WQ0028904_Final Permit_20070614

W A rEiQ Michael F. Easley, Governor
QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
5 �
Q Coleen Sullins. Director
Division of Water Quality
.tune 14, 2007
Mr, Phillip Edmunds
Friendly Tabernacle Church
574 Slate Road
Mount Airy, NC 2703 0
RECEIVED I DEN / DWQ
SUBJECT: Pump and Haul Permit No. WQ0028904 AQU1FER?RnTFPT10N SECTION
Friendly Tabernacle Church JUN 2 0 209
Surry County
Dear Mr, Edmunds:
In accordance with your application received May 3 0, 2007, we are forwarding herewith Permit
No. WQ0028904 to Friendly Tabernacle Church for the continued operation of the existing pump and
haul system serving the new Friendly Tabernacle Church located on Slate Road near Mount Airy.
This permit shall be effective from the date of issuance until January 1, 2008, 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. Please note permit
condition # 21 that requiring Friendly Tabernacle Church to construct the sewer lateral required
to connect to the new municipal sewer line along Champ Creek, This lateral must be installed and
operational before expiration of this pump and haul permit (See Sewer Extension Permit #
WQ0030620 issued to Friendly Tabernacle on August 8, 2006).
If any parts, requirements, or limitations contained in this permit are unacceptable to you, you
have the right to request an adj udicatory hearing upon written request within 3 0 days following receipt of
this permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714, Unless such demands are made this permit shall be final and binding.
Should you have any questions, please contact Mr. Mike Mickey or me at [phone].
Sincerely,
r.PrL--�
teve W. Tedder
Regional Water Quality Supervisor
cc: Surry County Health Department
APS Central Files/WSRO
IVOe Carollna
North Carolina Division of Water Quality 585 %ughtown Street Phone [phone] Customer Service
Winston-Salem Regional office Winston-Salem, NC 27107 Fax [phone]
Internet: www.ncwaterqualitv.org
An Equal Opportunity)AfiirmaUve Action Employer— 60% Recycled/l0% Post Consumer Paper

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
PUMP AND HAUL 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
FRIENDLY TABERNACLE CHURCH
SURRY COUNTY
for the continued operation of a domestic wastewater pump and haul system that serves Friendly
Tabernacle Church with no discharge of wastes to the surface waters, pursuant to the application
received May 30, 2007, and in conformity with the previous proj ect plans, 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 1, 2008, and shall be
subject to the following specified conditions and limitations-
1. This permit shall become voidable unless the subject pump and haul activities are carried out
in a manner which has been approved by this Division.
2. This permit is effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The facilities shall be properly maintained and operated at all times.
4. 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.

No type of domestic wastewater other than that from Friendly Tabernacle Church shall be
included in the pump and haul activities.
6. The permit shall become voidable unless the agreement between Friendly Tabernacle
Church, the City of Mount Airy and V&S Septic Service for the collection, transportation,
and ultimate disposal of the domestic wastewater is in full force and effect.
7. In the event that the facilities fail to perform satisfactorily; including the creation of nuisance
conditions, the Permittee shall cease operation of all pump and haul activities and take such
immediate corrective action, as may be required by this Division.
8. This pump and haul permit shall not be renewed.
9. The sewage and wastewater collected by this system shall be treated in the City of Mount
Airy Waste Water Treatment Plant (NC 0021121) prior to being discharged into the receiving
stream.
10. The Permittee is liable for any damages caused by a spill or failure of the pump and haul
operations.
11. Adequate inspection, maintenance and cleaning shall be provided by the Permittee to insure
proper operation of the subject facilities.
12. The Pennittee or his designee shall inspect the domestic wastewater collection 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 as long as the
pump and haul activities are being conducted and shall be made available upon request to the
Division of Water Quality or other permitting authority.
13. 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 domestic wastewater collection facilities at any reasonable time for the purpose
of determining compliance with this permit; may inspect or copy any records that must be
kept under the terms and conditions of this permit; and may obtain samples,
14. An accurate record of the monthly pump and haul activities must be maintained by the
Permittee, indicating:
a) date wastewater is removed from the facility,
b) name of facility from which wastewater is removed,

C) name of facility receiving wastewater,
d) volume of wastewater removed, and
e) status of permanent disposal option.
These records shall be submitted to the Winston-Salem Regional Office on or before the
fifteenth (15) day of the following month,
15. 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.
16. 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.
17. The Permittee shall provide for the installation and maintenance of a visual highwater alarm.
18. A leakage test shall be performed on the septic tank and dosing tank to insure that any
exfiltration occurs at a rate which does not exceed twenty (20) gallons per twenty-four (24)
hour per 1,000 gallons of tank capacity. The engineer's certification will serve as proof of
compliance with this condition.
19. A copy of the approved plans and specifications shall be maintained on file by the Permittee
for the life of the project.
20. Noncompliance Notification:
The Permittee shall report by telephone to the Winston-Salem Regional Office, (336) 771-
5000, 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 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.
b. Any failure of a pumping station, sewer line, etc, resulting in a by-pass directly to
receiving waters without treatment of all or any portion of the influent to such station
or facility.

