WQCS00296_Application_20201130

TOWN OF SHA LLOTTE
Post Office Sox 2287 • Shallotte, North Carolina 28459
Telephone: (910} 754-4032 • Facsimile: [phone]
November 24, 2020
Ms. Christyn L. Fertenbaugh, PE
NC Division of Water Resources
Municipal Permitting Unit
Attn: WQCS Renewals
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject: Town of Shallotte- Collection System Permit renewal
WQCSOO296
Dear Ms. Fertenbaugh:
Enclosed is the Collection System Permit renewal application package. Included is the signed application, supporting
documentation, and a digital copy of the complete application package. Should you have any questions, or require
additional information, please call me at 910-443-2082 or send email to [e-mail]. Thank you.
Sincerely,
David B. Bowman, P.E.
Town Engineer
Copy: Mimi Gaither, Town Administrator

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0900 — SYSTEM -WIDE WASTERWATER COLLECTION SYSTEMS
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:
❑ 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 Ietter 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 1.4 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

E. Summary of Attachments Required:
El
El
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
❑ Section VI.4
® Section VL6
❑ Section VII
Response Action Plan
Contingency Plan
Comprehensive Collection System Map
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:
Attn: PERCS Unit Supervisor
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By CourierlSpecial Delivery:
512 N. SALISBURY ST. Suite 925
RALEIGH, NORTH CAROLINA 27604
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 Shallotte
2. Facility Information: Name: Shallotte Collection System Permit No.: WQCS00296
3. Applicant type: ® Municipal ❑ State
❑ County ❑ Other:
4. Signature authority's name: Mimi Gaither per 15A NCAC 02T .0106(b)
Title: Town Administrator
5. Applicant's mailing address: PO Box 2287
City: Shallotte State: NC Zip: 28459-2287
6. Applicant's contact information:
Phone number: [phone] Fax number: () -
❑ Privately -Owned Public Utility
Email address: [e-mail]
II. CONTACT/CONSULTANT INFORMATION:
1. Contact Name: David B. Bowman, PE
2. Title/Affiliation: Town Engineer
3. Contact's mailing address: 1010 Central Avenue
4. City: Burlington State: NC Zip: 27215-
5. Contact's information:
Phone number: [phone] Fax number: [phone] Email address; dbowman a,atmc.net
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? ❑ New ® Renewal
2, County System is located in: Brunswick County
3. Owner & Name of Wastewater Treatment Facility(ies) receiving wastewater from this collection system:
Owner(s) & Name(s): Brunswick County, Shallotte WWTF
4. WWTF Permit Number(s): WQ0000798
5. What is the wastewater type? 100 % Domestic or % Industrial (See 15A NCAC 02T .0103(20))
Is there a Pretreatment Program in effect? ❑ Yes or ❑ No
6. Wastewater flow: 0.382 MGD (Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: 005 MGD
8. Explain how the wastewater flow was determined: ® 15A NCAC 02T .0114 or ❑ Representative Data
9. Population served by the collection system: 4698
1V. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description
Length
Gravity Sewer
18.08 (miles)
Force Main
30.68 (miles)
Vacuum Sewer
0 (miles)
Pressure Sewer
28.88 (miles)
APPLICATION CSA 04-16 Page 3 of 5

2. Pump Station
Pump Station Type
Number
Simplex Pump Stations (Serving Single Building)
1144
Simplex Pump Stations (Serving Multiple Buildings)
Duplex Pump Stations
95
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.
See attached Organizational Chart
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Charles Denely
Certification Number: 1002343
Back -Up ORC Name: Dwayne Simmons
Certification Number: 993029
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: $ 2,285,861
4. Submit a copy of your current annual budget.
5. Approximate capital improvement budge for the collection system only: S 1,289,000
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)
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:
n/a
APPLICATION CSA 04-16
Page 4 of 5

VI. COLLECTION SYSTEM COMPLIANCE:
1. Is a Response Action Plan currently in place ® Yes or ❑ No
2. If Yes, submit a copy of the Response Action Plan or see table 6 below.
3. Is a pump station contingency plan currently in place? ® Yes or ❑ No
4. if Yes, submit a copy of the pump station contingency plan or see table 6 below.
5. Is a comprehensive collection system map currently in place? ® Yes or ❑ No
6. Submit a submit a copy of the collection system map (CD or hardcopy) or indicate a schedule for completion
7. Thoroughly read and review the System -Wide Collection System Permit Conditions.
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.
Typically compliance schedules
Permit Condition
Current
Compliance?
If no, Indicate a
Compliance
Date
Typical
Compliance
Schedule
1(4) — Grease ordinance with legal authority to inspect/enforce
1:1 Yes ❑ No
12 — 18 mo.
I(5) — Grease inspection and enforcement program
Yes ❑ No
12 — 18 mo.
1(6) — Three to five year current Capital Improvement Plan.
>/ Yes • No
12 —18 mo.
1(8)— Pu np station contingency plan
1/ Yes ❑ No
3 mo.
I(9) — Pump station identification signs.
12. Yes 0 No
3 mo.
I(1 l) — 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 2" pump is
the spare if pump reliability is met).
6 — 9 mo,
/< Yes ■ No
II(7) — Accessible right-of-ways and easements.
® Yes • No
6 — 12 mo.
I I(9) — Response action plan with items 9 (a -- h).
III(3) — Comprehensive collection system map
® Yes ❑ No
3 mo.
10% per year
/it Yes ❑ 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, Mimi Gaither, Town Administrator attest that this application for Shallotte Collection System
(Signature Authority's Name & Title from Item 1.4)
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 civil penalties up to $25,000 per violation.
J Date: «• 24. 2 0
Signature: ,/
MAMA;
(Facility name from Item 1.1)
APPLICATION CSA 04- 1 6
Page 5 of 5

