NC0025321_Application (ATC)_20210414

APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources

SECTION 1: INSTRUCTIONS AND INFORMATION
A. The Division of Water Resources will accept this application package for review only if all of the items are provided and the
application is complete. Failure to submit all of the required items will result in the application package being returned as incomplete
per 15A NCAC 02T .0105(b).
B. Plans and specifications must be prepared in accordance with 15 NCAC 02H. 0100, 15A NCAC 02T, North Carolina General Statute
133-3, North Carolina General Statute 143-215.1, and Division of Water Resources Minimum Design Criteria for NPDES
Wastewater Treatment Facilities.
C. The plans and specifications submitted must represent a completed final design that is ready to advertise for bid.
D. Any content changes made to this Form ATC-12-14 shall result in the application package being returned.
E. The Applicant shall submit ONE ORIGINAL and ONE DIGITAL COPY (CD) of the application, all supporting documentation and
attachments. All information must be submitted bound or in a 3-ring binder, with a Section tab for each Section, except the
Engineering Plans.
F. Check the boxes below to indicate that the information is provided and the requirements are met.
G. If attachments are necessary for clarity or due to space limitations, such attachments are considered part of the application
package and must be numbered to correspond to the item referenced.
H. For any project that requires review under the State Environmental Policy Act (SEPA), an Authorization to Construct cannot be
issued prior to the completion of a State Clearinghouse advertisement period for a FONSI, EIS, etc. unless the project qualifies for
a Determination of Minor Construction Activity.
I. For more information, visit the Division of Water Resources web site at: https://deq.nc.gov/about/divisions/water-resources/water-
resources-permits/wastewater-branch/npdes-wastewater/authorization-to-construct.
J. In addition to this Authorization to Construct, the Applicant should be aware that other permits may be required from other Sections
of the Division of Water Resources (for example: reclaimed water facilities permits; Class A or B biosolids residuals permit).
SECTION 2: APPLICANT INFORMATION AND PROJECT DESCRIPTION

A. APPLICANT
Applicant’s name Town of Waynesville
Signature authority’s name per 15A NCAC 02T .0106(b) Rob Hites
Signature authority’s title Town Manager
Complete mailing address 16 South Main Street, Waynesville, NC 28786
Telephone number 828.452.2491
Email address [e-mail]

B. PROFESSIONAL ENGINEER
Professional Engineer’s name Keith Webb
Professional Engineer’s title Vice President
North Carolina Professional Engineer’s License No. 12809
Firm name McGill Associates, P.A.
Firm License number C-0459
Complete mailing address 55 Broad Street, Asheville, NC 28801
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 2

State of North Carolina
Department of Environmental Quality
Division of Water Resources

Telephone number 828.252.0575
Email address
C. NPDES PERMIT
NPDES Permit number NC0025321
Current Permitted flow (MGD) – include permit
flow phases if applicable 6 MGD

D. PROJECT DESCRIPTION
Provide a brief description of the project: installation of an influent Parshall flume, installation of primary treatment including
dual-channel screens, vortex grit removal system, and primary disc filters; installation of an influent pump station; rehabilitation
of aeration basins, replacement of diffusers, and installation of new blowers, demolition of two primary clarifiers and installation
of two 100-ft clarifiers, conversion of the intermediate pump station to return activated sludge/wastewater activated sludge
station, modification of chlorine contact basins, conversion of gas disinfection and dechlorination systems to liquid chemical
systems, installation of effluent reuse pump station, replacement of thickening mechanisms in two gravity thickeners,
replacement of existing 1.5-meter belt filter press to a new 2-meter belt filter press, installation of a septage receiving station and
a scum holding tank, installation of two electrical and control buildings, installation of system transfer and backup generator, and
installation of PLC based instrumentations and controls package for monitoring and operating treatment facilities.

