NC0026646_Application (ATC)_20240418

Inn Shaping Communities Together
meJ ill
April 2, 2024
Mr. Ori Tuvia RECEIVED
Complex Permitting Unit
NCDEQ Division of Water Resources APR 18 2024
Water Quality Permitting Section
9th Floor Archdale Building
512 North Salisbury Street NCDEQ/DWR/NPDES
Raleigh, North Carolina 27604
RE: Authorization to Construct Application
Wastewater Treatment Plant Upgrades ,�,,
Town of Pilot Mountain, North Carolina t�a'��
Mr. Tuvia:
On behalf of the Town of Pilot Mountain, we hereby request authorization to construct the
proposed Wastewater Treatment Plant Upgrades project. Enclosed is the Authorization to
Construct Application submittal package for the above referenced project. The submittal
package consists of:
1. Application for Authorization to Construct Permit (Hard Copy and Digital Copy via email)
2. Project Plans (Digital Copy via email)
3. Project Specifications (Digital Copy via email)
4. Design Calculations (Digital Copy via email)
5. NPDES Permit (NC0026646) (Digital Copy via email)
The proposed project generally includes: replacement mechanized screen, bypass channel with
manual bar rack; replacement of aeration basin equipment and improvements; chlorine contact
basin improvements including mud valves and chemical feed piping; chemical feed equipment
and building improvements; converting the dechlorination system from sulfur dioxide gas to liquid
sodium bisulfite; RAS/WAS pump station improvements, sludge holding tank equipment
replacement; effluent pump station improvements including replacement of vertical turbine
pumps, valves, piping, and controls; operations building lighting and roof replacement; new
generator and automatic transfer switch; and associated electrical, piping, paving, and other
appurtenances. Construction is scheduled to commence in late 2024. Should you have any
questions or need any additional information please call our office at 828-328-2024.
Sincerely,
MCGILL ASSOCIATES, P.A.
N0a1 W.
NOAH W. GREEN, PE
Project Engineer II
NWG:cr
Enclosures
cc: Michael Boaz, Town Manager
MCGILL ASSOCIATES 1240 19"' STREET LANE NVV. HICKORY NC 28601 /828.328 2024/MCGILLASSOCIATES COM

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
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. A check or money order must be submitted in the amount of$1000.00 (except minor modifications) dated within 90 days of
application submittal and made payable to North Carolina Department of Environmental Quality(NCDEQ).
C. 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.
D. The plans and specifications submitted must represent a completed fmal design that is ready to advertise for bid.
E. Any content changes made to this Form ATC 10-23 shall result in the application package being returned.
F. 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.
G. Check the boxes below to indicate that the information is provided and the requirements are met.
H. 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.
I. 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 or the funding entity specifies that this requirement does not apply.
J. For more information,visit the Division of Water Resources web site at:http://portal.ncdenr.org/web/wq/swp/ps/npdes.
K. 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 Pilot Mountain
Signature authority's name per 15A NCAC 02T.0106(b) Michael Boaz
Signature authority's title Town Manager
Complete mailing address 124 West Main Street,Box 1,Pilot Mountain,NC 27041
Telephone number [phone]
Email address [e-mail]
B. PROFESSIONAL ENGINEER
Professional Engineer's name Noah W.Green,PE
Professional Engineer's title Project Engineer II
North Carolina Professional Engineer's License No. 053056
Firm name McGill Associates,P.A.
Firm License number C-0459
Complete mailing address 1240 19th Street Lane NW,Hickory,NC 28601
Telephone number 828-328-2024
Email address [e-mail]
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 1

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
C. NPDES PERMIT
NPDES Permit number NC0026646
Current Permitted flow(MGD)—include permit 1.50
flow phases if applicable
D. PROJECT DESCRIPTION
Provide a brief description of the project:
The proposed project generally includes:replacement mechanized screen,bypass channel with manual bar rack;replacement of
aeration basin equipment and improvements;chlorine contact basin improvements including mud valves and chemical feed
piping; chemical feed equipment and building improvements;converting the dechlorination system from sulfur dioxide gas to liquid
sodium bisulfite;RAS/WAS pump station improvements,sludge holding tank equipment replacement;effluent pump station
improvements including replacement of vertical turbine pumps,valves,piping,and controls; operations building lighting and roof
replacement;new generator and automatic transfer switch;and associated electrical,piping,paving,and other appurtenances.
SECTION 3: APPLICATION ITEMS REQUIRED FOR SUBMITTAL FOR ALL PROJECTS
A. Cover Letter
N 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.
N 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.
❑ If the project is funded by American Rescue Plan Act(ARPA) funds, please include the ARPA project number in the cover
letter and here.-Not Applicable
B. NPDES Permit
N 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.
N 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.
N Not Applicable.
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 2

