WQ0007144_Application_20211029

D]vision of W.Ater Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0500 — WASTEWATER IRRIGATION SYSTEM —RENEWAL
FORM: W IS-R 02-21
Pursuant to I5A NCAC 02T .01D?(bl, if the application? does not include all required information and the necessary supporting
documentation, the application shall be returned, The application and attachmenis shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .0500, and .Division Policies. For more iuforniat1on, visit the Water Quality Permitting
Section's Nun -Discharge Branch website. The AppllcaW shall submit an elvetronic copy of the applienflun and attachments
yptr}adod as a single Parts ble Docuthent-Forniat (PIIF')-file to fit- tWledocs.dgq.nr.Zov1Forms!lVnnDiscUirE[e-Hranch-5uhmittsI­
• Forpt-Vey, or emailed to Non-Dischar2e.RerisAnedenr.aov if less than 20 megohytes (MR),
SECTION 1— APPLICANT INFORMATION
1. Applicant: YMCA of The Triangle Area, Inc,
2. Penn it No.: WQO07144
3. Signature authority: Mike Askew
Phone number: (252) 671.6I 17 Cell
Title: Camp Capital Projects and Planning Director
Email: mike.askew(rxseagull-seafarer.org
4. MAiling address; $01 Corporate Center Drive, Suite 200
City; Raleigh
State: NC Zip: 27607-
5. Contact person: Mike Askew
Primary phone number: [phone] Cell
Email: mike.askewseagull-seata� er.org
Secondary phone number: [phone] Ofiica
i SECTION 1:1—FACILITY INFORMATION
1. Physical address. 2744 Seafarer Road
City, Arapahoe
2. Treatment facility coordinates to the sixth decimal degree;
Latitude: 35,3415'
County: Pamlico
State; NC
Parcel No.: E09-20
Zip, 26510-
Longitude:-76.847532' Method: Map interpretalion by exindction
SECTION DI — FLOW INFORMATION
I. Permitted flow: 550DO GPD (The maximum allowable flow based art what has been perrndroec!
2. As -built flow: 5500D GPD (The maximum allowableflow based an what has beam comfrucred)
3. Average flow: 5854 GPD (The average of all repo)7ed floiws on the previous calendar year's NDiI &)
4. Hydraulic capacity: 10 % (Divide the average flow in item 3 by the As-budi flaw in Item 2)
5. Wastewater Composition: Nmestic : 100 % hidustrial: % Storrnwater: %
SECTION IV — BILLING INFORMATION
1. Billing address: 801 Corporate Center Drive, Suite 200
City: Raleigh state: NC Zip: 27607-
2. 'Verify the Applicant does not have any overdue annual fees:
hitps _!f[lei.nc.aavlalyoutfdivisinttsfwater-resourceslwster-resources-permitslwp-evaymettts
Pursuant to 15A NCAC 02T .0l2Dfc , permits for renewing facilities shall not be gi-anted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: W WIS-R 02-21 Page] of 5

SECTION V—OPERATOR, IN RESPONSIBLE CHARGE(OAC) INFORMATION
1. ORC: Stan Eudy Grade: Certification Nu-: 994723
Mailing address- 307 Magnolia Lane
City: Arapahoe
Phone number: [phone] Cell
2. Bnck-Up ORC: Robert Pegmin
Mailing address:
City, Arapahoe
Phone number. [phone] Cell
State: NC Zip: 28510-
Ernail: stan.ekidy@seagull-seaf'arer,org
Grade: Certification No.: 14914
State: lVC 'Lip: 285 LO-
Email:robbie.�egrain r�st?agall-seaf�rcr.vrg
SECTION VI — OPEN -ATMOSPHERE STRUCTURES
1. List all open -atmosphere treatment and storage structures associated with the reviewing permit. Attach additional sleets if
necessary.
Type
parcel No.
Volume (gal)
Liner Type
Freeboard (ft)
Latitude
Longitude
Storage
E09-20
604,000
Full, clay
35.22800
-76,949095"
Storage
E09-20
5,500,000
Full, clay
35,28210
-76.8471780
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SECTION VU—RELATED PERMITS
1. List all wastewater permits (i.e., sewer, collection systtin, NPDES, residuals) that have interactions with the renewing permit.
Attach additional: sheets if necessary.
_.. _ Permit Type Permit No. _ Relationship Type
Collection System
WQ0007144
1Nasterplari
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I
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SECTION VIII — KON1TORING WELLS
I. List all groundwater monitoring wells associated with the renewing pevin it. Attach additional sheets if necessary.
Well Name
Parcel No.
Status
Gradient
LaeatiGn
Latitude
Longitude
2
130-20
Active
Downgradient
Inside Review Boundary
35.2600
-76.8461911
5
B09.20
Active
Upgradient
Inside review Boitadary
35.8440
-76.9484911
6
E02-20
Active
Downgradient
Inside l eview $nundary
35.676"
-76.84996¢
7
E02-20
Active
Downgradient
Inside review Boundary
35A39°
-76.847880
8
E02-20
Active
Upgradicnt
Inside Review Boundary
33.3400
-7�,84906°
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Scleet
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4
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seleet
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FORM: WWIS-R (12-21 Page2 of