SECTION 3: APPLICATION ITEMS REQUIRED FOR SUBMITTAL FOR ALL PROJECTS
A. Cover Letter
The letter must include a request for the Authorization to Construct; the facility NPDES Number; a brief project description
that indicates whether the project is a new facility, facility modification, treatment process modification, or facility expansion;
the construction timeline; and a list of all items and attachments included in the application package.
If any of the requirements of 15 NCAC 02H. 0100, 15A NCAC 02T, North Carolina General Statute 133-3, North Carolina
General Statute 143-215.1, and Division of Water Resources Minimum Design Criteria for NPDES Wastewater Treatment
Facilities are not met by the proposed design, the letter must include an itemized list of the requirements that are not met.
B. NPDES Permit
Submit Part I of the Final NPDES permit for this facility that includes Part A (Effluent Limitations and Monitoring Requirements)
for the monthly average flow limit that corresponds to the work that is requested for this project.
C. Special Order by Consent
If the facility is subject to any Special Orders by Consent (SOC), submit the applicable SOC.
Not Applicable.
D. Finding of No Significant Impact or Record of Decision
Submit a copy of the Finding of No Significant Impact or Record of Decision for this project.
Provide a brief description of any of the mitigating factors or activities included in the approved Environmental Document
that impact any aspect of design of this project, if not specified in the Finding of No Significant Impact or Record of Decision.
___________________________________________________________________________________________
___
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources

Not Applicable.
E. Engineering Plans
Per 15A NCAC 02T .0504(c)(1), submit one set of detailed plans that have been signed, sealed and dated by a North Carolina
Licensed Professional Engineer.
Per 21 NCAC 56 .1103(a)(6), the name, address and License number of the Licensee’s firm shall be included on each sheet of
the engineering drawings.
Plans must be labeled as follows: FINAL DRAWING – FOR REVIEW PURPOSES ONLY – NOT RELEASED FOR CONSTRUCTION.
15A NCAC 02H .0124 requires multiple (dual at a minimum) components such as pumps, chemical feed systems, aeration
equipment and disinfection equipment. Is this requirement met by the design? Yes or No. If no, provide an
explanation: _____________________________ ___ ____ ____
Plans shall include:
Plans for all applicable disciplines needed for bidding and construction of the proposed project (check as appropriate):
Civil Not Applicable
Process Mechanical Not Applicable
Structural Not Applicable
Electrical Not Applicable
Instrumentation/Controls Not Applicable
Architectural Not Applicable
Building Mechanical Not Applicable
Building Plumbing Not Applicable
Plan and profile views and associated details of all modified treatment units including piping, valves, and equipment (pumps,
blowers, mixers, diffusers, etc.)
Are any modifications proposed that impact the hydraulic profile of the treatment facility? Yes or No. If yes, provide
a hydraulic profile drawing on one sheet that includes all impacted upstream and downstream units. The profile shall include
the top of wall elevations of each impacted treatment unit and the water surface elevations within each impacted treatment
unit for two flow conditions: (1) the NPDES permitted flow with all trains in service and (2) the peak hourly flow with one
treatment train removed from service.
Are any modifications proposed that impact the process flow diagram or process flow schematic of the treatment facility?
Yes or No. If yes, provide the process flow diagram or process flow schematic showing all modified flow paths including
aeration, recycle/return, wasting, and chemical feed, with the location of all monitoring and control instruments noted.
F. Engineering Specifications
Per 15A NCAC 02T .0504(c)(2), submit one set of specifications that have been signed, sealed and dated by a North Carolina
Licensed Professional Engineer.
Specifications must be labeled as follows: FINAL SPECIFICATIONS – FOR REVIEW PURPOSES ONLY – NOT RELEASED FOR
CONSTRUCTION.
Specifications shall include:
Specifications for all applicable disciplines needed for bidding and construction of the proposed project (check as
appropriate):
Civil Not Applicable
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 4

State of North Carolina
Department of Environmental Quality
Division of Water Resources