Board of Aldermen
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Note: All pump stations have the ability to pump peak capacity with the largest pump out of service.

ATTACHMENT A FOR CONDITION IV (4)
TOWN OF SHALLOTTE
HIGH PRIORITY LINES
Type: Material: Location of Priority Line:
1. Aerial- not buried Ductile Iron Whiteville Rd, Hwy 130 Bridge,
2. Aerial- not buried Ductile Iron Maid Street Bridge

Ordinance 1/2020-06
Budget Ordinance
For the Year Ending June 30, 2021
BE IT ORDAINED by the Town of Shallotte, North Carolina at its regular meeting on the 2nd day of June, 2020 at 5:15 pm that the following
anticipated fund revenues and expenditures by function, together with a certain fee and charges schedule(s), and with certain restrictions and
authorizations are hereby appropriated and approved for the operation of the Town's government and its activities for the fiscal year beginning July
1, 2020 and ending June 30, 2021.
Section 1. GENERAL FUND
Anticipated Revenues
Ad Valorem Taxes:
Ad Valorem, Current Year 2020 $ 2,152,968
Ad Valorem, Registered Motor Vehicles 133,450
Ad Valorem, Prior Year 2019 35,000
Ad Valorem, Prior Year 2018 10,000
Interest/ Penalties 15,000
Total
Other Taxes:
Beer and Wine Licenses
$ 2,346,418
550 550
Unrestricted Intergovernmental:
Local Options Sales Tax 1,374,618
Utility Sales Tax 391,441
Telecommunications Tax 39,543
Video Franchise Tax 74,755
ABC Profit Distribution -
Court Facility Fees 750
Beer and Wine Tax 20,089
Total
Restricted Intergovernmental
Powell Bill Proceeds 134,117
Federal Grants 61,790
State Grants
Police Grants
Occupancy Taxes 30,000
Collections Fees-Shallotte Tourism Develeopment 2,000
Law Enforcement -Drug Monies 500
SRFTC Donation -County 70500
Fire Department Donations -
Police Department Donations 2,000
District Fire Fees 858,497
Sunny Side Revenue 750
Controlled Substance Tax
ABC -Law Enforcement
Solid Waste Disposal Tax 2,994
Total
1,901,196
1,100,148

Permits and Fees
Notice/Advertising 200
Recording Fee 200
Sign Permits 500
Driveway Permits 150
Zoning Permit Fees 13,000
Sidewalk Fee in Lieu -
Rezone Application Fees 500
Annexation Fees Site Plan -Non Residential 500
Preliminary Plat -Major Subdivision
Stormwater Permit 500
Conditional Use 500
Text Amendment 300
Christmas Parade 2,500
Total
Ordinance #2020-06
Budget Ordinance
For the Year Ending June 30, 2021
$ 18,850
Sales and Services
Famrer's Market Revenue 2,000 2,000
Investment Earnings
Investment Earnings 24,500 24,500
Miscellaneous
Miscellaneous 7,500
Rental Income 4,000
Community Garden 250
Festival TDA 10,000
Total
Fund Balance Appropriated
Appropriated Fund Balance -Other
Appropriated Fund Balance -restricted -streets
Total
1,364,415
25,000
21,750
1,389,415
Total General Fund Revenues $ 6,804,827
Section 1 General Fund
Authorized Expenditures
Governing Board $ 96,960
Administration 1,271,991
Police 1,830,011
Fire 1,526,209
Fire training Facility 8,420
Transportation 633,075
Planning 223,835

Parks
Transfer to Capital Protects
Total General Fund Expenditures
Section 2 Water and Sewer Fund
Ordinance It2020-06
Budget Ordinance
For the Year Ending June 30, 2021
469,826
750,000
$ 6,804,827
Anticipated Revenues
Water Charges $ 888,013
Sewer Charges 1,635,911
Penalties -Water & Sewer Charges 17,000
Water Tap Fees 30,000
Sewer Tap Fees 79,000
Reconnect Fees 3,000
Assessment Fees 3,000
System Development Fees -Water 93,934
System Development Fees -Sewer 310,000
Application Fee 4,000
Credit Card Fee 2,500
Interest Income 14,100
Other Revenue 7,500
Water AIA Grant 150,000
Loan repayment from General Fund 19,920
Appropriated Fund Balance 962,768
Total Enterprise Fund Revenues $ 4,220,646
Authorized Expenditures
Water Operations $ 1,395,286
Sewer Operations 2,285,861
Debt Service 40,499
Regional Partnership Fee -Capital Charges Paid to Brunswick County 499,000
Total Enterprise Fund Appropriations $ 4,220,646
Section 3 Capital Projects
The following capital projects have been adopted under separate project ordiances and
transfers to these projects are included in this annual budget.
Rlverfront Development Capital Project
Revenues
Grants $ 500,000
Transfer from General Fund 1,030,000
Appropriated Fund Balance 19,000
Total Revenues $ 1,549,000
Expenditures
Professional Services $ 8,500
Capital Outlay-Riverwalk 1,540,500
Total Expenditures $ 1,549,000

