WQ0020301_Final Permit_20010820

v-, W A rE Michael F. Easley, Governor
C" R William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
,q Xa-7 Gregory J. Thorpe, Ph.D,
Acting Director
Division of Water Quality
August 20, 2001
Mr. Peter L. Kunkle, Senior Minister
First Christian Church
Oak Ridge Road
Kernersville, N.C. 27284
SUBJECT: Pump and Haul Permit No. WQ0020301
First Christian Church
Forsyth County
Dear Mr. Kunkle:
In accordance with your application received August 8, 2001, we are forwarding
herewith Permit No. WQ0020301, to First Christian Church for the operation of a pump and haul
disposal system.
This permit shall be effective from the date of issuance until February 20, 2002, and
shall be subject to the conditions and limitations as specified therein. Please pay particular
attention to the monitoring requirements in this permit. Failure to establish an adequate system
for collecting and maintaining the required operational information will result in future
compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable to you,
you have the right to request an adjudicatory hearing upon written request within 30 days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150B of North Carolina General Statutes, and filed with the Office of
Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands
are made this permit shall be final and binding.
If you need additional information concerning this matter, please contact Mr. Steve
Mauney or meat 336n71-4600.
Sincerely,
Larry D. Coble
Regional Supervisor
cc: Non -Discharge Permitting Unit
Central Files
Forsyth County Health Department - Attn: Charles Kahill
WSRO
N. C. Division of Water Quality
585 Waughtown Street Winston Salem, NC 27107
Phone [phone]; Fax [phone]; Internet http://wq.ehnr.state.nc.us
V*A
NCDENR
Customer Service
1 800 623-7748

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
FIRST CHRISTIAN CHURCH
FORSYTH COUNTY
FOR THE
operation of a domestic wastewater pump and haul system to serve the First Christian Church
with no discharge of wastes to the surface waters, pursuant to the application received August 8,
2001, and in conformity with the project plan, specifications, and other supporting data
subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit.
This permit shall be effective from the date of issuance until February 20, 2002, and shall
be subject to the following specified conditions and limitations:
This permit shall become voidable unless the subject pump and haul activities are carried
out in a manner which has been approved by this Division.
2. This permit is effective only with respect to the nature and volume of wastes described in
the application and other supporting data.
3. The facilities shall be properly maintained and operated at all times.
4. This permit is not transferable. In the event there is a desire for the facilities to change
ownership, or there is a name change of the Permittee, a formal permit request must be
submitted to the Division of Water Quality accompanied by an application fee,
documentation from the parties involved and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may
not be approved.

5. No type of domestic wastewater other than that from First Christian Church shall be
included in the pump and haul activities.
6. The permit shall become voidable unless the agreement between First Christian Church,
Mueller Septic Tank Company and The City of Greensboro for the collection,
transportation, and ultimate disposal of the domestic wastewater is in full force and
effect.
7. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall cease operation of all pump and haul activities
and take such immediate corrective action, as may be required by this Division.
8. This pump and haul permit shall not be renewed.
9. The sewage and wastewater collected by this system shall be treated in the Osborne
Wastewater Treatment Plant prior to being discharged into the receiving stream.
10. The Winston-Salem Regional Office, telephone no. [phone] shall be notified at
least forty-eight (48) hours in advance of operation of the pump and haul activities so that
an in -place inspection can be made. Such notification to the regional supervisor shall be
made during the normal office hours from 8.00 a.m. until 5:00 p.m. on Monday through
Friday, excluding State Holidays.
11, The Permittee is liable for any damages caused by a spill or failure of the pump and haul
operations.
12. Adequate inspection, maintenance and cleaning shall be provided by the Permittee to
insure proper operation of the subject facilities.
13. The Permittee or his designee shall inspect the pump and haul collection facilities to
prevent malfunctions and deterioration, operator errors and discharges which may cause
or lead to the release of wastes to the environment, a threat to human health, or a
nuisance. The Permittee shall keep an inspection log or summary including at least the
date and time of inspection, observations made, and any maintenance, repairs, or
corrective actions taken by the Permittee. This log of inspections shall be maintained by
the Permittee for as long as the pump and haul activities are being conducted and shall be
made available upon request to the Division of Water Quality or other permitting
authority.
14. Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises or place
on or related to the pump and haul collection facilities at any reasonable time for the
purpose of determining compliance with this permit; may inspect or copy any records that
must be kept under the terms and conditions of this permit; and may obtain samples.

