WQ0041123_Application_20190821

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
WATER QUALITY REGIONAL OPERATIONS SECTION
NON -DISCHARGE APPLICATION REVIEVOREOUEST FORM
August 21, 2019
To: WaRO-WQROS: David May / Robert Tankard
From: Ashley Kabat, Water Quality Permitting Section - Non -Discharge Branch
Permit Number: WQ004 / / 2 3
Applicant: Currituck Water and Sewer, LLC
Owner Type: Organization
Facility Name: Currituck Water Resource Recovery Facility
Signature Authority: Matthew Gauss
Address: c/o Robert G. Burgin, Jr., PO Box 1804, Irmo, SC 29063
Fee Category: Non -Discharge Major
Comments/Other Information:
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Permit Type: High-R°ate In
Project Type: New Project
Owner in BIMS? No
Facility in BIMS? No
Title: President
County: Currituck
Fee Amount: $1,310 -New Project
Attached, you will find all information submitted in support of the above -referenced application for your review,
comment, and/or action. Within 45 calendar days, please take the following actions:
® Return this form completed. ® Return a completed staff report.
❑ Attach an Attachment B for Certification. ❑ Issue an Attachment B Certification.
When you receive this request form, please write your name and dates in the spaces below, make a copy of this sheet, and
return it to the appropriate Central Office Water Quality Permitting Section contact person listed above.
RO-WQROS Reviewer:
Date: 1
FORM: WQROSNDARR 09-15 Page 1 of 1

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
MATTHEW GAUSS - PRESIDENT
CURRITUCK WATER AND SEWER, LLC
C/O ROBERT G. BURGIN, JR., PO BOX 1804
IRmo, SC 29063
Dear Mr. Gauss:
NORTH CAROLINA
Environmental Quality
August 21, 2019
Subject: Acknowledgement of
Application No. WQ0041123
Currituck Water Resource Recovery
Facility
High -Rate Infiltration System
Currituck County
The Water Quality Permitting Section acknowledges receipt of your permit application and
supporting documentation received on August 21, 2019. Your application package has been assigned the
number listed above, and the primary reviewer is Ashley Kabat.
Central and Regional Office staff will perform a detailed review of the provided application, and
may contact you with a request for additional information. To ensure maximum efficiency in processing
permit applications, the Division of Water Resources requests your assistance in providing a timely and
complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt of a complete application. If you have any questions, please contact
Ashley Kabat at (919) 707-3 65 8 or [e-mail].
Sincerely,
Nathaniel D. Thornburg, Supervisor
Division of Water Resources
cc: Washington Regional Office, Water Quality Regional Operations Section
Permit File WQ0041123
D
E Q;A North Carolina Department of Environmental Quality I Division of Water Resources
_ 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
�1 /� 919.707.9000

State of North Carolina
Department of Environmental Quality
D-WR Division of Water Resources
15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION
Plans, specifications and supporting documents shall be prepared in accordance with 15A NCAC 02H .0400 (if necessary), 15A
NCAC 02L .0100, 15A NCAC 02T .0100, 15A NCAC 02T .0700, Division Policies and good engineering practices. Failure to
submit all required items will necessitate additional processing and review time.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
General — When submitting an application to the Water Quality Permitting Section's Non -Discharge Permitting Unit, please use the
following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking
the provided boxes will help produce a quicker review time and reduce the amount of requested additional information.
Unless otherwise noted. the Applicant shall submit one original and two copies of the application and supporting documentation.
A. Cover Letter (All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ). The appropriate fee amount for new and major modification applications may be found at: Standard Review
Project Fees.
C. High -Rate Infiltration Systems (FORM: HRIS 06-16) Application (All Application Packages):
® Submit the completed and appropriately executed High -Rate Infiltration Systems (FORM: HRIS 06-16) 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.
® If the Applicant Type in Item I.2. is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2. is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The facility name in Item II.1. shall be consistent with the facility name on the plans, specifications, agreements, etc.
® The Professional Engineer's Certification on Page 13 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 13 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).
❑ If this project is for a renewal without modification, use the Non -Discharge System Renewal (FORM: NDSR) application.
D. Property Ownership Documentation (All Application Packages):
➢ Per 15A NCAC 02T .0704(f). the Applicant shall demonstrate they are the owner of all property containing the wastewater
treatment and high -rate infiltration facilities:
® Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
® Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
❑ Provide all agreements, easements, setback waivers, etc. that have a direct impact on the wastewater treatment, conveyance,
storage and high -rate infiltration facilities.
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INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 1 of 6

