WQ0033325_Permit Renewal_20161123

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Date: 11/23/16
To: Aquifer Protection Section Central Office
Central Office Reviewer: D. Goodrich
Regional Login No: ??
County: Bladen
Permittee: Bladen County Water Distric
Project Name: Tobermory Well ReUse
Application No.: WQ0033325
I. GENERAL INFORMATION
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
® Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals
❑ Distribution of Residuals
❑ Attachment B included
❑ Surface Disposal
❑ 503 regulated ® 503 exempt
❑ Closed -loop Groundwater Remediation ❑ Otherllnjection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 10/13/16
b. Person contacted and contact information: Randy Garner (Utilities Director)
c. Site visit conducted by: Jim Barber and Tony Honeycutt
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the BIMS record for this application correct?
® Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location: Chicken Foot Road, NC (Bladen County)
b. Driving Directions: Take Hwy 87 south from downtown Fayetteville and turn right onto Tobermory Road.
At the second paved road, turn right onto W. Bladen Union Church Rd. Turn left onto Chicken Foot Road
,and go approximately 1.5 miles and water supply well w/elevated tank will be on the right. The fenced area
behind the elevated tank will comprise the reuse irrigation site of approximately one acre.
c. USGS Quadrangle Map name and number: Saint Pauls, NC (H-23 SW)
d. Latitude: 34.817908 Longitude: -78.884284 (approx. center of treatment building on -site).
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater): Waste
water generated from the backwashing of filters used to remove iron and/or manganese (or both) from
groundwater distributed through the Bladen County Water System.
For Disposal and Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): same as 2 above
b. Driving Directions: same as 2 above
c. USGS Quadrangle Map name and number: same as 2 above
d. Latitude: 34.817964 Longitude: -78.885269 (approx. center of irrigation area, see attached GIS map)
e.
FORM: APSARRTobermoryWel1WQ00333255 Nov 2016.doc 1

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
II. NEW AND MAJOR MODIFICATION APPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description. Of Waste(S) And Facilities
1. Please attach completed rating sheet. Facility Classification:
2. ' Are the new treatment facilities adequate for the type of waste and disposal system?
® Yes ❑ No ❑ N/A. If no, please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? ❑
Yes ❑ No ❑ N/A. If no, please explain:
't 5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No ❑
N/A. If no, please explain: I
6. Are the proposed application rates for newsites(hydraulic or nutrient) acceptable?
❑ Yes ❑ No ❑ N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
❑ Yes n No ❑ N/A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or ❑ No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
9.. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and, recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No n N/A If yes, attach list of sites
with restrictions (Certification B?)
IIL RENEWAL AND MODIFICATION APPLICATIONS (use previous section for new or major modification
systems)
Description Of Waste(S) And Facilities
1. Are there appropriately certified ORCs for the facilities? n Yes or ® No.
Operator in Charge: Certificate #:Facility declassified per Jon Risgaard request (attached). Contact
Beth Buffington for letter addressing declassification.
FORM: APSARRTobermoryWe11WQ00333255 Nov 2016.doc 2

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Backup- Operator in Charge: Certificate #:
2 Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment facilities adequate for the type of waste and disposal system? ® Yes or ❑ No.
If no, please explain:
3. Are the site conditions (soils, topography, depth to water table, etc) maintained appropriately and adequately
assimilating. the waste? ® Yes or ❑ No. If no, please explain:
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? If yes, please explain: No. Surrounding area has not changed since site was
originally permitted.
5. Is the residuals management plan for the facility adequate and/or acceptable to the Division?
® Yes or ❑ No. If no, please explain:
6. Are the existing application rates (hydraulic or nutrient) still acceptable? ® Yes or ❑ No. If no, please
explain:
7. Is the existing groundwater monitoring program. (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ® N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions be required for added sites? ❑ Yes ® No ❑ N/A If yes, attach list of sites
with restrictions (Certification B?)
9. Are there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ® No. If yes, please attach a
map showing conflict areas or attach any new maps you have received from the applicant to be incorporated
into the permit:
10. Is the description of the facilities, type and/orvolume of waste(s) as written in the existing permit correct?
Yes or ❑ No. If no, please explain:
11. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ® N/A. If no, please explain:
12. Has a review of all self -monitoring data been conducted (GW, NDMR, and NDAR as applicable)? ® Yes or
❑ No ❑ N/A. Please summarize any findings resulting from this review: By Tony Honeycutt on a monthly
basis and prior to annual inspection.
13. Check all that apply: ® No. compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc):
14. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? ❑ Yes
n No ❑ Not Determined ® N/A.. If no, please explain:
FORM: APSARRTobermoryWe11WQ00333255 Nov 2016.doc 3

' AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
15. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit?
Yes or Z No El N/A. If yes, please explain:
FORM: APSARRTobermoryWe11WQ00333255 Nov 2016.doc 4

' AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities — New, Renewal, And Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
❑ In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5L/"Non-Discharge")
❑ Other (Specify: ) /
2. Does system use same well for water source and injection? ❑ Yes ❑ No
- 3. Are there any potential pollution sources that may affect injection? n Yes n No
What is/are the pollution source(s)? . What is the distance of the injection well(s) from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? ft.
5. Quality of drainage at site: ❑ Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ❑ Low ❑ Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ❑ Yes ❑ No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? n Yes or n No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution,
sources, roads, approximate scale, and north. arrow.
Injection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
❑ Yes ❑ No. If yes, explain:
2. For closed -loop heat pump systems, h s system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of any type), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ❑ No. If yes, explain:
4. Drilling contractor: Name:
FORM: APSARRTobermoryWellWQ00333255 Nov 2016.doc 5

' AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
Address:
Certification number:
5. Complete and attach Well Construction Data Sheet.
FORM: APSARRTobermoryWellWQ00333255 Nov 2016.doc
6

AQUIFER PROTECTION SECTION REGIONAL STAFF REPORT
V. EVAL UATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application.:
2. Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item
Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition
Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition: -
Condition
Reason
7 Recommendation: ❑ Hold,,pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; n Deny. If deny, please state reasons:
8. Signature of report preparer(s): vJ M' 212Relfg-
i
4J QR 0 S
Signature of Am regional supervisor: J / ./ /� �� �2�__!J % Z-�-1
Date: ht.*
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
It is recommended that the subject permit be re-issued/renewed.
FORM: APSARRTobermoryWelIWQ00333255 Nov 2016.doc 7

AQUIFER PROTECTION SECTION REGIONAL STAFF, REPORT
The use of the backwash water is for irrigating the grass planted at the well site (mixture of bermuda and
centiped) is acceptable.
The grass cover at the site is uniform arid the grass condition is acceptable. No evidence of stressed vegetation,
due to the iron content of the filtered backwash water, was noted during the site visit.
Commercial fertilizer and lime will need to be applied, as needed, for optimum turfgrass growth.
1
J
FORM: APSARRTobermoryWe11WQ00333255 Nov 2016.doc 8

https:/ibladen2.connectgis.com/Map.aspx
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Results

Barber, Jim
From: Henson, Belinda
Sent: Thursday, August 14, 2014 12:08 PM
To: Honeycutt, Tony; Barber, Jim
Subject: FW: Declassification of well backflush systems
Attachments: 131115 - Backflush memo.pdf
From: Risgaard, Jon
Sent: Thursday, August 14, 2014 11:47 AM
To: Buffington, Beth
Cc: Poupart, Jeff; Zimmerman, Jay; Basinger, Corey; Cranford, Chuck; Davidson, Landon; Gregson, Jim; Henson, Belinda;
King, Morella s; Knight, Sherri; May, David; Parker, Michael; Pitner, Andrew; Bolich, Rick; Smith, Danny; Tankard, Robert
Subject: Declassification of well backflush systems
Beth,
Please declassify two wastewater irrigation system (WQ0033942, and WQ0033325) for well back flush systems in Bladen
County. These systems were recently classified as needing an certified spray irrigation operator. These systems are
both low flow (<8000 gallons/week) low impact systems where I do not feel classification is warranted. I have spoken
with region, and both Jay Z and Jeff P about these and I hope we are all on the same page. Generally I do not feel that
many of these small water treatment back flush systems will need to be permitted, let alone need a certified
operator. We have had significant pushback from Aqua, and other water supply utilities on the requirements for
managing this type of wastewater and we have tried to work with them on a case -by -case basis to find low cost and low
impact solutions. Currently we have -a 2013 memo (see attached) from Tom Reeder that recognizes the low potential for.
impact from some of these systems, directs us to create futpre rules that allow for these systems to be permitted by
rule, and reduces current setback requirements to the water supply well. I am also working with Aqua on deeming
another filter type as permitted under existing 02T rules.
In your notification letter please include a statement that a certified operator may be required in the future if
environmental impacts or non-compliance occur at the facility. 'Also, please keep an eye out for similar systems that
have already been classified that we may be able to declassify.
Thanks
Jon
:Jon Risgaard - Supervisor, Non -Discharge Permitting Unit
Wa-e.r'QuaJ.ity Permitting Section
1636 Mail Service Center
Raleigh, .NC 27699-1636
919-807-6458
http://portal.ncdenr.org/web/wq/aps/lau

