WQ0042465_Application_20210420

I. PRESUBMITTAL INFORMATION:
1. Contacted representative from regional office (Pre -submittal)?: ® Yes ❑ No
2. Contact name (For Regional Office): Jason Robinson NC DePt of Environmental Quality
II. APPLICANT INFORMATION:
MAR 2 2 2021
1. Applicant's name (Municipality, Individual, Corporation, etc): Orange County
Raleigh Regional Office
2. Applicant type: ❑ Municipal ❑ State ❑ Privately -Owned Public Utility
® County ❑ Other: f,
3. Origin of Wastewater:
❑ Residential Subdivision ❑ Retail (Stores, Shopping Centers) Domestic: 100 %
❑ Apartments/Condominiums ❑ Institution Commercial:
❑ Mobile Nome Park ❑ Hospital Industrial:
❑ School ❑ Church Other:
❑ Restaurant ❑ Nursing Home
❑ Office ® Other (specify)
4. Signature authority's name: Robert Williams per 15A NCAC 02T .0106(b)
Title: Orange County Solid Waste Management Directot
S. Applicant's mailing address: Orange County Solid Waste Management, 1207 Eubanks Rd
City: Chapel Hill State: NC Zip: 2751 6-
6. Applicant's contact information:
Phone number: [phone] Email: [e-mail]
III. CONTACT/CONSULTANT INFORMATION:
1. Contact name: Kristina Velasauez Witosky
Title/Affiliation: Disposal Manager
2. Contact's information:
Phone number: [phone]
IV. RECEIVING FACILITY INFORMATION:
Email: kwitoskygorangecountVnc.gov
If more than 1 facility has agreed to accept the wastewater, please list all the owners, facility names, and permit
numbers as a separate attachment)
1. Owner: City of Durham
2. Facility name: South Durham Water Reclamation Facility
3. Facility permit number:
4.WWTF permit number: NCO047597
S. WWTF contact name: Tyrone Battle
Title/Affiliation: Industrial Waste Control Program Administrator
6. WWTF contact information:
Phone number: (9I9) 560-4386
Email: [e-mail]_v
APPLICATION P&H 01-16 Page 3 of 5

V. PROJECT INFORMATION:
1. Location of Project (physical address): 3605 Walnut Grove Church Road, Hillsborough, NC 27278
Approximate Coordinates (Decimal Degrees): latitude: 36.1438o Longitude:-79.12090
2. Duration of Pump and Haul Request (Six Months Typical): 12 months
3. Has a prior permit been issued? ❑ New ® Prior Pump & Haul Permit
Permit No.: WQ0036I 10
4. Permanent Method of Wastewater Disposal: n/a NC Dept of Environmental Quality
5. Date Permanent Disposal will be available: n/a
6. Have permits / approvals for permanent disposal been obtained? MAR ��zt
❑ Yes ® No Permit Number: Raleigh Regional Office
7. Is there a Pretreatment Program in effect? ❑ Yes ® No
8. Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: <30 Gallons per Day
10. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .0114 or ® Representative Data
If representative data, describe: Pump and haul operations have been in effect since 2013. There have been less
than 8 pump events on average per year, at approximately 900 gallons per event.
11. Describe Tank / Container wastewater will be pumped from (attach description if necessary):
Concrete underground tank with manhole access; 1000 gallon capacity
12. Is Tank / Container in place or will it be installed (attach description if necessary):
In place now.
13. What type of high water alarm does the container have (and/or):
® Audible and Visual ® Telemetry (Auto Dialer / SCADA)
VI. CERTIFICATION:
1. Applicant's Certification: (Signature of Signing Official and Project Name)
I,Robert Williams, attest that this application for Walnut Grove Convenience Center 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 documentation and attachments are not included, this application package is
subject to being returned as incomplete. I understand that issuance of a permit will require pump and haul facilities or
activities to be inspected at least daily by me or a designated representative. Note: In accordance with North Carolina
General Statutes 143-215.6A and 1.43-215.613 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.
aj
Signing Official Signature Dat
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
ACTIVITIES SHALL BE INSPECTED AT LEAST DAILY BY THE PERMITTEE OR IT'S REPRESENTATIVE PER 1SA NCAC 02T .0204(d).
APPLICATION P&H 01-16 Page 4 of 5

