WQCS00030_Renewal (Application)_20230703

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
Andy Smith, Asssitant Director Resources Water of
City of Statesville
PO Box 1111
Statesville, NC 28687-1111
Subject: Permit Renewal
Application No. WQCS00030
Statesville Collection System
Iredell County
Dear Permittee:
NORTH CAROLINA
Environmental Quality
July 03, 2023
The Water Quality Permitting Section acknowledges the July 3, 2023 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's Non -discharge
permitting branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https•//deq nc g_ov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
ec: WQPS Laserfiche File w/application
Sincerely,
Cynthia Demery
Administrative Assistant
Water Quality Permitting Section
D Q�
North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 1 610 East Center Avenue, Suite 301 1 Mooresville, North Carolina 28115
704.663.10A

CITY of
tat e
PUBLIC UTILITIES
P. 0. Box 1111, Statesville, NC 28687-1111
k " • IT -1
Assistant City Manager/City Engineer 704 878-3551
Public Works Director 704 878-3552
Public Utilities Director 704 761-2383
Office Manager 704 878-3567
29 June 2023 RECEIVED
Water Quality Permitting Section JUL 0 3 .2023
Municipal Permitting Unit
1617 Mail Service Center
Raleigh NC 27699-1617 NCDEQ/DWR/NPDES
Subject: System -wide Wastewater Collection System Permit Renewal
References: (a) 15A NCAC 02T .0100
(b) 15A NCAC 02T .0400
Enclosures: (1) Application CSA 04-16
(2) Application Section IV.3, Pump Station List
(3) Application Section IVA, High Priority Lines List
(4) Application Section VA, Annual Budget for Collection System
(5) Application Section V.6, Capital Improvement Plan
(6) Application Section VI.2, Response Action Plan
(7) Application Section VIA, Contingency Plan
(8) Application Section VI.6, Comprehensive Collection System Map
(9) City of Statesville and Town of Troutman Wastewater Agreement (28Dec98)
and Amendment (17Nov08)
To Whom It May Concern:
Please find enclosed the subject collection system permit renewal application. Point of contact
is the undersigned at phone [phone], email [e-mail].
Sincerely,
William E. Vaughan, PE
Public Utilities Director

Enclosure 1
CSA 04-16
System -wide Wastewater Permit Application
(Renewal)

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
y 15A NCAC 02T .0400 — SYSTEM -WIDE WASTEWATER COLLECTION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM CSA 04-16 & 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 System -wide Collection System Permitting website:
General — When submitting an application to the Municipal 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.
The Applicant shall submit one original and one copy of the application and supportine documentation.
The copy may be submitted in digital format.
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 04-16) Application:
® Submit the completed and appropriately executed System -wide Wastewater Collection System (FORM: CSA 04-
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 Section I.3 is a Privately -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 1.3 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 Directors are not authorized to sign this permit application, according to the rule,
unless they are formally delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 5

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 IVA
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 VIA
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:
NCDEQ-DWR
Water Quality Permitting Section
MUNICIPAL PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY ST. Suite 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION CSA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 5

I. APPLICANT INFORMATION:
1. Applicant's name (Municipality, Public Utility, etc): City of Statesville
2. Facility Information: Name: City of Statesville Collection System Permit No.: WQCS00030
3. Applicant type: ® Municipal ❑ State ❑ Privately -Owned Public Utility
❑ County ❑ Other:
4. Signature authority's name: Ron Smith per 15A NCAC 02T .0106(b)
Title: City Manager
5. Applicant's mailing address: P.O. Box 1111
City: Statesville State: NC Zip: 28687-1111
6. Applicant's contact information:
Phone number: [phone] Fax number: Email address: [e-mail]
H. CONTACT/CONSULTANT INFORMATION:
1. Contact Name: William E. Vaughan, PE
2. Title/Affiliation: Public Utilities Director
3. Contact's mailing address: 301 South Center Street
4. City: Statesville State: NC Zip: 28677
5. Contact's information:
Phone number: [phone] Fax number: Email address: [e-mail]
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑ New ® Renewal
2. County System is located in: Iredell_ County
3. Owner & Name of Wastewater Treatment Facility(ies) receiving wastewater from this collection system:
Owner(s) & Name(s): City of Statesville, Third Creek WWTP; City of Statesville, Fourth Creek WWTP
4. WWTF Permit Number(s): NCO020591 (3'd Ck WWTP); NCO031836 (41 Ck WWTP)
5. What is the wastewater type? 60% Domestic or40% Industrial (See 15A NCAC 02T .0103(20
I)1
Is there a Pretreatment Program in effect? ® Yes or ❑ No
6. Wastewater flow: 4.03 MGD (Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: 6.0 MGD
8. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T .0114 or ® Representative Data
9. Population served by the collection system: 28,884
IV. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description
Length
Gravity Sewer
272 miles
Force Main
20.7 miles
Vacuum Sewer
0 miles
Pressure Sewer
0 miles
APPLICATION CSA 04-16 Page 3 of 5

2. Pump Stations for Collection System:
Pump Station Type
Number
Simplex Pump Stations(Serving Single Building)
0
Simplex Pump Stations(Serving Multiple Buildings)
0
Duplex Pump Stations
19
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 (Can convey peak hourly wastewater flow with largest single pump out of service)
➢ Reliability Source (permanent/portable generator, portable pumps)
➢ Capacity of Station (Pump Station Capacity in GPM)
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.
The collection system lines are maintained by the Sewer Maintenance Division of the Public Utilities Department. The city -
owned pump stations are maintained by Water Resources Department's applicable WWTP (3'd Ck, 41' Ck).
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Clyde Fox
Certification Number: 997772
Back -Up ORC Name: James Adam Surratt
Certification Number: 999548
See the "WOCS Contacts and ORC Report' for a current listing of the ORC(s) the Division has on file for WQCS permit
3. Approximate annual budget for collection system only: $ 562,000
4. Submit a copy of your current annual budget.
5. Approximate capital improvement budget for the collection system only: S 33,000,000 (FY 24-34)
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)
Satellite System
Contact Information(Name, Address, Phone Number
Town of Troutman
Ron Wyatt, Town Mgr, 400 N. Eastway Drive, Troutman NC 28166
704 528-7600
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:
See attached Enclosure 9.
APPLICATION CSA 04-16 Page 4 of 5

VI.
VIL
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.
Permit Condition
Current
Compliance?
If no, Indicate a
Compliance
Date
Typical
Compliance
Schedule
I(4) — Grease ordinance with legal authority to inspectlenforce
® Yes ❑ No
12 — 18 mo.
I(5) — Grease inspection and enforcement program
® Yes ❑ No
12 —18 mo.
I(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.
1(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 21 pump is
the spare if pump reliability is met).
® Yes ❑ No
6 — 9 mo.
II(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): N/A.
APPLICANT'S CERTIFICATION per 15A NCAC 02T .0106(b):
I, Ron Smith, City Manager
(Signature Authority's Name & Title from Item I.4)
attest that this application for City of Statesville
(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 certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
$10,000 as well as 'vil penajties up to $25,000 per violation.
Signature: Date: 12- 1 1-d
APPLICATION CSA 04-16 Page 5 of 5

Enclosure 2
CSA 04-16 Section IV.3
Pump Station List

3RD CREEK WWTP
Location
Address
Alarm Type
Pump
Reliability
Reliability
Source
(Generator)
Capacity
Utility 2
Phone
HP
GPM
Head
(ft)
Barkley Road
114 East Barkley Road
Light/Horn
Yes
Diesel/Perm
7.5
236
50
City
704-872-2193
Newton Drive
2051 Newton Drive
Light/Horn
Yes
Diesel/Port
7.5
100
50
City
704-872-2158
Industrial Drive
1302 Industrial Drive
Light/Horn
Yes
Diesel/Port
7.5
225
36
City
704-872-2170
Park Drive
1018 Park Drive
Light/Horn
Yes
Diesel/Port
10
100
50
City
704-872-2099
Interstate Equipment
1610 Salisbury Highway
Light/Horn
Yes
Diesel/Port
7.5
100
50
City
704-872-2191
Airport
508 Old Airport Road
Light/Horn
Yes
Diesel/Perm
50
190
142
Energy United
704-871-1415
Kennedy Drive
2415 Kennedy Drive
Light/Horn
Yes
CNG/Perm
30
740
78
City
704-871-1496
Pine Forest
153 Planters Drive
Light/Horn
Yes
Diesel/Perm
20
250
112
City
704-873-2923
Wildwood
196 Skyuka Drive
Light/Horn
Yes
CNG/Perm
7.5
70
1 107
Duke Energy
704-872-5518
Giant Oaks
248 Giant Oak Avenue
Light/Horn
Yes
CNG/Perm
25
200
1 93
City
877-991-1911
3'd Creek WWTP
444 Third Creek Road
Diesel
704-872-9621
704-437-2413
4T" CREEK WWTP
Location
Address
Alarm Type
Pump
Reliability
Reliability
Source
(Generator)
Capacity
Utility
Phone
HP
GPM
Head
(ft)
Statesville Business Park
341 Business Park Drive
Light/Horn
Yes
Diesel/Perm
40
10
180
City
704-878-3403
Hatfield
152 Hatfield Road
Light/Horn
Yes
CNG/Perm
10
260
60
Energy United
704-872-2198
Valley Stream
241 OTH1 Valley Stream Road
Light/Horn
Yes
Diesel/Port
2
160
20
City
704-878-3469
Commerce Blvd (ASMO)
2748 Commerce Blvd
Light/Horn
Yes
Diesel/Perm
60
336
160
Energy United
704-872-2270
Marjorie Road
241 Marjorie Road
Light/Horn
Yes
CNG/Perm
10
150
45
City
704-878-3470
Davis Hospital
269 Mocksville Road
Light/Horn
Yes
Diesel/Perm
20
180
114
Energy United
704-873-3540
Deer Ridge (Barnes Pump)
144 Deer Ridge Lane
Light/Horn
Yes
CNG/Perm
30
167
133
Energy United
704-873-7647
Fifth Creek
1014 Turnersburg Hwy
Light/Horn
Yes
Diesel/Perm
72
890
195
Duke Energy
704-876-9018
Mitchell Farm Road
263 Mitchell Farm Road
Light/Horn
Yes
Diesel /Perm
40
307
196
Duke Energy
704-876-1255
4th Creek WWTP
693 Bell Farm Road
Diesel
City
704-878-3437
704-437-2414
Notes:
1. Peak hourly wastewater flow with largest single pump out of service
2. Contact phones: Energy United, 1-800-522-3793; Duke Energy, 1-800-769-3766; City of Statesville Dispatch, 704-878-3419

