WQ0002428_Renewal (Application)_20200428

April 28, 2020
RECEIVEDINCDEQIDWR
Mr. Rick Bolich
Aquifer Protection Section Supervisor MAY 0 6 2020
Division of Water Quality
NCDENR Non-Discharge
Permitting Unit
1628 Mail Service Center
Raleigh, NC 27699-1628
RE: Mountaire - Mount Vernon Hatchery #WQ0002428 Renewal
Dear Mr. Bolich,
Enclosed please find the documentation needed for the renewal of the wastewater irrigation system
permit for the Mountaire Mount Vernon Hatchery located at 175 Foust Road Siler City, North Carolina
27344. If you have any questions or need additional information, please contact me at 302-934-
4052.
Sincerely,
_—yvaLA
Tanya Rog rs-Vickers
Director of Environmental Compliance
CC: Mr. Douglas Goodwin, Mountaire
Mr. James Hendrick, Mountaire
M r
Mountaire Farms Inc.
"We measure quality by how well we service our internal and external customers"

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE SYSTEM RENEWAL
Division of Water Resources FORM: NDSR 01-20
This form is for renewal without modification for all non-discharge system permits,except Residuals Management and Single-
Family Residence Wastewater Irrigation System permits.
For more information, visit the Water Quality Permitting Section's Non-Discharge Branch Website.
I. PERMITTEE INFORMATION: RECEIVED/NCDEOIDWR
1. Permittee:Mountaire Farms Inc.
2. Signature authority's name:Phillip Plylar per 15A NCAC 02T.0106(b) Title:President MAY 0 6 2020
Primary Telephone number:[phone] Select Secondary number: ( )_- Select Non-Discharge
Permitting Unit
Email Address:
3. Permittee's mailing address:PO Box 1320
City:Millsboro State:DE Zip: 19966-
4. Billing address(if different from above):same as above
City: State: Zip:5. Contact person's name(if different from signature authority):Tanya Rogers-Vickers Title:Director of Environmental
Compliance
Primary Telephone number: (302 )934-4052 Select Secondary number:( )_- Select
Email Address:[e-mail]
II. PERMIT INFORMATION:
1. Existing permit number:WQ0002428
2. Has the facility been constructed?®Yes or❑No
If yes,has the facility been constructed in accordance with the permit and the Division-approved plans and specifications?
[15A NCAC 02T.0110] Z Yes or❑No
If no,a formal permit modification request shall be submitted to the Division.
3. Has any of the property ownership within the facility and/or disposal area changed from what is indicated in the current permit
(Attachment B—disposal field owner/lessee)? ®Yes or❑No
Has the Permittee had a name change or has the permit changed ownership? ❑Yes or Z No
If yes to either,a permit modification request shall be submitted to the Division. [15A NCAC 02T.0105]
4. Is this facility a Privately-Owned Public Utility? ❑Yes or®No
If yes,provide two copies of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission
demonstrating the Applicant is authorized to hold the utility franchise. [15A NCAC 02T.0115(a)(1)]
5. Is the Permittee a Home/Property Owners'Associations or Developers of lots to be sold? 0 Yes or ® No
If yes,provide the following:
• For Home/Property Owners' Associations — Operational Agreement (FORM: HOA) and a copy of the proposed or
approved Articles of Incorporation,Declarations,and By-laws[15A NCAC 02T.01 15(c)l
• For Developers of lots to be sold—Operational Agreement(FORM: DEV) [15A NCAC 02T.0115(b)]
FORM: NDSR 01-20 Page 1 of 5