E: Soil Evaluation (All Application Packages that include new high -rate infiltration sites):
® Per 15A NCAC 02T .0704(b) and the Soil Scientist Evaluation Policy, submit a detailed soil evaluation that has been signed,
sealed and dated by a North Carolina Licensed Soil Scientist and includes at a minimum:
® The report shall identify all the basins/fields with project name, location, and include a statement that the basins/fields
were recommended for the proposed land application activity.
® Field delineated detailed soils map meeting all of the requirements of the Soil Scientist Evaluation Policy.
® Soil profile descriptions meeting all of the requirements of the Soil Scientist Evaluation Policy.
® Provide all soil boring logs performed at the site.
❑ For non -basins, a standard soil fertility analysis conducted no more than one year prior to permit application for each map
unit in the soil map legend for the following parameters:
❑ Acidity ❑ Exchangeable sodium percentage (by calculation) ❑ Phosphorus
❑ Base saturation (by calculation) ❑ Magnesium ❑ Potassium
❑ Calcium ❑ Manganese ❑ Sodium
❑ Cation exchange capacity ❑ Percent humic matter ❑ Zinc
❑ Copper ❑ pH
➢ Saturated hydraulic conductivity (KsAT) data that shall include at a minimum:
❑ A minimum of three KsAT tests shall be conducted in the most restrictive horizon for each soil series in the soil map.
❑ All KsAT tests shall be conducted in areas representative of the site.
❑ All KsAT tests shall be run until steady-state equilibrium has been achieved.
❑ All collected KsAT data shall be submitted, including copies of field worksheets showing all collected readings.
❑ Submit a soil profile description for each KsAT data point that shall extend at least one foot below the tested horizon.
Soil evaluation recommendations shall include at a minimum:
❑ A brief summary of each map unit and its composition and identification of minor contrasting soils.
❑ For non -basins, maximum precipitation rate (in/yr) for each soil/map unit within the proposed infiltration areas.
❑ Seasonal infiltration restrictions, if appropriate.
❑ Identification of areas not suitable for high -rate infiltration.
❑ Recommended geometric mean KsAT rate to be used in the water balance for each soil/map unit based upon in -situ
measurement of the saturated hydraulic conductivity from the most restrictive horizon.
❑ Recommended drainage coefficient to be used in the water balance based upon comprehensive site evaluation, review
of collected onsite data, minor amounts of contrasting soils and the nature of the wastewater to be applied.
❑ For non -basins, recommended annual hydraulic loading rate (in/yr) for each soil/map unit within the proposed
infiltration areas based upon in -situ KsAT measurements form the most restrictive soil horizon.
❑ For basins, recommended hydraulic loading rate (GPD/ft2) for each soil/map unit within the proposed infiltration areas
based upon in -situ KsAT measurements form the most restrictive soil horizon.
NOTE — If the soil evaluation was performed more than one year prior to the submittal of this application package, a statement shall
be included indicating that the site has not changed since the original investigation.
F. Agronomist Evaluation (All Application Packages that include new infiltration sites with cover crops or new crops for existing
infiltration sites):
❑ Per 15A NCAC 02T .0704(i), submit an agronomist evaluation that has been signed, sealed and dated by a qualified professional
and includes at a minimum:
❑ Proposed nutrient uptake values for each cover crop based upon each field's dominant soil series and percent slope.
❑ Plant available nitrogen calculations for each cover crop using the designed effluent concentrations in Application Item
V.1. and proposed mineralization and volatilization rates.
❑ Historical site consideration, soil binding and plant uptake of phosphorus.
❑ Seasonal infiltration restrictions, if appropriate.
❑ A clear and reproducible map showing all areas investigated and their relation to proposed fields and crops.
❑ Maintenance and management plan for all specified crops.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 2 of 6

G. Hydrogeologic Report (All Application Packages treating industrial waste or having a design flow over 25,000 GPD):
® Per 15A NCAC 02T .0704(e), the Hydrogeologic Investigation and Reporting Policy, the Groundwater Modeling Policy and
the Performance and Analysis of Aquifer Slug Tests and Pumping Tests Policy, submit a detailed hydrogeologic description
that has been signed, sealed and dated by a qualified professional and includes at a minimum:
® A hydrogeologic description to a depth of 20 feet below land surface or bedrock, whichever is less. A greater depth of
investigation is required if the respective depth is used in predictive calculations.
® Representative borings within the infiltration areas and all proposed earthen impoundments.
® A description of the regional and local geology and hydrogeology.
® A description, based on field observations of the site, of the site topographic setting, streams, springs and other groundwater
discharge features, drainage features, existing and abandoned wells, rock outcrops, and other features that may affect the
movement of the contaminant plume and treated wastewater.
® Changes in lithology underlying the site.
® Depth to bedrock and occurrence of any rock outcrops.
® The hydraulic conductivity and transmissivity of the affected aquifer(s).
® Depth to the seasonal high water table (SHWT).
® A discussion of the relationship between the affected aquifers of the site to local and regional geologic and hydrogeologic
features.
® A discussion of the groundwater flow regime of the site prior to operation of the proposed facility and post operation of
the proposed facility focusing on the relationship of the system to groundwater receptors, groundwater discharge features,
and groundwater flow media.
® If the SHWT is within six feet of the surface, a mounding analysis to predict the level of the SHWT after wastewater
application.
H. Water Balance (All Application Packages that include new or modified infiltration sites, changes in flow or changes in storage):
® Per the Water Balance Calculation Policy, submit information clearly demonstrating that the effluent can be assimilated
regardless of precipitation events or temperature, and there are no crop or equipment maintenance issues that would necessitate
storage.
OR
❑ Per 15A NCAC 02T .0704(k) and the Water Balance Calculation Policy, submit a water balance that has been signed, sealed
and dated by a qualified professional and includes at a minimum:
❑ At least a two-year iteration of data computation that considers precipitation into and evaporation from all open atmosphere
storage impoundments, and uses a variable number of days per month.
❑ Precipitation based on the 80th percentile and a minimum of 30 years of observed data.
❑ Potential Evapotranspiration (PET) using the Thomthwaite method, or another approved methodology, using a minimum
of 30 years of observed temperature data.
❑ Soil drainage based on the geometric mean of the in -situ KsAT tests in the most restrictive horizon and a drainage coefficient
ranging from 4 to 10% (unless otherwise technically documented).
➢ Other factors that may restrict the hydraulic loading rate when determining a water balance include:
❑ Depth to the SHWT and groundwater lateral movement that may result in groundwater mounding.
❑ Nutrient limitations and seasonal application times to ensure high -rate infiltration does not exceed agronomic rates.
❑ Crop management activities resulting in cessation of infiltration for crop removal.
NOTE — High -Rate Infiltration Systems serving residential facilities shall have a minimum of 14 days of wet weather storage.
1. Engineering Plans (All Application Packages):
® Per 15A NCAC 02T .0704(c)(1), submit standard size and 11 x 17-inch plan sets that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer, and shall include at a minimum:
® Table of contents with each sheet numbered.
® A general location map with at least two geographic references and a vicinity map.
® A process and instrumentation diagram showing all flow, recycle/return, aeration, chemical, electrical and wasting paths.
® Plan and profile views of all treatment and storage units, including their piping, valves, and equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), as well as their dimensions and elevations.
® Details of all piping, valves, pumps, blowers, mixers, diffusers, recording devices, fencing, auxiliary power, etc.
® A hydraulic profile from the treatment plant headworks to the highest infiltration point.
® The high -rate infiltration area with an overlay of the suitable infiltration areas depicted in the Soil Evaluation.
❑ For non -basins, each nozzle/emitter and its wetted area influence and each infiltration zone labeled as it will be operated.
❑ For non -basins, locations within the infiltration system of air releases, drains, control valves, highest infiltration
nozzle/emitter, etc.
❑ For non -basin automated infiltration systems, provide the location and details of the precipitation/soil moisture sensor.
® Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 3 of 6

