WQ0023511_Final Permit_20040212

p4 W A-r$ Michael F. Easley, Governor
William G. Boss Jr., Secretary
?_
(DO U K-)�'.
r North Carolina Department of Environment and Natural Resources
D C Alan W. Klimek, P.E., Director
Coleen H. Sullins, Deputy Director
February 12, 2004
'.PERRY HOLLIDAY — SUPERINTENDENT
IREDELL-STATESViLLE SCHOOLS
POST OFFICE Box 911
STATESVILLE, NORTH CAROLINA 28677
Division of Water Quality
Subject: Permit No. WQ0023511
Woodland Heights Elementary/Middle School
Wastewater Surface Irrigation
Iredell County
Dear Dr. Holliday:
In accordance with your permit application received January 20, 2004, and subsequent additional
information received January 27, 2004 and February 9, 2004, we are forwarding herewith Permit No.
WQ0023511, dated February 12, 2004, to Iredell-Statesville Schools for the construction and operation of the
subject wastewater treatment and surface irrigation facilities.
This permit shall be effective from the date of issuance until January 31, 2009, 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, 6714 Mail Service Center, Raleigh, NC 27699-
6714. Unless such demands are trade this permit shall be final and binding.
One set of approved plans and specifications is being forwarded to you. If you need additional
information concerning this matter, please contact Nathaniel Thornburg at [phone] extension 533.
Sincere ,
,Alan W. Klimek, P.E.
cc: Iredell County Health Department
Mooresville Regional Office, Water Quality Section
Mooresville Regional Office, Groundwater Section
Groundwater Section, Central Office
Donald Munday, PE — Piedmont Design Associates
Technical Assistance and Certification Unit
Water Quality Central Files
NDPU Files
Non -Discharge Permitting Unit Internet http://h2o.eur.state.nauslndpu
I617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] Fax [phone]
DENR Customer Service Center Telephone [phone]
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N M

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
SIIIi;>rACE. 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
Iredell®Statesville Schools
Iredell County
FOR THE
construction and operation of a 19,200 gallon per day (GPD) wastewater collection, treatment and disposal
facility consisting of:
a wastewater collection system composed of:
dual 4,000 gallon grease traps, approximately 900 linear feet of 8-inch gravity sewer, approximately 300
linear feet of 6-inch gravity sewer, approximately 15 linear feet of 4-inch gravity sewer;
a wastewater treatment facility composed of:
a manually cleaned aerated bar screen with a 1,200 gallon tank and a manually operated 3-inch Geyser
solids pump, a manually cleaned aerated fine screen with a 1,200 gallon tank and a manually operated 3-
inch Geyser solids pump, a 13,000 gallon aerated flow equalization basin with dual six-inch Geyser
pumps, a flow splitter box diverting flow to two trains;
Train L an 11,100 gallon extended aeration basin, two (2) 1,550 gallon clarifiers each equipped with one
(1) manuaIly operated 3-inch waste sludge Geyser pump, a 2,880 gallon aerated sludge holding tank, a
2,000 gallon mudwell basin with dual 3-inch Geyser pumps, two (2) 135 gallon aerated biological filters
with a loading rate of 1.48 gpm/ft2, a 2,000 gallon clearwell with dual 4-inch Geyser pumps and dual 45
gallon per minute (gpm) backwash pumps;
Train 2: an 11,850 gallon extended aeration basin, two (2) 1,550 gallon clarifiers each equipped with one
(1) Manually operated 3-inch waste sludge Geyser pump, a 2,960 gallon aerated sludge holding tank, a
2,000 gallon mudwell basin with dual 3-inch Geyser pumps, two (2) 135 gallon aerated biological filters
with a loading rate of 1.48 gpm/ft2, a 2,000 gallon clearwell with dual 4-inch Geyser pumps and dual 45
gallon per minute (gpm) backwash pumps;
a flow converging box, a 1,000 gallon chlorinator with 30 minutes minimum contact time, a 500 gallon
dechlorinator, four (4) 240 cubic feet per minute (cfm) blowers, four (4) 66 cfm blowers;

