WQ0041240_Application (FTSE)_20191008

i Vys �� �J2 lC (' 1 0� ��State
of North Carolina
Department of Environmental Quality
INWRDivision of Water Resources
—momor 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dkblon of W#Eer Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: 00-t l -;Lb (to be completed by Dwtz)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Pilot Mountain (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Michael Boaz per 15A NCAC 02T .0106(b)
Title: Town Manaeer
4. Applicant's mailing address: 124 W. Main Street
City: Pilot Mountain State: NC Zip: 27041
5. Applicant's contact information:
Phone number: [phone] Email Address: mboaz .pilotmountainnc.org
II. PROJECT INFORMATION:
1. Project name: Sunset Sewer Subbasin Rehabilitation Project
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Surry
4. Approximate Coordinates (Decimal Degrees): Latitude: 30.23.24' Longitude:-80.28.51`
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
IawV-135-111aF.11►Y1lZI-Te]W I:11 133
1, Professional Engineer: John F. Akers License Number: 024645
Firm: WithersRavenel
Mailing address: 424 Gallimore Dairy Road, Suite C
City: Greensboro State: NC Zip: 27409-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Pilot Mountain Permit Number: NCO026646
Owner Name: Town of Pilot Mountain
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00112
Owner Name(s): Town of Pilot Mountain
FORM: FTA 04-16 Page I of 5

State of North Carolina
Department of Environmental Quality
DWR000,Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: I V (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Town of Pilot Mountain (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Michael Boaz per 15A NCAC 02T .0106(b)
Title: Town Manager - NC Department of
4. Applicant's mailing address: 124 W. Main Street Environmental Quality
Received
City: Pilot Mountain State: NC Zip: 27041- - OCT O 8 2019
5. Applicant's contact information:
Phone number: (3) 444-3000 Email Address: mboazOVilotmountainnc org i Winston-Salem
Regional Office
I1. PROJECT INFORMATION:
1. Project name: Sunset Sewer Subbasin Rehabilitation Project
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Sorry
4. Approximate Coordinates (Decimal Degrees): Latitude: 30.23.24' Longitude:-80.28.51 °
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: John F. Akers License Number: 024645
Firm: WithersRavenel
Mailing address: 424 Gallimore Dairy Road, Suite C
City: Greensboro State: NC Zip: 27409-_
Phone number: [phone] Email Address: iakers(a withersravenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: _ Permit Number:
Owner Name:
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00112
Owner Name(s): Town of Pilot Mountain
FORM: FTA 04-16 Page I of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Reaional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Qualitv Section
Wilmington, North Carolina 28405
Hanover, Onslow, Fender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

Vl. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
® School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(I))
Daily Design Flow e,n
No. of Units
Flow
High School
9,420 gal/daqy
1
9,420 GPD
Residential
360 gal/minute/dwelling
68
24,480 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
33,900 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0.034 GPD (per 15A NCAC 02T .0l 14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name: Sunset Lift Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 30.23.24' Longitude:-80.28.51 °
3. Design flow of the pump station: 0.144 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 100 gallons per minute at 94 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
4
1,970
PVC
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(l):
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B).
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & W
tZ Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top sloe of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications cart be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC'02B .0200? ®Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reauest is required Prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
tid F• 4kers attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:'
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
(Signature Authority's name & title from Ap)51ication Item I.3.)
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 documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 04- l6 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Pilot Mountain
Project Name for which flow is being requested: Sunset Sewer Subbasin Rehabilitation
More than one FTSE may be required fora single project if the owner of the WWTP is not responsible for all pomp
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Pilot Mountain WWTP
li. WWTP Facility Permit #: NC0026646
All flows are in MGD
c. WWTP facility's permitted flow 0.5000
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow 0.1687
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
It. Percent of permitted flow used
0.034
33%
g05A
e
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project
connection point and the WWTP:
(A)
(B) (C) (D)=(B+C)
(E)=(A-D)
Design
Obligated,
Pump Average Daily
Approx. Not Yet Total Current
Station Firm Flow**
Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pi),
Daily Flow, Daily Flow, Obligated
Available
Number) MGD MGD
MGD MGD Flow
Capacity***
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Td N s mcc hu e 1 certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation of
the planned improvements identified in the planning assessment where applicable. This analysis
has been performed in accordance with local established policies and procedures using the best
available data. This certification applies to those items listed above in Sections I and II plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
Official Signature
Date
Page 2 of 6
FTSE 04-16

