WQ0034386_Renewal (Application)_20210830

N ON-D ISCHARGE P ERMIT R ENEWAL
A PPLICATION

L A G RANGE W ASTEWATER T REATMENT P LANT

T OWN OF L A G RANGE, NC

A UGUST 2021

P REPARED B Y:

120 N. B OYLAN A VENUE
R ALEIGH, NC 27603
L ICENSE N O.: F-0115

Form RWS-R 02-21

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02U RECLAIMED WATER SYSTEM RENEWAL
FORM: RWS-R 02-21
Pursuant to 15A NCAC 02T .0107(b), if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02U, and Division Policies. For more information, visit the Water
Non-Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments uploaded as
a single Portable Document Format (PDF) file to https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-Submittal-Form-Ver2,
or emailed to [e-mail] if less than 20 megabytes (MB).
SECTION I APPLICANT INFORMATION
1.Applicant: La Grange Wastewater Treatment Plant
2.Permit No.: WQ0034386
3.Signature authority: John Craft Title: Town Manager
Phone number: [phone] Office Email: [e-mail]
4.Mailing address: P.O. Box 368
City: La Grange State: North carolina Zip: 28551-368
5.Contact person: John Craft Email: [e-mail]
Primary phone number: [phone] Office Secondary phone number: (252) 566-800 Office
SECTION II FACILITY INFORMATION
1.Physical address: 700 E. King Street County: Lenoir Parcel No.: 27040
City: La Grange State: NC Zip: 28551-368
2.Treatment facility coordinates to the sixth decimal degree:
Latitude: 35.309978° Longitude: -77.776428° Method: Unknown
SECTION III FLOW INFORMATION
1.Permitted flow: 330000 GPD (The maximum allowable flow based on what has been permitted)
2.As-built flow: 330000 GPD (The maximum allowable flow based on what has been constructed)
3.Average flow: 171,556 GPD ()
4.Hydraulic capacity: 52 % (Divide the average flow in Item 3 by the As-built flow in Item 2)
5.Wastewater composition: Domestic : 100 % Industrial: 0 % Stormwater: 0 %
SECTION IV BILLING INFORMATION
1.Billing address: P.O. Box 368
City: La Grange State: NC Zip: 28551-368
2.Verify the Applicant does not have any overdue annual fees:
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wq-epayments
Pursuant to 15A NCAC 02T .0120(c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.

FORM: RWS-R 02-21 Page 1 of 6

SECTION V OPERATOR IN RESPONSIBLE CHARGE (ORC) INFORMATION
(NOT APPLICABLE FOR CONJUNCTIVE SYSTEMS)
1.ORC: Grade: Certification No.:
Mailing address:
City: State: Zip: -
Phone number: ( ) - Select Email:
2.Back-Up ORC: Grade: Certification No.:
Mailing address:
City: State: Zip: -
Phone number: ( ) - Select Email:
SECTION VI OPEN-ATMOSPHERE STRUCTURES
1. List all open-atmosphere treatment and storage structures associated with the renewing permit. Attach additional sheets if
necessary.
Type Parcel No. Volume (gal) Liner Type Freeboard (ft) Latitude Longitude
Select Select . ° - . °
Select Select . ° - . °
Select Select . ° - . °
Select Select . ° - . °
SECTION VII RELATED PERMITS
1.List all wastewater permits (i.e., sewer, collection system, NPDES, residuals) that have interactions with the renewing permit.
Attach additional sheets if necessary.
Permit Type Permit No. Relationship Type
Discharge NC0021644 NPDES
Select Select
Select Select
Select Select
SECTION VIII MONITORING WELLS
1.List all groundwater monitoring wells associated with the renewing permit. Attach additional sheets if necessary.
Well Name Parcel No. Status Gradient Location Latitude Longitude
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
FORM: RWS-R 02-21 Page 2of 6

