Application - 11/9/2012

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
NIM
x�
NCDENR
Domestic Wastewater Pump and Haul Application
INSTRUCTIONS FOR FORM:
The Division of Water Quality will not accept this application unless all the instructions are followed.
Plans and specifications must be prepared in accordance with 15A NCAC 2T .0200, all applicable
general statutes, and good engineering practices. Failure to submit all of the required items will lead to
additional processing time for the permit application or in the application being returned as incomplete.
A. Application Form:
✓ Submit one original and one copy of the completed and appropriately executed application form. The Division of
Water Quality (Division) will only accept complete application packages.
✓The project name should be consistent with the project name on any plans, letter of flow acceptance, operational
agreements, etc.
B. Application Fee (New and Renewal Packages):
-./The appropriate application fee is $810 for flows <10,000 GPD and $1,310 for flows >10,000 GPD.
-/Submit the check payable to: North Carolina Department of Environment and Natural Resources (NCDENR).
C. Cover Letter:
✓ Submit a cover letter explaining the circumstances associated with this pump and haul request as required by 15A
NCAC 2T .0204. Please note that pump and haul permits are not acceptable as a long term domestic wastewater
treatment alternative.
D. Receiving Facility:
✓ Submit a letter from the owner/authority of the receiving wastewater treatment facility stating that the pumped and
hauled wastewater will be accepted and specifying the volume of wastewater that will be accepted.
E. Contract Hauler:
✓ Submit a letter or contract from the hauler stating his capability and willingness to perform the pumping and hauling.
F. Detailed Plans and Specifications:
✓Submit two sets of detailed plans and specifications that have been signed, sealed, and dated by a Licensed NC
Professional Engineer.
,/Plans must include the following minimum items: a general location map and a diagram of the components
associated with the pump and haul activity (drains, piping, tanks, pumps).
,/The tank detail should indicate the high water alarm (both audible and visual or an auto dialer).
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
Surface Water Protection Supervisor
WIRO Regional Office
Department of Environment and Natural Resources IEC
NOV 0 9 �Oi�
BY:
Form: P&H 01/12 Page 1 of 4

NORTH CAROLINA �
DEPARTMENT OF ` •
ENVIRONMENT AND = �-
NATURAL RESOURCES pENR
Division of Water Quality
WIRO Regional Office
Non -Discharge Pump and Haul Permit Application
Application Number: (to be completed by DWQ for new projects)
I. GENERAL INFORMATION:
1. Applicant (corporation, individual, other): Onslow Water and Sewer Authority
2. Print owners or signing official's name and title (person legally responsible for the facility and its compliance):
Billy Joe Farmer, Executive Director
3. Mailing address of applicant: PO Box 1415
City: Jacksonville State: NC Zip: 28540
Telephone number: [phone] Facsimile number: ( )
Email Address: BFarmeraa,onwasa.com
4. Project name (facility or establishment): Summerhouse
5. County where project is located: Onslow
6. Fee submitted: $ (See Instruction B.)
7. Name and complete address of engineering firm: ONWASA Engineering Division
PO Box 1415
City: Jacksonville State: NC Zip: 28540
Telephone number: [phone] Facsimile number: [phone]
8. Name and affiliation of contact person who can answer questions about project:
Matthew E. Hypes, PE — Engineering Director Email Address: mh}yes(a)onwasa.com
II. PERMIT INFORMATION:
1. If this application is being submitted as a result of a modification to or renewal of an existing permit, please
provide the existing permit number and the issuance date
2. Specify whether the applicant is: public XXX or private
ECF IVE
Form: P&H 01/12 Page 2 of 5 NOV 3 011
BY.