15. An accurate record of the monthly pump and haul activities must be maintained by the
Permittee, indicating:
a) date wastewater is removed from the facility,
b) name of facility from which wastewater is removed,
c) name of facility receiving wastewater,
d) volume of wastewater removed, and
e) status of permanent disposal option.
These records shall be submitted to the Winston-Salem Regional Office on or before the
fifteenth (15) day of the following month.
16. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division of Water Quality in accordance with
North Carolina General Statute 143-215.6.
17. The issuance of this permit does not preclude the Permittee from complying with any and
all statutes, rules, regulations, or ordinances which may be imposed by other government
agencies (local, state, and federal) which have jurisdiction.
18. The Permittee shall provide for the installation and maintenance of an audible and visual
highwater alarm.
19. A leakage test shall be performed on the septic tank and dosing tank to insure that any
exfiltration occurs at a rate which does not exceed twenty (20) gallons per twenty-four
(24) hour per 1,000 gallons of tank capacity. The engineer's certification will serve as
proof of compliance with this condition.
20. A copy of the approved plans and specifications shall be maintained on file by the
Permittee for the life of the project.
21. Noncompliance Notification:
The Permittee shall report by telephone to the Winston-Salem Regional Office, at
telephone no. [phone], as soon as possible, but in no case more than 24 hours or
on the next working day following the occurrence or first knowledge of the occurrence of
any of the following:
a. Any process unit failure, due to known or unknown reasons, that render the
facility incapable of adequate wastewater treatment such as mechanical or
electrical failures of pumps, aerators, compressors, et.

I
b. Any failure of a pumping station, sewer line, etc. resulting in a by-pass directly to
receiving waters without treatment of all or any portion of the influent to such
station or facility.
Persons reporting such occurrences by telephone shall also file a written report in
letter form within 15 days following first knowledge of the occurrence. This
report must outline the actions taken or proposed to be taken"to ensure that the
problem does not recur.
22. Upon completion of construction and prior to operation of the subject pump and haul
activities, a certification must be received from a professional engineer certifying that the
permitted facilities have been installed in accordance with this permit, the approved plans
and specifications_ Mail the certification to the Permits and Engineering Unit, P.O. Box.
27687, Raleigh, NC 27611-7687.
23. The annual administering and compliance fee must be paid by the Permittee within thirty
(30) days after being billed by the Division. Failure to pay the fee accordingly may cause
the Division to initiate action to revoke this permit as specified by 15 NCAC 2H.
0205(c)(4).
Permit issued this the 20th day of August, 2001.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Larry %Coble
Winston-Salem Regional Supervisor
By Authority of the Environmental Management Commission
Permit No. WQ0020301

Permit No. WQ0020301
August 20, 2001
Engineer's Certification
I , as a duly registered Professional Engineer in the
State of North Carolina, having been authorized to observe (periodically, weekly, full time) the
construction
of the project ,
Project Name Location
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the approved plans and specifications.
Signature.
Date
Registration No.

State of North Carolina
Department of Environment, Health, and Natural Resou,
Division of Environmental Management
Non -Discharge Peru Application
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AM ORIGINAL)
PUMP AND HAUL DISPOSAL SYSTEM
I. GENERAL INFORMATION:
1 _ Applicant (corporation, individual, or other). 1 IKSI� ��L
2. Print Owners or Signing Official's Name andEKEZEr
Title (the person who is legally
responsible for the facility and its corn pliance): eikAc- �/(�/m ��/i%�/�/��
3. Mailing Address:
City:��'C/iiL�iE'S �'G.L State: Zip:
Telephone No.: ( ) _ � -73,' X
4. Project Name (subdivision, facility, or establishment name - should be consistent with
project name on plans/specs., letters of flow acceptance, Operational Agreements, etc.):
Cw
5. Application Date: 11 1 d 6. Fee Submitted: $
7. County where project is located:��
8. Latitude: Longitude: of facility being pumped
II. PERMIT INFORMATION:
1. Permit No. (will be completed by DEM):
2. If this application is being submitted as a result of a modification to an existing
permit, Iist the existing permit number !u and issue date
3. Specify whether the applicant is public or ✓ private.
ASS! GNED TOR�
FORM: PHDS 4/91 Page I of b 0U E DATE
j7

