WQCS00251_Renewal (Application)_20210219

This cover sheet lists items included in the permit application
package for the renewal of the Town of Stoneville Sanitary
Sewer Collection System Permit #WQCS00251:
1. Cover Letter
2. Application
3. Pump Station List
4. High Priority Lines
5. Annual Budget for Collection System
6. CIP
7. Response Action Plan
8. Contingency Plan RECEIVED
9. Sanitary Sewer System Map FEB 1 9 2021
NCDEQ/DWR/NPDES

State of North Carolina v
DW R Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0400—SYSTEM-WIDE WASTERWATER 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 Pretreatment,Emergency Response,&Collection Systems(PERCS)Unit,
please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of requested
additional information.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Cover Letter
® Submit a cover letter listing all items and attachments included in the permit application package
B. No Application Fee Required
> No application fee is necessary. The permittee will be billed an annual fee upon issuance of the permit
> The appropriate annual fee for systemwide wastewater collection system permits may be found at:
> Annual Non-Discharge Fees
C. System-Wide Wastewater Collection System(FORM: CSA 04-16)Application:
O 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 I.3 is a corporation or company, provide documentation if it is registered for
business with the North Carolina Secretary of State.
D. General Information:
➢ The Authorized signing official listed in Section I.4 should match with that of the Applicant certification page in
accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated
as the signing official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T
.0106(b).
> NOTE - Public Works Director's are not authorized to sign this permit application according to the rule
unless they are delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION Page 1 of 5

F •
E. Summary of Attachments Required:
❑ Instruction A: Cover Letter
❑ Instruction C: Application
❑ Instruction C: Ownership Documentation(i.e.CPCN)(If necessary)
❑ Instruction D: Delegation Letter(If necessary for signing official)
❑ Section IV.3 Pump Station List
❑ Section IV.4 High Priority Lines List
❑ Section V.4 Annual Budget for Collection System (Updated and Approved)
❑ Section V.6 Capital Improvement Plan(Updated and Approved)
❑ Section VI.2 Response Action Plan
❑ Section VI.4 Contingency Plan
❑ Section VI.6 Comprehensive Collection System Map
❑ Section VII Note Any Potential Compliance Issues
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS,SHOULD BE SENT TO:
NCDEQ-DWR
Water Quality Permitting Section
PERCS UNIT
By U.S.Postal Service: By Courier/Special Delivery:
Attn: PERCS Unit Supervisor 512 N.SALISBURY ST.Suite 925
1617 MAIL SERVICE CENTER RALEIGH,NORTH CAROLINA 27604
RALEIGH,NORTH CAROLINA 27699-1617
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):Town of Stoneville
2. Facility Information: Name: Town of Stoneville Collection System Permit No.:WQCS00251
3. Applicant type: ®Municipal ❑ State ❑Privately-Owned Public Utility
❑County ❑ Other:
4. Signature authority's name:Perry Webster per 15A NCAC 02T.0106(b)
Title:Interim Town Manager
5. Applicant's mailing address: 101 Smith St
City:Stoneville State:NC Zip:27048-
6. Applicant's contact information:
Phone number: [phone] Fax number: [phone] Email address:mmalloy@a,stonevillenc.org
II. CONTACT/CONSULTANT INFORMATION:
1. Contact Name:
2. Title/Affiliation:
3. Contact's mailing address:
4. City: State: Zip:5. Contact's information:
Phone number:( )= Fax number: ( ) - Email address:
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑New ®Renewal
2. County System is located in: Rockingham County
3. Owner&Name of Wastewater Treatment Facility(ies)receiving wastewater from this collection system:
Owner(s)&Name(s):Town Of Mayodan
4. WWTF Permit Number(s): NC0021873
5. What is the wastewater type? 95%Domestic or 5%Industrial(See 15A NCAC 02T.0103(20))
y Is there a Pretreatment Program in effect?❑Yes or®No
6. Wastewater flow: .65 MGD(Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: MGD
8. Explain how the wastewater flow was determined: ❑ 15A NCAC 02T.0114 or® Representative Data
9. Population served by the collection system: 1250
IV. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description Length
Gravity Sewer 16.2(miles)
Force Main 4.34(miles)
Vacuum Sewer (miles)
Pressure Sewer (miles)
APPLICATION CSA 04-16 Page 3 of 5

