WQ0007144_Final Permit_19960820

State of North Carolina
Department of Environment,
Health and Natural Resources ; •
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary r'%sJ F1
A. Preston Howard, Jr., P.E., Director
August 20, 1996
Mr. Doug McMillan, Chief Executive Officer
The Capital Area YMCA
Post Office Box 10976
Raleigh, North Carolina 27605
Subject: Permit No. WQ0007144 Modification
The Capital Area YMCA
Camp Seafarer
Wastewater Spray Irrigation
Pamlico County
Dear Mr. McMillan:
This permit modification is in response to three requests made by The Wooten Company, on behalf
of The Capital Area YMCA. In a letter dated March 22, 1996, the Division was requested to modify the
July 31, 1996, completion or under construction date to a December 31, 1996 date for the collection
system and lift station improvements, and to change from a maximum camp occupancy of 750 persons per
day to an average camp occupancy of 750 persons per day. In a letter dated June 17, 1996, the Division is
also requested to modify the July 31, 1996, completion or under construction date to a December 31, 1996
date for the wastewater disinfection facilities.
In response, it is noted the Division issued a permit for the collection system and lift station
improvements at the Capital Area YMCA's Camp Sea Gull with a December 31, 1996 completion or under
construction date. Therefore, the Division agrees and has modified this permit for the Camp Seafarer
improvements to be completed or under construction before December 31, 1996 as well, with completion
by May 31, 1997.
The Division is unable to allow the change from a maximum camp occupancy of 750 persons per
day to an average of 750 persons per day. The Soil Scientist's report submitted by the Capital Area YMCA
and the Wooten Company indicates that the existing spray irrigation disposal field only has the disposal
capacity to consistently handle 498 camp residents per day. Also, the Division does not have the
information needed to depend on the existing treatment lagoons for adequate storage and later disposal of
the wastewater from the additional campers. There are two additional spray fields being authorized by this
permit, but until these spray fields are operational, the Division can only evaluate and depend on the
capacity of the existing spray field. Therefore, the permittee must demonstrate there is adequate long term
storage and adequate spray field capacity to dispose of the additional wastewater on the spray field in
existence, and adequate lagoon storage to handle the wastewater being generated until the new spray fields
are operational. This demonstration also must include the lagoon storage report this permit and the
previous permit issued February 29, 1996, requires the Capital YMCA to submit by December 31, 1996.
P.Q. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

The Wooten Company reported it would be impossible for the planned wastewater disinfection
facilities to be under construction by the July 31, 1996, date required in the permit issued February 29,
1996. The Division has modified this permit to require the wastewater disinfection facilities to be
completed or under construction before December 31, 1996, as requested.
Please note, the permit dates, included in this permit, for completion of construction shall include
the time it takes to obtain any required permit modifications. The Division will be unable to make any
further modifications to this permit without a formal permit modification request, including a fee.
In accordance with the above, the Division is forwarding herewith Permit No.
WQ0007144 dated August 20, 1996, as modified and continuing to require the Capital
Area YMCA to make facility improvements and upgrades which comply with current
State requirements. This also authorizes the continued operation of the existing subject wastewater
treatment and spray irrigation facilities. Until adequate treatment facilities are approved and installed, this
permit shall restrict the number of camp occupants per day to allow the spray irrigation disposal system to
accommodate spray irrigation of any wastewater storage build-up in the existing lagoons. The new
disinfection facilities and pump station facilities required by this permit shall need to be submitted for
approval of the proposed design.
To explain why the Division is requiring the construction of new treatment facilities and the repair
and/or upgrade of existing facilities, we would like to call your attention to the April 20, 1994, Agreement
Letter, where the Division of Environmental Management (now the Division of Water Quality) agreed to
allow The Capital Area YMCA to temporarily increase it's spray irrigation rate for the subject facility in
dealing with a lagoon treatment and storage problem. This approval was given based on a commitment by
The Capital Area YMCA to submit a request for modification of the subject permit that would upgrade the
treatment and disposal facilities to ensure proper wastewater treatment and prevent these type situations
from reoccurring.
On December 29, 1994, the Division received a permit application that only requested an increase
in spray irrigation rates with the addition of spray fields and did not request any treatment facility
improvements. The engineers report, submitted with the permit application, confirms that substantial
treatment and disposal facility improvements are necessary. Since The Capital Area YMCA failed to
request any of the expected facility improvements, as part of the April 20, 1994, agreement letter, this
permit requires specific treatment and disposal facility improvements as recommended by the submitted
engineers report.
The lack of disinfection prior to spray irrigation of wastewater and the unrestricted access of
campers to the spray field causes the Division much concern for the adequate wastewater treatment at this
facility, and for the health and safety of the campers and staff. It is unacceptable to simply increase the
spray irrigation acreage and spray irrigation rate without improving the treatment and. disposal facilities.
The Division fully expects the aging and primitive lagoon treatment and spray system to be upgraded to
meet present day standards for the protection of human health and the environment.
This permit shall be effective from the date of issuance until March 31, 1998, shall void Permit
No. WQ0007144 issued February 29, 1996, and shall be subject to the conditions and limitations as
specified therein. Please pay particular attention to the monitoring requirements in this permit. Failure to
establish an adequate system for collecting and maintaining the required operational information will result
in future compliance problems.