J: Specifications (All Application Packages):
® Per 15A NCAC 02T .0704(c)(2), submit specifications that have been signed, sealed and dated by a North Carolina licensed
Professional Engineer, and shall include at a minimum:
® Table of contents with each section/page numbered.
® Detailed specifications for each treatment/storage/infiltration unit, as well as all piping, valves, equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), nozzles/emitters, precipitation/soil moisture sensor (if applicable),
audible/visual high water alarms, liner material, etc.
® Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
® Materials (i.e., concrete, masonry, steel, painting, method of construction, etc.)
® Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
❑ Means for ensuring quality and integrity of the finished product, including leakage, pressure and liner testing.
® Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
K. Engineering Calculations (All Application Packages):
® Per 15A NCAC 02T .0704(c)(3), submit engineering calculations that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
® Hydraulic and pollutant loading calculations for each treatment unit demonstrating how the designed effluent
concentrations in Application Item V.I. were determined.
® Sizing criteria for each treatment unit and associated equipment (i.e., blowers, mixers, flow meters, pumps, etc.).
® Total and effective storage calculations for each storage unit.
® Friction/total dynamic head calculations and system curve analysis for each pump used.
® Manufacturer's information for all treatment units, pumps, blowers, mixers, diffusers, flow meters, etc.
® Flotation calculations for all treatment and storage units constructed partially or entirely below grade.
® For non -basins, a demonstration that the designed maximum precipitation and annual loading rates do not exceed the
recommended rates.
® For basins, a demonstration that the designed loading rate (GPD/ft2) does not exceed the recommended rate.
® A demonstration that the specified auxiliary power source is capable of powering all essential treatment units.
L. Site Map (All Application Packages):
® Per 15A NCAC 02T .0704(d), submit standard size and 11 x 17-inch site maps that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer and/or Professional Land Surveyor and shall include at a minimum:
® A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and
showing all facility -related structures and fences within the wastewater treatment, storage and infiltration areas.
® Soil mapping units shown on all infiltration sites.
® The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage
and infiltration sites.
® Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108.
® Setbacks as required by 15A NCAC 02T .0706.
® Site property boundaries within 500 feet of all wastewater treatment, storage and infiltration sites.
® All habitable residences or places of public assembly within 500 feet of all treatment, storage and infiltration sites.
NOTE — For clarity, multiple site maps of the facility with cut sheet annotations may be submitted.
M. Power Reliability Plan (All Application Packages):
® Per 15A NCAC 02T .0705(k), submit documentation of power reliability that shall consist of at a minimum:
® An automatically activated standby power supply onsite that is capable of powering all essential treatment units under
design conditions, OR
➢ Approval from the Director that the facility:
❑ Serves a private water distribution system that has automatic shut-off during power failures and has no elevated water
storage tanks,
❑ Has sufficient storage capacity that no potential for overflow exists, and
❑ Can tolerate septic wastewater due to prolonged detention.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 4 of 6

N. Operition and Maintenance Plan (All Application Packages):
❑ Per 15A NCAC 02T .0707, submit an operation and maintenance (O&M) plan encompassing all wastewater treatment, storage
and infiltration systems that shall include at a minimum a description of:
❑ Operation of the wastewater treatment, storage and infiltration systems in sufficient detail to show what operations are
necessary for the system to function and by whom the functions are to be conducted.
❑ Anticipated maintenance of the wastewater treatment, storage and infiltration systems.
❑ Safety measures, including restriction of access to the site and equipment.
❑ Spill prevention provisions such as response to upsets and bypasses, including how to control, contain and remediate.
❑ Contact information for plant personnel, emergency responders and regulatory agencies.
NOTE — A final O&M Plan shall be submitted with the partial and/or final Engineering Certification required under 15A NCAC
02T .0116, however, a preliminary O&M Plan shall be submitted with each application package.
O. Residuals Management Plan (All Application Packages with new, expanding or replacement wastewater treatment systems):
❑ Per 15A NCAC 02T .0704(i) and .0708, submit a Residuals Management Plan that shall include at a minimum:
❑ A detailed explanation of how generated residuals (including trash, sediment and grit) will be collected, handled, processed,
stored, treated, and disposed.
❑ An evaluation of the treatment facility's residuals storage requirements based upon the maximum anticipated residuals
production rate and ability to remove residuals.
❑ A permit for residuals utilization or a written commitment to the Applicant from a Permittee of a Department approved
residuals disposal/utilization program that has adequate permitted capacity to accept the residuals or has submitted a
residuals/utilization program application.
❑ If oil/grease removal and collection are a designed unit process, submit an oil/grease disposal plan detailing how the
oil/grease will be collected, handled, processed, stored and disposed.
NOTE — Per 15A NCAC 02T .0705(n), a minimum of 30 days of residual storage shall be provided.
NOTE — Per 15A NCAC 02T .0704(i), a written commitment to the Applicant from a Permittee of a Department approved residuals
disposal/utilization program is not required at the time of this application, however, it shall be provided prior to operation of any
permitted facilities herein.
NOTE — If an on -site restaurant or other business with food preparation is contributing wastewater to this system, an oil/grease
disposal plan shall be submitted.
P. Additional Documentation:
➢ Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) and .0704(Q), provide 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 wastewater treatment and high -rate infiltration system, or
® Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
➢ Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit modification
(i.e., compliance schedules, permit description, monitoring, permit conditions, etc.).
➢ Final Environmental Document (All Application Packages using public monies or lands subject to the North Carolina
Environmental Policy Act under 15A NCAC 01 C .0100 to .0400):
❑ Per 15A NCAC 02T .0105(c)(4), submit one copy of the environmental assessment and three copies of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
❑ Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the wastewater treatment and high -rate infiltration system.
➢ Floodway Regulation Compliance (All Application Packages where any portion of the wastewater treatment, storage and
infiltration system is located within the 100-year floodplain):
❑ Per 15A NCAC 02T .0105(c)(8), provide written documentation from all local governing entities that the facility is in
compliance with all local ordinances regarding construction or operation of wastewater treatment and/or disposal facilities
within the floodplain.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 5 oi'6