PUMP AND HAUL DISPOSAL
PAGE 2 (4/91)
III. INFORMATION ON WASTEWATER:
1. Nature of Wastewater: l 00 % Domestic; % Commercial;
Industrial; % Other waste (specify):
2. PIease provide a one or two word description specifying the origin of the wastewater,
such as school, subdivision, hospital, commercial, industrial, apartments, etc.:
3- If wastewater is not domestic in nature, what level of pretreatment has been provided
to ensure prat � ti n of the receiving wastewater treatment facility?
4. Volume of wastewater to be pumped & hauled: , 00 I _ gallons per day
5. Explanation of how wastewater volume was determined: �,� , ' L_oal %-r'I��s
IV. TREATMENT FACILITY INFORMATION:, l�
1. Name of wastewater treatment facility receiving wastewater:hL6''�4%�t�'�
2. Treatment facility permit no.:
3. Treatment facility contact person and telephone no:
4. County where treatment facility is located: I L-FOP.D
5- Distance to treatment facility: 13 R,. __ nules
V. OTHER INFORMATION:
1. Brief project description: o PuM { qG( L ;J 1Zk) ilk Pi 0PZ�Fg- T '� LEA'
F'�AIWIV6 PrIC, L.� Gtn 1L L�� SC R C16AJrC7-)Ck 1-S C' VP1- I
2. Explanation of why a pump & haul permit is being requested (be specific & explain if an
environmental emergency exists):
A5 �a-T D 46(-,)Ve ///��}��7r9eQ IS-641L1A6
P6kC t D 104-&-ZN A-T e. i iR / lam/ 1 J r r . 1 ��i/ / it G'iL
3. Specify how long pump & haul permit needed (shall not exceed 6 months): months
4. What will be the permanent method of wastewater disposal once the pump & haul
activities have ceased? eoe
5. Date that permanent disposal method will be available: to-/-oo
2of6

PUMP AND HAUL DISPOSAL
PAGE 3 of 6 (4/91)
6. Have permits/approvals for permanent disposal method been obtained?�
Yes; Permit No. Permitting Agency L
JI
No; Pending Permit No. Permitting Agency �?T w-'s V
7. Describe how the wastewater will be transported (truck, rail car, etc_) and provide theS
typical hauling volume of the vehicle providing the hauling: 1 PJtCK - �b00 L�
tYP g P g g � : (;�1�
L
8. Name of �
owner of transporting vehicle: L�- --TJC C:C?_ (_ P�
9. Mailing Address of Hauler:
City: K&k) —I�yj�i state: N'C Zip: 02�
Telephone No.: -b 43'�
10. What type of tank or other container will the wastewater, be pumped from and what is the -
volume of this container? _%9T_J(!, _TP/Jg ��?� wr U L .
11. Was the tank or container already in placc or will it be installed for these activities?
QI_R6A_t_ e�lSTi�C
12. What type of high water alarm does the container have?
audible and visual auto dialer
THIS APPLICATION PACKAGE WELL NOT BE ACCEPTED BY THE
DIVISION OF ENVIRONMENTAL MANAGEMENT UNLESS ALL OF
THE APPLICABLE ITEMS ARE INCLUDED WITH THE SUBMITTAL
Required Items
a. One original and two copies of the completed and appropriately executed application form.
b. Three sets of detailed plans and specifications signed and sealed by a North Carolina
Professional Engineer. The plans/specifications must include a general location map, a plan
view of the storage facility and its reIationship to property lines, and details showing the high
water alarms (provide either audible and visual or an auto dialer). Each sheet of the plans and
the first page of the specifications must be signed and sealed.
c.. The appropriate permit processing fee, in accordance with 15A NCAC 211 .0205(c)(5).
d. A letter must be provided from the owner/authority of the wastewater treatment facility
stating that the wastewater will be accepted and specifying the volume that will be accepted.
The letter should be a recent letter and should refer to the project by the same name as that
identified on the application and the plans/specifications.
e. A copy of the contract or agreement between the wastewater hauler and the applicant and a
map indicating the haul route.
f. The application package should be sent to the appropriate regional office, according to the
attached listing on page 4, which provides the regional responsibility by county. If there are
any questions contact the appropriate regional office.

Name and Complefe Address of Engineering Firm:
PUMP AND HAUL DISYUSAL
PAGE 5 (4/91)
City:
Telephone No.
State:
Professional Engineer's Certification:
I, , attest that this application for
Zip:
has been reviewed by me and is accurate
and complete 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.
North Carolina Professional Engineer's Registration No.
Print Name of Engineer
Seal and Signature (specify date):
Applicant's Certification:
I, PO11 L . 7LWP—tom% , attest that this application for Fi 9S 1
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 includ�l this application package will be, returned as
incomplete.
Signature l Date
5of6

DOIR-�
1117192 DEPARTMENT OF ENVIRONi,.r_-NT AND NATURAL RESOURCES
CASH RECEIPTS JOURNAL VOUCHER WITH SUMMARY
DOCUMENT ID: 1 6 Deposit Date: 101,7 10 Iq I al —01011-1
APP, CODE: E—El GL EFFECTIVE DATE:
DIVISION a,� aukJfOwO f DATA TYPE CODE:
Page 3 of :3
Budget Code: lgl q 1-3101 ()1
Deposit No.!
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