WQ0042579_More Information Received_20220310

Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.) *
Yes No
If not an application what is the submittal type?* Annual Report
Residual Annual Report
Additional Information
Other
Permit Number (IR) *
WQ0042579
Applicant/Permittee
Brunswick County
Email Notifications
...................................................................................
Does this need review by the hydrogeologist? *
Yes No
Regional Office
Wilmington
CO Reviewer
Admin Reviewer

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Name* Carter Hubard
Email Address*
[e-mail]
Project Information
Application/Document Type*
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Phone Number*
9107624200
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
N DAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Perm it Type:* Wastewater Irrigation High -Rate Infiltration
Other Wastewater Reclaimed Water
Closed -Loop Recycle Residuals
Single -Family Residence Wastewater Other
Irrigation
Permit Number: * WQ0042579
Has Current Existing permit number
Applicant/Permittee Address* 250 Grey Water Road NE, PO Box 249, Supply, North Carolina
Facility Name* Mulberry Branch WRF
Please provide comments/notes on your current submittal below.
Revised HRIS Application signed
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
HRIS Application Revised Signed 3-8-22.pdf 724.53KB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
Submission Date 3/9/2022

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION
Plans, specifications and supporting documents shall be prepared in accordance with 15A NCAC 02H .0400 (if necessary), 15A
NCAC 02L .0100, 15A NCAC 02T .0100, 15A NCAC 02T .0700, Division Policies and Qood engmeerine practices. Failure to
submit all required items will necessitate additional processing and review time.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit ►rehsiee
General — When submitting an application to the Water Quality Permitting Section's Non -Discharge 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.
Unless otherwise noted. the Applicant shall submit one original and two copies of the application and supporting documentation_
A. Cover Letter (All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ). The appropriate fee amount for new and major modification applications may be found at: Standard Review
Project Fees,
C. High -Rate Infiltration Systems (FORM: HRIS 06-16) Application (All Application Packages):
® Submit the completed and appropriately executed High -Rate Infiltration Systems (FORM: HRIS 06-16) 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 Item 1.2. is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2. is a partnership or d/b.:a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The facility name in Item 11.1. shall be consistent with the facility name on the plans, specifications, agreements, etc.
® The Professional Engineer's Certification on Page 13 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 13 of the application shall be signed in accordance with ISA NCAC 02T .0106(b). Per
SA 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).
❑ If this project is for a renewal without modification, use the Non -Discharge Svstem Renewal (FORM: NDSR) application.
D. Property Ownership Documentation (All Application Packages):
➢ Per 15A NCAC 02T .0704 , the Applicant shall demonstrate they are the owner of all property containing the wastewater
treatment and high -rate infiltration facilities:
® Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
® Provide all agreements, easements, setback waivers, etc. that have a direct impact on the wastewater treatment, conveyance,
storage and high -rate infiltration facilities.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 1 of 6

E. Soil Evaluation (All Application Packages that include new high -rate infiltration sites):
® Per 15A NCAC 02T .0704(b) and the Soil Scientist Evaluation Polie , submit a detailed soil evaluation that has been signed,
sealed and dated by a North Carolina Licensed Soil Scientist and includes at a minimum:
® The report shall identify all the basins/fields with project name, location, and include a statement that the basins. fields
were recommended for the proposed land application activity.
® Field delineated detailed soils map meeting all of the requirements of the Soil Scientist Evaluation PoliC _
® Soil profile descriptions meeting all of the requirements of the Soil Scientist Evaluation Policv.
® Provide all soil boring logs performed at the site.
❑ For non -basins, a standard soil fertility analysis conducted no more than one year prior to permit application for each map
unit in the soil map legend for the following parameters:
❑ Acidity ❑ Exchangeable sodium percentage (by calculation) ❑ Phosphorus
❑ Base saturation (by calculation) ❑ Magnesium ❑ Potassium
❑ Calcium ❑ Manganese ❑ Sodium
❑ Cation exchange capacity ❑ Percent humic matter ❑ Zinc
❑ Copper ❑ pH
➢ Saturated hydraulic conductivity (KSAT) data that shall include at a minimum:
❑ A minimum of three KSAT tests shall be conducted in the most restrictive horizon for each soil series in the soil map.
❑ All KSAT tests shall be conducted in areas representative of the site.
❑ All KSAT tests shall be run until steady-state equilibrium has been achieved.
❑ All collected KSAT data shall be submitted, including copies of field worksheets showing all collected readings.
❑ Submit a soil profile description for each KSAT data point that shall extend at least one foot below the tested horizon.
➢ Soil evaluation recommendations shall include at a minimum:
❑ A brief summary of each map unit and its composition and identification of minor contrasting soils.
❑ For non -basins, maximum precipitation rate (in/hr) for each soilimap unit within the proposed infiltration areas.
❑ Seasonal infiltration restrictions, if appropriate.
❑ Identification of areas not suitable for high -rate infiltration.
❑ Recommended geometric mean KSAT rate to be used in the water balance for each soil: -map unit based upon in -situ
measurement of the saturated hydraulic conductivity from the most restrictive horizon.
❑ Recommended drainage coefficient to be used in the water balance based upon comprehensive site evaluation, review
of collected onsite data, minor amounts of contrasting soils and the nature of the wastewater to be applied.
❑ For non -basins, recommended annual hydraulic loading rate (in/yr) for each soil. -map unit within the proposed
infiltration areas based upon in -situ KSAT measurements form the most restrictive soil horizon.
❑ For basins, recommended hydraulic loading rate (GPD.:ftz) for each soil:'map unit within the proposed infiltration areas
based upon in -situ KSAT measurements form the most restrictive soil horizon.
NOTE -- If the soil evaluation was performed more than one year prior to the submittal of this application package, a statement shall
be included indicating that the site has not changed since the original investigation.
Agronomist Evaluation (All Application Packages that include new infiltration sites with cover crops or new crops for existing
infiltration sites):
® Per l 5A NCAC 02T .0704(i), submit an agronomist evaluation that has been signed, sealed and dated by a qualified professional
and includes at a minimum:
® Proposed nutrient uptake values for each cover crop based upon each field's dominant soil series and percent slope.
® Plant available nitrogen calculations for each cover crop using the designed effluent concentrations in Application Item
V.I. and proposed mineralization and volatilization rates.
® Historical site consideration, soil binding and plant uptake of phosphorus.
® Seasonal infiltration restrictions, if appropriate.
® A clear and reproducible map showing all areas investigated and their relation to proposed fields and crops.
® Maintenance and management plan for all specified crops.
INSTRUCTIONS FOR FORM- HRIS 06-16 & SUPPORTING DOCUMENTATION Page 2 of 6

