WQ0034964_Regional Office Historical File Pre 2018

NCDENR
North Carolina Department o‘ Environment and Ntur Rscurces
Division of Water Quality
Beverly, Eaves Perdue Ccleen H. Sullins Cee Freeman
Governer Director Secretary
Mr. Jack Shytles. Mayor
Town of Polkville
PO Box 146
Polkville, NC 28136.
September 7, 2010
Subject Permit No. WQ0034964
Woods Grill Sewer Extension
Wastewater Collection System Extension
Cleveland County, North Carolina
Dear Mri. Shytles,
In accordance with your application received on August 27, 2010, we are forwarding herewith
Permit No. WQ0034964 dated September. 7, 2010, to the Town of PcIkville for the construction and
operation of the subject wastewater collection system extension. This permit shall be effective from the
date of issuance until rescinded and shall be subject to the conditions and limitations as specified
therein. This cover letter shall be considered a part of this permit and is therefore incorporated therein
by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities. be properly operated and maintained in accordance with 15A NCAC 2T .0403or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitutean acceptance of any part of the project that does
not meet 1) 15A NCAC 2T; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum; Design
Criteria adopted February 12, 1996, as applicable, 3) and the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as applicable,
unless specifically mentioned herein. Division approval is based on acceptance cf the certification
.provided by a North Carolina. -licensed Professional Engineer in the application. It shall be the
Permittee's responsibility to ensure that the as -constructed project meets the appropriate design criteria
and rules. Failure to comply may result in penalties in accordance with North Carolina General Statute
§143-215„6A through §143-215,6C, construction of additional or replacement wastewater collection
facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing board.
.MooresOle Regional OffK\e,
Location,. 610 East Center Ave., Su1te 301 Mooresville, NC 28115
Phone: [phone] \ Fax' [phone] \ CustomerServce: 1-877-623-6748
Internet: ,rva-vv_npyvajp,icayality_.o[g.
NorffiCarOlina
,Natirralk/

Mr. Shylies
Page 2
Serernber 7, 2C1.',:.';
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations, 'permission is hereby'
granted for the construction and operation of approximately 1,182 linear feet f 8-inch gravity' ,sewer
and the discharge of 6,600 gallons per day of domestic,' wastewater in conformity with 15A NCAC 2T,
the Division's Gravity Sewer Minimum Design Criteria adopted February' 12, 1996, as applicable: the
Div.ision's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and .Force Mains
adopted June 1, 2000, as applicable and other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit.
The sewage and wastewater collected by this system shall be treated in the City of Shelby
VWVTP (NPDES Permit No. NC0024538) prior to being discharged into the receiving stream.
Assessing subsequent impacts to the downstream collection system and treatment
facility is the complete responsibility of the City of Shelby. Shelby must utilize whatever
tracking tools necessary for planning additions of sewer flow in order to maintain compliance
with the WWTP permitted limits and the collection system permit WQCS00037.
Assessing subsequent impacts to the downstream collection system and treatment
facility is the complete responsibility of the Town of Polkville. Polkville must utilize whatever
tracking tools necessary for planning additions of sewer flow in order to maintain compliance
with the WWTP permitted limits and the collection system permit.
Assessing subsequent impacts to the downstream collection system and treatment
facility is the complete responsibility of the Kingstown. Kingstown must utilize whatever
tracking tools necessary for planning additions of sewer flow in order to maintain compliance
with the WWTP permitted limits and the collection system permit WQCSD0258.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding_
If you need additional information concerning this matter, please contact Dee Browder at (704)
663-1699
Sincerely,
4.) -
16 r C leen H S Ilins
co Mooresville Regional Office, Collection System Permit Files
Surface Water Protection Central Files
PERCS

