w/w) as Sodium Hypochlorite: 10.5-16%
Exposure Standards: None established for Sodium Hypochlorite, as Chlorine exposure standards are:
PEL (OSHA): 1 ppm as C12 STEL (OSHA): 3 ppm as CIZ
TLV (ACGIH): 0.5 ppm as Cl2 TWA (ACGIH): 0.5 ppm as C12
WEEL (AIHA): 2 mg/m3, 15 minute TWA as CIZ STEL (ACGIH): 1 ppm as C12
Emergency Overview: May cause burns to the eyes, skin and mucous membranes.
SECTION 3 PHYSICAL/CHEMICAL CHARACTERISTICS
Alternate Names :
Bleach
Chemical Name:
Sodium Hypochlorite
Chemical Family:
Oxidizing Agent
Molecular Formula:
Na-O-CI
Form:
Liquid
Appearance:
Water clear to a slight greenish -yellow, or light yellow aqueous solution
Odor:
Chlorine odor
pH:
11-14, dependent upon % weight as Sodium Hypochlorite
Vapor Pressure:
Not available
Vapor Density Air=1 :
Not available
Boiling Point:
Approximately 2301 F (1101' C)
Freezing Point:
14 F(8% w/w Cl2 solution), 7 F(10% w/w Cl2 solution), -3 F (12% w/w Cl2 solution)
Solubility (Water):
Completely Soluble
Solubility (Other):
Reacts with Many Organic Solvents
Density:
Appx. 10 lbs. per gallon
Evaporation Rate:
Not Available
Specific Gravity:
1.126 (8% w/w Cl2 solution), 1.163 (10% w/w Cl2 solution), 1.202 (12% w/w C12solution),
1.25 15% w/w Cl2 solution
Molecular Weight:
74.5
SECTION 4 STABILITY & REACTIVITY DATA
Chemical Stability Stable X7 Unstable
Incompatibility Conditions to Avoid): Stability decreases with heat and light exposure.
Incompatibility (Materials to Avoid): May react violently with strong acids. Other incompatibles include strong
caustics, ammonia, urea, reducing agents, organics, ether and oxidizable materials. Reaction with metals (nickel, iron,
cobalt and copper) may roduce oxygen gas, which supports combustion. May react with or anohalo en compounds to

(545138)
form spontaneously combustible compounds. May react explosively with nitro- and chloro-organic compounds as well as
acids and reducing agents. Acidification liberates chlorine gas.
Hazardous Decomposition or Byproducts: Chlorine gas. Decomposes with heat and reacts with acids.
Hazardous gases/vapors produced are hypochlorous acid, chlorine and hydrochloric acid. Composition depends upon
temperature and decrease in pH. Additional decomposition products, which depend on pH, temperature and time, are
sodium chloride and chlorate, and oxygen.
No Mechanical Shock or Impact
No Static Discharge
Oxidizer: No if <12% by weight,
Yes if > than 12% by weight
Hazardous Polymerization
I Mav Occur
Will Not Occur X
Note: Sodium Hypochlorite reacts violently with amines and ammonium salts. Solutions are reactive with common cleaning
products such as toilet bowl cleaners, rust removers, vinegar, acids, organics and ammonia products to produce hazardous
gases such as chlorine and other chlorinated species.
SECTION 5 POTENTIAL HEALTH EFFECTS AND FIRST AID INFORMATION
GENERAL: May cause immediate pain. Exposure to the skin may cause sensitization or other allergic responses. If the eye
is not irrigated immediately after it has been exposed permanent eye damage may occur. Strict adherence to first aid
measures following any exposure is essential. SPEED IS ESSENTIAL!
ROUTE(S) OF ENTRY AND POTENTIAL
EMERGENCY & FIRST AIDE PROCEDURES
HEALTH EFFECTS
INHALATION: Strong irritating to mucous
If inhaled, move expose person to fresh air. If person is not
membranes in the nose, throat and respiratory tract.
breathing, call 911 or an ambulance, then give artificial respiration,
Prolonged contact can cause chronic irritation,
preferably mouth-to-mouth if possible. If breathing is difficult, have
pulmonary edema and central nervous system
trained person administer oxygen. Call a poison control center or
depression. Repeated inhalation exposure may
medical physician for further treatment advice. Have the product label
cause impairment of lung function and permanent
or MSDS with you when calling or going for medical treatment.
lung damage.
