WQ0009772_Application_20211210

(CA Carolina Water Service
11101111 of North Caroline
December 2, 2021 RECEIVED
DEC 1 0 2021
NCDEQ-DWR
Water Quality Permitting Section NCDEQIDWRINPDES
1617 Mail Service Center
Raleigh NC 27699-1617
Carolina Water Service of North Carolina hereby submits the attached Collection System Permit
Application for Monteray Shores. Included in the application package is:
1. Completed Application
2. CPCN
3. Pump Station List
4. Annual Budget
5. Capital Improvement Plan
6. Response Action Plan
7. Contingency Plan
8. Collection System Map
Please reach out to Brent Milliron, Regulatory Compliance Manager at
[e-mail] or myself at [e-mail] if
further information or clarification is needed.
Respectfully,
•
Dana Hill
Director of Operations
4944 Parkway Plaza Boulevard, Suite 375 • Charlotte, North Carolina 28217
[phone] • [e-mail] •www.carolinawaterservicenc.corn

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0400—SYSTEM-WIDE WASTEWATER COLLECTION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM CSA 04-16&SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A NCAC 02T .0400, and all relevant
Division Policies. Failure to submit all required items will necessitate additional processing and review time.
For more information, visit the System-wide Collection System Permitting website:
General — When submitting an application to the Municipal Permitting Unit, please use the following instructions as a
checklist in order to ensure all required items are submitted. Adherence to these instructions and checking the provided
boxes will help produce a quicker review time and reduce the amount of requested additional information.
The Applicant shall submit one original and one copy of the application and supporting documentation.
The copy may be submitted in digital format.
A. Cover Letter
❑ Submit a cover letter listing all items and attachments included in the permit application package
B. No Application Fee Required
➢ No application fee is necessary. The permittee will be billed an annual fee upon issuance of the permit
➢ The appropriate annual fee for systemwide wastewater collection system permits may be found at:
➢ Annual Non-Discharge Fees
C. System-Wide Wastewater Collection System (FORM: CSA 04-16)Application:
❑ Submit the completed and appropriately executed System-wide Wastewater Collection System (FORM: CSA 04-
16) 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.
❑ If the Applicant Type in Section I.3 is a Privately-Owned Public Utility, provide the Certificate of Public
Convenience and Necessity(CPCN)from the North Carolina Utilities Commission demonstrating the Applicant is
authorized to hold the utility franchise for the area to be served by the wastewater collection system, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area
or that franchise approval is expected.
❑ If the Applicant Type in Section I.3 is a corporation or company, provide documentation if it is registered for
business with the North Carolina Secretary of State.
D. General Information:
➢ The Authorized signing official listed in Section 1.4 should match with that of the Applicant certification page in
accordance with I5A 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).
➢ NOTE - Public Works Directors are not authorized to sign this permit application, according to the rule,
unless they are formally delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCIIMF.NTATInN

E. Summary of Attachments Required:
❑ Instruction A: Cover Letter
❑ Instruction C: Application
❑ Instruction C: Ownership Documentation (i.e. CPCN) (If necessary)
❑ Instruction D: Delegation Letter(If necessary for signing official)
❑ Section IV.3 Pump Station List
❑ Section IV.4 High Priority Lines List
❑ Section V.4 Annual Budget for Collection System (Updated and Approved)
❑ Section V.6 Capital Improvement Plan (Updated and Approved)
❑ Section VI.2 Response Action Plan
❑ Section VI.4 Contingency Plan
❑ Section VI.6 Comprehensive Collection System Map
❑ Section VII Note Any Potential Compliance Issues
THE COMPLETED APPLICATION PACKAGE,INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS,SHOULD BE SENT TO:
NCDEQ-DWR
Water Quality Permitting Section
MUNICIPAL PERMITTING UNIT
By U.S.Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N.SALISBURY ST.Suite 925
RALEIGH,NORTH CAROLINA 27699-1617 RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone] TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION n _ r

