WQ0035784_Additional Information Response - Incomplete_20220808

August 5, 2022
Ms. Lauren Raup-Plummer, Engineer III
Division of Water Resources

Subject: Application No. WQ0035784
Additional Information Request
The Cottages of Boone WWTP
Wastewater Irrigation System
Watauga County

A. Cover/Response Letter:
1. No comment.

B. Application/Permit Fees:
1. The 2022 annual permit fee is now overdue. A copy of the 2022 invoice with a due date of May 2,
2022 is enclosed. Please see that the permit fee is paid and provide a copy of the receipt.
 Payment status pending

C. Application (WWIS-R 02-21):
1. The ORC information in Section V has not been updated. Please update the application to list the
current designated ORC and back-up ORC information.
 Form updated

D. Application (WWIS 06-16):
1. Consultant Information in Section III was not completed. Please provide the consulting engineer’s
contact information.
 Form updated.
2. Within Section IV. General Requirements, the applicant indicated that they are a Home/Property
Owners’ Association. Pursuant to 15A NCAC 02T .0115, Home/Property Owners’ Associations
are required to submit an Operational Agreement. A copy of the Operational Agreement (Form:
HOA) was not provided. Please provide the necessary documentation required by 15A NCAC 02T
.0115.
 The Cottages of Boone is not an HOA/POA. The box was checked by mistake. Form has been
updated accordingly.
3. The response to Section VIII. Setbacks indicated that the applicant is not intending to comply with
15A NCAC 02T .0506(c). The current permit for The Cottages of Boone WWTP indicates that the
facility is currently permitted to be compliant with 15A NCAC 02T .0506(c). Is the facility no
longer meeting the reclaimed water quality effluent standards outlined in Attachment A and the
permit? Please note, if the facility is no longer compliant with 15A NCAC 02T .0506(c), then
setbacks from drip irrigation sites to property lines will be increased from 0 feet to 50 feet. Please
provide clarification.
 Data redacted from form. The estimated field observed distances originally provided were not
representative. Section omitted unless the Division requests otherwise.
 The box on Section VIII, Item 4. has been de-selected. The Cottages of Boone intends to comply
with 15A NCAC 02T 0506.(c)
4. The Professional Engineer’s Certification on page 12 of the application was not completed. Please
have a North Carolina Professional Engineer certify the WWIS 06-16 form for the proposed
modifications.
 Page 12 of form WWIS-06-16 has been certified by Mark Brooks. See attached document.

E. Property Ownership Documentation:
1. No comment.

F. Engineering Plans:
1. A detail sheet was not provided. Please provide details of all piping and valves, including proposed
pipe material and diameter for the 90% outlet pipe and the proposed elevations for the modified
features relative to the equalization tank and surrounding treatment components.
 8/8/2022: Pending (c/o Mark Brooks)

G. Specifications:
1. Signed and sealed engineering specifications were not provided in the response package. Was the
“Engineer’s Evaluation of Valve Installation” letter meant to serve as a specification cover letter
for the product specification sheets? If so, this document was not sealed. Please provide
specifications meeting the requirements of 15A NCAC 02T .0504(c)(2).
 8/8/2022: Pending (c/o Mark Brooks)

H. Engineer’s Evaluation Letter:
1. On the second page of the letter, there appears to be a revision in the equalization tank’s storage
volume from 54,496 gallons to 49,274 gallons. Please confirm that the new equalization tank’s
effective storage volume is 49,274, and please revise Section V.11.a. of the WWIS 06-16
application form to reflect the current storage volume so that the Non-Discharge Branch can revise
the facility description, accordingly.
 The installation of the 90% pipe will reduce the tank volume to 49,274. Currently, 54,496 is
correct.
2. Within the description and rationale for the 90% outlet piping, it mentions that the floor drain within
the drum screen building pumps back to the influent pump station. The influent pump station was
not included within the schematic and hydraulic profile on Sheet N-2.1 and the piping does not
appear to be depicted on the facility layout on Sheet N-3.2. The Winston-Salem Regional Office indicated
that the influent pump station was at a much higher elevation than the rest of the treatment facility; please
provide additional information regarding the described piping configuration between the drum screen and
the influent pump station.
 8/8/2022: Pending (c/o Mark Brooks)

I. Engineering Calculations:
1. The Engineer’s Evaluation included calculations comparing the initially designed equalization
pumps to the gravity knife valve configuration. The letter summarizing the results was not sealed
as required by 15A NCAC 02T .0504(c)(3). Please revise as needed.
 8/8/2022: Pending (c/o Mark Brooks)

J. Site Map:
1. No comment.

K. Power Reliability Plan:
1. No comment.

L. Operation & Maintenance Plan:
1. The provided Operation and Maintenance Manual was not revised to include operation and
maintenance for the proposed knife valve or the proposed 90% outlet pipe and associated gate
valve. For example, Page 12 references the Equalization Tank pumps with an incorrect detail
screen for the configuration on Page 28. Please review and revise the Operation and Maintenance
Manual to reflect the modified facilities.
 The O&M provided is based upon the existing treatment facility and will be updated once
sufficient plans and specs of the modified facilities have been obtained. 8/8/2022: Pending (c/o
Mark Brooks)

M. Residuals Management Plan:
1. No comment.
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0500 – WASTEWATER IRRIGATION SYSTEM – RENEWAL
FORM: WWIS-R 02-21

FORM: WWIS-R 02-21 Page 1 of 6
Pursuant to 15A NCAC 02T .0107(b), if the application does not include all required i nformation and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .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 https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-Submittal-
Form-Ver2, or emailed to [e-mail] if less than 20 megabytes (MB).
SECTION I – APPLICANT INFORMATION
1. Applicant: Wallace Loft LLC d.b.a. The Cottages of Boone
2. Permit No.: WQ0035784
3. Signature authority: Sean Dwyer Title: Director
Phone number: [phone] Select Email: [e-mail]
4. Mailing address: 5 Bryant Park, 28th Floor
City: New York State: NY Zip: 10018-
5. Contact person: Christopher Garnic Email: [e-mail]
Primary phone number: [phone] Select Secondary phone number: ( ) - Select

SECTION II – FACILITY INFORMATION
1. Physical address: 615 Fallview Ln. County: Watauga Parcel No.: 2900326210000
City: Boone State: NC Zip: 28607-
2. Treatment facility coordinates to the sixth decimal degree:
Latitude: 36.197996° Longitude: -81.700029° Method: Geodetic quality GPS survey