a surface irrigation disposal system composed of:
a 252,000 gallon lined storage basin (148,000 gallons of active storage volume) with dual 178 gpm
pumps and audible/visual high water alarms, a rain/moisture sensor and a 7.15 acre drip irrigation field
divided into four (4) zones consisting of approximately 77,650 linear feet of drip line and approximately
38,820 emitters, each rated at 0.62 gallons per hour (gph)
to serve Woodland Heights Eletnentary/Middle School, with no discharge of wastes to the surface waters,
pursuant to the application received January 20, 2004, and subsequent additional information received by the
Division, and in conformity with the project plan, specifications, and other supporting data subsequently filed and
approved by the Department of Environment and Natural Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until January 31, 2009, and shall be subject to the
following specified conditions and limitations:
1. PERFORMANCE STANDARDS
1. 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. If
this ro'ect is to be completed in 12hases and partially certified, -you shall retain the responsibility to
track further construction approved under the same permit, and shall provide a final certificate of
completion once the entire project has been completed. Mail the Certification to the Non -Discharge
Permitting Unit, Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617.
2. The Mooresville Regional Office, telephone number [phone], shall be notified at least forty-
eight (48) hours in advance of operation of the installed facilities 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.
The surface 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 therm
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 (Division), 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 Division.
6. Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited.
7. The following buffers shall be maintained:
a) 100 feet between wetted area and any residence or places of public assembly under separate
ownership,
b) 50 feet between wetted area and property lines,
c) 100 feet between wetted area and wells,
d) 50 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 treatment/storage units and any wells, and
g) 50 feet between treatment units and property lines.

8. A leakage test shall be performed on the dual train extended aeration treatment plant to ensure that
any exfiltration occurs at a rate that does not exceed twenty (20) gallons per twenty-four (24) hours
per 1,000 gallons of tank capacity. The engineer's certification will serve as proof of compliance with
this condition.
9. If excavation into bedrock is required for the installation of any tank or the wet weather storage basin,
the pit shall be lined with a 10 mil synthetic liner at a minimum.
10. The disposal system shall be connected to a rain or moisture sensor that shall indicate when
wastewater application is not appropriate in accordance with Condition 11(4) of this permit.
II. OPERATION AND MAINTENANCE REQUIREMENTS
The facilities shall be properly maintained and operated at all times.
2. Upon classification of the wastewater treatment and irrigation facilities by the Water Pollution
Control System Operators Certification Commission (WPCSOCC), the Permittee shall designate and
employ a certified operator to be in responsible charge (ORC) and one or more certified operator(s) to
be back-up ORC(s) of the facilities in accordance with 15A NCAC 8G ,0201. The ORC shall visit
the facilities in accordance with 15A NCAC 8G .0204 or as specified in this permit and shall comply
with all other conditions specified in these rules.
3. A suitable year round vegetative cover of leaf litter and pine forest shall be maintained. PAN
application shall not exceed 100 lbslyr.
4. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause runoff.
5. Adequate measures shall be taken to prevent wastewater runoff from the irrigation field.
6. 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.
7. The application rate shall not exceed a cumulative loading of 26 inches over any twelve (12) month
period at an instantaneous application rate not to exceed 0.4 inches per hour.
No type of wastewater other than that from Woodland Heights ElementarylMiddle School shall be
irrigated onto the irrigation area.
9. No traffic or equipment shall be allowed on the disposal area except while installation occurs or while
normal maintenance is being performed.
10. 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.
11. Freeboard in the wet weather storage basin shall not be less than two feet at any time.
12. A waste -level gauge to monitor waste levels in the wet weather storage basin shall be installed prior
to operation. This gauge shall have readily visible permanent markings indicating the maximum
liquid level at the top of the temporary liquid storage volume, minimum liquid Ievel at the bottom of
the temporary liquid storage volume, and top of the dam elevations. Caution must be taken not to
damage the integrity of the liner when installing the gauge.

13. A protective vegetative cover shall be established and maintained on all earthen basin embankments
(outside toe of embankment to maximum pumping elevation), berms, pipe runs, erosion control areas,
and surface water diversions. Trees, shrubs, and other woody vegetation shall not be allowed to grow
on the earthen basin dikes or embankments. Earthen basin embankment areas shall be kept mowed or
otherwise controlled and accessible.
14. The chlorine tablets used in the disinfection facility shall be of the kind and type specified in the plans
and specifications approved by the Division.
III. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, soil or plant tissue analyses) deemed
necessary by the Division to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
2. Influent flow shall be continuously monitored and daily flow values shall be reported on Form
NDMR.
The Permittee shall install an appropriate flow measurement device consistent with approved
engineering and scientific practices to ensure the accuracy and reliability of influent flow
measurement. Flow measurement devices selected shall be capable of measuring flows with a
maximum deviation of less than 10 percent from true flow, accurately calibrated at a nvnimurn of
once per year, and maintained to ensure that the accuracy of the measurements is consistent with the
accepted capability of that type of device. The Permittee shall keep records of flow measurement
device calibration on file for a period of at least three years. At a minimum, data to be included in
this documentation shall be:
a. Date of flow measurement device calibration
b. Name of person performing calibration
c. Percent from true flow
3. The effluent from the subject facilities shall be monitored by the Permittee at a point prior to
irrigation every March, June and November for the following parameters:
BODS
I NO2-NO3 I
pH
Fecal Coliform
TSS
NH3 as N
TKN r
Total Phosphorous
r During the operational period((September through June), nitrate(as NO -N), total ammonia (as
NH3-N) and Total Kjeldhal Nitrogen shall be sampled monthly.
The annual average of Total Nitrogen collected from samples during operational months shall be no
more than 15 mg/l.
4. 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.
5. Freeboard in the wet weather storage basin shall be recorded weekly.
A

