WQ0028749_Renewal Application_20240415

Initial Review
Reviewer nathaniel.thorn burg
Is this submittal an application? (Excluding additional information.) *
Yes No
Permit Number (IR) * WQ0028749
Applicant/Permittee Louisiana-Pacific Corporation
Applicant/Permittee Address 10475 Boston Rd, Roxboro, NC 27574
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category Minor
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Organization
Louisiana-Pacific OSB - Roxboro WWTF
Person
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
04/15/2024
$0
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* Tony Creson
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*
336-503-3166
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.
https://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number:*
WQ0028749
Has Current Existing permit number
Applicant/Permittee*
Louisiana-Pacific Corporation
Applicant/Permittee Address*
10475 Boston Rd, Roxboro, NC 27574
Facility Name*
Louisiana-Pacific OSB - Roxboro WWTF
Please provide comments/notes on your current submittal below.
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
20240415 WWIS Permit Renewal - LP Roxboro OSB.pdf 5.01 MB
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
Submission Date
�2ttf 7Y02.re
4/13/2024

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
f &XIO NTK6►al IIIIM1111MIiT1.1 l Y D► TI :V Y 04 tM I N N RKI Y U101MIRM Y DI►/ M N 0401 D►IUKI I
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 .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:Hedocs.deci.nc.2ov/Forms/NonDischar2e-Branch-Submittal-
Form-Ver2, or emailed to Non-Dischar2e.Reports(a)ncdenr.2ov if less than 20 megabytes (MB).
SECTION I
—APPLICANT INFORMATION
1.
Applicant: Louisiana-Pacific Corporation
2.
Permit No .: WQ0028749
3.
Signature authority: Gary Home
Phone number: [phone] Office
Title: Plant Manager
Email: gary.homeOalpcorp.com
4.
Mailing address: 10475 Boston Rd
City: Roxboro
State: NC Zip: 27574-6774
5.
Contact person: Tony Creson
Primary phone number: [phone] Office
Email: tony.cresonOa 1pcorp.com
Secondary phone number: [phone] Cell
SECTION II — FACILITY INFORMATION
1. Physical address: 10475 Boston Rd
City: Roxboro
2. Treatment facility coordinates to the sixth decimal degree:
Latitude: 36.521639° Longitude:-78.917664'
County: Person
State: NC
Parcel No.: A66 11
Zip: 27574-6774
Method: Navigation quality GPS
SECTION III — FLOW INFORMATION
1.
Permitted flow: 4000 GPD (The maximum allowable flow based on what has been permitted)
2.
As -built flow: 4000 GPD (The maximum allowable flow based on what has been constructed)
3.
Average flow: 1744 GPD (The average of all reported flows on the previous calendar year's NDMRs)
4.
Hydraulic capacity: 44 % (Divide the average flow in Item 3 by the As -built flow in Item 2)
5.
Wastewater composition: Domestic: 100 % Industrial: 0 % Stormwater: 0 %
SECTION IV — BILLING INFORMATION
1. Billing address: 10475 Boston Rd
City: Roxboro State: NC Zip: 27574-6774
2. Verify the Applicant does not have any overdue annual fees:
https://deq.nc. gov/about/divisions/water-re source s/water-re source s-permits/wq-epUments
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.
FORM: WWIS-R 02-21 Page 1 of 6

SECTION V — OPERATOR IN RESPONSIBLE CHARGE (ORC) INFORMATION
1. ORC: Billy Joe Brightwell
Grade: SI Certification No.: 1000087
Mailing address: 10475 Boston Rd
City: Roxboro
State: NC Zip: 27574-6774
Phone number: [phone] Cell
Email: billy.brightwellglpcorp.com
2. Back -Up ORC: Kenneth Chad Leinbach
Grade: SI Certification No.: 23928
Mailing address: 1284 Windy Ridge Road
City: Chapel Hill
State: NC Zip: 27517-
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
Storage
A66 58
340,750
Full, clay
2
36.5216560
-78.9188730
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SECTION VII — RELATED PERMITS
1. 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
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Select
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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
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FORM: WWIS-R 02-21 Page 2 of 6

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
Irrigation
Person
A66 58
Louisiana Pacific Corporation
2.50
grass
36.5216390
-78.9176640
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total Acreage:
2.5
FORM: WWIS-R 02-21 Page 3 of 6