THE ENGINEER'S CERTFICATION 1S REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER G.S. 89C-3.
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL. IF CERTIFICATION BY AND ENGINEER IS REQUIRED,
THIS PAGE IS NOT NECESSARY.
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
I, Not AD licable ,attest that this application for Not Applicable) has been reviewed by me and is accurate, complete and
consistent with the information in the engineering plans, calculations, and all 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
all the applicable regulations. Although other professionals may have developed certain portions of this submittal package,
inclusion of these materials under my signature and seal signifies that I 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.
a. Not Applicable)
Professional Engineer Name
Not Applicable)
Engineering Firm
Not Applicable)
Mailing Address
Not Applicable) 2e. N/A 2f. N/A
City State Zip
(Not Applicable) 2h. N/A 2i. Not Applicable)
Telephone Facsimile E-mail
APPLICATION P&H 01-16 Page 5 of

State of North Carolina
V Z a Department of Environmental Quality
Division of Water Resources
.0W,,R
15A NCAC 02T .0200 — WASTEWATER PUMP AND HAUL SYSTEMS
Di` vision of Water Resources INSTRUCTIONS FOR FORM P&H 01-I6 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A NCAC 02T_ .0200 and Division policies. Failure to
submit all required items will necessitate additional processing and review time. For more information, visit the Wastewater
Branch's website or contact the Regional Office serving your county.
General —This permit application applies to all pump and haul activities of wastewater under the authority of the Division on Water
Resources. Permit coverage is required for the system producing the wastewater. This permit does not apply to the transport of
animal waste from an animal waste management systems, not the transport of wastewater residuals or biosoiids.
NOTE: Pump and haul permits are not acceptable long term domestic wastewater treatment alternatives and shall only be Issued
in cases of environmental emergencies, nuisance conditions, health problems, or for unavoidable delays in construction of system
previously permitted by the Division.
The Applicant shall submit one original and one coRy of the application and supporting documentation.
A. Pre -submittal Contact & Cover Letter
® Contact the appropriate Regional Office prior to submittal
® Submit a cover letter explaining the clrcutnstances associated with this pump and haul permit request
B. Application Fee (Domestic Wastewater Only)
® Submit a check made payable to: North Carolina Department of Environmental Quality (NCDEQ)
> The appropriate application fee is: $810.00 for flows < 10,000 GPD and $1,310.00 for flows > 10,000 GPD
C. Wastewater Pump and Haul (FORM: P&H 01-16) Application:
® Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H 01-1G) application, Any
unauthorized content changes to this form shall result In the application package being returned. If necessary for clarity or
due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to
correspond to the section and item to which they refer
D. Receiving Facility Letter:
N Submit a letter from the owner/authority of the, receiving wastewater treatment facility, as required by 15A NCAC 02T
.0204 (b), stating that the pumped and hauled wastewater w,ll be accepted and specifying the volume and type of
wastewater that will be accepted. The letter should be signed by an authorized signing official In accordance with 15A
NCAC 02T .0106f bi
E. Contract Hauler Letter:
® Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
® Letter shall include: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:
® The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T .010G 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)
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer (if required)
G. Plans and Specifications (Required for activities that result in the Practice of Engineering per G.S. 89C-3):
® Submit two sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional Engineer)
® Plans must include:
> A general location map ■111116� A'IIf,L�lAI�,,111lI
> Diagram of the components associated with the pump
> Tank Details that Indicate high water alarm nva PUMPHAULAPPiM1VC-20 810.00
> Other items as required NC DEPART OF EWRONMENTAL QUAUTY
0312&2MI # Pages 5 FPS 0OC133SUSI
iNSTRUCTiONS FOR APPLICATION P&H 01-16 if 5