If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following receipt of
this permit. This request must be in the form of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer
27447, Raleigh, NC 27611-7447. Unless such demands are made this permit shall be final and binding.
If you need additional information concerning this matter, please contact Mr. John Seymour at
[phone] ext. 546.
Sincerely,
Preston �Io aid, Jr., P.E.
cc: Director of the Pamlico County Health Department
The Wooten Company
Washington Regional Office, Water Quality Section
Washington Regional Office, Groundwater Section
Brian Wootton, Groundwater Section, Central Office
Training and Certification Unit (no rating change)
Facilities Assessment Unit

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
RALEIGH
SPRAY IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
The Capital Area YMCA -Camp Seafarer
Pamlico County
FOR THE
continued operation of an existing spray irrigation treatment and disposal facility, with a maximum
allowable camp occupancy 750 persons per day, consisting of an existing 6,000 linear feet wastewater
collection system, a sewer lift station, two stabilization/holding lagoons one at 2.55 acres and the other at
2.25 acres having a total estimate of 14.1 million gallons capacity, an existing 5.8 acre wetted area spray
field (19.8 gross acre size) labeled area no.1, mobile spray irrigation equipment using two above ground
lateral lines and senniger model 7025 RD nozzles with an engine driven irrigation pump, and all associated
valves, piping, pumps, spray equipment and appurtenances to treat and spray irrigate wastewater onto the
existing spray area;
and, the construction and operation of two new spray irrigation fields which are sized at approximately 5.8
wetted acres (14.1 gross acres) for area No. 2 and 3.5 wetted acres (8.7 gross acres) for area No.3, the
construction and maintenance of fencing to restrict access to the existing and two new spray field areas,
and fencing to restrict access to the existing stabilization/holding lagoons, the installation of replacement
pumping and spray irrigation equipment adequate to extend to and effectively irrigate the new spray
irrigation areas, and all associated pumps, piping, valves and appurtenances to serve The Capital Area
YMCA's Camp Seafarer with no discharge of wastes to the surface waters, pursuant to the application
received December 29, 1994, and the modification requests received March 22, 1996, and June 17, 1996,
and in conformity with the project plan, specifications, and other supporting data subsequently filed and
approved by the Department of Environment, Health and Natural Resources and considered a part of this
permit.
This permit shall be effective from the date of issuance until March 31, 1998, shall void Permit
No. WQ0007144 issued February 29, 1996, and shall be subject to the following specified conditions and
limitations:
I. PERFORMANCE STANDARDS
The Washington Regional Office, telephone number 919/ 946-6481 shall be notified at least
forty-eight (48) hours in advance of the initial operation of the new spray irrigation fields
so that an in -place inspection can be made. Such notification to the regional supervisor shall
be made during the normal office hours from 8:00 a.m. until 5.00 p.m. on Monday through
Friday, excluding State Holidays.