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERM T
This permit shall be effective from the date of issuance untuntil escinded and shall be subject to the
following specified conditions and limitations:
1.. This, permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions, of this permit; 15A NCAC 2T: the Division cf Water Quality's
(Division) Gravity Sewer rvii,nimum Design Criteria adopted February 12 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000: as applicable; and other supporting materials unless specifically
mentioned herein.
This permit shall be effective only with respect to the nature and volume of wastes described n the
application and other supporting data.
The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system-i,,vide collection system perrrit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403. If an individual
permit is not required, the following performance criteria shall he met as provided in 15A NCAC '2T
,0403,
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 1,5A NCAC 28 .0200.
b. A map of the sewer system shall be developed and shall be actively maintained,
c. An operation and maintenance plan shall be developed and implem,ented,
d. Pump stations that are not connected to a telemetry system shall be inspected every day (Le,
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week,
e. High -priority sewer lines shall be inspected at least once per every six-month period cf time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years,
h. Overflows and bypasses shall be reported to the appropriate Division regio,nal office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C.

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee; a formai permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval .of this request shall be
considered cn its merits and may or may not be approved.
5,. Construction of the gravity sewers. pump stationsand force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge cf ',wastewater
to the surface waters of the State,
Per 15A NCAC 2T .0116, upon completion of construction and prior to operation of these
permitted facilities, the completed Engineering Certification form attached to this permit shall be
submitted with the required supporting documents to the address provided on the form. A complete
certification is one where the form is fully executed and the supporting documents are provided as
applicable.
A copy of the construction record drawings shall be maintained cn fiie by the Permittee for the life
of the wastewater collection facilities,
Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the
Division's Gravity Sewer Design Criteria adopted February 12., 1996 as applicable; the Division's
Minimum Design Criteria for the FasteTra,ck Permitting of Pump Station and Force Mains adopted
June 1_2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215.6C.
In the event that the wastewater collection facilities fail' to perform satisfactorily. including the
creation cf nuisance conditions, the Permittee shall take immediate corrective action; including
those as may be required by this Division, such as the construction cf additional or replaciement
facilities.
10, The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not lirnited to apphcabbe n ier buffer
rules in 15A NCAC 2B 0200, erosion and sedimentation control requirements in 15A, NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15,A NCAC 2H .0500.
1 1 Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the fallowing,
a Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps; line
blockage or breakage, etce or
b Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion ef the influent to such station or facility„

Voice mal messages or faxed information is permissible, but shall not be considered as the
initial verbal report Overflows and spills occurring outside normal business hours may also be
reported to the Division of Emergency Management at telephone nuniter [phone] or
[phone] Persons reporting any of the above occurrences shall file a spill report by
complenng Part I of Form CS-SSO nor the most ourrect Divisr,oh approved form), withIn 'lye days
fcblowing first knowledae of the occurrence. This report shall outline the actions taken or
proposed to ensure that the problem does not recur, Part of Form OS-SSO (or the most
orient Division approved form) can also be completed to show that the SSO was beyond
control.
Permit issued this the nth day of September, 2010.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMiSSION
for Golden H Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commisston
Permit Number WQ0034964

Permit No. WQ0034964
September 7, 2010
Owner/Ili/GCS
Jack Shytles, Mayor
Town of Polkville
PO Box 146
Pcikville, NC 28136
woos
David Lattimore
n g stown
1502 Williamson Road
Kingstown, NC .28150
)11P/111-P
Rick Howell, City Manager
City of Shelby
PO Box 207
Shelby, NC 28151
PP
David Odom
Odom & Associates Eng., inc.
152 E. Main Street.
Forest City, NC 28043
Complete and submit this. form to the permit issuing regional office with the folicwing:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
▪ Changes to the project should be clearly identified en the record drawings or in written summary form. Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations cir
minimum design criteria
This project shall not be considered .complete nor allowed to operate until this Engineer's Certification and ail
required supporting documentation have been received by the Division.. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIRCATION
r_j Partial D Final
as a duly registered Professional Engineer in the State of North Carolina; having been
authorized to observe, (Li periodically: weekly, El full time) the construction. of Woods Grill Sewer Extension, a
Cleveland County project for the Perrnittee, hereby state that, to the best of my abilities: due care and MIrgerice was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit) 15A NCAC 21 the Division of Water. Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 as applicable: the Division's 'Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable, and other supporting materials
North Carolina Professional E-ngineer's
seal, signature, and date.
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions

Application Number
• USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
(to be completed by DM))
1 OwneriPermittee:
la. TOWN OF POLKVILLE
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Hon. JACK SHYTLES, MAYOR
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
lc, The legal entity who will own this system is:
0 Individual 0 Federal Il Municipality 0 State/County 0 Private Partnership Ej Corporation 0 Other (specify):
Q ld PO BOX 146
U— Mailing Address
• lf. NC
State
O th.
Telephone
2 Project (Facility) information:
2a WOODS GRILL SEWER EXTENSION
le. POLKVILLE
City
1g, 28136
Facsimile
CL Brief Project Name (permit will refer to this name)
CL
< 3. Contact Person:
• 3a. SCOTT ROACH, EIT — PROJECT MANAGER
Name and Affiliation of Someone Who Can Answer Questions About this Application
0
IL
1-
3b, 828-247-4495
Phone Number
1 Project is
1 j
Zip Code
E-mail
RECEIVEDDtV-
1511,,,m OF WATER QUALITY
WE 21-2 10
SVVP SECTION
MOORESVILLE REGIONAL OFFICE
2h, CLEVELAND
County Where Project is Located
3c, .cott odomen ineenn
E-mail
New 0 Modification (of an existing permit) If Modification, Permit No.:
2. Owner is Public (skip to Item 8(3))
2a. If private, applicant will be:
O Private (go to Item 2(a))
2b If sold, facilities owned by a (must choose one)
0 Retaining Ownership (i,e. store, church, single office, etc.) or
0 Leasing units (lots, townhomes. etc, - skip to Item B(3))
Ej Selling units (lots, townhomes, etc. - go to Item B(2b))
D Public Utility (Instruction C)
0 Homeowner Assoc./Developer (Instruction D)
3. CITY OF SHELBY
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. CITY OF SHELBY WWTF 4b. NC0024538
Name of WWTF WWTF Permit No.
5a, TOWN OF KINGSTOWN 5b. 8" Gravity 5c. W00024522
Owner of Downstream Sewer Receiving Sewer Size 0 Force Main Permit # of Downstream Sewer (Instruction E
6. The origin of this wastewater is (check all that apply):
rt
w
a.
th
CD Residential Subdivision
Ej Apartments/Condominiums
El Mobile Home Park
O School
Restaurant
O Office
0 Retail (Stores, shopping centers)
0 Institution
O Hospital
0 Church
O Nursing Home
O Other (specify):
Volume of wastewater to be allocated or permitted for this particular project:
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
O Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
Flow has already been allocated in Permit No. NC0024538 & WQ0024522
O Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
100 % Domestic/Commercial
% Industrial (attach
description )
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
00 gallons per day
FTA12/07

9, Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T ,0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 1,5A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
Q = 120 SEATS x 40GPD/SEAT + 5 HOMES © 3 BEDROOMS / HOME x 120 GPD / BEDROOM = 6600 GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8"
Length (feet)
1182
New Gravity or Additional
Force Main
NEW GRAVITY
E; 11 Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
LLI
D Pump Station Location ID N/A (self chosen - as shown on plans/map for
Z
im. Design Flow
Operational Point Power Reliability Option
Z (MGD)
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
0 2 - portable generator w/MTS
0
I Pump Station Location ID N/A (self chosen - as shown on plans/map for
Design Flow Power Reliability Option
Operational Point . -
(MGD) GPM TDH 1permanent generator MATS; Force Main Size Force Main Length
2 - portable generator WRITS
, ce Pump Station Location ID N/A (self chosen - as shown on plans/map for
Ili
Design Flow
Operational Point Power Reliability Option
(MGD) 1 - permanent generator w/ATS; Force Main Size Force Main Length
GPM @TDH
2 - portable generator w/MTS
12, Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
O Yes 1 No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
Yes D No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA 1.2/07