Process Mechanical Not Applicable
Structural Not Applicable
Electrical Not Applicable
Instrumentation/Controls Not Applicable
Architectural Not Applicable
Building Mechanical Not Applicable
Building Plumbing Not Applicable
Detailed specifications for all treatment units and processes including piping, valves, equipment (pumps, blowers, mixers,
diffusers, etc.), and instrumentation.
Means of ensuring quality and integrity of the finished product including leakage testing requirements for structures and
pipelines, and performance testing requirements for equipment.
Bid Form for publicly bid projects.
G. Construction Sequence Plan
Construction Sequence Plan such that construction activities will not result in overflows or bypasses to waters of the State.
The Plan must not imply that the Contractor is responsible for operation of treatment facilities. List the location of the
Construction Sequence Plan as in the Engineering Plans or in the Engineering Specifications or in both: Specification Section
011000 Summary
H. Engineering Calculations
Per 15A NCAC 02T .0504(c)(3), submit one set of engineering calculations that have been signed, sealed and dated by a North
Carolina Licensed Professional Engineer; the seal, signature and date shall be placed on the cover sheet of the calculations.
For new or expanding facilities and for treatment process modifications that are included in Section 4.C, the calculations shall
include at a minimum:
Demonstration of how peak hour design flow was determined with a justification of the selected peaking factor.
Influent pollutant loading demonstrating how the design influent characteristics in Section 4.B.2 of this form were
determined.
Pollutant loading for each treatment unit demonstrating how the design effluent concentrations in Section 4.B.2 of this form
were determined.
Hydraulic loading for each treatment unit.
Sizing criteria for each treatment unit and associated equipment (blowers, mixers, pumps, etc.)
Total dynamic head (TDH) calculations and system curve analysis for each pump specified that is included in Section 4.C.6.
Buoyancy calculations for all below grade structures.
Supporting documentation that the specified auxiliary power source is capable of powering all essential treatment units.
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources

I. Permits
Provide the following information for each permit and/or certification required for this project:
Permit/Certification
Not
Applicable
Date
Submitted
Date
Approved
Permit/
Certification
Number
If Not Issued Provide
Status and Expected
Issuance Date
Dam Safety x
Soil Erosion and Sediment Control May 2021 June 2021
USCOE / Section 404 Permit x
Water Quality Certification (401) x
USCOE / Section 10 x
Stormwater Management Plan May 2021 June 2021
CAMA x
NCDOT Encroachment Agreement x
Railroad Encroachment Agreement x
Other: x
J. Residuals Management Plan
For all new facilities, expanding facilities, or modifications that result in a change to sludge production and/or sludge
processes, provide a Residuals Management Plan meeting the requirements of 15A NCAC 02T .0504(j) and 15A NCAC 02T
.0508; the Plan must include:
A detailed explanation as to how the generated residuals (including trash, sediment and grit) will be collected, handled,
processed, stored, treated, and disposed.
An evaluation of the treatment facility’s residuals storage requirements based upon the maximum anticipated residuals
production rate and ability to remove residuals.
A permit for residuals utilization or a written commitment to the Applicant from a Permittee of a Department approved
residuals disposal/utilization program that has adequate permitted capacity to accept the residuals or has submitted a
residuals/utilization program application.
If oil, grease, grit or screenings removal and collection is a designated unit process, a detailed explanation as to how the
oil/grease will be collected, handled, processed, stored and disposed.
Not Applicable.

APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 6

State of North Carolina
Department of Environmental Quality
Division of Water Resources

SECTION 4: PROJECT INFORMATION
A. WASTEWATER TREATMENT PLANT FLOW INFORMATION – COMPLETE FOR NEW OR EXPANDING FACILITIES
1. Provide the following flow information: n/a; facility is not new or expanding
Plant Flows
Existing Plant Design MGD
Current NPDES Permit Limit MGD
Current Annual Average
(past 12 months) MGD

For Past 12 Months:
Start Date: month/yr
End Date: month/yr
For Past 24 Months:
Start Date: month/yr
End Date: month/yr
Maximum Month MGD MGD
Maximum Day MGD MGD
Peak Hour MGD MGD

APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 7

State of North Carolina
Department of Environmental Quality
Division of Water Resources