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
E. Engineering Plans
N 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.
N 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.
N Plans must be labeled as follows:FINAL DRAWING—FOR REVIEW PURPOSES ONLY—NOT RELEASED FOR
CONSTRUCTION.
N I5A 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?E]Yes or❑No. If no,provide an explanation:
Plans shall include:
N Plans for all applicable disciplines needed for bidding and construction of the proposed project(check as appropriate):
N Civil 0 Not Applicable
N Process Mechanical 0 Not Applicable
N Structural 0 Not Applicable
N Electrical 0 Not Applicable
N Instrumentation/Controls 0 Not Applicable
❑ Architectural N Not Applicable
❑ Building Mechanical N Not Applicable
❑ Building Plumbing N Not Applicable
N Plan and profile views and associated details of all modified treatment units including piping,valves, and equipment(pumps,
blowers,mixers,diffusers,etc.)
N 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.
N 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. N Engineering Specifications
N 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.
N Specifications must be labeled as follows: FINAL SPECIFICATIONS — FOR REVIEW PURPOSES ONLY — NOT
RELEASED FOR CONSTRUCTION.
Specifications shall include:
N Specifications for all applicable disciplines needed for bidding and construction of the proposed project(check as appropriate):
N Civil 0 Not Applicable
N Process Mechanical 0 Not Applicable
N Structural 0 Not Applicable
N Electrical 0 Not Applicable
N Instrumentation/Controls 0 Not Applicable
O Architectural N Not Applicable
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 3

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
❑ Building Mechanical ® Not Applicable
❑ Building Plumbing Z 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
El 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:(SEE SHEET G-003)
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.Not Applicable-Existing Structures
® Supporting documentation that the specified auxiliary power source is capable of powering all essential treatment units.
I. Permits
El Provide the following information for each permit and/or certification required for this project:
Permit/ If Not Issued Provide
Not Date Date Certification Status and Expected
Permit/Certification Applicable Submitted Approved Number Issuance Date
Dam Safety X
Soil Erosion and Sediment Control X
USCOE /Section 404 Permit X
Water Quality Certification(401) X
USCOE/Section 10 X
Stormwater Management Plan X
CAMA X
NCDOT Encroachment Agreement X
Railroad Encroachment Agreement X
Other: X
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 4

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
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(i)and.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. (Proposed Improvements are equipment only and will not result in a change to sludge production and/or
sludge process'.
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 5

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
SECTION 4: PROJECT INFORMATION
A. WASTEWATER TREATMENT PLANT FLOW INFORMATION—COMPLETE FOR NEW OR
EXPANDING FACILITIES-Not Applicable
1. Provide the following flow information:
Plant Flows
Existing Plant Design MGD
Current NPDES Permit Limit MGD
Current Annual Average MGD
(past 12 months)
For Past 12 Months: For Past 24 Months:
Start Date: month/yr Start Date: month/yr
End 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 10-23) Page 6

•
State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
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 Desi Criteria for NPDES Wastewater
Treatment Facilities been met by the proposed design and specifications?EYes or 1No. 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:
Project Basis of Design
Influent Design Influent Design Influent
Concentration Concentration Load
-Current (Must be (Must be
Annual supported by supported by Design Effluent
Average(past Engineering Engineering Concentration and/or NPDES Permit Limits
12 months)if Calculations Calculations Load (monthly average)
Parameter Available [Section 3.H]) [Section 3.H])
Ammonia Nitrogen N/A 35 mg/L 438 lb/day 28.6 rng/L 28.6 mg/L
(NH3-N)
Biochemical
Oxygen Demand 176 mg/L 250 mg/L 3,128 mg/L 30 mg/L 30 mg/L
(BOD5)
Fecal Coliform 200 per 100 mL 200 per 100 mL
Nitrate+Nitrite
Nitrogen(NO3-N+ N/A N/A
NO2-N)
Total Kjeldahl N/A
Nitrogen
N/A N/A
Total Nitrogen
N/A N/A
N/A N/A
Total Phosphorus N/A N/A N/A
N/A N/A
Total Suspended Solids(TSS) 81 mg/L 220 mg/L 2,752 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 0 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:
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(1),power reliability shall be provided consisting of automatically activated standby power supply
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 7

•
State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
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? 0 Yes or 0 No. If no,explain the alternative design criteria proposed for this project in accordance 15A NCAC
02T.105(n): Not applicable
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: Not applicable
9. Is the treatment facility located within the 100-year flood plain? ®Yes or 0 No. If yes,describe how the facility is
protected from the 100-year flood:All electrical equipment is 2.0 feet or higher than the 100-year flood elevation.Tops of
concrete walls are 12 inches above the 100-year flood elevation.
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):
No.of Plan Sheet Specification Calculations
Treatment Unit Type Size per Unit Provided?
Units Reference Reference (Yes or No)
Coarse; bypass M-241 to
Yp
Manual Bar Screen i 3.75 MGD at peak hourly flow N/A No
channel M-244
Mechanical Bar Element Screen - M-241 to
Screen l 6 mm openings 3.75 MGD at peak hourly flow M 244 462157 Yes
Grit Removal N/A
Flow Equalization N/A
Primary Clarifier N/A
Primary Clarifier N/A
Other N/A
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 8