. 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 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.
❑ 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 t
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.
I 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: DEW 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.
® No — Skip Attachment E.
FORM: WWIS-R 02-21 Page 4 of 6

ATTACHMENT F — DEMONSTRATION OF FUTURE WASTEWATER TREATMENT CAPACITIES
71sthemapplhicant a municipality, county, sanitary district, or public utility?
Ye— 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 .01180), 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 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 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.
ATTACHMENT G — EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Pennittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
® 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 SCHEDULESIM
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.
FORM: WWIS-R 02-21 Page 5 of 6

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 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.
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, Gary Home 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 A 106(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:
Non-Discha rze.Reports(i�, ncdenr.zov
Laserfiche Upload:
https://edoes.deg.ne.gov/Forms/NonDischarge-Branch-
Submittal-Form-Vert
FORM: W WIS-R 02-21 Page 6 of 6

Appendix A
Site Map
(one page)

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Appendix B
Signature Authority Delegation
Not Required — For Reference
(two pages)

10475 Boston Road
Roxboro, NC 27574
336-503-3166
LPCorp.com
February 12, 2024
Division Of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, NC 27699
Hello, Ms Gerald:
Louisiana-Pacific Corporation is providing the enclosed signatory authorization form:
• Signature Authority Designation
This submittal fulfills your request via email dated February 7, 2024 "WQ0028749 - Louisiana-Pacific
Corporation, Roxboro OSB - Signature Authority Designation Request".
If you have any questions concerning this submittal, please contact me.
Sincerely,
Tony Creson
Plant Environmental Manager
[e-mail]
336-503-3166
Enclosure
eCC: [e-mail]
[e-mail]

February 8, 2024
Division of Water Resources
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Signature Authority Designation
To Whom It May Concern:
As an appropriate signing official for Louisiana-Pacific Corp, Roxboro OSB (citytowm
county or business name) as designated by 15A NCAC 2T .0106, I hereby delegate authority to sign and
certify all permit applications, reports or other permit related documents to the following staff for the
following permit types (sewer, spray, land application) and/or permit numbers:
Position
Person
Currently in
Position
Permit Tyne
or Permit
Number
Plant Manager
Gary Horne
W 0028749
If you have any questions, please contact me at the following:
Permittee/Applicant name (please print): Jimmy Mason
Title: Executive Vice President
Complete mailing address: 1610 West End Ave., Suite 200
City: Nashville State: TN Zip: _ 37203
Telephone number: [phone] Email: [e-mail]
Sincerely,
6
ignature

Appendix H
Affiliations
1. Submitted in accordance with guidance on form referenced b. this
2. This appendix shows email -receipt from NCDENR website upon successful submittal of
updated Affiliations.
(three pages)

Tony Creson
From: lase rfiche. [e-mail]
Sent: Thursday, April 11, 2024 5:12 PM
To: Tony Creson
Subject: Copy of Form DWR - NonDischarge Submittal Form - June 1 2020
Attachments: Non -Discharge Branch UploadSubmittal Form.pdf
This Message Is From an Untrusted Sender
You have not previously corresponded with this sender.
Thank you!
Your form has been submitted.
You're receiving this email because someone requested that you get a copy of this form.

Project Contact Information
Please provide information on the person to be contacted by NDB Staff reaardina electronic submittal, confirmation of receipt. and other correspondence.
Name* Tony Creson
Email Address*
[e-mail]
Project Information
Application/Document Type*
Phone Number*
3365033166
O New (Fee Required)
O Modification - Major (Fee Required)
O Renewal with Major Modification (Fee
Required)
O Annual Report
O Additional Information
O Other
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
Permit Type:* Qi Wastewater Irrigation C High -Rate Infiltration
O Other Wastewater C Reclaimed Water
O Closed -Loop Recycle C Residuals
O Single -Family Residence Wastewater C Other
Irrigation
Permit Number:* WQ0028749
Has Current Existing permit number
Applicant/Permittee* Gary Horne
Applicant/Permittee Address* 10475 Boston Rd, Roxboro, NC 27574
Facility Name* Louisiana-Pacific OSB - Roxboro WWTF

Please provide comments/notes on your current submittal below.
This doesn't actually request a "Change in Ownership", rather we request a change in various fields of the Non -Discharge Permit Contacts Report.
Please refer to attached PDF (Comments therein) for requested update information. Attaching the PDF seemed the more straightforward way of
concisely conveying the changes needed. Feel free to contact Tony (below) if you'd like to discuss further.
Tony Creson
[e-mail]
336-503-3166
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.)
Non -Discharge Permit Contacts Report -
91.84KB
CORRECTIONS.pdf
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*
Submission Date Is filled in automatically once submitted.

