WQ0040139_Application_20180705

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0200 — WASTEWATER PUMP AND HAUL SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM P&H 01-16 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T.0100, 15A NCAC 02T.0200 and Division policies. Failure to submit
all required items will necessitate additional processing and review time. For more information, visit the Wastewater Branch's
website or contact the Regional Office serving your county.
General — This permit application applies to all pump and haul activities of wastewater under the authority of the Division on Water
Resources. Permit coverage is required for the system producing the wastewater. This permit does not apply to the transport of
animal waste from an animal waste management systems, not the transport of wastewater residuals or biosolids.
NOTE: Pump and haul permits are not acceptable long term domestic wastewater treatment alternatives and
in cases of environmental emergencies, nuisance conditions, health problems, or for unavoidable delays in coi
previously permitted by the Division.
B. Application Fee (Domestic Wastewater Only)
❑ Submit a check made payable to: North Carolina Department of Environmental Quality (NCDEQ)
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The appropriate application fee is: $810.00 for flows < 10,000 GPD and $1,310.00 for flows > 10,000 GPD'n
only be issued
tion of system
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C. Wastewater Pump and Haul (FORM: P&H 01-16) Application:
❑ Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H 01-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or
due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to
correspond to the section and item to which they refer
D. Receiving Facility Letter:
❑ Submit a letter from the owner/authority of the receiving wastewater treatment facility, as required by 15A NCAC 02T.0204
(b), stating that the pumped and hauled wastewater will be accepted and specifying the volume and type of wastewater that
will be accepted. The letter should be signed by an authorized signing official in accordance with 15A NCAC 02T .0106(b)
E. Contract Hauler Letter:
❑ Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
❑ Letter shall include: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:
❑ The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T.0106(b). Per 15A
NCAC 02T .0106(c), 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(b)
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer (if required)
G. Plans and Specifications (Required for activities that result in the Practice of Engineering per G.S. 89C-3):
❑ Submit two sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional Engineer)
❑ Plans must include:
➢ A general location map
➢ Diagram of the components associated with the pump and haul activity (drains, piping, tanks, pumps, etc)
Tank Details that indicate high water alarm
➢ Other items as required
INSTRUCTIONS FOR APPLICATION P&H 01-I6 Pagel of 5
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A. Pre -submittal Contact & Cover Letter
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❑ Contact the appropriate Regional Office prior to submittal
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❑ Submit a cover letter explaining the circumstances associated with this pump and haul permit request
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B. Application Fee (Domestic Wastewater Only)
❑ Submit a check made payable to: North Carolina Department of Environmental Quality (NCDEQ)
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The appropriate application fee is: $810.00 for flows < 10,000 GPD and $1,310.00 for flows > 10,000 GPD'n
only be issued
tion of system
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r— p
W O
N Z
O SJ
60 a
C. Wastewater Pump and Haul (FORM: P&H 01-16) Application:
❑ Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H 01-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or
due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to
correspond to the section and item to which they refer
D. Receiving Facility Letter:
❑ Submit a letter from the owner/authority of the receiving wastewater treatment facility, as required by 15A NCAC 02T.0204
(b), stating that the pumped and hauled wastewater will be accepted and specifying the volume and type of wastewater that
will be accepted. The letter should be signed by an authorized signing official in accordance with 15A NCAC 02T .0106(b)
E. Contract Hauler Letter:
❑ Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
❑ Letter shall include: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:
❑ The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T.0106(b). Per 15A
NCAC 02T .0106(c), 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(b)
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer (if required)
G. Plans and Specifications (Required for activities that result in the Practice of Engineering per G.S. 89C-3):
❑ Submit two sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional Engineer)
❑ Plans must include:
➢ A general location map
➢ Diagram of the components associated with the pump and haul activity (drains, piping, tanks, pumps, etc)
Tank Details that indicate high water alarm
➢ Other items as required
INSTRUCTIONS FOR APPLICATION P&H 01-I6 Pagel of 5

I. PRESUBMITTAL INFORMATION:
1. Contacted representative from regional office (Pre -submittal)?: ® Yes ❑ No
2. Contact name (For Regional Office): Ori Tuvia
II. APPLICANT INFORMATION:
1. Applicant's name (Municipality, Individual, Corporation, etc): Stanley Environmental Solutions
2. Applicant type: ®Municipal ❑ State ❑ Privately -Owned Public Utility
❑ County ❑ Other:
3. Origin of Wastewater:
❑ Residential Subdivision ❑ Retail (Stores, Shopping Centers) Domestic: None
® Apartments/Condominiums ❑ Institution Commercial:
❑ Mobile Home Park ❑ Hospital Industrial:
❑ School ❑ Church Other: Clean up water
❑ Restaurant ❑ Nursing Home
❑ Office ® Other (specify)
4. Signature authority's name: Jim Lanier per 15A NCAC 02T .0106(b)
Title: VP Operations
5. Applicant's mailing address: PO Box 184
City: Stanley State: NC Zip: 28164-
6. Applicant's contact information:
Phone number: [phone] Email: [e-mail]
III. CONTACT/CONSULTANT INFORMATION:
1. Contact name: Jim Lanier
Title/Affiliation: VP Operations
2. Contact's information:
Phone number: [phone] Email: jimgstanleyenviro.com
IV. RECEIVING FACILITY INFORMATION:
If more than 1 facility has agreed to accept the wastewater, please list all the owners, facility names, and permit
numbers as a separate attachment)
1. Owner: Wind River Environmental Solutions
2. Facility name: Earth Farms LLC
3. Facility permit number: SDTF-36-04
4.WWTF permit number: 3613 -COMPOST -2017
5. WWTF contact name: Shane Roberts 704.363.5072
Title/Affiliation: Mer.
6. WWTF contact information:
Phone number: [phone] Email: [e-mail]
APPLICATION P&H 0 1- 16 Page 3 of 5