•
State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
2. SECONDARY TREATMENT(BIOLOGICAL REACTORS AND CLARIFIERS)(i.e.,biological and chemical
processes to remove organics and nutrients)
No.of Plan Sheet Specification Calculatios
Treatment Unit Units Type Size per Unit Reference Reference Provided?
(Yes or No)
Aerobic Zones/ Orbal Style
M-201 to
Tanks 1 Oxidation Ditch 1,559,700 gallons M-205 465361 Yes
with 3 Rings
Anoxic Zones/ N/A
Tanks
Anaerobic N/A
Zones/Tanks
Sequencing Batch N/A
Reactor(SBR)
Membrane N/A
Bioreactor(MBR)
Secondary N/A
Clarifier
Secondary
N/A
Clarifier
Other N/A
3. TERTIARY TREATMENT-Not applicable
No.of Plan Sheet Specification Calculations
Treatment Unit Provided?
Units Type Size per Unit Reference Reference
(Yes or No)
Tertiary Clarifier N/A
TertiaryClarifierN/A
Tertiary Filter N/A
Tertiary Membrane N/A
Filtration
Post-Treatment N/A
Flow Equalization
Post-Aeration N/A
Other N/A
4. DISINFECTION
No.of Plan Sheet Specification Calculatios
Treatment Unit Units Type Size per Unit Reference Reference Provided?
(Yes or No)
Ultraviolet Light N/A
Chlorination Sodium One(1)330 Gallon Tote;
M-401 to
N/A Hypochlorite One(1)Skid with Two(2) Feed M 405 463344 Yes
(12.4%) Pumps
Dechlorination Sodium One(1)55 Gallon Tank; M-401 to Yes
N/A Bisulfate One(1)Skid with Two(2) Feed M-405 463344
(38%) Pumps
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 9

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
5. RESIDUALS TREATMENT
No.of Plan Sheet Specification Calculations
Treatment Unit Provided
Units Type Size per Unit Reference Reference
(Yes or No)
Gravity Thickening N/A
Tank
Mechanical
Thickening/ N/A
Dewatering
Aerobic Digestion N/A
Anaerobic N/A
Digestion
Composting N/A
Drying N/A
Other N/A Sludge Storage 117,400 gallons; M-701 to 465116 Yes
Tank (4) 15.0 HP Blowers M-704
6. PUMP SYSTEMS(include influent,intermediate,effluent,major recycles,waste sludge,thickened waste sludge and plant
drain pumps)
Capacity
Location No. of Purpose Type of each Plan Sheet Specification
Pumps pump Reference Reference
GPM TDH
Discharge Effluent M-601 to
Effluent Pump Station 2 Water Vertical Turbine 2600 200 M 605 432421
N/A
7. MIXERS-Not applicable
No. of Power of Plan Sheet Specification
Location Mixers Purpose Type each pjxer Reference Reference
(HN/A
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 10

State of North Carolina
DW RDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
8. BLOWERS-Not applicable
No. of Capacity of Plan Sheet Specification
Location Blowers purpose Type ea(hh Blower Reference Reference
CFM)
9. ODOR CONTROL-Not applicable
Location No.of Purpose Type Plan Sheet Specification
Units Reference Reference
N/A
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'l are
as follows:
Minimum Distance Is Minimum Distance
Required from Nearest Requirement met by the
Setback Parameter Design?If"No",identify
Treatment/Storage Setback Waivers in Item D.2
Unit Below
Any habitable residence or place of assembly under separate 100 ft ®Yes ❑ No
ownership or not to be maintained as part of the project site
Any private or public water supply source 100 ft ®Yes ❑ No
Surface waters(streams—intermittent and perennial,perennial 50 ft ®Yes ❑ No
waterbodies,and wetlands)
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: Not applicable
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 11

State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
SECTION 5: APPLICATION CERTIFICATION BY PROFESSIONAL ENGINEER
Professional Engineer's Certification per 15A NCAC 02T.0105:
I,Noah W. Green, PE,McGill Associates,attest that this application package for an Authorization to Construct
(Typed Name of Professional Engineer)
for the Town of Pilot Mountain—Wastewater Treatment Plant Upgrades
(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:
`�`\' `� CAR0 ii
.• •
Q•`OFSS4,• 7 S".
:4 SEAL .-
• 053056
W W. .
i*A4—
.tiGINE�.-
�°�y w. Ga�� iy
!lIII11�
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 12

•
State of North Carolina
DWRDepartment of Environmental Quality
Division of Water Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT
FORM ATC 10-23
SECTION 6: APPLICATION CERTIFICATION BY APPLICANT
Applicant's Certification per 15A NCAC 02T.0106(b):
I, Michael Boaz,Town Manager ,attest that this application package for an Authorization to Construct
(Typed Name of Signature Authority and Title)
for the Town of Pilot Mountain—Wastewater Treatment Plant Upgrades
(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$10,000,as well as civil penalties up to$25,000 per violation.
Signature: — Date: 3/11/2024
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 By,y Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY STREET,9TH FLOOR
RALEIGH,NORTH CAROLINA 27699-1617 RALEIGH,NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT(FORM ATC 10-23) Page 12