/ w
2. Pump Stations for Collection System:
Pump Station Type Number
Simplex Pump Stations(Serving Single Building) 2
Simplex Pump Stations(Serving Multiple Buildings)
Duplex Pump Stations 5
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.
Stoneville Public Works Dept(Director and 2 Techs)is responsible to management,operation and maintenance of the
collection system
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Mark Malloy Certification Number: 986923
Back-Up ORC Name: Anthony Smith Certification Number: 1007026
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: $365,488.00
4. Submit a copy of your current annual budget.
5. Approximate capital improvement budge for the collection system only: $0
6. Submit a copy of your current capital improvement plan.
7. Is this collection system currently a satellite system 0 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)
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:
APPLICATION CSA 04-16 Page 4 of 5

VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place®Yes or 0 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 El No
6. Submit a submit a copy of the collection system map(CD or hardcopy)or indicate a schedule for completion
7. Thoroughly read and review the System-Wide Collection System Permit Conditions. Typically compliance schedules
are only offered to NEW permit applicants and NOT permit renewals. Any compliance dates must be included within
the permit prior to issuance or the permit holder will be found in violation upon inspection.
Current If no,Indicate a Typical
Permit Condition Compliance Compliance
Compliance? Date Schedule
I(4)—Grease ordinance with legal authority to inspect/enforce ® Yes ❑No
I(5)— Grease inspection and enforcement program ®Yes ❑No
I(6)—Three to five year current Capital Improvement Plan. ®Yes El No
I(8)—Pump station contingency plan ®Yes El No
I(9)—Pump station identification signs. ®Yes ❑No
I(11)—Functional and conspicuous audible and visual alarms. ®Yes ❑ No
H(5)—Spare pumps for any station where one pump cannot
handle peak flows alone(in a duplex station,the 2nd pump is ® Yes ❑No
the spare if pump reliability is met).
II(7)—Accessible right-of-ways and easements. ®Yes ❑No
II(9)—Response action plan with Items 9(a—h). ®Yes ❑No
III(3)—Comprehensive collection system map ®Yes El No
For conditions not listed,compliance dates are not typically offered. List any permit conditions that may be difficult for the
applicant to meet(attach clarification if needed):
VII. APPLICANT'S CERTIFICATION per 15A NCAC 02T.0106(b):
I, (,()Q Q attest that this application for Town of Stoneville
(Signature Authority's Name&Title from Item I.4) (Facility name from Item I.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,this application package
will be returned to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
$10,000 as we as civil penalties
up to$25,000 per violation.
Signature: ( / Date: a 1 I DG` 07 O )
APPLICATION CSA 04-16 Page 5 of 5

Directions To Lift Stations
Directions are from Town Hall (101 Smith St, Stoneville NC)
Lift Station Address — 228 Simpson St:
Take Main St travel east to Simpson St, turn left. Travel approx.
1 mile, turn into driveway on right. Arrive at L/S
Lift Station Address — 112 Lemons St:
Take Main St travel east to Lemons St, turn left. Travel approx.
one half mile, turn into driveway on right. Arrive at L/S.
Lift Station Address — 546 Stone Mtn Rd: (Church St L/S)
Take Main St travel east to Church St, turn right. Travel approx.
1 mile, turn into driveway on right. Arrive at L/S.
Lift Station Address — 2880 Hwy 220 Bus. (River L/S)
Take Main St travel west to 220 Business (Henry St), turn left.
Travel approx. 3 miles, turn into driveway on right. Arrive at
L/S.
Lift Station Address —8918 Hwy 220 N (WWTP L/S)
Take Main St travel west to Highway 220. Take the ramp
headed south. Travel approx. 1 mile, turn into driveway on
right. Drive thru red gate. Travel driveway, arrive at L/S.
*All stations have audible, visual SCADA alarm systems
*All stations have back up generators