I. APPLICANT INFORMATION:
1. Applicant's name(Municipality,Public Utility,etc): Carolina Water Service of North Carolina
2. Facility Information: Name: Monteray Shores Collection System Permit No.: WQCSOO
3. Applicant type: ❑Municipal ❑State ®Privately-Owned Public Utility
❑County ❑ Other:
4. Signature authority's name: Dana Hill per 15A NCAC 02T .0106(b)
Title:Director of Operations
5. Applicant's mailing address:4944 Parkway Plaza Blvd, Ste.375
City:Charlotte State:NC Zip:28217-
6. Applicant's contact information:
Phone number: [phone] Fax number:( ) - Email address:[e-mail]
CONTACT/CONSULTANT INFORMATION:
1. Contact Name:
2. Title/Affiliation:
3. Contact's mailing address:
4. City: State: Zip: -
5. Contact's information:
Phone number: ( ) - Fax number:( )= Email address:
II. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ®New ❑Renewal
2. County System is located in: Currituck County
3. Owner&Name of Wastewater Treatment Facility(ies)receiving wastewater from this collection system:
Owner(s)&Name(s):Carolina Water Service of North Carolina
4. WWTF Permit Number(s): W00009772
5. What is the wastewater type? 100%Domestic or %Industrial(See 15A NCAC 02T.0103(20))
IIs there a Pretreatment Program in effect?❑Yes or❑No
6. Wastewater flow: .25 MGD(Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: .72 MGD
8. Explain how the wastewater flow was determined:❑ 15A NCAC 02T.0114 or®Representative Data
9. Population served by the collection system: Seasonal(-2000)
III. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description Length
Gravity Sewer 10.23(miles)
Force Main 7.53(miles)
Vacuum Sewer (miles)
Pressure Sewer (miles)
APPLICATION CSA 04-16

2. Pump Stations for Collection System:
Pump Station Type Number
Simplex Pump Stations(Serving Single Building)
Simplex Pump Stations(Serving Multiple Buildings)
Duplex
p Pump Stations 18
3. Submit a list of all major(i.e.not simplex pump station serving a single family home)pump stations. Include the following
information:
> Pump Station Name
> Physical Location
> Alarm Type(i.e.audible,visual,telemetry,SCADA)
> Pump Reliability(Can convey peak hourly wastewater flow with largest single pump out of service)
> Reliability Source(permanent/portable generator,portable pumps)
> Capacity of Station(Pump Station Capacity in GPM)
4. Submit a list of all high priority lines according per I 5A NCAC 02T.0402(2)known to exist in the collection system. Head the
list with"Attachment A for Condition V(4)"and include the system name. NONE
> Use the same line identification regularly used by the applicant
> Indicate type of high priority line(i.e.aerial),material and general location
IV. COLLECTION SYSTEM ADMINISTRATION:
1. Provide a brief description of the organizational structure that is responsible for management, operation and maintenance of
the collection system.
Our organizational structure can be seen in the flow chart below.In addition,Carolina Water Service Inc. of
North Carolina operates multiple systems throughout the state which allows for additional personnel to be
brought in during emergency situations.
Donald
Denton
Dana Hill
Dinctor.State.. ,...
Anthony
r-II
Area Managers
I I
ravis Tucke Wayne Scott
Rodman Osborne
Lead O.erator Field Technician O.-rator
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Travis Tucker Certification Number: 1002180
Back-Up ORC Name: Dana Hill Certification Number: 1009343
See the"WQCS Contacts and ORC Report"for a current listing of the ORC(s)the Division has on file for WQCS permit
3. Approximate annual budget for collection system only: $207752.00
4. Submit a copy of your current annual budget
5. Approximate capital improvement budge for the collection system only: $27000.00
APPLICATION CSA 04-16 ,

6. Submit a copy of your current capital improvement plan.
7. Is this collection system currently a satellite system ❑Yes or®No
8. Do any satellite systems discharge to this collection system❑Yes or®No(If yes complete table below)
Satellite System Contact Information(Name,Address,Phone Number)
Complete for Satellite Systems that have a flow
Y or capacity greater than 200,000 GPD(Average daily flow)
9. List any agreements or ordinances currently in place to address flows from satellite systems:
V. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place®Yes or❑No
2. If Yes,submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place?®Yes or❑No
4. If Yes,submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? ®Yes or 0 No
6. Submit a submit a copy of the collection system map(CD or hardcopy)or indicate a schedule for completion
7. Thoroughly read and review the System-Wide Collection System Permit Conditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Current If no,Indicate a Typical
Permit Condition Compliance Compliance
Compliance?
Date Schedule
I(4)—Grease ordinance with legal authority to inspect/enforce ❑Yes ®No 12—18 mo.
I(5)— Grease inspection and enforcement program ®Yes ❑No 12-18 mo.
I(6)—Three to five year current Capital Improvement Plan. ®Yes ❑No 12— 18 mo.
I(8)—Pump station contingency plan ®Yes ❑No 3 mo.
I(9)—Pump station identification signs. ®Yes ❑No
3 mo.
I(11)—Functional and conspicuous audible and visual alarms. ®Yes ❑No 3—6 mo.
11(5)—Spare pumps for any station where one pump cannot
handle peak flows alone(in a duplex station,the 2nd pump is ®Yes ❑No 6—9 mo.
the spare if pump reliability is met).
11(7)—Accessible right-of-ways and easements. ®Yes ❑No 6—12 mo.
II(9)—Response action plan with Items 9(a—h). ®Yes ❑No 3 mo.
III(3)—Comprehensive collection system map ®Yes ❑No 10%per year
For conditions not listed,compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet(attach clarification if needed):
APPI 1CAT1IN CC (IA 14

