NC0020354_Authorization to Construct_20180810

No.tncarorna Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
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 143-215.1, and Division of Water Resources Minimum Design Criteria for NPDES
Wastewater Treatment Facilities.
C. The plans and specifications submitted must represent a completed final design that is ready to advertise for bid.
D. Any content changes made to this Form ATC -12-14 shall result in the application package being returned.
E. The Applicant shall submit ONE ORIGINAL and ONE DIGITAL COPY (CD) of the application, all supporting documentation and
attachments. All information must be submitted bound or in a 3 -ring binder, with a Section tab for each Section, except the
Engineering Plans.
F. Check the boxes below to indicate that the information is provided and the requirements are met.
G. If attachments are necessary for clarity or due to space limitations, such attachments are considered part of the application
package and must be numbered to correspond to the item referenced.
H. For any project that requires review under the State Environmental Policy Act (SEPA), an Authorization to Construct cannot be
issued prior to the completion of a State Clearinghouse advertisement period for a FONSI, EIS, etc. unless the project qualifies
for a Determination of Minor Construction Activity.
I. For more information, visit the Division of Water Resources web site at: bhlttp.//P-Qria1.ncdenr.org/web/wq/swp/ps/nodes.
J. In addition to this Authorization to Construct, the Applicant should be aware that other permits may be required from other
Sections of the Division of Water Resources (for example: reclaimed water facilities permits; Class A or B biosolids residuals
permit).
SECTION 2: APPLICANT INFORMATION AND PROJECT DESCRIPTION
A. APPLICANT
Applicant's name Town of Pittsboro
Signature authority's name per 15A NCAC 02T.0106(b) Mr. John Poteat
Signature authority's title Utilities Director
Complete mailing address 635 East Street, Pittsboro, NC 27312
Telephone number [phone]
Email address [e-mail]
B. PROFESSIONAL ENGINEER
Professional Engineer's name
Professional Engineer's title
North Carolina Professional Engineer's License No
Firm name
Firm License number
Complete mailing address
Telephone number
Charles W. Davis
Project Manager
NC 22531
The Wooten Company
F-0115
120 N. Boylan Ave., Raleigh, NC 27603
[phone]
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 1

Nonhcawrm Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
lEmail address cdavis0thewootencompany.com
F
C. NPDES PERMIT
NPDES Permit number
NCO020354
I Current Permitted flow (MGD) — include permit 1.249 mgd
flow phases if applicable
D. PROJECT DESCRIPTION
Provide a brief description of the project: The project includes the construction of a new headworkslpump station to transmit
wastewater from Pittsboro to the Sanford Big Buffalo Wastewater Treatment Plant. The headworks consists of the followine:
mechanical bar screens with screening compaction, grit removal, influent flow measurement and odor control. The transfer
pump station consists of three (31 transfer pumps, two (2) equalization pumps, and odor control system. The existing
aeration/clarifier basins and the existing sludge storage tanks will be modified to become equalization storage. An 18 -inch
force main is being provided from the new pump station to the Sanford plant.
SECTION 3: APPLICATION ITEMS REQUIRED FOR SUBMITTAL FOR ALL PROJECTS
A. Cover Letter
® The letter must include a request for the Authorization to Construct; the facility NPDES Number; a brief project description
that indicates whether the project is a new facility, facility modification, treatment process modification, or facility
expansion; the construction timeline; and a list of all items and attachments included in the application package.
® If any of the requirements of 15 NCAC 02H. 0100, 15A NCAC 02T, North Carolina General Statute 133-3, North Carolina
General Statute 143-215.1, and Division of Water Resources Minimum Design Criteria for NPDES Wastewater Treatment
Facilities are not met by the proposed design, the letter must include an itemized list of the requirements that are not met.
B. NPDES Permit
® Submit Part I of the Final NPDES permit for this facility that includes Part A (Effluent Limitations and Monitoring
Requirements) for the monthly average flow limit that corresponds to the work that is requested for this project.
C. Special Order by Consent
❑ If the facility is subject to any Special Orders by Consent (SOC), submit the applicable SOC.
® Not Applicable.
D. Finding of No Significant Impact or Record of Decision
❑ Submit a copy of the Finding of No Significant Impact or Record of Decision for this project.
❑ Provide a brief description of any of the mitigating factors or activities included in the approved Environmental Document
that impact any aspect of design of this project, if not specified in the Finding of No Significant Impact or Record of Decision.
❑ Not Applicable.
E. Engineering Plans
® Per 15A NCAC 02T .0504X1(1), submit one set of detailed plans that have been signed, sealed and dated by a North Carolina
Licensed Professional Engineer.
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 2