2. Upon completion of construction and prior to operation of this permitted facility, a
certification must be received from a professional engineer certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting materials. Mail the Certification to the Water Quality
Permits and Engineering Unit, P.O. Box 29535, Raleigh, NC 27626-0535.
3. The spray irrigation facilities shall be effectively maintained and operated at all times so that
there is no discharge to the surface waters, nor any contamination of ground waters which
will render them unsatisfactory for normal use. In the event that the facilities fail to perform
satisfactorily, including the creation of nuisance conditions or failure of the irrigation area
to adequately assimilate the wastewater, the Permittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such
as the construction of additional or replacement wastewater treatment and disposal facilities.
4. The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwaters resulting from the operation of this facility.
5. The residuals generated from these treatment facilities must be disposed in accordance with
General Statute 143-215.1 and in a manner approved by the North Carolina Division of
Water Quality.
6. Diversion or bypassing of the untreated wastewater from the treatment facilities is
prohibited.
7. The following buffers shall be maintained:
a) 400 feet between wetted area and any residence or places of public assembly under
separate ownership,
b) 150 feet between wetted area and property lines,
c) 100 feet between wetted area and wells,
d) 100 feet between wetted area and drainageways or surface water bodies,
e) 50 feet between wetted area and public right of ways,
f) 100 feet between wastewater treatment units and wells, and
g) 50 feet between wastewater treatment units and property lines.
Some of the buffers specified above may not have been included in previous permits for
this waste treatment and disposal system. These buffers are not intended to prohibit or
prevent modifications, which are required by the Division, to improve performance of the
existing treatment facility. These buffers do, however, apply to modifications 'of the
treatment and disposal facilities which are for the purpose of increasing the flow that is
tributary to the facility. These buffers do apply to any expansion or modification of the
spray irrigation areas and apply in instances in which the sale of property would cause any
of the buffers now complied with, for the treatment and disposal facilities, to be violated.
The applicant is advised that any modifications to the existing facilities will require a permit
modification.
8. Until updated treatment facilities are approved and installed, this permit shall restrict the
number of camp occupants to a maximum of 750 persons per day, to the capacity of the
spray irrigation treatment disposal system during the summer season and accommodate any
winter disposal of summer wastewater storage. This limit is based on the water balance, the
disposal capacity and the projected occupancy rate stated by the permittee.
II. OPERATION AND MAINTENANCE REQUIREMENTS
Effective wastewater disinfection facilities shall be permitted and shall be completed or
under construction by December 31, 1996, so that adequate disinfection occurs prior to
wastewater spray irrigation. Construction must be completed by May 31, 1997.
2