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INFORMATION ON WASTEWATER:
Nature of wastewater: 100% Domestic % Commercial % Industrial
% Other waste (specify):
Please provide a one or two -word description specifying the origin of the wastewater (school, restaurant,
apartments, commercial): residential development
Volume of wastewater generated by this project: 80.000/week approx. 11,430 gallons per day.
Explanation of how wastewater flow was determined: maximum volume that Holly Ridge WWTP ORC has
agreed to accept.
Description of any pretreatment of wastewater prior to pumping and hauling: N/A
TREATMENT FACILITY INFORMATION:
Name of treatment facility receiving wastewater: Holly Ridge WTF
NPDES permit number of treatment facility: WQ0019907
Treatment facility contact person and telephone no: Allen Rhue [phone]
County where treatment facility is located: Onslow
CONTRACT HAULER INFORMATION:
Name of owner/company of transporting (hauler) vehicle: ONWASA
Mailing address of hauler: P O Box 1415, Jacksonville NC 28540
Telephone number of hauler: [phone]
Provide the typical hauling volume of the vehicle: Contract Hauler (2 trucks) — 7500 gal/load and 4000 gal/load
ONWASA Hauler - 2,400 gallons/load
GENERAL PROJECT INFORMATION
Brief project description: Summerhouse, a residential PUD, was designed and constructed to include 1,029
residential lots approximately 4 years ago.
Explanation of why pump and haul is being requested: Only 6 houses and the clubhouse currently exist. With this
meager wastewater flow, the 0.1 MGD MBR units cannot be started up and run in compliance with permit
requirements.
Specify how long the pump and haul permit will be needed (maximum of six months): until the recommended
0.03 MGD of actual wastewater flow is realized. It is understood that the pump -and -haul operation will last longer
than 6 months for this Project.
What will be the permanent method of wastewater disposal once the pump and haul activities have ceased?:
Operation of the Summerhouse WU and high rate infiltration ponds
Date that permanent disposal method will be available: Currently in place, but can't be operated — see 2 & 3, above
Have permits/approvals for the permanent disposal method been obtained?
XXX Yes; Permit No. W00029945 Permitting agency DWQ/APS/LAU
No; Pending permit No
Permitting agency
What type of tank or container will the wastewater be pumped from and what is the volume of this container?
Existing concrete sewage Pump Station Nos.2, 3, and 4 in the Summerhouse at Everett Bay Development
Form: P&H 01/12 Page 3 of 5

8. Is the tank or container already in place or will it be installed for these activities? Existing
9. What type of high water alarms do the containers have? Audible and visual YES Auto dialer YES
VII. OWNER'S SIGNATURE:
Applicant's Signature and Certification:
I, Timothy Webb , attest that this application for Summerhouse
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 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. Note: In accordance with NC General Statutes 143-215.6A and
143-215.613, any person who knowingly makes any false statement, representation, or certification in any
application 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 violation.
Signature: Date:
VIII. PROFESSIONAL ENGINEER'S CERTIFICATION:
I, Matthew E. Hypes, PE , attest that this application for Summerhouse
has been reviewed by me and is
accurate, complete and consistent with the information supplied in the engineering plans, calculations, and all
other supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the
proposed design has been prepared in accordance with the applicable regulations. Although certain portions of
this submittal package may have been developed by other professionals, inclusion of these materials under my
signature and seal signifies that I have reviewed this material and have judged it to be consistent with the
proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who
knowingly makes any false statement, representation, or certification in any application 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.
North Carolina Professional Engineer's seal, signature, and date:

Form: P&H 01/12 Page 4 of 5

DIVISION OF WATER QUALITY REGIONAL OFFICES
Asheville Regional Office
SWP Supervisor
2090 US Highway 70
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Avery
Macon
Buncombe
Madison
Burke
McDowell
Caldwell
Mitchell
Cherokee
Polk
Clay
Rutherford
Graham
Swain
Haywood
Transylvania
Henderson
Yancey
Jackson
Raleigh Regional Office
Office
SWP Supervisor
3800 Barrett Drive
Raleigh, NC 27609
Phone- [phone]
Fax: [phone]
Chatham
Durham
Edgecombe
Franklin
Granville
Halifax
Johnston
Lee
Nash
Northampton
Orange
Person
Vance
Wake
Warren
Wilson
Winston-Salem Regional Office
SWP Supervisor
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
Fax: [phone]
Alamance
Alleghany
Ashe
Caswell
Davidson
Davie
Forsyth
Guilford
Rockingham
Randolph
Stokes
Surry
Watauga
Wilkes
Yadkin
Fayetteville Regional Office
SWP Supervisor
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Phone: [phone]
Fax: [phone]
Anson
Moore
Bladen
Robeson
Cumberland
Richmond
Harnett
Sampson
Hoke
Scotland
Montgomery
Washington Regional Office
SWP Supervisor
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Beaufort
Bertie
Camden
Chowan
Craven
Currituck
Dare
Gates
Greene
Hertford
Hyde
Jones
Lenoir
Martin
Pamlico
Pasquotank
Perquimans
Pitt
Tyrell
Washington
Wayne
Form: P&H 01/12 Page 5 of 5
Mooresville Regional Office
SWP Supervisor
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Alexander
Lincoln
Cabarrus
Mecklenburg
Catawba
Rowan
Cleveland
Stanly
Gaston
Union
Iredell
Wilmington Regional
SWP Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
Phone: [phone]
Fax: [phone]
Brunswick New Hanover
Carteret Onslow
Columbus Pender
Duplin