WQ0039488_Renewal Application_20220830

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0039488
Applicant/Permittee South Camden Water and Sewer District
Applicant/Permittee Address PO Box 190 Camden NC 27921
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
Owner Type
Facility Name
County
Fee Category
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
County
Courthouse Area WWTP
Camden
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date 08/30/2022
Below list any additional email address that need notification about a new project.
... ... ..
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

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* Charles Jones
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*
2523403040
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: *
WQ0039488
Has Current Existing permit number
Applicant/Permittee*
South Camden Water and Sewer District
Applicant/Permittee Address*
PO Box 190 Camden NC 27921
Facility Name*
Courthouse Area WWTP
Please provide comments/notes on your current submittal below.
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.)
W00039488 PERMIT RENEWAL APPLICATION 2022.pdf 428.98KB
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 8/30/2022

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEM -- RENEWAL
FORM: HRIS-R 02-21
Pursuant to 15A NCAC 02T .0107(b), if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02T .0700, and Division Policies. For more information, visit the Water Quality Permitting
Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) file to litt s:Hedoes.de .iie, ov/Pot-ms/NoiiDiscliat-e-Bi-ancii-Silbmittal-
Form-Vei•2, or emailed to Noii-Discharge.RenortsAiiedeni•.eov if less than 20 megabytes (MB).
SECTI4lN I — APPLICANT.INFORMATI. N
1. Applicant: South Camden Water and Sewer District
2. Permit No.: WQ0039488
3. Signature authority: Erin Burke Title: County Manager
Phone number: [phone] Office Entail: [e-mail]
4. Mailing address: PO Box 190
City: Camden State: NC Zip: 27921- l 90
5. Contact person: Charles Jones Email: [e-mail]
Primary phone number: [phone] Cell Secondary phone number: [phone] Office
1. Physical address: 407 US Highway 158 East
City: Camden
2. Treatment facility coordinates to the sixth decimal degree:
Latitude: 36.353611° Longitude:-76.133544'
County: Camden Parcel No.: 028945004948490000
State: NC Zip: 27921-190
Method: Digital or raw photo extraction
SECTION :III — FLOW INFORMATION
1. Permitted flow: 99890 GPD (The nrarinnan allowable flow based on what has been permitted)
2. As -built flow: 50000 GPD (The maximum allowable flow based on whal has been constructed)
3. Average flow: 22964 GPD (The average of all reported flows on the previous calendaryears NDh4Rs)
4. Hydraulic capacity: 46 % (Divide the average flow in Item 3 by the As -built flow in Item 2)
5. Wastewater composition: Domestic : 100 % Industrial: 0 % Stormwater: 0 %
SECTION IV BILLING INFORMATION
1. Billing address: PO Box 190
City: Camden State: NC Zip: 27921-190
2. Verify the Applicant does not have any overdue annual fees:
litt s:llde .nc. ov/about/divisions/water-resources/water-resources- ermits/w -e a mctits
Pursuant to .15A NCAC 02T .0120(c), permits for renewing facilities shall not be granted if the Applicant or any affiliation has
an unpaid annual fee.
FORM: HRIS-R 02-21 Page 1 of 6

1. ORC: Jovon Taylor Grade: 3 Certification No.: 1010297
Mailing address: PO Box 190
City: Camden State: NC Zip: 27921-190
Phone number: [phone] Cell Email: [e-mail]
2. Back -Up ORC: Charles Jones Grade: 4 Certification No.: 985305
Mailing address: PO Box 190
City: Camden State: NC Zip: 27921-190
Phone number: [phone] Cell Email: [e-mail]
1. List all open -atmosphere treatment and storage structures associated with the renewing permit. Attach additional sheets if
necessary.
Type Parcel No. Volume (gal) Liner Type Freeboard (ft) Latitude Longitude
Select Select - °
Select Select
Select Select °
Select Select 0-
1. List all wastewater permits (i.e., sewer, collection system, NPDES, residuals) that have interactions with the renewing permit.
Attach additional sheets if necessary.
Permit Type Permit No. Relationship Type
Select Select
Select Select
Select Select
Select Select
SECTION VIII —MONITORING. WELLS
1. List all groundwater monitoring wells associated with the renewing permit. Attach additional sheets if necessary.
Well Name
Parcel No.
Status
Gradient
Location
Latitude
Longitude
MW-1
028945004948490000
Active
Upgradient
On Review Boundary
36,3536330
-76.134516"
MW-2
028945004948490000
Active
Downgradient
On Review Boundary
36,3526660
-76.136616°
MW-3
028945004948490000
Active
Downgradient
On Review Boundary
36.353333°
-76.132533°
Select
Select
Select
0°
Select
Select
Select
0°
Select
Select
Select
°
- ° j
Select
Select
Select
°
°
Select
Select
Select
0°
Select
Select
Select
°
- °
Select
Select
Select
0°
Select
Select
Select
0°
FORM: HR1S-R 02-21 Page 2 of 6