2. The subject stabilization/storage lagoon shall be effectively fenced to prevent access by the
public. The fence shall be completed or under construction by July 31, 1996.
3. The entire existing spray field area shall be isolated and shall be fenced to prevent access by
the public. As previously agreed, any golf course shall be relocated as necessary to
eliminate this use from all spray areas. The fencing and golf course relocation shall be
completed or under construction by July 31, 1996.
4. The existing spray irrigation pumping system shall have all necessary replacement parts,
including addition of pumps and a generator or engine that will be immediately available to
maintain the continued operation of the spray system.
5. Stabilization/storage lagoon measurements and soundings shall be made to confirm the
present treatment and storage capacities. A report detailing the results, including
calculations and procedures, shall be submitted by December 31, 1996, to the Division's
Permits and Engineering Unit and the Washington Regional Office. If the lagoons do not
have the estimated 14.1 million gallon capacity, appropriate corrective action must be taken
including any necessary permit modification or the decrease in camp occupants to ensure
adequate facilities for wastewater treatment.
6. The Camp Seafarer sewer collection system shall be repaired to reduce or eliminate
groundwater, inflow and infiltration, which are allowing substantial quantities of
extraneous water to enter the sewer system. All needed repairs (or permitted additions)
shall be completed or under construction by December 31, 1996. Construction must be
completed by May 31, 1997.
7. The existing sewer lift stations shall be repaired to correct all safety problems indicated by
the "Engineering Evaluation of Wastewater System Needs" report, with all repairs to be
completed or under construction by December 31, 1996. If substantial design changes are
made, a permit modification will be required. Construction must be completed by May 31,
1997,
8. A permanent and effective pump station shall be installed to replace the "portable" spray
irrigation pumping arrangement. The spray irrigation pump station shall be completed or
under construction by December 31, 1996. if the YMCA does not choose to request a
modification to this station, acceptable justification, calculations and details shall be
provided to show why this "portable" arrangement should be allowed to continue.
9. Spray Area No. 3 is wooded and shall, if needed, have enough of the understory removed
for effective spray irrigation before it's utilization for spray irrigation of wastewater.
10. A plan for the permitted disposal of the wastewater residuals in the stabilization/holding
lagoon shall be prepared and ready for implementation on or before December 31, 1996.
11. The facilities shall be properly maintained and operated at all times.
12. Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of
the wastewater treatment facilities. The operator must hold a certificate of the type and
grade at least equivalent to or greater than the classification assigned to the wastewater
treatment facilities by the Certification Commission. The Permittee must also employ a
certified back-up operator of the appropriate type and grade to comply'with the conditions
of Title 15A, Chapter 8A, .0202. The ORC of the facility must visit each Class I facility at
least weekly and each Class II, III, and IV facility at least daily, excluding weekends and
holidays, and must properly manage and document daily operation and maintenance of the
facility and must comply with all other conditions of Title 15A, Chapter 8A, .0202.
13 _ A suitable vegetative cover of the spray irrigation area shall be maintained.
3

14. Irrigation shall not be performed during inclement weather or when the ground is in a
condition that will cause runoff.
15. Adequate measures shall be taken to prevent wastewater runoff from the spray field.
16. The facilities shall be effectively maintained and operated as a non -discharge system to
prevent the discharge of any wastewater resulting from the operation of this facility.
17. The application rate on spray area No. 1 shall not exceed a cumulative loading of 54 inches
per acre over any twelve (12) month period at an instantaneous application rate that shall
not allow any runoff or ponding. Special care shall be taken to supervise spray irrigation
for this spray area since the soils are reported as damaged from topsoil removal, erosion
and soil compaction. All efforts must be made to repair the areas and prevent any runoff.
The application rate on spray area No. 2 shall not exceed a cumulative loading of 83.2
inches per acre over any twelve (12) month period at an instantaneous application rate that
shall not allow any runoff or ponding.
The application rate on spray area No. 3 shall not exceed a cumulative loading of 69.4
inches per acre over any twelve (12) month period at an instantaneous application rate that
shall not allow any runoff or ponding.
18. No type of wastewater other than that from The Capital Area YMCA's Camp Seafarer shall
be sprayed onto the irrigation area.
19. No traffic or equipment shall be allowed on the disposal area except while installation
occurs or while normal maintenance is being performed.
20. Public access to the land application sites shall be controlled during active site use. Such
controls may include the posting of signs showing the activities being conducted at each
site. Adequate fencing and all steps necessary shall be taken to prevent children from
entering the spray area.
21. Freeboard in the treatment lagoons shall not be less than two feet at any time.
III. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, soil or plant tissue analyses)
deemed necessary by the Division of Water Quality to insure surface and ground water
protection will be established and an acceptable sampling reporting schedule shall be
followed.
2. Adequate records shall be maintained by the Permittee tracking the amount of wastewater
disposed. These records shall include, but are not necessarily limited to, the following
information:
a. date of irrigation,
b. volume of wastewater irrigated,
c. field irrigated,
d. length of time field is irrigated,
e. continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings for each
field,
f. weather conditions, and
g. maintenance of cover crops.
4