High Priority Lines List Town of Stoneville
1. Simpson St 0/F Aerial - DIP
2. Gerry St 0/F Aerial - DIP
3. King St O/F Aerial - DIP
4. Oaklawn St 0/F Aerial - DIP
5. Henry St O/F Aerial - DIP
6. Bryan St O/F 1 0/F Aerial - DIP
7. Bryan St 0/F 2 0/F Aerial - DIP
8. Dixie Circle 0/F Aerial - DIP
9. Bus 220 1 0/F Aerial - DIP
10. Bus 220 2 O/F Aerial - DIP
11. Priddy Rd 0/F Aerial - DIP
12. Park O/F Aerial - DIP
13. 220 Bypass 0/F Aerial - DIP
14. Stone St O/F Aerial - DIP
15. E Matthews St 0/F Aerial - DIP

(sTE1Nt1" Iz
: F;$CAI.YEAR Z020«2021 RU 'ET, ;
FY 16-17 FY 17-18 FY 18-19 FY 19-20 FY 20-21
Budget f Budget Budget Budget Budget Expenditure Highlights
7140121-WWT Salaries 41,837 41,895 42,546 42,305 42;498
7130122-WWT OT 2,100 2,000
7140122-WWT Comp Call Out 13,810 12,930 5,500 4,420 4,650
7140125-WWT Professional Services •
9,000 1,802 1,802 100 100
7140181- WWT FICA 4,368 3,052 3;205 3,735 3,760
7140182-WWT Retirement 4,091 . 2,992 5,342 4,370 4,964
7140183-WWT Medical Insurance 10,407- 8,895 7,880 8,901 9,000
7130184-401K/4576 •
1,465 1,474
7140186- WWT Worker's Compensation 882 970 1,430 1;696 1,800
7140212-WWT Uniforms; . 1;500 • .1;500 1,500 1,500 1;500
7140271-WWT Sewer Usage 103,500 .100,080 109,972 110,000 120,000
7140290-WWT Other Supplies 3,500 ; 3,500 3,500 1,000 1,000
7140291- WWT Sewer System Maintenance 22,000 15,000 12,000 14,500 13,000
7140311- WWT Travel 2,210 2,210 2,210 1;000 500
7140314-WWT Diesel Fuel 2,500 2,500 2,500 3,000 2,500
7140321-WWT Telephone 1,690 2,500 2,500 1,200 1,800
7140331-WWT Electricity 20,000 20,000 20,000 20,000 22,000
7140333 - WWT Gas 2,000 . 2,500
7140350-WWT Pump Repair 10,000 10;000 10,000 14,116 19,000
7140352-WWT Equipment Maintenance . 2,500 2,500 2,500. 2,000 1,500
7140353 -WWT Vehicle.Maintenance 2,000 2,000 ,750
7140355- WWT Equipment 1,000' 750
7140360-WWT Office:Supplies 750 500
7140395-WWT Training 2,000 2;000 2,000 1,000 - 500
7140399- WWT Miscellaneous
7140451-WWT Liability Insurance , 5,280 5,808 6,389 5,935 6,100
7140491-WWT Dues&Subscriptions 1,500 1,500 1,500 . 1,500 1,000
7140500-USDA Sewer Project Pre Exp
7140550-WWT Capital.Outlay 237,835
7140552- WWT-Principal SCADA 7,030 5,375 5,375 5,215 1,768 Year 5 of 5
7140553-WWT.-Interest SCADA 90 Year 5 of 5
7140556- WWT USDA Backhoe.Principal 9,072 9,072 9,072 8,248 9,072 Year 5 of 7
7140557-WWT USDA Backhoe Interest 825 Year 5 of 6
7140558-USDA -Sewer Loan Principal 13,000 13,000 13,000 Year 2 of 40
7140559-USDA Sewer Loan Interest 18,292 18,292 17,708 Year 2 of 40
7140565-CDBG Expense 1,000 0
7140658- USDA Equip Principal 4,322 Year 1 of 15
7140659-USDA Equip Interest Year 1 of 15
7140674- WWT Matthews St.-Principal 24,000 24,000 24,000 24,000 0
7140991-WWT Contingency
9100717-WWT Debt Principal-Bonds 51,500 51,500 51,500 51,492 51,492 Year 17 of 20
9100727-WWT Bonds-Interest 10,960 10,960 10,960 6,850 5,480 Year 17 of 20
TOTAL WWT $ 606,972 $ 342,541 $ 376,475. $ 381,105 $ 365,488,