SKIN CONTACT: Prolonged and repeated
If on skin or clothing, take off all contaminated clothing and rinse
exposure to dilute solutions often causes irritation,
skin immediately with plenty of water for 15-20 minutes. If irritation
redness, pain and drying and cracking of the skin.
persists, repeat flushing. Do not transport victim unless the
Human evidence has indicated that an ingredient in
recommended irrigation period is completed unless flushing can be
this product can cause skin sensitization. Depending
continued during transport. Call a poison control center or medical
upon the concentration and how soon after exposure
physician for treatment advice. Have the product label or MSDS with
the skin is washed with water, skin contact may cause
you when calling or going for medical treatment.
burns and tissue destruction.
EYE CONTACT: Strongly irritating to eyes.
If in eyes, hold eye open and rinse slowly and gently with plenty of
Exposure to vapor can cause tearing, conjunctivitis
water for 15-20 minutes. Remove contact lenses, if present, after the
and burning of the eyes. Eye contact may cause a
first 5 minutes, then continue rinsing eye for 10-15 minutes. Do not
corneal injury. The severity of the effects depend on
transport victim until the recommended flushing period is completed
the concentration and how soon after exposure the
unless irrigation can be continued during transport. Call a poison
eyes are washed with water. In severe exposure
control center or medical physician for further treatment advice. Have
cases, glaucoma, cataracts and permanent blindness
the product label and/or MSDS with you when calling or going to
may occur.
medical treatment.
INGESTION: Corrosive. Can cause severe
If swallowed, call poison control center or medical physician
corrosion of and damage to the gastrointestinal tract
immediately for treatment advice. Have the product label or MSDS
(including mouth, throat, and esophagus). Exposure
with you when calling or going for medical treatment. Have exposed
is characterized by nausea, vomiting, abdominal pain,
person sip a glass of water if able to swallow, and dilute immediately
diarrhea, bleeding, and/or tissue ulceration.
by giving milk, melted ice cream, starch paste or antacids such as milk
of magnesia. Avoid sodium bicarbonate because of carbon dioxide
release. DO NOT INDUCE VOMITING, LAVAGE OR ACIDIC
ANTIDOTES unless told to do so by poison control center or medical
physician. DO NOT give anything by mouth to an unconscious
person. If spontaneous vomiting occurs, have victim lean forward with
head down to avoid breathing in of vomitus, rinse mouth and
administer more water.
NOTE TO PHYSICIAN(S): Pre-existing medical conditions may be aggravated by exposures affecting target organs. There
are no known chronic effects. Probable mucosal damage may contraindicate the use of gastric lavage. In addition to the
alkalinity of this product, the continued generation of chlorine gas after ingestion can damage further the stomach mucous,
depending on the amount ingested. Consideration may be given to removal of the product from the stomach, taking care to
avoid perforation of esophagus or stomach. An ounce of 1 % sodium thiosulfate or milk of magnesia is helpful.
SECTION 6 TOXICOLOGICAL DATA
ANIMAL DATA: Inhalation 0.25-hour LC50 - 10.5 mg/L in rats; Acute Dermal LD50 - 10,000 mg/kg in rabbits;
Acute Oral LD50 - 8910 mg/kg in rats

(545138)
SUMMARY: The concentrated solution is corrosive to skin, and a 5% solution is a severe eye irritant. Solutions
containing more than 5% available chlorine are classified by DOT corrosive (please see section 10 of this MSDS). Toxicity
described in animals from single exposures by ingestion include muscular weakness, and hypoactivity. Repeated ingestion
exposure in animals caused an increase in the relative weight of adrenal glands in one study, but no pathological changes
were observed in two other studies. Long-term administration of compound in drinking water of rats caused depression of the
immune system. No adverse changes were observed in an eight week dermal study of a 1 % solution in guinea pigs. Tests in
animals demonstrate no carcinogenic activity by either the oral or dermal routes. Tests in bacterial and mammalian cell
cultures demonstrate mutagenic activity.