G. Hydrogeologic Report (All Application Packages treating industrial waste or having a design flow over 25,000 GPD):
® Per ISA NCAC 02T ,0704(e), the Hydrogeologic investigation and Reporting Policy, the Groundwater Modeling_Policy and
the Performance and Analysis of Aquifer Slug Tests and Pumping Tests Policy, submit a detailed hydrogeologic description
that has been signed, sealed and dated by a qualified professional and includes at a minimum:
® A hydrogcologic description to a depth of 20 feet below land surface or bedrock, whichever is less. A greater depth of
investigation is required if the respective depth is used in predictive calculations.
® Representative borings within the infiltration areas and all proposed earthen impoundments.
® A description of the regional and local geology and hydrogeology.
® A description, based on field observations of the site, of the site topographic setting, streams, springs and other groundwater
discharge features, drainage features, existing and abandoned wells, rock outcrops, and other features that may affect the
movement of the contaminant plume and treated wastewater.
® Changes in lithology underlying the site.
® Depth to bedrock and occurrence of any rock outcrops.
® The hydraulic conductivity and transmissivity of the affected aquifer(s).
® Depth to the seasonal high water table (SHWT).
® A discussion of the relationship between the affected aquifers of the site to local and regional geologic and hydrogeologic
features.
® A discussion of the groundwater flow regime of the site prior to operation of the proposed facility and post operation of
the proposed facility focusing on the relationship of the system to groundwater receptors, groundwater discharge features,
and groundwater flow media.
® If the SHWT is within six feet of the surface, a mounding analysis to predict the level of the SHWT after wastewater
application.
H. Water Balance (All Application Packages that include new or modified infiltration sites, changes inflow or changes in storage):
❑ Per the Water Balance Calculation Policy, submit information clearly demonstrating that the effluent can be assimilated
regardless of precipitation events or temperature, and there are no crop or equipment maintenance issues that would necessitate
storage.
OR
® Per 15A NCAC 02T .0704(k) and the Water Balance Calculation Policy, submit a water balance that has been signed, sealed
and dated by a qualified professional and includes at a minimum:
® At least a two-year iteration of data computation that considers precipitation into and evaporation from all open atmosphere
storage impoundments, and uses a variable number of days per month.
® Precipitation based on the 801 percentile and a minimum of30 years of observed data.
® Potential Evapotranspiration (PET) using the Thomthwaite method, or another approved methodology, using a minimum
of 30 years of observed temperature data.
® Soil drainage based on the geometric mean of the in -situ K$A7 tests in the most restrictive horizon and a drainage coefficient
ranging from 4 to 10% (unless otherwise technically documented).
Other factors that may restrict the hydraulic loading rate when determining a water balance include:
® Depth to the SHWT and groundwater lateral movement that may result in groundwater mounding.
® Nutrient limitations and seasonal application times to ensure high -rate infiltration does not exceed agronomic rates.
® Crop management activities resulting in cessation of infiltration for crop removal.
NOTE -- High -Rate Infiltration Systems serving residential facilities shall have a minimum of 14 days of wet weather storage.
Engineering Plans (All Application Packages):
® Per 15A NCAC 02T .0704 c I , submit standard size and I I x 17-inch plan sets that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer, and shall include at a minimum-
0 Table of contents with each sheet numbered.
® A general location map with at least two geographic references and a vicinity map.
® A process and instrumentation diagram showing all flow, recycle.'retum, aeration, chemical, electrical and wasting paths.
® Plan and profile views of all treatment and storage units, including their piping, valves, and equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), as well as their dimensions and elevations.
® Details of all piping, valves, pumps, blowers, mixers, diffusers, recording devices, fencing, auxiliary power, etc.
® A hydraulic profile from the treatment plant headworks to the highest infiltration point.
® The high -rate infiltration area with an overlay of the suitable infiltration areas depicted in the Soil Evaluation.
❑ For non -basins, each nozzle.:emitter and its wetted area influence and each infiltration zone labeled as it will be operated.
❑ For non -basins, locations within the infiltration system of air releases, drains, control valves, highest infiltration
nozzle/emitter, etc.
❑ For non -basin automated infiltration systems, provide the location and details of the precipitation/soil moisture sensor.
® Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 3 of 6

J. Specifications (All Application Packages):
® Per I SA NCAC 02T ,0704(c)(2), submit specifications that have been signed, sealed and dated by a North Carolina licensed
Professional Engineer, and shall include at a minimum:
® Table of contents with each section/page numbered.
® Detailed specifications for each treatmcnt/storager'infiltration unit, as well as all piping, valves, equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), nozzles:emitters, precipitation/soil moisture sensor (if applicable),
audible/visual high water alarms, liner material, etc.
® Site Work (i.e,, earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
® Materials (i.e., concrete, masonry, steel, painting, method of construction, etc.)
® Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
® Means for ensuring quality and integrity of the finished product, including leakage, pressure and liner testing.
® Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
K. Engineering Calculations (All Application Packages):
® Per 15A NCAC 02T .0704(c)(3), submit engineering calculations that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
® Hydraulic and pollutant loading calculations for each treatment unit demonstrating how the designed effluent
concentrations in Application Item V.I. were determined.
® Sizing criteria for each treatment unit and associated equipment (i.e , blowers, mixers, flow meters, pumps, etc.).
® Total and effective storage calculations for each storage unit_
® Friction/total dynamic head calculations and system curve analysis for each pump used.
® Manufacturer's information for all treatment units, pumps, blowers, mixers, diffusers, flow meters, etc.
® Flotation calculations for all treatment and storage units constructed partially or entirely below grade.
❑ For non -basins, a demonstration that the designed maximum precipitation and annual loading rates do not exceed the
recommended rates.
® For basins, a demonstration that the designed loading rate (GPDift') does not exceed the recommended rate.
® A demonstration that the specified auxiliary power source is capable of powering all essential treatment units.
L. Site Map (All Application Packages):
® Per 15A NCAC 02T .0704 d , submit standard size and 1 I x 17-inch site maps that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer and/or Professional Land Surve or, and shall include at a minimum:
® 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 the wastewater treatment, storage and infiltration areas.
® Soil mapping units shown on all infiltration sites.
® The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage
and infiltration sites.
® Delineation of the compliance and review boundaries per l 5A NCAC 02�..0107 and .0108.
® Setbacks as required by 15A NCAC 02T .0706.
® Site property boundaries within 500 feet of all wastewater treatment, storage and infiltration sites.
® All habitable residences or places of public assembly within 500 feet of all treatment, storage and infiltration sites.
NOTE — For clarity, multiple site maps of the facility with cut sheet annotations may be submitted.
M. Power Reliability Plan (All Application Packages):
® Per 15A NCAC 02T .0705(k), submit documentation of power reliabi' ity that shall consist of at a minimum:
® An automatically activated standby power supply onsite that is capable of powering all essential treatment units under
design conditions, OR
➢ Approval from the Director that the facility:
❑ Serves a private water distribution system that has automatic shut-off during power failures and has no elevated water
storage tanks,
❑ Has sufficient storage capacity that no potential for overflow exists, and
❑ Can tolerate septic wastewater due to prolonged detention,
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 4 of 6