SECTION III – FLOW INFORMATION
1. Permitted flow: 108530 GPD (The maximum allowable flow based on what has been permitted)
2. As-built flow: 108530 GPD (The maximum allowable flow based on what has been constructed)
3. Average flow: 58549 GPD (The average of all reported flows on the previous calendar year’s NDMRs)
4. Hydraulic capacity: 53 % (Divide the average flow in Item 3 by the As-built flow in Item 2)
5. Wastewater composition: Domestic : 100 % Industrial: % Stormwater: %

SECTION IV – BILLING INFORMATION
1. Billing address: 615 Fallview Ln
City: Boone State: NC Zip: 28607-
2. Verify the Applicant does not have any overdue annual fees:
https://deq.nc.gov/about/divisions/water -resources/water-resources-permits/wq-epayments
Pursuant to 15A NCAC 02T .0120(c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.

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SECTION V – OPERATOR IN RESPONSIBLE CHARGE (ORC) INFORMATION
1. ORC: Eric Youngs Grade: SI Certification No.: 1000412
Mailing address: 773 Sanford Ave
City: Mocksville State: NC Zip: 27028-
Phone number: [phone] Cell Email: [e-mail]
2. Back-Up ORC: Todd Robinson Grade: SI Certification No.: 1006252
Mailing address: 773 Sanford Ave
City: Mocksville State: NC Zip: 27028-
Phone number: [phone] Cell Email: [e-mail]

SECTION VI – OPEN-ATMOSPHERE STRUCTURES
1. List 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
5-Day Upset 2900-32-6210 548,000 Full, metal 60 36.19913° -81.70090°
Storage 2900-32-6210 1,562,000 Full, metal 100 36.19913° -81.70090°
Select Select . ° - . °
Select Select . ° - . °

SECTION VII – RELATED PERMITS
1. List all wastewater permits (i.e., sewer, collection system, NPDES, residuals) that have interactions with the renewing permi t.
Attach additional sheets if necessary.
Permit Type Permit No. Relationship Type
Sewer NC0089991 NPDES
Discharge NC0042770 Receiving WWTP
Collection System WQCSD0738 Discharging collection system
Select Select

SECTION VIII – 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
MW1 2900-24-2220 Active Select Select . ° - . °
MW2 2900-24-2220 Active Select Select . ° - . °
MW3 Active Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
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SECTION IX – IRRIGATION FIELDS
1. List all irrigation fields associated with the renewing permit. Attach additional sheets if necessary.
Field County Parcel No. Deeded Owner Area Cover Crop Latitude Longitude
1 WATAUGA CCC-Boone, LLC 2.80 MIXED
HARDWOOD/PINE 36.202779° -81.705226°
2 WATAUGA CCC-Boone, LLC 2.70 MIXED
HARDWOOD/PINE 36.202203° -81.704549°
3 WATAUGA CCC-Boone, LLC 1.86 MIXED
HARDWOOD/PINE 36.202258° -81.703531°
4 WATAUGA CCC-Boone, LLC 2.72 MIXED
HARDWOOD/PINE 36.201789° -81.702476°
5 WATAUGA CCC-Boone, LLC 1.72 MIXED
HARDWOOD/PINE 36.19994° -81.698554°
6 WATAUGA CCC-Boone, LLC 2.59 MIXED
HARDWOOD/PINE 36.199283° -81.699303°
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Total Acreage: 14.39

ATTACHMENT A – SITE MAP
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:
A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and show ing
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.
Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and 15A NCAC 02T .0506(c)
if applicable.
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 delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.

ATTACHMENT C – FLOW REDUCTION
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 .0114(f).
No – Skip Attachment C.

ATTACHMENT D – CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
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 Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise.
No – Skip Attachment D.

ATTACHMENT E – OPERATIONAL AGREEMENT
Is the Applicant a Home/Property Owners' Association or Developer of Lots to be Sold?
Yes (Home/Property Owners' Association) – Pursuant to 15A NCAC 02T .0115(a)(2), submit an executed Operational Agreement
(FORM: HOA). Pursuant to 15A NCAC 02T .0115(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 02T .0115(a)(2), submit an executed Operational Agreement
(FORM: DEV). Pursuant to 15A NCAC 02T .0115(b), if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and By-laws.
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No – Skip Attachment E.

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ATTACHMENT F – DEMONSTRATION OF FUTURE WASTEWATER TREATMENT CAPACITIES
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 .0118(1), 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 improveme nts.
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 02T .0118(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 a ll
permits needed for the expansion of the wastewater treatment, utilization, or disposa l system and, if construction is needed,
submit final plans and specifications for expansion, including a construction schedule. If expansion is not proposed or is pr oposed
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.

ATTACHMENT G – EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation syste m?
Yes – Skip Attachment G.
No – Pursuant to 15A NCAC 02T .0116(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.

ATTACHMENT I – COMPLIANCE SCHEDULES
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.

ATTACHMENT J – CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
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 J.

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ATTACHMENT K – INDUSTRIAL WASTEWATER
Does the wastewater composition in Section III, 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 .0504(h). Provide an
overview of the manufacturing process; an inventory of all chemical and biological materials used in the manufacturing proces s;
and an overview of the cleaning and treatment methodology.
No – Provide an overview of the manufacturing process; an inventory of all chemical and biological mater ials used in the
manufacturing process; and an overview of the cleaning and treatment methodology.

ATTACHMENT L – SETBACK WAIVERS
Does the existing permit include setback waivers?
Yes – Pursuant to 15A NCAC 02T .0506(d), 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.