B. WASTEWATER TREATMENT FACILITY DESIGN INFORMATION – COMPLETE FOR NEW OR EXPANDING FACILITIES AND
FOR TREATMENT PROCESS MODIFICATIONS
1. Have all of the requirements of 15 NCAC 02H. 0100, 15A NCAC 02T, North Carolina General Statute 133-3, North Carolina
General Statute 143-215.1, and Division of Water Resources Minimum Design Criteria for NPDES Wastewater Treatment
Facilities been met by the proposed design and specifications? Yes or No. If no, provide justification as to why the
requirements are not met, consistent with 15A NCAC 02T .0105(n): ______________________________________________
2. Provide the design influent and effluent characteristics that are used as the basis for the project design, and the NPDES
permit limits for the following parameters:
Parameter
Influent
Concentration -
Current Annual
Average (past
12 months) if
Available
Project Basis of Design
NPDES Permit Limits
(monthly average)
Design Influent
Concentration
(Must be
supported by
Engineering
Calculations
[Section 3.H])
Design Influent
Load
(Must be
supported by
Engineering
Calculations
[Section 3.H])
Design Effluent
Concentration and/or
Load
Ammonia Nitrogen
(NH3-N) mg/L 23.1 mg/L 1,156 lb/day
9 mg/L Summer 9 mg/L Summer
21 mg/L Winter 21 mg/L Winter
Biochemical
Oxygen Demand
(BOD5)
173 mg/L 220 mg/L 11,009 lb/day
30 mg/L Summer 30 mg/L Summer
30 mg/L Winter 30 mg/L Winter
Fecal Coliform 200 per 100 mL 200 per 100 mL
Nitrate + Nitrite
Nitrogen (NO3-N +
NO2-N)
mg/L mg/L
Total Kjeldahl
Nitrogen mg/L
Total Nitrogen mg/L mg/L
lb/year lb/year
Total Phosphorus mg/L mg/L lb/day
mg/L mg/L
lb/year lb/year
Total Suspended
Solids (TSS) 219 mg/L 260 mg/L 13,010 lb/day 30 mg/L 30 mg/L
3. Based on the “Project Basis of Design” parameters listed above, will the proposed design allow the treatment facility to
meet the NPDES Permit Limits listed above? Yes or No. If no, describe how and why the Permit Limits will not be
met:
4. Per 15A NCAC 02T .0505(j), by-pass and overflow lines are prohibited. Is this condition met by the design? Yes or No
If no, describe the treatment units bypassed, why this is necessary, and where the bypass discharges:
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 8

State of North Carolina
Department of Environmental Quality
Division of Water Resources

5. Per 15A NCAC 02T .0505(k), multiple pumps shall be provided wherever pumps are used. Is this condition met by the
design? Yes or No. If no, provide an explanation:
6. Per 15A NCAC 02T .0505(l), power reliability shall be provided consisting of automatically activated standby power supply
onsite capable of powering all essential treatment units under design conditions, or dual power supply shall be provided
per 15A NCAC 02H. 0124(2)(a). Is this condition met by the design? Yes or No. If no, provide (as an attachment
to this Application) written approval from the Director that the facility:
 Has a private water supply that automatically shuts off during power failures and does not contain elevated water
storage tanks, and
 Has sufficient storage capacity that no potential for overflow exists, and
 Can tolerate septic wastewater due to prolonged detention.
7. Per 15A NCAC 02T .0505(o), a minimum of 30 days of residual storage shall be provided. Is this condition met by the
design? Yes or No. If no, explain the alternative design criteria proposed for this project in accordance 15A NCAC
02T .105(n):
8. Per 15A NCAC 02T .0505(q), the public shall be prohibited from access to the wastewater treatment facilities. Explain how
the design complies with this requirement: The plant is enclosed by the fence and gate.
9. Is the treatment facility located within the 100-year flood plain? Yes or No. If yes, describe how the facility is protected
from the 100-year flood: All improvements are designed to limit topography and floodplain impacts as much as practical. Best
management practices for erosion and sediment control will be utilized during construction. The reuse pump station is
watertight and vented 2 foot above the 100-year flood elevation. No WWTP components will be built in the floodway. The
aeration basin modifications will be performed in an existing structure. The only space available within the boundaries of the
WWTP that will permit the construction of large circular secondary clarifiers is the location of the existing primary clarifiers.
While every effort will be made during the design process to locate the new secondary clarifiers outside the 100-year
floodplain, they must be sized to perform adequately and constructed in a location that does not disrupt the hydraulic profile
of the WWTP.
C. WASTEWATER TREATMENT UNIT AND MECHANICAL EQUIPMENT INFORMATION – COMPLETE FOR NEW OR
EXPANDING FACILITIES AND FOR MODIFIED TREATMENT UNITS
1. PRELIMINARY AND PRIMARY TREATMENT (i.e., physical removal operations and flow equalization):
Treatment Unit No. of
Units Type Size per Unit Plan Sheet
Reference
Specification
Reference
Calculations
Provided?
(Yes or No)
Manual Bar Screen MGD at peak hourly flow
Mechanical Bar
Screen 2 Perforated
Plate 15 MGD at peak hourly flow MA Sheets 462153
Grit Removal 1 Vortex 15 MGD at peak hourly flow MA Sheets 462323
Flow Equalization -- gallons
Primary Clarifier Circular ft diameter; ft side
water depth
Primary Clarifier Rectangular square feet; ft side
water depth
Other 3 Disc Filter 15 MGD with 2 units in
operation MA
Sheets 466141
2. SECONDARY TREATMENT (BIOLOGICAL REACTORS AND CLARIFIERS) (i.e., biological and chemical processes to remove
organics and nutrients)
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 9