SECTION IX -IRRIGATION I FOLDS
1. List all iTrip ion fields associated with the renewing pennit. Attach additional sheets if necessary.
Ficld County - — Parcel No. Dftded Owner Area Corer Cmp Latitude L-nirgitudc
1
Pamlico
JE09-20
'YMCA of The Triangle Area
5.80
trees
35A7970
-76.84806311
2
Pamlico
E09-20
'YMCA of I'M Triangle Area
5.80
grass/trees
35.15430
-76.849190"
3
Pamlico
E09-20
YMCA of The Triangle Area
6.40
trees
35.74740
-76.848597°r
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Total Acreage.
FORM: WWIS-R 02-21 Page 3 of 6

ATTACHMENT A — SITE MAP
Was the facility originally permitted or had a major madification issued after Septer bff I, 2006?
❑ Yes — Pursuant to I5A NCAC 02T-0105(4), submit a site snap pursuant to the requirements in 15A NCAC 02T .0504(d). These
requirements are:
❑ A scaled map ofthe site with topographic contour intervals not exceeding 10 feetor25 pereent aftotal site rcliefand showing
all facility -related structures and fences within the wastewatertreatmeut, sturage, and irrigation areas.
❑ Soil mapping units shown on all irrigation sites.
❑ The location of all wells (including usage and conOruutiurn de(aiis if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage,
and irrigation sites.
'❑- Delineation oftlte caiipliance and review boundaries per ISA NCAC 021..0107 and .01U8, and i5A NCAC 02T .45i}b(c�
if applicable.
❑ Setbacks as required by I5A NCAC 02T .0506.
❑ Site properly boundaries within 500 feet of all wastewater treatment, storage, and irrigations sites.
❑ All habitable residences or places cf pubiic assembly within 500 feet of all treatment, stc rige, and irrigation sites.
0 No — Skip Attachment A.
ATI'AC14 M P NT B — SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section 1, Item 3 meet the requirements pursuant to 15A NCAC 42T .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 REDUCI`ION
Does the existing permit include an approved stow 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 paFruit renewal. 1f any of these monthly averages are with in20% of the approved
Flow reduction value, the Perm ittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T,01 I4ffi.
No — Skip Attachment C.
I ATTACHMENT D — CERTInCATE OF FUBLIC CONVENIENCE ANV NECESSITY I
is the Applicant a Privately -Owned Public Utility?
❑ Yes -- Pursuant to I5A NCAC 02T .0115.(a)fl�, submit the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Ccnun ission demonstrating the Applicant is authorized to hold the utility franchise.
No —Skip Attachment p.
ATTACHMENT E — OPERATIONAL AGREll, NI ENT I
1s the Applicant a Home/Property Owners' Association or Developer of Lots to he Sold?
❑ Yes (Home/Property Owners' Association) —Pursuant to 15A NCAC 02T .0115(a)(2}, submit an executed Operational Agreement
(FORM: , Pursuant to 15A NCAC 02T .oi 15fe), 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.
Q Yes (Developer of Lots to be Sold) — Pursuant to I5A NCAC 02T .0115(a)(2), submit an executed Operational Agreement
(FORM;. p». Pursuant to 15A NCAC 02T .0115(, if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and Bylaws.
Nu — Skip Attachment E.
FORM: WWIS-k 02-21 Pagc 4 of 6