6. Three (3) copies of all monitoring data [as specified in Conditions I11(2) and 111(3)] on Form NDMR-
I and three (3) copies of all operation and disposal records [as specified in Conditions 111(4),and
1II(5)] on Form NDAR-I shall be submitted monthly on or before the last day of the following
month. All information shall be submitted to the following address:
NC Division of Water Quality
Water Quality Section
Non -Discharge Compliance/Enforcement Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
An annual representative soils analysis (Standard Soil Fertility Analysis) shall be conducted on each
irrigation field and the results maintained on file by the Permittee for a minimum of five years. The
Standard Soil Fertility Analysis shall include, but is not necessarily limited to, the following
parameters:
Acidity
Magnesium
Phosphorus
Potassium
Calcium
Manganese
Cation Exchange Capacity
Sodium
Copper
H
Percent Humic Matter
Zinc
Exchangeable Sodium Percentage
Base Saturation (by calculation)
8. Nmicompliance Notification:
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number (704)
663-1699, 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 render 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.
d. Any time that self -monitoring information indicates that the facility has gone out of compliance
with its permit limitations.
Occurrences outside normal business hours may also be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone].
Persons reporting such occurrences by telephone shall also file a written report in letter -form within
five (S) days following first knowledge of the occurrence. This report must outline the actions taken
or proposed to be taken to ensure that the problem does not recur.

IV. GROUNDWATER REQUIREMENTS
1. Well Construction / Abandonment Criteria:
a. Prior to beginning waste disposal operations, within ninety (90) days of permit issuance, 3
monitoring wells (MW-1 through MW-3), 1 upgradient and 2 downgradient, shall be installed to
monitor groundwater quality. The well(s) shall be constructed such that the water level in the well
is never above or below the screened (open) portion of the well at any time during the year. The
general location and name for each well is marked on Figure 1. Each monitoring well shall be
located at the Review boundary, constructed in accordance with this permit, and approved by the
Mooresville Regional Office.
b. The well(s) must be constructed by either a North Carolina Certified Well Contractor, the
property owner, or the property lessee according to General Statutes 87-98.4(b)(2). If the
construction is not performed by a certified well contractor, the property owner or lessee,
provided that they are a natural person, must physically perform the actual well construction
activities. All well(s) must be constructed according to the North Carolina Well Construction
Standards (15A NCAC 2C .0108) and any local county rules.
c_ The Mooresville Regional Office, telephone number [phone], shall be notified at least
forty-eight (48) hours prior to the construction of any monitoring well so that an inspection can be
made of the monitoring well location. Such notification to the regional groundwater 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.
d. Within thirty (30) days of completion of all well construction activities, a certification must be
received from a professional engineer or a licensed geologist certifying that the monitoring
well(s) are located according to this permit.
2. Sampling Criteria:
a. Monitor wells MW-1, MW-2, and MW-3 shall be sampled initially after construction and prior to
waste disposal operations, and thereafter every June, October, and February for the parameters
listed below. Prior to sampling the parameters, the measurement of water levels must be taken.
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
relative to a common datum.
Nitrate, NO3-N
Fecal Coliform
Total Dissolved Solids, TDS
Chloride, Cl
Total Phosphorus
Total Organic Carbon, TOC
field pH
Total Ammonia, NH3-N
Volatile Organic Compounds, VOCs
' VOCs shall be sampled in June only
b. For Total Organic Carbon (TOC), if concentrations greater than 10 ing/l are detected in any
down -gradient 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/l, this concentration will be taken to
represent the naturally occurring TOC concentration. Any exceedances of this naturally occurring
TOC concentration in the down -gradient wells shall be subject to the additional sampling and
analysis as described above.

