WQ0012796_Application_20221216

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0012796
ApplicantlPermittee HIM ALLIANCE LLC
ApplicantlPermittee Address 2941 WAKEFIELD PINES DR., RALEIGH, NC 27614
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
Organization
HIM Alliance WWTF
Greene
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount
Complete App Date
$0
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* Lulu Garcia
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*
9199041184
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
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Permit Number: * WQ0012796
Has Current Existing permit number
Applicant/Permittee* HM ALLIANCE LLC
Applicant/Permittee Address* 2941 WAKEFIELD PINES DR., RALEIGH, NC 27614
Facility Name* HM Alliance WWTF
Please provide comments/notes on your current submittal below.
CHANGE OF OWNERSHIP OF THE LAKEVIEW PACKING WASTEWATER IRRIGATION
High -Rate Infiltration
Reclaimed Water
Residuals
Other
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.)
SKM_C4050i22121518370 copy.pdf 2.53MB
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
�LVLV

Submission Date 12/16/2022

State of North Carolina
Department of Environmental QualiP
Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
'06ivislon of er Resources INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION
This form is for ownership changes or name changes of a non -discharge system permit. Please note that "Permittee"
references the existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit iwbsite
A. Non -Discharge Permit Ownership/Name Change (FORM: NDPONC 06-16) Application (All Applications):
Submit an original completed and appropriately executed Non -Discharge Permit Ownership/Name Change (FORM: NDPONC
06-16) application.
The Existing Perinittee's Certification shall be signed in accordance with 15A NCAC 01221T,0106021. Per 15A NCAC 02T
0106 c official if a delegation letter is provided from a person who
J_J, an alternate person may be designated as the signing offi,
meets the criteria in 15A NCAC 02T 0 l2k(_bj.
The Applicant's Certification shall be signed in accordance with 15A NCAC 02T 0106(hj. Per 15A NCAC 02L.0106Lcb 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(h).
B. Existing Permit (All Applications):
Submit a copy of the most recently issued permit.
C. Property Ownership Documentation (All Applications):
➢ Per 15A NCAC 02T.0504(f). 15A NCAC 02T .0601(cl 15A NCAC 021.0�704 , 15A NCAC 021,0804, 15A NCAC 02T
1004 d 15A NCAC 021'jjjL�5 , 15—A NCAC ±LU DF or5A N A 02L,0202
the Applicant shall demonstrate they are the owner of all property containing the non -discharge system 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.
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
Per 15A NCAC 02T .0115(21 �1, provide one copy of 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.
E. Operational Agreements (All Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to
be sold):
➢ Home/Propggy Owners' Associations
Per 15A NCAC 02T e0IL5Lcj, submit an original properly executed Operational Agreement (_FORM: 1IOA).
Per 15A NCAC 02T 0 IL-5icl, submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws.
➢ Developgrs of lots to be sold
Per 15A NCAC 02T M, 15Q2), submit an original of the properly executed
F. Operation and Maintenance Agreement (All Applications for Single -Family Wastewater Irrigation Systems):
Per L15A NCAC 02T,0604 h ration a�ndMaiptenance �Aree�uient FORM. S�FRWWlS
L1, submit an original of a notarized Qp��
Q&M j that has been signed and dated by all deeded property owners.
1',AYA—C-e_'VZ.#FC tllk—A
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service: 21 Courier/Special Delivery:
Email -
Non -Discharge Branch Non -Discharge Branch — Archdale 942W Non-Disc�hoc.R �Dorts(d�mcdcn�
1617 Mail Service Center 512 N. Salisbury St.
Raleigh, NC 27699-1617 Raleigh, NC 27604
Telephone Number. [phone]
FNSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION Page I of I

State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
tsion of Water Resources FORM: NDPONC 06-16
L EXISTING PERMITTEE INFORMATION:
1. Permittee's name: L&Lp, I'ViLl If
2. Signature authority's name:
per 15ANCACO2L.0106(b) Title:
3. Permittee's mailing address: g
City: S:�04:� "') ALI f State: iv C_ Zip:
4. Permittee's contact information: Phone number: Q5 0_g0_qEQ? Email Address: Rovd juZ eir
5. Demonstration of historical consideration for permit approval - 15A NCAC 02T 0 120:
Has the Permittee or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.613? Yes or 00
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? Yes or (0
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? Yes or &
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? Yes or
e. Has unpaid annual fees in accordance with 15A!!CAQ_02T .Oi05 2 ? Yes or No
IL FACILITY INFORMATION:
1. Facility name: /�i
2. Facility's physical address: >2
City: /2. Ct &2'ry State: Zip: ,�?R,5::5-/ County: i-C
III. PERMIT INFORMATION: / 2 '794P
1. Existing permit number: WQ00/,2 7V,4nd most recent issuance date:
2. Existing permit type: W4,� 4c- twf4e- �+ At-1 ',F c_j ", C,
3. Reason for the permit application: -NVe
4. Has the facility been constructed? 06r No
IV. APPLICANT INFORMATION:
1. Applicant's mine: HM Alliance, LLC
2. Signature authority's name: Jose Luis Martinez Tenorio per 15A NCAC 02T .0106_& Title: President
3. Applicant's mailing address: 2941 Wakefield Pines Dr.
City: Raleigh State: __.hLc_ Zip: 27614 -
4. Applicant's contact information: Phone number: Email Address: [e-mail]
5. Demonstration of historical consideration for permit approval - 1j5A NCACO2T,0 120:
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. 143-215.613? Yes or Na
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
c. Has unpaid annual fees in accordance with 15A NCAC 02T .QIQ_S je)L21? Yes or No
FORM: NDPONC 06-16 Page 1 of 2

