McDowell Co. Septic Tank Permits

DIVISION OF ENVIRONMENTAL MANAGEMENT
ASHEVILLE REGIONAL OFFICE
GROUNDWATER SECTION
September 23, 1991
MEMORANDUM
TO: Jeff Lautier
Raleigh Central Office
FROM: Fred C. Hankinson �C 1
Asheville Regional Office
SUBJECT: Application for Amendment of Permit No. 4714
McDowell Nursing Home -
Permit No. WQ 0005519 and GW 91256
McDowell County, North Carolina
i
Additional septic tank drain field is being constructed;
to accommodate additional beds in the nursing home. The I
additional drain field is within compliance boundaries. No
groundwater monitoring is deemed necessary at this time.
FCH/gc
cc: Jim Reid

DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
September 25, 1991
MEMORANDUM
TO: Don Safrit
THROUGH: Bob Cheek 0 C
FROM: Jeff Lautier
SUBJECT: McDowell Nursing Facility
Subsurface Disposal System
Permit Renewal Application
McDowell County
WQ0005519/GW912'56
(Mark Hawes: DEM SERG Review Engineer)
The Groundwater Section has reviewed the subject permit renewal
application for the continued operation of a 8,400 gpd subsurface
disposal system incorporating 13,455 linear feet of drain line.
This will produce a loading rate of .05 gpd/ft2. A review of the
site using the computer model EPAGW indicated of low risk of 21.
Standard exceedance beyond the facility compliance. boundary.
This is mainly due to the fact that the drain field is situated
for enough away from the surrounding property line to accommodate
a compliance boundary 250 feet from the perimeter of the drain
field in the anticipated directions of groundwater flow. The
Groundwater Section therefore has no objection to reissuance of
this permit, provided that the following condition is included:
1. Any groundwater quality monitoring, as deemed necessary
by the Division, shall be provided.
BC/JL:ja/91256.
c c t ► on L r%
Central Files
Permit Issuance Files
�"��j rSE9 2 7 1991

DIVISION OF ENVIRONMENTAL MANAGEMENT
GROUNDWATER SECTION
MEMORANDUM
TO: -Duy\ L i A
DATE : + 5 , 1991
FROM: Jack Floy
SUBJECT: Application for_
✓Renewal/Amendment of Permit No.j�
New Permit
Facility Name MAouall Alvrsias Horne
County AC oc.)-ed
Type of Project: d�Cveh/ac�o.s4.QsYrvi
Central Office Contact:
Applicable Permit Numbers: WQ OOCi SS/ 9 GW
AC
We have received a copy of the above referenced application,
wh'ch was sent to your regional office for comment on or about
19Ofl
You should review the application package for completeness
and adequacy of relevant information and submit your request for
ad tional information to me (via telephone or memo) by
, 199/so that all required information. can be
re uested from the applicant at one time. A copy of our formal
request to the applicant for additional information will be
provided to you.
If you do not require additional information from the
applicant to complete your evaluation of the project, you should
review the application package and submit your comments to me by
If a copy of the application package has not been made
available to your office, PLEASE LET ME KNOW IMMEDIATELY so that
a copy can be forwarded to you as soon as possible.
JF:ja/Appl.shl
D A�d�
9P - 61991
Groundwater Section
Asheville Re 'onal Office