APPLICANT’S CERTIFICATION
I, attest that this application
(Signature authority’s name as noted in Section I, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts 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 02T .0120(b), 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 02T .0106(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:
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email: Laserfiche Upload:
[e-mail] https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-
Submittal-Form-Ver2

Sean Dwyer
DocuSign Envelope ID: 36140D9A-C8EC-4F02-B43C-AB37BDE123F9
09-Aug-2022 | 1:11 AM SGT
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0500 – WASTEWATER IRRIGATION SYSTEMS
INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION

INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION Page 1 of 6
Plans, specifications and supporting documents shall be prepared in accordance with 15A NCAC 02H .0400 (if necessary), 15A
NCAC 02L .0100, 15A NCAC 02T .0100, 15A NCAC 02T .0700, Division Policies and good engineering practices. Failure to
submit all required items will necessitate additional processing and review time.
For more information, visit the Water Quality Permitting Section’s Non-Discharge Permitting Unit website
General – When submitting an application to the Water Quality Permitting Section’s Non-Discharge Permitting Unit, please use the
following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking
the provided boxes will help produce a quicker review time and reduce the amount of requested additional information.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation.
A. Cover Letter (All Application Packages):
List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ). The appropriate fee amount for new and major modification applications may be found at: Standard Review
Project Fees.
C. Wastewater Irrigation Systems (FORM: WWIS 06-16) Application (All Application Packages):
Submit the completed and appropriately executed Wastewater Irrigation Systems (FORM: WWIS 06-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or due
to space restrictions, attachments to the application may be made, as long as the attachments are numbered to correspond to the
section and item to which they refer.
If the Applicant Type in Item I.2. is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
If the Applicant Type in Item I.2. is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
The facility name in Item II.1. shall be consistent with the facility name on the plans, specifications, agreements, etc.
The Professional Engineer’s Certification on Page 12 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
The Applicant’s Certification on Page 12 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
If this project is for a renewal without modification, use the Non-Discharge System Renewal (FORM: NDSR) application.
D. Property Ownership Documentation (All Application Packages):
 Per 15A NCAC 02T .0504(f), the Applicant shall demonstrate they are the owner of all property containing the wastewater
treatment, storage and irrigation facilities:
Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
Provide all agreements, easements, setback waivers, etc. that have a direct impact on the wastewater treatment, conveyance,
storage and irrigation facilities.
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INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION Page 2 of 6
E. Soil Evaluation (All Application Packages that include new irrigation sites):
Per 15A NCAC 02T .0504(b) and the Soil Scientist Evaluation Policy, submit a detailed soil evaluation that has been signed,
sealed and dated by a North Carolina Licensed Soil Scientist and includes at a minimum:
The report shall identify all the sites/fields with project name, location, and include a statement that the sites/fields were
recommended for the proposed land application activity.
Field delineated detailed soils map meeting all of the requirements of the Soil Scientist Evaluation Policy.
Soil profile descriptions meeting all of the requirements of the Soil Scientist Evaluation Policy.
Provide all soil boring logs performed at the site.
Standard soil fertility analysis conducted no more than one year prior to permit application for each map unit in the soil
map legend for the following parameters:
Acidity Exchangeable sodium percentage (by calculation) Phosphorus
Base saturation (by calculation) Magnesium Potassium
Calcium Manganese Sodium
Cation exchange capacity Percent humic matter Zinc
Copper pH
 Saturated hydraulic conductivity (KSAT) data that shall include at a minimum:
A minimum of three KSAT tests shall be conducted in the most restrictive horizon for each soil series in the soil map.
All KSAT tests shall be conducted in areas representative of the site.
All KSAT tests shall be run until steady-state equilibrium has been achieved.
All collected KSAT data shall be submitted, including copies of field worksheets showing all collected readings.
Submit a soil profile description for each KSAT data point that shall extend at least one foot below the tested horizon.
 Soil evaluation recommendations shall include at a minimum:
A brief summary of each map unit and its composition and identification of minor contrasting soils.
Maximum irrigation precipitation rate (in/hr) for each soil/map unit within the proposed irrigation areas.
Seasonal irrigation restrictions, if appropriate.
Identification of areas not suitable for wastewater irrigation.
Recommended geometric mean KSAT rate to be used in the water balance for each soil/map unit based upon in-situ
measurement of the saturated hydraulic conductivity from the most restrictive horizon.
Recommended drainage coefficient to be used in the water balance based upon comprehensive site evaluation, review
of collected onsite data, minor amounts of contrasting soils and the nature of the wastewater to be applied.
Recommended annual hydraulic loading rate (in/yr) for each soil/map unit within the proposed irrigation areas based
upon in-situ KSAT measurements form the most restrictive soil horizon.
NOTE – If the soil evaluation was performed more than one year prior to the submittal of this application package, a statement shall
be included indicating that the site has not changed since the original investigation.
F. Agronomist Evaluation (All Application Packages that include new irrigation sites or new crops for existing irrigation sites):
Per 15A NCAC 02T .0504(i), submit an agronomist evaluation that has been signed, sealed and dated by a qualified professional
and includes at a minimum:
Proposed nutrient uptake values for each cover crop based upon each field’s dominant soil series and percent slope.
Plant available nitrogen calculations for each cover crop using the designed effluent concentrations in Application Item
V.1. and proposed mineralization and volatilization rates.
Historical site consideration, soil binding and plant uptake of phosphorus.
Seasonal irrigation restrictions, if appropriate.
A clear and reproducible map showing all areas investigated and their relation to proposed fields and crops.
Maintenance and management plan for all specified crops.
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G. Hydrogeologic Report (All Application Packages treating industrial waste or having a design flow over 25,000 GPD):
Per 15A NCAC 02T .0504(e), the Hydrogeologic Investigation and Reporting Policy, the Groundwater Modeling Policy and
the Performance and Analysis of Aquifer Slug Tests and Pumping Tests Policy, submit a detailed hydrogeologic description
that has been signed, sealed and dated by a qualified professional and includes at a minimum:
A hydrogeologic description to a depth of 20 feet below land surface or bedrock, whichever is less. A greater depth of
investigation is required if the respective depth is used in predictive calculations.
Representative borings within the irrigation areas and all proposed earthen impoundments.
A description of the regional and local geology and hydrogeology.
A description, based on field observations of the site, of the site topographic setting, streams, springs and other groundwater
discharge features, drainage features, existing and abandoned wells, rock outcrops, and other features that may affect the
movement of the contaminant plume and treated wastewater.
Changes in lithology underlying the site.
Depth to bedrock and occurrence of any rock outcrops.
The hydraulic conductivity and transmissivity of the affected aquifer(s).
Depth to the seasonal high water table (SHWT).
A discussion of the relationship between the affected aquifers of the site to local and regional geologic and hydrogeologic
features.
A discussion of the groundwater flow regime of the site prior to operation of the proposed facility and post operation of
the proposed facility focusing on the relationship of the system to groundwater receptors, groundwater discharge features,
and groundwater flow media.
If the SHWT is within six feet of the surface, a mounding analysis to predict the level of the SHWT after wastewater
application.
H. Water Balance (All Application Packages that include new or modified irrigation sites, changes in flow or changes in storage):
Per 15A NCAC 02T .0504(k) and the Water Balance Calculation Policy, submit a water balance that has been signed, sealed
and dated by a qualified professional and includes at a minimum:
At least a two-year iteration of data computation that considers precipitation into and evaporation from all open atmosphere
storage impoundments, and uses a variable number of days per month.
