WQ0018992_Application_20200521

01
RECEIVED
By Nathaniel Thornburg at 3:14 pm, May 21, 2020
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.
L PERMITTEE INFORMATION:
1. Permittee: A Place at the Beach -Atlantic Beach. NC dba Southwinds Condo Association
2. Signature authority's name: Terry K Barbour per 15A NCAC 02T .0106(b)
Primary Telephone number: (2L2) 247-2318 Secondary number: [phone]
Email Address: southwindshoaab(_gmail.com
1. Permittee's mailing address: PO Box 818
City: Atlantic Beach State: NC Zip: 28512-
1. Billing address (if different from above):
City: State: Zip:
1. Contact person's name (if different from signature authority): Title:
Primary Telephone number: (__) _-
Email Address:
I. PERMIT INFORMATION:
1. Existing permit number: WQ0018992
2. Has the facility been constructed? Yes or No
Secondary number: (_) _-
Title: Association Manager
If yes, has the facility been constructed in accordance with the permit and the Division -approved plans and
specifications? [15A NCAC 02T .0110] Yes or No
If no, a formal permit modification request shall be submitted to the Division.
1. 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 No
If yes to either, a permit modification request shall be submitted to the Division. [15A NCAC 02T .010
HYPERLINK "http://reports.oah.state.nc.us/ncac/title%2015a%20-
%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20t/ 15 a%20ncac%2002t%20.0105.pdf' 5 ]
1. 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)1
1. Is the Permittee a Home/Property Owners' Associations or Developers of lots to be sold? 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 .0115(c)]
• For Developers of lots to be sold — Operational Agreement (FORM: DEV) [ 15A NCAC 02T .0115(b)]

Does the facility treat and dispose of industrial wastewater? If yes, complete items below. If no, skip to
the next section.
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
Indicate the approximate percentage of wastewater makeup:
Industrial: % Domestic: % Stormwater: %
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. [G.S. 141-215.l(d)]
L SITE MAP:
• Provide an updated site map in accordance with 15A NCAC 02T .0105(d) that shows the following:
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, scale, and legible in black and white
Topographic contour intervals not exceeding 10 feet or 25 percent of total site relief
Soil mapping units on all disposal sites
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 (if applicable)
For reclaimed water generation permits only, 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.
L GROUNDWATER MONITORING WELLS
• 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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
• Coordinates must be in NAD83 and have 6 decimal degrees
L SETBACK WAIVERS, EASEMENTS, AND LEASES:
• 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
Type
Grantor
or
Parcel
No.
Grantee
Expiration
Date
County
Registered
Deed
Book
Deed
Page
Document
Description
a
• The document description shall list any reduced setbacks with distance, etc.
• For reclaimed water utilization permits only:

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.
I. RELATED PERMITS
• 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
• 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, Terry K Barbour, 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, representati on, 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 provided from a person
who meets the criteria in 15A NCAC 02T .0106(b)

Signature: Terry K f3a-rbo� Date: 05/21/2020
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 Upload
By Email:
https://edocs.deg.nc.gov/Forms/NonDischarge-Branch-
Non-Discharge.Reports(a ncdenr.gov
Submittal -Form
TELEPHONE NUMBER: 919 707-3654