GROUNDWATER SECTION GW # i S
DIVISION OF ENVIRONMENTAL MANAGEMENT
RECORD OF WASTE DISPOSAL' PERMIT APPLICATION REVIEW
REVIEW BY% '-/f1AI'kV50 DATE - /?14 6V FIELD INVESTIGATION? (Y I )
FACILITY NAME n 1,J6 / '(12-9 /W e- COUNTY A/
LOCATION ' 46,6L Sk l
TYPE OF DISPOSAL SYSTEM ( LAGOON, ETC.) .S/%le" DESIGN CAP. ( GPD) �l%d
DESCRIPTION OF FACILITYyh
SIZE OF IMPOUNDMENT (FT. SQ )
WASTE SOURCE : ❑ MUN. SLUDGE
❑IND. SLUDGE ❑IND. W. WATER
& / OR SIZE OF APPLICATION AREA
MUN. W. WATER: [:]PRIMARY []SECONDARY
OTHERS
DISTANCE FROM WASTE SOURCE TO NEAREST: STREAM FT.,
FOR WELL: TYPE OF USE'1 ''( DEPTH qf%
WHAT DESIGN CONDITIONS WILL
fN(-1 65 )WJfA56--
-i "a n'�:-1
WHAT NATURAL SITE CONDITIONS
❑ TERTIARY
WELL '210 FT.
, PUMP RATE ( EST. ) 4�; Pm
C / INCREASE CHANCff OF GW CONTAMINATION:
/ INCREASE CHANCE OF GW CONTAMINATION
DEPTH TO: BEDROCK 70 FT. , SEASONAL HIGH W. T.!S'
SURFICIAL AQUIFER
GEN. LITHOLOGYLdd-I-AV Glace
HYD. COND. FT./DAY MEASURED
ESTIMATED
THICKNESS FT.
FT. , ANNUAL W. T. FLUX :� FT.
BEDROCK / ARTESIAN AQUIFER
FT./DAY MEASURED
❑ ESTIMATED
NO. OF MONITOR WELLS: PROPOSED: UP 49 DOWN ; EXISTING: UP DOWN
FROM WORKSHEET: SITE NUMERICAL DESCRIPTION = _U - S - - (O 9- A— _ L'21z-
Leh r"A j$ y S` eW-j T 1 2 3 4 5 6 6A 6B
SITE GRADE (HYDROGEOL.) _ 1 1 1 SITUATION GRADEg�_
PROPOSED SAMPLING SCHEDULE & PARAMETER(S) : Nispe
REMARKS/RECOMMENDATIONS: K v m o n' a 0Q — w 61 i� C-ec- o r r-7 r ,-�
Ee-