Precipitation based on the 80th percentile and a minimum of 30 years of observed data.
Potential Evapotranspiration (PET) using the Thornthwaite method, or another approved methodology, using a minimum
of 30 years of observed temperature data.
Soil drainage based on the geometric mean of the in-situ KSAT tests in the most restrictive horizon and a drainage coefficient
ranging from 4 to 10% (unless otherwise technically documented).
 Other factors that may restrict the hydraulic loading rate when determining a water balance include:
Depth to the SHWT and groundwater lateral movement that may result in groundwater mounding.
Nutrient limitations and seasonal application times to ensure wastewater irrigation does not exceed agronomic rates.
Crop management activities resulting in cessation of irrigation for crop removal.
NOTE – Wastewater Irrigation Systems serving residential facilities shall have a minimum of 14 days of wet weather storage.
I. Engineering Plans (All Application Packages):
Per 15A NCAC 02T .0504(c)(1), submit standard size and 11 x 17-inch plan sets that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer, and shall include at a minimum:
Table of contents with each sheet numbered.
A general location map with at least two geographic references and a vicinity map.
A process and instrumentation diagram showing all flow, recycle/return, aeration, chemical, electrical and wasting paths.
Plan and profile views of all treatment and storage units, including their piping, valves, and equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), as well as their dimensions and elevations.
Details of all piping, valves, pumps, blowers, mixers, diffusers, recording devices, fencing, auxiliary power, etc.
A hydraulic profile from the treatment plant headworks to the highest irrigation point.
The irrigation area with an overlay of the suitable irrigation areas depicted in the Soil Evaluation.
Each nozzle/emitter and their wetted area influence, and each irrigation zone labeled as it will be operated.
Locations within the irrigation system of air releases, drains, control valves, highest irrigation nozzle/emitter, etc.
For automated irrigation systems, provide the location and details of the precipitation/soil moisture sensor.
Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
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J. Specifications (All Application Packages):
Per 15A NCAC 02T .0504(c)(2), submit specifications that have been signed, sealed and dated by a North Carolina licensed
Professional Engineer, and shall include at a minimum:
Table of contents with each section/page numbered.
Detailed specifications for each treatment/storage/irrigation unit, as well as all piping, valves, equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), nozzles/emitters, precipitation/soil moisture sensor (if applicable),
audible/visual high water alarms, liner material, etc.
Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
Materials (i.e., concrete, masonry, steel, painting, method of construction, etc.)
Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
Means for ensuring quality and integrity of the finished product, including leakage, pressure and liner testing.
Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
K. Engineering Calculations (All Application Packages):
Per 15A NCAC 02T .0504(c)(3), submit engineering calculations that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
Hydraulic and pollutant loading calculations for each treatment unit demonstrating how the designed effluent
concentrations in Application Item V.1. were determined.
Sizing criteria for each treatment unit and associated equipment (i.e., blowers, mixers, flow meters, pumps, etc.).
Total and effective storage calculations for each storage unit.
Friction/total dynamic head calculations and system curve analysis for each pump used.
Manufacturer’s information for all treatment units, pumps, blowers, mixers, diffusers, flow meters, irrigation system, etc.
Flotation calculations for all treatment and storage units constructed partially or entirely below grade.
A demonstration that the designed maximum precipitation and annual loading rates do not exceed the recommended rates.
A demonstration that the specified auxiliary power source is capable of powering all essential treatment units.
L. Site Map (All Application Packages):
Per 15A NCAC 02T .0504(d), submit standard size and 11 x 17-inch site maps that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer and/or Professional Land Surveyor, and shall include at a minimum:
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.
Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and 15A NCAC 02T .0506(c)
if applicable.
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.
NOTE – For clarity, multiple site maps of the facility with cut sheet annotations may be submitted.
M. Power Reliability Plan (All Application Packages):
Per 15A NCAC 02T .0505(l), submit documentation of power reliability that shall consist of at a minimum:
An automatically activated standby power supply onsite that is capable of powering all essential treatment units under
design conditions, OR
 Approval from the Director that the facility:
Serves a private water distribution system that has automatic shut-off during power failures and has no elevated water
storage tanks,
Has sufficient storage capacity that no potential for overflow exists, and
Can tolerate septic wastewater due to prolonged detention.
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N. Operation and Maintenance Plan (All Application Packages):
Per 15A NCAC 02T .0507, submit an operation and maintenance (O&M) plan encompassing all wastewater treatment, storage
and irrigation systems that shall include at a minimum a description of:
Operation of the wastewater treatment, storage and irrigation systems in sufficient detail to show what operations are
necessary for the system to function and by whom the functions are to be conducted.
Anticipated maintenance of the wastewater treatment, storage and irrigation systems.
Safety measures, including restriction of access to the site and equipment.
Spill prevention provisions such as response to upsets and bypasses, including how to control, contain and remediate.
Contact information for plant personnel, emergency responders and regulatory agencies.
NOTE – A final O&M Plan shall be submitted with the partial and/or final Engineering Certification required under 15A NCAC
02T .0116, however, a preliminary O&M Plan shall be submitted with each application package.
O. Residuals Management Plan (All Application Packages with new, expanding or replacement wastewater treatment systems):
Per 15A NCAC 02T .0504(j) and .0508, submit a Residuals Management Plan that shall include at a minimum:
A detailed explanation of how generated residuals (including trash, sediment and grit) will be collected, handled, processed,
stored, treated, and disposed.
An evaluation of the treatment facility’s residuals storage requirements based upon the maximum anticipated residuals
production rate and ability to remove residuals.
A permit for residuals utilization or a written commitment to the Applicant from a Permittee of a Department approved
residuals disposal/utilization program that has adequate permitted capacity to accept the residuals or has submitted a
residuals/utilization program application.
If oil/grease removal and collection are a designed unit process, submit an oil/grease disposal plan detailing how the
oil/grease will be collected, handled, processed, stored and disposed.
NOTE – Per 15A NCAC 02T .0505(o), a minimum of 30 days of residual storage shall be provided.
NOTE – Per 15A NCAC 02T .0504(j), a written commitment to the Applicant from a Permittee of a Department approved residuals
disposal/utilization program is not required at the time of this application, however, it shall be provided prior to operation of any
permitted facilities herein.
NOTE – If an on-site restaurant or other business with food preparation is contributing wastewater to this system, an oil/grease
disposal plan shall be submitted.
P. Additional Documentation:
 Certificate of Public Convenience and Necessity (All Application Packages for Privately-Owned Public Utilities):
Per 15A NCAC 02T .0115(a)(1) and .0504(g), provide the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be
served by the wastewater treatment and irrigation system, or
Provide a letter from the North Carolina Utilities Commission’s Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
 Existing Permit (All Modification Packages):
Submit the most recently issued existing permit.
Provide a list of any items within the permit the Applicant would like the Division to address during the permit modification
(i.e., compliance schedules, permit description, monitoring, permit conditions, etc.).
 Final Environmental Document (All Application Packages using public monies or lands subject to the North Carolina
Environmental Policy Act under 15A NCAC 01C .0100 to .0400):
Per 15A NCAC 02T .0105(c)(4), submit one copy of the environmental assessment and three copies of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the wastewater treatment and irrigation system.
 Floodway Regulation Compliance (All Application Packages where any portion of the wastewater treatment, storage and
irrigation system is located within the 100-year floodplain):
Per 15A NCAC 02T .0105(c)(8), provide written documentation from all local governing entities that the facility is in
compliance with all local ordinances regarding construction or operation of wastewater treatment and/or disposal facilities
within the floodplain.