V Additional Documentation (continued):
Operational Agreements (All Application Packages for Home/Property Owners' Associations and Developers of lots to be
sold):
➢ Home/ProWlty Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed ,Operational Agreemiit (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit the proposed or approved Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
Threatened or Endangered Aquatic Species Documentation (All Application Packages):
❑ Per 15A NCAC 02T .0105(c)(10), submit documentation from the Department's Natural Heritage Program demonstrating
the presence or absence of threatened or endangered aquatic species within the boundary of the wastewater treatment,
storage and infiltration facilities.
❑ If the facility directly impacts such species, this documentation shall provide information on the need for permit conditions
pursuant to 15A NCAC 02B .0110.
Wastewater Chemical Analysis (All Application Packages treating Industrial Waste):
❑ Per 15A NCAC 02T .0704(h), provide a complete Division certified laboratory chemical analysis of the effluent to be
infiltrated for the following parameters (For new facilities, an analysis from a similar facility's effluent is acceptable):
❑ Ammonia Nitrogen (NH3-N) ❑ Nitrate Nitrogen (NO3-N) ❑ Total Organic Carbon
❑ Calcium ❑ pH ❑ Total Phosphorus
❑ Chemical Oxygen Demand (COD) ❑ Phenol ❑ Total Trihalomethanes
❑ Chloride ❑ Sodium ❑ Total Volatile Organic Compounds
❑ Fecal Coliform ❑ Sodium Adsorption Ratio (SAR) ❑ Toxicity Test Parameters
❑ 5-day Biochemical Oxygen Demand (BOD5) ❑ Total Dissolved Solids
❑ Magnesium ❑ Total Kjeldahl Nitrogen (TKN)
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 PERMITTING UNIT
By U.S. Postal Service: By Courier/Sneclal Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 6 of 6

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources FORM: HRIS 06-16
1. APPLICANT INFORMATION:
1. Applicant's name: Currituck Water and Sewer, LLC
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Matthew Gauss per 15A NCAC 02T .0106(b) Title: President
4. Applicant's mailing address:
City: Raleigh State: NC Zip: 27609-
5. Applicant's contact information:
Phone number: 919 630-3461 Email Address: '
( )
II. FACILITY INFORMATION: 2
1. Facility name: Currituck Water Resourse Recovery Facility a
2. Facility status: Proposed Npn-D'cchar9(�'
3. Facility type: Major (> 10,000 GPD or > 300 disposal acres)
permittmg'Jnet
4. Facility's physical address: I I I Universal Cir
City: Moyock State: NC Zip: 27958- County: Currituck
5. Wastewater Treatment Facility Coordinates (Decimal Degrees): Latitude: 36.5291'' Longitude:-76.2488'
Datum: NAD83 Level of accuracy: Nearest 10 seconds Method of measurement: Navigation quality GPS
6. USGS Map Name: Moyoc
III. CONSULTANT INFORMATION:
1. Professional Engineer: Robert G. Burgin, Jr. License Number: 10184
Firm: C-4128
Mailing address: PO Box 1804
City: Irmo State: SC Zip: 29063-
Phone number: [phone] Email Address: rgb(a,bur ig nen ing eeringinc.com
2. Soil Scientist: Edwin Andrews & Associates, PLLC License Number: 1226
Firm:
Mailing address: PO Box 30653
City: Raleigh State: NC Zip: 27622-
Phone number: [phone] Email Address: Edwin Andrews <edwinandrewspcAgmail.com>
3. Geologist: Edwin Andrews & Associates. PLLC License Number: 3
Firm:
Mailing address: PO Box 30653
City: Ralei State: NC Zip: 27622-
Phone number: [phone] Email Address: Edwin Andrews <edwinandrewspcna gmail.com>
4. Agronomist: Edwin Andrews & Associates, PLLC Firm:
Mailing address: PO Box 30653
City: Raleigh State: NC Zip: 27622-
Phone number: (9j 9) 306-3069 Email Address: Edwin Andrews <edwinandrewspc(&gmail.com>
FORM: HRIS 06-16
Page 1 of 13

IV.' GENERAL REQUIREMENTS— 15A NCAC 02T .0100:
1. Application type: ® New ❑ Major Modification ❑ Minor Modification
If a modification, provide the existing permit number: WQ00 and most recent issuance date:
2. Application fee: $1,310 - Standard - Major Facility- New Permit
3. Does this project utilize public monies or lands? ❑ Yes or ® No
If yes, was an Environmental Assessment required under 15A NCAC 0 l C? ❑ Yes or ❑ No
If yes, which final environmental document is submitted? ❑ Finding of No Significant Impact or ❑ Record of Decision
Briefly describe any mitigating factors from the Environmental Assessment that may impact this facility:
4. What is the status of the following permits/certifications applicable to the subject facility?
Perm it/Certification
Date
Submitted
Date
Approved
Permit/Certification
Number
Agency Reviewer
Collection System (O _> 200,000 GPD)
Dam Safety
Erosion & Sedimentation Control Plan
Nationwide 12 / Section 404
Pretreatment
Sewer System
Stormwater Management Plan
Wetlands 401
Other:
5. What is the wastewater type? ® Domestic or F1 Industrial (See 15A NCAC 02T .0103(20))
Is there a Pretreatment Program in effect? ❑ Yes or ❑ No
Has a wastewater chemical analysis been submitted? ❑ Yes or ❑ No
6. Wastewater flow: 450,000 GPD
Limited by: ® Treatment, ❑ Storage, ❑ Field/Basin Hydraulics, ❑ Field Agronomics or ❑ Groundwater Mounding
7. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .0114 or ❑ Representative Data
Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes or ❑ No
Establishment Type
Daily Design Flow
No. of Units
Flow
Bedrooms
120 gal/bedroom
3,750
450,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
450,000 GPD
a See 15A NCAC 02T .0114(b), (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
FORM: HRIS 06-16 Page 2 of 13