State of North Carolina
Department of Environmental Quality
Division of Water Resources

Treatment Unit No. of
Units Type Size per Unit Plan Sheet
Reference
Specification
Reference
Calculations
Provided?
(Yes or No)
Aerobic Zones/
Tanks 4 615,000 gallons MB Sheets 465133
Anoxic Zones/
Tanks gallons
Anaerobic
Zones/Tanks gallons
Sequencing Batch
Reactor (SBR) -- gallons
Membrane
Bioreactor (MBR) -- gallons
Secondary Clarifier 2 Circular 100 ft diameter; 15 ft side
water depth MF Sheets 464321
Secondary Clarifier Rectangular square feet; ft
side water depth
Other

3. TERTIARY TREATMENT
Treatment Unit No. of
Units Type Size per Unit Plan Sheet
Reference
Specification
Reference
Calculations
Provided?
(Yes or No)
Tertiary Clarifier Circular ft diameter; ft
side water depth
Tertiary Clarifier Rectangular square feet; ft
side water depth
Tertiary Filter square feet
Tertiary Membrane
Filtration square feet
Post-Treatment
Flow Equalization -- gallons
Post-Aeration gallons
Other
4. DISINFECTION
Treatment Unit No. of
Units Type Size per Unit Plan Sheet
Reference
Specification
Reference
Calculations
Provided?
(Yes or No)
Ultraviolet Light

(Parallel; in
series)
gal/day per bank at
peak hourly flow;
number of banks;
number of lamps/bank

Chlorination 2 liquid (Gas;
tablet; liquid)
83,020 gallons of contact
tank/unit
MH and
MG Sheets
434143,
463344,463366

Dechlorination 2 liquid (Gas;
tablet; liquid)
1833.5 gallons of contact
tank/unit MG Sheets 434143,463344
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 10

State of North Carolina
Department of Environmental Quality
Division of Water Resources

5. RESIDUALS TREATMENT
Treatment Unit No. of
Units Type Size per Unit Plan Sheet
Reference
Specification
Reference
Calculations
Provided?
(Yes or No)
Gravity Thickening
Tank 2 Gravity
380 square feet; 10 ft side water
depth; 616 square feet; 10 ft
side water depth
MI Sheets 467113

Mechanical
Thickening/
Dewatering
1 Belt Filter
Press 2000 dry lb/hour MJ Sheets 467621

Aerobic Digestion gallons
Anaerobic
Digestion gallons
Composting dry lb/hour
Drying dry lb/hour
Other
6. PUMP SYSTEMS (include influent, intermediate, effluent, major recycles, waste sludge, thickened waste sludge and plant
drain pumps)
Location No. of
Pumps Purpose Type
Capacity of
each pump Plan Sheet
Reference
Specification
Reference GPM TDH
Influent 4 Influent Submersible 3,472 37 MA 105 432500
Primary Sludge 2 Primary Sludge Submersible 225 41 MA 108 432500
WAS 2 Secondary Sludge Self-Priming, Solid-
Handling 520 47 MF sheets 432300
Reuse 2 Effluent Reuse Submersible 750 144 MH-103 432500
Secondary Clarifiers 2 Scum Transfer Submersible Grinder 30 24 MF-106 432613

7. MIXERS
Location No. of
Mixers Purpose Type
Power of
each Mixer
(HP)
Plan Sheet
Reference
Specification
Reference

8. BLOWERS
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)

Application for Authorization to Construct Permit (FORM ATC-12-14) Page 11

State of North Carolina
Department of Environmental Quality
Division of Water Resources

Location No. of
Blowers Purpose Type
Capacity of
each Blower
(CFM)
Plan Sheet
Reference
Specification
Reference
By aeration basins 4 Aeration Rotary Screw 2330 MC sheets 431251