5.0 CAPITAL IMPROVEMENT PLAN
A Capital Improvement Program (CIP) is a twenty-year plan for the financing of major projects
that represent significant contributions to the overall inventory of physical assets. As a long-
range plan,the CIP reflects the Town's policy regarding physical and economic development. By
creating a planned schedule of public improvements,the CIP outlines present and future public
needs and priorities and provides public and private sector decision-makers with valuable
information on which to base investment decisions. Effective planning will be important as
Stoneville and the surrounding area grows.
Capital project planning is an ongoing process. Projects that have been tentatively scheduled in
previous CI Ps are reassessed, along with new, proposed projects. A test of the effectiveness of
the capital planning process is the orderly manner in which projects are planned for, scheduled,
and finally budgeted, year-by-year.
A sewer system CIP was put together based on the assessment of the conditions of each asset
in the Town's sewer inventory, areas that currently experience issues, and the potential for
growth in the Town limits and surrounding areas. The capital improvement plan for the Town
of Stoneville is attached in Appendix D. The table below shows the list of projects included in
the CIP. The attached version shows each project in detail.
Table 12:Recommended Sewer System Capital Improvement Projects
Project Description Estimated Project Cost
0-5 Year Range(2017-2022)
USDA Sewer Rehab Project' Go,N,, fiQ- ! $2,688,255
West Matthews Sewer Replacement COM ,Ie 74c_ $1,198,500
Church Street Outfall Replacement c oivy /e ! $570,000
6- 10 Year Range (2023-2027)
Brown Street Gravity Sewer Replacement $857,000
Simpson St. Outfall Replacement $1,157,000
11- 15 Year Range(2028-2032)
Smith Street Gravity Sewer Replacement $657,000
Church Street Gravity Sewer Rehab $420,000
Lemon St. Forcemain Relocation $245,500
16-20 Year Range (2033-2037)
Stone Property $1,325,500
US 220 Gravity Sewer Extension $593,000
1-Project has already received funding and construction is expected to begin in late 2017
„KC LKC Engineering,PLLC
Aberdeen,NC PAGE 116

OF STO
t4i,
N C Sanitary Sewer Spill/Overflow Response SOP
1.0 Purpose
This procedure details necessary response actions for sanitary sewer overflows and spills
within the Town of Stoneville.
2.0 Responsibility
The Public Works Division of the Town of Stoneville is responsible for responding to
sanitary sewer spills and overflows.
3.0 Procedure/Rule
3.1 Sanitary Sewer Spill/Overflow Response for Public Incidents
1.Notification and Investigation
a. As calls are received,the Public Works crew immediately responds to the
SSO reported site. Crew responding to an overflow needs to record the start
time.
b. The first determination to make is whether the overflow is caused by a
public or private line stoppage. Incidents that occur on private property will
be subject to different response procedures. (Refer to 3.2)
c. The second determination to make is whether the overflow is contained or
non-contained. Contained is defined as an overflow that does not enter a
drainage ditch,drain pipe,creek, stream, or body of water. A sanitary sewer
back up into a residence if stopped on the town side is also considered a
contained spill Non-contained is defined as an overflow that is able to enter a
drainage ditch,drain pipe,creek, stream, or body of water.Non-contained
incidents receive top priority designation due to their increased probability of
endangering human and environmental health.
d. After it is determined that the spill is caused by a public line/town
maintained line stoppage,evaluation of the following factors will commence:
cause of incident, immediate corrective measures required,containment and
volume determination. Volume determination is determined through in house
training.
e. If media communications become apparent,the Town Manager will be the
POC.
2. Cleanup
a. When the overflow situation is in a controlled state,cleanup will
commence. Cleanup surrounds the elimination of all visible overflow
materials, including water and solids. When completed,the area should be
sanitized and/or flushed as necessary to eliminate any health or pollution
threats.
b. As required, after cleanup, lime may be spread and grass seed and straw
may be applied for cosmetic purposes and to prevent erosion. The area should
be monitored and/or tested as long as necessary to validate effectiveness of
cleanup efforts. Streams and lakes should be monitored as long as necessary
for a fish kill and to watch for pockets of waste water.