ArrA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs.
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
MEMORANDUM
November 15, 2013
To: Water Quality Permitting Section
Water Quality Regional Operations Secti
Public Water Supply Section
From: Thomas A Reeder, Director
Division of Water Resources
Subject: Interpretation of setback requirements for potable water wells
In order to provide clarification' on available permitting alternatives for managing greensand (iron and
manganese removal water purification systems) and siinilar sinall filter backwash (sand or calcite filters)
wastewaters at potable water wells this interpretation=of setback requirements forpotable water wells, is
being given.
Existing regulations classify the potable well filter backwash as a wastewater and allow for its
management though a number of permitting programs. An NPDES permit is an option if surface water is
available for discharge: Another option is a pump and haul permit; however, operational costs make this
alternative impractical in cases. A non -discharge (i.e., land application) permit is a third option;
however, many well sites do not have adequate space for a disposal system due to regulatory setback
requirements to wells (100 -ft) and property lines (50 . to 150 . ft). Additionally, effluent . storage
requirements increase construction and operational costs, but might not provide necessary protections.
Due to the low risk and small volume of typical backwash water at potable water wells it has been
determined that the setback requirement in 15A-NCAC 02T between wastewater disposal and a well was
not intended.to apply to the well from which the backwash water is being generated.
This interpretation only applies to disposal to the land surface of potable water well backwash from
greensand or other small type filters, not to include backwash from conventional filters or wastewaters
from reverse osmosis and ion exchange units, provided the potable water well does not exceed the
Maximum Contaminant Level (MCL) for radionuclides or arsenic. This interpretation does not exempt
the land application of the backwash water from meeting all other permitting requirements established in
15A NCAC 02T.
In addition changes to the non -discharge r.;ules (rsA NCAC 02T) to better accommodate the permitting
needs of this waste will be made. The recommended?: changes will include rule language that will permit
by regulations systems using treatment producing low volume and low risk wastewaters that do not
contain greater than threshold levels radioactive material or arsenic.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone]FAX: [phone]
Internet: www.ncwatercualitv-orq
An Equal Opportunity) Affirmative Action Employer
ti

State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
Division of WaterResourcesNON-DISCHARGE APPLICATION REVIEW REQUEST FORM
September 20, 2016
To: RG-WQROS ii da-Henson er Al:len -
From: David Goodrich, Water Quality Permitting Section - Non -Discharge Permitting Unit
RECEIVED
DEQ/DWR
SEP232016.,
FAYETTEVILLE ROONAL OFFICE
Permit Number: WQ0033325 Permit Type: Wastewater Irrigation
Applicant: Bladen County Water District Project Type: Renewal
Owner Type: County Owner in BIMS? Yes
Facility Name: Tobermory Well Facility in BIMS? Yes
Signature Authority: Randy Garner Title: Director
Address: 272 Smith Circle, Elizabethtown, North Carolina 28337 County: Bladen
Fee Category: Non -Discharge Minor Fee Amount: $0
Comments/Other Information:
Attached, you will find all information submitted in support of the above -referenced application for your review,
comment; and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed. El Return a completed staff report.
n Attach an Attachment B for Certification. n Issue an Attachment B Certification.
. When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer:
J A^ -
Date: / ?i
FORM: WQROSNDARR 09-15 Page 1 of 1