Enclosure 3
CSA 04-16 Section IVA
High Priority Lines List

Collection System Report
Third Creek Crossings
Job Foreman Completion Date
Renort Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
1# 10 Other (please note problem on reverse side)
Report
Codes
Third Creek Locations
Closest Address
Inspection
Date
Inspection
Date
Inspection
Date
Inspection
Date
10" 1232 Wilmington Av.
12" 138 Foggy Bottom Ln.
12" 1444 Harris St.
12" 1921 Wilson Lee Blvd.
15" 1105 Winston Av.
15" 1219 Goldsboro Av.
15" 2253 Bristol Rd.
15" 324 S. Miller Av.
15" 762 Buffalo Shoals Rd.
16" 118 Raleigh Av.
16" 1444 Harris St.
16" 152 Newton Alley
16" 208 Corinthian Dr.
16" 1903 5th St.
18" 124 Bostian Bridge Dr.
24" 180 Cara Ln. (Hillcrest Trailer Park)
24" 229 Belfast Rd.
30" 137 Pendergrass Dr.
30" Under 1-77 --Behind 3rd creek school
30" 175 Club House Dr.
30" 201 Hunters Hill Dr. (2 diff. locations)
8" 1212 Harris St.
8" 237 Cara Ln. (Hillcrest Trailer Park)
8" 635 Meadowlane Dr.
8" 1026 Cass St.
8" 108 -C Wall St. & 1-77
8" 115 Megby Tr.
8" 119 Megby Tr.
8" 1201 Wall St.
8" 123 E. Raleigh Av. & Dobson Av.
8" 1335 11th St.
8" 139 Tenth Green Ct.
8" 175 Club House Dr.
8" 197 Hunters Hill Dr.
8" 220 Wedge View Way

Collection System Report
Third Creek Underground Creek Crossing
Job Foreman Completion Date
Report Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
# 10 Other (please note problem on reverse side)
Report Third Creek Locations Inspection Inspection Inspection Inspection
Codes Closest Address Date Date Date Date
15" 1201 Wall St.
8" 120 Megby Ln.
8" 135 17th Tee Ln.
8" 1921 Wilson lee Blvd.
8" 207 E. Raleigh Ave.

Collection System Report
Third Creek Overhead Piers & Trestles
Job Foreman Completion Date
Report Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
1# 10 Other (please note problem on reverse side)
Report
Codes
Third Creek Locations
Closest Address
Inspection
Date
Inspection
Date
Inspection
Date
Inspection
Date
10" 353 Forest Hollow Dr.
12" 313 Bristol Dr.
12" At Hidden Lakes
8" E. of Crowell Av. At W.Garner Bagnal Blvd.
8" 130 Lippard St.
8" E. of Cochran St. & Cedar St.
8" 135 17th Tee Ln
8" 207 E. Raleigh Ave.
8" 1921 Wilson W. Lee Blvd.
15" 1201 Wall St.
8" 120 Megby Trail

Collection System Report
Fourth Creek Crossings
Job Foreman Completion Date
Report Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
1# 10 Other (please note problem on reverse side)
Report
Codes
Fourth Creek Locations
Closest Address
Inspection
Date
Inspection
Date
Inspection
Date
Inspection
Date
10" 341 W. Bingham St.
12" 1335 Museum Rd.
12" 2224 Wexford Way
12" 474 N. Center St. @ S.H.S.
12" 1036 Hunter St.
12" 502 Wilson St.
15" 304 Gregory Rd.
15" Victory Ln. & 1-40
15" 1180 Free Nancy Av.
16" 545 N. Race St. @ Anderson Park (1)
16" 545 N. Race St. @ Anderson Park (2)
16" 816 Alexander St.
18" 2360 Northside Dr.
21" 1250 Northside Dr.
24" 437 Tradd St. @ S.H.S.
24" 406 Oakhurst Rd.
30" 1364 Royality Cir.
30" 232 Pump Station Rd.
30" 140 Turnersburg Hwy.
30" 1637 Brookgreen Av. @ 1-77
42" 450 Signal Hill Dr.
8" 121 Anna Dr.
8" 1630 Crown Vue Ct.
8" 232 Pump Station Rd.
8" 701 Springdale Rd.
8" 144 James Farm Rd.
8" 163 Intercraft Dr.
8" 178 May Dr.
8" 334 N. Oakland Av.
8" 340 Wilson St.
8" 442 Salisbury Rd.
8" 453 N. Lackey St.
8" 502 Wilson St.
8" 503 Fall St.
8" 843 Stockton St.
8" 857 Wendover Rd.
8" 870 Wendover Rd.
8" 904 Hedrick Cir.

Collection System Report
Fourth Creek Crossings
Job Foreman Completion Date
Renort Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
# 10 Other (please note problem on reverse side)
Report Fourth Creek Locations Inspection Inspection Inspection Inspection
Codes Closest Address Date Date Date Date
8" 119 Coddington Ln.
8" 127 Coddington Ln.
8" 646 Hartness Rd.
8" 628 E. Front St.
6" 628 E. Front St.
8" 105 Coddington Ln.
12" 115 W. Bell St.

Collection System Report
Fourth Creek Underground Creek Crossing
Job Foreman Completion Date
Report Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
1# 10 Other (please note problem on reverse side)
Report
Codes
Fourth Creek Locations
Closest Address
Inspection
Date
Inspection
Date
Inspection
Date
Inspection
Date
15" 1134 Fourth Creek Landing Dr.
15" Behind 121 Anna Dr.
15" N. of Victory Ln. (1)
15" N. of Victory Ln. (2)
15" N. of Victory Ln. (3)
18" 2500 Northside Dr.
27" 114 Millsaps Rd.
8" 1019 Valley St.
8" 229 Chestnut St.
8" 1004 Hempstead PI
8" 1120 Fourth Creek Landing Dr.
8" 161 Intercraft Dr.
8" 2020 Crouch St.
8" 2024 Crouch St.
8" 2179 Deer View Cir.
8" 218 Springfield Rd.
8" 2441 E. Broad St.
8" 3302 Camden Rd.
8" 838 St. Cloud Dr.
8" End of August Dr.
8" St. Cloud Dr.
8" 139 Coddington Ln.
8" 2929 E. Broad St.
8" 3112 E. Broad St.
8" 3126 Meadow Rue Dr.
8" 406 Turnersburg Hwy.
8" 477 S. Greenbriar Rd.
8" E. of 1124 Fourth Creek Landing Dr.
8" E. of 380 James Farm Rd.
8" N. of 1104 Graham St.
8" N. of 2215 E. Greenbriar Rd. (1)
8" N. of 2215 E. Greenbriar Rd. (2)
8" N. of 2215 E. Greenbriar Rd. (3)
8" South of 2441 E. Broad St.

Collection System Report
Fourth Creek Overhead Piers & Trestles
Job Foreman Completion Date
Report Information Codes
# 1 Everything is OK
# 6 Clearing work needs to be done
# 2 Lines needs cleaning
# 7 Erosion prevention needs to be done
# 3 Manholes needs work
# 8 Manholes needs cleaning
# 4 Structure needs cleaning
# 9 Manholes needs sealing
# 5 Structure needs painting
1# 10 Other (please note problem on reverse side)
Report
Codes
Fourth Creek Locations
Closest Address
Inspection
Date
Inspection
Date
Inspection
Date
Inspection
Date
12" 818 E. Sharpe St.
16" 1635 Simonton Rd. at Signal Hill Dr.
16" 204 Austin Healey Dr. & Simonton Rd.
24" 1515 Forest Park Dr.
24" 434 Oakdale Dr. & Bryant St.
24" Simonton Rd. & 1-77 (In the Curve)
24" Simonton Rd. at Signal Hill Dr.
24" Valley Stream Rd. @ Beechwood Rd
24" 1547 Brookgreen Av.
24" 222 Knox St.
6" 1203 Valley Stream Rd.
6" 2441 E. Broad St. @ Statesville Manor
8" 531 Stoneybrooke Rd.
8" 123 Lincoln St.
8" 1358 Radio Rd.
8" 474 N. Center St. @ S. H. S.
8" 815 Partridge Dr.
8" 920 Brookwood Ct.

Enclosure 4
CSA 04-16 Section VA
Annual Budget for Collection System

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NORTH CAROLINA
ADOPTED MUNICIPAL
OPERATING BUDGET
JULY 11 2022 - JUNE 30, 2023

WATER AND SEWER FUND PUBLIC UTILITIES - SEWER MAINTENANCE
Original
Adopted a
,
Actual
Actual
Budget
Budget
%
2019-20
2020-21
2021-22
2022-23
Change
Salaries -Permanent
$ 275,609
$ 248,875
$ 279,416
$ 284,059
1.66%
Salaries -Overtime
14,706
17,481
24,000
24,000
0.00%
Salaries -Longevity
-
-
-
-
N/A
FICA Expense
21,516
19,511
23,246
24,741,
6.43%
Group Life
983
935
Retirement
28,025
28,367
40,723
45,795
12.45%
Group Health
68,650
84,021
72,000
79,200
10.00%
Christmas Bonus
525
450
450
15,420
3326.67%
Total Personnel
410,014
399,640
440,973
474,447
7.59%
Professional Services
-
4,045
6,145
6,145
0.00%
Gasoline
2,649
1,881
4,500
5,850
30.00%
Diesel Fuel
16,400
12,784
20,000
42,900
114.50%
IT -Communications
-
-
8,054
-
N/A
Travel and Training
50
172
2,370
2,470
4.22%
Maint and Repair - Bldgs & Grnds
765
157
2,900
2,900
0.00%
Maint and Repair - Equipment
25,563
18,568
27,750
30,660
10.49%
MaintandRepair- Auto&Truck
16,690
12,717
16,500
17,820
8.00%
Bldgs Equip and Land Rent
204
-
2,000
2,000
0.00%
Hand Tools
1,632
1,963
3,000
4,000
33.33%
Supplies -General
2,285
2,364
3,500
3,500
0.00%
Supplies -Materials
2,475
2,231
5,200
5,598
7.65%
Non -Depreciable
14,339
-
10,999
11,998
9.08%
IT - Non -Depreciable
1,396
2,722
-
-
N/A
Uniforms
2,202
2,263
4,200
4,580
9.05%
Contracted Serv-General
-
-
-
-
N/A
Dues & Subscriptions
100
100
1,000
1,000
0.00%
Insurance & Bonds
22,542
24,796
27,000
30,200
11.85%
Inventory Short/Over
597
3,336
1,500
1,500
0.00%
OSHA - Safety
3,619
3,744
6,250
7,930
26.88%
Sewer Maintenance
56,561
62,511
100,000
114,400
14.40%
Sewer Maintenance Supplies
16,120
34,891
50,000
63,750
27.50%
Total Operating
186,189
191,245
302,868
359,201
18.60%
Capital Outlay -Equipment
462,283
-
-
360,000
N/A
Capital Improvement Sewer
218,701
61,360
250,000
590,000
136.00%
Total Capital Outlay
680,984
61,360
250,000
950,000
280.00%
Total Sewer Maintenance
$ 1,277,187
$ 652,245
$ 993,841
$ 1,783,648
79.47%
Page 151