WASTE DISPOSAL PERMIT APPLICATION
REVIEW
WORKSHEET
;f
/f C
Fodlffy
� vYSI /5
e-
V/Ow e �l
rw .-
.evl
®YL
Dole:
Mad
Determine the aWance
Fbht votue
0 1 2
J 4
on grekrfd betwreon can'
farnlnati n source and
fiance in
20M * 300 -999
75- 149
35 - 49
10. 19
Distance
Pt: Vokre
wale r wipply (,.cell Of
motors
1000 - 20M 150 - 299
50.74 20 - yi
0-9
(Ste 1
P )
dfearfo.
Distance In
6= 4 IODI - J 100
251 - ISM
101 - 160
J 1- 60
feel
3100-e200 501
- HOOD let - 250 61 - 100
0-30
UQift- If watef table In pefrrhooble bedrock pf. vokse -6. in poorly ponneoble bedrock
Sled 2
Point wlue
0 1 2
J 4
pt. value ■ 4
Estlmatethe depth
to the water table
Motors
604 J0-60f 2D-29
12-29 6-I1
6 0 7
5-7 J4 1525
e 0
6-I p
14iv,
Depth
P1 Varue
below, base of eon-
Feel
2DO a 01-200 61 90
36�o 24.35
16-25 9-15 Jar
0-2 0
W.i,
(Step 2I
tomh,aklon source
J,
more tthan 5 % of
the year.
Pckt_V i,a
0 1 _
1 4
IS
Estknose wader
Wolof table
Groderd Gradient
Gradient
Gradient Grodied
Gradient
Grodieri
Pt.;Vokse
table gradient
prodlenf and
knwy from olmod
law than
lew than grealof
greater
(Step J)
Romconlamih-
flowdtectan
ON water Not
2peroert
2poicend than
ItM2
allon el+e
wpples that
toward
Cawood percent
percent
t
on claw -
water
wafer toward
toward
anon 1000
supply but
KfppN water
wrote(
msdew
hat the
and Is the euppty
-Ppty
ardlcbafod
onfic"ed bdnof
and Isthe
dredlon of
direction of the arfF
anticbated
flaw
Clow cipafed
direction
dYeclion
of now
of Bow
Sleo
Wnade of
rmeabllMy-
sorption for the
waste disposal slle.
(2) A Row - pock > 100`
_
feet below
l—►
J
surface
(3)I cokrm - bedrock
ply
perfneable
O6 O
�
to
(4) II column - bedrock -
�ry�
p
P-rocble
�U0
Clay wAh
no more
than 501
Clay Bond ^
Sand with Sand with
15-30% low MOM
rnN' 1S i r-Jrry
Clean
grovel or
C1eon the coarse
sand smd
Mae than JO
OA
2A
4A
ell
eA
9A
More than 95
I
1
I
II
1
II
I
II
1
II
I
II
25 -29
OB
IC
ID
• •2F
JE
' 4G
5F
6E
7F
BE
9G
9M
75 - 94
20.24
OC
2C
IE
JD
4D
SE
SG
6F
7G
BF
9H
9N
60 -74
15 - 19
CO
38
IF
4C
4E
6C
5H
7D
7H
BG
91
90
46 - 59
10 -14
OE
48
2D
' 58
4F
6D
51
7E
71
90
9.1
9P
2e - 45
3-9
IB
68
2E
7B
5C
7C
SJ
BD
7J
9E
9K
9Q
10 - 27
Lew than J
IB
08
JC
BC
50
98
5K
9C
7K
9F
9L
9R
Lou than 1
Bedrock of lard surface; I - 52- I I - 92
Utal
Degree of confidence In accuracy of wines
RMAe
Point of concern with regard to oonlQnkhvt earae it
SIOD dA Addillonal Qsallfief (ardo only Ore)
Note : If Bedrock of lend surfoce• dose 10 (pkw approprlole letter)
A - very conNani
B - fairly conAderd
C .With low contldenoe
W - neon by wall
S - sp&v / dream
8 - perkrefef of complance
D - Cone of depression of noofby pkrnpifg well has.
of wil Ikety. hAsenoe coo amhanf Bar
E - Distance In Slop 1 based on separation from
cotdon,*X rl pkme rather than poW eo i
�■ Wale source In groundwater discharge area.
Ihka rniingl grovel raNk cordsr*KOioncidepth / ddcmce
M - FW rnokndinp under site hkft likoty
P ■ Silo has poor percolation polenilal (vatue of J ar lea in Slop 4 )
O. Wade source in groundwalor recharge area
i - Wolof table In wry Moldy froctuted or aavwoda rock
� r—
Category
,(Step 4)
ConMence
(Step 5)
Paird of,Concem
(Step 6A)
Okr�lrtbr
(Step 68)
K - Area underlain by c000rou MnedOne
y ■ Sale underlain by, I of mare ortestan aquifers

r.
WASTE DISPOSAL- PERMIT APPLICATION REVIEW WORKSHEET (CONT.)
F,
i
�.'ft1z.Z
• Site Nirtxrrt;al dnw-rtntbn
f�/ , �
.ter" I•
Told slop Slop 1 Step 2 Srep J
Stop 4 S4ep
Shp 6r1 Step m
( Add Step 1 - 4 (OmR letters) ),
SNle Grode bos•d on "F00*010& Parameters
91*12 A
Hazard Potenrid Matra Identtber (WM )
( Choose One) D G
1
B E
H
C
F 3
HPMI
U2 9
Total Penn / Sorp.
FPM
(1) Nwwlcol Site Descrip}bn (horn Step 7),
a) PAR VALUE (Stage S)
3
SITUATION RATING : (1) - (2)
-
(table below)
SITUATION GRADE
&
-
nos m co orx
L J
(see table below)
31*0 If) SITUATION GRADE -
(we table below)
SITUATION RATING TABLE
To bo used for Step V (Noturd) and Step 10 (Modtlhd)
(Step 10)
SITUATION RATING
PROBABILITY OF
SITUATION
(Combined Value)
CONTAMNATION DEGREE OF ACCEPTABILITY
GRADE
E or Ism
IrnprabdAe Probably 000sploble
A
-7 to J
7 Probably 000.pk bte or
J to 41
fnorgholy traooep4abb
? Aoceplar>a tnom Ink
C
44 b 47
Paba* Probc** rn000epktble
D
or rnargy acceptable
+A Of more
Very Probable Atnod certain to be
F
unacceptable
The p+obablIty of confornawnhalbn from Mtuallons having vokm between 17 and - 7 Y dRflc uft to categorize
sa0sfoctorty. Therefor.. "* range of values mK"wnted by grades B and C. Y deslpned a* by a question mark
Aoceptance or mOctton of ca dfe tof hne Intended purpose Is a responsblilfy of the particular repukrIory ogency
and may depend on speckd requfernents of the agency or on foosbrty and eueatrbn of approved
engineering of a atle (Stage 4 ).

