WQ0001664_Renewal Application_20190813

INITIAL REVIEW
Reviewer Thornburg, Nathaniel
Project Number* WQ0001664
SUBMITTAL DATED: 8/7/2019
Project Contact Information
Rease provide inforrration on the person to be contacted by MB Staff regarding electronic submittal, confirmation of receipt, and other issues.
......................................................................................................................................................................................................................................................................................................................................................................................................
Name * Brent Milliron
Email Address*
[e-mail]
Project Information
Application Type* r
New
r
Renewal
r
Annual Report
Permit Type * r
Wastewater Irrigation
r
Other Wastewater
r
Closed -Loop Recycle
r
Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?*
r Yes r Nor N/A
Permit Number WQ0001664
currently has project
Phone Number*
[phone]
r Modification (Major or Minor)
r Additional Information
r Other
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Applicant\Permittee * Carolina Water Service, Inc. of North Carolina
Facility Name * Belvedere Plantation WWTF
Please provide comments/notes on your current submittal below.
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
Belvedere WWTF Renewal Packet.pdf 641.1 KB
Upload only 1 R7F docurrent. IVLlfiple documents rust be contained into one R7F file.

For new and modification permit applications, a paper copy may be required. If YGL' have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a aaoe- a1,o1:cation is required,
be advised, applications accepted far pre -review until both the paper and eIect-c-i_ col. es -,ave been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments (cales, soils
report, specs, etc.)
o One full-size engineering plan set
o One 11x27" engineering plan set
o One extra set of specifications
o Fee (if required)
Mailing address:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
By U.S. Postal Service
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
By Courier/Special Delivery:
�----------------------------------------------------------------------------
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❑ivision of Water Resources
i Division of Water Resources
-------------- - ---- ----- -----------------------------------
Non -Discharge Branch
1---------
Non -Discharge Branch
1617 Mail Service Center
i Aft: Nathaniel Thornburg, 90 Floor, O f`uce #942W
Raleigh. NC 27699-1617
512 N. Salisbury St.
Far questions or problems contact Tessa Monday [e-mail] or 919.707.3560.
* I;W By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. 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).
Signature
�'r�c�l��'
Submission Date 8/7/2019

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 08-19
This form is for renewal without modification for all non -discharge system permits, except Residuals Management and Single -
Family Residence Wastewater Irrigation System permits.
For more information, visit the Water Quality Permitting Section's Non -Discharge Brunch.
I. PERMITTEE INFORMATION:
1. Permittee: Carolina Water Service Inc. of NC
2. Signature authority's name: J Bryce Mendenhall per 15A NCAC 02T .0106(b) Title: Vice President of Operations
Primary Telephone number: [phone]
Email Address: Brvce.Mendenhall(cDcarolinawaterservicenc.com
3. Permittee's mailing address: P.O. Box 240908
City: Charlotte State: NC Zip: 28224-0908
4. Billing address (if different from above):
City: State: Zip: -
5. Contact person's name (if different from signature authority): Dana Hill Title: Director of Operations
Primary Telephone number: (704 319-0503 Office
Email Address: Dana.HillAcarolinawatersericenc.com
II. PERMIT INFORMATION:
1. Existing permit number: WQ001664
2. Has the facility been constructed? ® Yes or ❑ No
Secondary number: (2� 269-2540 Cell
If yes, has the facility been constructed in accordance with the permit and the Division -approved plans and specifications?
[ 15A NCAC 02T .01101 ® Yes or ❑ No
If no, a formal permit modification request shall be submitted to the Division.
3. Has any of the property ownership within the facility and/or disposal area changed from what is indicated in the current permit
(Attachment B — disposal field owner/lessee)? ❑ Yes or ® No
Has the Permittee had a name change or has the permit changed ownership? ❑ Yes or ® No
If yes to either, a permit modification request shall be submitted to the Division. [ 15A NCAC 02T .0105]
4. Is this facility a Privately -Owned Public Utility? ® Yes or ❑ No
If yes, provide two copies of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission
demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the non -discharge system.
[ 15A NCAC 02T .0115(a)(1)1
5. Is the Permittee a Home/Property Owners' Associations or Developers of lots to be sold? ❑ Yes or ® No
If yes, provide the following:
• For Home/Property Owners' Associations — Operational Agreement (FORM: HOA} and a copy of the proposed or
approved Articles of Incorporation, Declarations, and By-laws [15A NCAC 02T .0115(c) I
• For Developers of lots to be sold -- Operational Agreement (FORM: DEV) [ 15A NCAC 02T .0115(b)1
FORM: NDSR 02-19 Page 1 of 3