c. For Volatile Organic Compounds (VQCs) sampled in June, use only one of the following
methods:
1) Standard Method 6230D, Practical Quantitation Limit (PQL) at 0.5 ug/L or less
2) Standard Method 6210, PQL at 0.5 ug/L or less
3) EPA Method 8021, Low Concentration, PQL at 0.5 ug/L or less
4) EPA Method 8260, Low Concentration, PQL at 0.5 ug/L or less
5) Another method with prior approval by the Groundwater Section Chief.
Any of the referenced methods used for VQCs must at a minimum, include all the constituents
listed in Table VIII of Standard Method 6230D. Any method used must provide a PQL of 0.5
ug/L or less, which must be supported by laboratory proficiency studies as required by the DWQ
Laboratory Certification Unit. Any constituents detected above the Method Detection Limit
(MDL) but below the PQL of 0.5 ug/L must be qualified (estimated) and reported.
d. Any laboratory selected to analyze parameters must be Division of Water Quality (DWQ)
certified for those parameters required..
Reporting / Documentation:
a. All reports and docurnentation (GW-1, GW-30, GW-59) shall be mailed to the following address:
Groundwater Section
Permits and Compliance Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Updated blank forms may be downloaded from the Groundwater Section's website at
http://Lrw.ehnr.state.nc.us/ or requested from the address mentioned above.
b. For the initial sampling of the well(s), the permittee shall submit a copy of the GW-1 Form (Well
Construction Record) with the Compliance Monitoring Form (GW-59), for each well to the
address listed in the "Reporting / Documentation" section of the Groundwater Requirements.
Initial Compliance Monitoring Forms that do not include copies of the GW-1 form may be
returned to the permittee without being processed. Failure to submit these forms as required by
this permit may result in the initiation of enforcement activities pursuant to NC General Statutes
143-215.6A.
c. The results of the sampling and analysis must be received on Form GW-59 (Groundwater Quality
Monitoring: Compliance Report Form) by the Groundwater Section (address listed in the
"Reporting / Documentation" section of the Groundwater Requirements), on or before the last
working day of the month following the sampling month. The data of all groundwater sampling
analyses required by the permit conditions must be reported using the most recent GW-59 form
along with attached copies of the laboratory analyses.

Within sixty (60) days of completion of the monitoring wells, the permittee shall submit two
original copies of a scaled site map (scale no greater than 1 "=100�; however, special provisions
may be granted upon prior approval for large properties. The maps must include the following
information:
1) The location and identity of each monitoring well.
2) The location of major components of the waste disposal system.
3) The location of property boundaries within 500 feet of the disposal area(s).
4) The latitude and longitude of the established horizontal control monument.
5) The elevation of the top of the well casing (which shall be known as the "measuring point")
relative to a common datum.
6) The depth of water below the measuring point at the time the measuring point is established.
7) The location of Review and Compliance boundaries.
8) The date the map is prepared and/or revised.
Control monuments shall be installed in such a manner and made of such materials that the
monument will not be destroyed due to activities that may take place on the property. Maps and
any supporting documentation shall be sent to the Groundwater Section as addressed in the
"Reporting / Documentation" above.
The permittee is responsible for the geographic accuracy of any map submitted, however
produced.
4. Vertical Separation Requirements:
For domestic wastewater:
Waste shall not be applied or discharged onto or below the land surface when the vertical separation
between the waste and the seasonal high water table is less than one (1) foot.
Liner Requirements:
The storage basin shall have either a liner of natural material at least one (1) foot in thickness and
having a hydraulic conductivity of no greater than 1 x 10' centimeters per second when compacted,
or a synthetic liner of sufficient thickness to exhibit structural integrity and an effective hydraulic
conductivity no greater than that of the natural material liner, according to 15A NCAC 2H .0219(f).
6. Applicable Boundaries:
The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in 15A
NCAC 2L, Groundwater Classifications and Standards. The Compliance Boundary for the
disposal system individually permitted on or after December 30, 1983 is established at either 250
feet from the waste disposal area, or 50 feet within 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 remediation action according to 15A NCAC 2L .0106(d)(2).
b. The 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 action in accordance with 15A NCAC 2L .0106(d)(1).

V. INSPECTIONS
Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to insure proper
operation of the subject facilities.
2. The Permittee 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 Pennittee 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
trade available upon request to the Division or other permitting authority.
Any duly authorized officer, employee, or representative of the Division 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.
VI. GENERAL CONDITIONS
L 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
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 [in-dtations contained in this permit may subject the Permittee
to an enforcement action by the Division in accordance with North Carolina General Statute 143-
215.6A to 143-215.6C.
The issuance of this permit does not exempt 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, including but not limited to applicable river buffer rules in 15A
NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Chapter 4 and under
the Division's General Permit NCG010000, and any requirements pertaining to wetlands under 15A
NCAC 2B .0200 and 2H .0500.
6. A set of approved plans and specifications for the subject project must be retained by the Permittee
for the Iife 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 211.0205 (c)(4).
S. 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.