3. The effluent from the subject facilities shall be monitored by the Pennittee at the point prior
to irrigation every March, July, and November for the following parameters:
BOD5 TSS
Fecal Coliform pH
NH3 as N
4. Three (3) copies of all operation and disposal records (as specified in condition III 2) on
Form NDAR-I shall be submitted on or before the last day of the following month. Three
(3) copies of all effluent monitoring data (as specified in condition I113) on Form NDMR-1
shall be submitted on or before the last day of April, August, and December. All
information shall be submitted to the following address:
NC Division of Water Quality
Water Quality Section
Facility Assessment Unit
PO Box 29535
Raleigh, NC 27626-0535
5. Noncompliance Notification:
The Permittee shall report by telephone to the Washington Regional Office, telephone
number 9191 946-6481 as soon as possible, but in no case more than 24 hours or on the
next working day following the occurrence or first knowledge of the occurrence of any of
the following:
a. Any occurrence at the wastewater treatment facility which results in the treatment of
significant amounts of wastes which are abnormal in quantity or characteristic, such as
the dumping of the contents of a sludge digester, the known passage of a slug of
hazardous substance through the facility, or any other unusual circumstances;
b. Any process unit failure, due to known or unknown reasons, that renders the facility
incapable of adequate wastewater treatment, such as mechanical or electrical failures of
pumps, aerators, compressors, etc.;
c. Any failure of a pumping station, sewer line, or treatment facility resulting in a by-pass
directly to receiving waters without treatment of all or any portion of the influent to
such station or facility; or
d. Any time that self -monitoring information indicates that the facility has gone out of
compliance with its permit limitations.
Persons reporting such occurrences by telephone shall also file a written report in letter
form within 15 days following first knowledge of the occurrence.- This reporrmust outline
the actions taken or proposed to be taken to ensure that the problem does not recur.
I V . GROUNDWATER REQUIREMENTS
1. Monitor wells 1 and 2 shall be sampled March, July, and November for the following
parameters:
Nitrate (NO3) Ammonia Nitrogen
TDS TOC
PH Water Level
Chloride Fecal Coliforms
Total Suspended Solids
Volatile Organic Compounds - In November only (by Method 1 or 2 below)

Method 1: Method 6230D (Capillary - Column), "Standard Methods For The
Examination of Water and Wastewater", 17th ed., 1989
Method 2: Method 502,2 "Methods For The Determination Of Organic Compounds
In Drinking Water", U.S. EPA-600/4-88/039
The measurement of water levels must be made prior to sampling for the remaining
parameters_ The depth to water in each well shall be measured from the surveyed point on
the top of the casing.
The measuring points (top of well casing) of all monitoring wells shall be surveyed to
provide the relative elevation of the measuring point for each monitoring well.
If TOC concentrations greater than 10 mg/l are detected in any downgradient monitoring
well, additional sampling and analysis must be conducted to identify the individual
constituents comprising this TOC concentration. If the TOC concentration as measured in
the background monitor well exceeds 10 mg/1, this concentration will be taken to represent
the naturally occurring TOC concentration. Any exceedances of this naturally occurring
TOC concentration in the downgradient wells shall be subject to the additional sampling
and analysis as described above.
If any volatile organic compounds are detected by Method 6230D, or the equivalent Method
502.2, then the Washington Regional Office Groundwater Supervisor, telephone number
919/ 946-6481 must be contacted immediately for further instructions regarding any
additional follow-up analyses required. The results of all initial and follow-up analyses
must be submitted simultaneously.
The results of the sampling and analysis shall be sent to the Groundwater Section, Permits
and Compliance Unit, P.O. Box 29535 Raleigh, N.C. 27626-0535 on Form GW-59
[Compliance Monitoring Report Form] every April, August, and December.
3. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall
be provided.
4. The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in
15A NCAC 2L, Groundwater CIassifications and Standards. The Compliance Boundary is
for the disposal system constructed prior to December 31, 1983 is established at either (1)
500 feet from the waste disposal area, or (2) at the property boundary, whichever is closest
to the waste disposal area. An exceedance of Groundwater Quality Standards at or beyond
the Compliance Boundary is subject to immediate remediation action in addition to the
penalty provisions applicable under General Statute 143-215.6A(a)(1).
In accordance with 15A NCAC 2L, a REVIEW BOUNDARY is established around the
disposal systems midway between the Compliance Boundary and the perimeter of the
waste disposal area. Any exceedance of standards at the Review Boundary shall require
remediation action on the part of the permittee.
V . INSPECTIONS
1. Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to
insure proper operation of the subject facilities.
rel