SECTION IX UTILIZATION FIELDS
1.List all utilization fields associated with the renewing permit. Attach additional sheets if necessary.
Field County Parcel No. Deeded Owner Area Cover Crop Latitude Longitude
A Lenoir 100596 Town of La Grange 23.71 Soybean 35.311871° -77.781006°
B Lenoir 16063 Town of La Grange 17.39 Tobacco/Soybean 35.308822° -77.782408°
C Lenoir 16005 Town of La Grange 31.42 Tobacco/Soybean 35.317649° -77.788038°
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
Total Acreage: 72.52
FORM: RWS-R 02-21 Page 3of 6

ATTACHMENT A SITE MAP
Was the facility originally permitted or had a major modification issued after September 1, 2006?
Yes Pursuant to 15A NCAC 02T .0105(d), submit a site map pursuant to the requirements in 15A NCAC 02U .0201(d). These
requirements are:
A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and showing
all facility-related structures and fences within 500 feet of the treatment, storage, and utilization areas.
Soil mapping units shown on all utilization sites.
Delineation of the compliance and review boundaries per 15A NCAC 02U .0501(a)(6).
Setbacks as required by 15A NCAC 02U .0701.
Site property boundaries within 500 feet of all treatment, storage, and u tilization sites.
No Skip Attachment A.
ATTACHMENT B SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106(b)?
Yes Skip Attachment B.
No Submit a delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.
ATTACHMENT C FLOW REDUCTION
Does the existing permit include an approved flow reduction?
Yes Submit a copy of the flow reduction approval letter, as well as 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
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T .0114(f).
No Skip Attachment C.
ATTACHMENT D CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
Is the Applicant a Privately-Owned Public Utility?
Yes Pursuant to 15A NCAC 02T .0115(a)(1), submit the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise.
No Skip Attachment D.
ATTACHMENT E OPERATIONAL AGREEMENT
Is the Applicant a Home/Property Owners' Association or Developer of Lots to be Sold?
Yes (Home/Property Owners' Association) Pursuant to 15A NCAC 02T .0115(a)(2), submit an executed Operational Agreement
(FORM: HOA). Pursuant to 15A NCAC 02T .0115(c), if the applicant is a legally formed Homeowners' or Property Owner's
Association, submit a copy of the Articles of Incorporation, Declarations, and By-laws.
Yes (Developer of Lots to be Sold) Pursuant to 15A NCAC 02T .0115(a)(2), submit an executed Operational Agreement
(FORM: DEV). Pursuant to 15A NCAC 02T .0115(b), if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and By-laws.
No Skip Attachment E.

FORM: RWS-R 02-21 Page 4of 6

ATTACHMENT F DEMONSTRATION OF FUTURE WASTEWATER TREATMENT CAPACITIES
Is the applicant a municipality, county, sanitary district, or public utility?
Yes Proceed to the next question.
No Skip Attachment F.
Does the hydraulic capacity in Section III, Item 4 exceed 70%?
Yes (the hydraulic capacity is greater than 70%, but less than 80%) Pursuant to 15A NCAC 02T .0118(1), prior to exceeding
80 percent of the system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee
shall submit an engineering evaluation of their future wastewater treatment, utilization, and disposal needs. This evaluation shall
outline plans for meeting future wastewater treatment, utilization, or disposal needs by either expansion of the existing system,
elimination or reduction of extraneous flows, or water conservation and shall include the source of funding for the improvements.
If expansion is not proposed or is proposed for a later date, a justification shall be made that wastewater treatment needs will be
met based on past growth records and future growth projections, and as appropriate, shall include conservation plans or other
measures to achieve waste flow reductions.
Yes (the hydraulic capacity greater than 80%) Proceed to the next question.
No Skip Attachment F.
If answered Yes above, does the hydraulic capacity in Section III, Item 4 exceed 80%?
Yes (the hydraulic capacity is greater than 80%) Pursuant to 15A NCAC 02T .0118(2), prior to exceeding 90 percent of the
system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee shall obtain all
permits needed for the expansion of the wastewater treatment, utilization, or disposal system and, if construction is needed,
submit final plans and specifications for expansion, including a construction schedule. If expansion is not proposed or is proposed
for a later date, a justification shall be made that wastewater treatment needs will be met based on past growth records and future
growth projections, and as appropriate, shall include conservation plans or other specific measures to achieve waste flow
reductions.
No Skip Attachment F.
ATTACHMENT G EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and u tilization system?
Yes Skip Attachment G.
No Pursuant to 15A NCAC 02T .0116(c), provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and u tilization system on
property not owned by the Permittee.
ATTACHMENT H AFFILIATIONS
f record correct? Check affiliations.
Yes Skip Attachment H.
No Provide the corrected affiliations and their contact information.
ATTACHMENT I COMPLIANCE SCHEDULES
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
Yes Submit documentation that the compliance schedules have been met.
No Skip Attachment I.
ATTACHMENT J CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
Does the Permittee have any existing civil penalties or outstanding violations?
Yes (civil penalties) Submit payment for the civil penalty, or proof of remission request.
Yes (violations) Submit a copy of your response to the Notice of Violation.
No Skip Attachment J.