VI. APPLICANT'S CERTIFICATION per 15A NCAC 02T.0106(b):
I,Dana Hill,Director of Operations attest that this application for Monteray Shores Collection System
(Signature Authority's Name&Title from Item I.4) (Facility name from Item I.1)
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 information and attachments are not included,this application package
will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, 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.
Signature: Date: /L-3-
APPLICATION CSA 04-16

yuo -
•
NORTH CAROLINA
PUBLIC STAFF
UTILITIES COMMISSION
September 30, 1992
RE: Monteray Shores Subdivision
Currituck County, North Carolina
To Whom It May Concern:
This letter is to confirm that Carolina Water Service, Inc. , of North
Carolina has been granted a Certificate of Public Convenience and Necessity to
furnish water and sewer utility service in Corolla Light Subdivision in Currituck
County, North Carolina, under Docket No. W-354, Sub 47, and Monteray Shores
Subdivision is a contiguous extension of the Corolla Light Subdivision water and
sewer system. A contiguous extension of a franchised system does not require an
additional franchise.
I hope the above supplied the information you need. If I can be of further
assistance to you, please do not hesitate to contact me.
Sincerely,
Andy Le , Director
Public Staff-Water Division
ARL:cks
Executive Director Communications Economic Research
733-2435 733-2810 733-2902 LegalTransportation
733-6110 733-7766 66
Accounting Consumer Services Electric
Natural Gas Water
733,4279 733-9277
733-2267 733-4326 733-5610
P.O.Box 29520•Raleigh,North Carolina 27626-0520•Fax[phone]
An Equal Opportunity/Affirmative Action Employer

PS Name Location-Corolla NC Alarm Type PumpReliability V Reliability Source
CL1 1148 Morris Drive A,V,T Y
Portable
CL2
1159 Franklin A,V,T Y Portable
CL3 1198 Dunton A,V,T Y
Portable
CL4
1069 Ocean Trail A,V,T Y Portable
CL6 1058 Hampton A,V,T y
Portable
MS1
973 Ocean Trail A,V,T Y Portable
MS2 996 Ocean Trail A,V,T y
Portable
MS3
857 Oakridge A,V,T Y Portable
MS4 874 Azure A,V,T y
Portable
MS5
819 Rosewood A,V,T Y Portable
MS6 895 Ocean Trail A,V,T y
Portable
MS7
821 Ocean Trail A,V,T Y Portable
MS8 788 Ranger A,V,T Y
Portable
MS9
777 Voyager A,V,T Y Portable
MS10 814 Ocean Trail A,V,T Y
Portable
MS11
791 Sunset A,V,T Y Porta
ble
MS12 815 Ocean Trail A,V,T Y
Portable
MS13
Devils Bay& Cruz Bay A,V,T Y
Permanent

Monteray Shores S & Corolla Light S
O&M
Avg Annual Spend
Salaries
131,707
Capitalized Time (14,522)
Sewer Rodding 17,271
Maint. Supplies 556
Maint. Repairs 57,865
Maint. Permits
2,385
Maint. Electric Equip Repair 3,252
Other Maintenace Expenses 4,507
Communications Expense (SCADA??) 4,731
Total 207,752
Capital Spending Budget
Project In-Service Date Total Expected Project Cost
No Major Collection System Projects Planned
GL Spend
$27,000 over last 12 months