i
rim
Groundws
Asheville Ri
'� 3 t.1: I0. 3 0
91 5�O
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Environmental Management
Non -Discharge Permit Application
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
SEPTIC TANK / LOW PRESSURE PIPE / GRAVITY
SUBSURFACE DISPOSAL SYSTEMS
[FOR MECHANICAL TREATMENT SYSTEMS WITH
SUBSURFACE DISPOSAL USE FORM MTDSI
(1 4E DIVISION OF ENVIRONMENTAL MANAGEMENT HAS JURISDICTION IF THE SYSTEM
T'EATS-INDUSTRIAL WASTEWATER OR IF THE SYSTEM IS OWNED BY A SANITARY
DISTRICT, A METROPOLITAN SEWAGE DISTRICT, A WATER & SEWER AUTHORITY, A
COUNTY, A MUNICIPALITY, OR A PUBLIC UTILITY. THE DIVISION OF ENVIRONMENTAL
HEALTH HAS JURISDICTION FOR OTHER DOMESTIC SUBSURFACE SYSTEMS)
I. • GENERAL INFORMATION:
1. Applicant (corporatioCi�.dividual, or other):
2. Print Owners or Signing Official's Name and Title (the person who is legally
responsible for the facility and its compliance): 4066-2-11- vc . I�YC
3. Mailing. Address: .9 -3 DUX Z70
City: State: /Ue— Zip: QN&I
Telephone No.: (, 7D ) 6,50 - 303 Zz
4. Project Name (subdivision, facility, or establishment name - should be consistent with
project name on plans/specs., letters of flow acceptance, Operational Agreements, etc.):
.. . ' .. �dr�&,OEZC... /1j��St�c1Ca �.F�•1 i Ems-- '
S. Application Date: �5 1 �12, 1q9 r 6. Fee Submitted: $ ' °"
7.. County where project is located: Ma DDu�_--z '
8. Address of treatment and subsurface facility: 26L4 42&=
r�r`FPI�ln� cE ,eo�kD, OF'F Se 7-74 .4>5' M t 5. of .Z -4-q'
.. - 9 Latitude- 3 % o� 31 JIA ; Longitude: g 1257 ! 57' W of subsurface fields
!.':_ FORM: LPPG 4/91 Page 1 of 10

I
LOW PRESSURFIGRAVITY
PAGE 2 (4/91).
-:PERMIT INFORMATION: _
1: Permit No. (will be completed by DEM):
I
• 2. Specify whether project is:
new; renewal*; _ L---, modification.
*If renewal, complete only sections I, II, III and applicant signature
(on pg.9). Submit only pgs. 1, 2, 9 (original and 3 copies of each). Engineer
signature not required for renewal. i
i
3. If this application is being submitted as a result of a renewand issued or modification
o ation to an
existing permit, list the existing permit number I
4. Specify whether the applicant is public or l� private.
5. Specify whether applicant is: sanitary district; metropolitan sewage district;
ater & sewer authority; county; municipality; public utility;
ther (explain) OIdIC) �
III. INFORMATION ON 'WASTEWATER:
=1: N atup of Wastewater: /00 % Domestic; � . % Commercial;
al;
Industrial; . 0 %Other waste (specify):
Please provide a one or two word description specifying the origin of the
2. p wastewater,
such as school subdivision, hospital, commercial, industrial, apartments, etc.:
3. If wastewater is not domestic in nature, what level of pretreatment has been provided
to ensure protection of the receiving treatment system: 4 *—K
4. Volume of wastewater generated by this project:
ova gallons per day
5. Explanation of how wastewater volume was determined:
. l;
' tames �
6. Brief project description: _
�• /D ��p5 D /µPS' �1Sr2/Pdroi� Orr F
-There There may be questions on thus application that are .not applicable i to the.
at low
stems vs.
subject project, such as questions aimed applicable or N/A; however, be 'certain
systems. In those instances state not pp application package will
that all pertinent questions have been answered or the
be returned as incomplete.
IY DESIGN INFORMATION:
"1. Specify the type of system that is being installed: low pressure;
V _ othery
2 of 10

