Application Forms

Non-Discharge Branch

Non-Discharge Branch

Use the tabs below to view the application forms and miscellaneous documents.

Electronic Applications are now being accepted!

Notice: The 15A NCAC 02T and 02U Rules have changed.  The application forms may reference the old rule citation.  For questions regarding the application forms, please contact Nathaniel Thornburg.

Application Forms

Application Forms

Permit Type

New / Modification3 Application

Renewal Application

Ownership / Name Change

Single-Family Residence System

SFRWWIS 06-16 

SFRWWISO&M 08-13

SFRLRW 11-13

SFRWWIS-R 02-21

SFRWWIS-CO 03-21

Wastewater Irrigation System

WWIS 06-16

 WWIS-R 02-21 NDPONC 06-16

High-Rate Infiltration System

HRIS 06-16

HRIS-R 02-21

 NDPONC 06-16

Closed-Loop Recycle System

CLRS 06-16

CLRS-R 02-21

 NDPONC 06-16

Other Wastewater System

ONDWWS 06-16

 ONDWWS-R 02-21 NDPONC 06-16
       

Reclaimed Water Bulk Distribution

RWPI 06-16

RWBD 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Conjunctive Utilization

RWPI 06-16

RWCU 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Generation

RWPI 06-16

RWG 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Dedicated (Non-Conjunctive) Utilization

RWPI 06-16

RWNC 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Distribution Lines

RWPI 06-16

RWDL 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Local Program Approval

RWPI 06-16

RWLPA 06-16

 RWS-R 02-21 NDPONC 06-16

Reclaimed Water Wetlands Augmentation

RWPI 06-16

RWWA 06-16

 RWS-R 02-21 NDPONC 06-16
       

Residuals Class A Distribution 1, 2

DCAR 06-16

RSC 06-16

DCAR 06-16

RSC 06-16

  

Residuals Land Application Program 1, 2

RLAP 06-16

LOA 06-16

RSC 06-16

RLAP 06-16

LOA 06-16

RSC 06-16

  

Residuals Surface Disposal 1, 2

SDR 06-16

RSC 06-16

SDR 06-16

RSC 06-16

  
1 - The County Manager Notification (Form: CMN) has been updated in accordance with  Session Law 2013-340, which is intended to provide the county board an opportunity to comment on proposed residuals land application sites within their county. Accordingly, the form title has been changed to County Board Notification (Form: CBN). The updated form is required prior to the permitting of proposed new fields, and can be found as part of the Form: RLAP (under section V. Land Application Site Certification). Please note that this notification is not required for fields deemed permitted to receive Class A residuals under 15A NCAC 02T .1100.
2 - The web location of our Critical Watershed Map has been changed to a permanent location at: Water Supply Watersheds. 
3 - For questions about which portions of the application form(s) are required for modifications, please contact Nathaniel Thornburg.
Miscellaneous Documents

Miscellaneous Documents

Documents

Form

Download

Checklist for Boat Washing Operations with Closed-Loop Recycle System

 N/A PDF

Coastal Area Map - 15A NCAC 02H .0403

N/A

JPG

Developer Operational Agreement

DEV 01-20

PDF

General Permit to Discharge Reclaimed Water from Conjunctive Use Reclaimed Water Systems

 NCG580000 PDF

Homeowner's Association Operational Agreement

HOA 01-20

PDF

Operator Designation Form

 WPCSOCC

PDF

Setback Waiver Form - Class B Residuals

 NDRMPW-LAS 11-18 PDF
Setback Waiver Form - Residual Treatment/Storage/Disposal

NDRMPW-ST 11-18

PDF
Setback Waiver Form - Wastewater & Reclaimed Water NDWSW 02-19

PDF
Signature Delegation Authority Letter

NDSDAL 01-20

 DOC

Watershed Classification Attachment

WSCA 08-13

PDF

 

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