Appendix I
Compliance Schedules
1. Copy of PE -stamped Completion document to DEQ.
2. Supporting documentation
(18 pages)

Z ' J1
Engineers and SoH Scientists
Agri -Waste Technology, Inc.
501 N. Salem Street, Suite 203
Apex, North Carolina 27502
919-859-0669
www.agriwaste.com
Nathaniel D. Thornburg
Environmental Engineer II
Division of Water Quality
NC Department of Environmental Quality
2728 Capital Boulevard
Raleigh, NC 27604
Subject: Louisiana-Pacific Corporation
c/o Mike Sarder
Wastewater Treatment System (WQ0028749)
10475 Boston Road, Roxboro, NC 27574
Person County
PIN#'s 0200-00-68-6834
0200-00-57-0857
0200-00-67-8622
Dear Mr. Thornburg;
August 7, 2019
This document was
originally signed and
sealed by Kevin D.
Davidson, NC PE
4024582 on August 7,
2019. This medium shall
not be considered a
signed and sealed
document.
Please consider this information for a modification to an existing permit (Permit#
WQ0028749) for a wastewater treatment and irrigation system. The property is located at
10475 Boston Road, Durham, NC in Person County. The property is currently served by
a recirculating sand filter treatment system with a surface irrigation disposal system. The
modification will utilize a single AdvanTex AX-100 treatment unit with LTV disinfection
in place of the sand filter treatment system. The existing chlorination/dechlorination unit
will be utilized for disinfection of the irrigated effluent. The previously permitted and
installed surface irrigation disposal system will be utilized without modification. The
following information is included for your review.
Section A: Cover Letter
Included as this letter.
Section B: Application Fee
Major Modification Fee included.
Section C: Wastewater irrigation Systems Application
Form included (Appendix C).
Section D: Property Ownership Documentation
Deed indicating purchase of property by Louisiana-Pacific Corporation
(Appendix D).

Section E: Soil Evaluation
NIA Irrigation area defined in original permit - no new irrigation areas.
Section F: Agronomist Evaluation
N/A Irrigation area defined in original permit - no new irrigation areas or
new crops for existing area.
Section G: Hydrogeologic Report
NIA System does not treat industrial waste or exceed 25,000 GPD.
Section H: Water Balance
NIA System does not change irrigation practices, flow, or storage
Section I: Engineering Plans
Included (Appendix I).
Section J: Specifications
Included (Appendix J).
Section K. Engineering Calculations
Included (Appendix K).
Section L: Site Map
Included (Appendix L)
Section M: Power Reliability Plan
Approval statement included (Appendix M)
Section N: Operation and Maintenance Plan
Plan included (Appendix N).
Section O: Residuals Management Plan
Plan included (Appendix O).
Section P: Additional Documentation:
Certificate of Public Convenience and Necessity
N/A System does not involve a privately -owned public utility.
Existing Permit
Existing Permit 4WQ0028749 included (Appendix P.2)
Final Environmental Document
NIA System does not use public monies or lands.
Floodway Regulation Compliance
The site is not located in the 100-year floodplain (per map)
Information included (Appendix P.4).

Operational Agreements
NIA Applicant is single -party owner of property/system
Threatened or Endangered Aquatic Species Documentation
None identified in Project Area
Information included (Appendix P.6)
Wastewater Chemical Analysis
N/A System does not treat industrial waste.
Thank you for your review of this information. If you have any questions or comments
on this information, please feel free to contact me at [e-mail] or via
telephone at 919-859-0669.
Regards,
Kevin D. Davidson, P.E.
V.P. of Engineering

Appendix List
Appendix C Wastewater Irrigation System Application
Appendix D Property Ownership Documentation
Appendix I Engineering Plans
Appendix J Specifications
Appendix K Engineering Calculations
Appendix L Site Map
Appendix M Power Reliability Plan
Appendix N Operation and Maintenance Plan
Appendix O Residuals Management Plan
Appendix P.2 Existing Permit 4WQ0028749
Appendix PA Floodway Regulation Compliance
Appendix P.6 Threatened or Endangered Aquatic Species Documentation