` ••• - 'f• Lam.... 1
LOW PRESSURI:IGRAV=
PAGE 3 (4/91)
``..2c Provide a brief listing of the components of this treatment and disposal system (if not
covered by specific questions below), including dimensions, capacities, loading rates,
and detention times of tanks, pumping facilities (duplex pumps), high water alarms,
filters (specify type), ponds, lagoons, disinfection facilities, subsurface fields, etc.:
'.C15�r gsUI-F u�
- ( D a5i St 6!oA5 2 /4t4iN %. gUK�S S Nt n �z ill Si : xES
Pt�P 2- ti �tST Bac t5 u:/ u r�"thy , S 4 iAk-)P,_ D,5 7460171-eJ AOceS
�4J'GW rl &X> c &,1GsS of / 2 S ' 40AJ4 • - -
r
3. Specify the loading rate recommendation, as determined by' the soils scientist, for the
. subsurface disposal field: S GPD 'per square foot
.4. Specify the loading rate recommendation, as determined by the soils scientist, for the
=air area (100% replacement) subsurface disposal field: , S� GPD'per square ft.
-.5.. Specify design loading rate that will occur in disposal field: GPD / fL2
(In coastal areas the maximum is 1.5 GPD / square foot for gravity systems and 1.0
GPD per square foot for low pressure systems).
_ 6. Specify the number of subsurface fields: / ; The dimensions of -the fields:
. Supply line dia.: Z ¢" Manifold dia.: 3 1` ; Distribution lateral
dia.: Hole dia.: d.5" Afil ; Number of laterals: 140f 42 ; Lateral length
(typically 70 fL max, for LPP & 100 ft. max. for gravity): l 55` l', Trench
width: 3 ; Trench depth: f /u ; Minimum pressure head:
r
Maximum pressure head: 0-4- ; Minimum vertical separation between trench
bottoms and mean. seasonal high water table: r ; Distance on centers (forLPP not
less than 5 fQ: �� ; Maximum slope of trenches (should be less than 0.2% for
gravity systems):p./�?, Details must be provided in plans/specs-which
demonstrate that the ends of lines are plugged, that turn -ups are provided
for J,PP, =and that measures will be taken (grade boards, etc.) to, ensure
that laterals are properly installed.
'. 7. The following criteria should be used for the sizing of residential septic tanks:
a. three bedrooms or less , use minimum 900 gallons;
b. four bedrooms, use minimum 1000 gallons;
l e. five bedrooms, use minimum 1250 gallons.
,. 8. For businesses with a design flow less than 600 GPD, the minimum tank capacity shall
is be twice the flow.