9. ODOR CONTROL
Location No. of
Units Purpose Type Plan Sheet
Reference
Specification
Reference

D. SETBACKS – COMPLETE FOR NEW WASTEWATER TREATMENT STRUCTURES
1. The minimum distance for each setback parameter to the wastewater treatment/storage units per 15A NCAC 02T .0506(b)
are as follows:
Setback Parameter
Minimum Distance
Required from Nearest
Treatment/Storage
Unit
Is Minimum Distance
Requirement met by the
Design? If “No”, identify
Setback Waivers in Item D.2
Below
Any habitable residence or place of assembly under separate
ownership or not to be maintained as part of the project site 100 ft Yes No
Any private or public water supply source 100 ft Yes No
Surface waters (streams – intermittent and perennial, perennial
waterbodies, and wetlands) 50 ft Yes No
Any well with exception of monitoring wells 100 ft Yes No
Any property line 50 ft Yes No
2. Have any setback waivers been obtained per 15A NCAC 02T .0506(d)? Yes or No. If yes, have these waivers been
written, notarized and signed by all parties involved and recorded with the County Register of Deeds? Yes or No. If
no, provide an explanation: ___________________

Water Resources
ENVIRONMENTAL QUALITY
State of North Carolina
Department of Environmental Quality
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)
SECTION 5: APPLICATION CERTIFICATION BY PROFESSIONAL ENGINEER
Professional Engineer's Certification per 15A NCAC 02T .0105:
I, M. Keith Webb, attest that this application package for an Authorization to Construct
(Typed Name of Professional Engineer)
for the Wastewater Treatment Plant Improvements Phase I,
(Facility and Project Name)
was prepared under my direct supervisory control and to the best of my knowledge is accurate, complete and consistent
with the information supplied in the engineering plans, specifications, calculations, and all other supporting
documentation for this project. I further attest that to the best of my knowledge the proposed design has been
prepared in accordance with all applicable regulations and statutes, 15 NCAC 02H. 0100, 15A NCAC 02T, North Carolina
General Statute 133-3, North Carolina General Statute 143-215.1, and Division of Water Resources Minimum Design
Criteria for NPDES Wastewater Treatment Facilities, and this Authorization to Construct Permit Application, except as
provided for and explained in Section 4.B.1 of this Application. I understand that the Division of Water Resources'
issuance of the Authorization to Construct Permit may be based solely upon this Certification and that the Division may
waive the technical review of the plans, specifications, calculations and other supporting documentation provided in this
application package. I further understand that the application package may be subject to a future audit by the Division.
Although certain portions of this submittal package may have been prepared, signed and sealed by other professionals
licensed in North Carolina, inclusion of these materials under my signature and seal signifies that I have reviewed the
materials and have determined that the materials are consistent with the project design.
I understand that 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 with written signature placed over or adjacent to the seal and dated:
1 800 :
4- 13 -2-1
Application for Authorization to Construct Permit (FORM ATC-12-14) Page 12

Water Resources
ENVIRONMENTAL QUALITY
State of North Carolina
Department of Environmental Quality
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC-12-14)
SECTION 6: APPLICATION CERTIFICATION BY APPLICANT
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Rob Hites, Town Manager, attest that this application package for an Authorization to Construct
(Typed Name of Signature Authority and Title)
for the Wastewater Treatment Plant Improvements Phase L
(Facility and Project Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. I further certify that in
accordance with 15A NCAC 02T .0120(b), the Applicant or any affiliate has not been convicted of environmental crimes,
has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where all
appeals have been abandoned or exhausted, are compliant with any active compliance schedule, and does not have any
overdue annual fees.
I understand that the Division of Water Resources' issuance of the Authorization to Construct Permit may be based
solely upon acceptance of the Licensed Professional Engineer's Certification contained in Section 5, and that the Division
may waive the technical review of the plans, specifications, calculations and other supporting documentation provided
in this application package. I further understand that the application package may be subject to a future audit.
I understand that 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 $10,0000,, as well as civil penalties up to $25,000 peer violation.
fi4 '/ �/ /C' / Date: �// / '
Signature: i � ��- t. � , =-
THE COMPLETED APPLICATION AND SUPPORTING INFORMATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER RESOURCES/NPDES
By U.S. Postal Service
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
By Courier/Special Delivery:
512 N. SALISBURY STREET, 9TH FLOOR
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
Application for Authorization to Construct Permit (FORM ATC-12-14)
Page 13