Existing Permitter's Certification per 15A NCAC 021.0106M:
attest that this application. for
(Signature Authority's name & title from Application Item 1.2.)
Lakeview Packing Co. Inc.
(Facility name from Application Item 11. 1
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
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 the existing 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 as incomplete. I further certify that the existing Pennittee 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 021.0105(e}.
NOTE — In accordance with General Statutes 143-215.6A and L143-215.613, 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 $10,000as-qell as evil pepdtie )Vp"to)$25,000 per violation.
Applicant's Certification per 15A NCAC 02T flifif-thl:
Jose_ Luis Martinez Tenorio, President of HM Alliance, LLC attest that this application for
(Signature Authority's name & title from Application Item IV.2.)
Lakeview Packing Co. Inc.
(Facility name from Application Item 11, 1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
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 _q�010�5e .
NOTE — In accor feral S s 143-215.6A and j143-215,6B, any person who knowingly makes any false statement,
representation,
on, or rtific in pplication packages be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 well es up to $25,000 per violation.
Signature: Date:
FORM: NDPONC 06-16 Page 2 of 2

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April 12, 2022
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3739 JNC 403 SGUTI
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SuWct: Ptnmit No. WW
Lakeview Cmpamy Parking
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In *ice ". . permia renc%4A] r4gqjcst ftx=ivd Omber 20, 2021. and su q-.icrm
a1ftil10rtA3 I:Rfmm=orl r 1;,:k! h 3. 2072, wt at fomwdirrg Imrtvhith Permtt No WQOG 1274+, dw.Dd
April 12. 242>. w Laktvi-cw P._, ,...- C'ornps15'. I,K Fur Rhc cantjnued ape muon of the Pdbaeclmww4 %atcr
ftTAkt 1i L end 1 mg=¢n fo,; i I i1m;j Pkast n[r1C L. jg 1h, � rex%%r permit SUI IiD00r a CC15=6vt on Ink t.
2022l1 e . ncc d45 Ater the ttpmtvKm d3le oftix CtLgjr<g Pcrm11l
Tlr is pc rmrt iball be c ffwul -c f n7 J utw 1.20, 2 through Nmxmbcr 30, 2029. shall ti oi-d Permit ]Nq
W l V96 Issued J utv 25. 2017. srrd %U I be W" w the c xldttror« ,mod Iimilarwm 1lwr Ln The
Pcrmittee �h*il submit a rmewO rpplicalion no latrr thin Jdae �, 203g.
Plcwc paY mtkn1'art W OK manraonng rcq LL,rvmgnb 4iud AeEad:hAl-mis A, H. and C for 1hcv may
k�ffu f-om the prttrods perm M «tee Far I Lan= to csLablrsh an .y kgL4.Mc m-stern for Collec end
rlmrk a,aing ChC requtrrri curtrafxmaJ in fon atron LhaJJ rest,![ in futurr camp:LXTcc pnobrcnis
Th c Qirl'Sion h, t rem ¢h ed th a f0wo i rig p-qrrn i1 corldiM>nw m':nce the I rsl psrm i t is}p Imcc daled
Jul 25. 2017:
Gld Cbm&Wa V 1 2 Thrs oxd on 1ua Lk�LLn rt;m.ved beCU1c tioc permll i S rrr}1 Yaadlbk
'I h r f0110W 1 AM fltrfrl iI Coradi#iOmt air orw L o-tt th-E last PCeMlt i"ujkT #r dated Ju I y 2S, 2017;
Cbnditran 1 I 71r i s itmdailtm tuqurros 6K P'errnittre to register with rho \ njth
Secn=V Of �t prior to (t uroi rIg waster 3Cr tfc=C!nt aM I mgX co OW ratJoiti,,
edition I r I I- The solbwks ha4e b updzcd
C&adjtion 111 16. - 7Te Permiacc is toqurmi W 1c st and C�hbratc mctGri rig eq uipmcnt ahnual IV.
C*odsci on VII 10 - T!r i s p:rrn 11 shall not to rsn mvd ,f 1h[ Pcmmec or i1n}, affilhibm Lm not
paid the "uirW ,znn" frc
DE
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)une 27, 2022
lwxb Thomas T-umage
La%mew P21ck;ng Compam a ro
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takeOeu Padarg Cornpanx }
Mon-dl arge It No. wrQo012796
r
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The North Carolina Dien ct water Fkefourr5 oarrducted an ire4v� of the Lake mw PadrJng
COMPanY WIM7 on 6{22J202Z. This „w4*abDn vmS OXdLKtOd b;� welfy that the fMKY j5 opermAg Sri
WmPi AnCe wdh the aDndbOrkS and i ImicAtk)ns spebiW wn Nm dju:tEar(e Pemit No. WQN 12-;%. Titie
find, 3n0 wmmenF3 rk during Oc5 irGP&Cbm are pwided I n Che &XJQ&W COW of tJw, i
runt cntltLc%r9 'ComPILVrce lr$pecdm Rep ,
Thtre WEIV no nifrant [tSLK-, or fina,rg5 r#od during the irks ton and ttFcr&ors, a response to this
ing)m or+ text r5 nut fmvimd.
t! M lhot Md h any ems. p Co not hwitatt, W Ontaa rrke y hh the Water
QL01'f RCgtO" 00eradOM SCNIW in the til4 uhroon Reghymr at 252- 5-3912 or " ermialt at
aw-
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Wader (tAlrty Regkml OpmtkmS 5ecLi3n
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Division Of Water R urcr$, NCDEQ