Appendix C
Wastewater Irrigation Systems Application

State of North Carolina
Department of Environmental Quality
DWR_Division of Water Resources
15A NCAC 02T .0500 — WASTEWATER IRRIGATION SYSTEMS
Division of Wider Resource's INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION
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 Permittin 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 ARplicant 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 (Ail 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 1.2. 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 Il.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
Cp 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.
INSTRUCTIONS FOR FORM: VMS 06-16 & SUPPORTING DOCUMENTATION Page 1 of 6

E. Soil Evaluation (All Application Packages that include new irrigation sites): LWA No New Irrigation Site
❑ 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 (sn/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 (Ail Application Packages that include new irrigation sites or new crops for existing irrigation sites):
❑ Per 15A NCAC 02T .0504(il 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. L 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.
IA No New Irrigation Site
INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION Page 2 of 6

G. Hydrogeologic Report (All Application Packages treating industrial waste or having a design flow over 25,000 GPD): El
❑ Per 1SA NCAC 02T .0504(e), the H dro eolo is Investi ation and Reporting Polio , the Groundwater Modeling Policy and
the Performance and Analysis of A uifer Slug Tests and PumpingPjLmping Tests Polio 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 Iocal 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: /A No New Irrigation Site, Change in Flow or Storage
❑ At least a two-year iteration of data computation that consi ers precipitation into and evaporation from all open
atmosphere storage impoundments, and uses a variable number of days per month.
❑ Precipitation based on the 801 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 KsAr 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 En ineer, 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. /A No Change in
❑ The irrigation area with an overlay of the suitable irrigation areas depicted in the Soil Evaluation.[irrigation System
❑ 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.
INSTRUCTIONS FOR FORM: WWIS 06-16 & SUPPORTING DOCUMENTATION Page 3 of 6

Permit No. WQ0028749 Wastewater Irrigation System
Louisiana-Pacific Corporation November S, 2019
Louisiana-Pacific OSB — Roxboro WWTF Person County
ENGINEERING CERTIFICAT)(ON
❑ Partial ❑X Final
I, Kevin D. Davidson as a duly licensed North Carolina Professional
Engineer, having © periodically / ❑ fully observed the construction ofthe permitted facilities, do hereby
state to the best of my abilities that the facility was constructed in compliance with G.S. 143-215.1,
Administrative Code Title I SA Subchapter 02T, this permit, and the Division -approved plans and
specifications.
Documentation of any variation to this permit, and the Division -approved plans and specifications, is in the
attached as -built drawings.
Description of variations: System installed to meet intent of desiM and issued permit modification.
Installation of specified control panel has been completed.
Kevin D. Davidson
Professional Engineer's Naane
Agri -Waste Technology, Inc.
Firth Name
501 N. Salem Street, Suite 203
Address
I
C-0519
- Firm No.
Apex NC 27502
City Stare Zip code
919-367-6317
Telephone
kdavic
Email
ImoP
31y1-7,-zv
I Seal, Signature, and Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
DOCUMENTATION, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
By U.S. Postal Service By Courier/Special Delivery
1617 MALL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
WQ0028749 Version 3.1 Shell Version 181105 Page 10 of 10

Permit No. WQ0028749 Wastewater irrigation System
Louisiana-Pacific Corporation November 8, 2019
Louisiana-Pacific OSB -- Roxboro WWTF Person County
ENGINEERING CERTIFICATION
❑ Partial 0 Final
1, Kevin D. Davidson as a duly licensed North Carolina Professional
Engineer, having ® periodically I [] fully observed the construction of the permitted facilities, do hereby
state to the best of my abilities that the facility was constructed in compliance with G.S. 143-215.1,
Administrative Code Title 15A Subchapter 02T, this permit, and the Division -approved plans and
specifications.
Documentation of any variation to this permit, and the Division -approved plans and specifications, is in the
attached as -built drawings.
Description of variations: System installed to meet intent of design and, issued permit modification.
Installation of specified control panel has been completed.
Kevin D. Davidson
Professional Engineer's Name
Agri -Waste Technology, Inc.
Firm Name
501 N. Salem Street, Suite 203
Address
Apex
city
NC
State
919-367-6317 kdavid
Telephow Email
C-0519
Firm No.
27502
4yc A'',ti'.3bl�A �
�4 Pil'
0 AL x
Zip Code - 3�
ste.com
Sea], Signature, and Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
DOCUMENTATION, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
B) U.S. Postal Service By Courier/SpecialDelivery
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
WQ0028749 Version 3.1 Shell Version 181105 Page 10 of 10