LOW PRESSURFJGRAVITY
PAGE 4 (4191)
L.!:: 9. The following criteria should be used for the sizing of septic tanks for residences with �.
more than five bedrooms, multiple family residences, tanks serving two or more
residences*, or establishments with a flow between 600 GPD and 1500 GPD:
Septic Tank Volume = (1.17) (daily sewage flow) + 5W gallons
*Minimum septic tank capacity shall be 1500 gallons
10. For design flows between 1500 GPD and 4500 GPD, the following criteria shall be
used: Septic Tank Volume = (0.75) (daily sewage flow) + 1125 gallons
11.. For design flows which exceed 4500 GPD, use a septic tank capacity equal to the flow.
12. .. Specify the septic tank volume: J D1da © gallons
13. Specify the ` mp tank volume: &50 gallons
- =14. Specify the number of sannt/hir capacity: '0 S' at e GPM
15. Specify the high water alarms:, audible & visual; auto dialer
16. Name of closest downstlope surface waters: Ur,� AAAODnu66r" io
' 17. Classification of closest downslope surface waters:01 (as established
by the Environmental Management Commission and specified on page 7 :of this
application). ,
18. If a power failure at the facility could impact waters classified as 'WS, SA, B, or
SB, describe which of the measures are being i lemented to prevent such impact, as
required in 15 NCAC 2H .0200:
19. The different disposal fields, laterals, or groups of laterals in a subsurface system are
typically designed to be dosed at different rates or volumes froone another. Explain
m
the method that will be used to ensure that the proper dosing rates and volumes occur:
'4 I `Zcfl �O tJr�-u Z� Lau-> t NTo� JIo[3s L�J-Zc�.5
l IJST��$'O D� L-rl�•�W 1 t! �O[7�i >='C.ocy 1)I 57rLrr3dT,r�nl ���C�
20. The project must conform to the following buffers:
a) 100 feet between the disposal area and any public or private water supply
including wells;
b) 50 feet between disposal area and waters classified as WS-I, WS-II, WS-III
or B; and 100 feet between the disposal area and the normal high water
level of waters classified as SA or SB;
c) 50 feet between any the disposal area and any stream, lake, river, or
natural drainage way;
d) 50 feet between the treatment/disposal systems and property lines;
`r`3` 4of10 '

'7 21:"
LOW PRESSURE/GRAVITY
PAGE 5 (4/91)
e) 10 feet between the disposal area and any surface water interceptor drains
or diversions (upslope);
f) 25 feet between the disposal area and any surface water interceptor drains
or diversions (downslope) and any groundwater drainage systems;
g) 20 feet between disposal area and any other subsurface disposal area
except the repair area.
If any of the applicable buffers are are not being met, please explain how the proposed
buffers will provide equal or better protection of Waters of the State with no
increased potential for nuisance conditions: �A 14A
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE
DIVISION OF ENVIRONMENTAL MANAGEMENT UNLESS ALL OF
= THE APPLICABLE ITEMS ARE INCLUDED WITH THE SUBMITTAL
Required Items '
One original and three copies of the completed and appropriately executed application form.
b. The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(c)(5).
'c. Five sets of detailed plans and specifications signed and sealed by a North Carolina
Professional Engineer. The plans must include a general location map, a topographic map,
a site -map which indicates where borings or hand auger samples were taken, a map
showing the treatment/disposal facilities, buffers, structures, and property lines; along with
all wells, surface waters (100-year flood elevation), and surface drainage features within
500 feet of the treatnient/disposal facilities. Each sheet of the plans and the first page of
the specifications must be signed and sealed.
;d. Five copies of an Operational Agreement (original and 4 copies) must be submitted if the
wastewater treatment and disposal facilities will be serving single family residences,
condominiums, mobile homes, or town houses and if the subject facilities will be owned
' by the individual residents, a homeowners association, or a developer. i
c
Five copies of all reports, evaluations, agreements, supporting calculations, etc., must be
submitted as a part of the supporting documents which are signed and sealed by the North
Carolina Professional Engineer. Although certain portions of this required submittal must
be developed by other professionals, inclusion of these materials under the signature and
seal of a North Carolina Professional Engineer signifies that he has reviewed this material
and has judged it to be consistent with his proposed design.
Five copies of the existing permit if a renewal or modification.
g. A soils scientist report which includes texture, color, and structure of soils down to a
1 of seven feet, depth, thickness and type of any restrictive horizons, hydraulic
-depth
conductivity in the most restrictive horizon, cation exchange capacity (CEC), depth
of seasonal high water table, soil pH, soils map (if available), and recommended loading
rates. This report must be signed by the soils scientist.
�'t' 5 of 10