WATER AND SEWER FUND PUBLIC UTILITIES - THIRD CREEK
Original
Adopted
Actual
Actual
Budget
Budget
%
2019-20
2020-21
2021-22
2022-23
Change
Salaries -Permanent
$ 352,500
$ 312,898
$ 323,828
$ 356,948
10.23%
Salaries -Overtime
40,720
29,177
44,000
44,000
0.00%
Salaries -Longevity
-
-
-
-
N/A
FICA Expense
28,717
24,918
28,179
32,049
13.73%
Group Life
1,276
1,144
1,338
1,542
15.25%
Retirement
39,491
39,191
49,357
59,322
20.19%
Group Health
86,150
84,021
84,000
92,400
10.00%
Christmas Bonus
525
525
525
17,990
3326.67%
Total Personnel
549,379
491,874
531,227
604,251
13.75%
Professional Services
18,682
21,002
48,785
51,460
5.48%
Gasoline
1,964
1,969
3,125
4,063
30.02%
Diesel
10,142
6,369
14,000
18,200
30.00%
Communications
17,808
11,893
20,324
24,389
20.00%
IT -Communications
240
240
314
-
N/A
Utilities
4,860
4,569
7,000
7,200
2.86%
Travel and Training
52
-
3,180
3,180
0.00%
Maint and Repair - Bldgs & Grnds
4,873
7,420
60,587
15,800
-73.92%
Maint and Repair - Equipment
30,398
44,456
61,365
67,150
9.43%
Maint and Repair - Auto & Truck
4,413
9,538
5,500
5,800
5.45%
Hand Tools
465
424
1,000
1,000
0.00%
Supplies -General
2,251
1,825
2,500
3,000
20.00%
Supplies -Janitorial
1,265
1,049
1,400
1,400
0.00%
Supplies -Chemical
117,508
132,044
150,635
157,140
4.32%
Supplies -Materials
779
487
2,200
3,200
45.45%
Supplies -Laboratory
6,843
5,801
12,000
12,600
5.00%
Non -Depreciable
6,655
-
-
-
N/A
IT- Non -Depreciable
-
-
4,800
-
N/A
Uniforms
1,867
1,977
3,156
3,156
0.00%
Contracted Serv-General
79,138
49,909
53,200
81,600
53.38%
Tipping Fees
1,652
1,656
1,650
1,650
0.00%
Dues & Subscriptions
6,564
6,498
7,792
7,752
-0.51%
Insurance & Bonds
17,059
18,765
20,500
23,000
12.20%
Miscellaneous Expense
-
-
-
-
N/A
Inside Charges - Electric
256,778
215,341
275,000
275,000
0.00%
Inside Charges - Water
1,215
1,150
2,100
2,520
20.00%
Inside Charges - Sewer
-
-
210
252
20.00%
Inside Charges - Stormwater
4,188
4,568
888
4,600
418.02%
Total Operating
597,659
548,950
763,211
775,112
1.56%
Capital Outlay Other Imp
-
-
41,000
124,500
203.66%
Capital Outlay -Equipment
33,980
20,100
47,500
212,000
346.32%
Total Capital Outlay
33,980
20,100
88,500
336,500
280.23%
Principal&interest-bonds
1,278,681
1,259,307
1,442,434
1,422,179
0.00%
Total Debt Service
1,278,681
1,259,307
1,442,434
1,422,179
-1.40%
Total Third Creek
$ 2,459,699
$ 2,320,231
$ 2,825,372
$ 3,138,042
11.07%
Page158

WATER AND SEWER FUND
PUBLIC UTILITIES - FOURTH CREEK
Original
Adopted
Actual
Actual
Budget
Budget
%
2019-20
2020-21
2021-22
2022-23
Change
Salaries -Permanent
$ 587,174
$ 619,044
$ 640,799
$ 769,457
20.08%
Salaries -Overtime
29,837
31,130
30,000
35,000
16.67%
Salaries -Temporary
-
-
-
- -
N/A
Salaries -Longevity
300
300
300
-
N/A
FICA Expense
44,702
46,941
51,419
64,491
25.42%
Group Life
2,090
2,214
2,640
3,329
26.10%
Retirement
58,790
71,497
90,108
119,370
32.47%
Group Health
137,792
168,042
168,000
198,000
17.86%
Christmas Bonus
1,050
975
1,050
38,550
3571.43%
Total Personnel 861,735 940,143 984,316 1,228,197 24.78%
Professional Services
96,984
86,140
121,789
139,788
14.78%
Professional Services
-
-
2,000
2,000
0.00%
Professional Services - Legal
-
75,544
-
-
N/A
Gasoline
4,487
4,321
10,166
13,216
30.00%
Diesel Fuel
21,524
14,078
34,047
44,261
30.00%
Communications
12,513
8,472
25,240
30,288
20.00%
IT -Communications
1,242
1,264
1,358
-
N/A
Utilities
20,047
31,120
32,000
32,000
0.00%
Travel and Training
2,811
55
7,525
7,525
0.00%
Maint and Repair- Bldgs & Grnds
30,468
56,486
50,000
50,000
0.00%
Maint and Repair- Equipment
135,729
81,412
135,000
135,000
0.00%
Maint and Repair -Auto &Truck
8,674
7,045
10,000
10,000
0.00%
Hand Tools
569
816
1,000
1,200
20.00%
Supplies -General
3,389
12,849
4,800
5,000
4.17%
Supplies -Janitorial
2,384
3,544
4,000
4,000
0.00%
Supplies -Chemical
76,430
57,611
105,000
112,150
6.81%
Supplies -Materials
1,330
579
1,400
1,400
0.00%
Supplies -Laboratory
21,969
27,242
38,000
45,000
18.42%
Supplies -Kiln Dust
50,990
39,007
80,525
76,500
-5.00%
Non -Depreciable
25,145
4,192
-
-
N/A
IT- Non -Depreciable
-
1,845
5,550
-
N/A
Uniforms
2,325
2,901
4,250
4,250
0.00%
Reimbursements
816,524
986,600
805,107
844,520
4.90%
Contracted Serv-General
157,240
115,675
132,450
141,421
6.77%
Tipping Fees
1,469
1,470
1,500
1,460
-2.67%
Dues & Subscriptions
8,610
11,303
9,437
9,437
0.00%
Insurance & Bonds
37,907
41,698
45,500
51,000
12.09%
Miscellaneous Expense
1,374
-
100
100
0.00%
OSHA - Safety
8,489
10,048
19,954
11,454
-42.60%
Inside Charges - Electric
347,668
331,943
334,840
334,840
0.00%
Inside Charges -Water
3,417
2,460
5,800
6,960
20.00%
Inside Charges - Stormwater
6,256
6,824
6,119
6,119
0.00%
Bad Debt Expense
35,260
29,240
-
-
N/A
Computer Software
-
-
1,000
1,000
0.00%
Total Operating
1,943,224
2,053,784
2,035,457
2,121,889
4.25%
Page160

WATER AND SEWER FUND
PUBLIC UTILITIES - FOURTH CREEK
Original
Adopted
Actual
Actual
Budget
Budget
%
2019-20
2020-21
2021-22
2022-23
Change
Capital Outlay Other Imp
-
-
60,000
134,800
124.67%
Capital Outlay -Equipment
623,714
415,158
360,000
1,514,000
320.56%
Total Capital Outlay
623,714
415,158
420,000
1,648,800
292.57%
Principal&Interest Payments
222,299
222,299
222,299
422,299
89.97%
Total Debt Service
222,299
222,299
222,299
422,299
89.97%
Internal Pilot
220,654
239,217
228,288
228,288
0.00%
Total Transfer
220,654
239,217
228,288
228,288
0.00%
Total Fourth Creek
$ 3,871,626
$ 3,870,601
$ 3,890,360
$ 5,649,473
45.22%
Page 161

RECEIVED
JUL 0 3 2023
NCDEQ/DWR/NPDES
Enclosure 5
CSA 04-16 Section V.6
Capital Improvement Plan

Capital Improvement Plan (Sewer Collection Svstem)
SCADA Lift Stations 0
562,700
0
0
0
0
-
-
TOTAL.
IMPACT
562,700
Sewer maintenance projects
250,000
250,000
250,000
250,000
250,000
250,000
250,000
250,000
250,000
250,000
250,000
2,750,000
Lift station emergent requirements
72,100
74,263
76,490
78,785
81,150
83,600
-
-
-
466,388
Arey Road 3rd Ck Trunk Sewer
150,000
0
0
0
1,500,000
0
-
-
1,650,000
Lift station emergent requirements
72,100
77,750
84,000
90,000
97,000
104,000
110,000
113,000
119,000
123,000
128,000
1,117,850
Upsize Exit 54 Swr Extn to Jennings Pk
550,000
0
0
0
0
0
-
-
-
-
550,000
Interstate Lift Station
1 0
1 200,000
1 0
1 0
1 0
0
1
1
1
1
1
1 200,000
SCADA Integraton (Lift Stations)
0
650,000
0
0
0
0
-
-
-
-
650,000
Exit 45 Sewer Expansion
0
0
3,485,000
0
0
0
3,485,000
Third Creek Gravity Sewer
0
400,000
0
5,100,000
0
0
5,500,000
Totals:
$2,517,200
$14 100,713
$4 270,490
$6 843,785
$2,553,150
$762,600
$360,000
$363,000
$369,000
$373,000
$378 000
$32 890,938