State of North Carolina
DWR
Division of Water Resources
III. SITE MAP:
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 08-19
1. Provide an updated site map in accordance with 15A NCAC 02T: 0105(d) that shows the following:
The site map is not required to be signed or sealed by a Professional Engineer. However, the map must indicate the source of
information. For example, parcel lines taken from a county GIS map should reference the GIS website.
❑ Legend, north arrow, scale, and legible in black and white
❑ Topographic contour intervals not exceeding 10 feet or 25 percent of total site relief
❑ Soil mapping units on all disposal sites
❑ All facility -related structures and fences within the treatment, storage, and disposal areas
❑ All habitable residences and places of assembly within 500 feet of all treatment, storage, and irrigations sites
❑ Location of all wells, streams (ephemeral, intermittent, and perennial), springs, lakes, ponds, ditches, and other surface
drainage features within 500 feet of all waste treatment, storage, and disposal site(s)
❑ Location and identification of each monitoring well (identify any background/upgradient wells)
❑ Latitude and longitude coordinates of all monitoring wells (decimal degrees to 6 digits)
❑ Location and identification of major components of the waste disposal system
❑ The wetted perimeter of all irrigation fields with field names (named according to the approved permit)
❑ Location and ownership of property boundaries within 500 feet of the disposal area (including road/rail right-of-ways)
❑ The delineation of compliance and review boundaries
❑ Distance measurements verifying all setbacks are being met
❑ Stormwater drainage controls
❑ 100-year floodplain (if applicable)
❑ For reclaimed water generation permits only, provide a separate map showing all distribution lines and utilization permit
locations that are connected to the water generation facility and are permitted by the Non -Discharge Branch (excludes
Local Program permitted facilities). Include all reclaimed water distribution line and reclaimed water utilization permit
numbers.
IV. SETBACK WAIVERS, EASEMENTS, AND LEASES:
1. Does the permit have any setback waivers, easements, or leases? ❑ Yes or ® No
If yes, provide copies of all documents and complete the table below:
Document
Type
Grantor or
Parcel No.
Grantee
Expiration
Date
County
Registered
Deed
Book
Deed Page
Document
Description e
Select
Select
Select
Select
Select
a. The document description shall list any reduced setbacks with distance, etc.
2. For reclaimed water utilization permits only:
Is reclaimed water utilized on property not controlled by the generator? ❑ Yes or ® No
A lease, easement, or agreement must be provided allowing for the utilization of reclaimed water on the property or within the
facility. For irrigation of reclaimed water, an easement is required per 15A NCAC 02U .0501(6j. All documents shall be listed
in the table above.
FORM: NDSR 02-19 Page 2 of 3

DWR
Division of Water Resources
V. RELATED PERMITS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE SYSTEM RENEWAL
FORM: NDSR 08-19
1. If this permit has interactions with other wastewater permits (collection systems, NPDES, etc.), complete the table below
(provide additional pages if necessary):
Permit Type
Permit No.
Description
Collection System
WQCS00331
Issued: 9/1/2017 Expires: 8/31/2025;
2. Does the facility have an approved flow reduction [15A NCAC 02T .0114(f)1? ® Yes or ❑ No
If yes, attach 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 value, the Permittee shall provide a reevaluation of
the reduced flow value using the methodology applied to the original flow reduction application. Also, attach a copy of the
flow reduction approval letter.
Applicant's Certification per 15A NCAC 02T .0106(b):
Kt 11, attest that this renewal application has been reviewed by me, and is accurate and complete to the best of my
knowledge. I understand that any unauthorized discharge of wastewater from this non -discharge system to surface waters or the land
may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim
against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application are not completed, this application may be returned to me as incomplete. I further certify that the Applicant or any parent,
subsidiary, or other affiliate of the Applicant has not been convicted of an environmental crime, has not abandoned a wastewater facility
without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant
with any active compliance schedule, and does not have any overdue annual fees.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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 include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation. The Applicant's Certification shall be signed in accordance with
15A NCAC 02T 0106112). Per 15A NCAC 021.0l06 c eC/ACO2T.0I06(b1
te person may be designated as the signing official if a delegation
letter is Provid d oara-mison who meets t ' riteria 1 A
Signature:
Date: [} r &LJ, 9,
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE BRANCH
By U.S. Postal Service: By Courier: By Email:
Non -Discharge Branch Non -Discharge Branch — Archdale 640D Non-Discharge.Reports[a ncdenr.gov
1617 Mail Service Center 512 N. Salisbury St.
Raleigh, NC 27699-1617 Raleigh, NC 27604
TELEPHONE NUMBER: [phone]
FORM: NDSR 02-19 Page 3 of 3