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P. Additional Documentation (continued):
 Operational Agreements (All Application Packages for Home/Property Owners' Associations and Developers of lots to be
sold):
 Home/Property Owners’ Associations
Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
Per 15A NCAC 02T .0115(c), submit the proposed or approved Articles of Incorporation, Declarations and By-laws.
 Developers of lots to be sold
Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
 Threatened or Endangered Aquatic Species Documentation (All Application Packages):
Per 15A NCAC 02T .0105(c)(10), submit documentation from the Department’s Natural Heritage Program demonstrating
the presence or absence of threatened or endangered aquatic species within the boundary of the wastewater treatment,
storage and irrigation facilities.
If the facility directly impacts such species, this documentation shall provide information on the need for permit conditions
pursuant to 15A NCAC 02B .0110.
 Wastewater Chemical Analysis (All Application Packages treating Industrial Waste):
Per 15A NCAC 02T .0504(h), provide a complete Division certified laboratory chemical analysis of the effluent to be
irrigated for the following parameters (For new facilities, an analysis from a similar facility’s effluent is acceptable):
Ammonia Nitrogen (NH3-N) Nitrate Nitrogen (NO3-N) Total Organic Carbon
Calcium pH Total Phosphorus
Chemical Oxygen Demand (COD) Phenol Total Trihalomethanes
Chloride Sodium Total Volatile Organic Compounds
Fecal Coliform Sodium Adsorption Ratio (SAR) Toxicity Test Parameters
5-day Biochemical Oxygen Demand (BOD5) Total Dissolved Solids
Magnesium Total Kjeldahl Nitrogen (TKN)

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 PERMITTING UNIT

By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604

TELEPHONE NUMBER: [phone] FAX NUMBER: [phone]
DocuSign Envelope ID: F7D16F8F-0B81-4245-A269-EB9EEABCC6BC
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0500 – WASTEWATER IRRIGATION SYSTEMS
FORM: WWIS 06-16

FORM: WWIS 06-16 Page 1 of 12
I. APPLICANT INFORMATION:
1. Applicant's name: WALLACE LOFT, LLC d.b.a The Cottages of Boone
2. Applicant type: Individual Corporation General Partnership Privately-Owned Public Utility
Federal State Municipal County
3. Signature authority’s name: Sean Dwyer per 15A NCAC 02T .0106(b) Title: Director
4. Applicant’s mailing address: 5 Bryant Park, 28th Floor
City: New York State: NY Zip: 10018-
5. Applicant’s contact information:
Phone number: [phone] Email Address: [e-mail]
II. FACILITY INFORMATION:
1. Facility name: The Cottages of Boone
2. Facility status: Existing
3. Facility type: Major (≥ 10,000 GPD or ≥ 300 disposal acres)
4. Facility’s physical address: 615 Fallview Lane
City: Boone State: NC Zip: 28607- County: WATAUGA
5. Wastewater Treatment Facility Coordinates (Decimal Degrees): Latitude: 36.197966○ Longitude: -81.700029○
Datum: Select Level of accuracy: Select Method of measurement: Geodetic quality GPS survey
6. USGS Map Name:
III. CONSULTANT INFORMATION:
1. Professional Engineer: Mark Brooks License Number: 026539 Firm: Brooks Engineering Associates, P.A.
Mailing address: 15 Arlington St.
City: Asheville State: NC Zip: 28801-
Phone number: [phone] Email Address: [e-mail]
2. Soil Scientist: License Number: Firm:
Mailing address:
City: State: Zip: -
Phone number: ( ) - Email Address:
3. Geologist: License Number: Firm:
Mailing address:
City: State: Zip: -
Phone number: ( ) - Email Address:
4. Agronomist: Firm:
Mailing address:
City: State: Zip: -
Phone number: ( ) - Email Address:
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FORM: WWIS 06-16 Page 2 of 12
IV. GENERAL REQUIREMENTS – 15A NCAC 02T .0100:
1. Application type: New Major Modification Minor Modification
If a modification, provide the existing permit number: WQ0035784 and most recent issuance date: October 25, 2017
2. Application fee: $0 - Standard - Minor Modification
3. Does this project utilize public monies or lands? Yes or No
If yes, was an Environmental Assessment required under 15A NCAC 01C? Yes or No
If yes, which final environmental document is submitted? Finding of No Significant Impact or Record of Decision
Briefly describe any mitigating factors from the Environmental Assessment that may impact this facility:
4. What is the status of the following permits/certifications applicable to the subject facility?
Permit/Certification Date
Submitted
Date
Approved
Permit/Certification
Number Agency Reviewer
Collection System (Q ≥ 200,000 GPD)
Dam Safety
Erosion & Sedimentation Control Plan
Nationwide 12 / Section 404
Pretreatment
Sewer System 10/31/21 Pending WQ0035784 Ms. Lauren Plummer
Stormwater Management Plan
Wetlands 401
Other: Temporary Domestic
Wastewater Pump & Haul Permit 7/29/21 8/26/21 WQ0042770 Mr. Lon Snider
5. What is the wastewater type? Domestic or Industrial (See 15A NCAC 02T .0103(20))
Is there a Pretreatment Program in effect? Yes or No
Has a wastewater chemical analysis been submitted? Yes or No
6. Wastewater flow: 105,000 GPD
Limited by: Treatment, Storage, Field Hydraulics, Field Agronomics or Groundwater Mounding
7. Explain how the wastewater flow was determined: 15A NCAC 02T .0114 or Representative Data
Has a flow reduction been approved under 15A NCAC 02T .0114(f)? Yes or No
Establishment Type Daily Design Flow a No. of Units Flow
Residential 120 gal/bedroom 859 105,000 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total 105,000 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2), for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).

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FORM: WWIS 06-16 Page 3 of 12
IV. GENERAL REQUIREMENTS – 15A NCAC 02T .0100 (continued):
8. What is the nearest 100-year flood elevation to the facility? feet mean sea level. Source:
Are any treatment, storage or irrigation facilities located within the 100-year flood plain? Yes or No
If yes, which facilities are affected and what measures are being taken to protect them against flooding?
If yes, has the Applicant submitted written documentation of compliance with §143 Article 21 Part 6? Yes or No
9. Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing
information provided by the Department’s Natural Heritage Program? Yes or No
10. Does the facility have a proposed or existing groundwater monitoring well network? Yes or No
If no, provide an explanation as to why a groundwater monitoring well network is not proposed:
If yes, complete the following table (NOTE – This table may be expanded for additional wells):
Well Name Status Latitude a Longitude a Gradient Location
MW1 Active 36.2014○ -81.7045○ Down Gradient Outside Compliance Boundary
MW2 Active 36.1995○ -81.7004○ Down Gradient Outside Compliance Boundary
MW3 Active 36.2015○ -81.7024○ Down Gradient Outside Compliance Boundary
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
Select . ○ - . ○ Select Select
a Provide the following latitude and longitude coordinate determination information:
Datum: NAD83 Level of accuracy: Nearest 10 seconds Method of measurement:
Conversion from state coordinate plane
11. If the Applicant is a Privately-Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
Yes, No or N/A
12. If the Applicant is a Developer of lots to be sold, has a Developer’s Operational Agreement (FORM: DEV) been submitted?
Yes, No or N/A
13. If the Applicant is a Home/Property Owners' Association, has an Association Operational Agreement (FORM: HOA) been
submitted? Yes, No or N/A
14. Demonstration of historical consideration for permit approval – 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? Yes or No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? Yes or No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? Yes or No
d. Is non-compliant with an existing non-discharge permit, settlement agreement or order? Yes or No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? Yes or No

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FORM: WWIS 06-16 Page 4 of 12
V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA – 15A NCAC 02T .0505:
1. For the following parameters, provide the estimated influent concentrations and designed effluent concentrations as
determined in the Engineering Calculations, and utilized in the Agronomic Evaluation and Groundwater Modeling (if
applicable):
Parameter Estimated Influent Concentration Designed Effluent Concentration
(monthly average)
Ammonia Nitrogen (NH3-N) mg/L mg/L
Biochemical Oxygen Demand (BOD5) mg/L mg/L
Fecal Coliforms per 100 mL
Nitrate Nitrogen (NO3-N) mg/L mg/L
Nitrite Nitrogen (NO2-N) mg/L mg/L
Total Kjeldahl Nitrogen mg/L
Total Nitrogen mg/L mg/L
Total Phosphorus mg/L mg/L
Total Suspended Solids (TSS) mg/L mg/L
2. Is flow equalization of at least 25% of the average daily flow provided? Yes or No
3. Does the treatment facility include any bypass or overflow lines? Yes or No
If yes, describe what treatment units are bypassed, why this is necessary, and where the bypass discharges:
4. Are multiple pumps provided wherever pumps are used? Yes or No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0505(k)?
5. Check the appropriate box describing how power reliability will be provided in accordance with 15A NCAC 02T .0505(l):
Automatically activated standby power supply onsite capable of powering all essential treatment units; or
Approval from the Director that the facility:
 Has a private water supply that automatically shuts off during power failures and does not contain elevated water
storage tanks;
 Has sufficient storage capacity that no potential for overflow exists; and
 Can tolerate septic wastewater due to prolonged detention.
6. If the wastewater treatment system is located within the 100-year flood plain, are there water-tight seals on all treatment units
or a minimum of two feet protection from the 100-year flood plain elevation? Yes, No or N/A
7. In accordance with 15A NCAC 02T .0505(o), how many days of residuals storage are provided? 72
8. How does the Applicant propose to prohibit public access to the wastewater treatment and storage facilities? Signage and
gates
9. If an influent pump station is part of the proposed facility (i.e., within the wastewater treatment plant boundary), does the
influent pump station meet the design criteria in 15A NCAC 02T .0305(h)? Yes, No, N/A – To be permitted
separately, or N/A – Gravity fed
10. If septic tanks are part of the wastewater treatment facility, do the septic tanks adhere to the standards in 15A NCAC 18A
.1900? Yes, No or N/A

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FORM: WWIS 06-16 Page 5 of 12
V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA – 15A NCAC 02T .0505 (continued):
11. Provide the requested treatment unit and mechanical equipment information:
a. PRELIMINARY / PRIMARY TREATMENT (i.e., physical removal operations and flow equalization):
Treatment Unit No. of
Units
Manufacturer or
Material
Dimensions (ft) /
Spacings (in)
Volume
(gallons)
Plan Sheet
Reference
Specification
Reference
Flow Equalization 1 Steel 54,496 N-4.2
Flow
Equalization
Tank Detail
Select
Select
Select
Select
b. SECONDARY / TERTIARY TREATMENT (i.e., biological and chemical processes to remove organics and nutrients)
Treatment Unit No. of
Units
Manufacturer or
Material Dimensions (ft) Volume
(gallons)
Plan Sheet
Reference
Specification
Reference
Select
Select
Select
Select
Select
Select
Select
Select
c. DISINFECTION
Treatment Unit No. of
Units
Manufacturer or
Material Dimensions (ft) Volume
(gallons)
Plan Sheet
Reference
Specification
Reference
Select
Select
 If chlorination is the proposed method of disinfection, specify detention time provided: minutes (NOTE – 30
minutes minimum required), and indicate what treatment unit chlorine contact occurs:
 If ultraviolet (UV) light is the proposed method of disinfection, specify the number of banks: 2, number of lamps per
bank: 4 and maximum disinfection capacity: 150 GPM.
d. RESIDUAL TREATMENT
Treatment Unit No. of
Units
Manufacturer or
Material Dimensions (ft) Volume
(gallons)
Plan Sheet
Reference
Specification
Reference
Select
Select

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FORM: WWIS 06-16 Page 6 of 12
V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA – 15A NCAC 02T .0505 (continued):
e. PUMPS
Location No. of
Pumps Purpose Manufacturer /
Type
Capacity Plan Sheet
Reference
Specification
Reference GPM TDH

f. BLOWERS
Location No. of
Blowers Units Served Manufacturer /
Type
Capacity
(CFM)
Plan Sheet
Reference
Specification
Reference

g. MIXERS
Location No. of
Mixers Units Served Manufacturer /
Type
Power
(hp)
Plan Sheet
Reference
Specification
Reference

h. RECORDING DEVICES & RELIABILITY
Device No. of
Units Location Manufacturer Maximum
Capacity
Plan Sheet
Reference
Specification
Reference
Select
Select
Select
Select
i. EFFLUENT PUMP / FIELD DOSING TANK (IF APPLICABLE):
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FORM: WWIS 06-16 Page 7 of 12
Plan Sheet
Reference
Specification
Reference
Internal dimensions (L x W x H or φ x H) ft ft ft
Total volume ft3 gallons
Dosing volume ft3 gallons
Audible & visual alarms
Equipment to prevent irrigation during rain
events
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FORM: WWIS 06-16 Page 8 of 12
VI. EARTHEN IMPOUNDMENT DESIGN CRITERIA – 15A NCAC 02T .0505:
IF MORE THAN ONE IMPOUNDMENT, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. What is the earthen impoundment type? Select
2. Storage Impoundment Coordinates (Decimal Degrees): Latitude: . ○ Longitude: - . ○
Datum: Select Level of accuracy: Select Method of measurement: Select
3. Do any impoundments include a discharge point (pipe, spillway, etc)? Yes or No
4. Are subsurface drains present beneath or around the impoundment to control groundwater elevation? Yes or No
5. Is the impoundment designed to receive surface runoff? Yes or No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the water balance? Yes or No
6. If a liner is present, how will it be protected from wind driven wave action?:
7. Will the earthen impoundment water be placed directly into or in contact with GA classified groundwater? Yes or No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not result in a
contravention of GA groundwater standards? Yes or No
8. What is the depth to bedrock from the earthen impoundment bottom elevation? ft
If the depth to bedrock is less than four feet, has the Applicant provided a liner with a hydraulic conductivity no greater than
1 x 10-7 cm/s? Yes, No or N/A
Has the Applicant provided predictive calculations or modeling demonstrating that surface
water or groundwater standards will not be contravened? Yes or No
If the earthen impoundment is excavated into bedrock, has the Applicant provided predictive calculations or modeling
demonstrating that surface water or groundwater standards will not be contravened? Yes, No or N/A
9. If the earthen impoundment is lined and the mean seasonal high water table is higher than the impoundment bottom
elevation, how will the liner be protected (e.g., bubbling, groundwater infiltration, etc.)?
10. If applicable, provide the specification page references for the liner installation and testing requirements:
11. If the earthen impoundment is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? Yes or No
12. Provide the requested earthen impoundment design elements and dimensions:
Earthen Impoundment Design Elements Earthen Impoundment Dimensions
Liner type: Clay Synthetic Top of embankment elevation: ft Other Unlined
Liner hydraulic conductivity: x - cm/s Freeboard elevation: ft
Hazard class: Select Toe of slope elevation: ft
Designed freeboard: ft Impoundment bottom elevation: ft
Total volume: ft3 gallons Mean seasonal high water table depth: ft
Effective volume: ft3 gallons Embankment slope: :
Effective storage time: days Top of dam water surface area: ft2
Plan Sheet Reference: Freeboard elevation water surface area: ft2
Specification Section: Bottom of impoundment surface area: ft2
NOTE – The effective volume shall be the volume between the two foot freeboard elevation and the: (1) pump intake pipe
elevation; (2) impoundment bottom elevation or (3) mean seasonal high water table, whichever is closest to the two foot
freeboard elevation.
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FORM: WWIS 06-16 Page 9 of 12
VII. IRRIGATION SYSTEM DESIGN CRITERIA – 15A NCAC 02T .0505:
1. Provide the minimum depth to the seasonal high water table within the irrigation area:
NOTE – The vertical separation between the seasonal high water table and the ground surface shall be at least one foot.
2. Are there any artificial drainage or water movement structures (e.g., surface water or groundwater) within 200 feet of the
irrigation area? Yes or No
If yes, were these structures addressed in the Soil Evaluation and/or Hydrogeologic Report, and are these structures to be
maintained or modified? n/a
3. Soil Evaluation recommended loading rates (NOTE – This table may be expanded for additional soil series):
Soil Series Fields within
Soil Series
Recommended
Loading Rate
(in/hr)
Recommended
Loading Rate
(in/yr)
Annual / Seasonal
Loading
If Seasonal, list
appropriate
months
Select
Select
Select
Select
Select
Select
4. Are the designed loading rates less than or equal to Soil Evaluation recommended loading rates? Yes or No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0505(n)?
5. How does the Applicant propose to prohibit public access to the irrigation system? Signage
6. Has the irrigation system been equipped with a flow meter to accurately determine the volume of effluent applied to each
field as listed in VII.8.? Yes or No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0505(t)?
7. Provide the required cover crop information and demonstrate the effluent will be applied at or below agronomic rates:
Cover Crop Soil Series % Slope Nitrogen Uptake Rate
(lbs/ac∙yr)
Phosphorus Uptake
Rate (lbs/ac∙yr)

a. Specify where the nitrogen and phosphorus uptake rates for each cover crop were obtained:
b. Proposed nitrogen mineralization rate:
c. Proposed nitrogen volatilization rate:
d. Minimum irrigation area from the Agronomist Evaluation’s nitrogen balance: ft2
e. Minimum irrigation area from the Agronomist Evaluation’s phosphorus balance: ft2
f. Minimum irrigation area from the water balance: ft2

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FORM: WWIS 06-16 Page 10 of 12
VII. IRRIGATION SYSTEM DESIGN CRITERIA – 15A NCAC 02T .0505 (continued):
8. Field Information (NOTE – This table may be expanded for additional fields):

Field Area
(acres)
Dominant
Soil Series
Designed
Loading
Rate
(in/hr)
Designed
Loading
Rate
(in/yr)
Latitude a Longitude a
Waterbody
Stream Index
No. b
Classification
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
. ○ - . ○
Total
a Provide the following latitude and longitude coordinate determination information:
Datum: Select Level of accuracy: Select Method of measurement: Select
b For assistance determining the waterbody stream index number and its associated classification, instructions may be
downloaded at: http://deq.nc.gov/about/divisions/water-resources/planning/classification-standards/classifications
Spray Irrigation Design Elements Drip Irrigation Design Elements
Nozzle wetted diameter: ft Emitter wetted area: ft2
Nozzle wetted area: ft2 Distance between laterals: ft
Nozzle capacity: GPM Distance between emitters: ft
Nozzle manufacturer/model: / Emitter capacity: GPH
Elevation of highest nozzle: ft Emitter manufacturer/model: /
Specification Section: Elevation of highest emitter: ft
Specification Section:

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FORM: WWIS 06-16 Page 11 of 12
VIII. SETBACKS – 15A NCAC 02T .0506:
1. Does the project comply with all setbacks found in the river basin rules (15A NCAC 02B .0200)? Yes or No
If no, list non-compliant setbacks:
2. Have any setback waivers been obtained in order to comply with 15A NCAC 02T .506(a) and .0506(b)? Yes or No
If yes, have these waivers been written, notarized and signed by all parties involved and recorded with the County Register of
Deeds? Yes or No
3. Provide the minimum field observed distances (ft) for each setback parameter to the irrigation system and treatment/storage
units (NOTE – Distances greater than 500 feet may be marked N/A):
Setback Parameter Irrigation
System
Treatment /
Storage Units
Any habitable residence or place of assembly under separate ownership or not to be
maintained as part of the project site
Any habitable residence or place of assembly owned by the Permittee to be maintained as
part of the project site
Any private or public water supply source
Surface waters (streams – intermittent and perennial, perennial waterbodies, and wetlands)
Groundwater lowering ditches (where the bottom of the ditch intersects the SHWT)
Subsurface groundwater lowering drainage systems
Surface water diversions (ephemeral streams, waterways, ditches)
Any well with exception of monitoring wells
Any property line
Top of slope of embankments or cuts of two feet or more in vertical height
Any water line from a disposal system
Any swimming pool
Public right of way
Nitrification field
Any building foundation or basement
Impounded public water supplies
Public shallow groundwater supply (less than 50 feet deep)
4. Does the Applicant intend on complying with 15A NCAC 02T .0506(c) in order to have reduced irrigation setbacks to
property lines? Yes or No
If yes, complete the following table by providing the required concentrations as determined in the Engineering Calculations:
Parameter Estimated Influent
Concentration
Designed Effluent
Concentration
(monthly average)
Designed Effluent
Concentration
(daily maximum)
Ammonia Nitrogen (NH3-N) mg/L mg/L mg/L
Biochemical Oxygen Demand
(BOD5) mg/L mg/L mg/L
Fecal Coliforms per 100 mL per 100 mL
Total Suspended Solids (TSS) mg/L mg/L mg/L
Turbidity NTU

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FORM: WWIS 06-16 Page 12 of 12
IX. COASTAL WASTE TREATMENT DISPOSAL REQUIREMENTS – 15A NCAC 02H .0400:
1. Is this facility located in a Coastal Area as defined per 15A NCAC 02H .0403? Yes or No
For assistance determining if the facility is located within the Coastal Area, a reference map may be downloaded at: Coastal
Areas Boundary.
2. Is this an Interim Treatment and Disposal Facility per 15A NCAC 02H .0404(g)? Yes or No
NOTE – Interim facilities do not include County and Municipal area-wide collection and treatment systems.
IF ANSWERED YES TO ITEMS IX.1. AND IX.2., THEN COMPLETE ITEMS IX.3. THROUGH IX.17.
3. Is equalization of at least 25% of the average daily flow provided? Yes or No
4. How will noise and odor be controlled?
5. Is an automatically activated standby power source provided? Yes or No
6. Are all essential treatment units provided in duplicate? Yes or No
NOTE – Per 15A NCAC 02T .0103(16), essential treatment units are defined as any unit associated with the wastewater
treatment process whose loss would likely render the facility incapable of meeting the required performance criteria, including
aeration units or other main treatment units, clarification equipment, filters, disinfection equipment, pumps and blowers.
7. Are the disposal units (i.e., irrigation fields) provided in duplicate (e.g., more than one field)? Yes or No
8. Is there an impounded public surface water supply within 500 feet of the wetted area? Yes or No
9. Is there a public shallow groundwater supply (less than 50 feet deep) within 500 feet of the wetted area? Yes or No
10. Is there a private groundwater supply within 100 feet of the wetted area? Yes or No
11. Are there any SA classified waters within 100 feet of the wetted area? Yes or No
12. Are there any non-SA classified waters within 50 feet of the wetted area? Yes or No
13. Are there any surface water diversions (i.e., drainage ditches) within 25 feet of the wetted area? Yes or No
14. Per the requirements in 15A NCAC 02H .0404(g)(7), how much green area is provided? ft2
15. Is the green area clearly delineated on the plans? Yes or No
16. Is the spray irrigation wetted area within 200 feet of any adjoining properties? Yes, No or N/A (i.e., drip irrigation)
17. Does the designed annual loading rate exceed 91 inches? Yes or No
DocuSign Envelope ID: F7D16F8F-0B81-4245-A269-EB9EEABCC6BC
The Cottages of BooneSean Dwyer, DirectorDocuSign Envelope ID: F7D16F8F-0B81-4245-A269-EB9EEABCC6BC08-Aug-2022 | 10:50 PM SGT