SECTION IX INFILTRATION SITES --,
I. List all infiltration sites associated with the renewing permit, Attach additional sheets if necessary.
Site
County
Pat -eel No.
Deeded Owner
Area
Cover Crop
Latitude
Longitude
001
CAMDEN
028945004948490000
South Camden Water and
Sewer District
0.50
N/A
36,3534970
-76,1332890
002
CAMDEN
028945004948490000
South Camden Water and
Sewer District
0,50
NIA
36.3532490
-76,1338590
0
0
0
O
0
0
O
0
O
O
0
0
O
o
O
O
O
O
O
O
O
O
O
O
0
0
q
0
0
0
0
0
0
0
O
O
0
0
0
0
O
O
O
O
O
O
O
O
O
0
0
O
n
o
0
0
0
0
O
o
0
0
0
0
0
0
0
0
FORM: HRIS-R 02-21 Page 3 of 6

Total Acreage: 1.0
ATTACHMENT A — SITE .MAP
Was the facility originally permitted or had a major modification issued after September 1, 2006?
❑ Yes — Pursuant to 15A NCAC 02T .0105(d), submit a site map pursuant to the requirements in 15A NCAC 02T .0704(d). "These
requirements are:
❑ A scaled map of the site with topographic contour intervals not exceeding; 10 feet or 25 percent of total site relief and showing
all facility -related structures and fences within 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 15A NCAC 02L .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.
® No — Skip Attachment A.
ATTACHMENT'B — SIGNATURE AUTHORITY DELEGATION .
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106(b)?
® Yes --- Skip Attachment B.
❑ No — Submit a delegation letter pursuant to 15A NCAC 021 .0106(c) authorizing the signature authority to sign.
ATTACHMENT C FLOW. REDUCTION
Does the existing permit include an approved flow reduction?
❑ Yes — Submit a copy of the flow reduction approval letter, as well as the measured monthly average amount of wastewater flow
contributed per unit for the 12 months prior to permit renewal. If any of these monthly averages are within 20% of the approved
flow reduction value, the Permittee shall provide a reevaluation of the reduced flow value pursuant to the requirements in 15A
NCAC 02T .0114 .
® No — Skip Attachment C.
♦mT'•lf�11�T.11�1m.T5' ATTTf.1 mi!\wii� ':'l lttil'r'l ltilh AfTATT '
Is the Applicant a Home/Property Owners' Association or Developer of Lots to be Sold?
❑ Yes (Home/Property Owners' Association) —Pursuant to 15A NCAC 02T .0115(a)(2), submit an executed Operational Ag reeement
(FORM: HOA). Pursuant to 15A NCAC 02T .0115(c), if the applicant is a legally formed Homeowners' or Property Owner's
Association, submit a copy of the Articles of Incorporation, Declarations, and By-laws.
❑ Yes (Developer of Lots to be Sold) -- Pursuant to 15A NCAC 02T .0115(a)(2), submit an executed Operational Agreement
(FORM:DEV). Pursuant to 15A NCAC 02T .0115(b), if the applicant is a developer of lots to be sold, submit a copy of the
Articles of Incorporation, Declarations, and By-laws.
® No — Skip Attachment E.
FORM: HR1S-R 02-21 Page 4 of 6