State of North Carolina
DW R Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE SYSTEM RENEWAL
Division of Water Resources FORM:NDSR 01-20
6. Does the facility treat and dispose of industrial wastewater?
If yes,complete items below. If no,skip to the next section.
Indicate the approximate percentage of wastewater makeup:
Industrial: 95% Domestic: 5% Stormwater:
For all industrial wastewater sources (excluding those permitted under a pretreatment permit), provide a detailed industrial
process description including:
• An overview of the manufacturing process
• An inventory of all materials used for manufacture,including chemicals and biological matter
• An overview of cleaning and treatment methodology,including an inventory of treatment materials and compounds
Has the nature of wastes(e.g.,change in industrial processes,introduction of new materials or chemicals,etc.)described in the
approved permit application(s)changed? ❑Yes or®No
If yes,a permit modification request shall be submitted to the Division. jG.S. 143.-215.1(d)1
III. SITE MAP:
1. Provide an updated site map in accordance with 15A NCAC 02T.0105(d)that shows the following(if applicable):
The site map is not required to be signed or sealed by a Professional Engineer. However,the map must indicate the source of
information. For example,parcel lines taken from a county GIS map should reference the GIS website.
® Legend,north arrow,and scale
® Topographic contours on all disposal sites
® Soil mapping units on all disposal sites
►�I All facility-related structures and fences within the treatment,storage,and disposal areas
® All habitable residences and places of assembly within 500 feet of all treatment,storage,and irrigations sites
® Location of all wells, streams (ephemeral, intermittent, and perennial), springs, lakes,ponds, ditches, and other surface
drainage features within 500 feet of all waste treatment,storage,and disposal site(s)
® Latitude and longitude coordinates of all monitoring wells(decimal degrees to 6 digits)
® Location and identification of major components of the waste disposal system
® The wetted perimeter of all irrigation fields with field names(named according to the approved permit)
® Location and ownership of property boundaries within 500 feet of the disposal area(including road/rail right-of-ways)
® The delineation of compliance and review boundaries
® Distance measurements verifying all setbacks are being met
❑ Stormwater drainage controls
❑ 100-year floodplain
❑ For reclaimed water generation permits, provide a separate map showing all distribution lines and utilization permit
locations that are connected to the water generation facility and are permitted by the Non-Discharge Branch (excludes
Local Program permitted facilities). Include all reclaimed water distribution line and reclaimed water utilization permit
numbers.
FORM: NDSR 01-20 Page 2 of 5

State of North Carolina
DW R Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE SYSTEM RENEWAL
Division of Water Resources FORM: NDSR 01-20
IV. GROUNDWATER MONITORING WELLS
1. Does the facility have a proposed or existing groundwater monitoring well network? ®Yes or❑No
If no,skip to next section.
If yes,complete the following table(NOTE—This table may be expanded for additional wells):
Well Name Status Latitude a Longitude a Gradient Location
1B Active - Up Gradient Between Compliance&
Review Boundary
2 Active - Down Gradient Inside Review
Boundary
3 Active - Down Gradient On Compliance
Boundary
4 Active - Down Gradient On Compliance
Boundary
Select ° - 0
Select Select
Select • - Select Select
Select • - Select Select
Select • - Select Select
Select • - Select Select
Select • - Select Select
a. Coordinates must be in NAD83 and have 6 decimal degrees
V. SETBACK WAIVERS,EASEMENTS,AND LEASES:
1. Does the permit have any setback waivers,easements,or leases? ❑Yes or®No
If yes,provide copies of all documents and complete the table below:
Document Grantor or Expiration ' County Deed Document
Type Parcel No. Grantee Date Registered Book Deed Page Description a
Select
Select
Select
Select
Select
Select
Select
a. The document description shall list any reduced setbacks with distance,etc.
2. For reclaimed water utilization permits:
Is reclaimed water utilized on property not controlled by the generator? ❑Yes or❑No
A lease,easement,or agreement must be provided allowing for the utilization of reclaimed water on the property or within the
facility. For irrigation of reclaimed water,an easement is required per 15A NCAC 02U.0501(6). All documents shall be listed
in the table above.
FORM:NDSR 01-20 Page 3 of 5

