WQ0005247_More Information Received_20221102

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) * WQ0005247
Applicant/Permittee North Carolina Department of Natural and Cultural Resources
Email Notifications
....... ........ ......... ......... ......... ......... ..................
Does this need review by the hydrogeologist? * Yes No
Regional Office
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* David Mumford
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*
984-867-8000
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: *
WQ0005247
Has Current Existing permit number
Applicant/Permittee Address*
13304 Creedmoor Rd. Wake Forest NC 27587
Facility Name*
Falls Lake SRA - Rollingview WWTF
Please provide comments/notes on your current submittal below.
Attn: Alys Hannum
Revised Renewal Application with additional information as requested for WQ0005247
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.)
WWIS RV WQ00052472022 11.pdf 15.21MB
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 11/2/2022

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0500 WASTEWATER IRRIGATION SYSTEM RENEWAL
FORM: WWIS-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 02T .0500, and Division Policies. For more information, visit the Water Quality Permitting
-Discharge Branch website. The Applicant shall submit anelectronic copy of the application and attachments
uploaded 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: North Carolina Department of Natural and Cultural Resources
2.Permit No.: WQ0005247
3.Signature authority: Jody ReavisTitle: Chief Of Maintenance
Phone number: [phone]OfficeEmail: [e-mail]
4.Mailing address: 13304 Creedmoor Road
City: Wake Forest State: NCZip: 27587-
5.Contact person: David MumfordEmail: [e-mail]
Primary phone number: [phone]OfficeSecondary phone number: [phone]Cell
SECTION II FACILITY INFORMATION
1.Physical address: 4201 Baptist RoadCounty: DurhamParcel No.: 193983
City: Durham State: NCZip: 27703-
2.Treatment facility coordinates to the sixth decimal degree:
Latitude: 36.007884°Longitude: -78.730661°Method: Address matching
SECTION III FLOW INFORMATION
1.Permitted flow: 9990GPD (The maximum allowable flow based on what has been permitted)
2.As-built flow: 10500GPD (The maximum allowable flow based on what has been constructed)
3.Average flow: 4018GPD ()
4.Hydraulic capacity: 38%(Divide the average flow in Item 3 by the As-built flow in Item 2)
5.Wastewater composition: Domestic : 100%Industrial: %Stormwater: %
SECTION IVBILLING INFORMATION
1.Billing address: 13304 Creedmoor Road
City: Wake Forest State: NCZip: 27587-
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.
FORM: WWIS-R 02-21Page 1 of 6

SECTION V OPERATOR IN RESPONSIBLE CHARGE (ORC) INFORMATION
1.ORC: Joel Valentine Grade: SI Certification No.: 1012362
Mailing address: 13304 Creedmoor Rd.
City: Wake Forest State: NC Zip: 27587-
Phone number: [phone] Office Email: [e-mail]
2.Back-Up ORC: Vincent Shea Grade: SI Certification No.: 998524
Mailing address: 13304 Creedmoor Road
City: Wake Forest State: NC Zip: 27587-
Phone number: [phone] Office Email: [e-mail]
SECTION VI OPEN-ATMOSPHERE STRUCTURES
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
Treatment/Storage 193983 7,000,000 Apron, concrete 2.0 36.007989° -78.730253°
Treatment/Storage 193983 5,000,000 Apron, concrete 2 36.007882° -78.730950°
Select Select . ° - . °
Select Select . ° - . °
SECTION VII 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
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
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
Select Select Select . ° - . °
FORM: WWIS-R 02-21 Page 2 of 6

SECTION IX IRRIGATION FIELDS
1.List all irrigation fields associated with the renewing permit. Attach additional sheets if necessary.
Field County Parcel No. Deeded Owner Area Cover Crop Latitude Longitude
Durham 193956 USA - US Army Corps of
LLS 3.55 Pine 36.006376° -78.728474°
Engineers
Durham 193956 USA - US Army Corps of 3.55
UPR Pine 36.005136° -78.728255°
Engineers
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
. ° - . °
Total Acreage: 7.1
FORM: WWIS-R 02-21 Page 3 of 6

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 .0504(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 irrigation areas.
Soil mapping units shown on all irrigation 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 irrigation sites.
Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108, and 15A NCAC 02T .0506(c)
if applicable.
Setbacks as required by 15A NCAC 02T .0506.
Site property boundaries within 500 feet of all wastewater treatment, storage, and irrigation sites.
All habitable residences or places of public assembly within 500 feet of all treatment, storage, and irrigation 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 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(f).
No Skip Attachment C.
ATTACHMENT D CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
Is the Applicant a Privately-Owned Public Utility?
Yes Pursuant to 15A NCAC 02T .0115(a)(1), submit the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise.
No Skip Attachment D.
ATTACHMENT E OPERATIONAL AGREEMENT
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 Agreement
(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: WWIS-R 02-21 Page 4 of 6

ATTACHMENT 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 future
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, and irrigation 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, and irrigation system on
property not owned by the Permittee.
ATTACHMENT H AFFILIATIONS
f 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.
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.