Enclosure 6
CSA 04-16 Section VI.2
Response Action Plan

CITY of
tat e
PUBLIC UTILITIES
P. O. Box 1111, Statesville, NC 28687-1111
Assistant City Manager/City Engineer
Public Works Director
Public Utilities Director
Office Manager
City of Statesville
Sanitary Sewer Overflow Response Plan
June, 2023
Reference: NC GS 143-215.1C
704 878-3551
704 878-3552
704 761-2383
704 878-3567
Introduction. In accordance with North Carolina General Statutes (reference) and system
permit operating requirments, the following plan addresses sanitary sewer overflows
(SSO) events associated with the operation of the City of Statesville permitted sanitary
sewer collection system (permit WQCS00030) and operation of two wastewater
treatment facilities (permits NCO020591 and NC0031836). The purpose of the Sanitary
Sewer Overflow Response Plan is to protect the citizens of the City of Statesville, North
Carolina and the environment by establishing written procedures for responding to SSOs.
This plan applies to all Public Utilities Department personnel that in the course of their
work may deal with SSOs. These procedures will be reviewed at least semi-annually, or
whenever revised guidance from County, State or Federal authorities dictate a revision is
necessary.
2. Plan of Action.
i. Upon discovery of an SSO, Water/Sewer Division or treatment plant personnel will
respond and make an immediate assessment. If an overflow has occurred, the
Water/Sewer Maintenance Superintendent or Public Utililies Department Operations
Manager, as applicable, will be notified.
ii. The Water/Sewer Maintenance Superintendent (or Public Utilities Department
Operations Manager for treatment plants) will determine what course of action is
required to stop the overflow and clean up the site. Appendix A contains SSO Initial
Response Procedures.
(1) NC DEQ provides a spill volume estimating guide at the following web
site:
https://www.deq.nc.gov/water-quality/surface-water-protection/peres/wcs-
sso-documents/ssoflowestimationguiderevi/download
iii. The Water/Sewer Maintenance Superintendent or Public Utilities Department
Operatons Manager will make a record of all events and will coordinate reporting

with the Public Utilities Departement Director and the Public Information Officer as
necessary.
iv. Reporting. Reporting requirements are as followv
(1) Per NC GS 143-215.1C.(al), any discharge of 1,000 gallons or more of
untreated wastewater discharged to the surface waters of the State must be
reported to NC DEQ as soon as practicable, but no later than 24 hours
after determination that a discharge has reached the surface waters of the
State.
(2) Per system operating permit requirements (WQCS00030 permit), any SSO
and/or spill over 1,000 gallons to the ground, or any SSO and/or spill,
regardless of volume, that reaches surface waters, must be reported.
(3) Telephonic reporting. Upon detemination that a reportable spill has
occurred, the NC DEQ Mooresville Regional Office will be notified
immediately, but in no case more than 24 hours from the time of the spill
was discovered. The telephone number for the Mooresville Regional
Office is [phone]. If unable to contact the Regional Office, report
the spill to the State Division of Emergency Management 24-hour number
at 1-800-858-0638.
(4) Public notification. In the event of a discharge of 1,000 gallons or more of
untreated wastewater to the surface waters of the State, a press release to
all print and electronic news media that provide general coverage in
Iredell County setting out the details of the discharge will be made. The
press release will be within 24 hours after the determination that a
discharge has reached the surface waters. AppendixZ'contains guidance G
on immediate (24 hour) and, as necessary, extended public notification
requirements.
(5) Written reporting. NC DEQ Form CS-SSO (Appendix B) will be
submitted withing five business days of first knowledge of the SSO.
Alternatively, SSO electronic reporting is available. Guidance is at the
following website:
https://www.deq.nc.gov/about/divisions/water-resources/water-quality-
permitting/municipal-npdes-pretreatment-and-collection-
system/collection-systems/information-sewer-system-overflows
3. Emergency Response Equipment. Appendix D describes equipment available for
emergency spill response.
4. Records.

a. Records pertaining to SSOs will be maintained for a minimum of three
years in accordance with the system operating permit requirements.
b. Maintenance Records. The Water/Sewer Division keeps daily work
reports on routine work requirements such as rodding, grease and root
problems, flow monitoring, TV inspection and outfall mowing and
inspection. Maintenance records will be annotated to indicated SSO repair
activities for data retrieval.

APPENDIX A
SSO Initial Response Procedures
1. Determine source of the SSO.
a. Contact caller and get info on spill; location, start time, etc.
b. Determine if spill caused by blockage, equipment failure, or damage to sewer
system.
2. Take action to stop the SSO.
a. Locate the point of discharge.
b. Determine cause of spill.
c. Develop plan of attack to and take action necessary to stop the SSO.
d. If necessary, call out enough personnel to control spill.
3. Take action to contain spill.
a. Determine extent of spill and containment necessary.
b. Block all entry points to storm drains, creeks, lakes, or any other access to waters
of the state.
c. If necessary, use pneumatic plugs to block storm drain system and prevent spill
from traveling any further in the storm drain system.
d. Use vac -truck to rinse and clean storm drain system, channels, etc. and return
captured sewage to the sanitary sewer system.
e. Decontaminate site (e.g., lime on ground) to maximum extent possible.
4. Document Activity.
a. Estimate volume of spill.
b. Determine percentage of spill recovered.
c. It is important to take photos throughout the response process to document the
event. Photograph any evidence of spill volume, extent or severity.
5. Report.
a. Fill out the Collection System Sanitary System Overflow Reporting Form (NC
DEQ CS -SS) as completely as possible.
b. Notify Wastewater Collections System Supervisor of spill and any mitigation
activities taken.
c. Per NC GS 143-215.1C.(al), any discharge of 1,000 gallons or more of
untreated wastewater to the surface waters of the State must be reported to
NC DEQ as soon as practicable, but no later than 24 hours after
determination that a discharge has reached the surface waters of the State.

d. Water/Sewer Maintenance Superintendent or Public Utilities Department
Operations Manager (for treatment plants), report using on-line reporting system.

Appendix B
Collection System Sanitary Sewer Overflow Reporting Form Form CS-SSO

RECEIVED State of North Carolina
Department of Environment and Natural Resources
DWRDivision of Water Resources
U o Collection System Sanitary Sewer Overflow Reporting Form
Division of Water Resources Form CS-SSO
PART I: y���, fa ,.ja1 o^
This form shall be submitted°Y#I �pf�a4�iste r�a1J Es
within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: (WQCS# if active, otherwise use WQCSD#)
Facility: Incident #: Owner:
Region: City: County:
Source of SSO (check applicable): ❑ Sanitary Sewer ❑ Pump Station / Lift Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump
Station 6, Manhole at Westall & Bragg Street, etc.):
Manhole #:
Latitude (degrees/minute/second): Longitude (degrees/minute/second):
Incident Started Dt: Time: Incident End Dt: Time:
(mm-dd-yyyy) (hh:mm) AM/PM (mm-dd-yyyy) (hh:mm) AM/PM
Estimated volume of the SSO: gallons Estimated Duration (round to nearest hour): hour(s)
Describe how the volume was determined:
Weather conditions during the SSO event:
Did the SSO reach surface waters? ❑ Yes ❑ No ❑ Unknown
Volume reaching surface waters: gallons Surface water name:
Did the SSO result in a fish kill? ❑ Yes ❑ No ❑ Unknown
If Yes, what is the estimated number of fish killed?
SPECIFIC cause(s) of the SSO:
❑Severe Natural Conditions ❑ Grease
❑Pump Station Equipment Failure ❑ Power Outage
❑Other (Please explain in Part II)
❑Roots ❑Inflow & Infiltration
❑Vandalism ❑ Debris in line ❑Pipe Failure (Break)
24-hour verbal notification (name of person contacted):
❑DWR ❑Emergency Management Date (mm-dd-yyy): Time: (hh:mm AM/PM):
Per G.S. 143-215.1 C(b), the owner or operator of any wastewater collection system shall:
In the event of a discharge of 1,000 gallons or more of untreated wastewater to the surface waters of the State, issue
a press release to all print and electronic news media that provide general coverage in the county where the
discharge occurred setting out the details of the discharge. The press release shall be issued within 24 hours after
the owner or operator has determined that the discharge has reached surface waters of the State.
In the event of a discharge of 15,000 gallons or more of untreated wastewater to the surface waters of the State,
publish a notice of the discharge in a newspaper having general circulation in the county in which the discharge
occurs and in each county downstream from the point of discharge that is significantly affected by the discharge. The
Regional Office shall determine which counties are significantly affected by the discharge and shall approve the form
and content of the notice and the newspapers in which the notice is published.
WHETHER OF NOT PART II IS COMPLETED, A SIGNATURE IS REQUIRED SEE PAGE 13
Form CS-SSO Page I

In order to submit a claim for justification of an SSO, you must use Part II of form CS-SSO with additional documentation as
necessary. DWR staff will review the justification claim and determine if enforcement action is appropriate.
PART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS
IS HAS BEEN SUBMITTED ELECTRONICALLY THROUGH THE ONLINE REPORTING SYSTEM
Form CS-SSO Page 2

Severe Natural Conditions (hurricane, tornado, etc.)
Describe the "severe natural condition" in detail:
How much advance warning did you have and what actions were taken in preparation for the event?
Comments:
Form CS-SSO Page 3

Grease (Documentation such as cleaning inspection enforcement actions, past overflow reports, educational
material and distribution date, etc. should be available upon request.)
When was the last time this specific line (or wet well) was cleaned?
Do you have an enforceable grease ordinance that requires new or retrofit of
grease traps/interceptors? ❑ Yes ❑ No ❑ NA ❑ NE
Have there been recent inspection and/or enforcement actions taken on near-
by restaurants or other nonresidential grease contributors? ❑ Yes ❑ No ❑NA ❑ NE
Explain:
Have there been other SSOs or blockages in this areas that were also caused
by grease ❑ Yes ❑ No ❑NA ❑ NE
When?
If yes, describe them:
Have cleaning and inspections ever been done at this location?
Explain.
Have educational material about grease been distributed in the past?
When:
and to whom:
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
Explain:
If the SSO occurred at a pump station, when was the wet well and pumps last checked
for grease accumulation:
Were the floats clean? ❑ Yes ❑ No ❑NA ❑ NE
Comments:
Form CS-SSO Page 4