( 7IitiEs
, Inc:
SANITARY SEWER OVERFLOW AND SPILL RESPONSE ACTION PLAN
Monteray Shores Sanitary Sewer Collection System
WQCS00xxx
A Sanitary Sewer Overflow(SSO) can endanger the environment and affect the health of individuals and
wildlife that come in contact. It is the policy of our company that any and all SSO's be investigated
immediately and actions taken to prevent or minimize any and all environmental impact.
The public should contact our 24 hour customer service number at 1-800-525-7990 and provide as much
information as possible on the location of the problem. On-call staff will be dispatched immediately for full
investigation. This number will reach our office during normal business hours and than an emergency call
service center after normal business hours. Available and current on-call staff information is kept at all times to
ensure that appropriate staff can be dispatched immediately.
Any operations employee that comes across an SSO should contact the Operating Manager, Area Manager or
Regional Manager immediately and take immediate action to assess,minimize, prevent or mitigate any such
event.
The local Operating Manager and ORC of the system will be the primary interface between the company and
the NC Dept. of Environment and Natural Resources, Division of Water Quality (DWQ) and county health
department(if required). The appropriate manager will follow the current and then in place SSO reporting
policy as designated by DWQ (see attached reporting form)or any other regulatory agency having jurisdiction.
As of the writing of this document;
• Report any spill of 1,000 gallons or more; and
• Any spill, regardless of the volume, if any waste reaches the surface waters of the State. Any conveyances
such as drainage ditches or storm sewers are considered waters of the State.
1) Report by telephone to a person(not a fax or voicemail)to the Washington Regional DWQ Office at
252-946-6481 during normal business hours(Monday through Friday, 8 am to 5 pm)as soon as
possible, but in no case more that 24 hours after the SSO is known or discovered. To report outside of
regular business hours, call [phone].
2) Follow up the verbal report by sending the completed written report using the attached form or most
current within five days.
3) If the discharge involves 1,000 gallons or more AND reaches surface waters, a press release must be
issued within 48 hours of first notification. If the discharge is 15,000 gallons or more, a public notice
must be published within 10 days and proof of publication shall be provided to DWQ within 30 days.
Containment Procedures
As soon as an employee arrives at the site of the SSO,he/she shall use whatever means necessary to contain the
spillasto prevent
p e ent it from reaching surface waters. If there is no danger or potential of the SSO reaching surface
waters,the SSO should be contained in as small an area as possible but use of any means possible such as

construction of dams, ditches, checks etc. The sewage contained or collected shall be returned to the sewer
system or y taken to the WWTP by pumps,pumper trucks or other available means.
If possible, a blocked or damaged section of collection main should be bypassed around the problem area using
transfer pumps from an upstream manhole into a downstream manhole. The damaged
ma main section
plugged if possible to prevent waste from entering the problem area. g should be
The area should be sectioned off to prevent any unauthorized person from entering the contaminated area.
Blockage Correction
Employees should treat a reported blockage with utmost urgency to prevent any spill or backup from causing
environmental or home damage. The first person on site should try to assess the problem and determine if flow
can be maintained or restored using temporary pump bypass or other means, of if the problem area can be
blocked off and the waste transported from a manhole to the WWTP using a pump or pumper truck.
Contractors should be called immediately and employee should stay on site or within close distance to assist
with emergency work. Containment and bypass equipment and measures shall remain on site until the blockage
is corrected.
Clean up
Remove all debris such as plastic,paper or other materials from the site, bag or place in a container and dispose
of properly in dumpster at WWTP site.
Clean or wash area thoroughly and return this water to the sewer system or treatment plant. If on soil or dirt,
apply a liberal layer of white hydrated lime to raise the pH and kill pathogenic organisms and to treat for odor.
Apply straw and grass seed if appropriate.
If the SSO reaches surface waters, every effort should be made to contain the spill area by use of dams near a
manhole or area accessible to a pumper truck and mobile equipment. The contained area should be pumped
back into the sewer system. Two employees or one employee and a contractor shall be present at all time while
pump is operated. Backhoe or other equipment should be available to help maintain earthen dams until clean up
efforts are complete.
If possible, the area should be flushed with potable water and that water also returned to the seer system. The
operator should try and use a broom or other measures to agitate sludge on the bottom during the pumping and
cleaning efforts to make sure it is all retrieved. Rocks and rip-rap should be washed of residue.
If surface waters are used for drinking source or recreation, additional measures must be taken to notify local
health departments.
Water samples to include dissolved oxygen and fecal bacteriological samples should be taken frequently before
clean up, during and after clean up. In addition, samples should be taken upstream and downstream of the
affected area.
Spare Parts and Equipment List
Portable trailer mounted generator to operate pump stations and/or electrical equipment in the event of power
loss or in remote locations. This will be kept in good running order at all times at the WWTP location.
Common parts such as electrical components such as elapsed time meters,voltage phase monitors etc. are kept
in stock at the Monteray Shores WWTP and can be accessed at all times.