wr
CuCiCCC Pacific CCCCCCCIu CCCC A
Engineers and Soil Scientists
Project Location: 10475 Boston Road
Roxboro, NC 27574
Person County
PIN #s 0200 00 68 6834
020000570857
020000678622
Permit No, W00028749
Project Owner: Louisiana—Pacific Corporation
c/o Mike Sarder
10475 Boston Road
Roxboro, NC 27574
[phone]
[e-mail]
Project Consultants
System Overview
Kevin Davidson, P.E.
[e-mail]
Agri Waste Technology, nc.
501 N. Salem Street, Ste 203
Apex, NC 27502
[phone]
[phone] Fox
SITE
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Detail Sheet 1
Sheet
Do
Detail Sheet 2
Sheet
7:
Detail Sheet C
Sheet
8*
Site Ma
Existing Non Discharge Spray Disposal p
w/ Sand EiKer Pre Treatment System.
4,000 gpd Max. Daily Elow; Domestic Waste.
Modification of Pre Treatment to AdvanTex.
Design Standard Existing Surface Spray; AdvanTex AX 100
with Existing Chlorination/Dechlorinotion
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PIN 1, 0200-O06E-6834
O2O0Oo-57-085E
1- a2aa0.fiE-1122
Permit No. W-2-P
PROFESSIONAL ENGINEER SEAL
This document was
Originally signed and
sealed by Kevin D.
Davidson, NC PE #024582
an September 13, 2019.
This medium shall not be
considered a signed and
sealed document.
FINAL DESIGN
NOT RELEASED FOR CONSTRUCTION
REV ISSUED WE DESCRIPTION
Cover Sheet
REVISED BY:
REVISED ON:
RELEASED BY:
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PIN # 0200-00-57-0857
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DRAWING NUMBER
WW-2

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Permit N, WD0028749
PROFESSIONAL ENGINEER SEAL
Existing Flow D. er
(To Be Abandoned)
o `iT
This document was
originally signed and
Baled by Kevin D.
Davidson, NC PE 4024582
an September 13, 2019.
This medium shall not be
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considered a signed and
sealed document.
Existing
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( Be Connected [o elation T Existing pu — —
To d to Recirc Tank
New
From
Recirculation Tan Facility pmmp rank m
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Louuisiana-pacific
or
Facility
FINAL DESIGN
NOT RELEASED FOR CONSTRUCTION
NOTES:
1.) Adjust tank and pod location to meet site constraints.
2.) Core new outlet hole for 4" PVC pipe into side of existing 6000-gal c
Recirculation Tank. Pipe penetration shall be sealed. a Z
3.) New 4000-gal Recirculation Tank shall have a minimum burial
depth of 21". The burial depth of the tank shall be adjusted to achieve pp; €
l
ExistingChori
a 1 % min. slope from the new outlet hole in the existing Recirc. Tank so
orination
g
to the inlet boot of the New 4000-gal Recirculation Tank. The invert Units
Units
height of the Recirculating Splitter Valve shall be adjusted to achieve a
1 % min. slope to the existing Chlorination Units.
SHEET TITLE
New Component
Layout
Fkistin9 S
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DRAWN BY:
s. d<ne9
CREATED ON:
7/31t2DIg
REVISED BY
REVISED ON:
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Pond
RELEASED BY:
RELEASED ON:
New Component Layout
DRAWING NUMBER
WW_4

