WQCS00315_Renewal (Application)_20220303

Sedgefield Sanitary District
February 23, 2022 RECEIVED
MAR 0 3 2022
NCDEQ/DWRJNPDES
To: The North Carolina Department of Environment and Natural Resources Division of
Water Resources Peres Unit:
In response to the letter from the NCDENR regarding the renewal of Sedgefield
Sanitary District permit number WQCS00315. The following items pertinent to SSD are
included in this renewal packet:
Application
High Priority Lines list
Annual Budget for Collection System
Capital Improvement Plan
Response Action Plan
Comprehensive Collection System Map
Thank you for your time. If there are any questions please contact our office at [336] 299-
8879.
Very Truly Yours,
Erin son
Sedgefield Sanitary District

State of North Carolina
Department of Environment and Natural Resources
�.. Division of Water Resources
15A NCAC 02T.0400—SYSTEM-WIDE WASTERWATER COLLECTION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM CSA 08-13&SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100, 15A NCAC 02T .0400, and all relevant
Division Policies. Failure to submit all required items will necessitate additional processing and review time.
For more information, visit the Surface Water Section's Collection System website at:
http.://portal.ncdenr.org/web/wq/swp/ps/cs
General — When submitting an application to the Pretreatment, Emergency Response, & Collection Systems (PERCS)
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.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Cover Letter
❑ Submit a cover letter listing all items and attachments included in the permit application package
B. No Application Fee Required
➢ No application fee is necessary. The permittee will be billed an annual fee upon issuance of the permit
➢ The appropriate annual fee for systemwide wastewater collection system permits may be found at:
> Annual Non-Discharge Fees
C. System-Wide Wastewater Collection System (FORM: CSA 08-13)Application:
❑ Submit the completed and appropriately executed System-wide Wastewater Collection System (FORM: CSA 08-
13) 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 Section 1.3 is a Privatley-Owned Public Utility, provide the Certificate of Public
Convenience and Necessity (CPCN) 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 collection 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.
❑ If the Applicant Type in Section I.3 is a corporation or company, provide documentation if it is registered for
business with the North Carolina Secretary of State.
D. General Information:
➢ The Authorized signing official listed in Section I.4 should match with that of the Applicant certification page 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).
➢ NOTE - Public Works Director's are not authorized to sign this permit application according to the rule
unless they are delegated.
INSTRUCTIONS FOR APPLICATION CSA 08-13&SUPPORTING DOCUMENTATION Page 1 of 6

E. Summary of Attachments Required:
❑ Instruction A: Cover Letter
❑ Instruction C: Application
❑ Instruction C: Ownership Documentation(i.e.CPCN)(If necessary)
❑ Instruction D: Delegation Letter(If necessary for signing official)
❑ Section IV.3 Pump Station List
❑ Section IV.4 High Priority Lines List
❑ Section V.4 Annual Budget for Collection System(Updated and Approved)
❑ Section V.6 Capital Improvement Plan (Updated and Approved)
❑ Section VI.2 Response Action Plan
❑ Section VI.4 Contingency Plan
❑ Section VI.6 Comprehensive Collection System Map
❑ Section VII Note Any Potential Compliance Issues
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS,SHOULD BE SENT TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES
PERCS UNIT
By U.S.Postal Service: By Courier/Special Delivery:
Attn: PERCS Unit Supervisor 512 N.SALISBURY ST.Suite 925
1617 MAIL SERVICE CENTER RALEIGH,NORTH CAROLINA 27604
RALEIGH,NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone] FAX NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION CSA 08-13&SUPPORTING DOCUMENTATION Page 2 of 5

I. APPLICANT INFORMATION:
1. Applicant's name(Municipality, Public Utility,etc): SEDGEFIELD SANITARY DISTRICT
2. Facility Information: Name: Collection System Permit No.: WQCS00315
3. Applicant type: ® Municipal ❑ State ❑ Privately-Owned Public Utility
❑ County ❑ Other:
4. Signature authority's name:J.ROBERT STOUT per I 5A NCAC 02T .0106(b)
Title:CHAIRMAN
5. Applicant's mailing address: PO BOX 79056
City:GREENSBORO State:NC Zip:27417-9056
6. Applicant's contact information:
Phone number:[phone] Fax number:[phone] Email address:
SEDGEFIELDSANITARY(Q TRIAD.RR.COM
II. CONTACT/CONSULTANT INFORMATION:
1. C
ontact Name:J.ROBERT STOUT
2. Title/Affiliation: CHAIRMAN
3. Contact's mailing address: PO BOX 79056
4. City:GREENSBORO State:NC Zip:27417-9056
5. Contact's information:
Phone number:[phone] Fax number: (336) 299-8827 Email address:
[e-mail]
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑New ® Renewal
2. County System is located in: GUILFORD County
3. Owner&Name of Wastewater Treatment Facility(ies)receiving wastewater from this collection system:
Owner(s)&Name(s):CITY OF HIGH POINT
4. WWTF Permit Number(s):
5. What is the wastewater type? 100%Domestic (See 15A NCAC 02T
or %Industrial .0103(20))
Is there a Pretreatment Program in effect?❑ Yes or❑No
6. Wastewater flow:0.14 MGD(Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: MGD
8. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T.0114 or® Representative Data
9. Population served by the collection system: 523 HOMES
IV. COLLECTION SYSTEM INFORMATION:
APPLICATION CSA 08-13 Page 3 of 5