Industrial Pump and Haul Activities
Per 15A NCAC 02T .0203(A)12i. Industrial pump and haul activities are deemed permitted provided the following criteria is met:
➢ The facility notifies the appropriate Division regional office In writing advising of the type of operation, type and quantity of
wastewater generated, location, and the receiving wastewater treatment facility. A letter from the facility accepting the
wastewater (type and quantity) specifically agreeing to accept wastewater from the applicant shall be Included.
D The wastewater does not contain any human waste.
➢ The waste is collected and discharged into a sewer or treatment system designed and permitted to accept the type of
wastewater being pumped and hauled.
The pump and haul activity is not to alleviate a failing wastewater system.
The Division regional office concurs in writing that the activity meets the criteria in this Rule.
CONTACT THE REGIONAL OFFICE PRIOR TO INITIATING ANY INDUSTRIAL PUMP AND HAUL ACTIVITES. SUBMITTAL OF THIS
APPLICATION/DOCUMENTS AND WRITTEN APPROVAL IS STILL REQUIRED FOR INDUSTRIAL PUMP AND HAUL ACTIVITIES
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE
APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Operations
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Operations
Fayetteville, North Carolina 28301
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Operations
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Operations
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertle, Camden, Chowan, Craven,
Water quality Operations
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, P05quotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water quality Operations
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
(336)-776-9800
INSTRUCTIONS FOR APPLICATION P&H 01-I6 rage 2 of 5

ORANGE COUNTY
NOULT1I CARC)LINA
SOLID WASTE MANAGEMENT
1207 Eubanks Road
PO Box 17177
Chapel Hill, North Carolina 27516
March 15, 2021
Jason Robinson, P.E.
Water Quality Operations
NC Division of Water Resources
North Carolina Department of Environmental Quality
3800 Barrett Drive
Raleigh, North Carolina 27609
Dear Mr. Robinson:
Phone [phone]
Fax [phone]
OFE11viforlifietlla$ Quail,,
MAR 2 2 2021
Rai'Digh Regional Office
Please find attached an updated application for a pump and haul permit renewal for the Orange County
Walnut Grove Convenience Center septic tank located at 3605 Walnut Grove Church Road,
Hillsborough, NC 27278
Attached you will find the completed state application form along with the required letters from the Hauler
and the Receiving Facility for the waste.
The permit fee will be paid upon receipt of the invoice from DWR. As the septic holding system and the
pumping and hauling of waste will not continue for an entire year; would the state be amenable to issue a
prorated permit fee invoice?
Please note that no design or operational changes have been made since the renewal approved in March 2020.
The county has received bids for the installation of a permanent onsite septic system. The system was
designed by Draper Aden and Associates and has been approved by the local approval authority for
installation. The permanent system should be completed and ready for use by the end of May 2021. At that
time the septic holding tank will be abandoned and decommissioned as required.
Please do let us know if you have any questions regarding this application.
Sincerely,
Robert Williams, Director
OC Solid Waste Management
cc: Bruce Woody, Assistant Director, OCSWM
Kristina Witosky, Disposal Operations Manager, OCSWM
Attachments: (1) DWR Application Form P&H 01-16, (1) Letter from McFarland Septic, LLC
(1)Letter from the City of Durham

McFarland Septic, LLC
6801-A Mt. Hermon Church Road
Durham NC 27705
March 4, 2021
Orange County Solid Waste Management
P.O. Box 17177
Chapel Hill NC 27516-7177
- . i , .._ I,' 4, .
MAX 2 Z 202,
Raleigh Regio1W off
co
The purpose of this letter is to state that McFarland Septic, LLC is willing and able to enter into a
contract with the Orange County Health Department to perform a pump and haul. We have a tank
capacity of 2500 gallons. Our permit number is #00698. If you have any questions or need any further
information, please contact our office. Thank you for considering us in this matter.
Sincerely,
Waylon McFarland
McFarland Septic, LLC

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