WQ0028785_Renewal Application_20240828

Initial Review
Reviewer nathaniel.thornburg
Is this submittal an application? (Excluding additional information.) *
Yes No
Permit Number (IR) * WO0028785
Applicant/Permittee Queens Grant Recreation Assn., Inc.
Applicant/Permittee Address 926 N. Anderson Blvd, Topsail Beach,NC 28445
Is the owner in BIMS? Yes No Is the facility in BIMS?
Owner Type Organization
Facility Name Queens Grant WWTP
County Pender
Fee Category Major
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review by the hydrogeologist? * Yes No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date
08/28/2024
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
Yes No

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* William Cilento
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*
5042598571
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.
https://edoes.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:*
WQ0028785
Has Current Existing permit number
Applicant/Permittee *
Queens Grant Recreation Assn., Inc.
Applicant/Permittee Address*
926 N. Anderson Blvd, Topsail Beach,NC 28445
Facility Name*
Queens Grant WWTP
Please provide comments/notes on your current submittal below.
Renewal of Permit with no changes in operation.
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.)
Scanned from a Xerox Multifunction Printer (18).pdf 478.99KB
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
�%l%AM&W t�A4'Va
Submission Date 8/28/2024

State of North Carolina
DWR
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 httDs: lledocs.deo.nc.aovfForms/NonDisc harge- Bra nch-Submittai-
Form-Ver2. or emailed to Non-Discharse.Renorts.'d nedenr.gov if less than 20 megabytes (MB).
I. Applicant: Queens Grant WWTF
2. Permit No.: W00028785
3. Signature authority: William Cilento
Phone number: [phone] Cell
4. Mailing address: PO Box 12051
SECTION I — APPLICANT INFORMATION
Title: President, Queens Grant Recreation Association,
Inc.
City: Wilmington
5. Contact person: William Cilento
Primary phone number: [phone] Cell
Email: cilentwt-1ei:wfu.edu
State: NC Zip: 28405-
Email: cilentwt(wfu.edu
Secondary phone number: [phone] Cel I
SECTION 17 -- FACILITY INFORMATION
Physical address: 926 N. Andersen Blvd County: Pender Parcel No.: 42
City: Topsail Beach State: NC Zip: 28445-
2. Treatment facility coordinates to the sixth decimal degree:
Latitude: 34.381858° Longitude:-77.609458 Method: Unknown
SECTION III — FLOW INFORMATIO
1. Permitted flow: 35400 GPD (The maximum allowable flow based on what has been permitted)
2. As -built flow: 35400 GPD (The maximum allowable flow based on what has been constructed)
3. Average flow: 5203 GPD (The average of all reported flows on the previous calendar year's NDMRs)
4. Hydraulic capacity: 14 0A (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
I . Billing address: PO Box 12051
City: Wilmington State: NC Zip: 28405-
2. Verify the Applicant does not have any overdue annual fees:
httus:lldea.nc.aovlabout/divisions/water-resources water-resources-pennit,,.wp-e:)avments
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.
Pa
FORM: HRIS-R 02-21 ge 1 of 6

SECTION V — OPERATOR IN RESPONSIBLE CHARGE (ORC) INFORMATION
1. ORC: Darrell Covington
Grade: 4 Certification No.: 1002814
Mailing address: 1324 Sofia Court
City: Jacksonville
State: NC Zip: 28540-
Phone number: [phone] Cell
Email: [e-mail]
2. Back -Up ORC: Sheila Covington
Grade: 2 Certification No.: 1007664
Mailing address: 1324 Sofia Court
City: Jacksonville
State: NC Zip: 28540-
Phone number: [phone] Cell
Email: covington9161;ci!yahoo.com
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
Select Select °
Select Select - °
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
I. 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 I
4213-92-2246-
Active
Downgradient
On Compliance Boundary
34-3818580
-77,6094580
0000
MW2
4213-92-5921-
Active
Downgradient
On Compliance Boundary
34.381858°
-7T6094580
0000
MW3
42 13-92-5921 -
Active
Downgradient
On Compliance Boundary
34.3818580
-77.6094580
0000
MW4
4213-92-5921-
Active
Downgradient
Inside Field
34.3818580
-77.6094580
oaoo
Select
Select
Select
j
Select
Select
Select
Select
Select
Select
Select
Select
Select
FORM: HRIS-R 02-21
Page 2 of 6

Select Select Select 0°
Select Select Select ° -
Select Select Select
SECTION IX — INFTLTRATION STIES
1. List all infiltration sites associated with the renewing permit. Attach additional sheets if necessary.
Site County Parcel No. Deeded Owner Area Cover Crop Latitude Longitude
Pender 4213-92-5921- Queens Grant Rec Association
Field l 0000 0.15 J Grass 34.381858"-77.609458°
Pender 4213-92-5921- Q ueens Grant rec Association 0.15
Field _ 0000 I Grass 34.381858° 77.609458°
M
I I O
- 41
FnRM• HRi4-R 02-21 Page 3 of

4 - ��
Total Acreage:
ATTACHMENT A — SITE MAP
Was the facility originally permitted or had a major modification issued after September I, 2006?
❑ Yes -- Pursuant to 15A NCAC 02T .0105(d), submit a site map pursuant to the requirements in 15A NCAC 021'.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.
40 ATTACHMENT B —SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section 1, Item 3 meet the requirements pursuant to 15A NCAC 02T .01060)?
® Yes Skip Attachment B.
❑ No — Submit a delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.
4
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 .01 14(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 l 5A NCAC 02T .0 i 15(a)(2), submit an executed Operational Aereement
(FORM: HOA). Pursuant to 15A NCAC 02T .01 I5(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 .01 15(a)(2), submit an executed Operational Aareement
(FORM: DEV). Pursuant to 15A NCAC 02T .01 15(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: HRIS-R 02-21 Page 4 of 6

