HomeMy WebLinkAboutWQ0029894_Final Permit_20060505W A TF,9QG Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
(� Alan W. Klimek, P.E. Director
Division of Water Quality
May 5, 2006
Randell Woodruff
Camden County
P.O. Box 190
Camden, NC 27921
Subject: Permit No. WQ0029894
Camden County Wastewater
Treatment Plant
Wastewater Treatment and
Reclaimed Water Utilization System
Camden County
Dear Mr. Woodruff.
In accordance with your permit application received February 17, 2006, and subsequent additional
information received April 27, 2006, we are forwarding herewith Permit Number. WQ0029894, dated
May 5, 2006, to Camden County Wastewater Treatment Plant for the construction and operation of the
subject wastewater treatment and reclaimed water utilization system.
This permit shall be effective from the date of issuance until April 30, 2011, 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, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following receipt of
this permit. This request must be in the forth of a written petition, conforming to Chapter 150B of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made this permit shall be final and binding,
One set of approved plans and specifications is being forwarded to you. If you need additional
information concerning this matter, please contact Matthew Fleahman t (919) 715-6173.
Sincere]
.Alan W. Klimek, E.
cc: Camden County Health Department
Washington Regional Office, Aquifer Protection Section
James Bowen, P.E. Hobbs Upchurch & Associates
Technical Assistance and Certification Unit
Aquifer Protection Central Files
LAU Files
NorthCarolin a
J wAma!!y
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone (919) 733-3221 Customer Service
Internet; www,ncwaterquality.org 2728 Capital Boulevard Raleigh, NC 27604 FAX (919) 715-6048 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER TREATMENT AND RECLAIMED WATER UTILIZATION PERMIT
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
Camden County Wastewater Treatment Plant
Camden County
FOR THE
construction and operation of a 100,000 GPD wastewater treatment and reclaimed water utilization
system consisting of
one (1) influent pump station with two (2) 100 gallon per minute (GPM) and one (1) 175 GPM
submersible pumps and one (1) 235 cubic feet per minute (CFM) blower; one (1) 26,964 gallon aerated
flow equalization basin with one (1) 235 cubic feet per minute (CFM) blower; a manually cleaned bar
screen with 1/8 inch spacings; one (1) 2,000 gallon grit removal chamber; two (2) 37,749 gallon coarse
bubble aeration basins served by (1) 235 CFM blower; two (2) 10,785 gallon clarifiers each with a 70
GPM sludge airlift; two (2) upflow, continuous backwash, single media filters each with a total of 56.5
square feet (ft) of area; two (2) ultraviolet (UV) disinfection banks with a total of eight (8) lamps; a
magnetic flowmeter; a turbidity meter; a permanent standby generator; a 60,440 gallon aerated sludge
holding basin; an approximately 500,895 gallon synthetically lined 5-day upset pond; an approximately
8,840,000 gallon synthetically lined wet weather storage pond providing approximately 59.72 days of
storage; an effluent pump station with two (2) 100 gallon per minute (GPM) and one (1) 175 GPM
submersible pumps and audible/visual high water alarms; nine (9) spray irrigation zones totaling 49.3
acres; and a rain sensor
to serve Camden County with no discharge of wastes to the surface waters, pursuant to the application
received February 17, 2006 and subsequent additional information received by the Division, 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 April 30, 2011, and shall be subject to
the following specified conditions and limitations:
is PERFORMANCE STANDARDS
1. Upon completion of construction and prior to operation of this permitted facility, a certification
must be received from a professional engineer certifying that the permitted facility has been
installed in accordance with this permit, the approved plans and specifications, and other
supporting materials. If this project is to be completed in phases and partially certified, you shall
retain the responsibility to track further construction approved under the same permit, and shall
provide a final certificate of completion once the entire project has been completed. Mail the
Certification to the Land Application Unit, 1636 Mail Service Center, Raleigh, NC 27699-1636.
2. The Washington Regional Office, telephone number (252) 946-6481, shall be notified at least
forty-eight (48) hours in advance of operation of the installed facilities 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.
The reclaimed water utilization facilities shall be effectively maintained and operated at all times
so that there is no discharge to the surface waters, nor any contamination of ground waters, which
will render them unsatisfactory for normal use. In the event that the facilities fail to perform
satisfactorily, including the creation of nuisance conditions or failure of the irrigation area to
adequately assimilate the wastewater, the Permittee shall take immediate corrective actions
including those actions that may be required by the Division of Water Quality (Division), such as
the construction of additional or replacement wastewater treatment and disposal facilities.
4. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to
surface water or ground water resulting from the operation of this facility.
5. The residuals generated from these treatment facilities must be disposed in accordance with
General Statute 143-215.1 and in a manner approved by the Division.
6. Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited.
7. The following buffers shall be maintained:
a. 100 feet between wetted areas and water supply wells,
b. 100 feet between wetted areas and waters classified as SA,
c. 25 feet between wetted areas and surface waters not classified as SA,
d. 100 feet between wastewater treatment units and wells,
e. 50 feet between reclaimed water storage/irrigation ponds and property lines, and
f. 50 feet between wastewater treatment units and property lines.
8. Public access to the irrigation sites shall be controlled during active site use. Such controls may
include the posting of signs showing the activities being conducted at each site. A sign shall be
posted in plain sight in the clubhouse showing these activities.
9. A leakage test shall be performed on the dosing tank to insure that any exfiltration occurs at a
rate, which does not exceed twenty (20) gallons per twenty-four (24) hours per 1,000 gallons of
tank capacity. The engineer's certification will serve as proof of compliance with this condition.
10. The disposal system shall be connected to a rain or moisture sensor that shall indicate when
wastewater application is not appropriate in accordance with Condition Il(4) of this permit.
IL The following shall be requirements for the reclaimed water distribution, storage, and utilization
facilities:
a. All reclaimed water valves, storage facilities, and outlets shall be tagged or labeled to warn
the public or employees that the water is not intended for drinking. Where appropriate, such
warning shall inform the public or employees to avoid contact with the water.
2
b. All reclaimed water piping, valves, outlets, and other appurtenances shall be color -coded,
taped, or otherwise marked to identify the source of the water as being reclaimed water.
i. All reclaimed water piping and appurtenances shall be either colored purple (i.e., Pantone
522) and embossed or integrally stamped or marked "CAUTION: RECLAIMED
WATER — DO NOT DRINK" or' be installed with a purple (i.e., Pantone 522)
identification tape or polyethylene vinyl wrap. The warning shall be stamped on opposite
sides of the pipe and repeated every three feet or less.
ii. Identification tape shall be at least three inches wide and have white or black Iettering on
purple (i.e., Pantone 522) field stating "CAUTION: RECLAIMED WATER — DO NOT
DRINK." Identification tape shall be installed on top of reclaimed water pipelines,
fastened at least every 10 feet to each pipe length and run continuously the entire length
of the pipe.
c. All reclaimed water valves and outlets shall be of a type, or secured in a manner, that permits
operation by authorized personnel only.
d. Above -ground hose bibs (i.e., spigots or other hand-operatcd connections) shall not be
present. Hose bibs shall be located in locked below -grade vaults that shall be clearly labeled
as being of non -potable quality. As an alternative to the use of locked below -grade vaults
with standard hose bibs services, hose bibs, which can only be operated by a special tool or
connected to a special hose connection, may be placed in non -lockable underground services
boxes clearly labeled as non -potable water.
IL OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times.
2. Upon classification of the wastewater treatment and irrigation facilities by the Water Pollution
Control System Operators Certification Commission (WPCSOCC), the Permittee shall designate
and employ a certified operator to be in responsible charge (ORC) and one or more certified
operator(s) to be back-up ORC(s) of the facilities in accordance with 15A NCAC 8G .0201. The
ORC shall visit the facilities in accordance with 15A NCAC 8G .0204 or as specified in this
permit and shall comply with all other conditions specified in these rules.
3. A suitable, year-round vegetative cover shall be maintained on the irrigation areas.
The vegetative cover shall consist of a homogenous stand of tree species that prefer fine and
medium textured soils and moderate pH levels, such as Green ash and Hybrid poplar. The
spacing of the tree stand shall be 8 by 10 feet. Prior to establishing the hardwood plantation, all
existing vegetation must be cleared. All Iarge plant debris must be taken off -site while smaller
debris can be disked into the soil to facilitate planting of desirable species. Planting rows shall be
ripped on 10-foot spacings parallel to drainage ditches and to a depth of at least 18 inches. The
entire spray field shall be disked to improve infiltration and to assure incorporation of any
surficial organic material. Site preparation must be completed when the soils are dry to avoid
damage to the capacity of the site and other soil characteristics.