IV.' GENERAL REQUIREMENTS— 15A NCAC 02T .0100 (continued):
8. What is the nearest 100-year flood elevation to the facility? 16 feet mean sea level. Source: Counjy
Are any treatment, storage or infiltration facilities located within the 100-year flood plain? ❑ Yes or ® No
If yes, which facilities are affected and what measures are being taken to protect them against flooding?
If yes, has the Applicant submitted written documentation of compliance with § 143 Article 21 Part 6? ❑ Yes or ❑ No
9. Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing
information provided by the Department's Natural Heritage Program? ❑ Yes or ® No
10. Does the facility have a proposed or existing groundwater monitoring well network? ® Yes or ❑ No
If no, provide an explanation as to why a groundwater monitoring well network is not proposed:
If yes, complete the following table (NOTE — This table may be expanded for additional wells):
Well Name
Status
Latitude a
Longitude °
Gradient
Location
B 1
Propose
36.53040
-76.24270
Up Gradient
Outside Compliance Bo
B2
Proposed
36.5301 °
-76.24040
Up Gradient
Outside Compliance Bou
MI
Proposed
36.53140
-76.24220
Down Gradient
On Compliance Bounda
M2
Proposed
36.5314"
-76.24000
Down Gradient
On Com liance Bound
M3
Proposed
36.52920
-76.24280
Down Gradient
On Compliance Bound
M4
Proposed
36.5292"
-76.24050
Down Gradient
On Compliance Bound
Select
0-
0Select
Select
Select
0-
0Select
Select
Select
0-
0Select
Select
Select
0-
0Select
Select
a Provide the following latitude and longitude coordinate determination information:
Datum: NAD83 Level of accuracy: Nearest 10th of a second Method of measurement:
Geodetic quality GPS survey
11. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
® Yes, ❑No or ❑N/A
12. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been submitted?
❑ Yes, ❑No or ❑N/A
13. If the Applicant is a Home/Property Owners' Association, has an Association Operational Agreement (FORM: HOA) been
submitted? ❑ Yes, ❑No or ❑N/A
14. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.613? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
FORM: HRIS 06-16 Page 3 of 13

V. ' WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705:
1. For the following parameters, provide the estimated influent concentrations and designed effluent concentrations as
determined in the Engineering Calculations, and utilized in the Agronomic Evaluation and Groundwater Modeling (if
applicable):
Parameter
Estimated Influent Concentration
Designed Effluent Concentration
(monthly average)
Ammonia Nitrogen (NH3-N)
40 mg/L
0.3 mg/L
Biochemical Oxygen Demand (BODs)
275 mg/L
2.0 mg/L
Fecal Coliforms
200 per 100 mL
Nitrate Nitrogen (NO3-N)
10 mg/L
0.6 mg/L
Nitrite Nitrogen (NO2-N)
10 mg/L
6.0 mg/L
Total Kjeldahl Nitrogen
6.9 mg/L
Total Nitrogen
60 mg/L
6.6 mg/L
Total Phosphorus
10 mg/L
1.0 mg/L
Total Suspended Solids (TSS)
300 mg/L
1.0 mg/L
2. Is flow equalization of at least 25% of the average daily flow provided? ® Yes or ❑ No
3. Does the treatment facility include any bypass or overflow lines? ❑ Yes or ® No
If yes, describe what treatment units are bypassed, why this is necessary, and where the bypass discharges:
4. Are multiple pumps provided wherever pumps are used? ® Yes or ❑ No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0705(i)?
5. Check the appropriate box describing how power reliability will be provided in accordance with 15A NCAC 02T .0705(k):
® Automatically activated standby power supply onsite capable of powering all essential treatment units; or
❑ Approval from the Director that the facility:
Has a private water supply that automatically shuts off during power failures and does not contain elevated water
storage tanks;
➢ Has sufficient storage capacity that no potential for overflow exists; and
➢ Can tolerate septic wastewater due to prolonged detention.
6. If the wastewater treatment system is located within the 100-year flood plain, are there water -tight seals on alt treatment units
or a minimum of two feet protection from the 100-year flood plain elevation? ❑ Yes, ❑ No or ® N/A
7. In accordance with 15A NCAC 02T .0705(n), how many days of residuals storage are provided? 10.89
8. How does the Applicant propose to prohibit public access to the wastewater treatment and storage facilities? Fence
9. If an influent pump station is part of the proposed facility (i.e., within the wastewater treatment plant boundary), does the
influent pump station meet the design criteria in 15A NCAC 02T .0305(h)? ❑ Yes, ❑ No, ® N/A — To be permitted
separately, or ❑ N/A — Gravity fed
10. If septic tanks are part of the wastewater treatment facility, do the septic tanks adhere to the standards in 15A NCAC 18A
.1900? ❑ Yes, ❑ No or ® N/A
FORM: HRIS 06-16 Page 4 of 13

V. ' WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
11. Provide the requested treatment unit and mechanical equipment information:
a. PRELIMINARY / PRIMARY TREATMENT (i.e., physical removal operations and flow equalization):
Treatment Unit
No. of
Units
Manufacturer or
Material
Dimensions (ft) /
S acin s in(gallons)
Volume
Plan Sheet
Reference
Specification
Reference
Fine Screen
2
Contec
9 x 17
N/A
C403
Sect 38
Flow Equalization
1
165 x 115
563993
C306
Sect 30
Select
Select
Select
b. SECONDARY / TERTIARY TREATMENT (i.e., biological and chemical processes to remove organics and nutrients)
Treatment Unit
No. of
Units
Manufacturer or
Material(gallons)
Dimensions (ft)
Volume
Plan Sheet
Reference
Specification
Reference
Anoxic Basin
9
A3-USA
11.5 x 11.5
71,696
C409
Sect 60
Aeration Basin
9
A3-USA
11.5 x 11.5
71,359
C409
Sect 53
Membrane Bioreactor (MBR)
6
A3-USA
11.5 x 11.5
47124
C409
Sect 50
Select
Select
Select
Select
Select
c. DISINFECTION
No. of
Manufacturer or
Volume
Plan Sheet
Specification
Treatment Unit
Dimensions (ft)
Units
Material
allons
Reference
Reference
Ultraviolet
2
A3-USA
N/A
N/A
C200
Sect 63
Select
➢ If chlorination is the proposed method of disinfection, specify detention time provided: minutes (NOTE — 30
minutes minimum required), and indicate what treatment unit chlorine contact occurs:
➢ If ultraviolet (UV) light is the proposed method of disinfection, specify the number of banks: 31 number of lamps per
bank: 6 and maximum disinfection capacity: 200 GPM.
d. RESIDUAL TREATMENT
Treatment Unit
No. of
Manufacturer or
Dimensions (ft)
Volume
Plan Sheet
Specification
Units
Material(gallons)
Reference
Reference
Select
12
Davco
9.5 x 14
64,673
C400
Existing
Select
FORM: HRIS 06-16 Page 5 of 13

V. . WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
e. PUMPS
Location
No. of
Pum s
Purpose
Manufacturer!
Type
Ca acit
Plan Sheet
Reference
Specification
Reference
GPM
TDH
Equalization
4
EQ
AMT
25
14
C406
30
32
SRC
6
Sludge Recycle
AMT
416
5
C200
32
Permeate
6
Permeate
Varisco
104
165
C200
55
Sludge Holding
6
Sludge Holding
AMT
44
40
C200
66
IBGW
9
Groundwater
Lowering
AMT
44
40
C200
66
f. BLOWERS
Location
No. of
Blowers
Units Served
Manufacturer /
Type
Capacity
(CFM)
Plan Sheet
Reference
Specification
Reference
Skids
6
Oxic
Kaeser
371
C200
53
Skids
6
Membrane
Kaeser
385
C200
51
Sludge Holding
2
Sludge Holding
FPZ
260
C200
Calc
g. MIXERS
Location
No. of
Mixers
Units Served
Manufacturer /
Type
Power
h
Plan Sheet
Reference
Specification
Reference
Anoxic
9
9
Faggiolati
0.75
C200
61
h. RECORDING DEVICES & RELIABILITY
Device
No. of
Units
Location
Manufacturer
Maximum
Capacity
Plan Sheet
Reference
Specification
Reference
Influent Flow Measuring Device
2
Fine Screen
Seimens
3000
C200
Sect 40
Effluent Flow Measuring Device
3
Eq. Skids
IFM Efactor
200
C200
Sect 40
Turbidimeter
3
Eq. Skids
B1ueBox
N/A
C200
Sect 57
Other
9
Eq. Skid
BlueBox
N/A
C200
Sect 57
i. EFFLUENT PUMP / DOSING TANK (IF APPLICABLE):
FORM: HRIS 06-16 Page 6 of 13

Plan Sheet
Reference
Specification
Reference
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
N/A
Total volume
ft3
gallons
Dosing volume
ft3
gallons
Audible & visual alarms
Equipment to prevent infiltration during rain
events if applicable)
FORM: HRIS 06-16 Page 7 of 13

VL ' EARtHEN STORAGE IMPOUNDMENT DESIGN CRITERIA —15A NCAC 02T .0705:
IF MORE THAN ONE IMPOUNDMENT. PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. What is the earthen impoundment type? 5-Day Upset
2. Storage Impoundment Coordinates (Decimal Degrees): Latitude: 36.5291' Longitude:-72.2463'
Datum: NAD83 Level of accuracy: Nearest second Method of measurement: Navigation quality GPS
3. Do any impoundments include a discharge point (pipe, spillway, etc)? ❑ Yes or ® No
4. Are subsurface drains present beneath or around the impoundment to control groundwater elevation? ❑ Yes or ® No
5. Is the impoundment designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the water balance? ❑ Yes or ❑ No
6. If a liner is present, how will it be protected from wind driven wave action?:
7. Will the earthen impoundment water be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not result in a
contravention of GA groundwater standards? ❑ Yes or ❑ No
8. What is the depth to bedrock from the earthen impoundment bottom elevation? N/A ft
If the depth to bedrock is less than four feet, has the Applicant provided a liner with a hydraulic conductivity no greater than
1 x 10'7 cm/s? ❑ Yes, ❑ No or ® N/A
Has the Applicant provided predictive calculations or modeling demonstrating that surface
water or groundwater standards will not be contravened? ❑ Yes or ❑ No
If the earthen impoundment is excavated into bedrock, has the Applicant provided predictive calculations or modeling
demonstrating that surface water or groundwater standards will not be contravened? ❑ Yes, ❑ No or ❑ N/A
9. If the earthen impoundment is lined and the mean seasonal high water table is higher than the impoundment bottom
elevation, how will the liner be protected (e.g., bubbling, groundwater infiltration, etc.)?
10. If applicable, provide the specification page references for the liner installation and testing requirements:
11. If the earthen impoundment is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
12. Provide the requested earthen impoundment design elements and dimensions:
Earthen Impoundment Design Elements
Earthen Impoundment Dimensions
Liner type:
--EHLiner
Clay
I
Top of embankment elevation:
22 ft
Other
UnlE]Syni edc
hydraulic conductivity:
x - cm/s
Freeboard elevation:
20 ft
Hazard class:
Not Applicable
Toe of slope elevation:
18 ft
Designed freeboard:
2 ft
Impoundment bottom elevation:
17 ft
Total volume:
1,704,318 ft'
I ,275,000
allons
Mean seasonal high water table depth:
14 ft
Effective volume:
1,022,591 ft,
7,650,000
gallons
Embankment slope:
3 :1
Effective storage time:
17 days
Top of dam water surface area:
340,863 ft2
Plan Sheet Reference:
C-311
Freeboard elevation water surface area:
326,851 ft2
Specification Section:
Sect 4
Bottom of impoundment surface area:
305,833 ft2
NOTE — The effective volume shall be the volume between the two foot freeboard elevation and the: (1) pump intake pipe
elevation; (2) impoundment bottom elevation or (3) mean seasonal high water table, whichever is closest to the two foot
freeboard elevation.
FORM: HRIS 06-16 Page 8 of 13

VIC INFILTRATION SYSTEM DESIGN CRITERIA — 15A NCAC 02T .0705:
1. Provide the minimum depth to the seasonal high water table within the infiltration area: 14
NOTE — The vertical separation between the seasonal high water table and the ground surface shall be at least one foot.
2. Are there any artificial drainage or water movement structures (e.g., surface water or groundwater) within 200 feet of the
infiltration area? ® Yes or ❑ No
If yes, were these structures addressed in the Soil Evaluation and/or Hydrogeologic Report, and are these structures to be
maintained or modified? Yes
3. Soil Evaluation recommended loading rates (NOTE — This table may be expanded for additional soil series):
Soil Series
Basins/Fields
within Soil
Series
Recommended
Loading Rate
in/hr
Recommended
Loading Rate
in/ r
Recommended
Loading Rate
GPD/ft2
Annual /
Seasonal
Loading
If Seasonal, list
appropriate
months
Tomotley
9
0.2673
97.58
4.0
Annual
Select
Select
Select
Select
Select
4. Are the designed loading rates less than or equal to Soil Evaluation recommended loading rates? ® Yes or ❑ No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0705(m )?
5. How does the Applicant propose to prohibit public access to the infiltration facilities? aim
6. Has the infiltration system been equipped with a flow meter to accurately determine the volume of effluent applied to each
basin/field as listed in VII.8.? ❑ Yes or ❑ No
If no, how does the Applicant intend on determining the amount of effluent applied to each basin/field?
7. For non -basins, provide the required cover crop information and demonstrate the effluent will be applied at or below
agronomic rates:
Cover Crop
Soil Series
% Slope
Nitrogen Uptake Rate
Ibs/ac• r
Phosphorus Uptake
Rate Ibs/ac• r
a. Specify where the nitrogen and phosphorus uptake rates for each cover crop were obtained:
b. Proposed nitrogen mineralization rate:
c. Proposed nitrogen volatilization rate:
d. Minimum infiltration area from the Agronomist Evaluation's nitrogen balance: ft2
e. Minimum infiltration area from the Agronomist Evaluation's phosphorus balance: ft2
f. Minimum infiltration area from the water balance: ft2
FORM: HRIS 06-16 Page 9 of 13

