WQ0010197_Renewal Application_20221028

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0010197
Applicant/Permittee American & Efird LLC
Applicant/Permittee Address 20 American St., Mt. Holly, NC 28120
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type
Facility Name
County
Fee Category Closed -Loop Recycle
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Organization
American & Efird - Mount Holly CLRS
Gaston
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
llr�ore
Fee Amount $0
Complete App Date 10/28/2022
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* Jimmy Summers
Email Address*
Jimmy. Sum [e-mail]
m
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*
704-951-2578
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
Permit Type:*
Wastewater Irrigation
High -Rate Infiltration
Other Wastewater
Reclaimed Water
Closed -Loop Recycle
Residuals
Single -Family Residence Wastewater
Other
Irrigation
Permit Number: *
WQ0010197
Has Current Existing permit number
Applicant/Permittee*
American & Efird LLC
Applicant/Permittee Address*
20 American St., Mt. Holly, NC 28120
Facility Name*
American & Efird - Mount Holly CLRS
Please provide comments/notes on your current submittal below.
I have attached a completed Non -Discharge System Renewal CLRS-R 02-21 form for renewal
of the referenced permit, as well as all supporting information. The permit expires on April 30,
2023, and the renewal application is due to be submitted six months prior to expiration, or by
October 30, 2022. There have been no changes since our last renewal. Please advise as
soon as possible if additional information is required.
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.)
CLRS-R-02-21.pdf 1.26MB
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
C: y6&,Wlwetd
Submission Date 10/28/2022

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02U –CLOSED-LOOP RECYCLE SYSTEM –RENEWAL
FORM: CLRS-R02-21
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 attachmentsshall be prepared in accordance with 15A
NCAC 02T .0100, 15A NCAC 02U, and Division Policies. For more information, visit the Water Quality Permitting Section’s
Non-Discharge Branch website. The Applicant shall submit anelectronic copy of the application and attachmentsuploaded as
a single Portable Document Format (PDF) file tohttps://edocs.deq.nc.gov/Forms/NonDischarge-Branch-Submittal-Form-Ver2,
or emailed to [e-mail] less than 20 megabytes (MB).
SECTION I –APPLICANT INFORMATION
1.Applicant: American & Efird LLC
2.Permit No.: WQ0010197
3.Signature authority: Jimmy SummersTitle: VP EHS / Sustainability
Phone number: [phone]OfficeEmail: [e-mail]
4.Mailing address: 121 West Trade St., Suite 1700
City: CharlotteState: NCZip: 28202-
5.Contact person: Jimmy SummersEmail: [e-mail]
Primary phone number: [phone]OfficeSecondary phone number: [phone]Cell
SECTION II –FACILITY INFORMATION
1.Physical address: 20 American StCounty: GastonParcel No.: 217834
City: Mt. HollyState: NCZip: 28120-
2.Treatment facility coordinates to the sixth decimal degree:
Latitude: 35.287143°Longitude: -81.12982°Method: Address matching
SECTION III–BILLING INFORMATION
1.Billing address: 121 West Trade St., Suite 1700
City: CharlotteState: NCZip: 28202-
2.Verify the Applicant does not have any overdue annual fees:
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wq-epayments
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.
SECTION IV–OPEN-ATMOSPHERE STRUCTURES
1.List all open-atmosphere treatment and storage structures associated with the renewing permit. Attach additional sheets if
necessary.
TypeParcel No.Volume (gal)Liner TypeFreeboard (ft)LatitudeLongitude
Treatment/Storage2178341,000,000Unlined335.286522°-81.1150°
SelectSelect.°-.°
SelectSelect.°-.°
SelectSelect.°-.°
FORM: CLRS-R 02-21Page 1of 3

SECTION V – RELATED PERMITS
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
Discharge NCG500000 NPDES
Discharge IUP 1157 Receiving WWTP
Discharge NCG170314 Offsite stormwater system
SECTION VI – 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
Select Select Select . °- . °
Select Select Select . °- . °
Select Select Select . °- . °
Select Select Select . °- . °
Select Select Select . °- . °
Select Select Select . °- . °
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 02U .0201(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 500 feet of the treatment, storage, and recycle areas.
Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108.
Setbacks as required by 15A NCAC 02U .0701.
Site property boundaries within 500 feet of all treatment, storage, and recycle 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 02T .0106(c) authorizing the signature authority to sign.
ATTACHMENT C – EASEMENT, ENCROACHMENT, AND LEASE AGREEMENTS
Does the Permittee own all of the land associated with the treatment, storage, and recycle system?
Yes – Skip Attachment C.
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 treatment, storage, and recycle system on property not owned by the Permittee.
ATTACHMENT D – AFFILIATIONS
Are the Permittee’s affiliations of record correct? Check affiliations.
Yes – Skip Attachment D.
No – Provide the corrected affiliations and their contact information.
FORM: CLRS-R 02-21 Page 2 of 3

ATTACHMENT E – 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 E.
ATTACHMENT F – 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 F.
ATTACHMENT G – INDUSTRIAL WASTEWATER
Does the closed-loop recycle system treat and/or store industrial wastewater?
Yes – Proceed to the next question.
No – Skip Attachment G.
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 02U .0201(g). 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.
ATTACHMENT H – SETBACK WAIVERS
Does the existing permit include setback waivers?
Yes – Pursuant to 15A NCAC 02U .0701(g), 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.
No – Skip Attachment H.
APPLICANT’S CERTIFICATION
I, 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
, that the applicant, or any
application package will be returned as incomplete. I further certify pursuant to 15A NCAC 02T .0120(b)
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 .0106(b). 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 may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:Laserfiche Upload:
https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-
[e-mail]
Submittal-Form-Ver2
FORM: CLRS-R 02-21 Page 3 of 3