WQCS00140_Renewal (Application)_20220812

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0400—SYSTEM-WIDE WASTEWATER 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 Municipal Permitting 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.
The copy may be submitted in digital format. RECEIVED
A. Cover Letter AUG 1 2 2022
® Submit a cover letter listing all items and attachments included in the permit application package EQIDWRINPDES
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 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 1.3 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 I 5A 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 Directors are not authorized to sign this permit application, according to the rule,
unless they are formally delegated.
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION Page 1 of 5

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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
MUNICIPAL PERMITTING UNIT
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N.SALISBURY ST.Suite 925
RALEIGH,NORTH CAROLINA 27699-1617 RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone] TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION CSA 04-16&SUPPORTING DOCUMENTATION Page 2 of 5

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Town of Columbus
P.O. Box 146
Columbus, NC 28782
August 3, 2022
Michael Montebello
Supervisor RECEIVED
Municipal Permitting Unit
Division of Water Resources AUG 1 2 2022
1617 Mail Service Center
Raleigh, NC 27699 NCDEQ/DWRINPDES
Dear Mr. Montebello,
Please find enclosed the Town of Columbus' pp
permit renewal application for Permit No. WQCS00140. If
you have any questions, please feel free to contact me Jason Phillips at [phone] or by e-mail at
[e-mail].
Sincerely,
Jason Phillips
Assistant Director/ORC
Town of Columbus
P.O. Box 146
Columbus, NC 28782

. I. APPLICANT INFORMATION:
1. Applicant's name(Municipality,Public Utility,etc):Town of Columbus
2. Facility Information: Name: TOC Collection System Permit No.: WQCS00140
3. Applicant type: ®Municipal ❑State ❑Privately-Owned Public Utility
❑County ❑Other:
4. Signature authority's name:Tim Barth per 15A NCAC 02T.0106(b)
Title:Town Manager
5. Applicant's mailing address:P.O.Box 146
City: Columbus State:NC Zip:28782-
6. Applicant's contact information:
Phone number:[phone] Fax number: ()_- Email address:townmanagerAcolumbusnc.com
II. CONTACT/CONSULTANT INFORMATION:
1. Contact Name:Jason Phillips
2. Title/Affiliation:ORC
3. Contact's mailing address: P.O.Box 146
4. City:Columbus State:NC Zip:28782-
5. Contact's information:
Phone number:[phone] Fax number: ( )_- Email address:[e-mail]
III. GENERAL REQUIREMENTS:
1. New Permit or Premit Renewal? El New ®Renewal
2. County System is located in: Polk County
3. Owner&Name of Wastewater Treatment Facility(ies)receiving wastewater from this collection system:
Owner(s)&Name(s):Town of Columbus
4. WWTF Permit Number(s): NC 0021369
5. What is the wastewater type? 100%Domestic or %Industrial(See 15A NCAC 02T.0103(20))
Lj Is there a Pretreatment Program in effect?❑Yes or❑No
6. Wastewater flow: .140 MGD(Current average flow of wastewater generated by collection system)
7. Combined permitted flow of all treatment plants: .800 MGD
8. Explain how the wastewater flow was determined: ❑ I5A NCAC 02T .0114 or® Representative Data
9. Population served by the collection system: 1.200
IV. COLLECTION SYSTEM INFORMATION:
1. Line Lengths for Collection System:
Sewer Line Description Length
Gravity Sewer 18.2(miles)
Force Main 2(miles)
Vacuum Sewer 0(miles)
Pressure Sewer 0(miles)
APPLICATION CSA 04-16 Page 3 of 5

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2. Pump Stations for Collection System:
Pump Station Type Number
Simplex Pump Stations(Serving Single Building)
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.
2. Indicate the current designated collection system operators for the collection system per 15A NCAC 08G.0201
Main ORC Name: Jason Phillips Certification Number:990185
Back-Up ORC Name: James Smith Certification Number: 988472
See the"WQCS 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: $200,000
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❑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

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• 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 El 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. 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 El No 12—18 mo.
I(5)— Grease inspection and enforcement program ®Yes El No 12—18 mo.
I(6)—Three to five year current Capital Improvement Plan. ❑Yes ❑No 12—18 mo.
1(8)—Pump station contingency plan ®Yes ❑No 3 mo.
I(9)—Pump station identification signs. Z Yes ❑No 3 mo.
I(11)—Functional and conspicuous audible and visual alarms. ®Yes ❑No 3—6 mo.
11(5)—Spare pumps for any station where one pump cannot
handle peak flows alone(in a duplex station,the 2°a pump is ®Yes El No 6—9 mo.
the spare if pump reliability is met).
I1(7)—Accessible right-of-ways and easements. ®Yes ❑No 6—12 mo.
11(9)—Response action plan with Items 9(a—h). ®Yes ❑No 3 mo.
III(3)—Comprehensive collection system map ❑Yes ®No 10%per year
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):
WI. APPLICANT'S CERTIFICATION per 15A NCAC 02T.0106(b):
I,Tim Barth attest that this application for Town of Columbus
(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 well as civil penalties up to$25,000 per violation.
Signature: 31.ir-osy Oird Date:
APPLICATION CSA 04-16 Page 5 of 5

August 3, 2022
Collection System Permit No. WQCS00140
Town of Columbus
PO Box 146
Columbus, NC 28782
NCDENR Collection System
High Priority List
Manhole Numbers Priority
Between#114&#115 Stream Crossing
Between#287 &#290 Above Ground
Between#284&#286 Above Ground
Between#404&#124 Stream Crossing
Between#121&#122 Stream Crossing
Between#146&#149 Stream Crossing
Between#182 &#183 Stream Crossing
Between#350&#351 Stream Crossing
Between#288&#289 Stream Crossing