N. Operation and Maintenance Plan (All Application Packages):
® Per 15A NCAC 02T 0707, submit an operation and maintenance (O&M) plan encompassing all wastewater treatment, storage
and infiltration systems that shall include at a minimum a description of-
® Operation of the wastewater treatment, storage and infiltration systems in sufficient detail to show what operations are
necessary for the system to function and by whom the functions are to be conducted.
® Anticipated maintenance of the wastewater treatment, storage and infiltration systems.
® Safety measures, including restriction of access to the site and equipment.
® Spill prevention provisions such as response to upsets and bypasses, including how to control, contain and remediate.
® Contact information for plant personnel, emergency responders and regulatory agencies.
NOTE — A final O&M Plan shall be submitted with the partial and/or final Engineering Certification required under 15A NCAC
02T .01 16, however, a preliminary O&M Plan shall be submitted with each application package.
0. Residuals Management Plan (All Application Packages with new, expanding or replacement wastewater treatment systems):
® Per 15A NCAC 02T .0704(i) and .0708, submit a Residuals Management Plan that shall include at a minimum:
® A detailed explanation of how generated residuals (including trash, sediment and grit) will be collected, handled, processed,
stored, treated, and disposed.
® An evaluation of the treatment facility's residuals storage requirements based upon the maximum anticipated residuals
production rate and ability to remove residuals.
® A permit for residuals utilization or a written commitment to the Applicant from a Permittee of a Department approved
residuals disposal. -utilization program that has adequate permitted capacity to accept the residuals or has submitted a
residuals. -'Utilization program application.
❑ If oil. -grease removal and collection are a designed unit process, submit an oil/grease disposal plan detailing how the
oil. -'grease will be collected, handled, processed, stored and disposed.
NOTE — Per 15A NCAC 02T .0705(n), a minimum of 30 days of residual storage shall be provided.
NOTE — Per I SA NCAC 02T .0704(i), a written commitment to the Applicant from a Permittee of a Department approved residuals
disposal/utilization program is not required at the time of this application, however, it shall be provided prior to operation of any
permitted facilities herein.
NOTE — If an on -site restaurant or other business with food preparation is contributing wastewater to this system, an oil/grease
disposal plan shall be submitted.
P. Additional Documentation:
➢ Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115 a i and .07�g), provide the Certificate of Public Convenience and Necessity 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 treatment and high -rate infiltration 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.
➢ Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit modification
(i.e., compliance schedules, permit description, monitoring, permit conditions, etc.).
➢ Final Environmental Document (All Application Packages using public monies or lands subject to the North Carolina
Environmental Policy Act under 15A NCAC 01 C .0100 to 0400):
® Per 15A NCAC 02T .0105(c)(4), submit one copy of the environmental assessment and three copies of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
❑ Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the wastewater treatment and high -rate infiltration system.
➢ Floodway Regulation Compliance (Ail Application Packages where any portion of the wastewater treatment, storage and
infiltration system is located within the 100-year floodplain):
® Per I SA NCAC 02T .0105(c)(8), provide written documentation from all local governing entities that the facility is in
compliance with all local ordinances regarding construction or operation of wastewater treatment and/or disposal facilities
within the floodplain.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 5 of 6

P. Additional Documentation (continued):
➢ Operational Agreements (All Application Packages for Home/Property Owners' Associations and Developers of lots to be
sold):
➢ Home/Pro a Owners' Associations
❑ Per 15A NCAC 02T .01 15c , submit the properly executed Operational Agreement FORM: HOA .
❑ Per I SA NCAC 02T .01 15(c), submit the proposed or approved Articles of Incorporation, Declarations and By-laws-
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement FORM: DEV .
➢ Threatened or Endangered Aquatic Species Documentation (All Application Packages):
® Per 15A NCAC 02T .01_ 05(c)(10), submit documentation from the Department's Natural Heritage Program demonstrating
the presence or absence of threatened or endangered aquatic species within the boundary of the wastewater treatment,
storage and infiltration facilities.
❑ If the facility directly impacts such species, this documentation shall provide information on the need for permit conditions
pursuant to 15A NCAC 02B .0110.
➢ Wastewater Chemical Analysis (All Application Packages treating Industrial Waste):
❑ Per 15A NCAC 02T .0704(h), provide a complete Division certified laboratory chemical analysis of the effluent to be
infiltrated for the following parameters (For new facilities, an analysis from a similar facility's effluent is acceptab,e);
❑ Ammonia Nitrogen (NH3-N) ❑ Nitrate Nitrogen (NO3-N) ❑ Total Organic Carbon
❑ Calcium ❑ pH
❑ Chemical Oxygen Demand (COD) ❑ Phenol ❑ Total Phosphorus
❑ Chloride ❑Total Trihalomethanes
❑ Sad.um ❑ Total Volatile Organic Compounds
❑ Fecal Coliform ❑ Sodium Adsorp'ion Ra-,i« (SAR1 ❑ Toxicity Test Parameters
❑ 5-day Biochemical Oxygen Demand (BOD5) ❑ Total Dissolved Solids
❑ Magnesium ❑ Total Kjeldahl Nitrogen JI(N)
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier.-Snecial Delivery:
512 N. SALISBURY ST.
RALEIGH NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION
Page 6 of 6

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0700 -- HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources FORM: HRIS 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: Brunswick Coun
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Uti:jty
❑ Federal ❑ State ❑ Municipal ® County
3. Signature authority's name: John Nichols, PE. CPESC per 15A i\CAC,02T .0106(b) Title: Public Utility Director
4. Applicant's mailing address: PO Box 249
City: Bolivia State: NC Zip: 28422-_
5. Applicant's contact information:
Phone number: [phone] Email Address: John. [e-mail]_v
It. FACILITY INFORMATION:
I. Facility name: Mulberry Branch Water Reclamation Facility.
2. Facility status: Proposed
3. Facility type: Major (> 10,000 GPD or >_ 300 disposal acres)
4. Facility's physical address: Forest St Extension NW
City: Shallotte State: NC Zip: 28470- County: Brunswick
S. Wastewater Treatment Facility Coordinates (Decimal Degrees): Latitude: 33159'57.0" Longitude:-7M2'46.9"
Datum:NAD83 Level of accuracy: Nearest 10th of a second Method of measurement:
Aerial photography with ground control
6. USGS Map Name: A USGS Map of the Protect Site may be found in Attachment P.3 "Engineering Re ort/Envrronmental
Information Document Wastewater Treatment and Disposal for the City of South ort" in Figure 7.1 a re ort Rage 49.
III. CONSULTANT INFORMATION:
I. Professional Engineer: T. Carter Hubard, PE License Number: 24984 Firm: WK Dickson & Co.. Inc.
Mailing address: 300 N. Third Street Suite 301
City: Wilmington
State: NC Zip: 28401
Phone number: (N10) 762-4200
Email Address. tchubardta`)wkdickson.com
2. Soil Scientist: Edwin Andrews
License Number: C-224 Firm: Edwin Andrews & Associates
Mailing address: PO Box 30653
City: Raleigh State: NC
Zip: 27622-0653
Phone number: (L12) 851-7844
Email Address: [e-mail]
3. Geologist: Edwin Andrews
License Number: 1226 Firm: Edwin Andrews & Associates
Mailing address: PO Box 30653
City: Raleigh State: NC
Zip: 27622-0653
Phone number: (N19) 851-7844
Email Address: edwinandrews c m jzmail.com
4. Agronomist: Edwin Andrews
Firm: Edwin Andrews & Associates
Mailing address: PO Box 30653
City: Raleigh State: NC
Zip: 27622-0653
Phone number: [phone]
Email Address: edwinandrewspcCgmail.com
FORM: HRIS 06-16 Page I of 19

IV. GENERAL REQUIREMENTS— 15A NCAC 02T .0100:
1. Application type: ® New ❑ Major Modification ❑ Minor Modification
If a modification, provide the existing permit number: WQ00_ and most recent issuance date:
2. Application fee: S1,310 -Standard - Major Facili -New Permit
3. Does this project utilize public monies or lands? ® Yes or ❑ No
If yes, was an Environmental Assessment required under 15A NCAC 01 C? ® Yes or ❑ No
If yes, which final environmental document is submitted? ❑ Finding of No Significant Impact or ❑ Record of Decision
Briefly describe any mitigating factors from the Environmental Assessment that may impact this facility: Environmental
Assessment is currently pending,all comments thus far have been responded to and final apRroval is [)ending.
4. What is the status of the following permits/certifications applicable to the subject facility?
Permit/Certification
Collection System Q > 200,000 GPD
Date
Submitted
Date
Approved
Permit/Certification
Number
Agency Reviewer
Dam Safety
Erosion & Sedimentation Control Plan
8 10.'21
9 24 21
BRUNS-2022-022
Nationwide 12 r Section 404
7r1201
9 29 21
SAW-2021-01545
Pretreatment
Sewer r
Stormwater Management Plan
&110i21
SW8 210809
Steve Pusey
Wetlands 401
T16?21
9 28 21
20210653
Other:
5. What is the wastewater type? ® Domestic or Industrial (See 15A NCAC 02T .0103(20 )
Is there a Pretreatment Program in effect? ❑ Yes or ❑ No
Hasa wastewater chemical analysis been submitted? ❑ Yes or ❑ No
6. Wastewater flow: Please refer to the Engineering Re ort/Environmcntal Information Document in Attachment P.3 for a
description of how the design flow was determined. The design flow is 750,000 GPD
Limited by: ❑ Treatment, ❑ Storage, ® Field/Basin Hydraulics, ❑ Field Agronomics or ❑ Groundwater Mounding
7. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .01 14 or ® Representative Data
Has a flow reduction been approved under 15A NCAC 02T .0I 14(f)? ❑ Yes or ® No
Establishment Type I Daily Design Flow' INo. of Units Flow
gal;'
GPD
gal;'
GPD
gal:'
GPD
gal:"
GPD
gal:'
GPD
gal.:
GPD
Total
GPD
a See 15A NCAC 02T .0114 d e l and(e)(2),for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
FORM: HRIS 06-16 Page 2 of 19

IV. GENERAL REQUIREMENTS- 15A NCAC 02T .0100 (continued):
8. What is the nearest 100-year flood elevation to the facility? 26.5 feet mean sea level, Source: NC Flood Risk
Are any treatment, storage or infiltration facilities located within the 100-year flood plain? ® Yes or ❑ No
If yes, which facilities are affected and what measures are being taken to protect them against flooding? The nearest
If yes, has the Applicant submitted written documentation of compliance with § 143 Article 2,1 Part 6? ❑ Yes or ® No
9. Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing
information provided by the Department's Natural Heritage Program? ® Yes or ❑ No
10. Does the facility have a proposed or existing groundwater monitoring well network? ® Yes or ❑ No
If no, provide an explanation as to why a groundwater monitoring well network is not proposed:
If yes, complete the following table (NOTE This table maybe expanded for additional wells):
Well Name
Status
Latitude a
Longitude'
Gradient
Location
BA 1
Proposed
340 00' 38.4"
-078' 23' 23'
Cross Gradient
Inside Review
Boundary
BA 2
Proposed
340 00' 34.9"
-078' 23' 2.4"
Down Gradient
Inside Review
Boundary
BA 3
Proposed
340 00' 39.9"
0780 22' 55.3"
Up Gradient
On Compliance
Loundary
BB 1
Proposed
340 00' 47.4"
078' 22' 49.1"
Up Gradient
Inside Review
Boundary
BB 2
Proposed
340 00' 41.3"
078" 22' 50.1"
Down Gradient
Inside Review
Boundary
BB 3
Proposed
34" 00' 44.5"
078G 22' 47.9"
Cross Gradient
On Compliance
Boundary
W l
Proposed
34° 00' 42.9"
078` 22' 46.3"
Down Gradient
Outside Compliance
Boundary
W2
Proposed
340 00' 42.4"
078° 22' 39.8"
Down Gradient
Outside Compliance
Boundary
BC I
Proposed
340 00' 45.6"
0780 22' 35.7"
Up Gradient
Inside Review
Boundary
BC 2
Proposed
340 OU 39.1"
078° 22' 37.5"
Cross Gradient
On Compliance
Boundary
BC 3
Proposed
340 00' 37.9"
0780 22' 30.4"
Down Gradient
Inside Review
BoundaLy
a Provide the following latitude and longitude coordinate determination information:
Datum:NAD83 Level of accuracy. Nearest 10' of a second. Method of measurement:
Conversion from State Plan Coordinate
11. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
❑ Yes, ❑No or ®NIA
12. If the Applicant is a Developer of lots to be sold, has a Developer's O erational Agreement FORM: DEV been submitted?
❑ Yes, [-]No or ®N/A
13. if the Applicant is a Home/Property Owners' Association, has an Association Operational Agreement FORM: HOA been
submitted? ❑ Yes, ❑No or ®N/A
14. Demonstration of historical consideration for permit approval - 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal taw or G.S. 143-215.6B? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
FORM: HRIS 06-16 Page 3 of 19

e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(c)(2)? ❑ Yes or ® No
FORM: HR1S 06-16 Page 4 of 19

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705:
I. For the following parameters, provide the estimated influent concentrations and designed effluent concentrations as
determined in the Engineering Calculations, and utilized in the Agronomic Evaluation and Groundwater Modeling (if
applicable):
Parameter
Estimated Influent Concentration
Designed Effluent Concentration
(monthly average)
Ammonia Nitrogen (NH3-N)
36.3 mg/L
0.39 mg/L
Biochemical Oxygen Demand (BOD5)
300 mg/L
1.39 mg/L
Fecal Coliforms
14 per 100 mL
Nitrate Nitrogen (NO3-N)
0 mg/L
3.6 mg/L
Nitrite Nitrogen (NOz-N)
0 mg/L
0.17 mg/L
Total Kjeidahl Nitrogen
1.5 mg/L
Total Nitrogen
42.6 mg/L
5.38 mg/L
Total Phosphorus
6.1 mg/L
2.12 mg/L
Total Suspended Solids (TSS)
350 mg/L
2.t5 mg/L
2. Is flow equalization of at least 25% of the average daily flow provided? ® Yes or ❑ No
3. Does the treatment facility include any bypass or overflow lines? ® Yes or ❑ No
If yes, describe what treatment units are bypassed, why this is necessary, and where the bypass discharges: There is s a force
main that conveys wastewater directly from the Influent Pump Station to the Anaerobic Selector at the head of the Oxidation
Ditch bypassing the Equalization Basin. No treatment processes will be bypassed with this line. There is a small diameter
drain line from the oxidation ditches that discharges to the plant drain pump station. This is a small pump station which
conveys wastewater to the head of the anaerobic selector. This drain line is intended to be used only for taking the oxidation
ditch out of service and not for bypassing treatment. While this drain line can be used to bypass the secondaty clarifiers
ultimately the flow would cycle back through the secondary clarifiers before being able to flow to the disc filter,
4. Are multiple pumps provided wherever pumps are used? ® Yes or ❑ No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0705 ' ?
5. Check the appropriate box describing how power reliability will be provided in accordance with 15A NCAC 02T .0705(k):
® Automatically activated standby power supply onsite capable of powering all essential treatment units; or
❑ Approval from the Director that the facility:
➢ Hasa private water supply that automatically shuts off during power failures and does not contain elevated water
storage tanks;
➢ Has sufficient storage capacity that no potential for overflow exists; and
➢ Can tolerate septic wastewater due to prolonged detention.
6. If the wastewater treatment system is located within the 100-year flood plain, are there water -tight seals on all treatment units
or a minimum of two feet protection from the 100-year flood plain elevation? ❑ Yes, ❑ No or ® N:'A
7. In accordance with I SA NCAC 02T .0705(n), how many days of residuals storage are provided? Sludge will primarily be
wasted to the Regional Facili for disposal - See attached Biosolids Report. Additionally. onsite storage is available.
8. How does the Applicant propose to prohibit public access to the wastewater treatment and storage facilities? The location of
the site is remote. There are several dirt roads that lead to the area. These roads will either be izated or an earthen barricade
will be install. Please refer to sheet C4 in the plan set.
9. If an influent pump station is part of the proposed facility (i.e., within the wastewater treatment plant boundary), does the
influent pump station meet the design criteria in 1 SA NCAC 02-F .0305(h)? ® Yes, ❑ No, ❑ N A — To be permitted
separately, or ❑ N.-A — Gravity fed
10. If septic tanks are part of the wastewater treatment facility, do the septic tanks adhere to the standards in 15A NCAC 18A
.1900? ❑ Yes, ❑ No or ®N?A
FORM: HRIS 06-16 page 5 of 19

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
11. Provide the requested treatment unit and mechanical equipment information:
a. PRELIMINARY/ PRIMARY TREATMENT (i.e., physical removal operations and flow equalization):
Treatment Unit
No. of
Manufacturer or
Dimensions (ft) /
Volume
Plan Sheet
Specification
Units
Material
Spacings in(gallons)
Reference
Reference
Mechanical Bar Screen
1
Rotary Drum-
0.25 inches
3.125 gpd
M 1, 2, 4, 5
46 21 33
Manual Bar Screen
1
Bypass Screen
I - inch
3.125 gpd
M I, 2
Ni
Other
I
Stacked Tray
M1, 2, 3, 4
46 23 00
Other
1
Equalization Tank
325,,000
M8
33 1600
gal
Other
1
Septage Receiving
M28, 29
46 21 33
Station
b. SECONDARY / TERTIARY TREATMENT (i.e., biological and chemical processes to remove organics and nutrients)
Treatment Unit
No. of
Manufacturer or
Dimensions (ft)
Volume
Plan Sheet
Specification
Units
Material*(gallons)
Reference
Reference
Other
I
Veolia-Anaerobic
Selector
25 x 41 x 12
90,000
M10, 11
46 51 47
Aeration Basin
2
Veolia-Oxidation I
Ditches
Apprx89 x 36 x 18
800,000
M 10, 11
46 51 47
Clarifier
2
Veolia-Secondary
Clarifiers
35 ft Dia. X 16
115,000
M 10, 14, 15
44 42 20
Tertiary Filters
2
Veolia-Disc Filter
_
1,875,000
M18, 19
46 61 46
d each
Select
Select
Select
Select
*Note: Manufacturers listed are the basis of design. Actual manufacturer to be determined by bidding process.
c. DISINFECTION
Treatment Unit
No. of
Manufacturer or
Dimensions (ft)
Volume
Plan Sheet
Specification
Units
Material*
(gallons)Reference
Reference
Ultraviolet
2
Trojan
Approx. 52 x 8 x 7
Iv1GD
M20, 21
43 32 64
Select
*Note: Manufacturers listed are the basis of design. Actual manufacturer to be determined by bidding process.
➢ If chlorination is the proposed method of disinfection, specify detention time provided: minutes (NOTE — 30
minutes minimum required), and indicate what treatment unit chlorine contact occurs:
➢ If ultraviolet (UV) light is the proposed method of disinfection, specify the number of banks: 2 number of lamps per
bank: 12 and maximum disinfection capacity: 1.875 GPM.
d. RESIDUAL TREATMENT
Treatment Unit
No. of
Manufacturer or
Dimensions (ft)
Volume
Plan Sheet
Specification
Units
Material(gallons)
Reference
Reference
Aerobic Digester
]
Concrete
75 ft. Dia.
600,000
M24, 25, 256
18 ft S WD.
Select
FORM: HRIS 06-16 Page 6 of 19

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
e. PUMPS
Location
No. of
Purpose
Manufacturer{
Capaci
Plan Sheet
Specification
GPM
TDH
Pumps
Type
Reference
Reference
PS No. 1
3
Headworks to EQ
Tank and Lagoon
Self Priming
11650
47.4
M6,7
22 1330
PS No. 2
13
HcaddwWorks. to
Self Priming
1,302
82.2
M6, 7
22 1330
PS No. 3
3
LTV Disinfection to
Infiltration Basins
Self Priming
1302
70.3
M22, 23
22 1330
RAS: Secondary
PS No. 4
3
Clarifiers to
Self Priming
394
93.8
M16, 17
22 1330
Anaerobic Selector
WAS: Secondary
PS No. 5
2
Clarifier to Aerobic
Self Priming
250
102
M16, 17
22 1330
Digesters
Sludge Transfer:
PS No. 6
2
Aerobic Digester to
Self Priming
740
44.1
M24
22 13 30
Truck Loading
PS No. 7
2
Plant Drain to
Anaerobic Selector
Self Priming
800
400
47.2
107
M27
22 1330
Scum Pump Station
2
Secondary Clarifier
to Aerobic Digesters
Chopper Pump
275
39
M30
43 24 16
Jet Aeration — EQ
Basin
1
Mixing
Solids Handling
2,928
20
M9
4322 13
Jet Aeration—
Oxidation Ditch
6
Mixing
Solids Handling
1,775
25
M13
4322 13
Jet Aeration --
Digester
I
Mixing
Solids Handling
5,856
22
M26
4322 13
Grit Pumps
2
Grit Removal
Submersible
250
160
11.2 1
18.6
MI,M2,M4
46 23 00
Non Potable Water
2
Non Potable Water
Vertical Turbine
60
189 1
M22,M23
43 21 49
f. BLOWERS
Location
No. of
Units Served
Manufacturer I
Capacity
Plan Sheet
Specification
Blowers
Type
(CFM)
Reference
Reference
Equalization Tank
2
1-Equalization Tank
Positive
450 scfm
M8, 9
43 1133
Displacement
Oxidation Ditch
3
2-Oxidation Ditches
Positive
350-475
M10, 12
43 1 133
Displacement
scfm
Aerobic Digesters
3
2-Aerobic Digesters
Positive
322-580
M24, 25, 26
43 11 33
Displacement
scfm
g. MIXERS
Location
No. of
Mixers
Units Served
Manufacturer 1
Type
Power
h
Plan Sheet
Reference
Specification
Reference
Anaerobic Selector
1
Anaerobic Selector
Top Entry
2
M10
46 51 47
Anaerobic Selector
I
Anaerobic Selector
Top Entry
0.75
M10
46 5147
Anaerobic Selector
7 1
Anaerobic Selector
Top Entry
0.5
MIO
46 51 47
h. RECORDING DEVICES & RELIABILITY
No. of Maximum Plan Sheet Specification
Device Units Location Manufacturer Capacity Reference Reference
FORM: HRIS 06-16 Page 7 of 19

Influent F:ow
MeasuringDevice
2
Headworks
Toshiba or Equal
3,500
GPM
M3
40-91-16
Effluent Flow
Effluent Pump
2,000
MeasuringDevice
I
Station
Toshiba or Equal
GPM
M23
40-91-16
Effluent Flow
Measurin Device
3
High Rate
Infiltration Basis
Toshiba or Equal
1,500
GPM
C50-C-52
40-91-16
Select
EFFLUENT PUMP DOSING TANK (IF APPLICABLE):
Plan Sheet
Reference
Specification
Reference
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
Total volume
ft'
gallons
Dosing volume
ftl
gallons
Audible & visual alarms
Equipment to prevent infiltration during rain
events if applicable)
FORM: HRIS 06-16 Page 8 of 19

VI. EARTHEN STORAGE IMPOUNDMENT DESIGN CRITERIA — 15A NCAC 02T .0705:
IF MORE THAN ONE IMPOUNDMENT PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. What is the earthen impoundment type? Select
2. Storage Impoundment Coordinates (Decimal Degrees): Latitude: Longitude: -
Datum: Select Level of accuracy: Select Method of measurement: Select
3. Do any impoundments include a discharge point (pipe, spillway, etc)? ❑ Yes or ❑ No
4. Are subsurface drains present beneath or around the impoundment to control groundwater elevation? ❑ Yes or ❑ No
5. Is the impoundment designed to receive surface runoff? ❑ Yes or ❑ No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the water balance? ❑ Yes or ❑ No
6. If a liner is present, how will it be protected from wind driven wave action':
7. Will the earthen impoundment water be placed directly into or in contact with GA classified groundwater? ❑ Yes or ❑ No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not result in a
contravention of GA groundwater standards? ❑ Yes or ❑ No
8. What is the depth to bedrock from the earthen impoundment bottom elevation? ft
If the depth to bedrock is less than four feet, has the Applicant provided a liner with a hydraulic conductivity no greater than
I x 10-' cm/s? ❑ Yes, No or ❑ N.--A
Has the Applicant provided predictive calculations or modeling demonstrating that surface
water or groundwater standards will not be contravened? ❑ Yes or ❑ No
If the earthen impoundment is excavated into bedrock, has the Applicant provided predictive calculations or modeling
demonstrating that surface water or groundwater standards will not be contravened? ❑ Yes, ❑ No or ❑ N: A
9. If the earthen impoundment is lined and the mean seasonal high water table is higher than the impoundment bottom
elevation, how will the liner be protected (e.g., bubbling, groundwater infiltration, etc.)?
10. If applicable, provide the specification page references for the liner installation and testing requirements:
11. If the earthen impoundment is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
12. Provide the requested earthen impoundment design elements and dimensions:
Earthen Impoundment Design Elements
Earthen Impoundment Dimensions
Liner type:
ClaySynthetic
Top of embankment elevation:
ft
Other
I LJ Unlined
Liner hydraulic conductivity:
x cm/s
Freeboard elevation:
ft
Hazard class:
Select
Toe of slope elevation:
ft
Designed freeboard:
ft
Impoundment bottom elevation:
ft
Total volume:
ft3
gallons
Mean seasonal high water table depth:
ft
Effective volume:
ft3
gallons
Embankment slope:
Effective storage time:
days
Top of dam water surface area:
ft2
Plan Sheet Reference:
Freeboard elevation water surface area:
ft2
Specification Section:
Bottom of impoundment surface area:
ft2
NOTE — The effective volume shall be the volume between the two foot freeboard elevation and the: (1) pump intake pipe
elevation; (2) impoundment bottom elevation or (3) mean seasonal high water table, whichever is closest to the two foot
freeboard elevation.
FORM: HRIS 06-16 Page 9 of 19

VII. INFILTRATION SYSTEM DESIGN CRITERIA— 15A NCAC 02T .0705:
1. Provide the minimum depth to the seasonal high water table within the infiltration area: Basin A: 4 ft. Basin B: 4 ft, Basin C:
4ft
NOTE — The vertical separation between the seasonal high water table and the ground surface shall be at least one foot.
2. Are there any artificial drainage or water movement structures (e.g., surface water or groundwater) within 200 feet of the
infiltration area? ® Yes or ❑ No
If yes, were these structures addressed in the Soil Evaluation and/or Hydrogeologic Report, and are these structures to be
maintained or modified? Goundwater lowering drains arc being installed as part of the Infiltraction System to manage
groundwater mounding. The nearest wetland area to a groundwater lowering drain is 150 ft. The groundwater collected in
the groundwater lowering drains will be conveyed by gravitymains and discharged to two levels reader u land of
MulbeM Branch.
3. Soil Evaluation recommended loading rates (NOTE —This table maybe expanded for additional soil series):
Soil Series
Basins/Fields
within Soil
Series
Recommended
Loading Rate
In/hr
Recommended
Loading Rate
inl r
Recommended
Loading Rate
GPDIft2
Annual 1
Seasonal
Loading
If Seasonal, list
appropriate
months
Baymeade
A
2
-
4.43
Annual
Baymeade
B
2
-
4.43
Annual
Baymeade
C
2
-
4.43
Annual
Select
Select
Select
4. Are the designed loading rates less than or equal to Soil Evaluation recommended loading rates? ® Yes or ❑ No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0705(m)?
5. How does the Applicant propose to prohibit public access to the infiltration facilities? The location of the site is remote.
There are several dirt roads that lead to the area. These roads will be Gated and fill material from excavations will be used to
form an earthen barricade. Please refer to C4 in the plan set.
6. Has the infiltration system been equipped with a flow meter to accurately determine the volume of effluent applied to each
basin/field as listed in VII.8.? ® Yes or ❑ No
If no, how does the Applicant intend on determining the amount of effluent applied to each basin;'field?
7. For non -basins, provide the required cover crop information and demonstrate the effluent will be applied at or below
agronomic rates:
Cover Crop
Soil Series
% Slope
Nitrogen Uptake Rate
lbs/ac• r
Phosphorus Uptake
Rate lbs."ac• r
FORM: HRIS 06-16 Page 10 of 19

a. Specify where the nitrogen and phosphorus uptake rates for each cover crop were obtained:
b. Proposed nitrogen mineralization rate:
c. Proposed nitrogen vo:ati:ization rate:
d. Minimum infiltration area from the Agronomist Evaluation's nitrogen balance: ftZ
e. Minimum infiltration area from the Agronomist Evaluation's phosphorus balance: ft2
f. Minimum infiltration arca from the watcr balance: ft`
FORM: HRIS 06-16 Page 1 I of 19

VII. INFILTRATION SYSTEM DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
8. Basin/Field Information (NOTE —This table may be expanded for additional fields):
Basin/
Field
Area
(acres)
Dominant
Soil Series
Designed
Loading
Rate
in/hr
Designed
Loading
Rate
inl r
Designed
Loading
Rate
GPD/ftz
Latitude `
Longitude'
aterbody
Stream
6
Index No.
fication
Classification
A
1.68
Baymeade
2
-
4.43
3400 38.4
.78022,56 2„
15-25-2-7
C,Sw
B
1.01
Baymeade
2
-
4.43
3400'144.5
_78022,49.1"
15-25-2-7
C,Sw
C
1.36
Baymeade
2
-
4.43
3400,40.4
_78 37675°
15-25-2-7
C,Sw
v
a
o
�
v
a
a
°
a
a
�
a
a
p
9
O
Total
4.05
a Provide the following latitude and longitude coordinate determination information:
Datum: NAD83 Level of accuracy: Nearest 10`s of a Second Method of measurement: Conversion from State
Coordinate Plane
b For assistance determining the waterbody stream index number and its associated classification, instructions may be
downloaded at: httn://deg.ne.gov/about/divisions/water-resources/planning: classification-standards/classifications
9. High -Rate Infiltration System design criteria:
a. Infiltration Fields:
Spray Infiltration Design Elements
Drip Infiltration Design Elements
Nozzle wetted diameter:
ft
Emitter wetted area:
ft2
Nozzle wetted area:
W
Distance between laterals:
ft
Nozzle capacity:
GPM
Distance between emitters:
ft
Nozzle manufacturer/model:
1
Emitter capacity:
GPH
Elevation of highest nozzle:
ft
Emitter manufacturer/model:
Specification Section:
Elevation of highest emitter:
ft
Specification Section:
FORM: HRIS 06-16 Page 12 of 19

VII. INFILTRATION SYSTEM DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
b. Infiltration Basins:
IF MORE THAN TWO BASINS, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
A
Top of embankment elevation:
68 ft
Hazard class:
Not Applicable
Freeboard elevation:
67.4 ft
Designed freeboard:
2.0 ft
Toe of slope elevation:
62.5 ft
Total volume:
484,839 ft3
Impoundment bottom elevation:
54.0 ft
Infiltrative surface area:
71,754 ftz
Mean seasonal high water table depth:
4 ft
Daily infiltrative capacity:
317,718.6 GPD
Embankment slope:
3: 1
Plan Sheet Reference:
C42, 43, 47
Top of dam water surface area:
95,395 ft2
Specification Section:
3123 16 Excavation and Fill
3123 16.13 Trenching
31 25 14.13 Hydraulically
Applied Erosion Control
Freeboard elevation water surface area:
73,332 ft2
Bottom of impoundment surface area:
15,333 ft'
i. Does this basin include a discharge point (pipe, spillway, etc)? ❑ Yes or ® No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ® Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? ftZ, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to l 00-year flood plain elevation) been provided? ® Yes or ❑ No
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
B
Top of embankment elevation:
68.1 ft
Hazard class:
Not Applicable
Freeboard elevation:
66.1 ft
Designed freeboard:
2.0 ft
Toe of slope elevation:
62.0 ft
Total volume:
315,333 ft3
Impoundment bottom elevation:
54.0 ft
Infiltrative surface area:
42,294 ft2
Mean seasonal high water table depth:
4 ft
Daily infiltrative capacity:
187,273.1 GPD
Embankment slope:
3: 1
Plan Sheet Reference:
C44, 47
Top of dam water surface area:
56,951 ft2
Specification Section:
31 23 16 Excavation and Fill
31 23 16.13 Trenching
31 25 14.13 Hydraulically
Applied Erosion Control
Freeboard elevation water surface area:
44,086 ft'
Bottom of impoundment surface area:
8,754 ftZ
i. Does this basin include a discharge point (pipe, spillway, etc)? ® Yes or ❑ No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ® Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? ft', and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
FORM: HRIS 06-16 Page 13 of 19

If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ® Yes or ❑ No
FORM: HR1S 06-16 Page 14 of 19

Inflltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
C
Top of embankment elevation:
68 ft
Hazard class:
Not Applicable
Freeboard elevation:
66 ft
Designed freeboard:
2.0 ft
Toe of slope elevation:
67.5 ft
Total volume:
389,097 ft3
Impoundment bottom elevation:
54.0 ft
Infiltrative surface area:
55,333 ft2
Mean seasonal high water table depth:
4 ft
Daily infiltrative capacity:
245,008 GPD
Embankment slope:
3: 1
Plan Sheet Reference:
C45, C47
Top of dam water surface area:
77,177 ft2
Specification Section:
31 23 16 Excavation and Fill
3123 16.13 Trenching
3 t 25 14.13 Hydraulically
A lied Erosion Control
Freeboard elevation water surface area:
59,364 ft'
Bottom of impoundment surface area:
12,224 ft2
i. Does this basin include a discharge point (pipe, spillway, etc)? ® Yes or ❑ No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ® Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ® Yes or ❑ No
Vill. SETBACKS —15A NCAC 02T .0706:
1. Does the project comply with all setbacks found in the river basin rules (15A NCAC 02B .0200)? ® Yes or ❑ No
If no, list non -compliant setbacks:
2. Have any setback waivers been obtained in order to comply with 15A NCAC 02T .706(a) and .0706(d)? ❑ Yes or ® No
If yes, have these waivers been written, notarized and signed by all parties involved and recorded with the County Register of
Deeds? ❑ Yes or ❑ No
3 Provide the minimum field observed distances (ft) for each setback parameter to the infiltration system and treatment/storage
units (NOTE — Distances greater than 500 feet may be marked N;'A):
Setback Parameter
Infiltration
System
Treatment 1
Storage Unit$
Any habitable residence or place of assembly under separate ownership or not to be
maintained as part of the project site
NIA
NIA
Any habitable residence or place of assembly owned by the Permittee to be maintained as
art of the project site
NIA
Any private or public water supply source
N/A
NIA
Surface waters (streams intermittent and perennial, perennial waterbodies, and wetlands)
165 ft
57 ft
Groundwater lowering ditches (where the bottom of the ditch intersects the SHWT)
N/A
Subsurface groundwater lowering drainage systems
100 ft
Surface water diversions (ephemeral streams, waterways, ditches)
NIA
Any well with exception of monitoring wells
N'A
N/A
Any property line
154 ft
174 ft
FORM: HRIS 06-16 Page 15 of 19