CARCINOGENICITY: None of the components present in this material at concentrations equal to or greater than 0.1% are
listed by IARC, NTP, OSHA or ACGIH as carcinogen.
MUTAGENICITY: Sodium Hypochlorite has been shown to produce damage to genetic material when tested in vitro.
Studies in vivo have shown no evidence of mutagenic potential for this material. It is judged that the risk of genetic damage is
insignificant for sodium hypochlorite because of its biological activity, lack of mutagenicity in vivo, and failure to produce
carcinogenic response.
SECTION 7 FIRE AND EXPLOSION HAZARD DATA
Flash Point: This product does not flash
Flammable Limits (Lower): Not Applicable
Flammable Limits (Upper): Not Applicable
Auto ignition Temperature: Not Applicable
Decomposition Temperature: Not Applicable I Rate of Burning: Not Available
Explosive Power: Not Available
Sensitivity to Mechanical Impact:
Sensitivity to Static Discharge:
Not expected to be sensitive to
Not expected to be sensitive to
mechanical impact
static discharge
Fire and Explosion Hazards: This material is non-
Extinguishing Media: Use agents appropriate for
flammable but is decomposed by heat and light, causing a
surrounding fire. Foam, dry chemical, carbon dioxide, water
pressure build-up which could result in an explosion. When
fog or spray. If leak or spill has not ignited, use water spray
heated, it may release chlorine gas or hydrochloric acid.
to disperse the vapors and to protect persons attempting to
Vigorous reaction with oxidizable or organic materials may
stop the leak.
result in fire.
Fire Fighting Procedures: Water spray should be
Fire Fighting Protective Equipment: Full protective
used to cool containers and may be used to knock down
clothing, including a NIOSH approved self-contained
escaping vapor. Remove storage vessels from the fire
breathing apparatus, must be worn in a fire involving this
zone.
material. Toxic gas vapors are produced upon
decomposition.
SECTION 8 ECOLOGICAL INFORMATION
The toxicity and corrosivity of this product is a function of concentration and the concentration's pH.
ECOTOXICOLOGICAL INFORMATION: Toxic to aquatic life. 96-hour LC50: fathead minnows: 0.090-5.9 mg/L, bluegill
sunfish: 0.10-2.48 mg/L, shore crab: 1.418 mg/L, grass shrimp: 52.0 mg/L, scud: 0.145-4.0 mg/L, water flea: 2.1 mg/L.
ENVIRONMENTAL EFFECTS: Do not contaminate domestic or irrigation water supplies, lakes, streams, ponds, or rivers.
May be an aesthetic nuisance due to color. Mammals and birds, exposed wildlife would be subject to skin irritation and burns
due to the corrosive nature of this material.
SECTION 9 DISPOSAL CONSIDERATIONS
Treatment, storage, transportation, and disposal must be in accordance with applicable Federal, State, and Local
regulations. Do not burn. Do not flush to surface water or sanitary sewer system. If pH of material is equal to or
greater than a 12.5, the material is a RCRA Hazardous Waste D002, corrosive.
SECTION 10 TRANSPORT INFORMATION
U.S. DOT Basic Shipping Description: Hypochlorite Solutions, 8, UN1791, III
U.S. DOT Hazardous Substance: Yes, RQ 100 pounds (Sodium Hypochlorite)
U.S. DOT Marine Pollutant: No
U.S. DOT Required Label: Corrosive (see column 6, 49 CFR §172.101)
U.S. DOT Packaging Exception: Yes, if package meets the criteria of a limited quantity or consumer
commodity as defined by 49 CFR §171.8, §173.144 and .154, and §172.312 and .316
N. AMERICAN EMERGENCY GUIDE PAGE NUMBER: 154
Transportation Emergency Phone Numbers: CHEMTREC 1-800-424-9300
SECTION 11 PRECAUTIONS FOR SAFE HANDLING AND STORAGE
PRECAUTIONS TO BE TAKEN IN HANDLING AND STORING: Take all precautions to avoid personal contact.