PeiTnit issued this the 12th day of February, 2004
NORTH C OLINA E IRONMENTAL MANAGEMENT COMMISSION
r
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Managernent Commission
Permit Number WQ0023511

Permit No. WQ0023511
February 12, 2004
ENGINEER'S CERTIFICATION
Partial Final
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 Nance
Location and County
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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Parcel 10
OW ner'e Name and Address
1F2.1
IF1.1
L4vei lF[.j
IG PAsl
Com m en[s
BEARD, GLADYS M, 1308 MORNINGSIDE DR,
1
4626669488
CHARLOTTE, NC. 28205900E
125
80
20
NIA
SOBIECH, MARK R 6 DAWN E. 402 BEECH TREE
_
2
4626688389
RD, MOORESVILLE, NC, 281170000
126
00
NIA
13
THOM PSON, ROBERT F & SALLIE, 410 BEECH
3
4625688207
TREE RD. MOORESVILLE, NC, 281178988
125
56
NIA
12
30RDAN, STERLING L, 414 BEECHTREE RD,
4
4626687190
MOORESVILLE. NC. 281178988
153
83 1
27
i8
8'GALV W Eii CASIrIG
LONGING, EDWARD P & 3UDY C. 420 BEECH
5
4626678926
TRFE RO, MOORESVILLE, NC, 281170000
NIA
NIA
NIA
NIA
d'G A L V WELL CASING -r10 r A G
H OCE, RYAN 6 RHONDA &, 1945 N CANNON
6
4026678861
BLVD, KANNAPOLi S. NC. 280830000
NIA
N/A
NM
MIA
6-G ALV WELL CASING NO TAG
CAUal-E, LAMES F & 3ANICE K, 26 DOUGLAS AVE
7
4626679606
NW. CONCORD, NC, 280250000
NIA
NIA
NIA
NIA
W ELL HEAD COVER LOC KEG
CRITZ, LEE CATHER INE A '394 BEECH TREE RD.
8
4626781439
M00R ES V IL L E, NC, 281178987
185
38
36
8
8-PVC WELL CASHIG NO TAG
BLSHOP, NYLE S & CYNTHIA A, 120 KINGS
9
4626300755
CR 05S LANE, MOORESVILLE, NC, 281170000
NIA
57
e0
20
6-PVC WELL CASIfIG -AO SAG
BASINGER, 3ASON A &, 129 HILEATH DR,
10
462678335D
MOORESVILLE, NC, 291170DOO
N1A
NIA
N1A
NIA
6-G A L V WELL t]AS IIIO 1407AG
STIEGEL, ROBERT MAARK & MARSHA. 1620
11
4626781d62
BILTM 0 r E DR CHARLOTTE, NC 2620100 n0
NIA
NIA
NIA
NIA
6"GALV WELLCASING -tip TAG
7
1
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WATER POLLUTION CONTROL SYSTEM OPERAXORS
CERTIFICATION COI\ MISSION
CLASSIFICATION
RATING SHEET FOR WATER POLLUTION CONTROL SYSTEMS
FACILITN' INFOWyLATION:
NAME OF FACILITY. h�G �� ;! �/. 115
MAILING ADDRESS: P.J
COUNTY:
CONTACT PERSON: (_%A1. 1- / �'ll,,I') .I w TELE;?I�CN (�� � � � c "�^�` �: ~ -)ij
P�
_ERbET NO: Che.^k One: NC WQ _ f/ HEALTFI DP.
W C.
TELEPHONE:
RATENG INFORMATION: (Before completing this section, please: refer to pages 2-4)
F ERl 1! 1 D FL.OW: G t iv1 tiD
--�-
CI__RCK CLASSM- CATION: WASTEN�TATER: I
COLT ECTION: 1
.P9 /?
--S'R2tY IRRIGATION SUBSURFACE
PrIYSIC_4L /CT_ UC.AT GRADE I
bl`!`R? Y ES NO -_jZ
Ix
2�� 3,
2 3 4
LAND APPLICATION
GRADE H
RATED BY: la f r REGION: // ��Q DATE: =2f- cl';�-
REGIONAL ONCE' TraL.EPHONEE NUMBER: f' c � C �- lC------ - EXT: -=