Plantings will be staged to assure liquid will be available to facilitate the establishment of the
hardwood plantation. Lime and fertilizer shall be placed on the spray held to improve early
growth and survival of planted trees and groundcover. Elevated bedding shall be prepared at
appropriate row spacing (i.e. 10 feet). Access corridors for sprinkler system and anticipated
mowing shall be delineated. The spray field shall be seeded with a groundcover consisting of tall
fescue or bahiagrass at a rate of 25 to 50 pounds of seed per acre. Tree lines shall be established
on the initial twenty percent (20%) of the area to be developed to accommodate the initial
intended flow. Tree seedlings shall be planted in winter or early spring. The remaining eighty
percent (80%) of the land mass shall be planted as liquid loadings increase and the capacity is
developed in the mechanical wastewater treatment facility. A minimum of 10 feet separation
between spray heads and tree rows shall be maintained.
Within one year following planting, a follow up inspection shall be performed and replanting will
occur where necessary. Regular mowing between planting rows within the spray field with low
ground pressure equipment following adequate drainage/drydown of the spray zone shall occur
two (2) to four (4) times annually.
4. irrigation shall not be performed during inclement weather or when the ground is in a condition
that will cause runoff.
5. Adequate measures shall be taken to prevent wastewater runoff from the irrigation field.
b. The facilities shall be effectively maintained and operated as a non -discharge system to prevent
the discharge of any wastewater resulting from the operation of this facility.
7. The application rate shall not exceed a cumulative loading of 27.04 inches over any twelve (12)
month period at an instantaneous application rate not to exceed 0.25 inches per hour.
8. An automatically activated standby power source shall be on site and operational at all times. if a
generator is employed as an alternate power supply, it shall be tested weekly by interrupting the
primary power source.
9. No type of wastewater other than that from Camden County Wastewater Treatment Plant shall be
irrigated onto the irrigation area.
10. Freeboard in the 5-day upset pond and the 57-day storage pond shall not be Iess than 2 feet at any
time.
11. A waste -level gauge, to monitor waste levels in the storage pond, shall be installed within 50 days
of issuance of this permit. This gauge shall have readily visible permanent markings indicating
the maximum liquid level at the top of the temporary liquid storage volume, minimum liquid
level at the bottom of the temporary liquid storage volume, and top of the dam elevations.
Caution must be taken not to damage the integrity of the liner when installing the gauge.
12. A protective vegetative cover shall be established and maintained on all earthen basin
embankments (outside toe of embankment to maximum pumping elevation), berms, pipe runs,
erosion control areas, and surface water diversions. Trees, shrubs, and other woody vegetation
shall not be allowed to grow on the earthen basin dikes or embankments. Earthen basin
embankment areas shall be kept mowed or otherwise controlled and accessible.
13. All wastewater shall be routed to the five-day holding pond should the limit for fecal coliform
(daily maximum concentration of 25 per 100 ml) or turbidity (instantaneous maximum of 10
NTU) be exceeded, until such time that the problems associated with the treatment capability of
the wastewater treatment plant have been corrected. The wastewater in the five-day holding pond
shall be pumped back to the treatment plant for re -treatment or treated in the five-day pond prior
to discharge to the storage pond.
4
14. The existing transversal ditches and the two new lateral ditches shall be deepened from their
current average depth of 3 feet to a minimum of 5 feet below ground surface.
11I. MONITORING AND REPORTING REQUIREMENTS
1. Any monitoring (including groundwater, surface water, soil or plant tissue analyses) deemed
necessary by the Division to insure surface and ground water protection will be established and
an acceptable sampling reporting schedule shall be followed.
2. Influent flow shall be continuously monitored and daily flow values shall be reported on Form
NDMR.
The Permittee shall install an appropriate flow measurement device consistent with approved
engineering and scientific practices to ensure the accuracy and reliability of influent flow
measurement. Flow measurement devices selected shall be capable of measuring flows with a
maximum deviation of less than 10 percent from true flow, accurately calibrated at a minimum of
once per year, and maintained to ensure that the accuracy of the measurements is consistent with
the accepted capability of that type of device. The Permittee shall keep records of flow
measurement device calibration on file for a period of at least three years. At a minimum, data to
be included in this documentation shall be:
a. Date of flow measurement device calibration
b. Name of person performing calibration
c. Percent from true flow
Plans and specifications for the flow measuring device shall be prepared by a licensed
Professional Engineer and submitted to the appropriate regional office 30 days prior to
installation. The flow -measuring device shall be installed within 1 year of the date of this permit.