FORM: HRIS-R 02-21 Page 5 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 .01 18(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 .01 18(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
1 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 .01 16(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.
ATTACHMENT H— 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 1.
ATTACHMENT J — CIVIL PENALTIES AND OUTSTANDING VIOLATIONS 10
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: HRIS-R 02-21 Pao. F 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 .0704(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 L —SETBACK WAIVERS
Does the existing permit include setback waivers?
❑ Yes — Pursuant to 1.5A 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.
® No Skip Attachment L.
APPLICANT'S CERTIFICATION --- _ — —
attest that this application
(Signature authority's name as noted in Section 1, Item 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 pursuant to 15A NCAC 02T .0I20(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 .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 § 143-215.613, 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 includ a ne n t to exceed $10,000 as well as civil penalties up to $'?5,000 pe�r/violation.
Signature: _/ �f Date: ild 7,/�Z T
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email: Laserfiche Upload:
Non -Discharge.Reoorts(r-)ncdenr.%2.y htti)s:Hedoes.deci.ne.gov/Forms/NonDischarge-Branch-
Submittal-Farm-Ver2
FORM: HRIS-R 02-21 Page 7 of 6

STATE OF NORTH CAROLINA
COUNTY OF Pender 0 Permit No. W00028785
OPERATIONAL AGREEMENT.
This AGREEMENT made pursuant to G.S. 143-215.1 (dI) and entered into this 19 day of
AUGUST 2024 , by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
QUEENS GRANT REC ASSOCIATION, INC. a non-profit corporation organized
and existing under and by virtue of the laws of the State of North Carolina, hereinafter known as the
ASSOCIATION.
WITNESSETH:
The ASSOCIATION was formed for the purpose, among others, of handling the property, affairs and
business of the development known as QUEENS GRANT REC ASSOCIATION, INC.
(hereinafter the Development); of operating, maintaining, re -constructing and repairing the common
elements of the lands and improvements subject to unit ownership, including the wastewater collection
system with pumps, wastewater treatment works, and/or disposal facilities (hereinafter Disposal System);
and of collecting dues and assessment to provide funds for such operation, maintenance, re -construction
and repair.
2. The ASSOCIATION desires, to construct and/or operate a Disposal System to provide sanitary sewage
disposal to serve the Development on said lands.
3. The ASSOCIATION has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and/or operate the Disposal System.
4. The Development was created subject to unit ownership in the dwellings units, other improvements and
lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C of the North Carolina General Statutes.
5. The COMMISSION desires to assure that the Disposal System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to protect the
quality of the waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and ASSOCIATION do hereby mutually agree as follows:
1. The ASSOCIATION shall construct the Disposal System and/or make any additions or modifications to
the Disposal System in accordance with the permit and plans and specifications hereafter issued and
approved by the COMMISSION, and shall thereafter properly operate and maintain such systems and
facilities in accordance with applicable permit provisions and law.
2. The ASSOCIATION shall provide in the Declaration and Association Bylaws that the Disposal System
and appurtenances thereto are part of the common elements and shall thereafter be properly maintained
and operated in conformity with law and the provisions of the permit for construction, operation, repair,
and maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire
wastewater treatment, collection and disposal system as a common clement, which will receive the highest
priority for expenditures by the Association except for Federal, State, and local taxes and insurance.
FORM: HOA 0 1 -20 Page 1 of ?.

The ASSOCIATION shall provide in the Declaration and Association Bylaws that the Disposal System
will be maintained out of the common expenses. In order to assure that there shall be funds readily
available to repair, maintain, or construct the Disposal System beyond the routine operation and
maintenance expenses, the Declaration and Association Bylaws shall provide that a fund be created out of
the common expenses. Such fund shall be separate from the routine maintenance fund allocated for the
facility and shall be part of the yearly budget.
4. In the event the common expense allocation and separate fund(s) are not adequate for the construction,
repair, and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for
special assessments to cover such necessary costs. There shall be no limit on the amount of such
assessments, and the Declaration and Bylaws shall be provided such that special assessments can be made
as necessary at any time.
5. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the ASSOCIATION shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit may require as condition of accepting the Development's wastewater.
6. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the ASSOCIATION to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the ASSOCIATION shall
provide in the ASSOCIATION Bylaws that the ASSOCIATION shall not enter into voluntary dissolution
without first having transferred its said system and facilities to some person, corporation or other entity
acceptable to and approved by the COMMISSION by the issuance of a permit.
7. The ASSOCIATION shall not transfer, convey, assign or otherwise relinquish or release its responsibility
for the operation and maintenance of its Disposal System until a permit has been reissued to the
ASSOCIATION's successor.
S. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, and 7 above shall be conditions of any
permit issued by the COMMISSION to the ASSOCIATION for the construction, maintenance, repair and
operation of the Disposal System.
9. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration
is filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of
the Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL
MANAGEMENT COMMISSION
S. Daniel Smith, Director
Division of Water Resources
-QUEENS GRANT REC ASSOCIATION
Name of ASSOCIATION
Bv:
(Signature)
WILLIAM CILENTO, PRESIDENT
Print Name and Title
/ 19 ,20
(Date) (Date)
FORM: HOA 01 -20
Page 2 of 2