Keep container closed except when transferring material. Locate safety shower and eyewash station close to chemical
handling area. Use normal good industrial hygiene and housekeeping practices, wash thoroughly after handling. Store in a
cool, dry, well -ventilated area, away from incompatibles (minimum distance of 20-25 feet per NFPA Code 1) and direct
sunlight. Keep container properly labeled at all times. Vented containers must be used and must be kept closed when not

(545138)
being used. Long-term storage is impossible without decomposition. Only use containers made from tinted glass,
polyethylene & FRP. Keep out of reach of children.
PROCESS HAZARDS: Not Available
STORAGE TEMPERATURE: Store containers below 29°C and above freezing point. Do not expose sealed containers
above 40oC. Try to store in the dark at the lowest possible temperature, but keep from freezing, to slow -down decomposition.
SECTION 12 EXPOSURE CONTROLS/PERSONAL PROTECTION
ENGINEERING CONTROLS: Full handling precautions should be taken at all times. Provide good room ventilation plus
local exhaust at points of emission and low level floor exhaust in immediate handling area. Where engineering controls are not
feasible, use adequate local exhaust ventilation wherever mist, spray or vapor may be generated.
PERSONAL PROTECTIVE EQUIPMENT:
Eye: Use chemical safety goggles when there is potential for contact (splashing), faceshield recommended —
ANSI Z87.1
Skin: Gloves and protective clothing (apron, boots, and bodysuits) made from rubber, vinyl, neoprene or PVC.
Standard work clothing closed at the neck and wrist while wearing impervious equipment.
Respiratory (Specify Type): A NIOSH/MSHA approved air purifying respirator with an acid gas cartridge or
canister may be permissible under circumstances where airborne concentrations are expected to exceed
exposure limits. Protection provided by air purifying respirators is limited. Use a positive pressure air
supplied respirator if there is potential for uncontrolled releases, exposure levels are not known, or other
circumstances where air purifying respirators may not provide adequate protection.
Other: Eyewash, shower station (ANSI Z358.1) must be provided within the immediate work area.
SECTION 13 ACCIDENTAL RELEASE MEASURES
Ventilate enclosed area. Collect product for recovery or disposal. For release to land, contain discharge by constructing dikes
or applying inert absorbent; for release to water, utilize damming and/or water diversion to reduce the spread of contamination;
and, for release to air, vapors may be suppressed by the use of a water fog. All run-off water must be captured for treatment
and disposal. Collect contaminated soil and water, and absorbent for disposal. Notify applicable government authority if
release is reportable or could adversely affect the environment. Please follow all Local, State and Federal Laws for clean-up
and disposal of all contaminated material. Deactivating Chemicals: Sodium Sulfite, Sodium Thiosulfate and Sodium
Bisulfite.
SECTION 14 REGULATORY INFORMATION
OSHA CLASSIFICATION, 29 CFR §1900-1910:
Physical Hazards: Reactivity Health Hazards: Acute - Skin Sensitizer, Corrosive
CERCLA AND SARA REGULATIONS, 40 CFR 4300-373:
Reportable Quantity = 100 lb. CERCLA Hazardous Material: Yes
Title III Hazard Classifications: Acute - yes, Chronic - no, Fire - yes, Reactivity - yes & Sudden Release of
Pressure - No. This product may be reportable under the requirements of 40 CFR §370.
SARA Extremely Hazardous Substance: No SARA Toxic Chemical: No CA Prop 65: No
FDA 21 CFR 178.1010: Yes, Approved as Sanitizer
NSF Whitebook (former USDA Approval) Listing: Aqua Guard Chlorinating Sanitizer 10.5% - 3D, B1, B2,
D1, D2, G4, G7, GX, Q4, Aqua Guard Bleach 12.5% - 3D, B1, B2, D1, D2, G4, GX, Q4
EPA "CLEAN AIR ACT": This product does not contain nor is it manufactured with ozone depleting substances. It is not
defined as a Hazardous Air Pollutant per 40 CFR 112.