Ordinance 02020-06
Budget Ordinance
For the Year EndingJune 30, 2021
Shallotte Riverfront Utilities Capital Project
Revenues
USDA Loan Proceeds $ 1,900,000
Grants 300,000
Transfer from Water and Sewer Fund 10,000
Total Revenues $ 2,210,000
Expenditures
Legal Services $ 60,000
Professional Services 250,000
Capital Outlay 1,900,000
Total Expenditures $ 2,210,000
Section 4 Levy of Taxes
There Is hereby levied, for fiscal year 2021, an Ad Valorem Tax Rate of $0.3525 per One Hundred Dollars ($100)
valuation of taxable property as listed for taxes as of January 1, 2020, for the purpose of raising the revenue from current
taxes as set forth in the foregoing estimates of revenues, and in order to finance the foregoing applicable appropriations.
Section 5 Levy of Fees
There Is hereby established For the fiscal year 2021 various fees as listed in Attachment A.
Section 6 Finance Office -Special Authorization
A. The finance officer may transfer amounts between objects of expenditure within a department without limitation and
without a report being requested.
B. The finance officer may not transfer amounts between funds or from any contingency appropriations within a fund.
Section 7. Budget Ordinance Utilization
A. This ordinance shall be the basis of the financial plan for the Town of Shallotte during fiscal year 2021. The finance
officer shall administer the budget and ensure that the operating officials are provided guidance and sufficient details to
implement their appropriate portion of the budget.
B. The finance officer shall establish and maintain all records which are in agreement with this ordinance and the
Local Government Budget and Fiscal Control Act of the State of North Carolina (Chapter 159 of the General Statutes).
C, The finance officer will provide a monthly report to the Board of Aldermen.
Section 8 Budget Ordinance Copies
Copies of the Budget Ordinance shall be furnished to the Fiance Officer, the Budget Officer, and the Town Clerk of the
Town of Shallotte, NC for their direction In the carrying out of their duties.
Adopted this 17th day of June, 2020.
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_ Sandy StricklandICCMC
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Town of Shallotte
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Name
Chuck Denely
Dwayne Simmons
Aaron Stanley
James Harrison
SPILL RESPONSE INFORMATION
Phone
910-253-6789
910-287-5781
910-508-1698
910-393-8003
24 Hour on Call Technician on a Rotation Basis:
Workers on -call number 910-233-5693
1- 100 KW Generator
4 — Pump Trucks
2 — Backhoes
2-Trackhoes
Pipe, Fittings, Repair Clamps, etc.
4 — Dump Trucks
5 — Service Buildings w/ Tools
Mobile
274-6769
470-8952
508-1698
Maintenance Building on Russ Street
Maintenance Building on Russ Street
Maintenance Building on Russ Street
Maintenance Building on Russ Street
Maintenance Building on Russ Street
Maintenance Building on Russ Street
Maintenance Building on Russ Street

Spill Response Information Response Action/Pump Failure
Contingency Plan;
The following shall be procedure of response to lift station/pump failure and spill/overflow.
DWQ# WQCS00296
RESPONSE TIME- 30 MINUTES NOTIFICATION
ON CALL INFORMATION: Phone: [phone]
SUPERVISOR: Chuck Denely: 910-274-6769
ENGINEER: David B. Bowman, PE 910-443-2082
BRUNSWICK ELECTRIC MEMBERSHIP CORPORATION:
Main: 910-754-4391
Maintenance: 1-800-842-5871
Outages: 1-800-682-5309
ATLANTIC TELEPHONE MEMEBERSHIP CORPORATION: Day & Night
Main: 910-754-4311
Line Locate: 910-754-4317
REGIONAL OFFICE:
After hours:
910-796-7215
1-800-858-0368
BRUNSWICK COUNTY:
Main: 910-253-2000
Public Utilities: 910-253-2655
Ken Harmon 910-274-1098 West Brunswick High School Lift Station
SUPPLIER:
Fortaline Supplies
EQUIPMENT:
Emergency Generator, Spare pumps, parts, etc. — located at 103 Russ St. - Maintenance Building
EMERGENCY FUND:
Town Administrator: Mimi Gaither 910-754-4032
Finance Officer: Isaac Norris 910-754-4032
Mayor: Walt Eccard 910-755-7582
SITE SANITATION AND CLEANUP:
Pump truck, lime, Clorox, Line cleaning equipment — located at the maintenance building.
IF SPILL HAS OCCURRED, CALL SUPERVISOR AND REFER TO SPILL
OVERFLOW.