FORM: WWIS-R 02-21 Page 5 of 6

ATTACHMENT KINDUSTRIAL 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 orchemicals, etc.)?
YesProvide a chemical analysis of the wastewater pursuant to the requirements in 15A NCAC 02T .0504(h). 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 LSETBACK WAIVERS
Does the existing permit include setback waivers?
Yes Pursuant to 15A NCAC 02T .0506(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.
No Skip Attachment L.
I, Jody Reavisattest that this application
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 ofthis
application package are not completed, and that if all required supporting information and attachments arenot included, this
application package will be returned as incomplete. I further certify pursuant to 15A 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.
NoteCertification shallbe signed pursuant to15A NCAC 02T .0106(b). An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NCAC02T.0106(c). Pursuant to §143-215.6Aand § 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: 11/2/2022
THE COMPLETED APPLICATION ANDATTACHMENTS SHALL BE SUBMITTEDAS A SINGLE PDF FILEVIA:
Email:Laserfiche Upload:
https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-
[e-mail]
Submittal-Form-Ver2
FORM: WWIS-R 02-21Page 6of 6

North Carolina Division of Parks and Recreation

Secretary D. Reid Wilson
Governor Roy Cooper
Attachment G
Easement, Encroachment, And Lease Agreements

Lease Agreement for Falls Lake with US Army Corps of Engineers

Dwayne Patterson, Director
NC Division of Parks and Recreation
1615 MSC - Raleigh, NC 27699-1615
919.707.9300 / ncparks.gov

bƚƩƷŷ /ğƩƚƌźƓğ 5źǝźƭźƚƓ ƚŅ tğƩƉƭ ğƓķ wĻĭƩĻğƷźƚƓ

{ĻĭƩĻƷğƩǤ 5͵ wĻźķ ‘źƌƭƚƓ
DƚǝĻƩƓƚƩ wƚǤ /ƚƚƦĻƩ
Attachment L
Setback Waivers

{ĻƷĬğĭƉ ‘ğźǝĻƩƭ wĻĭƚƩķĻķ ǞźƷŷ 5ǒƩŷğƒ /ƚǒƓƷǤ wĻŭźƭƷĻƩ ƚŅ 5ĻĻķƭ

5ǞğǤƓĻ tğƷƷĻƩƭƚƓͲ 5źƩĻĭƷƚƩ
b/ 5źǝźƭźƚƓ ƚŅ tğƩƉƭ ğƓķ wĻĭƩĻğƷźƚƓ
ЊЏЊЎ a{/ Ώ wğƌĻźŭŷͲ b/ ЋАЏВВΏЊЏЊЎ
ВЊВ͵АЉА͵ВЌЉЉ Ή ƓĭƦğƩƉƭ͵ŭƚǝ

bƚƩƷŷ /ğƩƚƌźƓğ 5źǝźƭźƚƓ ƚŅ tğƩƉƭ ğƓķ wĻĭƩĻğƷźƚƓ

{ĻĭƩĻƷğƩǤ 5͵ wĻźķ ‘źƌƭƚƓ
DƚǝĻƩƓƚƩ wƚǤ /ƚƚƦĻƩ
{źƷĻ ağƦ

{źƷĻ ƒğƦ ĭƌĻğƩƌǤ ķĻƦźĭƷźƓŭ ƷŷĻ ƭĻǞĻƩ ƌźƓĻƭ ğƓķ ƷŷĻźƩ ƩĻƌğƷźƚƓ Ʒƚ ƷŷĻ ƷƩĻğƷƒĻƓƷ ǒƓźƷƭ
ğƓķ źƩƩźŭğƷźƚƓ ŅźĻƌķƭ ğƭ ƭƦĻĭźŅźĻķ źƓ ƷŷĻ ğķķźƷźƚƓğƌ źƓŅƚƩƒğƷźƚƓ ƩĻƨǒĻƭƷ ƩĻĭĻźǝĻķ ŅƩƚƒ
b/ 59v͵

5ǞğǤƓĻ tğƷƷĻƩƭƚƓͲ 5źƩĻĭƷƚƩ
b/ 5źǝźƭźƚƓ ƚŅ tğƩƉƭ ğƓķ wĻĭƩĻğƷźƚƓ
ЊЏЊЎ a{/ Ώ wğƌĻźŭŷͲ b/ ЋАЏВВΏЊЏЊЎ
ВЊВ͵АЉА͵ВЌЉЉ Ή ƓĭƦğƩƉƭ͵ŭƚǝ