4*. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? El Yes D No N/A
Sedimentation and Erosion Control Plan? Ej Yes E3 No N/A
Stormwater? ID Yes EJ No N/A
15, Does this project include any high priority lines, jsee 15A NCAC 02T 0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: El and provide details
1, Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, _JACK SHYTLES, MAYOR , attest that this application for TOWN OF POLKVILLE
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. Note: In accordance with North Carolina
General Statutes 143-215.6A and 143-215.68, 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
s as civil penalties up to $25, 000 per violation
7-g tc2
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC, REFER TO 15A NCAC 02T .0305
0 2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
I, DAVID W. 000M, P.E. , attest that this application for TOWN OF POLKV/LLE has
been reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations,
and all other supporting documentation to the best of my knowledge. 1 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
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 NC General Statutes 143-215.6A and 143-215,68, 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.
2a. DAVID W/ ODOM, PE
Professional Engineer Name
2b. ODOM & ASSOCIATES ENGINEERING, INC
Engineering Firm
2c. 152 E MAIN ST
Mailing Address
2d. FOREST CITY 2e, NC 21. 28043
City State Zip
2i.
2g. 8282474495 2h. 8282474498 davidodomRodomengineerino
Telephone Facsimile corn
NC PE Seat, Sjoature & Date
C 04./ %
FTA12/07

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit .Applications
(FTSE —10/07)
Project Applicant Name: iown of Polkville
Project Name for which flow is being requested: Woods Diner Sewer Extension
illore than one FTSE-10/07 may he required for a single project ifthe owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow
.1„ Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: n/a
b. WWTP Facility Permit 4: nia
AH fiows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP ula
e. WWTP facility's actual avgflow n/a
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used.
0.066
n/a
n/a
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
Pump Station Name
Kin' - o Pli S .ation
Approx. Capacity, MGD .Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
0..230 0.022
III, Certification Statement:
1, Mayor David Lattimore, certify that, to the hest of my knowledge, 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
sanitaty sewer overflows or overburden any downstream pump station en route to the receiving treatment
plant under normal circumstances, 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 ti for which I am the responsible party. Signature of this form indicates acceptance of
this wastewatqr . %
Signing Oficial Signal
Date

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: TOWN OFPOLKVILLE,
Project Name for which flow is being requested: WOODS DINER SEWER EXT
More than one FISE-.10/07 may be required fi)r a single project if the owner of the kilYTP is not responsible for all
pump stations along the route of the proposed '4,rastewater flow
1. Complete this section only if you are the owner of the wastewater treatment plant.
WWTP Facility Naine: N/A
b. WWTP Facility Permit : _____NLA
c. WWTP -facility's permitted, flow
d. Estimated obligated flow not yet tributary to the WWTP N/A
e. WWTP facility's actual avg. flow N/A
Total flow for this specific request 0.066
g. Total actual and obligated flows to the facility
h. Percent of -permitted, flow used
All flows are in MGD
N/A
N/A
N/A
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
Pump Station Name
Approx. Capacity, MGD Approx. Current Avg,
(Firm/Design) Daily Flow, MGD
Polkville Pump Station 0;120
0.002
HI. Certification Statement:
11, Jack Shvtles, Mayor , certify that, to the best of my knowledge, 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. 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 1 and 11 for which [am the responsible party. Signature of this form indicates
acceptance of this wastewater fiow.
Sign Oflkiai Sign u Date

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CITY OF SHE BY
North Carolina
Of a of the
City Manager
Octo
e
2
Town of Polkville
Attn: Honorable Jack
PO Box 146
Polkville, NC 28136
h
le
Re: Letter of Willingness
Town of Polkville Sewer Project
WWTP Permit No. NC0024538
Dear Honorable Mayor Shytl
This letter of willingness shall serve the proposed Town of Polkville Sanitary Sewer Project in
Polkville, NC. The City of Shelby does have the capacity at its Waste Water Treatment Facility
(Permit No. NC0024538) to accept the flow from this project which consists of a proposed pump
station and 6" force main via interconnect with the Town of Kingstown system. The City of
Shelby committed pursuant to Resolution No. 36-2000, 75,000 - 100,000 GPD of treatment
capacity at the Shelby Wastewater Treatment Plant for the Town of Kingstown and surrounding
area.
Should you have any further questions regarding this matter, please don't hesitate to contact
Brad Cornwell at [phone].
Cc: Mrs. Julie McMurry, Interim Utilities Director
Mr. Brad Cornwell, PLS, Assistant Utilities Director
Mr. David Odom, PE, Odom, Hollifield and Associates
MISSION STATEMENT .
We wt l the City of Shelby to be the best governed and most livable city in the, state
of North Carolina placing value on high quality services,. its. citizens and its employees.
WASHINGTON AT GRAHAM ST. • BOX 207 • SHELBY, NORTH C;AROLINA 28151-0207
PHONE [phone] • FAX [phone]