Roots
Do you have an active root control program on the line / area in question? ❑ Yes ❑ No ❑NA ❑ NE
Describe:
Have cleaning and inspections ever been increased at this location because
of roots? ❑ Yes ❑ No ❑NA ❑ NE
Explain:
What corrective actions have been accomplished at the SSO location (and
surrounding system if associated with the SSO)?
What corrective actions are planned at the SSO location to reduce root intrusion?
Has the line been smoke tested or videoed within the past year? ❑ Yes ❑ No ❑NA ❑ NE
If Yes, when?
Comments:
RECEIVED
JUL 0 31023
NCDEQ/DWR/NPDES
Form CS-SSO Page 5

Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule
❑ Yes
❑ No
DNA ❑ NE
in any permit that addresses 1/1?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflows this spill location
within the last year?
Has there been any flow studies to determine 1/1 problems in the
❑ Yes
❑ No
❑NA ❑ NE
collection system at the SSO location?
If Yes, when was the study completed and what actions did it recommend?
Has the line been smoke tested or videoed within the past year?
❑ Yes
❑ No
DNA ❑ NE
If Yes, when and what actions are necessary and the status of such actions:
Are there 1/1 related projects in your Capital Improvement Plan?
❑ Yes
❑ No
❑NA ❑ NE
If Yes, explain:
Have there been any grant or loan applications for 1/1 reduction projects?
❑ Yes
❑ No
DNA ❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections
❑ Yes
❑ No
❑NA ❑ NE
with storm sewers?
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream
❑ Yes
❑ No
❑NA ❑ NE
been inspected recently?
If Yes, explain:
What other corrective actions are planned to prevent future 1/1 related SSOs at
this location?
Comments:
Form CS-SSO Page 6

Pump Station Equipment Failure (Documentation of testing records etc should be provided upon request)
What kind of notification/alarm systems are present?
Auto-dialer/telemetry (one-way communication) ❑ Yes
Audible ❑ Yes
Visual ❑ Yes
SCADA (two-way communication) ❑ Yes
Emergency Contact Signage ❑ Yes
Other ❑ Yes
If Yes, explain:
Describe the equipment that failed:
What kind of situations trigger an alarm condition at this station (i.e. pump failure, power failure, high water, etc.)?
Were notification/alarm systems operable? ❑ Yes ❑ No ❑NA ❑ NE
In no, explain:
If a pump failed, when was the last maintenance and/or inspection performed?
What specifically was checked/maintained?
If a valve failed, when was it last exercised?
Were all pumps set to alternate?
❑ Yes ❑ No ❑NA ❑ NE
Did any pump show above normal run times prior to and during the SSO event? ❑ Yes ❑ No ❑NA ❑ NE
Were adequate spare parts on hand to fix the equipment
Was a spare or portable pump immediately available?
If a float problem, when were the floats last tested? How?
If an auto -dialer or SCADA, when was the system last tested? How?
Comments:
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
Form CS-SSO Page 7

Power outage (Documentation of testing, records, tec., should be provided of alternative power source upon
request.)
What is your alternate power or pumping source?
Did it function properly? ❑ Yes ❑ No ❑NA ❑ NE
Describe?
When was the alternate power or pumping source last tested under load?
If caused by a weather event, how much advance warning did you have and what actions were taken to prepare for the
event?
Comments:
Form CS-SSO Page 8

Vandalism
Provide police report number:
Was the site secured? ❑ Yes ❑ No
If Yes, how?
Have there been previous problems with vandalism at the SSO location?
If Yes, explain:
What security measures have been put in place to prevent similar ❑ Yes ❑ No
occurrences in the future?
Comments:
❑ NA
❑ NA
❑ NE
❑ NE
Form CS-SSO Page 9

Debris in line (Rocks, sticks, rags and other items not allowed in the collection system etc.)
What type of debris has been found in the line?
Suspected cause or source of debris:
Are manholes in the area secure and intact? ❑ Yes ❑ No ❑NA ❑ NE
When was the area last checked/cleaned?
Have cleaning and inspections ever been increased at this location ❑ Yes ❑ No ❑NA ❑ NE
due to previous problems with debris?
Explain:
Are appropriate educational materials being developed and distributed ❑ Yes ❑ No ❑NA ❑ NE
to prevent future similar occurrences?
Comments:
RECEIVED
JUL 0 3 2023
NCDEQ/DWR/NPDES
Form CS-SSO Page 10

Other (Pictures and police report, as applicable, must be available upon request.)
Describe:
Were adequate equipment and resources available to fix the problem?
If Yes, explain:
If the problem could not be immediately repaired, what actions
were taken to lessen the impact of the SSO?
Comments:
❑ Yes ❑ No ❑NA
❑ Yes ❑ No ❑NA
❑ NE
❑ NE
Form CS-SSO Page I I

Pipe Failure (Break)
Pipe size (inches)
What is the pipe material
What is the approximate age of the line/ pipe (years old)
Is this a gravity line?
Is this a force main line?
Is the line a "High Priority" line?
Last inspection date and findings
If a force main then,
Was the break on the force main vertical?
Was the break on the force main horizontal?
Was the leak at the joint due to gasket failure ?
Was the leak at the joint due to split bell?
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes ❑ No ❑NA ❑ NE
❑ Yes
❑ No
❑NA
❑ NE
❑ Yes
❑ No
❑NA
❑ NE
❑ Yes
❑ No
❑NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
When was the last inspection or test of the nearest air -release valve to determine if operable?
When was the last maintenance of the air release performed?
If gravity sewer then,
Does the line receive flow from a force main immediately upstream ❑ Yes ❑ No [:]NA ❑ NE
of the failed section of pipe?
If yes, what measures are taken to control the hydrogen sulfide production?
When was the line last inspected or videoed?
If line collapsed, what is the condition of the line up and down stream of the failure?
What type of repair was made?
If temporary, when is the permanent repair planned?
Have there been other failures of this line in the past five years? ❑ Yes ❑ No ❑NA ❑ NE
If so, then describe
Form CS-SSO Page 12

System Visitation
ORC ❑ Yes
Backup ❑ Yes
Name:
Certification Number:
Date visited:
Time visited:
How was the SSO remediated (i./e. Stopped and cleaned up)?
As a representative for the responsible party, I certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim:
Signature:
Telephone Number:
Title:
Date:
Any additional information desired to be submitted should be sent to the appropriate Division Regional Office within five
business days of first knowledge of the SSO with reference to the incident number (the incident number is only generated
when electronic entry of this form is completed, if used).
Form CS-SSO Page 13

Appendix C
Public Notification of Discharge of Untreated Waste
Reference: NC GS 143-215.1 C (b)
In the event of a discharge of 1,000 gallons or more of untreated waste to the surface
waters of the State, issue a press release to all print and electronic news media that
provide general coverage in the county where the discharge occurred setting out the
details of the discharge. The press release will be issued within 24 hours after the
determination is made that a discharge has reached the surface waters of the State. A
copy of the press release and a list of the news media to which it was distributed will
be retained for at least one year after the discharge. A copy of the press release and the
list of the news media to which it was distributed will be provided to any person upon
request.
In the event of a discharge of 15,000 gallons or more of untreated waste to the surface
waters of the State, a notice of the discharge will be published in a newspaper having
general circulation in Iredell County and, as determined by the NC Department of
Environmental Quality Secretary, each county downstream from the point of
discharge that is significantly affected by the discharge. The Secretary shall
determine, at the Secretary's sole discretion, which counties are significantly affected
by the discharge and shall approve the form and content of the notice and the
newspapers in which the notice is to be published. The notice shall be captioned
"NOTICE OF DISCHARGE OF UNTREATED WASTE". The notice will be
published within 10 days after the Secretary has determined the counties that are
significantly affected by the discharge and approved the form and content of the
notice and the newspapers in which the notice is to be published. Acopy of the notice
and proof of publication will be filed with the Department of Environmental Quality
within 30 days after the notice is published. Publication of a notice of is in addition to
the requirement to issue a press release.

Appendix Cl
Press Release (1,000 to 14,999 gallons)
Notification of of Discharge of Untreated Wastewater.
NC General Statute 143-215.0 requires that the owner or operator of any wastewater collection
or treatment works iss a press release when an untreated wastewater discharge of 1,000 gallons
or more reaches surfact waters.
In accordance with regulation, the following news release has been prepared and issued to the
affected county (ies):
The City of Statesville had a discharge of untreated wastewater on of an estimated
gallons at (insert description of location). The untreated wastewater was discharged
into (insert name of receiving stream, e.g.. unnamed tibributory to Creek in the S. Yadkin
River Basin, Creek in the S. Yadin River Basin, etc.).
The NC Division of Water Resources was notified of the event on and is reviewing the
matter. For more information, contact the City of Statesville at [phone].
RECEIVED
JUL 0 3 2023
NCDEQ/DWR/NPDES

Appendix C2
Public Notice (greater than 15,000 gallons)
NOTICE OF DISCHARGE OF UNTREATED SEWAGE
The City of Statesville had a discharge of untreated wastewater from its (enter collection system,
treatment facilty, pump station as applicable) located at (insert location) of approximately
gallons. The discharge occurred on for approximately hours. The
untreated wastewater entered (insert name of receiving stream, e.g.. unnamed tibributory to
Creek in the S. Yadkin River Basin, Creek in the S. Yadin River Basin, etc.). The
(insert system component, e.g. pipe, manhole, pump station, treatment plant appurtenance, etc.)
was repaird and placed by into service to prevent further discharge. This notice is required by
NC General Statute Article 21, Chapter 143.215C. For more information contact ,
Public Information Office at [phone].
Note: the Public Notice is in addition to the initial press releass.