ATTACHMENT F-•-DEMONSTRATION OF FUTURE WASTEWATERTREATMENT CAPACITIES
Is the applicant a municipality, county, satilt ary district, or public utility?
❑ Yes— Proceed to the next question.
Z No — Skip Attachment F.
Does the hydraulic capacity in Section ii1, Item 4 exceed 701/6?
❑ Yes (the hydr•flulic capacity is greater than 7VIa, but less than S4°/c) — Pursuant to ,I SA NCAC 02T .0118(11, prier to cxcecding
80 percent of the system's permitted hydrastilc capacity (based on the average flow during the last calendar year, the prr"14tce
shall submit an engineering evaluation of their future wastewater treatment, utilization, and disposal steeds. Tlus evaluation shall
outline plans for meeting future wastewater treatment, utilization, or disposal needs by either exrnimlion of the existing system,
elimination or reduction of extraneous flows, or water conservation and shall include the source offending 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 inductions.
❑ Yes (the hydraulic capacity greater than 801/o) — Proceed to the next question.
® No — Skip Attachment F.
If answered Yes above, does the hydraulic capacity in Section 111, Item 4 exceed 801A?
❑ Yes (the hydraulic capacity is greater than 8Q%) — Pursuant to 1 SA NQAC 02T .0111SJ2), prior to exceeding 40 percent of the
system's permitted hydraulic capacity (based on the average flow during the last calendar year), the perrnittee 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 oilier specific measures to achieve waste flow
reductions.
No — Skip Attachment F.
ATTACHNI ENT G — EASEMENT, CNCROACEAMNT, AND LEASE AGRE11,MENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, and irrigation system?
® Yes — Skip Attachment G.
❑ No — Pursuant to 15A NCAQ 02T .0I 16(c), provide a copy of all casements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, and irrigation system ail
property not owned by the Permittee.
ATTACHMENT H — AFFELIATIONS
Are the Permittee's affiliations of record conect? Check affiliations.
® Yes — Skip Attachment H.
❑ No —Provide the corrected affiliations and their contact information.
ATTACHMENT I — COMPLIANCE SCHEDM ErS
I)aes the existing permit include any Compliance Schedules? (See Section l of the most recently issued permit]
® Yes — Submit docurnentatinn that the conipliance schedules have been met.
❑ No — Skip Attachment I.
ATTACHMENT J — CIVIL PENALTIES AND OUTSTANDrNG VIOLATIONS
Does the Perin ittee have any existing civil penalties or outstanding violations?
❑ Yes (civil penalties) —Submit payment for the civil frerrally, or proof of remission request.
❑ Yes (violations) — Submit a copy of your response to the Notice of Violation.
® No — Skip Attachment L
FORM: V1 WIS-R 02-21 Page 5 of 6

ATTACHMENT K - INDUSTRIAL WASTl~WATER
Does the wastewater composition in Section 111, Item 5 include any irdustrial wastewater?
�] Yes- Proceed to the next question.
® No- Skip Attachment K.
Has tite natui a of the industrial wastewater changed since the last permit issuance (i.e., changes in industrial process, introdut tion of
new materials or chemicals, etc.)?
Yes - Provide a chemical analysis of the wastewater pursuant to the requirements in 15A NCAC 02T .0304(h7. Provide an
overview of the manufacturing process; an inventory of all chemical and biological materials used in thr, manufacturing process;
and an overview of the cleaning and treatment methodology.
® No - Provide an overview of the manufacturing process; an inventory of all chemical and biological trtaterials used in the
Manufacturing pro"is; and an overview of the cleaning and treatment methodology,
ATTACttl►t[ NT L - SETBACK WAIVRRS
Does the existing permit include sethack waivers`?
❑ Yes - Pursuant to 15A NCAC 02T .0546(d?, provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the cotinty Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02L .0107.
0 No -- Skip Attachment L.
I APPLICANT'S CERTIFICATION
i rK e- ALLv attest that this application
authority's name as rated in Section I, Item 3)
has been reviewed by me and is accurate and complete to the hest of my knowledge. 1 understand that if all required parts of this
application package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as Incomplete. I further certify pursuant to I5A NCAC 02T .0120fh1, that the applicant, or any
parent, subsidiary, or other of dime of the applicant has; not been convicted of enviranmental Crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, s0lement agreement, pr order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuantto I SA NC AC 02T.0106fbi. An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NCAC 02T .0106(c , Pursuant to § 143-215.6A and § 143-215.68, any
person who knowingly makes any false statement, repte=Wion, or certification in any application package shall be guilty of a Class
2 misderneanur, which miry include u fine not to exceed S10,000 as Well as civil penalties up to $25,000 per violation.
5i:gnat ore:
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FORM: WWIS-R 02-21 rage 6 of 6