1. Line Lengths for Collection System:
Sewer Line Description Length
Gravity Sewer 7.2(miles)
Force Main 0(miles)
Vacuum Sewer 0(miles)
Pressure Sewer 0(miles)
2. Pump Stations for Collection System:
Pump Station Type Number
Simplex Pump Stations(Serving Single Building) N/A
Simplex Pump Stations(Serving Multiple Buildings) N/A
Duplex Pump Stations N/A
3. Submit a list of all major(i.e.not simplex pump station serving a single family home)pump
stations. Include the following information:
➢ Pump Station Name
➢ Physical Location
➢ Alarm Type(i.e.audible,visual,telemetry,SCADA)
➢ Pump Reliability
➢ Reliability Source(permanent/portable generator, portable pumps)
➢ Capacity of Station
4. Submit a list of all high priority lines according per 15A NCAC 02T.0402(2)known to exist in the collection system. Head
the list with"Attachment A for Condition V(4)"and include the system name.
➢ Use the same line identification regularly used by the applicant
➢ Indicate type of high priority line(i.e.aerial),material and general location
V. COLLECTION SYSTEM ADMINISTRATION:
1. Provide a brief description of the organizational structure that is responsible for management, operation and maintenance of
the collection system.
5 MEMBER BOARD OF DIRECTORS WITH A CHAIRMAN OF THE BOARD. FINANCE OFFICER/OFFICE
MANAGER
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.020I
Main ORC Name: ROBERT CHARLES WHITE Certification Number: 1010522
Back-Up ORC Name: CARLEY MARIE WHITE Certification Number: 1010801
3. Approximate annual budget for collection system only: $230255.00
4. Submit a copy of your current annual budget.
5. Approximate capital improvement budge for the collection system only: $ 100000.00
6. Submit a copy of your current capital improvement plan.
7. Is this collection system currently a satellite system ❑Yes or®No
8. Do any satellite systems discharge to this collection system❑Yes or®No(If yes complete table below)
APPLICATION CSA 08-13 Page 4 of 5

Satellite System Contact Information(Name,Address,Phone Number)
Complete for Satellite Systems that have a flow or capacity greater than 200,000 GPD(Average daily flow)
9. List any agreements or ordinances currently in place to address flows from satellite systems:
VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place®Yes or❑No
2. If Yes,submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place?❑Yes or❑No
4. If Yes,submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? ®Yes or❑No
6. Submit a submit a copy of the collection system map(CD or hardcopy)or indicate a schedule for completion
7. Thoroughly read and review the System-Wide Collection System Permit Conditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Current If no,Indicate a Typical
Permit Condition Compliance? Compliance Compliance
Date Schedule
I(4)—Grease ordinance with legal authority to inspect/enforce ®Yes ❑No 12—18 mo.
1(5)— Grease inspection and enforcement program ®Yes ❑No 12— 18 mo.
1(6)—Three to five year current Capital Improvement Plan. ®Yes ❑No 12-18 mo.
I(8)—Pump station contingency plan ❑ Yes ❑No 3 mo.
I(9)—Pump station identification signs. ❑ Yes ❑ No 3 mo.
I(11)—Functional and conspicuous audible and visual alarms. ❑ Yes ❑No 3—6 mo.
II(5)—Spare pumps for any station where one pump cannot
handle peak flows alone(in a duplex station,the 2nd pump is ❑ Yes ❑ No 6—9 mo.
the spare if pump reliability is met).
11(7)—Accessible right-of-ways and easements. ® Yes ❑No 6— 12 mo.
II(9)—Response action plan with Items 9(a—h). ® Yes ❑ No 3 mo.
III(3)—Comprehensive collection system map ® Yes ❑No 10%per year
For conditions not listed,compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet(attach clarification if needed):
VII. APPLICANT'S CERTIFICATION per 15A NCAC 02T.0106(b):
I,J.ROBET STOUT attest that this application for SEDGEFIELD SANITARY DISTRICT
APPLICATION CSA 08-13 Page 5 of 5

(Signature Authority's Name&Title from Item 1.4) (Facility name from Item I.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certif ation in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
$10,000 as well as ci ' pen ties up to 5,00 a iolati .
Signature: Date: 22s ZO ZZ—
APPLICATION CSA 08-13 Page 6 of 5