FORM: RWS-R 02-21 Page 5of 6

Attachment A

Site Map

00
1
dxm.sdleiFyarpSegnarGaL\\spaM\\sdleiFyarpS\\lareneG_\\4222-egnarGaL\\:U :htaP tnemucoDMP 15:33:3 1202/72/7 :devaS etaD

Attachment G

Newly Executed Agreements between
La Grange and Owners of Sprayfields A & B

7.0 USE OFTOWN OWNEI)TRAVELING SPRINK.LER IRRIGATION UNITS
ON C1JSTOMER OWNED i)tzoi,r'.wrY
A. 'I'lie J'OWN will make available liar use by the CUSTOMI'R, two (2) travelin.-
sprinkler irrigation machirICS. DUring operation oil the property o f(J J STOM E' R Cor
Purposes of irrigation, C USTOMER shall bear the responsibility for any and all feel
costs and labor associated with moving. setting or operating the Mlit.S, LVIIIeSS
otherwise neptiated with the TOWN, WrICI-Shil), I-01.1611C maintenance and storage
ofthe traveling Sj)r1111dCF Units, shall remain with the TOWN.
13. Operation of, the traveling SIN-1111dCr ][Tigat1011 LHIAS Oil (J1ST()N/1FR property shall 1,10
Fully coordinated by the CUSTOMF'R with the TOWN, and Shall fully comply with
the rC(jLdrC,11le11tS of the TOWN's Reclaimed Water Application Pertnit No.
NC0021644.
C, 'I'lie'['OWN\villpi'o\,idei-eaditiL,,sol-'recl,,iiiiiectwater ii,ict.ersl(acite(learl (.tJS'l.'OM.LlZ.
I pert), with a freclUcricy 1'()r portire .
)ro ng purposes as required by the TOWN's
Reclaimed Water Application Permit No, NC0021644,
8.0 RELIABILITY AND CHANGES IN RECLAIMED WATER STANDARDS &
REQ U I R L, M El NTS
A. 'File TOWN will endeavor to make its reclaimed Water Supply as reliable as is
practical. I lowever, the TOWN can not and does not ('LlaralltCe that there will be no
interruption in set -vice of reclaimed water. The Town shall not be liable for all
ill Lei-111116 oil in service.
13, The TOWN is entering into this aorecirient based oil its understanding of the State
and Federal RUICS governing reclaimed water systems in cfl'ect at the time of
CXeCL1t1O11 01' this agl'Mllerit. Should there be any clianoe in either the State or
Federal rides. or in the]-O'WN's understanding ofthose rules, this agreement shall be
deemed amended so as to be consistent with all State and I"ederal rUICS. T'he parties
agree to sign an amendment to bring it hito conformity Nvith State and 1"ederal rLdes'.
L_ L_ L,
IN WITNL.,"SS Will-,"Rt'OF, the CUSTOMER and TOWN haVC CXeCLIt,CCI this Agreement
Z7
in 1111.11tiple COPICS aS'Of-the (late first above written.
A GR IL
MS. ELE'ANM OR .1, WALSLEY ) N 1) eA Golog
Z
ATTEST'
_AL"
Jft�869
TO M/ N 0 1 1, A 1;� R AN (J IS, ELLIAN01 .1, WALMS1IFY
.. ........
X,
0,%
A4?