3. As an indicator of proper operation and maintenance, the facility shall produce an effluent in
compliance with the following limitations:
Parameter
Monthly Averages
Daily (Instantaneous) Maximum c
Flow
100,000 GPD
BOD5 (5-day, 20°C)
10 mg/l
15 mg/1
NH3 as N
4 mg/l
6 mg/l
TSS
5 mg/l
10 mg/l
Fecal Coliform
14 per 100 ml b
25 per 100 ml
Turbidity
10 NTU
The effluent pH shall not be less than 6.0 standard units nor greater than 9.0 standard units.
s Monthly averages for all but fecal coliform shall be the arithmetic mean of all samples
collected during the reporting period.
b
Monthly average for fecal coliform shall be the geometric mean of all samples collected
during the reporting period.
c Daily maximum shall be the maximum value of all samples collected during the reporting
period.
67
The Permittee shall monitor the effluent from the subject facilities at the point prior to irrigation
for the following parameters:
Parameter
Sampling Point
Sampling Frequency
Type of Sample
Flow
Influent or Effluent
Continuous
Recording
Turbidity
Effluent
Continuous
Recording
BOD5 {5-day, 20'Q
Effluent
*2/1\4onth
Composite
NH3 as N
Effluent
*2/Month
Composite
TSS
Effluent
*2/Month
Composite
Fecal Coliform
Effluent
*2/1\4onth
Grab
Settleable Matter
Effluent
Daily
Grab
NO3
Effluent
Triannually
Grab
TDS
Effluent
Triannually
Grab
TOC
Effluent
Triannually
Grab
Chloride
Effluent
'�*Triannually
Grab
pH
Effluent
**Triannually
Grab
2/Month sampling frequency only during the months of April through October. During the
remainder of the year, these parameters shall be monitored monthly.
** Triannually sampling shall be conducted during March, July and November.
If Groundwater sampling indicates or predicts problems with the compliance with Groundwater
Standards, this permit will be modified to include additional and/or more restrictive limitations.
4. The Permittee shall monitor the surface water at the specified locations for the following
parameters:
Parameter
Sampling Points
Sampling Frequency
Type of Sample
Turbidity
Surface Water Stations 1 and 2
Monthly
Grab
Ammonia Nitrogen
Surface Water Stations 1 and 2
Monthly
Grab
Fecal Coliform
Surface Water Stations 1 and 2
Monthly
Grab
BOD
Surface Water Stations 1 and 2
Monthly
Grab
Nitrate
Surface Water Stations 1 and 2
Monthly
Grab
TKN
Surface Water Stations 1 and 2
Monthly
Grab
Total Suspended
Solids
Surface Water Stations 1 and 2
Monthly
Grab
Surface Water Station 1 shall be located at the northern outfall pumps.
Surface Water Station 2 shall be located at the southern outfall pumps.
5. The Permittee shall maintain adequate records tracking the amount of wastewater disposed.
These records shall include, but are not necessarily limited to the following information:
R
a. Date and time of irrigation,
b. Volume of wastewater irrigated,
c. Zone irrigated,
d. Length of time zone is irrigated,
e. Continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings for each zone,
£ Weather conditions, and
g. Maintenance of cover crops.
6. Freeboard in the 5-day upset pond and the 57-day storage pond shall be recorded weekly.
7. Three (3) copies of all monitoring data [as specified in Conditions 111(2), 111(3), and I11(4)] on
Form NDMR-1 and three (3) copies of all operation and disposal records [as specified in
Conditions 111(5) and 111(6)] on Form NDAR-1 shall be submitted monthly on or before the last
day of the following month. All information shall be submitted to the following address;
NC Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
8. A record shall be maintained of all residuals removed from this facility. This record shall include
the name of the hauler, permit authorizing the disposal or a letter from a municipality agreeing to
accept the residuals, date the residuals were hauled, and volume of residuals removed.
9. A maintenance log shall be maintained at this facility including but not limited to the following
items:
a. Daily sampling results of dissolved oxygen in the aeration basin and at the clarifier weir.
b. Visual observations of the plant and plant site.
c. Record of preventative maintenance (changing of filters, adjusting belt tensions, alarm
testing, diffuser inspections and cleanings, etc.).
d. Date of calibration of flow measurement device.
e. Date and results of power interruption testing on alternate power supply.