V. PROJECT INFORMATION:
1. Location of Project (physical address): 9200
Approximate Coordinates (Decimal Degrees): Latitude: o Longitude: - 0
2. Duration of Pump and Haul Request (Six Months Typical): 2 months
3. Has a prior permit been issued? ® New ❑ Prior Pump & Haul Permit
Permit No.:
4. Permanent Method of Wastewater Disposal: City Sewer RECEIVED/NCDENR/DWR
5. Date Permanent Disposal will be available: Scheduled August 5th
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6. Have permits /approvals for permanent disposal been obtained? J Ui:
® Yes E]No Permit Number: WORDS
MOORESVILLE REGIONAL OFFICE
7. Is there a Pretreatment Program in effect? ❑ Yes ®No
8. Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: Less than 10,000 Gallons per Day
10. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T.0114 or ® Representative Data
If representative data, describe: This water is just water used to do the initial house cleaning before appartments
are occupied
11. Describe Tank / Container wastewater will be pumped from (attach description if necessary):
Pumped from manhole
12. Is Tank / Container in place or will it be installed (attach description if necessary):
Frac Tank 20,000 gallon
13. What type of high water alarm does the container have (and/or):
® Audible and Visual ® Telemetry (Auto Dialer/ SCADA)
VI. CERTIFICATION:
1. Applicant's Certification: (Signature of Signing Official and Project Name)
I, Jimmy R. Lanier attest that this application for Haven 49 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 documentation and attachments are not included, this application package is subject to
being returned as incomplete. I understand that issuance of a permit will require pump and haul facilities or activities to be
inspected at least dally by me or a designated representative. Note: in accordance with North Carolina 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.
la., _ Jimmy R. Lanier July 2 2018
gn' g Offici I
ignature Date
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
ACTIVITIES SHALL BE INSPECTED AT LEAST DAILY BY THE PERMITTEE OR IT'S REPRESENTATIVE PER 15A NCAC 02T.0204Ud.
APPLICATION P&H 01-16 Page 4 of 5

THE ENGINEER'S CERTIFICATION IS REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER G.S. 89C-3.
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL. IF CERTIFICATION BY AND ENGINEER IS REQUIRED,
THIS PAGE IS NOT NECESSARY.
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
, 1?ivurj 11114.JENE imp Pe ,attest that this application for has been reviewed by me and is
accurate, complete and consistent with the information 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 all the applicable regulations. Although other professionals may have developed certain portions
of this submittal package, 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
143-215.60, 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 $25,000 per
violation.
2a. t-ON&j 4 -lE a &sY-
Professional Engineer Name
2b. Cm6-1EOESi d' S-mN6 , PA
Engineering Firm
2c. 2ZO SOJfH TRY rra grocer, ff 14 00
Mailing Address
2d. Cq*gLWp i z 2e. NG 2f. 2,97,0 2 -
City
City State Zip
29. -IIA 1-4510 2h.704-$-Jb--1851_2i. C'Icne.srevlc;�"stsa�.�..
Telephone Facsimile E-mail NC PE Seal, Signature & Date
RECEIVEOINCOENRIO`f'1 R
WOROS NAIOff\CE
tAO0RESV tIL1.E REGIO
APPLICATION P&H 01-16 Page 5 of

solutions
Mooresville Regional Office
Water Quality Operations
610 E. Central Ave.
Mooresville, NC 28115
Att. Ori Tuvia
_w earth
V;farm;
--"' ORGANICS
COMP09T & TOPSOIL PHODUCTS
Stanley Environmental Solutions has been hired to perform a Pump and Haul at Haven 49
9200 University City Blvd. Charlotte, NC. Stanley Environmental has a fleet of pump trucks
ranging from capacity of 3500 gall to 6000 gallon.
A 20,000 gallon Frac Tank has been installed with (2) 4" pumps which will alternate pumping
There is a telemetry dialer with a audible and visual alarm system.
The water can be hauled to Earth Farms LLC site for processing. The permit number is NC
SDTF 36-04. The water can also be hauled to Mecklenburg County McAlpine Creek WWTP in
Charlotte, NC. Permit number NC 01373

Tuvia, Ori A
From: Jim Lanier <[e-mail]>
Sent: Thursday, July 05, 2018 4:50 PM
To: Tuvia, Ori A; [e-mail]
Subject: (External] Fwd: Earth Farms Compost Facility, proposed receipt of flush water
Jim Lanier
VP Operations
Cell [phone]
Begin forwarded message:
From: "Wilson, Donna" <donna.wilsonCEDncdenr.gov>
Date: July 5, 2018 at 4:48:49 PM EDT
To: Jim Lanier <[e-mail]>
Subject: Earth Farms Compost Facility, proposed receipt of flush water
Jim,
The Solid Waste Section does not have any objections to the receipt of the flush water, as described
below, being accepted at the Earth Farms compost facility, Permit 3613 -COMPOST -2017, to be used for
moisture of the compost windrows.
Donna
Donna J. Wilson
Environmental Engineer
Solid Waste Section, Division of Waste Management
Department of Environmental Quality
Phone [phone]
Email [e-mail]
Section website httP://deg.nc.gov/about/divisions/waste-management/solid-waste-section
Office address - 217 W. Jones St., Raleigh, NC 27603
Mailing and delivery address - 1646 Mail Service Center, Raleigh, NC 27699-1646
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.