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HomeMy WebLinkAboutNC0023086_Authorization to Construct_20171229ftdin' Lc, -,dm `Dov ,Ucy\_ McGill A S S O C I A T E S December 22, 2017 Mr. Ron Berry '3PDE6---ti ►VCGu z300b RECEIVED/DENR/DWR North Carolina Department of Environmental Quality DEC 29 2017 NPDES Complex Permitting 512 North Salisbury Street (9th Floor Archdale Buildin Water Resources Raleigh, North Carolina 27604 g) Permitting Section Re: Request for Authorization to Construct Fontana Dam WWTP Improvements Town of Fontana Dam Graham County, North Carolina Dear Mr. Berry: The Town of Fontana Dam hereby requests Authorization to Construct the referenced proposed improvements at the Fontana Dam wastewater treatment plant (NPDES NC0023086) as shown and specified in the enclosed plans, specifications and other supporting documents prepared. This submittal includes one hard copy and one digital copy of the following: • Application for Authorization to Construct Permit (Form ATC -12-14) • Engineering plans for the proposed improvements • Engineering specifications for the proposed improvements • Engineering calculations for the proposed improvements • NPDES Permit NCO023086 • Fontana Dam WWTP Residuals Management Plan If you have any questions or we can provide any additional information, please contact me at kyle.seaman@mcgillengineers.com or by telephone at 828-252-0575, extension 114. Sincerely, McGILL ASSOCIATES, P.A. Kyle Seaman, PE Project Engineer Enclosures cc: Zelerie Rogers, Town of Fontana Dam Mike Dowd, PE, McGill Associates I \Prolects\2016\16 0033 1 \Utters\rb22dec I 7ncdwr doex 55 Broad Street P O Box 2259 ph 828 252 0575 Asheville North Carolina 28801 Asheville, North Carolina 28802 f 828 252 2518 www mceillengmeers corn Water Resources ENVIRONMEWAL QUALITY State of North Carolina Department of Environmental Quality Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) 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 143-2151. 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 //deg nc.gov/about/divisions/water-resources/water- resou rces-permits/wastewater-branch/n Ades-wastewater/a uthorization-to-construct. J. In adds tion 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 RECEIVED/DENR/DWR A. APPLICANT npr a a )n4-7 Applicant's name Town of Fontana Dam Signature authority's name per 15A NCAC 02T 0106(b) Zelerie Rogers Permitting Section Signature authority's title Town Administrator Complete mailing address P.O Box 128, Fontana Dam, NC 28733 Telephone number 828-498-2107 Email address zelerie.rogers@fontanavillage.com B. PROFESSIONAL ENGINEER Professional Engineer's name Kyle M. Seaman Professional Engineer's title Project Engineer North Carolina Professional Engineer's License No. 042470 Firrr 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) Page 1 Wafer Resources ENVIRONMENTAL OUAUTY State of North Carolina Department of Environmental Quality Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) Telephone number 828-252-0575 Email address kyle seaman@mcgillengineers com C. NPDES PERMIT NPDES Permit number NCO023086 Current Permitted flow (MGD) — Include permit 0 30 MGD flow phases if applicable D. PROJECT DESCRIPTION Provide a brief description of the project- Rehabilitate, clean, modify and/or replace multiple WWTP components to address the immediate needs of the facility and improve the quality of the effluent. The proposed project includes the rehabilitation of the existing clarifiers by replacing the sludge collector mechanism In one clarifier, replacing all four(4) submersible sludge pumps in both clarifiers; and replacing the scum pump for both clarifiers; cleaning of residual sludge in the chlorine contact tank, clarifiers and aerobic digester; replacement of the existing air piping within the aerobic digester; replacement of the existing sludge drying bed wet well pumps; modification of aerobic digester piping for the purposes of decanting and truck hauling as a replacement for the sludge drying beds, replacement of the existing gas chlorination system with a liquid chlorination/dechlorination system and the replacement in kind of a non-functional centrifugal blower. 