August 16, 2007
TOWN OF KINGSTOWN
2014 KINGSTON ROAD
KINGSTOWN, NC 28150
(704) 8 - 77 Fax [phone]
The 1lannrable Jack hyde
Town of P 1kv it e
PO Box16
Polk Dille, NC 28136
RE: Polkville Surer System Flow Acceptance
Dear Mayor Shy= k:
This letter is to confirm that the Town of Kings wn Sewer Systena can accept the 10,360 galln
per day of waste water from the Town of Polkville"s Sewer System Project, and adequately
convey this flow to the City of Shelby WWTP. The waste water collection system permit
number for the Town of Kingstown is WQ0024522.e suer and waste water collected by
this system will be treated in the City of Shelby V W1 P (NPDES t o N "003 3 0).
Sincere
Mayor Clarence Withrow
Town of Kingstown

Perm it Number WQ0034964
Permit Tracking S
P
a
APS__
09103°1J
Program Category
Non discharge
Permit Type
Gravity SewsrEx
Extensions
Primary Review
dee. brotvder
Coasts
er
Rule
permuted Flow
6600
Facility_
nsion, Pu
Facility Nar re
Woods Grill Sewer Extension
Location Address
Owner
Owner Name
Town of Polies le
nt
p Stattn
Pre
Ong Issue Apo Received Draft Initiated
09 0 /10 08/27 10
effPlated A ivities
fiesta arrant
Subdivision
u^astewater coI#action
Out
taterbodyr Name
Status
Active
Project Type
New Project
Version Permit Classifiedtie
1.00lndlvdtittel
Penni Contact Affiliation
Major/ inor Region
Minor Mooresville
Scheduled
issuance
County
Cleveland
FacilityCori tactAffiliation
Owner Type
Government - Mon i ipal
Owner Affii ati n
Jack Shytie
Mayor
PO Box146
Polkville
Pub lac Notice Issue
0910 a`1 tl
NC 28136
Eit tiv
R ue t 1e eiv Events
Additional Ictfcmidden received
Additional information requested
Epiratien
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. 2/2010 20: 55 7041530988
Permit No. WQ0034964
September 7, 2010
Owner/WQCS
Jack Shyties, Mayor
Town of Polkville
PO Box 146
Polkville, NC 26138
WOGS
David Lattimore
Kingstown
1502 Williamson Road
Kingstown, NC 28150
PDLKVILLE BAPTIST
1/4VTP
Rick Howell, City Manager
City of Shelby
PO Box 207
Shelby, NC 28151
1
PAGE 01
RECEIVED
IMION OF WATER QUALITY
OCT 0 4 2010
SVVP SECTION
PE MOORESVILLE REGIONAL OFFICE
David Odom
Qdom & Associates Eng., Inc,
152 E, Main Street
Forest City, NC 28043
Complete and submit this form to the permit issuing regional office with the foitowing:
One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
Supporting design calculations (selected pumps, system curve, operating paint, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
Changes to the project should be clearly identified on the record drawings or in written summaryorm, permit
modifications are required for any changes resulting In non-cornpliance with this permit, regulations or
'rnnimum d.son critera.
This project shall not be considered complete or allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
EIOINEEWS PlITIFIG/YTION
rj Partial 0/Final
1, 6 (1). , as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe penodically, D weekly, 0 full tirrie) the construction of Woods Grill Sewer Extension, a
Cleveland County project for the Permittee, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this perrrit; 16A NCAC 2T; the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 aa applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting materials,
North Carolina Professional Engineer's
seal, signature, and date:
•
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
mooREsviLLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking ail partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prier to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions.