WQ0023213_Renewal (Application)_20220829

DWR
State of North Carolina
Department of Environinental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02U - RECLAIMED WATER SYSTEM -RENEWAL
FORM: RWS-R 02-21
Pursuant to 15A NCAC 02T.01 07(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.0100, 15A NCAC 0211, 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,httDs-//edoes.deu.iic.Lwov/ForinsINonDiseliarc-,e-Braiieh,-Sithmittal-Form-Ver2
or emailed to Non-Discharf-te.Reliorts(ii)ncdeiii-.aov if less than 20 megabytes (MB).
SECTION I
APPLICANT INFORMATION
1. Applicant: City of Lexington N.C.
2. Permit No.: WQ0023213
3. SignatAre authority: Tom Johnson
Phone number: [phone], Cell
Title: Water Resources Director
Email: tdjohnson4 Iexingtonnc.gov
4. Mailing address: 28 West Center st.
City: Lexington
State: NC Zip, 27292-
5. Contact person: Steve Craver
--I- ____ — 11— ­1
Email: sccraver@lexijigtonn,c.gov
1 - - - A - — — — - __ I' I Cv - I - - �
rl Midl y PAIVIlt: RUHIUVI. k-1.)U) I_L+V-LV'+0 k-UH 3cculluary P11011C [)Ulll[)Cj -1 '� - 3rICUL
SECTION JI-FACtLITY INFO ATI 'ON'
....... .. . .... . . . . . . . . . . ...... .............................. . . .
1.
......... . ....... ........
Physical address: 220 Country Club Blvd. County: Davidson Parcel No.:
City, Lexington State: NC Zip: 27292-
2.
Treatment facility coordinates to the sixth decimal degree:
Latitude: 35.79361 V Longitude: -80.248333' Method: Select
. . . .. ................. . .... . SECTION 1,11, -FLOW INFORMATION
1.
Permitted flow: 300000 GPD (The maximum allowable flow based on what has been permitted)
2.
As -built flow: 300000 GPD (The maximum allowable flow based on what has been constructed)
3.
Average flow: 300000 GPD (The average of all reported. flaws on the previous calendar year's NDMRs)
4.
Hydraulic capacity: 100 % (Divide the merage flow in Item 3 by the As-builtflow in Item 2)
5,
Wastewater composition: Domestic: 42 % Industrial: 3 % Stormwater: %
. . . .... . ............... ...... . . . . . . . . ...... . . . . . . . . . . . . ............ . ............. ........... ................... ....... .................. . ......... - -------------- - -- -- --- ---- ---- -
...............
SECTION TV - BILLING INFORMATION
1.
Billing address: 28 W. Center St.
City: Lexington State! N.C. Zip: 27292-
2.
Verify, the Applicant does not have any overdue annual fees:
h!Ws://deg.ne..goy/tiboLit/clivisioiis/water-i,eso,urces/water-resou,rces-Deriiiits,/wc��n iits
Pursuant to 15A. NCAC 021" ,012QUc , permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: RWS-R 02-21 Page I of 6

SECTION V —OPERATOR. IN RESPONSIBLE CHARGE (ORC) INFORMATION
(NOT APPLICABLE FOR CONJUNCTIVE, SYSTEMS)
I . ORC: Jeff Walser Grade: 4 Certification No,: 100476
Mailing address: 28 W, Center St.
City: Lexington State: NC Zip: 27292-
Phone number: [phone] Office Email: JDWaslcr@lexingtonnc.­ov
2. Back -Up ORC. Steve Craver Grade: 4 Certification No.: 11241
Mailing address: 28 W. Center St.
City: Lexington State: N.C. Zip: 27292-
Phone number: (33 )6) 357-5090 Office 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
Tkeatment
300,000
Full, metal
2
35-7936110
-80.248330
Treatment
58,130
Full, metal
2
35.79361100
-80.248330
Treatment
1,038
Full, concrete
2
. .. ...... . . .
3 5.793 611 "
. ............
-80.248330
-..
-storage
..... . ..........
500,000
Full, metal
2
.... .. ........
3 5.793 611
-80.248330
SECTION VII — RELATED PERMITS . . . . . ........
I 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 VIII — MONITORING WELLS
t. List all groundwater monitoring wells associated with the renewing permit. Attach additional sheets if necessary.
. . . . ...... ...
Well Name Parcel No. Status Gradient Location Latitude Longitude
Select
Select
Select
0
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
. . . . . . ................. ..
Select
- -------- -
. ........
FORM: RWS-R 02-21 Page 2 of 6

SECTION I -- UTILIZATION FIELDS
List all utilization fields associated with the renewing permit. Attach additional sheets if necessary.
FielCounty I Parcel No. j Deeded Owner l Area � Cover Crap � Latitude i Langitucle
d
O
-
0
0
0
0
O
a
0
0
0
0
0
0
0
0
ra
0
0
0
a
O
O
O
Ct
O
O
O
0
O
0
O
O
0
O
''.
0
_
0
O
O
O
O
O
0
w
0
J
a
0
0
G
0
O
O
O
O
O
O
O
0
O
0
O
O
D
O
0
0
O
!J
Total Acreage:
FC)RIvC: RWS-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 l 5A NCAC 02U .020lfdl. These
requirements are:
El A scaled rnap of the site with topographic contour intervals not exceeding 1.0 feet or 25 percent oftotal site relief and showing
all facility -related structures and fences within 500 feet of the treatment, storage, and utilization areas.
❑ Soil mapping units shown on all utilization sites.
Delineation of the compliance and review boundaries per 15A NCAC 021.1 .0501Caj�).
❑ Setbacks as required by 15A NCAC 02U .0701.
❑ Site property boundaries within 500 feet of all treatment, storage, and utilization sites..
No — Ship Attachment A.
ATTACHMENT 11$-- $1GIV,1 9T l ?,,E AUT'114..1 iY )ELEGATl41Y
Does the signature authority in Section 1, Item 3 meet the requirements pursuant to -115A N1t__A�C 02� ._0106( )?
Yes — Skip Attachment B.
F No — Submit a delegation letter pursuant to 15A NCAC 02`I' „O106 c" authorizing the signature authority to sign.
ATTACHMENT C — FLOW RIEDUT —_TIHN
Does the existing permit include an approved flow reduction?
"Yes Submit a copy of the flaw reduction approval letter, as well as the measured monthly average amount of wastewater glow
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 _1.5_A
NCAC: 02T mtl l I
No — Skip Attachment. C.
Is the Applicant a Privately -Owned Public Utility?
71 Yes —Pursuant to ➢,SA NCAC 02T ,t�l l a d ➢ submit the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility firanchise.
No ...- Skip Attachment D.
AT°1<""ACH1"v1llENT 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 I A NCAC 02'T"' .0 t 15(a)(2),'submit an executed) erationai Agre�
(EQEPyII: 1➢_ C-)A Pursuant to ISA NCAC 0? 1 1' , 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 ➢ 5A NCAC _02T .0j l(aJU2 , submit an executed Qpetataclr�al A �rer,esnerrt:
FCl„ �RLAP'! . Pursuant to 15A m CAC 02T .01 15 , if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and By-laws.
® No ._ Ship Attachment E.
FORM: RWS-R 02-21 Page 4 of 6

ATTA"C,Hm'l�,N,T'IF,—'D1CMON$TRATION QF FUTURE WAST—FWATEA TREATMENT CAPACITIES
Is the applicant a municipality, county, sanitary district, or public utility?
E Yes — Proceed to the next question.
El No — Skip Attachment F.
Does the hydraulic capacity in Section 111, Item 4 exceed 70%❑ '?
Yes (the hydraulic capacity is greater than 70%, but less than 80%) - Pursuant to 15A NCAC 02T .0 11 8(l), prior to exceeding
80 percent of the system's pen-nitted hydraulic capacity (based on the average flow during the last calendar year), the pennittee
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 prqjections, and as appropriate, shall include conservation plans or other
Z�
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 111, Item 4 exceed 80%?
Yes (the hydraulic capacity is greater than 80%) — Pursuant to 15A- NCAC, 02T S�,LJJ8 --�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, ajustification 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.
E] No — Skip Attachment F.
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and utilization system'?
Z Yes — Skip Attachment G-
F No — Pursuant to J 5A NQAC 02T .01 IA(9), provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Perinittec, to operate and maintain the wastewater collection, treatment, conveyance, and utilization system on
property not owned by the Permittee,
ATTACHMENT — A'VF1L1AT1()N$
Are the Pen-nittee's affiliations of record correct? Check affiliations.
E Yes — Skip Attachment H.
F-1 No — Provide the corrected affiliations and their contact information.
AtTAC'
ffMENTI—COMPL,!,,A,N
CESCNEDULES
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.
Z No — Skip Attachment 1.
Does the Permittee have any existing civil penalties or outstanding violations?
F-1 Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request.
F-1 Yes (violations) — Submit a copy of your response to the Notice of Violation.
F� No — Skip Attachment J.
FORM: RWS-R 02-21 Page 5 of 6

Does the wastewater composition in Section III, Item 5 include any industrial wastewater?
Z Yes — Proceed to the next question.
7 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 02LJ Q20111).. 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,
Z 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 pen -nit include setback waivers?
Yes — Pursuant to 15A NCAC 02T .07011 (g), 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 .O 107,
2 No — Skip Attachment L,
1. -- 1�01eh j o A Y's attest that this application
(Signature autbority'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 parts of this
application package are not completed, and that if all required supporting infon-nation 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 NCAQ 021',Qj_��, An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NQAC 02'r 01 Qj6c Pursuant to § 143 -3-21.5.6A. and § 14-1- 5., any
2j6_B
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 S 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:
N on- Disc harge.Reports(-) ne den r. gov httus://edoes.deg.nc.gov/t"orms/Nonl ischa rge- Bra nch -
Submittal-Forni-Ver2
FORM: RWS-R 02-21 Page 6 of 6