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 PartA (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 ® Not Applicable Application for Authorization to Construct Permit (FORM ATC -12-14) Page 2 State of North Carolina Department of Environmental Quality Division of Water Resources Water Resources ENVIRONMENTAL QUALITY APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) 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): Z-1 Civil ❑ Not Applicable El Process Mechanical ❑ Not Applicable ❑ Structural ® NotApplicable ® Electrical ❑ Not,Apphcable ❑ Instrumentation/Controls ® Not Applicable ❑ Architectural ® Not Applicable ❑ Building Mechanical ® Not Applicable ❑ Building Plumbing ® Not Applicable ® Plan and profile views and associated deta`Is 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 proces I s 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. f Specifications shall include: ® Specifications 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 Ppplicable Application for Authorization to Construct Permit RM ATC -12-14) Page 3 State of North Carolina Department of Environmental Quality Division of Water Resources Water Resources ENVIRONMENTAL QUALITY APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) ® 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' Engineering Specifications Section 011000 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 4.13.2 of this form were determined ® Pollutant loading for each treatment unit demonstrating how the design effluent concentrations in Section 4.6 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 4.0 6. ® Buoyancy calculations for all below grade structures. ® Supporting documentation that the specified auxiliary power source is capable of powering all essential treatment units 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/ If Not Issued Provide Certification Status and Expected Number Issuance Date Dam Safety X Soil Erosion and Sediment Control X Application for Authorization to Construct Permit (FORM ATC -12-14) Page 4 State of North Carolina Department of Environmental Quality Division of Water Resources WaterResources ENVIRONMENTAL QUALITY APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14 USCOE /Section 404 Permit I X Water Quality Certification (401) X USCOE / Section 10 X I Stormwater Management Plan X CAMA y NCDOT Encroachment Agreement ! X Railroad Encroachment Agreement X Other: 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 applicatilon. ® 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 (FARM ATC -12-14) Page 5 i Water Resources ENVIRONMENTAL OUALITY State of North Carolina Department of Environmental Quality Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) SECTION 4: PROJECT INFORMATION A. WASTEWATER TREATMENT PLANT FLOW INFORMATION — COMPLETE FOR NEW OR EXPANDING FACILITIES Provide the following flow information: Application for Authorization to Construct Permit (FORM ATC -12-14) Page 6 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) Page 6 Water Resources LNVIRONN ENT AL QUAL Y State of North Carolina Department of Environmental Quality Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) 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 cnaracteristics that are used as the basis for the project design, and the NPDES permit limits for the following parameters 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 Applicat on for Authorization to Construct Permit (FORM ATC -12-14) Page 7 Project Basis of Design Design Influent Design Influent Influent Concentration Load Concentration - (Must be (Must be Current Annual supported by supported by Average g (past Engineering Engineering Design Effluent 12 months) if Calculations Calculations Concentration and/or NPDES Permit Limits Parameter Available [Section 3.1-1]) [Section 3.1-11]) Load (monthly average) Ammon a Nitrogen mg/L Summer mg/1-Summer (NH3-N) mg/L mg/L Ib/day mg/L Winter mg/L Winter Biochemical Oxygen Demand mg/L mg/L Ib/day mg/L SummerHEmg/LL mer mg/L Winterter (BODS) Fecal Coliform 200 per 100 mL N/A per 100 mL Nitrate + Nitrite