Appendix D
Emergency Response Equipment
(June, 2023)
Equipment
Location
Vac All Flushing Truck
Municipal Warehouse
Vac All Combination Unit
Municipal Warehouse
Model 444 Flexible Rodding
Machine
Municipal Warehouse
4-inch Trash Pump (2)
Municipal Warehouse
3-inch Mud Hog Pumps (3)
Municipal Warehouse
2 MGD pump, 8-in discharge &
suction
Third Creek WWTP
Camera Van
Municipal Warehouse
4-wheel drive tractor will bushhog
Municipal Warehouse
Backhoe
Municipal Warehouse
John Deere Loader
Municipal Warehouse
Rubber Tire Loader
Municipal Warehouse
Motor Grader
Municipal Warehouse
Easement Track Machine
Municipal Warehouse
Vac Ram 2000 Vac Trailer
Municipal Warehouse

Enclosure 7
CSA 04-16 Section VIA
Contingency Plan

PUBLIC UTILITIES
P. 0. Box 1111, Statesville, NC 28687-1111
MEMORANDUM
Assistant City Manager/City Engineer
Public Works Director
Public Utilities Director
Office Manager
27 June 2023
Subject: Pump Station Contingency Plan (3rd Creek WWTP)
Third Creek Pumv Stations
Pump Station
Phone
704-871-1415
-Airport
Barkley Rd.
704-872-2193
Industrial Dr.
704-872-2170
Interstate Equipment
704-872-2191
Dr.
704-871-1496
-Kennedy
Newton Drive
704-872-2158
Park Dr.
704-872-2099
Pine Forest
704-873-2923
Wildewood
704-872-5518
Giant Oak
877-991-1911
Emergency Contacts
704 878-3551
704 878-3552
704 761-2383
704 878-3562
Call Sequence
Name
Phone
Cell
1
Mike Fanton
716-904-0883
704-437-1202
2
Scott Austin
704-878-8796
704-437-2668
3
Steve Littlejohn
907-250-1208
704-437-2213
4
Andy Smith
704-402-9315
1 704-437-6288
Notes:
1. If you receive a call from a lift station, call the plant responsible for the station and
let them know which station called. If you cannot reach the plant, call the
supervisor of the plant.
Wm E. Vaughan, PE
Public Utilities Director

CITY of �`
CStat e
PUBLIC UTILITIES
P. O. Box 1111, Statesville, NC 28687-1111
MEMORANDUM
Assistant City Manager/City Engineer
Public Works Director
Public Utilities Director
Office Manager
27 June 2023
Subject: Pump Station Contingency Plan (4t' Creek WWTP)
Notes:
Fourth Creek Pump Stations
Pump Station
Phone
Commerce Blvd. ASMO
704-872-2270
Davis Hospital
704-873-3540
Hatfield Rd.
704-872-2197
Maijorie Rd.
704-878-2890
Statesville Business Park
704-878-3403
Valley Stream
704-872-6963
Fifth Creek
704-876-9018
Mitchell Farm
704-876-1255
Deer Ride
704-873-7647
Ern er enc Contacts
704 878-3551
704 878-3552
704 761-2383
704 878-3562
Call Sequence
Name
Phone
Cell
1
Seth Dufalt
704-495-7552
704-437-1203
2
Ken Galloway
828-308-5113
704-437-2792
3
Steve Little'ohn
907-250-1208
704-437-2213
4
Andy Smith
704-402-9315
704-437-6288
1. If you receive a call from a lift station, call the plant responsible for the station and
let them know which station called. If you cannot reach the plant, call the
superor of the plant.
2. When Dvisavis hospital lift station calls, it identifies itself as Station 1: it will
continue to call until it is reset. Press "9" to acknowledge the signal or call the
station back at 704-873-3540.
Wm E. Vaughan, PE
Public Utilities Director

Enclosure 8
CSA 04-16 Section VI.6
Comprehensive Collection System Map

Enclosure 9
City of Statesville and Town of Troutman
Wastewater Agreement (28Dec98) and Amendment
(17Nov08)
RECEIVED
JUL 0 3 2023
NCDEQIDWR/NPDES

STATE OF NORTH CAROLINA
COUNTY OF IREDELL
INTERLOCAL AGREEMENT BETWEEN
CITY OF STATESVILLE AND TOWN OF TROUTMAN
THIS AGREEMENT, made and entered into this the / day of November,
2008, by and between the City of Statesville, North Carolina, a municipal corporation
hereinafter referred to as "Statesville" and the Town of Troutman, North Carolina, a
municipal corporation hereinafter referred to as 'Troutman".
WITNESSETH:
WHEREAS, Statesville and Troutman entered into an agreement on December
28, 1998 whereby Statesville agreed to make available to Troutman a maximum amount
of 455,000 gallons per day of discharge treatment at Statesville's Third Creek
Wastewater Treatment Plant; and
WHEREAS, Statesville and Troutman wish to amend that agreement; and
WHEREAS, a dispute has arisen regarding the accuracy of meter readings taken
at Troutman's initial wastewater metering point at the Third Creek Plant; and
WHEREAS, Statesville and Troutman wish to resolve that dispute; and
WHEREAS, Statesville's Third Creek Wastewater Treatment Plant is now
undergoing an expansion; and
WHEREAS, the municipalities of Mooresville, Statesville, and Troutman entered
into a joint annexation boundary agreement in accordance with NCGS 160A-58.23 on
the 19'h day of March, 2007, and further amended it on the 18'' day of June, 2007; and
WHEREAS, the March 5, 2007 boundary agreement between Troutman and
Statesville included an area known as an "area of owner's choice'; and
WHEREAS, Statesville and Troutman wish to amend the annexation boundary
agreement by redefining the boundaries within the area of "Owner's Choice'.
NOW, THEREFORE, in consideration of the mutual covenants, terms, and
conditions herein, Statesville and Troutman mutually agree as follows:
1. The dispute involving sewer flow water inaccuracies of the Third Creek metering
point shall be settled by Statesville providing and reserving for Troutman an

additional capacity for the treatment of 21,428 gallons per day (hereinafter "gpd")
of sewer capacity in the expanded Third Creek Wastewater Treatment Plant.
Troutman shall not pay to Statesville any money for the reservation of this
additional capacity. However, as Troutman utilizes this additional capacity, it shall
pay to Statesville its customary rates for such usage. The granting of this
additional sewer capacity by Statesville to Troutman at no charge is made in full
and final settlement of Troutman's claims against Statesville arising out of the
alleged sewer flow meter inaccuracies at the Third Creek Metering point.
Troutman's right to this additional capacity shall be permanent. Troutman may
begin to utilize this additional capacity upon the completion of the Plants
expansion, and upon Troutman's submitting to Statesville a written request
therefor.
2. The formula for determining Troutman's sewer rate outlined in Exhibit A of the
Wastewater Agreement adopted on December 28, 1998 is hereby superseded by
the following:
"The sewer rate charged by Statesville to Troutman shall be
Statesville's inside rate minus collection system costs of
12%. At such time as Troutman connects to Statesville's
collection system Troutman shall pay Statesville's inside
sewer rate for the waste water that flows to the Third Creek
Plant only through the Statesville collection system."
3. The wastewater rate charged to Troutman. will be adjusted at the same time as it
is adjusted to Statesville's other customers, after notice to Troutman of the
proposed increase.
4. Wastewater flow will continue to be monitored and metered by Troutman and
inspected by Statesville through Troutman's metering station location at the IL
Creek Pump Station. Troutman shall present Statesville with any claims arising
out of the alleged malfunctioning of meters within ninety (90) days of Troutman's
having knowledge of such alleged malfunctioning.
5_ Troutman shall bear the cost of any new points of wastewater delivery and
wastewater metering points to the Statesville collection system. Statesville
reserves the right to approve the location, design, and inspect the progress of
construction and operation of such points of delivery.
6. Section C. GUARANTEED CAPACITY of the 1998 Wastewater Agreement is
amended and supersedes that agreement as follows:
A. Subject to the limitations and conditions set forth herein, Statesville agrees
to accept in the Statesville expanded wastewater system from Troutman
when needed or desired, such maximum flows allocated herein. The
maximum amount of wastewater to be discharged from the Town of

Troutman to Statesville after completion of the plant's expansion shall be
705,000 gpd of daily flow subject to the limitations stated in Paragraph B
below.
B. In addition to the 455,000 gpd of capacity already granted to Troutman in
the December 28, 1998 agreement, Statesville agrees to provide to
Troutman in minimal increments of 25,000 gpd, up to an additional
250,000 gpd from the capacity at the expanded Third Creek Wastewater
Treatment Plant. This allocation of additional capacity includes the 21,428
gpd allotment provided to Troutman as set forth in Paragraph #1 above.
The additional wastewater available for purchase by Troutman is 228,572
gpd. The right to purchase expires when the expanded Third Creek
Wastewater Treatment Plant reaches 70% of its allocated capacity flow.
Statesville shall notify Troutman when the expanded Third Creek
Wastewater Treatment Plant reaches 50% of its rated flow.
The cost of the 25,000 gpd increments shall be determined on the
date of completion of the construction of the Third Creek Wastewater
Treatment Plant expansion, and shall be established by dividing total
project cost (including but not limited to, design, bidding, contract
administration, debt service, finance and capital construction cost) by
increased gallons of capacity. This purchase price shall be adjusted
annually by the Consumer Price Index (CPI) for cities of 50,000 people
and in no event shall it decrease below the initial computed price. This
250,000 gpd offer of capacity fulfills Statesville's obligations to provide
additional treatment capacity outlined in its agreement with Troutman
dated December 28, 1998.
7. Troutman and Statesville agree to amend the Boundary Agreement approved on
March 19, 2007, between Mooresville, Troutman, and Statesville as shown on
Attachment B and the attached Map labeled "Proposed Boundary Agreement
between the City of Statesville and the Town of Troutman Revised October 22,
2008," pursuant to the provisions of NCGS 160A-58.23 and to work with
Mooresville as necessary, to implement such amendment.
S. The existing pond marked "Retention Pond" on the attached Map shall be made
available to owners within its drainage basin as an area for storm water retention
and planning in accordance with the standards of Best Management Practices
adopted by DENR. Such rights do not prohibit the property owner from seeking
compensation for the perpetual maintenance of the pond as a retention basin
should it be used as such.
9. Statesville shall continue to provide potable drinking water to Troutman at its
inside rates subject to (after notice) any water restrictions which Statesville may
impose from time to time on its own users. At such time as Statesville's water
plant reaches 80% of its rated capacity, Troutman's right to purchase additional

water shall terminate. Water will be metered and the meter maintained by
Statesville at its Barium Springs pump station.
10. Statesville may allow additional metering points for potable water distribution to
Troutman on the West side of Exit 45 and on the West side of Wallace Springs
Road when requested by Troutman. Such metering points shall be designed and
constructed solely at the Town of Troutman's expense. The City of Statesville
shall have the right to approve the design and inspect the construction and
maintenance of such point of delivery.
11. The Town of Troutman, in conjunction with Statesville, shall adopt one of two
alternatives for improving Murdock Road from its intersection with Old Murdock
Road to its intersection with Old Mountain Road as part of a regional
thoroughfare to carry traffic from Exit 45 of 1-77 to the Statesville Regional
Airport.
12. Troutman and Statesville agree to support one anther's efforts in the future
realignment of Murdock Road in the vicinity of the "So curves at Duck Creek
Road as presented on "proposed Boundary Agreement" between the City of
Statesville and the Town of Troutman in the Area Discussion revised October 17,
2008 map. Presently there are two proposed alternatives, but Troutman and
Statesville acknowledge that the North Carolina DOT would have final say about
any realignment of this road which will serve as a regional thoroughfare to cant'
traffic from Exit 45 off Interstate 77 to the Statesville Regional Airport. Once the
project is placed by the NCDOT on its Transportation Improvement Plan,
Troutman and Statesville will so designate the realignment on any
comprehensive transportation plans that either municipality might have.
Troutman and Statesville agree to require any subsequent developer to allocate
sufficient right of way for the proposed realignment realizing that any final
decisions would be within the jurisdiction of the NC DOT. Both municipalities will
continue to work cooperatively to see that this project is completed.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed in duplicate originals in their respective names by their respective Mayors and
attended by their Manager and/or Clerk and their corporate seals hereto affixed, all
pursuant to Resolutions duly adopted by their respective goveming boards.
ATTEST: CITY OF STATESVILLE
map d I ep-ac\A tJ
Mary Cr ddock, City Clerk Constantine H. Kutteh, Mayor