White hydrated lime will be kept on hand at the WWTP for spill abatement.
Normal hand tools such as shovels,rakes etc. will be kept on the Operator's truck or at the WWTP.
The ORC or Operating Manager must be familiar with all pumping equipment brands and have means to
contact a distributor or representative for expedited parts.
Contractors List and Contact Information
Gopher Utility—704-932-7662
Electrical and equipment repair work
Rusty Hardee-252-475-8674
Main/Service Repairs,backhoe contractor
Envirolink 252-236-1428
Pumper truck/vacuum truck and main cleaning.
Water& Waste Systems 919-625-8864
Electrical and repair work

Monteray Shores
Lift station Pump Failure Contingency Plan
Sanitary Sewer Collection System Permit WQCS00xxx
Carolina Water Service Inc. of North Carolina
Mission Statement
1. Carolina Water Service Inc. of NC (CWSNC) owns, operates and maintains the
sanitary sewer collection system serving Monteray Shores located in Currituck
County,NC. CWSNC is an investor owned private utility and is committed to
providing safe, reliable and cost effective service to our customers and with the
underlying commitment to act with integrity,protect the environment and
enhance the communities we serve. CWSNC works to maintain the system and
meet customer growth expectations and regulatory requirements in a financially
responsible manner. As a privately owned public utility, CWSNC is regulated
through the NC Utilities Commission.
Description of Systems
2. The service area currently serves a seasonal population. The system is comprised
of approximately 10.23 miles of gravity sewer collection mains; 7.53 miles of
pressure force main, (18)pump stations and a 0.720 MGD wastewater treatment
plant.
Objective of Plan
3. To insure a normal level of service in the event of a lift station pump failure while
protecting the environment. CWSNC is financially capable of making any and all
emergency repairs immediately and takes immediate action any time the system
may be compromised in order to protect the system integrity, the environment and
to meet regulatory requirements.
Criteria for Invoking the plan:
4. One or more pump failures or loss of power to any or all lift stations.

Roles,Responsibilities,and Authority
5. The local Operating Manager/ORC of the system will be in charge of operating
this contingency plan. If additional personnel are needed,he will contact the
appropriate Area Manger who will then assign more staff if deemed necessary.
Procedures for Invoking Contingency Mode
6. The area operator will monitor the system on an emergency basis until it is clear
that there are no problems with the operation of the system. The alarm systems for
all 18 lift stations have capabilities so that alarms will still be reported in the event
of power loss.
If an employee discovers a problem,he will immediately begin to diagnose to
correct the problem. The employee will also call his immediate supervisor and
describe the nature of the problem (e.g.,no electricity, pump failure to one or all
lift stations).
Procedures for Operating in Contingency Mode
7. Generators— Lift Stations are equipped with either fixed or mobile generator
transfer quick connects that will enable the operator to hook up available portable
generators located in the system. If all lift stations are without power, the Area
Manager will establish a rotation schedule based upon the capacity in the wet
wells and storage in the lines to rotate the generators between the lift stations.
One Pump Failure—Should one pump fail in the duplex stations,the operator is
to contact the necessary contractor from the contractors list and arrange to have
the pump checked immediately. Should the pump need to be replaced, the
operator should check the spare parts inventory and have installed, should one be
available. The other pump should be sent to a repair facility for a repair cost
estimate. The station should be checked on a daily basis until such time the pump
can be repaired or replaced.
Dual Pump Failure—Should both pumps fail in the duplex stations, the operator
is to contact the necessary contractors from the contractors list and arrange to
have the pumps checked immediately and/or to rent a portable pump if needed.
Should the pump need to be replaced, the operator should check the spare parts
inventory and have a pump installed, should one be available. The other pumps
should be sent to a repair facility for a repair cost estimate. The station should be
checked on a daily basis until such time that both pumps can be repaired or
replaced. If needed a vacuum pump truck should be called from the contractors
list to prevent any and all overflows.

Water Restrictions—If city wide or regional power outage lasts for more than
one day,we would consider restricting community water usage to reduce the flow
of wastewater through the system.
8. Criteria for Returning to normal operation mode:
Electricity returned to all stations and all lift station pumps are operational.
9. Post Contingency Plan :
The Area Manager will meet with personnel who assisted in operating this plan
to evaluate how well it worked. If necessary, changes will be made for any future
emergencies.

1.4
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Pressure Sewer 7.53 mi •
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Monteray Shores p �� "CONFIDENTIAL a PROPRIETARY INFORMATIOh� r~�U_N
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BOO tau 1� DISCLAIMER.This map is not a survery Map Produced By:SPQ /
w.'�."k�r`f." Collection System MetersCWSNCmakesnoguaranlee.impliatc. Date:10/07/2021 N impked.about the accuracy of this data.