2. The Permttee or his designee shall inspect the wastewater treatment and disposal facilities
to prevent malfunctions and deterioration, operator errors and discharges which may cause
or lead to the release of wastes to the environment, a threat to human health, or a nuisance.
The Permittee shall keep an inspection log or summary including at least the date and time
of inspection, observations made, and any maintenance, repairs, or corrective actions taken
by the Permittee. This log of inspections shall be maintained by the Permittee for a period
of three years from the date of the inspection and shall be made available upon request to
the Division of Water Quality or other permitting authority.
3. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises or place on
or related to the disposal site or facility at any reasonable time for the purpose of
determining compliance with this permit, may inspect or copy any records that must be
maintained under the terms and conditions of this permit, and may obtain samples of
groundwater, surface water, or leachate.
V1. GENERAL CONDITIONS
This permit shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other supporting
data.
2. This permit is effective only with respect to the nature and volume of wastes described in
the application and other supporting data.
3. This permit is not transferable. In the event there is a desire for the facilities to change
ownership, or there is a name change of the Permittee, a formal permit request must be
submitted to the Division of Water Quality accompanied by an application fee,
documentation from the parties involved, and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may
not be approved.
4. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division of Water Quality in accordance with
North Carolina General Statute 143-215.6(a) to 143-215.6(c).
5. The issuance of this permit does not preclude the Permittee from complying with any and
all statutes, rules, regulations, or ordinances which may be imposed by other government
agencies (local, state, and federal) which have jurisdiction.
6. A set of approved plans and specifications for the subject project must be retained by the
Permittee for the life of the project.
7. The annual administering and compliance fee must be paid by the Permittee within thirty
(30) days after being billed by the Division. Failure to pay the fee accordingly may cause
the Division to initiate action to revoke this permit as specified by 15A NCAC 2H .0205
(c)(4).
8. The Permittee, at least six (6) months prior to the expiration of this permit, shall request its
extension. Upon receipt of the request, the Commission will review the adequacy of the
facilities described therein, and if warranted, will extend the permit for such period of time
and under such conditions and limitations as it may deem appropriate.

9 . The subject wastewater treatment and disposal facilities shall be connected to an operational
publicly owned wastewater collection system within 180 days of its availability to the
subject facilities, if the subject wastewater treatment or disposal facilities are in
noncompliance with the terrns and conditions of this non -discharge permit or the governing
statutes or regulations. Prior to the initiation of these connection activities, appropriate
approval must be received from this Division.
Permit issued this the 20th day of August, 1996
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
reston oward, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission
Permit Number WQ0007144

Permit No. WQ0007144
August 20, 1996
ENGINEER'S CERTIFICATION
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
project, ,
Project Name
Location
for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the construction such that the construction was observed to be built within substantial compliance and
intent of this permit, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.

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