VII. INFILTRATION SYSTEM DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
8. Basin/Field Information (NOTE — This table may be expanded for additional fields):
Basin/
Field
Area
(acres)
Dominant
Soil Series
Designed
Loading
Rate
in/hr
Designed
Loading
Rate
in/ r
Designed
Loading
Rate
GPD/ft2
Latitude'
Lon
Longitude"
aterbody
Stream
Index No. "
Classification
1
0.287
Tomotley
0.2673
97.58
4.0
36.53130
-76..2423°
30-1-2-2-1
C;Sw
2
0.287
Tomotley
0.2673
97.58
4.0
36.53130
-76..24160
30-1-2-2-1
QSw
3
0.287
Tomotley
0.2673
97.58
4.0
36.53130
-76..24090
30-1-2-2-1
C;Sw
4
0.287
Tomotley
0.2673
97.58
4.0
36.5304"
-76..2423°
30-1-2-2-1
C;Sw
5
0.287
Tomotley
0.2673
97.58
4.0
36.53040
-76.24160
30-1-2-2-1
QSw
6
0.287
Tomotley
0.2673
97.58
4.0
36.53040
-76.24090
30-1-2-2-1
QSw
7
0.287
Tomotley
0.2673
97.58
4.0
36.52960
-76.24240
30-1-2-2-1
C;Sw
8
0.287
Tomotley
0.2673
97.58
4.0
36.52960
-76.24180
30-1-2-2-1
QSw
9
0.287
Tomotley
0.2673
1 97.58
4.0
36.52960
-76.24120
30-1-2-2-1
QSw
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total
' Provide the following latitude and longitude coordinate determination information:
Datum: NAD83 Level of accuracy: Nearest second Method of measurement:
Navigation quality GPS
b For assistance determining the waterbody stream index number and its associated classification, instructions may be
downloaded at: http://deq.nc.gov/about/divisions/water-resources/pIanning/cIassification-standards/classifications
9. High -Rate Infiltration System design criteria:
a. Infiltration Fields:
Spray Infiltration Design Elements
Drip Infiltration Design Elements
Nozzle wetted diameter:
ft
Emitter wetted area:
ft,
Nozzle wetted area:
ft2
Distance between laterals:
ft
Nozzle capacity:
GPM
Distance between emitters:
ft
Nozzle manufacturer/model:
!
Emitter capacity:
GPH
Elevation of highest nozzle:
ft
Emitter manufacturer/model:
/
Specification Section:
Elevation of highest emitter:
ft
Specification Section:
FORM: HRIS 06-16 Page 10 of 13

VIL INFILTRATION SYSTEM DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
b. Infiltration Basins:
IF MORE THAN TWO BASINS PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
1-9
Top of embankment elevation:
19.8 ft
Hazard class:
Low
Freeboard elevation:
2 ft
Designed freeboard:
2 ft
Toe of slope elevation:
17.8 ft
Total volume:
217,120 ft3
Impoundment bottom elevation:
13.4 ft
Infiltrative surface area:
12,500 ft2
Mean seasonal high water table depth:
14 ft
Daily infiltrative capacity:
50,000 GPD
Embankment slope:
2 : 1
Plan Sheet Reference:
C-309
Top of dam water surface area:
24,300 ft2
Specification Section:
Sect 4
Freeboard elevation water surface area:
21,000 ft2
Bottom of impoundment surface area:
12,500 ft2
i. Does this basin include a discharge point (pipe, spillway, etc)? ❑ Yes or ® No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ® Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ® No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ® No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
Top of embankment elevation:
ft
Hazard class:
Select
Freeboard elevation:
ft
Designed freeboard:
ft
Toe of slope elevation:
ft
Total volume:
ft3
Impoundment bottom elevation:
ft
Infiltrative surface area:
ft2
Mean seasonal high water table depth:
ft
Daily infiltrative capacity:
GPD
Embankment slope:
Plan Sheet Reference:
Top of dam water surface area:
ft2
Specification Section:
Freeboard elevation water surface area:
ft2
Bottom of impoundment surface area:
ft2
i. Does this basin include a discharge point (pipe, spillway, etc)? ❑ Yes or ❑ No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ❑ Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ❑ No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ❑ No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
FORM: HRIS 06-16 Page 11 of 13