c. Sewer backups/flood damage in homes or businesses should be evaluated
according to the severity of the incident. A contained SSO spill sheet should
be filled out.
d. Every attempt should be made to contain the spill."Do not enter"tape may
be necessary to keep the public out of affected areas.
3. Documentation(Public collection system)
a. Once cleanup and safety measures have been attained,the first response
field personnel should start the overflow form. Once completed the form
needs to be given to the ORC or back up ORC. The ORC will inspect the site
within 24 hours or if the ORC is not available within 24 hours the BORC will
come in afterhours to perform the inspection.The ORC will keep a copy of
the form on file. The Division of Water Quality(BIMS report)will be
completed within 5 days following first knowledge of the occurrence.
b. In instances of spills of 1,000 gallons or more contained or any amount
non-contained,the Public Works Director should report to the North Carolina
Division of Water Quality Winston-Salem Regional Office,at telephone
number(336) 776-9800 or 800-858-0368 (after hours) as soon as possible,
but in no case more than 24 hours following the occurrence or first
knowledge of occurrence of the incident.
c. Overflows and spills occurring outside of normal business hours may also
be reported to the Division's Emergency Response personnel at telephone
number(800) 858-0368.
d. For all non-contained incidents exceeding 1,000 gallons, a press release
will be prepared and faxed to all major electronic and print news media
outlets within the Stoneville area.
e. For non-contained incidents exceeding 15,000 gallons, a public notice will
be issued in conjunction with a press release. The public notice will be placed
in a newspaper with general circulation in the county in which the discharge
occurred and the county immediately downstream.
f. For non-contained incidents exceeding 1,000 gallons,the State Division of
Water Quality Regional Office should be notified to determine additional
public notice that may be required.
3.2 Sanitary Sewer Spill/Overflow Response for Private Incidents
1.Notification and Investigation
a. All calls are received and logged by town staff,noting exact time, location,
complaint, and contact information.
b. Upon notification of a private sanitary sewer overflow the person
responding should then attempt to make contact with a representative of the
"location" of this private sewer overflow in question by obtaining a contact
name and number.This information may be kept on file, as is the case for all
private lift stations, or may be checked in other sources such as the phone
book, the or Town Business Directory. Any and all information that is found
will be utilized to complete this contact. Multiple attempts are to be made,
regardless of busy signals or unavailable individuals.
c. Request for emergency assistance should be based upon an on-site
investigation. If the spill is contained or unthreatening to the surface water
system, the Town is not required to be involved.
d. If, for any other reasons,the Town is requested to respond, crews should
determine if the spill can be contained or stopped and take such action prior

to any other work.Town personnel should rectify the situation and bill the
property owner.
2. Documentation(Private collection system)
a. Upon providing aid as requested by the proper authority,our crews are
mandated to keep an accurate and precise record of all materials,vehicles,
and individuals that were called out to work on this incident. The responsible
owner,citizen,or party may be charged for any work performed. All records,
forms, and charges are to be turned in the next business day to the Public
Works Director.
b. Once the private overflow has been completely resolved and handled,the
field personnel in charge is required to complete the appropriate standard
overflow forms and submit them directly to the Public Works Director.
c. Contained spills that reach a quantity of 1,000 gallons and all non-
contained spills are required to be reported to the State of North Carolina and
the Rockingham County Health Department.

Town of Stoneville
Pump Failure Contingency Plan
Station Pumps
The town maintains 5 lift stations. Lemons, Simpson and Church have 2
pumps. River and WWTP have 3
Pump Failure
Whenever pump failure occurs either Public Works staff or contractor
will pull the pump and send it out to be repaired. CRU handles the
towns pump repairs. (919-775-2464)
Power Failure
Each station has a back up generator that is ran weekly to exercise in
case of power outage. Pump trucks are called if needed to prevent
overflows as well.
Station Pumps
The town maintains 5 lift stations. Lemons, Simpson and Church have 2
pumps. River and WWTP have 3 in accordance with the town collection
system permit 1-7.
Emergency Funds
The town has funds budgeted yearly for emergency repairs.
*This plan is in accordance with the town collection system permit 1-7

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