s
Water Resources
ENVIRONMENTAL QUALITY
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
S. JAY ZIMMERMAN
Director
September 20, 2016
RANDY GARNER — DIRECTOR
BLADEN COUNTY WATER DISTRICT
272 SMITH CIRCLE
ELIZABETHTOWN, NORTH CAROLINA 28337
Dear Mr. Garner:
Subject: Acknowledgement of
Application No. WQ0033325
Tobermory Well
. Wastewater Irrigation System
Bladen County
The Water .Quality Permitting Section .acknowledges receipt of your permit application and
supporting documentation received on September 15, 2016. Your application. package has been assigned
the number listed above, and the primary reviewer is David Goodrich.
Central and Regional Office staff will perform a detailed review of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days.
after receipt of a complete application. If you have any questions, please contact
David Goodrich at [phone] or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: FaLLyetille Regional Office; Water'Quality Regional Operations Section
Permit File WQ0033325-
State of North Carolina I Environmental Quality 1 Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919 807 6464

Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 11-13
I. PERMITTEE INFORMATION:
1. Permittee's name: Bladen County Water District
2. Signature authority's name: Randy Garner per 15A NCAC 02T .0106(b)
3. Permittee's mailing address: 272 Smith Circle
City: Elizabethtown
RECEIVED/NCDEO/DWR
SEP .15 1016
NorpOlsoharge
P rmitfing Unit
4. Perinittee's contact information: Phone number: [phone] Email Address: [e-mail]
State: NC Zip: 28337-
II. FACILITY INFORMATION:
1. Facility name: Tobermorey Well Backwash Irrigation System
2. Facility's physical address: 8129 Chicken Foot Road
City: Tar Heel State: NC Zip: 28392-
County: Bladen
Title: Director
HI. PERMIT INFORMATION:
1. Existing permit number: WQ0033325 and most recent issuance date: 5-29-09
2. Existing permit type: Select
3. Has the facility been constructed? ®Yes or ❑ No
4. Demonstration of historical consideration for permit approval — I5A 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 law or G.S. 143-215.6B?. ® Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ® Yes or El 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
e. Has unpaid annual fees in accordance with 1.5A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Randy Garner
(Signature Authority's name & title from Application Item I.2.)
attest that this application for
Tobermory Well Backwash irr,Qainn �T�em
(Facility name from Application Item II.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 are 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 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 a yell as civ-1 penalties up to $25,000 per violation.
Signature:
Date:
7-25-2016
FORM: NDSR 11-13 Page 1 of 1

Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
INSTRUCTIONS FOR FORM: NDSR 11-13 & SUPPORTING DOCUMENTATION
This form is for renewal without modification for all non -discharge system permits, except Residuals Management permits.
For more infOrniatir i; visit ithe'Water Quality Permitting Section's Non -Discharge Permitting Unit website at:
http: //porlal.ncdeni : orgh veb/wq/aps/lair
A. Non -Discharge System Renewal (FORM: NDSR 11-13) Application (All Application Packages):
® Submit one original atid,onp copy of the completed and appropriately executed Non -Discharge System Renewal (FORM:
NDSR 11-13) application: r,:).
El The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
altemate 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).
B. Existing Permit (All Application Packages):
® Submit two copies of the most recently issued pennit.
C. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0I 15(a)(1), provide two copies Pf 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 non -discharge system.
D. Operation and Maintenance Agreement (All Application Packages for Single -Family Residences):
Q Submit one original and one copy of the signed Operation and Maintenance Agreement (FORM: SFRWWIS O&M).
E. Operational Agreements (All Application Packages for Home/Property Owners' Associations and Developers of lots to be sold):
➢ Home/Property Owners' Associations
Q Per 15A NCAC 02T .0115(c), submit an original and one copy of the properly executed Operational Agreement (FORM:
HOA).
Q- Per 15A NCAC 02T .01 15(c), submit -an original and one copy of the proposed or approved Articles of Incorporation,
Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original and one copy of the properly executed Operational Agreement (FORM:
DEV).
F. Site Map (All Application Packages for permits originally issued or modified after September 1, 2006):
® Submit two copies of an updated site map in accordance with 15A.NCAC 02T .0105(d).
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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/Special Delivery:
512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: NDSR 11-13 & SUPPORTING DOCUMENTATION Page I of I