V1II. SETBACKS — 15A NCAC 02T .0706:
I. Does the project comply with all setbacks found in the river basin rules (15A NCAC 02B .0200)? ® Yes or ❑ No
If no, list non -compliant setbacks:
2. Have any setback waivers been obtained in order to comply with 15A NCAC 02T .706(a) and .0706(d)? ❑ Yes or ❑ No
If yes, have these waivers been written, notarized and signed by all parties involved and recorded with the County Register of
Deeds? ❑ Yes or ❑ No
3. Provide the minimum field observed distances (ft) for each setback parameter to the infiltration system and treatment/storage
units (NOTE — Distances greater than 500 feet may be marked N/A):
Setback Parameter
Infiltration
System
Treatment /
Storage Unit
Any habitable residence or place of assembly under separate ownership or not to be
maintained as part of the project site
687
300
Any habitable residence or place of assembly owned by the Permittee to be maintained as
art of the project site
N/A
Any private or public water supply source
1740
281
Surface waters (streams — intermittent and perennial, perennial waterbodies, and wetlands)
100
Groundwater lowering ditches (where the bottom of the ditch intersects the SH WT)
100
Subsurface groundwater lowering drainage systems
50
Surface water diversions (ephemeral streams, waterways, ditches)
100
Any well with exception of monitoring wells
1740
281
Any property line
100
50
Top of slope of embankments or cuts of two feet or more in vertical height
100
Any water line from a disposal system
N/A
Any swimming pool
N/A
Public right of way
2425
Nitrification field
2265
Any building foundation or basement
687
Impounded public water supplies
1740
Public shallow groundwater supply (less than 50 feet deep)
N/A
4. Does the Applicant intend on complying with either 15A NCAC 02T .0706(b) or (c)? ® Yes or ❑ No
If yes, what are the designed Total Nitrogen and Total Phosphorus effluent concentrations? TN: 4_0 mg/L TP: 2_0 mg/L
5. Does the Applicant intend on complying with the High -Rate Policy issued October 27, 2006? ® Yes or ❑ No
If yes, verify the following information:
✓ Are the most stringent effluent standards in both 15A NCAC 02T .0705(b) and 15A NCAC 02U .0301(b) met?
® Yes or ❑ No
✓ Is duality provided for all treatment units per 15A NCAC 02U .0402(c)? ® Yes or ❑ No
✓ Continuous online monitoring and recording of effluent for turbidity? ❑ Yes or ❑ No
✓ A lined 5-day upset pond is provided? ❑ Yes or ® No
✓ The 5-day upset pond has restricted access? ❑ Yes or ❑ No
✓ A certified operator of a grade equal or greater than the facility classification is on call 24 hrs/day? ® Yes or ❑ No
FORM: HRIS 06-16 Page 12 of 13

IX. COASTAL WASTE TREATMENT DISPOSAL REQUIREMENTS— 15A NCAC 02H .0400:
1. Is this facility located in a Coastal Area as defined per 15A NCAC 02" .0403? ® Yes or ❑ No
For assistance determining if the facility is located within the Coastal Area, a reference map may be downloaded at: Coastal
Areas Boundary.
2. Is this an Interim Treatment and Disposal Facility per 15A NCAC 02H .0404(p)? ® Yes or ❑ No
NOTE — Interim facilities do not include County and Municipal area -wide collection and treatment systems.
IF ANSWERED YES TO ITEMS IX.1. AND IX.2., THEN COMPLETE ITEMS IX.3. THROUGH IX.16.
3. Is equalization of at least 25% of the average daily flow provided? ® Yes or ❑ No
4. How will noise and odor be controlled? Sound Enclosure and Distance
5. Is an automatically activated standby power source provided? ® Yes or ❑ No
6. Are all essential treatment units provided in duplicate? ® Yes or ❑ No
NOTE — Per 15A NCAC 02T .0103(16), essential treatment units are defined as any unit associated with the wastewater
treatment process whose loss would likely render the facility incapable of meeting the required performance criteria, including
aeration units or other main treatment units, clarification equipment, filters, disinfection equipment, pumps and blowers.
7. Are the disposal units (i.e., infiltration basins/fields) provided in duplicate? ❑ Yes or ❑ No
8. Is there an impounded public surface water supply within 500 feet of the infiltration area? ❑ Yes or ® No
9. Is there a public shallow groundwater supply (less than 50 feet deep) within 500 feet of the infiltration area? ❑ Yes or ® No
10. Is there a private groundwater supply within 100 feet of the infiltration area? ❑ Yes or ® No
11. Are there any SA classified waters within 100 feet of the infiltration area? ❑ Yes or ® No
12. Are there any non -SA classified waters within 50 feet of the infiltration area? ❑ Yes or ® No
13. Are there any surface water diversions (i.e., drainage ditches) within 25 feet of the infiltration area? ❑ Yes or ® No
14. Per the requirements in 15A NCAC 02H .0404(Q)(7), how much green area is provided? ft2
15. Is the green area clearly delineated on the plans? ❑ Yes or ® No
16. Is the spray infiltration wetted area within 200 feet of any adjoining properties? ❑ Yes, ❑ No or ® N/A
X. GROUNDWATER LOWERING SYSTEM DESIGN:
1. Does this project utilize a groundwater lowering system? ® Yes or ❑ No (If yes, complete Items X.2. through X.4.)
2. Is the groundwater lowering system: ® mechanically lowered (i.e., pumped) or ❑ gravity fed?
3. Where does the groundwater lowering drainage system discharge? Pond
If the system mechanically lowers groundwater and discharges directly or indirectly (i.e., pond overflow) to surface waters,
wetlands and/or stormwater structures, provide the date the Applicant obtained written confirmation from the Water Quality
Regional Operations Section that operation of the groundwater lowering drainage system will not adversely affect surface
waters of the State. Submitted: 8/15/19 & Received:
4. Groundwater lowering system design criteria:
Groundwater Lowering System Design
Pipe diameter:
8 in
Discharge rate:
150000 GPD
Pipe material:
HDPE
Method to measure discharge rate:
Flowmeter
Pipe depth:
loft
Number of pumps:
9
Pipe length:
1000 ft
Pump capacity:
44 GPM
1 40 TDH
Pipe slope (gravity -fed):
0 %
Plan Sheet Reference:
C200
Trench backfill material:
Sand
Specification Section:
66
FORM: HRIS 06-16 Page 13 of 13

Professional Engineer's Certification:
Robelt G. Burgin, Jr. attest that this application for 1,
(Professional Engineer's name from Application Item 111. 1 .)
Currituck Water Resourse Recovery Facility
(Facility name from Application Item 11. 1 .)
has been reviewed by me and is aecumte, complete and consistent with the information supplied in the plans, specifications, engineering
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 this application package and its instructions, as well as all applicable regulations and statutes.
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 General Statutes 143-215.6A and 14301 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 $10,00(), as well as
civil penalties up to $25,()00 per violation.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0i06(b):
Matthew Gauss, President 1,
attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
Currituck Water Resourse Recovery Facility
(Facility name from Application Item II.I.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that any discharge of wastewater
from this non -discharge system to surface waters or the land will result in an immediate 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 ofthis permit be violated. I also understand that if all required parts ofthis application package 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. I furtller certiIY that the Applicant or any affiliate has not been convicted Oj' 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 do not have any overdue annual fees per 1 5A
NCAC 02T .0105(e).
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,(1bas well as civil I ies up to $25,000 per violation.
Signature:
Date:
FORM: KRIS 06-16 Page 13 of 13