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE SYSTEM RENEWAL
Division of Water Resources FORM:NDSR 01-20
VI. RELATED PERMITS
1. If this permit has interactions with other wastewater permits (collection systems, NPDES, etc.), complete the table below
(provide additional pages if necessary):
Permit Type Permit No. Description
Type V on Site WW 11671 Receive 30,000 Gallons/Week
2. Does the facility have an approved flow reduction[15A NCAC 02T.0114(f)]? ❑Yes or®No
If yes,attach 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 value,the Permittee shall provide a reevaluation of
the reduced flow value using the methodology applied to the original flow reduction application. Also, attach a copy of the
flow reduction approval letter.
APPLICANT'S CERTIFICATION 15A NCAC 02T.0106(b)
I,Phillip Plylar,attest that this renewal application has been reviewed by me,and is accurate and complete to the best of my knowledge.
I understand that any unauthorized discharge of wastewater from this non-discharge system to surface waters or the land may result in
an enforcement action that may include civil penalties,injunctive relief,and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
are not completed,this application may be returned to me as incomplete. I further certify that the Applicant or any parent, subsidiary,
or other affiliate of the Applicant has not been convicted of an environmental crime,has not abandoned a wastewater facility without
proper closure,does not have an outstanding civil penalty where all appeals have been exhausted or abandoned,are compliant with any
active compliance schedule,and does not have any overdue annual fees.
NOTE — In accordance with General Statutes 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. The Applicant's Certification 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 provid m a person who meets the criteria in 15A NCAC 02T.0106(b)
Signature: Date:
4'! /��.
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON-DISCHARGE BRANCH
By U.S.Postal Service: By Courier: By Email:
Non-Discharge Branch Non-Discharge Branch—Archdale 942W [e-mail]
1617 Mail Service Center 512 N. Salisbury St.
Raleigh,NC 27699-1617 Raleigh,NC 27604
TELEPHONE NUMBER: [phone]
FORM:NDSR 01-20 Page 4 of 5

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE SYSTEM RENEWAL
Division of Water Resources FORM• NDSR 01-20
FORM:NDSR 01-20 Page 5 of 5

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MONITORING WELL LOCATIONS
Bore Northing Easting Latitude Longitude
MW-1B 700,431.6 1,876,170.6 35.673829 -79.416942
MW-2 699,551.9 1,876,941.1 35.671421 -79.414335
MW-3 699,106.7 1,876,614.3 35.670194 -79.415429
MW-4 699,522.3 1,875,541.7 35.671323 -79.419046

PROPERTIES WITHIN 500 FEET OF PERMITTED AREAS
Mailing Address
PIN Site Address _ Owner Name Address City State Zip
8679-68-5420.000 420 BUCK GUNTER RD SLEEPY HOLLOW ESTATE MHP LLC _104 HEIDINGER DR CARY NC 27511
8679-49-9813.000 940 FOUST RD FOUST ELIZABETH T LIFE ESTATE 940 FOUST RD SILER CITY NC 27344
8679-58-4926 553 FOUST RD CONROY NATHAN WALES ETUX KATHLEEN ROGERS 954 BUCK GUNTER RD SILER CITY NC 27344
8679-58-9121.000 522 BUCK GUNTER RD :KIVETT CHARLES D ETUX LORETA E 524 BUCK GUNTER RD SILER CITY NC 27344
8679-67-1995.000 492 BUCK GUNTER RD KIVETT ROBERT DANIEL 492 BUCK GUNTER RD SILER CITY NC 27344
8679-68-3855.000 BUCK GUNTER RD GOLDSTON ERIC BERNARD 395 BRADFORD ROGERS LN SILER CITY NC 27344
8770-72-1689.000 US 421 S JONES JOSEPH RAY PO BOX 217 ALTAMAHAW NC 27202-0217
8780-12-6084.000 865 CARTER BROOKS RD JONES JOSEPH RAY PO BOX 217 ALTAMAHAW NC 27202-0217