EPA Pesticide: The 10.5% and 12.5% sodium hypochlorite products are registered with the U.S. EPA as a pesticide, as
required under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA). It is a violation of Federal law to use this
product for pesticidal applications in a manner inconsistent with the FIFRA labeling.
NPCA-HMIS RATING: HEALTH: 3 FLAMMABILITY: 0 REACTIVITY: 2
NFPA RATING: NONE AT THIS TIME
SECTION 15 REFERENCES
Suppliers' Material Safety Data Sheets and EPA Labeling Requirements
Olin and OxyChem Sodium Hypochlorite Handbook
Chlorine Institute Sodium Hypochlorite Pamphlet#96
Chlorine Institute Product Stewardship Bulletins for Sodium Hypochlorite
This information contained herein, while not guaranteed, is offered only as a guide to the handling of this specific material and has been
prepared in good faith by product knowledgeable personnel. This information is not intended to be all-inclusive as to the manner and
conditions of use, handling and storage. Other factors may involve other or additional safety or performance considerations. Though Allied
Universal Corporation is happy to respond to questions regarding safe handling of Allied's products, safe handling and use remains the
responsibility of the product's consumers and/or customers. No warranty of merchantability or fitness for purpose, or any other kind, express
or implied, is made regarding performance, stability or otherwise. Allied Universal Corp. will not be liable for any damages, losses, injuries or
consequential damages that may result from the use of or reliance on any information contained herein. No suggestions for use are intended
as, and nothing herein shall be construed as a recommendation to infringe any existing patents or violate any federal, state or local laws, rules,
regulations or ordinances.

AppendN B
10

1/4"Full Circle Impact Sprinkler
RAIN BIRD
L36HIL36AH SERIES
1
3 g%n -
4
2
0
6 ®� 5
8
9
® 14
15
16
17
L36AH
Ref.
Part Description
L36H
Discontinued
UPPER ASSEMBLY
1
Body Cap
(114474)
(714474)
2
Arm Spring Assy
(177527)
(177449)
3
Arm
(715063)
(112236)
4
Arm Spring
(114472)
(114472)
5
Arm Washer
(100270)
(100270)
6
Fulcrum Pin
(110726)
(110726)
7
Body
(114319)
(114319)
NOZZLES (Specify nozzle size when ordering)
8
Straight Bore, Quick Fit
107881xx 107881xx
BEARING ASSEMBLY
9
Bearing Assembly
177424 177425
10
Top Seal Washer
(6r)(103709)(VV)(100313)
11
Metal Top Seal Washer
(100312) (100312)
12
Bearing Spring
(106237) (106237)
13
Bearing Sleeve
177517 177511
14
Bearing Washer
(B) (100726) (B) (100726)
15
Wear Washer
(0) (703058) (0) (104762)
16
Seal or8rg Washer
(G)(102345) (B)(100726)
17
Bearing Nipple
177517 177517
18
Bearing Washer Kit
177447 777448
18 10
Top Seal Washer
(Gr) (103709) (W) (100313)
11
Metal Top Seal Washer
(100312) (100312)
12
Bearing Spring
(106237) (106237)
14
Bearing Washer
(B) (100726) (B) (100726)
15
Wear Washer
(0) (103058) (0) (104762)
16
Seal or8rg Washer
(G)(102345) (B)(100726)
Bearing washer color code: W = White, Gr = Dark Green, B = Black, 0 = Orange, G = Grey
* NOTE: Old style L36 has a plastic bearing nipple, while new style L36 has a brass bearing
nipple.
Note: Part numbers enclosed in brackets () are not available individually, but may be sold in assemblies or kits.