10. Noncompliance Notification.:
The Permittee shall report by telephone to the Washington Regional Office, telephone number
(252) 946-6481, 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 occurrence at the wastewater treatment facility which results in the treatment of
significant amounts of wastes which are abnormal in quantity or characteristic, such as the
dumping of the contents of a sludge digester; the known passage of a slug of hazardous
substance through the facility; or any other unusual circumstances.
b. 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, etc.
Any failure of a pumping ' station, sewer line, or treatment facility resulting in a by-pass
directly to receiving waters without treatment of all or any portion of the influent to such
station or facility.
d. Any time that self -monitoring information indicates that the facility has gone out of
compliance with its permit limitations.
Occurrences outside normal business hours may also be reported to the Division's
Emergency Response personnel at telephone number (900) 662-7956, (800) 859-0368, or
(919) 733-3300. Persons reporting such occurrences by telephone shall also file a written
report in letter form within. five (5) 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.
IV. GROUNDWATER REQUIREMENTS
1. The wet weather storage and five-day upset ponds shall have either a liner of natural material at
least one (1) foot in thickness and having a hydraulic conductivity of no greater than 1 x 10-6
centimeters per second when compacted, or a synthetic liner of sufficient thickness to exhibit
structural integrity and an effective hydraulic conductivity no greater than that of the natural
material liner, according to 15A NCAC 2H .0219(f).
2. The COMPLIANCE BOUNDARY and REVIEW BOUNDARY for the waste disposal area(s) is
specified by regulations in 15A NCAC 2H, Waste Not Discharged to Surface Waters, specifically
.0219(k)(1)(C)(1)(III). The Compliance Boundary and the Review Boundary for groundwater
shall be established at the property boundary. An exceedance of Groundwater Quality Standards
at or beyond the Compliance Boundary is subject to remediation action according to 15A NCAC
2L .0106(d)(2).
3. Waste shall not be applied or discharged onto or below the land surface when the vertical
separation between the waste and the seasonal high water table is less than one (1) foot.
V. INSPECTIONS
1. Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to insure
proper operation of the subject facilities.
2. The Permittee or his designee shall inspect the wastewater treatment and disposal 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 a period of three years from the
date of the inspection and shall be made available upon request to the Division or other permitting
authority.
3- Any duly authorized officer, employee, or representative of the Division may, upon presentation
of credentials, enter and inspect any property, premises or place on or related to the disposal site
or facility at any reasonable time for the purpose of determining compliance with this permit;
may inspect or copy any records that must be maintained under the terms and conditions of this
permit, and may obtain samples of groundwater, surface water, or leachate.
VI. GENERAL CONDITIONS
I. This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
2. Prior to construction, the executed agreement between the Department of Transportation (DOT)
and the County as per DOT approval letter dated February 16, 2006, shall be submitted to the
Division of Water Quality.
3. This permit is effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
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 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. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division in accordance with North Carolina General
Statute 143-215.6A to 143-215.6C.
6. The issuance of this permit does not exempt 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., including but not limited to applicable river
buffer rules in 15A NCAC 213.0200, erosion and sedimentation control requirements in 15A
NCAC Chapter 4 and under the Division's General Permit NCG010000, and any requirements
pertaining to wetlands under 15A NCAC 2B .0200 and 2H .0500.
7. The Permittee shall retain a set of approved plans and specifications for the subject facility for the
life of the project.
8. The Permittee shall pay the annual administering and compliance fee within thirty days of 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 211.0205 (c)(4).
9. The Permittee, at least six (6) months prior to the expiration of this permit, shall request its
extension. Upon receipt of the request, the Commission will review the adequacy of the facilities
described therein, and if warranted, will extend the permit for such period of time and under such
conditions and limitations as it may deem appropriate.
Permit issued this th9f5`h day of May, 2006
NORTH CAWLINA ENVWNMF-NTAL MANAGEMENT COMMISSION
;Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0029894
Permit No. WQ0029894
May S, 2006
ENGINEER'S CERTIFICATION
Partial Final
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 Naine
Location and County
for the 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 this permit, the approved plans and specifications, and other supporting
materials.
Signature
Date
Registration No.
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