Recirculation Settings
Total Daily Flow:
4,0IX] gpd
Treatment Emit Recirc. Ratio: Ti
Volume to Treatment Unit-,
12,OW gpd
CoseslHour-
6 doses
Required DoseslDay:
144 doses
Dose Volume:
K galldose
Pump Flowrate: 48.0 gpm
One Dose Eery:
10 min
Pump Time oN:
1.7 min
Pump Time OFF:
&3 min
Tank Float Settings
Float Set Points
(in)
Timer Enable I Low Water
30.0 2"above riltercartridge
Peak Enable
78.0 6,rbe1DwHWA
High WatefAlarm
84.0 Selowlank Infer
�RELIRLDLATIDN PDNP TIMER AND FLOAT SETTINGS
Ad—T,eAX100
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PodDetell
Svk MS
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ends n
Abwe Ground Fen Asse *
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Fan A.y Pad Detdl
sic Ms
Colleclre Air Viet
smcMs
. Recirculation tank to be approved by NC Department af F-th and Human services.
2. Recirculation tank to be buried with minimum of 21" soil cover.
3. Leakage fesN, of tank is regui red.
4. Documentation of conk testing shop be p ovided to certifying Engineer.
an 5. Tk ri s to extend m a of 6� above finished grade.
6. Final grading shall slope sodaway from tank openings.
�RELIRLDLATION TANK DETAIL (ar equivalent)
Top View
of Recirculating
Recirculacing Sputter Valve (RSV)
with Quick Disconnect
Sputter Valve in
Recirculation Tank
Inlet Riser
21 Di, PVC Riser/Lid
jDi,charg,0"eninger
Pipe
E
Recrculbab, Sputter VaIVe(MM4FRP)
Side View
of RSV in Recirc
Tank InletRiser
n RECIFiDLLATND SPI-m ER VALVE DEF
Wy.,,9 � _N..,..
AVVr
Engineers and Soil Sciatti—
Agn-Waste Technology, Inc.
501 N. Salem street, suite Apes, North Gerallna z]5020�
91P359A55e
vrvrv4.agnw e. en.
Louisiana—Pacific
Corporation
Wastewater Treotrnent System
owner mmrmmion.
Lwnisiana-Pacxlo �rparatmn
dD Tan, IT ns
10475 Boston Road
Roxboro NC 27574
(615) 9865600
tyenh4 kin,OLPC,m
Pro ,ty Inte,n,n114n:
0475 Boston Rood
1,,I,r, NC 1 174
Person Cwoty. NI
PIN ifs 0200-00-fiB-6834
02D0-00-5]-1151
0200-00-6I-8612
W00028I49
This document was
originally signed and
Baled by Kevin D.
Davidson, NO FE 4024582
on September 13, 2019.
This medium shall not be
considered a signed and
sealed document.
FINAL DESIGN
NOT RELEASED FOR CONSTRUCTION
REV ISSUED DAY DESCRIPTION
SHEET TITLE
Detail Sheet
DRAWN BY: CREATED ON:
S. Jones 7/31/2019
REVISED BY: REVISED ON:
RELEASED BY: RELEASED OF
SHEET NAME:
WW-5