TO BUY GENUINE RAIN BIRD PARTS, CONTACT YOUR LOCAL DISTRIBUTOR OR VISIT OUR ONLINESTOREAT WWW.RAINBIRD.COM Po91

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .0500 -- WASTEWATER IRRIGATION ,SYSTEM — RENEWAL
FORM: WWIS-R 02-21
Pursuant to 15A NCAC 02T .0107 b , if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .01001 15A NCAC 021' .0500, and Division Policies. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to I€tt s://etloes.de .nc. ov/Forms/No€►Disel€ar e-Bi-anch-Stibmittal-
Forn€-Ve€•2, or emailed to No€1-I)ischa€-ge.Renorts(toncde€t€'.gov if less than 20 megabytes (MB),
1. Applicant: Gates County
2. Permit No.: WQ0000267
3. Signature authority: Timothy Wilson Title: County Manager
Phone number: [phone] Select Email: [e-mail]
4. Mailing address: 115 Court St PO Box 148
City: Gatesville State: NC Zip: 27938-
5. Contact person: Timothy Wilson Email: [e-mail]
gatescountyne.gov
Primary phone number: [phone] Select Secondary phone number: ( ) - Select J
1. Physical address: SR 1316 Will Lane
City: Gatesville
2. Treatment facility coordinates to the sixth decimal degree:
Latitude: 36.4569' Longitude:-76,7230'
County: Gates Parcel No.: 1003522
State: NC Zip: 27938-
Method: Conversion from state coordinate plane
1. Permitted flow: 40000 GPD (The maximinn allowable flow based on what has been permitted)
2. As -built flow: 40000 GPD (The maximum allowable flow based on what has been constructed)
3. Average flow: 8197 GPD (The average of all reported flows on the previous calendar year's ND1lfRs)
4. Hydraulic capacity: 20.5 % (Divide the average flow h7Item 3 by the As -built flow in Item 2)
5. Wastewater composition: Domestic: 100 % Industrial: % Stormwater: %
1. Billing address: 115 Court St, PO Box 148
City: Gatesville State: NC Zip: 27938-
2. Verify the Applicant does not have any overdue annual fees:
hit ps:/Idec .na.6ov/about/divisions/Nvatcl--resources/water-resour�mils/w -�uts
Pursuant to 15A NCAC 02T ,0120f c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: W W1S-R 02-21 Page 1 of 6

1. ORC:
Grade:
Certification No.:
Mailing address:
City:
State;
Zip: -
Phone number: ( } - Select
Email:
2. Back -Up ORC:
Grade:
Certification No.:
Mailing address:
City:
State:
.Zip: -
Phone number: ( ) Select
Email:
1. Last all open -atmosphere treatment and storage structures associated with the renewing permit. Attach additional sheets if
necessary.
Type Parcel No. Volume (gal) Liner Type Freeboard (ft) Latitude Longitude
Storage 1003522 2,598,292 hull, synthetic 2 36.45690-76.72300
Select Select ° - °
Select Select 0°
Select Select ° - °
L List all wastewater permits (i.e., sewer, collection system, NPDES, residuals) that have interactions with the renewing permit.
Attach additional sheets if necessary.
Permit Type Permit No. Relationship Type
Select Select
Select Select
Select Select
Select Select
SECTION VLi —MONITORING WELLS.
1. List all groundwater monitoring wells associated with the renewing permit. Attach additional sheets if necessary.
Well Name
Parcel No.
Status
Gradient
Location
Latitude
Longitude
MW#lB
1003522
Active
Cross gradient
Inside Review Boundary
36.47500
-76,7223°
MW#2B
1003522
Active
Downgradient
Inside Review Boundary
36A5610
-76,7219°
MW#3B
1003522
Active
Downgradient
Inside Review Boundary
36,4544"
-76.72140
MW44B
1003522
Active
Downgradient
Inside Review Boundary
36.4532"
-76,72250
MW#5B
1003522
Active
Downgradient
Inside Review Boundary
36.45300
-76.72420
MW96B
1003522
Active
Downgradient
Inside Review Boundary
36A541 °
-76.7255�
MW#7B
1003522
Active
Downgradient
Inside Review Boundary
36.45510
-76.7259°
MW#8B
1003522
Active
Cross gradient
Inside Review Boundary
36.45600
-76.7254°
MW#9B
1003522
Active
Cross gradient
Inside Review Boundary
36.45600
-76,7270°
Select
Select
Select
- °
Select
Select
Select
FORM: W WIS-R 02-21 Page 2 of 6

1. List all irrigation fields associated with the renewing perinit. Attach additional sheets if necessary.
Field
County
PareeI No.