NNORTH CAROL INA
ENVIRONMENTA1. MA N'A('. F.4 ENT COM M FSSAON
DEPARTMENT OF EN V I I#ONM FATAL QUAL[TV
WASTF,WATER IRIRICATION SYSYEM PFR$11T
n accordance with the p fog. Isrons of Aniclo 21 of Ch4ftr 1 a3, Genc rW &afules of North [_ato I i ma as
amrndod. and ot'hcrapp]ic6lc La%�S. Rules. zod Rcgkiho'
PERM] S-S ION IS HEKE Y GRAIN- ED TO
Lakeview Packing Company, Inc.
Greene Cotility
cont<n ucd gxrarion -of a 16.235 Aran per da% (GPD) (operWing an a%%CMgC of 261 days per -ear far an
inn" avor-,gc floor of 4_242.555 $alJons) wagmarur irc=cni an,d krrtga' on fac.tlth' minsistirig of.
a 4,0W gallon grca a- trap %L Ith bft'fLr3 ar+d S Uj 11 • tics; a L 50 0 [*n per n1inuto (UP.N1 � dupJcx pump
s=ion uIth Ngh-w=r alamts and chcck + %-m. ,vproxirnmeLs .2,084 iin= fw (l.F)-of 4-Inch farce maLn,
a nunoal gate vab-e, rnn I,2WgaJIon baf.'llcd septic tanks in pau I -el.. z 707 &iJtm baffl&J cBia inc contxt
tam u ith mcicred dosing -pf ,%od 1 um h}poChJarirc; .a ')17-894 galltrn si-nthciJ aJ h- i rood treatmc n0 mrage
4 ; a Io0 GPM mu uaJlyQperatod pump man with duplox pumps and alarms for high and la -A- u3lor
Ic%V s, a floe meter, 700 LF of 3-inch force nimn. a *ray Field-dwcrtor vnad a box; a 9 74 =ru sprat•
irrigation an~a corisistrng-of cigbt fGrhfs uid1nng both solar -set Lrr,8=0n 2M how reel tmgwlon, and all
,ar;ratcd prptng. valvts.. controls, and appurmnances
to 5MC the Lads 1:1 1 ul% P;kJ41 ng Gun P y W`TV, with no d i 4chargc or %% astg.s to surfapo walem pursurm
to tix appl ical ion rc Lc i L cd UrlubcT 20. 2021, sub. qucnt add i 66" i nfonma6on re:3vod March 3, 20.22.
and to CAM romp+ v; i th the DG+a scan VPTp )vcd phis acid sPCckfMxi0ns cans4detud a Part of This porn it
This permit shall be effecaw from Jule 1. 2072 through Nu)vmbef 30. 2028. si 1 void Fermis No.
WQUU 12796 rcTci ur ILdY 25, 2017- AM shAl ba subjCa W the fa]Jo'A tng condi irons and I i m matrons
Pncr to rzsumin$ wasu %r awr trc,=cn t and i rt�, EHM rowans_ the Pc unlace OW1 ncgtsscr "I rh klhe
kcrelary -of Stares DfGcc tG do bumnm within die State of North Cl ina Documc:nUjoo mall be
�,ubakjaod t4 the JDiLyLooln of W=r Fkc&xL=s, Noon-Ujmxha c Brach. 1617 NUO Serrricc Venter
Motgh, t+Itr 2 7699- J 6I'7, or Kon-LBseJ>a.rrrt. E ceis ' rredt [ 1 SA N AC 02T -0 i 08(b){ 1)� B)]
3. lncc Waluriglcn RwcrW Offim tckpN= =mbcr(252) 94&46491, s].11 be notified z I-mt tg hours
co adrancc (cxc.IUd ag %mekerds and boll r s) of the fiicatity� rt,%uming %%astu%vatcr trt. ment 4M
itriplion pperattans [L5A KCAC 02T 1)1G$ hj(LXB)]
3 The fr nMo 9WI m flues rim"-41 of this pens 11 on DIV160n-aMorcd forms no laic r 1hwi J Line 3
02$. [ 15A NCAC o2T' 0105(b), 02T .0 J 091
'Q 127% VOOW 4.0 ShdlVa0=2 001