LOW PRESSURE/GRAVITY
PAGE 6 (4/91)
h. For systems treating industrial waste or any system with a design flow greater than
25,000 GPD a hydrogeologic and soils description of the subsurface to a depth of twenty
feet or bedrock, whichever is less. The number of borings shall be sufficient to
determine significant changes in lithology, the vertical permeability of the unsaturated
zone and the hydraulic conductivity of the saturated zone, depth to the mean seasonal
high water table, and a determination of transmissivity and specific yield of the
unconfined aquifer.
i. Proposal for groundwater monitoring.
J. Information on the location, construction details, and* primary usage of all wells within
500 feet of the treatment/disposal facilities.
k.- For industrial waste a complete chemical analysis of the typical wastewater to include, but
not be limited to Total Organic Carbon, BOD, COD, Chlorides, Phosphorus, Ammonia, _
Nitrates, Phenol, Total Trihalomethanes, Toxicity Test Parameters, Total Halogenated
Compounds, Total Colifoims, and Total Dissolved Solids.
':G�c`- 6 of 10

LOW PRESSURE/GRAVITY
PAGE 7 (4/91)
TO: REGIONAL WATER QUALITY SUPERVISOR
. Please provide me with the classification of the surface waters identified in number 5
below and on the attached map segment:
Name of surfacewaters:-
Classification (as established by the Environmental Management Cpmmission):
Proposed Classification, if applicable: %U IPJ
Signature of regional office personnel: Daie:
INSTRUCTIONS TO ENGINEER
In order to determine whether provisions for dual or standby power may be required for the.
subject facility, the classification of the closest downslope surface waters (the surface waters that
any overflow from the facility would now toward) must be determined. You are required to
submit this form, with items 1 through 10 completed, to the appropriate Division of Environmental
'Management Regional Water Quality Supervisor (see attached listing). At a minimum, you must
include an 8.5" by 11" copy of the portion of a 7.5 minute USGS Topographic Map which shows
-.`the subject surface waters. You must identify the location of the facility and the closest downslope
sui face waters (waters for which you are requesting the classification) on the submitted map copy.
} ' The application may not be submitted until this form is completed and included with the submittal.
1.
Applicant (corporation, individual, or other): )00176D�J Ti Carte
2.
Name,and Complete Address of Engineering Firm: AMGt• &4&ty 1'�
r,(11C
City: State:. 1� C: Zip: Z gg 01
Telephone No. 6704
'83.
Project Name: (&1?QWtom- A)04!iE /LJl7
4.
Facility design flow: GPD
5.
Name of closest downslope surface waters:`!-
6.
County(s) where project and surface waters are located:
7.
Map name and date: NZWO J 62 K,5/96
8.
North Carolina Professional Engineer's Registration No. /OS'7o9
9.
' eeeenttttt
Print Name of Engineer R
_
10.
,moo •....... ,y .
:9
Seal and Signature (specify date): :: •°pEESSIp •°• �':
g�
105IN
•s _r � n � fin' ......•• G _.`

DIVISION OF ENVIRONMENTAL MANAGEMENT REGIONAL OFFICES (4/91)
Asheville Regional WQ Super.
59 Woodfm Place
Asheville, NC 28802
704/251-6208
Avery Macon
Buncombe Madison
Burke McDowell
Caldwell Mitchell
Cherokee Polk
Clay Rutherford
Graham Swain
Haywood Transylvania
Henderson - Yancy
Jackson
Fayetteville Regional WQ Super.
Wachovia Building, Suite 714
Fayetteville, NC 28301
9191486-1541
Anson Moore
Bladeri Robeson
Cumberland Richmond
Harnett Sampson
Hoke Scotland
Montgomery
Winston-Salem Regional WQ Super.
8021 North Point Boulevard, Suite 100
Winston-Salem, NC 27106
919n61-2351
Alamance Rockingham
Alleghany Randolph
Ashe Stokes
Caswell Surry
Davidson Watauga
Davie Wilkes
Forsyth Yadkin
Guilford
Washington Regional WQ Super.
P O Box 1507
Washington, NC 27889
919/946-6481
Beaufort
Jones '
Bertie
Lenoir
Camden
Martin
Chowan
Pamlico
Craven
Pasquotank
Currituck
Perquimans
Dare
Pitt
Gates
Tyrell
Greene
Washington
Hertford
Wayne
Hyde
Mooresville Regional WQ Super.
919 North Main Street
Mooresville, NC 28115
704/663-1699
Alexander Mecklenburg
Caba= Rowan
Catawba Stanly
Gaston Union
Iredell -Cleveland
Lincoln
8 of 10
Raleigh Regional WQ Super.
3800 Barrett Dr., Suite 101
Raleigh, NC 27609
_919[733-2314
Chatham Nash
Durham Northampton
Edgecombe Orange
Franklin Person .
Granville" Vance
Halifax 'Wake;
Johnston Warren
Lea Wilson
Wilmington Region. WQ Super.
127 Cardinal Drive Cardinal,
Wilmington, NC 28405-3845
919/395-3900 ' .
Brunswick New Hanover
Carteret Onslow
Columbus Pendci
Duplin
i
i