m l'f✓w 1�1tpYd

STATE OF NORTH CAROLINA
UTILITIES COMMISSION
RALEIGH
APPENDIX A-T
DOCKET NO. W-354, SUB 304
BEFORE THE NORTH CAROLINA UTILITIES COMMISSION
CAROLINA WATER SERVICE, INC. OF NORTH CAROLINA
is granted this
CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
to provide water and sewer utility service
in
BELVEDERE PLANTATION SUBDIVISION
Pender County, North Carolina
subject to any orders, rules, regulations,
and conditions now or hereafter lawfully made
by the North Carolina Utilities Commission.
ISSUED BY ORDER OF THE COMMISSION.
This the 19'h day of January, 2007.
NORTH CAROLINA UTILITIES COMMISSION
�,41 � L • mOt7�M�'
Gail L. Mount, Deputy Clerk

Water Resources
ENVIRONMENTAL QUAL11 Y
February 22, 2018
Bryce Mendenhall, VP of Operations for NC & TN
Carolina Water Service, Inc. of North Carolina
4944 Parkway Plaza Boulevard, Suite 375
Charlotte, NC 28217
Subject: Adjusted Daily Sewage Flow Rate Approval
Belvedere Plantation (WQ0001664)
Pender County
Dear Mr. Mendenhall:
ROY COOPER
Governor
MICNAEL S. REGAN
Secretory
LINDA CULPEPPER
Intenm ntreclor
On December 11, 2017, the Division of Water Resources (Division) received an adjusted daily sewage
flow rate (flow reduction) request that would apply to all permitted but not yet tributary residential
connections and all future residential connections within the Belvedere Plantation WWTF service area.
In accordance with 15A NCAC 02T .0114(f)(2), the Division has evaluated the request as well as
additional information received on February 2, 2018, and based on the data submitted and the Division
of Water and Infrastructure (DWI) guidance, the Division hereby approves for use by the Belvedere
Plantation WWTF an adjusted daily sewage design flow rate with the following conditions:
• The flow reduction is applicable to residential single family dwellings only.
• The minimum flow for 1 and 2 bedroom dwellings shall be 130 gallons per day.
• Each additional bedroom above two bedrooms shall increase the volume by 65 gallons per day
per bedroom.
• This flow reduction shall not apply to sewer extension applications and/or permits for any other
public or private organizations whose wastewater flows are or might become tributary to
Belvedere Plantation collection system (WQCS00331).
Future sewer extension applications should be made using the flow reduction amount stated above. All
other aspects of the permitting process remain unchanged, and all applications must be in compliance
with the statues, rules, regulations and minimum design criteria as certified by the owner and engineer
Rep,ardless of the adjusted design daily wastewater flow rate at no time shall the wastewater flows
exceed the effluent limits defined in the NPDES Permit for the treatment facility or exceed the capacity
of the sewers downstream of any new sewer extension or service connections .
Nothing Compares 7�-L..
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center Raleigh, North Carolina 27699-1617
919-807-6300

Carolina Water Service, Inc., of North Carolina
WQ0001664
The granting of this flow reduction does not prohibit the Division from reopening, revoking, reissuing
and/or modifying the flow reduction as allowed by the laws, rules, and regulations contained in 15A
NCAC 02T, NCGS 143-215.1, or as needed to address changes in State and/or Federal regulations with
respect to wastewater collection systems, protection of surface waters and/or wastewater treatment.
If you have any questions, please contact Christyn Fertenbaugh, P.E., at [phone], or via email at
Christ n.Fertenbau h ncdenr. ov.
Sincerely,
for Linda Culpepper
Interim Director, Division of Water Resources
by Deborah Gore, Supervisor
Pretreatment, Emergency Response and Collection Systems Branch
Cc: Logan Parsons, E.I., LKC Engineering PLLC (lo an oAcen ineerin .com)
Wilmington Regional Office, Water Quality Regional Operations
Belvedere Plantation WWTF (WQ0001664)
PERCS (electronic copy)
Page 2 of 8

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