Nitroge-i (NO3-N + mg/L mg/L NO2-N) Total Kjaldahl Nitrogen mg/L Total N trogen mg/L mg/L Ib/year Ib/year Total Phosphorus mg/L mg/L Ib/day mg/L mg/L Ib/year Ib/year Total Suspended Solids (TSS) mg/L mg/L 39 9 Ib/day mg/L 30 mg/L 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 Applicat on for Authorization to Construct Permit (FORM ATC -12-14) Page 7 State of North Carolina Department of Environmental Quality Division of Water Resources Water Resources ENVIRONMENTAL QUALITY APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) 4 Per 15A NCAC 02T 050501 by-pass and overflow lines are prohibited Is this condition met by the design? ® Yes or Q 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: A single scum pump will be installed a potable pump will be used when the installed pump is out of service 6 Per 15A NCAC 02T 0505(1) 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(0) a minimum of 30 days of residual storage shall be provided Is this condition met by the design? ® Yes or Q 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(g) the public shall be prohibited from access to the wastewater treatment facilities Explain how the design complies with this requirement The entire facility is surrounded by chain-link fence and all gates are locked 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 C. WASTEWATER TREATMENT UNIT AND MECHANICAL EQUIPMENT INFORMATION -COMPLETE FOR NEW OR EXPANDING FACILITIES AND FOR MODIFIED TREATMENT UNITS I. PRELIMINARY AND PRIMARY TREATMENT (i.e., Treatment Unit Manual Bar Screen Mechanical Bar Screen Grit Removal Flow Equalization Primary Clarifier Primary Clarifier Other No. of I Units Type ical removal operations and flow equalization): Plan Sheet Specification Calculations Size per Unit Provided? Reference Reference (Yes or No) MGD at peak hourly flow MGD at peak hourly flow MGD at peak hourly flow gallons Circular ft diameter; ft side water depth Rectangular Application for Authorization to Construct Permit (FORM ATC -12-14) Page 8 K; 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) 2. SECONDARY TREATMENT (BIOLOGICAL REACTORS AND CLARIFIERS) (i e, biological and chemical processes to remove organics and nutrients) Treatment Unit No. of Units Type Size per Unit p Plan Sheet Reference Plan Sheet Reference Specification Calculations Provided? Reference Specification Reference Calculations Provided? (Yes or No) Aerobic Zones/ Tanks ft diameter; ft side water depth Provided? (Yes or No) gallons Tertiary Clarifier Rectangular square feet, ft side water depth Anoxic Zones/ Tanks Tertiary Filter gallons square feet Ultraviolet Light (Parallel; in Anaerobic Zones/Tanks gallons series) Post -Treatment Flow Equalization Sequencing Batch Reactor (SBR) -- -- gallons Post -Aeration Membrane Bioreactor (MBR) -- gallons Liquid Other Secondary Clarifier tank/unit Circular ft diameter, ft side water depth 4 1 Secondary Clarifier Rectangular square feet; ft side water depth Other 3. TERTIARY TREATMENT Treatment Unit No. of Units Type Yp Size per Unit Specification Plan Sheet Reference Specification Calculations Provided? Reference Tertiary Clarifier Circular ft diameter; ft side water depth Provided? (Yes or No) (Yes or No) Tertiary Clarifier Rectangular square feet, ft side water depth Tertiary Filter square feet Ultraviolet Light (Parallel; in Tertiary Membrane Filtration square feet series) Post -Treatment Flow Equalization -- gallons Post -Aeration M-301, M- gallons Chlorination 1 Liquid Other tank/unit 331, M-332 1124 10 4. DISINFECTION Treatment Unit No. of Type Size per Unit p Pian Sheet Specification Calculations Units I Reference Reference Provided? (Yes or No) gal/day per bank at Ultraviolet Light (Parallel; in peak hourly flow; series) number of banks, number of lamps/bank M-301, M- Yes Chlorination 1 Liquid 33,510 gallons of contact tank/unit 331, M-332 1124 10 Application for Authorization to Construct Permit (FORM ATC -12-14) Page 9 Wafer 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) Dechlorination I 1 i I S. RESIDUALS TRFATMFNT Liquid I 21,310 gallons of contact M-301, M- Yes tank/unit 331, M-332 112410 Treatment Unit