At achrent A for Condition V
Sed :efield Sanitary Sewer District
High Priority Lines
HPL #1- 8" Duct le Iron (3000 E. Sedgefield Dr.)
HPL #2- 8" Duct le Iron (I1-M22)
HPL #3- 12" Du • ile Iron (M13-M12)
HPL #4- 4" Duct le Iron (E1-E2)
HPL #5- 4" Duct le Iron (E3-E9)
HPL #6- 4" Duct le Iron (E3-E9)
HPL #7- 10" Du • ile Iron (F1-M13)
HPL #8- 8" Duct le Iron (F17-F16)
HPL #9- 8" Duct le Iron (F14-F15)
HPL #10- 8" Du ile l*on (M6)
HPL #11- 8" Du •tile Ion (3415 Old Onslow Rd.)
HPL #12- 8" Du • ile l•on (Stirrup Dr.) F56B-F56B1
HPL #13- 8" Du • ile Ion (F56-F52)
HPL #14- 8" Du •tile Iron (Waldenbrook) K11-K12
HPL #15- 8" Du •tile Iron (Stirrup Dr.) F56B1-F57

Sedgefield Sanitary District
Proposed Revised Budget
Fiscal year 2021-2022
Ad Valorem Taxes at 95%collectibility ($.0377/$100.00) $ 142000
Sewer Charges 125000
Rents 3576
Fund balance appropriated 64279
Total Budgeted Revenues $ 334855
Administration
Commissioners Meeting fee $ 1000
Salaries 45000
Employee Benefits 3600
Payroll taxes 7000
Travel 600
Rent 9900
Professional services 8500
Utilities 4400
Maintenance & repairs 800
Insurance 1000
Telephone & postage 9000
Office supplies 12000
Miscellaneous expense 300
Bad debt expense 1500
104600
Treatment
Contract treatment 75000
Maintenance & repairs 106000
Amortization 9255
Depreciation 40000
230255
$ 334855
Total Budgeted Expenditures

Capital improvement projects 2022
1. K Section Concrete hpl-8,000
2. F section plug bypass and video-6,500
3. D section Rooter and root-x-6,000
4. H-17 get roots out of main and root-x-4,000

C & C Environmental Services
Sedgefield Sanitary Sewer District Response Action Plan
Contact Numbers for 24 hour Response
1. Robert White (ORC/Owner) [phone]
2. Carley White (back-up ORC/Owner) [phone]
3. Pump and Vacuum Trucks:
Nathan Ward- [phone]
Total Environment- [phone]
Pierce Grading Company-[phone]
4. Emergency Lab Samling:
Pace Analytical- [phone]
5. Emergency Locates: 811 or 1-800-632-4949
6. DENR after hours: 1-800-858-0368
7. Winston Salem DEQ [phone]

Sedgefield Sanitary District
Response Action Plan
B. Response Time (Worst Case) 1 Hour
C. Equipment List and Spare Parts: %" letter with 500FT hose
6", 8" and 10" PVC pipe, 6", 8" and 10" Repair Flex Couplings
8" Stainless Steel Sleeves for Pipe Joint Repairs
Genorators X3
Hydraulic Cement, Epoxy and Non-Shrinking Grout
2- 2"pumps
3" Transfer pump
Extra Manhole Ring, Lid and Riser
Shops Located in Thomasville, NC
1. C&C Environmental Services has Smoke Test Equipment,
Trenchless Repair Equipment, Root Cutting Equipment,Camera
Equipment, Pumping Equipment, Confine Space Entry
Equipment and Pipe Repair Equipment. Shop-vac Equipment.
2. Pumping, Grading, Shoring and Excavating Equipment is
located at Pierce Grading Company in Thomasville and
available at Sunbelt Rentals which has 30 locations in NC.

D. Access to Cleaning Equipment: Jetter on Site, additional
jetting provided by Vortex in Greensboro, NC
E. Access to Construction Crews, Contractors and Engineers:
C & C Environmental Services
Pierce Grading Company
Willis Engineering
F. Source of Emergency Funds: Sedgefield Sanitary District
.Site sanitation and clean
G up materials: C&C Environmental
hovels and
Services keeps Hydrated Lime, pumps, rakes, shovels,p Y p p
water tanks at shop in Thomasville, NC.
H.Postoverflow/spillassessment: Performed by ORC and
Sitsanitation

Standard Operating Procedure for
Spill Response Plan
Sedgefield Sanitary District
1. Get Address of spill
2. Get address, phone number and contact name of person
reporting spill
3. Respond and Arrive and Evaluate problem
4. Take corrective actions to stop over flow or spill and make
necessary repairs or remove blockages
5. Evaluate volume of spill, duration of spill, and Area of spill
6. Report spill to NCDENR
7. Begin necessary clean up of spill
8. File 5-Day Report with Division of Water Quality