Deeded Owner
Area
Covet Crop
Latitude
Longitude
A
Gates
1003522
Gates County
5.16
Grass
36,45420
-76.722V
B
Gates
1003522
Gates County
5.17
Grass
36.45430
-76.7233p
C
Gates
1003522
Gates County
5.56
Grass
36,45590
-76.722V
D
Gates
1003522
Gates County
4.92
Grass
36.45630
-76.7237°
E
Gates
1003522
Gates County
4.90
Grass
36.45650
-76.72490
p
o
p
o
a
b
a
p
O
b
O
O
O
O
a
O
O
O
O
O
O
a
O
O
p
O
O
O
O
O
O
p
a
a
a
o
0
0
0
0
0
0
0
0
0
0
p
0
p
o',
a
ol,
p
a
0
0'
0
0
p
o
0
0
Total Acreage: 25.71
FORM: WWIS-R 02-21 Page 3 of 6

Was the facility originally permitted or had a major modification issued after September 1, 2006?
® Yes —Pursuant to 15A NCAC 02T .0105(d), submit a site map pursuant to the requirements in 15A NCAC 02T .0504(d). These
requirements are:
N A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and showing
all facility -related structures and fences within the wastewater treatment, storage, and irrigation areas.
® Soil mapping units shown on all irrigation sites.
® The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
N Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and I5A NCAC 02T ,0506ic)
if applicable.
N Setbacks as required by 15A ?NCAC 02T .0506.
® Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites.
® All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation sites.
❑ No — Skip Attachment A.
ATTACHMENT B. SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106(b)?
® Yes — Skip Attachment B.
❑ No — Submit a delerzation letter pursuant to 15A NCAC 02T (11 Oi c) authorizing the signature authority to sign.
Does the existing permit include an approved flow reduction?
❑ Yes — Submit a copy of the flow reduction approval letter, as well as 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
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T .01 14(t).
® No — Skip Attachment C.
Is the Applicant a Privately -Owned Public Utility?
❑ Yes — Pursuant to 15A NCAC 02T .0115(a)(1), submit the Certificate of Public Convenience and Necessity from the North
Carolina (Mlities Commission demonstrating the Applicant is authorized to hold the utility franchise.
® No — Skip Attachment D.
Is the Applicant a Home/Property Owners' Association or Developer of Lots to be Sold?
❑ Yes (Horne/Property Owners' Association)—Pursuantto i 5A NCAC 02T .01 15(a)(2), submit an executed Operational Agreement
(FORNJ,j IJOA). Pursuant to 1.5A NCAC 02T .01 15(c), if the applicant is a legally formed Homeowners' or Property Owner's
Association, submit a copy of the Articles of Incorporation, Declarations, and By-laws.
❑ Yes (Developer of Lots to be Sold) _ Pursuant to 15A NCAC 42l' .Ol 15(a){2}, submit an executed O)erational Agreement
tFORM: DEV). Pursuant to 15A NCAC 02T .01 15(b), if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and By-laws.
® No — Skip Attachment E.
FORM: WWIS-R 02-21 Page 4 of 6

ATTACHMENT F - DEMONSTRATION OIL: FUTURE WASTIEWAT)ER T. R ATMENT iCAPACITIES
Is the applicant a municipality, county, sanitary district, or public utility?
® Yes — Proceed to the next question.
❑ No — Skip Attachment F.
Does the hydraulic capacity in Section III, Item 4 exceed 70%?