10 WithersRavenel.
Our Peopte. Your Success.
424 Gattimore Dairy Road, Suite C
Greensboro, North Carolina 27409
t: 336.605.3009 1 f: 919.467.6008
TO: Division of Water Quality
450 West Hanes Mill Road, Suite 300
Winston Salem, NC 27105
Letter of Transmittal
• 10.04.2019 • • 06170524.00
•
Fast Track Sewer System Permitting
WEARESENDINGYOU ❑x Attached ❑ Under Separate Cover via
THE FOLLOWING ITEMS ❑Shop Drawings
❑ Copy of Letter
❑ Prints
❑ Plans
❑ Samples
❑ Specifications
❑ Change Order
❑ Diskette
❑O Other
Permit Application
COPIESDATE
2
09.16.2019
NO.
1
DESCRIPTION
Fast Track Permit Application & Flow Tracking Form
1
10.02.2019
2
Review Fee (Town of Pilot Mt. Check # 21332, $480.00)
NC Department of
ElIvIlumnental {uu ity
Received
W;Psten Salem
Regional
THESE ARE TRANSMITTED as checked below:
❑x For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested, ❑ Returned for corrections
❑ For review and comment ❑ Other
❑ FOR BIDS DUE
❑ Resubmit
❑ Submit
❑ Return
❑ PRINTS RETURNED AFTER LOAN TO US
copies for approval
copies for distribution
corrected prints
REMARKS: The attached application is for permitting of a replacement lift station NC DEQ/Division of Water
Infrastructure has requested that it be permitted, since it has not been individually permitted in the past.
COPY TO: Town of Pilot Mountain SIGNED: John F. Akers PE Senior Project Manager
If enclosures are not as noted, kindly notify us at once.

Henderson, Justin L
From:
Akers, John <[e-mail]>
Sent:
Monday, October 14, 2019 12:47 PM
To:
Henderson, Justin L
Cc:
Dolan, Casey; Rehak, Elisa; Michael Boaz
Subject:
[External] RE: Sunset Sewer Subbasin Rehabilitation Project
Attachments:
2019.07.28 REVISED - Sewage Pump Station Design-Flow_2019_1014.pdf
Justin:
Attached is our full estimate of flow. We used the 15 gpd per student based on a school with cafeteria, gym and
showers. I'll verify the obligated flow number with the town, but they did not indicate that they currently had any
obligated flow to the plant.
Thanks, John
From: Henderson, Justin L <[e-mail]>
Sent: Monday, October 14, 2019 12:02 PM
To: Akers, John <[e-mail]>
Subject: Sunset Sewer Subbasin Rehabilitation Project
John,
I am reviewing a fast track application package for the subject project and have the following additional information
requests:
1) How many students are being requested at the High School?
2) Does the school have a cafeteria? Gym & Showers?
3) The included FTSE indicated that the WWTP does not currently have any obligated but not yet tributary flow.
Can you verify that this is accurate?
The application will be placed on hold until the above information is received by this office. Please contact me with any
questions you may have. Thanks.
Justin Henderson
Environmental Specialist II
Winston Salem Regional Office
Division of Water Resources
[phone]
[e-mail]
Subscribe to Collection System & Sewer Permitting Updates

Henderson, Justin L
From: Akers, John <[e-mail]>
Sent: Tuesday, October 15, 2019 10:55 AM
To: Henderson, Justin L
Subject: [External] RE: Sunset Sewer subbasin rehab
Attachments: Lift Station Permit Application-Page_1.pdf
Justin: Attached is the revised page 1. The town confirmed that they have no obligated flow. Let me know if you need
anything else.
Thanks, John
From: Henderson, Justin L <[e-mail]>
Sent: Monday, October 14, 2019 12:24 PM
To: Akers, John <[e-mail]>
Subject: Sunset Sewer subbasin rehab
John,
One more additional information item to request for the subject project:
1) Submit a revised p. 1 of 5 of FTA with a completed Section IV. that provides the WWTP facility name, owner, and
permit number.
Thanks.
Justin Henderson
Environmental Specialist II
Winston Salem Regional Office
Division of Water Resources
[phone]
[e-mail]
Subscribe to Collection System & Sewer Permitting Updates

TOWN OF PILOT MOUNTAIN
Date Inv No./Desc
10/02/2019 PILOT MTN REVIEW FEE/LIPT STATION
P.O. No. Amount
$480.00
NC Donartment. of
Environmental Quality
Recelv2d
OCT 0 8 2019
Winston-Salem
Regional Office
Check: 21332 10/02/2019 Total Amt: $480.00