ATTEST
TOWN OF TROUTMAN
Elbert A. Richardson, Mayor

IV Admin. Of The Collection System Item No. 8 l3flP, 7—;ra_
STATE OF NORTH CAROLINA
COUNTY OF IREDELL
WASTEWATER AGREEMENT
BETWEEN
CITY OF STATESVILLE AND TOWN OF TROUTMAN
THIS AGREEMENT, made and entered into this day of
�L_=— , 1998, by and between the City of Statesville, North Carolina, a
municipal corporation hereinafter referred to as "Statesville" and the Town of
Troutman, North Carolina, a municipal corporation hereinafter referred to as
"Troutman".
WITNESSETH
THAT WHEREAS, Statesville owns, operates and maintains certain wastewater
collection and transmission lines and treatment plants within its service area; and
WHEREAS, Troutman desires to install certain wastewater collection and
transmission lines and appurtenant facilities into the wastewater system of Statesville for
transmission and treatment, and
WHEREAS, Statesville and Troutman desire to cooperate with each other to
provide wastewater service in their respective service area in the most cost effective and
practical manner possible.
WHEREAS, Chapter 23 of the Code of the City of Statesville, as amended,
provides the rules and regulations for any municipality desiring to discharge sewage
into the City of Statesville's sewage system.
NOW THEREFORE, in consideration of the mutual covenants, terms and
conditions hereto, Statesville and Troutman mutually agree,as follows:
A. GENERAL
1. Statesville will receive wastewater from Troutman at points of delivery
herein specified during the term of this Agreement or any renewal or
extension thereof, and will transport said wastewater for treatment in
quantities defined in this Agreement.
2. Statesville will furnish, install, operate and maintain adequate wastewater
transportation (i.e. collectors, force mains and pump stations) and
treatment systems to transport and treat wastewater quantities from the
Page 1

specified point(s) of delivery as specified herein from Troutman.
Statesville will be responsible for operations, maintenance and regulatory
compliance for the wastewater transportation system from the point(s) of
delivery specified herein to the wastewater treatment facility. Troutman
Will be responsible for operations, maintenance and regulatory
compliance for the wastewater transportation system upstream of the
Specified delivery point(s) including bypass and spill reporting
requirements. Troutman shall hold harmless, indemnify and defend
Statesville against any claims or regulatory actions arising from any
bypass or spill of wastewater within the Troutman system. Statesville
shall hold harmless, indemnify and defend Troutman against any claims
or regulatory actions arising from any bypass or spill of wastewater
within the Statesville system.
3. Statesville and Troutman shall exchange information with regard to their
long range wastewater planning and may conduct such planning
if such joint planning P g Jointly,
J P g is deemed mutually beneficial.
4. Troutman agrees that its wastewater, as delivered to the City
's
interceptor for treatment, shall not contain excessive amounts of
stormwater or surface drainage, as determined by Statesville. Troutman
further agrees to adopt and implement a program. to exclude such
stormwaters and surface drainage from its sanitary sewers, and such
program shall be subject to Statesville's approval on an annual basis as
long as said program is no more restrictive or demanding than
Statesville's own program. A copy of r Troutman' s
extraneous exclusions shall be program for such
provided to Statesville periodically as
revised. Troutman also agrees to provide to Statesville a copy of the
most recent sewer collection facilities map for the Town. Periodically,
at a minimum of five (5) years, the Town of Troutman shall provide
Updated versions of the Town's sewer collection facilities map to the
city.
3. Troutman shall continue infiltration and inflow (1/1) work in order to
minimize III contribution into its wastewater flow. Troutman shall
establish and conduct an appropriate ongoing I/1 program to identify and
correct collection system problems.
6. Statesville shall transmit and treat all wastewater discharged by
Troutman into Statesville's lines in accordance with this A
Provided, however, that Statesville shall not be liable for failcento
transmit and treat such wastewater in the event that such failure is caused
by circumstances over which Statesville has no control, including, but
not limited to, the following:
Page 2

(b) Theft, fire, vandalism, sabotage, criminal acts, or acts of
war;
(c) Strikes, equipment and/or electric failure or unavailability
of supplies; and
(d) Orders by the Government of the United States or the
State of North Carolina.
In the event that such failures occur, it is agreed that Troutman shall be
afforded the same rights and protection as any Statesville customer and
that Statesville shall exercise due diligence in providing for the repair,
replacement or other corrective actions as required to re-establish service
to the affected areas. These corrective actions may include the use of
temporary structures, equipment or facilities as deemed appropriate.
7. Nothing in this Agreement shall imply or contrive any ownership rights
by Troutman in any wastewater treatment facilities owned by Statesville.
Neither shall anything in the Agreement imply or contrive any ownership
rights by Statesville in any wastewater collection facilities owned by
Troutman.
8. This Agreement constitutes the sole Agreement between Statesville and
Troutman related to wastewater matters and may be amended from time
to time if the Parties so mutually agree to do so.
B. RIGHT OF STATESVILLE TO ACCESS TROUTMAN LINE
1. Statesville or customers of Statesville will be permitted by Troutman to
tap onto and access these lines being constructed by Troutman as a part
of this project, subject to Troutman's standard tap -on fees and user
availability fees.
2. Should Statesville or any of its customers access Troutman's lines, they
will be charged the same rates as charged by Troutman to its customers
inside the town limits of Troutman based upon the amount of wastewater
entering the Troutman lines.
3. Should Statesville or any of its customers access Troutman's lines, the
quantity of wastewater discharge produced by them shall not be charged
against the maximum amount of 455,000 gallons of discharge per day
being allocated to Troutman pursuant to this agreement. Troutman shall

have the responsibility of monitoring the amount of Statesville's
discharge into Troutman's system, subject to the right of Statesville to
have access to Troutman's meters and monitoring records.
4• Should Statesville or any of its customers access Troutman's lines, then
Statesville and its customers shall be responsible for any violation of
wastewater discharge requirements or regulations they may incur, and
shall defend, hold harmless and indemnify Troutman from any fine,
penalties, or other liability as the result of such violations.
C. GUARANTEED CAPACITY
1. Subject to the limitations and conditions set forth herein, Statesville
agrees to accept in the Statesville wastewater system from Troutman
when needed or desired, such maximum flows allocated herein. The
maximum amount of wastewater to be discharged from Troutman to
Statesville shall be 455.000 gallons per day of daily flow.
2. The daily flow is defined as wastewater flow measured on a daily basis
for a twenty-four (24) hour period from midnight to midnight. There
shall not be any instantaneous rate of wastewater discharge exceeding
three (3) times the maximum daily amount where instantaneous flow is
defined as the observed rate of flowat any given moment in time.
3. Troutman may acquire additional wastewater transportation and
treatment capacity from Statesville by mutual agreement, such capacity
to exist at the time of acquisition or to be provided by additional line
and/or treatment plant construction.
not to
unreasonably deny to Troutman additional treatment capacity swithin its
current WWTP, provided such additional wastewater capacity does not
jeopardize Statesville's ability to provide service to its then existing
service area and further provided under all circumstances Statesville at
all times retains no Iess than 30 % of the plant's capacity. Statesville and
Troutman shall begin negotiations to assess the availability of additional
capacity and identify alternatives when the average daily flow of
wastewater from Troutman reaches a sustained level of 0.318 mgd (70 %
of capacity). All cost sharing for the construction of any new facilities to
provide adequate capacity shall be determined at that time.
4• Statesville shall agree to provide letter of flow allocation for new
services and connections within thirty (30) calendar days from the date of
receipt of request from Troutman. Provided such flow allocations,
services and connections are in full compliance with the City of
Statesville's Sewer Use Ordinance (SUO) and the additional flow does
not cause Troutman to exceed its maximum daily flow allocation.
Page 4

Troutman shall provide Statesville information related to flows and
information to be provided to the North Carolina Department of
Environment and Natural Resources. In the case of new connections
Troutman will provide technical drawings and maps as part of such
request.
D. CHARACTER OF WASTEWATER FLOW
1. Troutman shall not discharge or allow to be discharged into Statesville's
wastewater system any wastewater not in compliance with the sewer use
ordinances and pretreatment programs of Statesville as they currently
exist and may be promulgated and amended in the future. Troutman
shall comply with all enforcement provisions of the respective sewer use
ordinance and pretreatment programs of Statesville as applicable.
Troutman shall comply specifically with the City of Statesville's sewer
use ordinance, Chapter 23. Statesville shall have the right to suspend
service to Troutman upon Troutman's failure to comply with provisions
of this agreement specified herein and to continue such suspension until
full compliance is met. Statesville may not suspend service, however,
until after giving Troutman at least 30 days notice to cure any failure to
comply on Troutman's part.
2. Statesville shall provide wastewater treatment services for Troutman and
shall administer an area wide pretreatment ordinance on behalf of
Statesville and Troutman. Statesville shall act as Troutman's agent and
on their behalf to enforce said ordinance. Troutman shall support and
aid in enforcement of the pretreatment ordinance. Statesville shall carry
out the industrial waste permitting process required by State and federal
regulations and shall monitor the industrial users and shall enforce the
provisions of the sewer use ordinance for applicable industrial discharges
in the Troutman service area. Statesville shall notify Troutman
immediately at the time it discovers any violation of its ordinances or
regulations by industrial users on Troutman's system and shall further
notify Troutman of any action being taken as a result of such violations.
In the event of a violation to the extent that a surcharge or penalty shall
be owed by any industrial user, the violating industry shall remit such
surcharge or penalty to Troutman. In the event of violation of the
regulations by such users, Statesville shall enforce said ordinance
provisions and Troutman shall remit payment to Statesville for such
penalties and surcharges owed. Statesville shall further have the right
and responsibility to enforce other provisions of said sewer use ordinance
within Troutman's sewage collection area.
Troutman shall abide by the policies of Statesville relating to sewer use
and other such policies that will be from time to time promulgated by
n.. __ r