August 3, 2022
Collection System Permit No.WQCS00140
Town of Columbus
PO Box 146
Columbus, NC 28782
NCDENR Collection System
Lift Station List:
Name Address Capacity
'Hospital' Lift Station 829 West Mills St. Duplex—200 GPM
'Highwood' Lift Station 15 Pine Tree Lane Duplex—150 GPM
'BP' Lift Station 404 W. Mills St. Duplex—400 GPM
'Case St.' Lift Station 160 Case St. Duplex—100 GPM
'Farm' Lift Station 451 Industrial Park Drive Duplex—280 GPM
Alarm Time: Audible
Reliability Source: Permanent Generator
24 hour run time of station:
Hospital Lift Station: 1%-2 hours each 24-hour period
Highwood Lift Station: 15—20 minutes each 24-hour period
BP Lift Station: 2 hours each 24-hour period
Case St. Lift Station: 1 hour each 24-hour period
Farm Lift Station: 20 minutes each 24-hour period

FY 22/23_Budget by Department
Proposed 5.19.22
Revised 5.25.22
Enterprise Fund Departments
EXPENSES _
Sewer Department
Account Description AccountNo FY 19/20 Actual FY 20/21 Actual FY 21/22 YTD FY 21/22 Budget FY 22/23 Proposed FY22/23 Revised
,-._ Salaries/Wages 60-7130-121 158,120 165,208 122,850 185,000 238,000 238,000
f Salaries OT/PT 60-7130-123 7,416 8,295 3,726 10,000 12,000 12,000
Council Salaries 60-7130-124 10,000 10,000 5,000 10,000 10,000 10,000
401(K) 60-7130-134_ 7,276. 7,983 6,073 10,000 12,500 12,500
FICA Taxes 60-7130-181 13,610 13,860 10,075 15,500 20,000 20,000
Retirement 60-7130-182 16,161 19,300 13,337 22,000 30,300 30,300
Health Insurance 60-7130-183 23,952 27,640 27,608 34,500 36,500 36,500
Worker Compensation Ins 60-7130-186 1,822 2,950 2,023 3,500 3,500 3,500
Accounting 60-7130-191 _ 3,325 3,590 5,250 3,800 6,000 6,000
Community Alert Notific 60-7130-193 500 0 0 500 500 500
Professional Services 60-7130-199 10,292 23,111 4,496 20,000 8,000 8,000
IT Services/Subscriptions 60-7130-200 6,349 10,000 10,000 10,000
Uniforms 60-7130-212 615 447 336 1,500 2,500 2,500
Safety 60-7130-230 593 634 2,388 1,000 2,000 2,000
Auto Fuel 60-7130-251 2,683 4,435 4,356 3,500 6,000 6,000
Office Supplies 60-7130-252 936 557_ 157 800 800 800
Expendable Equip&Supp 60-7130-260 1,828 2,062 573 2,000 2,000 2,000
Chemicals 60-7130-261 12,202 5,474 6,547 10,000 10,000 10,000
,Maintenance of Equipmen 60-7130-262 6131 0 434 2,500 2,500 2,500
Lift Stations 60-7130-270 13,444 13,150 22,956 20,000 20,000 20,000
Data Processing Supplie 60-7130-291 785 977 71 1,000 1,000 1,000
Maintenance of Vehicle 60-7130-310 2,013 40 2,340 3,000 3,000 3,000
Telephone [phone] 2,106 2,650 1,920 3,300 2,500 2,500
Postage 60-7130-322 2,045 3,350 2,347 5,000 5,000 5,000
Electricity 60-7130-331 51,618 44,120 33,183 50,000 50,000 50,000
Advertising 60-7130-370 834 0 0 500 500 500
Lab/Other Services 60-7130-390 9,925 13,257 12,936 20,000 20,000 20,000
-. . Sludge Hauling 60-7130-391 _ 37,642 30,217 43,714 30,000 30,000 30,000
Insurance and Bonds 60-7130-450 _ 8,244 8,414 9,817 9,000 10,000 10,000
Unemployment Reserve 60-7130-451 93 113 0 0 0 0
Staff Development 60-7130-460 241 624 0 2,500 2,500_ 2,500
Building Maintenance 60-7130-580 2,819 615 15 2,000 6,500 6,500
WWTP Equipment/Maint 60-7130-593 _ 34,520_ 7,556 15,500 15,000 15,000 15,000
Sewer Line Maintenance 60-7130-594 9,327 5,399 30,000 20,000 20,000 20,000
Capital Outlay 60-7130-700 22,513 0 0 25,000 0 _ 0
Sewer Department Total 470,113 426,028_ 396,377 552,400 599,100 599,100
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Financial and Capacity Building Consultancy
• Operation Manual Dhaka Water Supply and Sector Development Project
Emergencies and Contingency Plans
SI Type of Emergency Contingency Plan Reaction
1 Power failure due to Contact electricity office or start standby
supply Interruptions generator
2 Power failure due to 1) Start standby generator
system break down. 2) Inform office
3) Provide tankering away, or pump to nearest
canal if possible
3 Rising main damaged, 1) Shut down lift station, provide tankering away,
burst, blocked or leaking etc.
2) Inform office
3) Keep records of men, time, plant, equipment
and material used
4) Asses why it happened and take measures so
that it does not occur again
4 Pump or component Inform office
failure
ORG in association with 1CRA and Sodev Consult Page-4