Top of slope of embankments or cuts of two feet or more in vertical height
7.8 ft
Any water line from a disposal system
N A
Any swimming pool
N.:A
Public right of way
WA
Nitrification field
N A
Any building foundation or basement
MA
Impounded public water supplies
NIA
Public shallow groundwater supply (less than 50 feet deep)
WA
4. Does the Applicant intend on complying with either I SA NCAC 02T .0706(b) or (c)? ® Yes or ❑ No
If yes, what are the designed Total Nitrogen and Total Phosphorus effluent concentrations? TN: 7 mg/L TP: 3 mg/L
5. Does the Applicant intend on complying with the High -Rate Polia issued October 27, 2006? ❑ Yes or ®No
If yes, verify the following information:
✓ Arc the most stringent effluent standards in both 15A NCAC 02T .0705Ib) and 15A NCAC 02U .0301(b) met?
❑Yes or❑No
✓ Is duality provided for all treatment units per 15A NCAC 02U .0402(c)? ❑ Yes or ❑ No
✓ Continuous online monitoring and recording of effluent for turbidity? ❑ Yes or ❑ No
✓ A lined 5-day upset pond is provided? ❑ Yes or ❑ No
✓ The 5-day upset pond has restricted access? ❑ Yes or ❑ No
✓ A certified operator of a grade equal or greater than the facility classification is on call 24 hrs/day? ❑ Yes or ❑ No
FORM: HRIS 06-16 Page 16 of 19

IX. COASTAL WASTE TREATMENT DISPOSAL REQUIREMENTS — 15A NCAC 02H .0400:
1. Is this facility located in a Coastal Area as defined per 1 SA NCAC 02H .04o3? ® Yes or ❑ No
For assistance determining if the facility is located within the Coastal Area, a reference map may be downloaded at: Coastal
Areas Boundary.
2. Is this an Interim Treatment and Disposal Facility per i 5A NCAC 021­1.0404(g)? []Yes or ® No
NOTE — Interim facilities do not include County and Municipal area -wide collection and treatment systems.
IF ANSWERED YES TO ITEMS IX.I. AND IX.2., THEN COMPLETE ITEMS IX.3. THROUGH IX.16.
3. Is equalization of at least 25% of the average daily flow provided? ❑ Yes or ❑ No
4. How will noise and odor be controlled? Odor Control will be utilized at the headworks. All blowers will be in sound
attenuated enclosers for noise control
5. Is an automatically activated standby power source provided? ❑ Yes or ❑ No
6. Are all essential treatment units provided in duplicate? ❑ Yes or ❑ No
NOTE — Per 15A NCAC 02T .0103(16), essential treatment units are defined as any unit associated with the wastewater
treatment process whose loss would likely render the facility incapable of meeting the required performance criteria, including
aeration units or other main treatment units, clarification equipment, filters, disinfection equipment, pumps and blowers.
7. Are the disposal units (i.e., infiltration basins/fields) provided in duplicate? ❑ Yes or ❑ No
8. Is there an impounded public surface water supply within 500 feet of the infiltration area? ❑ Yes or ❑ No
9. Is there a public shallow groundwater supply (less than 50 feet deep) within 500 feet of the infiltration area? ❑ Yes or ❑ No
10. Is there a private groundwater supply within 100 feet of the infiltration area? ❑ Yes or ❑ No
11. Are there any SA classified waters within 100 feet of the infiltration area? [ Yes or ❑ No
12. Are there any non -SA classified waters within 50 feet of the infiltration area? ❑ Yes or ❑ No
13. Are there any surface water diversions (i.e., drainage ditches) within 25 feet of the infiltration area? ❑ Yes or ❑ No
14. Per the requirements in 15A NCAC 02H .0404 7 , how much green area is provided? ft2
15. Is the green area clearly delineated on the plans? ❑ Yes or ❑ No
16. Is the spray infiltration wetted area within 200 feet of any adjoining properties? ❑ Yes, ❑ No or ❑ N.-'A
X. GROUNDWATER LOWERING SYSTEM DESIGN:
1. Does this project utilize a groundwater lowering system? ® Yes or ❑ No (If yes, complete Items X.2. through X.4.)
2. Is the groundwater lowering system: ❑ mechanically lowered (i.e., pumped) or ® gravity fed?
3. Where does the groundwater lowering drainage system discharge? The groundwater collected in the groundwater lowering
drains will be conve ed by nressure head through the drains and discharged to two levels readers upland of Mulberry
Branch. The groundwater lowering underdrains are shown on C46-052 a detail of the levels reader is shown on D2.
If the system mechanically lowers groundwater and discharges directly or indirectly (i.e., pond overflow) to surface waters,
wetlands and/or stormwater structures, provide the date the Applicant obtained written confirmation from the Water Quality
FORM: HRIS 06-16 page I7 of 19

Rcgional Operations Section that operation of the groundwater lowering drainage system will not adversely affect surface
waters of the State. Submitted: & Received:
4_ Groundwater lowering system design criteria:
Pipe diameter:
Pipe material:
Pipe depth:
Pipe length:
Pipe slope (gravity -fed):
Trench backfill material:
Groundwater Lowering System Design
16 in Discharge rate:
PVC Method to measure discharge rate
12-17 ft
9,047 ft
Head Differential Driven
Class I or II Gravel
Number of pumps:
Pump capacity:
Plan Sheet Reference:
Specification Section:
Basin A 495,265 GPD
Basin B 320,907 GPD
Basin C 397,540 GPD
MODFLOW
Hydraulic Analysis
NIA
N/A GPM NIA TDH
DI and D2
NA
FORM: HRIS 06-16
Page 18 of 19

Professional Engineer's Certification:
I, T. Carter Hubard attest that this application for
(Professional Engineer's name from Application Item III. I.)
Mulberry Branch Water Reclamation Facility
(Facility name from Application Item II.I.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications, engineering
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 this application package and its instructions, as well as all applicable regulations
and statutes. 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 General Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false statement,
representation, or certification in any application package 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.
North Carolina Professional Engineer's seal, signature, and date:
,C\A CAR0�9,�,
oFt;ssrp 'f,
Mar 2 2022 1:43 PM
Applicant's Certification per 15A NCAC 0„2T .0106(b):
John Nichols attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
Mulberry Branch Water Reclamation Facility
(Facility name from Application item H.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that any discharge of wastewater
from this non -discharge system to surface waters or the land will result in an immediate enforcement action that may include civil
penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if all required
supporting information and attachments arc not included, this application package will be returned to me as incomplete. I further certify
that the Applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any
active compliance schedule, and do not have any overdue annual fees per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6R, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil pe 'tics p to $25,000 per violation. Signature: Date: -5' 8 . 2C)22
FORM: HRIS 06-16 Page 19 of 19