ATTACENT F —.DEMONSTRATION OF. FUTURE WASTEWATER TREATMENT:CAPACITIES.
Is the applicant a municipality, county, sanitary district, or public utility?
® Yes — Proceed to the next question.
❑ No — Skip Attachment F.
Does the hydraulic capacity in Section III, Item 4 exceed 70%?
❑ Yes (the hydraulic capacity is greater than 70%, but less than 80%) -- Pursuant to 15A NCAC 02T .0118(1), prior to exceeding
80 percent of the system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee
shall submit an engineering evaluation of their future wastewater treatment, utilization, and disposal needs. This evaluation shall
outline plans for meeting future wastewater treatment, utilization, or disposal needs by either expansion of the existing system,
elimination or reduction of extraneous flows, or water conservation and shall include the source of funding for the improvements.
If expansion is not proposed or is proposed for a later date, a justification shall be made that wastewater treatment needs will be
met based on past growth records and future growth projections, and as appropriate, shall include conservation plans or other
measures to achieve waste flow reductions.
❑ Yes (the hydraulic capacity greater than 80%) -- Proceed to the next question.
® No — Skip Attachment F.
If answered Yes above, does the hydraulic capacity in Section III, Item 4 exceed 80%?
❑ Yes (the hydraulic capacity is greater than 80%) — Pursuant to 15A NCAC 02T .0118(2), prior to exceeding 90 percent of the
system's permitted hydraulic capacity (based on the average flow during the last calendar year), the permittee shall obtain all
permits needed for the expansion of the wastewater treatment, utilization, or disposal system and, if construction is needed,
submit final plans and specifications for expansion, including a construction schedule. If expansion is not proposed or is proposed
for a later date, a justification shall be made that wastewater treatment needs will be met based on past growth records and fi►ture
growth projections, and as appropriate, shall include conservation plans or other specific measures to achieve waste flow
reductions.
❑ No — Skip Attachment F.
ATTACHMENT G — EASEMENT, :ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the wastewater collection, treatment, conveyance, infiltration, and groundwater
lowering (if applicable) system?
® Yes — Skip Attachment G.
❑ No —Pursuant to 15A NCAC 02T .0116(c), provide a copy of all easements, lease agreements, and encroachment agreements
allowing the Permittee to operate and maintain the wastewater collection, treatment, conveyance, infiltration, and groundwater
lowering (if applicable) system on property not owned by the Permittee.
ATTACHMENTH —AFFILIATIONS
Are the Permittee's affiliations of record correct? Check affiliations.
® Yes -- Skip Attachment H.
❑ No -- Provide the corrected affiliations and their contact information.
ATTACHMENT I.. COMPLIANCE SCHEDULES
Does the existing permit include any Compliance Schedules? (See Section I of the most recently issued permit)
❑ Yes — Submit documentation that the compliance schedules have been met.
® No — Skip Attachment I.
f ATTACHMENT J — CIVIL PENALTIES AND OUTSTANDING VIOLATIONS
Does the Permittee have any existing civil penalties or outstanding violations?
❑ Yes (civil penalties) — Submit payment for the civil penalty, or proof of remission request.
❑ Yes (violations) — Submit a copy of your response to the Notice of Violation.
® No — Skip Attachment J.
FOItM: HRIS-R 02-21 Page 5 of 6

ATTACHMENT K INDUSTRIAL WASTEWATER
Does the wastewater composition in Section III, Item 5 include any industrial wastewater?
❑ Yes — Proceed to the next question.
® No — Skip Attachment K.
Has the nature of the industrial wastewater changed since the last permit issuance (i.e., changes in industrial process, introduction of
new materials or chemicals, etc.)?
❑ Yes — Provide a chemical analysis of the wastewater pursuant to the requirements in 15A NCAC 02T .0704kh). Provide an
overview of the manufacturing process; an inventory of all chemical and biological materials used in the manufacturing process;
and an overview of the cleaning and treatment methodology.
❑ No — Provide an overview of the manufacturing process; an inventory of all chemical and biological materials used in the
manufacturing process; and an overview of the cleaning and treatment methodology.
Does the existing permit include setback waivers?
❑ Yes — Pursuant to 15A NCAC 02T .0706(d), provide setbacks waivers that have been written, notarized, signed by all parties
involved, and recorded with the county Register of Deeds. Waivers involving the compliance boundary shall be in accordance
with 15A NCAC 02L .0107.
Z No -- Skip Attachment L.
APPLICANT'S CERTIFICATION
I, off) attest that this application
(Signature authority's name as noted in Section I, Item 3)
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 package are not completed, and that if all required supporting information and attachments are not included, this
application package will be returned as incomplete. I fiu•ther certify pursuant to i 5A NCAC 02T .0120(b), that the applicant, or any
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under; not previously abandoned
a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agreement, or order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0 106b . An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NCAC 02T .0106(c). Pursuant to § 143-215.6A and § 143-215.6B, any
person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class
2 misdemeanor, which m• y�jincI ide a fine not to exceed $10,000 as well as civil penalties tip to $25,000 per violation.
Signature: Date: T Z q. Z Z
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Entail:
Non-DlselraYize.ReDorts unrtcdeut•.Uov
Laserfiche Upload:
htt€tsa/edocs.dep, nc,ZovlForms/NonDischaroc-B ra uclt-
Submittal-Form-Ver2
FORM: HRIS-R 02-21 Page 6 of 6