No. of Units T Type Size per Unit Capacity of each pump Plan Sheet Specification Calculations Specification P Plan Sheet Reference Specification Reference Provided? Reference Reference (Yes or No) Gravity Thickening TDH square feet; ft side Tank Clarifier 5 water depth Submersible Solids Mechanical Thickening/ Withdraw dry Ib/hour Dewatering 20 M-301, M-30 223120 Aerobic Digestion Supernatant/Digest Submersible Solids Anaerobic Digestion Handlins gallons 30 Composting 22 3120 dry lb/hour Drying dry lb/hour Other 6. PUMP SYSTEMS (include influent, intermediate, effluent, mayor recycles, waste sludge, thickened waste sludge and plant drain pumps) Location No. of Pumps Purpose Type Capacity of each pump plan Sheet Specification P Plan Sheet Reference Specification Reference GPM TDH Reference Reference Clarifier 5 Sludge/Scum Submersible Solids Withdraw Handling 100 20 M-301, M-30 223120 Digester Wet Well 2 Supernatant/Digest Submersible Solids er Overflow Handlins 136 30 M-303 22 3120 7. MIXERS Location No. of Mixers Purpose Power of Type each Mixer (HP) Plan Sheet Reference Specification Reference Application for Authorization to Construct Permit (FORM ATC -12-14) Page 10 Water Resources ENVIRONMENTAL QUALITY 8. BLOWERS State of North Carolina Department of Environmental Quality Division of Water Resources APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14) Location No. of Blowers Purpose Type Capacity of each Blower (CFM) Plan Sheet Reference Specification Reference 9. ODOR CONTROL Location No. of Units Purpose Type Plan SheetI Specification Reference 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 LSetbac,k Minimum Distance Is Minimum Distance meter Required from Nearest Requirement met by the Treatment/Storage Design? If "No", identify UnitSetback Waivers in Item D.2 Below Any haitable 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 11 Yes E] No Surface waters (streams — intermittent and perennial, perennial waterbodies, and wetlands) 50 ft ❑ Yes ❑ No ell with exception of monitoring wells 100 ft ❑ Yes ❑ No [AEnyproperty line 50 ft ❑Yes ❑ No 2. Have any setback waivers been obtained per 15A NCAC 02T .0506(d)? E:l 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 Application for Authorization to Construct Permit (FORM ATC -12-14) Page 11 I f» State of North Carolina ' Department of Environmental Quality Division of Water Resources Water Resources ENVIRONMENTAL QUALITY 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, Kyle M. Seaman, attest that this application package for an Authorization to Construct (Typed Name of Professional Engineer) for the Town of Fontana Dam Wastewater Treatment Plant Improvements (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 4.13.1 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 143-215.613, 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: `��►ltlill),/I •Q SEAL 'r-= 042470 -� _ y 'fj•• ZZ •zoi �� - C���l ; fid 1 `,�\� Application Tor Authorization to Construct Permit (FORM ATC -12-14) Page 12 Nz- State of North Carolina Department of Environmental Quality Division of Water Resources i9'c1tet RC,, ow p, `"`''IN: L"`''- OUr. , 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, Zelerie Rogers, Town Administrator of Fontana Dam attest that this application package for an Authorization to Construct (Typed Name of Signature Authority and Title) for the Town of Fontana Dam Wastewater Treatment Plant Improvements (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 NCACO2T.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 143-215.66 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 a ceed $10,000, as well as civil penalties up to $25,000 per violation. Signature:"2AI Date: THE COMPLETED APPLICATION AND SUPPORTING INFORMATION SHALL BE SUBMITTED TO: NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES x , DIVISION OF WATER RESOURCES/NPDES By U.S. Postal Service By Courier/Special Delivery: 1617 MAIL SERVICE CENTER 512 N. SALISBURY STREET, 9TH FLOOR RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604 TELEPHONE NUMBER: (919) 807-6396 A....Ii...,+i..n f... +n r -4.r. -r+ D—If /MPU ATr_17_1A1 Paaa 1 R