❑ Yes (the hydraulic capacity is greater than 70%, but less than 80%) — Pursuant to 15A NCAC 02T .01 18(I ), prior to exceeding
80 percent of the system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee
shall submit an engineering evaluation of their future wastewater treatment, utilization, and disposal needs. This evaluation shall
outline plans for meeting future wastewater treatment, utilization, or disposal needs by either expansion of the existing system,
elimination or reduction of extraneous flows, or water conservation and shall include the source of funding for the improvements.
If expansion is not proposed or is proposed for a later date, a justification shall be made that wastewater treatment needs will be
met based on past growth records and future growth projections, and as appropriate, shall include conservation plans or other
measures to achieve waste flow reductions.
❑ Yes (the hydraulic capacity greater than 80%) -- Proceed to the next question.
® No — Skip Attachment F.
If answered Yes above, does the hydraulic capacity in Section III, Item 4 exceed 80%?
❑ Yes (the hydraulic capacity is greater than 80%) -- Pursuant to 15A NCAC 02'1' .01 18(2), prior to exceeding 90 percent of the
system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee shall obtain all
permits needed for the expansion of the wastewater treatment, utilization, or disposal system and, if construction is needed,
submit final plans and specifications for expansion, including a construction schedule. If expansion is not proposed or is proposed
for a later date, a justification shall be made that wastewater treatment needs will be met based on past growth records and future
growth projections, and as appropriate, shall include conservation plans or other specific measures to achieve waste flow
reductions.
❑ No — Skip Attachment F,
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
® Yes — Skip Attachment G.
❑ No --- Pursuant to 15A NCAC 021 .01 16(c), provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system on
property not owned by the Permittee.
.........................................................................
ATTACHMENT H AFFILIATIONS
Are the Permittee's affiliations of record correct? Check affiliations.
® Yes -- Skip Attachment H.
❑ No --- Provide the corrected affiliations and their contact information,
ATTACH.AM, NT I; COM-PLIANCE:SCREDULE, S
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
❑ Yes — Submit documentation that the compliance schedules have been met.
® No — Skip Attachment I.
Does the Permittee have any existing civil penalties or outstanding violations?
❑ Yes (civil penalties) --- Submit payment for the civil penalty, or proof of remission request.
❑ Yes (violations) — Submit a copy of your response to the Notice of Violation.
® No -- Skip Attachment I.
FORM: W WIS-R 02-2I Page 5 of 6

Does the wastewater composition in Section 111, Item 5 include any industrial wastewater?
❑ Yes — Proceed to the next question.
® No — Skip Attachment K.
Has the nature of the industrial wastewater changed since the last permit issuance (i.e., changes in industrial process, introduction of
new materials or chemicals, etc.)?
❑ Yes -- Provide a chemical analysis of the wastewater pursuant to the requirements in 15A NCAC 02T ,0504JU
, Provide an
overview of the manufacturing process; an inventory of all chemical and biological materials used in the manufacturing process;
and an overview of the cleaning and treatment methodology.
❑ No — Provide an overview of the manufacturing process; an inventory of all chemical and biological materials used in the
manufacturing process; and an overview of the cleaning and treatment methodology.
Does the existing permit include setback waivers?
❑ Yes -- Pursuant to 15A NCAC 02T .0506(cl_l, provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02L ,0107.
® No — Skip Attachment L.
attest that this application
(Signature authority's name as noted in Section 1, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pails of this
application package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as incomplete. I further certify pursuant to 15A NCAC 02'f .012QLbl, that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agreement, or order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuant to 15A NCAC 021-.01.06(b). An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NCAC 02T .0106(c), Pursuant to § 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.
Signature:
Date: T'Z,(.� 2--
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDT FILE VIA:
Email:
Non-Dischar e.Re ports(a)nedenr. ov
Laserfiche Upload:
lit ti)s.//edoes.elect.nc.aov/Forms/NunDischjjrge-Branch-
Submittal-F or m-'Vert
FORM: WW1S-R 02-21 Page 6 of 6

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