Statesville relating to the operation of its wastewater transportation and
treatment system. However, any such regulations, ordinance or policies
shall not be arbitrary, capricious or unreasonable and shall be no more
restrictive upon Troutman than other Statesville customers. Statesville
shall immediately inform Troutman of any amendments or changes toy its
Sewer Use Ordinance or other such policies.
3. Troutman shall hold harmless and defend Statesville against any claims
arising from the transportation and treatment of wastewater received
from Troutman based upon overflows, failure in pump stations, and
failure to notify, all within the Troutman system.
4. Prior to connecting to Statesville's system, Troutman shall adopt a sewer
use ordinance that is no less stringent than Statesville's Sewer Use
Ordinance. Said ordinance shall also be revised in accordance with any
future revisions to the City of Statesville's sewer use ordinance, within
ninety (90) calendar days of notification by the City of approval by City
Council.
E. POINTS OF DELIVERY
1. The initial point of delivery of wastewater from Troutman to Statesville
shall be on the premises of Statesville's Third Creek Wastewater Plant at
a place to be designated by Statesville.
2. Additional points of delivery may be mutually agreed upon in the future
as requested by either party.
3. The points of delivery, which are the same points where metering and
sampling facilities are to be installed, shall constitute the points of
change in ownership, operation and maintenance responsibilities between
Statesville and Troutman.
4. Troutman shall notify Statesville no less than sixty (60) calendar days
prior to any initial wastewater discharge to Statesville's wastewater
system as to the estimated date that such initial discharge will occur.
Page 6

F. FLOW MEASURING/SAMPLING
1. Unless otherwise herein provided, Troutman shall furnish and install the
necessary metering and sampling equipment of proper type 'for
measuring the quantity and quality of wastewater delivered from
Troutman's system. The location, design, equipment and construction of
such metering and sampling facilities shall be in accordance with sound
engineering principles and shall be acceptable to both Statesville and
Troutman. Furthermore, such metering and sampling equipment shall be
approved by the City of Statesville prior to construction and installation
of such equipment.
2. Troutman hereto agrees to construct and Statesville -hereto agrees to
maintain the respective metering/sampling facilities in such a manner as
to ensure accurate measurement of flow and flow proportionate samples
from Troutman. Troutman shall have the right to inspect, read and test
the metering equipment and Statesville shall cooperate fully in this
regard. Statesville shall perform repairs or adjust any metering
equipment and Troutman shall cooperate fully in this regard. Statesville
shall perform repairs or adjust any metering equipment not conforming
to the standards of accuracy for which it was designed.
3. In the case of meter equipment failure, billing for wastewater flow shall
be made on the basis of an average of the previous twelve (12) months
until such failure is remedied.
4. Metering/sampling equipment shall be calibrated on an annual basis at
the expense of Statesville unless either party requests a more frequent
calibration. The party requesting the more frequent calibration shall bear
the expense of such.

G. PAYMPNT FOR SERVICF,S
1. Troutman shall provide for the total capital cost of the design,
construction and financing of the required metering and sampling
facilities at the point(s) of delivery as provided by Statesville.
2. Troutman shall pay all costs associated with connecting to and extending
any existing Statesville wastewater collection or transmission lines for
the transportation of Troutman's discharge.
3. Troutman shall pay to Statesville a service availability charge of
$1,542,450 ($3.39/gallon * 455,000 GPD) which is calculated as
Troutman's proportionate share of the treatment process and facilities
improvements. This payment shall be made within 30 days after
Troutman begins its construction of this project, providing the funding
Troutman is anticipating from the State of North Carolina is available at
that time. If Troutman's funding from the State of North Carolina is not
available within 30 days after Troutman begins construction, the payment
of this service availability charge shall be made as soon as the funding is
available to Troutman, but in no event shall Statesville allow the initial
connection of the Troutman wastewater system to the Statesville
wastewater system until the entire service availability charge of
$1,542,450 has been paid in full. Should Troutman in the future desire
to increase its flow allocation to the Statesville system, additional service
availability charges shall be assessed to Troutman by Statesville at that
time based on the additional flow allocation so requested. That flow
allocation, if available, will be provided at a rate equivalent to the net
present worth of that portion of the WVVTP at that time and may include
the cost of expansion or construction associated with the increase in flow
on a prorated basis, except as otherwise stipulated in this Agreement.
4. Troutman shall pay Statesville for the metered wastewater flow in
amounts up to the herein -stated quantity allowances at each delivery
point at the initial presently calculated rate of $1.92 per 1000 gallons or
$1.44 per 100 cubic feet. A rate schedule for wastewater flow is
attached to this agreement in Appendix A.
5. At appropriate intervals as deemed necessary by Statesville, but not more
than one time per year, an independent auditor chosen by Statesville and
Troutman will determine the actual cost of operation and maintenance of
the Third Creek Plant on a per 100 cubic feet or 1,000 gallon basis. This
cost shall be determined in accordance with Appendix A. Statesville
shall make available to Troutman all information relating to the
derivation of the above -referenced cost such that Troutman can make a

full and complete yearly audit of such cost. The cost of the independent
audit shall be shared equally by Troutman and Statesville.
6. If, at any time during the first- twenty-four (24) months that Troutman
discharges flow to Statesville, the average daily flow for any month from
the point(s) of delivery combined shall exceed the stated maximum daily
flow allocation, Troutman shall pay to Statesville, in addition to all other
rates, fees and charges, a penalty per 1,000 gallons or 100 cubic feet that
equals 100% of the rate being charged at the time for all flow amount
that exceeds the maximum daily allocation. The City shall also have the
right to charge Troutman a penalty that equals 100% of the rate being
charged at the time, for any flows that exceed the maximum
instantaneous rate as defined within this Agreement when the maximum
daily flow allocation is exceeded.
7. If, after the first twenty-four (24) months that Troutman discharges
wastewater flow to Statesville, the total daily flow amounts from the
point(s) of delivery combined shall exceed the stated maximum daily
flow allocations, Troutman shall pay to Statesville, in addition to all
other rates, fees and charges, a penalty per 1,000 gallons or 100 cubic
feet that equals 100% of the rate being charged at the time for all flow
amount that exceeds the maximum daily allocation. The City shall also
have the right to charge Troutman a penalty that equals 100% of the rate
being charged at the time, for any flows that exceed the maximum
instantaneous rate as defined within this Agreement when the maximum
daily flow allocation is exceeded.
8. It is the expressed desire of both parties to coordinate their respective
rate structures. Each party shall notify the other party no less than sixty
(60) days prior to the adoption of any rate changes.
9. Statesville will bill Troutman for the wastewater services provided in
accordance with Statesville's standard billing procedures for all other
wastewater customers. Statesville shall have the right to suspend service
to Troutman upon Troutman's failure to pay for the services billed and to
continue such suspension until such payment is made. However,
Statesville may not suspend service until after giving Troutman at least
30 days notice to pay for such services billed in full. Late payment
charges and any other penalties shall be applicable within the policies of
Statesville.
A30. o

H. DISPUTES
1. All claims, counterclaims, disputes and other matters in question
between the parities hereto arising out of or relating to this Agreement or
the breach thereof shall be decided by (1) formal mediation, (2) by a
court of competent jurisdiction. If the matter of disagreement concerns
rates to be paid, it is agree that participants shall continue payment based
on the rate in effect prior to the dispute, until the matter is settled.
I. TERM
1. Except as otherwise provided, the provisions of the Agreement shall
continue and be effective for a term of twenty (20) years from the date
Troutman pays to Statesville the service availability charge. It shall,
thereafter, be effective for a five-year period with automatic renewal
from one five-year period to the next; provided, however, that in the
event either party shall desire that this Agreement not be renewed for the
next effective period, they shall so notify the other party, thereby giving
the other party five years notice of termination. There shall be no
additional service availability charge paid by Troutman to Statesville
should this agreement be extended beyond the initial term.
2. It is agreed that Statesville may seek injunctive relief through a court of
competent jurisdiction upon Troutman's breach of or failure to perform
any of the terms of this agreement. Likewise, it is agreed that Troutman
may seek injunctive relief through a court of competent jurisdiction upon
Statesville's breach of or failure to perform any of the terms of this
agreement.
3. If at any time during the period of the agreement, by mutual consent,
both parties determine that they do not desire to continue the agreement,
then Statesville shall pay back to Troutman an amount of money
equivalent to the unamortized portion of the service availability charge
paid based upon an amortization of the service availability charge over
the 20-year term of this agreement. By way of example, should the
parties agree by mutual consent to terminate this agreement after five
years of the 20-year term have expired, Statesville will refund to
Troutman 75 % of the initial service availability charge, as 75 % of the
20-year term of this agreement would remain unfulfilled.
P-i na i n

4. Should Troutman not initiate any wastewater discharge to the Statesville
wastewater system within three (3) years of the date of this Agreement,
this Agreement shall be considered terminated at that time.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed in duplicate original in their respective names by their respective Mayors and
attested by their Manager and/or/Clerk and their corporate seals hereto affixed, all
pursuant to Resolutions duly adopted by their respective governing boards.
ATTEST:
City
ATTEST:
Clerk to Board
CITY OF STATESVILLE
Mayor
11 7102cV't'114 /

WASTEWATER AGREEMENT
BETWEEN
CITY OF STATESVILLE AND TOWN OF TROUTMAN
s
APPENDIX A
The formula for calculating the wastewater treatment charge is as follows:
OPERATIONAL COST (O&M[) (1)
+ ADMINISTRATION (G&A) (2)
+ 50% OF (O&Ml + (G&A)
= WASTEWATER CHARGE
1. • Operational cost is the personnel, operating and maintenance costs associated with operating
the City of Statesville Third Creek Wastewater Treatment Plant (plant).
2. Administration is the general and administrative cost associated with the plant that is not
charged to the plant's cost directly.
RECEIVED
JUL 0 3 .2023
NCDEQ/DWR/NPDES