LOW PRESSUREIGRAVITY
r- Page 9 (4191)
Flame and Complete Address of Engineering Firm: i JILI-4
City: f 5UW9V1 LL State: Zip:
Telephone No. f?�-�
Professional Engineer's Certification:
1, 4eyz(vc W. 1)670��j , 1P,45, , attest that this application for aplw:: '*ya1 5 is
Ae i)ulEz[. Ike-SJn., d-)xYr4 5 g D6PD51t-s`5.' has been reviewed by me and is accurate
and complete 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 the applicable regulations. Although certain
portions of this submittal package may have been developed by other professionals, 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.
North Carolina Professional Engineer's Registration No.
• Print Name of Engineer L�1 L-22445'
I
%�N CARp
Seal and Signature (specify date): •` •••••••••
•,.••E�SSIp' •. 9 ,
0569
-- F GIN
Applicant's Certification: 'CE,;;;,,���`
I, �L ,2 r— F . Ti4�LLo& , attest that this application four M oro i PeAr1 +ss r
- IA1� T a. •ri �/i�I )�� /�Y_�r11�N1 LlLtii il��lS' IJ/\f-i�/�i_ 57�%C�'/[ _
vC Y �W U tiC1 ) U •-rw . L-v �. v
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 attach ents� not included, thi application package will be returned as
incomplete.
Signature - Date
THE COMPLETED APPLICA ON PACKAGE, INCLUDING ALL SUPPORTING
INFORMATIONAND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY SECTION
PERMITS AND ENGINEERING UNIT
- .
POST OFFICE BOX 29535
•`== v
512 NORTH SALISBURY STREET.-
-
RALEIGH; NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: 919/733-5083 "
= r:
9 of 10
,•:

LOW PRESSL WGRAVnY
Page 10 (4/91) :..
PERMIT APPLICATION PROCESSING FEES
(effective October 1,1990) -
CATEGORY NEWAPPLICATIONS RENEWALS WrMOUT
MODIFICATIONS MODIFICATIONS
;.. > 1,000,000 GPD
Industrial
..$400
Domestic/Cooling Water
$400
10,001 - 1,000,000 GPD
Industrial
$400
Domesdc(Cooling Water
$400
.1,001 - 10,000 GPD
Industrial
$400
Domestic(Cooling Water
$400
< or =1,000 GPD and
Single Family Dwelling
• $240
Sludge < or = 300 Acres $400
Sludge > 300 Acres _ $400
Sewer Extensions
$300
$300
$250
$250
$200
$204
$120
$250
$250 -
(nondeiegated), .$400 0
Sewer Extensions
(delegated) .$200 -. :.:.0..
Closed -Loop Recycle '
or Evaporative , $400 $200
MOTE:. The Fees for Soil Remediation,Projects- are- the; same as for Sludges.
_ Under the Sewer Ektens on :Fee; ''delegated-.fo:°.municipalities" 4 applies
only to those ° governmental- jurisdictions.t.thai:,:haye specific delegation
- review authority; =as`granted":.b•y-_: tiie::Division of Environmental,..
Management. _ ,J-�
10 of 10 : .