AVVr
Engineers and Soil Scientists
Agri -Waste Technology, Inc.
501 N. Salem Efi—. Suite 203
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Apex, North Garet, . 2] 2
9111510 O
wvtw.agnwaste.coni
LOuisia0a-Pacific
Corporation
- can a Pe eau � roan {
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Waste P, Treatment System
own mt minion
er L ai iana-Padua carppraupa
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c/A WO, Sarder
10475 Roston Road
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IIII III
Roxboro NC 27574
(A15) 986-5600
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Property Information:
10475 Basta, Rood
Roxboro NC I7574
Person Coun1Y. NC
P
IN �s 0200-00-fiR- 14
ozoR-6R-5roe5T
0028749 zrz
aarxr�uadJ _ 1
mi^= ao�o.y�;,v) nv is mPor onm� ro.wnPo.l
Permit . !NOOG28149
NoW0
PROFESSIONAL ENGINEER SEAL
vP",F
o gorel
NW,
- _ _ _ _ -
4,000
6" (min) Aa'l A,,
wino
This document was
onginally signed and
sealed by Kevin D.
Davidson, NC PE #024582
nn Septemher 13, 2019.
This medium shall not be
C SYSTEIA PROBE VIEW - FOR ILLUSTRATION ONLY
�--�=��x-=r=
wllsidered a Signed and
sealed document.
4X6 TREATED POST
MOUNT PANEL DIRECTLY
RISER NSTALLAT ON N" A, ION.
1. Prep AdApAer Channel & R15er
TO POSTS OR TO
1.1, Bopghen Ahe dplh eprmeee pr the adapter pnd ! uvnh sandpaper.
ALUMINUM PLATE
1.z use o ' OF Alth ana acetone T in of FE c n finer d , e rmCee ar the adapter ana user. Tne oo,m,g sprmces meet he aeon and dry rar A
gppd ml pnd uvpAernght ipint. Letr IF, aaeetp,e Io�mephpl dry epmvletely
z. Apply Ad—TI,
21. Apply a bead Of meth—AE,te adhesive 1p the puiside pf the adapter. One T-pz packet pf MA320 adhesive is typical f,, one 24' riser.
rind off protruding screws
CONTROL (9 P 9 )
PANEL
FINAL DESIGN
NOT RaEASED FOR CONSTRUCTION
EEo 155UE0 GATE OESCRIPIFN
3. Install Riser
3.1. Ifthe deer F" p net"tit". prig, the r r praeuy
3.2 F'lrn,ly preee the �eer rim me Adopter �nl rme muom or the rser '1e reenng An the e ,erete (east-w-Adopters)
(bolted -down adapters). Twist the riser back and (prth slightly tp fully seat It an tp c eate a good band.
AI the adapter n,nge
O O O O
SINGLE o
CONDUIT
III
3.3. Apply a bead Af methacrylate atlheslve fA the lnslde or the acce Ilse! -adapter ]Alnt
3.4. Use a tongue depressor, putty knife, pr clean cl tIh 1A make a curio inuous fillet p, the inside Of the awes..W,r ,dppter
(pint.
(no Splices)
3.5. Apply hydraulic ce e,t TO bond outer ri wall and tap or tank,
4. Ensure safety net antlmTnner lid are Tn placesantl secured.
CONDUIT
IZr mlYl.
Sprety Net Below 2,d Riser AbRISER
OR WITH 4 - 3" DECK SCREWS
ENETRATIONS
WALL Po�
CORRUGATED PIPE IIIIPER POST
#Ey,SUPPORT
N.� u1NeiCOVEMINIMUM
20TO
Top Ai MA320 Adhesive WallH r I I
d auc
egp�ualenq amaALL
(NOMnoR 3PFE 1pPISEP
GRAVEL
18" �'�'/��SHEET
oTO POWER SOURCE
RT UNIT
CONDUIT�2tC7
TITLE
S 2et 2
Cy II(or
AINSTALL
TO BE 3/4" (min)
DRAWN BY:
CREATED ON:
Cps+ I, Place
(Install 4 clamps 'f 8'
o� y�eeAe� f Ae� ,e aeea)
,stall Safety Net In Each Access Riser
that does not contain an Inner Lid
MULTIPLE CONDUITS AS
NEEDED 3' BURIAL DEPTH
MINIMUM
ICI
s. dopes
T/aI/20Ie
REVISED BY:
REVISED ON:
RELEASED BY:
RELEASED ON:
SHEET Nape
�
Wel (/l
W - V
/1 Riser and Saiety NUetei
q
/>\ Contrd Penh Support