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 report
must outline the actions taken or proposed to be taken to ensure that the problem
does not recur.
21. The 6" gravity sewer line connecting Friendly Tabernacle Church to the new municipal
sewer line must be constructed and operational before the expiration of this pump and haul
peFnit (See Sewer Extension Permit # WQ0030620 issued to Friendly Tabernacle on August
S, 2006).
Pem-iit issued this the 14'h day of June, 2007.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Steve W. Tedder
Winston-Salem Regional Water Quality Supervisor
By Authority of the Environmental Management Commission
Permit No. WQ0028904
Expires January 1, 2008

I.
➢I.
NORTH CAROLINA
DEPARTMENT OF
ENVIRONMENT AND
NATURAL RESOURCES
AVJ-KYVA
1 •
If
C)ENF t
Division of Water Quality
Winston-Salem Regional Office
Non -Discharge Pump and Haul Permit Application
Application Number:
GENERAL INFORMATION:
(to be completed by DWQ for new projects)
1. Applicant (corporation, individual, other): , �� d ►7 d/�f / _qi ! r2 AG_ l eCJ2 uo-A�
T
2. Print w/ners or signing/official's name and title (person legally responsible for the facility and its compliance):
3. Mailing address of applicant:
City: /i?/,—.._..__._ State: Zip: -2�7.o a
Telephone number: Facsimile number:'7,`3513
Email Address: �?�7?c�`r-fC�.er� c.•:;,-� _
4. Project name (facility or establishment): ___ir�yj%Tt�C_ (S✓s"c
5. County where project is located:
6. Fee submitted: $ r (See Instruction B.)��--
7. Name and complete address of engineering firm:
City: d �/' State: Zip: Z7
Telephone number: ( } '75,9 - 6G,i t Facsimile number: ( )
S. Name and affiliation of contact person who can answer questions about project: r_
P-0-6.0d b9d + 17 r Email Address: d yyr,�,,,o2- _
PERMIT INFORMATION:
1. If this application is being submitted as a result of a modification to or renewal of an existing permit, please provide
the existing permit number ,Q Q Q Z,$ 9 0 and the issuance date L -Z3- b S
2. Specify whether the applicant is: public
Form: P&i-I 4/04 Page 2 of
or private 71/

III. INFORMATION ON WASTEWATER:
1. Nature of wastewater: _1_!�.12 %Domestic %Commercial "/0Industrial
"/pother waste (specify):
2. Please provide a one or two -word description specifying the origin of the wastewater (school, restaurant, apartments,
commercial): bo''!�A
3. Volume of wastewater generated by this project: 3 ,7-5— gallons per day.
4. Explanation of how wastewater flow was determined (I SA NCAC 2H .0219(1)):
'2= I37 G
5. Description of any pretreatment of wastewater prior to pumping and hauling:�
"7_ TREATMENT iF`ACILITY INFORMATION:
1. Name of treatment facility receiving wastewater: C' z %� d
2. NPDES permit number of treatment facility: IV C/ �® 6, Zll Z. l
3. Treatment facility contact person and telephone no: C.�JC j_, .�Y 7?_7,V 3 �
4. County where treatment facility is located: 60,
V. CONTRACT HAULER INFORMATION:
1. Name of owner/company of transporting (hauler) vehicle:_ Y +.5 5,6 X
v
2. Mailing address of hauler: y'i_� _ t[f�,t
3. Telephone number of hauler:
4. Provide the typical hauling volume of the vehicle: -4 o--L A
VI. GENERAL PROJECT INFORMATION
1. Brief project description: G G`
2. Explanation of why purnpp and haul is being requested: Z ',ka .71
F
l /
3. Specify bow long the pump and haul permit will be needed (maximum of six months):_ b 1'10s
4. What will be the permanent method of wastewater disposal once the pump and haul activities have ceased?:
5. Date that permanent disposal method will be available: AL7 /I 07
G. Have`` permits/approvals for the permanent disposal method been obtained?
f Yes; Permit No. Permitting agency +ili7a ryI r
No; Pending permit
Form: P&ll 4/04 Page 3 of 4
I
Permitting agency

7. What type of tank or container will the wastewater be pumped from and what is the volume of this container?
ODa
8. Is the tank or container already in place or will it be installed for these activities?
9. What type of high water alarm does the container have? Audible and visual Auto dialer
VII. OWNER'S SIGNATURE:
Applicant's Signature and Certification:
attest that this application for Eire 4-
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 are not
completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete_ Note: In accordance with NC General Statutes 143-215.6A and 143-215.613,
any person who knowingly makes any false statement, representation, or certification in any application 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.
Low
Signature; Dater d z
p, VIII. ENGINEER'S CERTIFICATION:
Professional Engineer's Certification:
I, , attest that this application for
has been reviewed by me and is
accurate, complete and consistent with the information supplied in the engineering plans, calculations, and al] other
supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed
design has been prepared in accordance with the applicable regulations. Although certain portions of this submittal
package may have been developed by other professionals, inclusion of these materials under my signature and seal
signifies that l have reviewed this material and have judged it to be consistent with the proposed design. Note: In
accordance with NC General Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false
statement, representation, or certification in any application 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.
North Carolina Professional Engineer's seal, signature, and date:
Form: P&I4 4/04 Paae 4 of 4