G, Process Flow Diagram
Existing 2.5-ac
Spray Irrigation
Field
Exist. Se tic Exist. PumpExist.
Existing 0=4,000 gpd Tankp 0=4,000 gpd Tank 0=4,000 gpd Recirculation
Louisiana-Pacific Tank
Facility 8,000 gal
6,000 gal
0=4,000 gpd
Advarl
Exist. AX100
Exist. Exist. New Recirc.
0=4,000 gpd 0=4,000 gpd 0=4,000 gpd Chlorination 0=4,000 gpd Treatment
Irrigation Storage Pond Tank Pod
Pump Tank 45,552 cu. ft. & 4,000 gal
4,000 gal Dechlorination
NOTES
1_ eo.ndary and Topogmphlnal inrormoron mken from Field Sarvey or cis Dom_
2, li,Adllani to fallow all NC DEQ and Person County applicable rules and regulations.
3. If actual site conditions vary from those shown on plans, contact Engineer before moving forward.
4. Pre ,onsir ron meeting to be held with Certified Installer prior to any construction .etivities.
5. Engineer inspection required during system Installation and al furl complArl
6. Engineer inspe rt (s), instouer eertireonon and engineer Eedlnedr.n a. insioued system is reg.ired.
7, Contractor to abide by a1I safety regulations during y,tem installation.
8. Upon system completion, Contractor tE supply Engineer with documentation of nstalloUn and a signed
letter indicating system was installed per approved design or noting any deviation from approved design.
9. Tre 11 system to be 10D from any welt 15 from any banding foundoton, 10' from water line End
50' from any stream/pond. V2rifi,.r.n of these setbacks to be pe 10 Ad by Contractor.
10, Actual inSt.II.r.0 End placement Ed treatment system to be overseen by Contractor.
11, Contractor to document system installation with photographs.
12. Contractor shall bockinl around 011 access areas such That storm water is shed away from pEienti El entry
points.
13, Invert elevations of EII components to be verified in field by Contractor tD insure proper operation.
14, Contractor to seed and/or mulch disturbed areas to coincide with existing landscape. Area shall not be
WE with uncovered soil.
15. All system piping and fittings to be SCH40 PVC (e Apl where noted). All gravity elbows to be Ion,
radius or long sweeping type elbows (AM).
16, New tank and pod to be set on 5" minimum gravel base. Use 45 or #57 stone for base.
17 TEnk(s) shall be bockflled wish grovel Er tank hole shall be over-eO.... ied a minimum of 2' in 0directions to allow for mechanical tamping of backfnl.
18, All tank penetrations shall be sealed with a cast in pl... boot with . stainless steel strap.
19, All metal in tanks shall be Stainless Steel.
20, New tanks to F— cast In place user adapter as specified.
21_ S,h, Tank tE hove approved effluent filter_
22. On site v and leak test required o all n w looks. Vacuum test .t 5 inches of TO for 2 m nutes_
Leak test for 24a hour duration wCh water level at 2elnch above riser connecilon. Doc. mentCit.n to be
provided to Engineer.
23, All n s t, have east -in lank .dopier, and be single piece r Risers shall be s ured io
cast -In tank adapters p nu.actu rer's re m endafions. Risers to extend 5' above soil suer.... and be
designed and m.inmin edo t.mprevent eErmxe water inrrow. Ri.ere to be gasketed and ......d wim mar (4)
1/4" diameter screws.
24. Ad v..1- Pod to be placed on gravel bed. 3a ktill around pods so that the top of the pods extends 2"
to 6' above finished grade.
25, Pump discharge piping icrii s and valves shall be of compatible corrosion -resistant material.
25, A threaded union shall be provided in each pump discharge line.
27, All valves shall be readily accessible from the ground surface.
28, 1E 1 CEnirEl Panel 24" (min) above grade.
29, Conir.l panel sh.11 be lacked or secured against unauthorized access.
30, All system wring to be installed in electrical conduit buried to a minimum depth of 18 All wire to be
OF or THWN rated.
31, Electrical service tE c.nir,l panel to be installed by I'. ce rased electrI6dn.
32, Separate circuits for ea.h pump and alarm/control panel ore required
(2-24DV, 20 amp; 1-120V, 15 amp)
Avvr
Engineers and Soil Scientists
PEE - -1.9y, Inc
501 N. Sabo Street, Suite 203
Al-, North Carolina 27502
019-b5&0660
rrviw.agrlwaste.com
Louisiana—Pacific
Corporation
Wastewater Treatment System
owner m rvmiont
LomswEna-Poore corp.rauon
c/o an, 5arder
10475 Boston Rood
Roxboro NC 27574
[phone]
UP 1e11b,,@1PCorlacom
Property In ErmaliEn_
104)3 E'RI n Rood
Roxboro NC 2I574
Person County, NC
PIN #s 0200- OR-
fiB-fiB34
0200-00-5J-085J
0200-00-6 H22
Permit No, W00028749
PROFESSIONAL ENGINEER SEAL
This document was
originally signed and
sealed by Kevin D.
Davidson, INC PE 4024582
on September "' 2019.
This medium shall not he
considered a signed and
sealed document.
FINAL DESIGN
NOT RELEASED FOR CONSTRUCTON
REA ISSUED WE DESCRIPTION
Detail Sheet 3
DRAWN BY: CREATED ON:
S. Jones 7/31/2019
DRAWING NUMBER ��TT
WW- !

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PROFESSIONAL ENGINEER SEAL
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This document was
rtriyina Ysiyne
n d and
sealed by Kevin P.
Davidson, NCPE#024582
----
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on September 13, 2919.
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I
considered a signed and
sealed document.
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7
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FINAL DESIGN
NOT RELEASED FOR CDNSTRucTION
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Note: No known
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CREATED ON:
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RELEASED BY:
RELEASED ON:
Site Map
DRAWING NUMBER
SM-1