NWn caow Division of Water Resources State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
® Per 21 NCAC 56 .1103(a)(61, 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 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:
N Plans for all applicable disciplines needed for bidding and construction of the proposed project (check as appropriate):
N Civil ❑ Not Applicable
N Process Mechanical ❑ Not Applicable
N Structural ❑ Not Applicable
N Electrical ❑ Not Applicable
N Instrumentation/Controls ❑ Not Applicable
N Architectural ❑ Not Applicable
N Building Mechanical ❑ Not Applicable
N Building Plumbing ❑ 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. See Sheet C1 of the Plans
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
❑ Not Applicable
N Process Mechanical
❑ Not Applicable
N Structural
❑ Not Applicable
N Electrical
❑ Not Applicable
N Instrumentation/Controls
❑ Not Applicable
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 3

Nonh Ca►dha Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
M 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 publically bid projects.
G. Construction Sequence Plan
® Construction Sequence Plan such that construction activities will not result in overflows or bypasses to waters of the State.
The Plan must not imply that the Contractor is responsible for operation of treatment facilities. List the location of the
Construction Sequence Plan as in the Engineering Plans or in the Engineering Specifications or in both: Specification Section
01100 — Summary of Work, Paragraph 1.03 Work Sequence
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 4.13.2 of this
form were determined.
® Hydraulic loading for each treatment unit.
® Sizing criteria for each treatment unit and associated equipment (blowers, mixers, pumps, etc.)
® Total dynamic head (TDH) calculations and system curve analysis for each pump specified that is included in Section 4.C.6.
® Buoyancy calculations for all below grade structures.
❑ Supporting documentation that the specified auxiliary power source is capable of powering all essential treatment units.
I. Permits
® Provide the following information for each permit and/or certification required for this project.-
Not
roject:
Permit/ If Not Issued Provide
Permit/Certification
Not
Applicable
Date
Submitted
Date
Approved
5/16/18
Certification
Number
Status and Expected
Issuance Date
August 2018
Dam Safety
N/A
Soil Erosion and Sediment Control
3/13/18
4/5/18
SAW -2018-
00847
USCOE 1 Section 404 Permit
Water Quality Certification (401)
4/5/18
5/17/18
_
18-0487
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 4

J.
NorthCardna State of North Carolina
Division of Water Resources Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
USCOE / Section 10
N/A
Stormwater Management Plan
N/A
CAMA
N/A
NCDOT Encroachment Agreement
2/16/18
August 2018
Railroad Encroachment Agreement
N/A
1/19/18
7/12/18
1257163
Other:
i
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(1) 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.
SECTION 4: PROJECT INFORMATION
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 5

Nwh «m Division of Water Resources State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
A. WASTEWATER TREATMENT PLANT FLOW INFORMATION —COMPLETE FOR NEW OR EXPANDING FACILITIES
1. Provide the following flow information:
Plant Flows
Existing Plant Design MGD
Current NPDES Permit Limit I MGD
Current Annual Average
(past 12 months) MGD
For Past 12 Months: For Past 24 Months:
Start Date: Start Date:
End Date: End Date:
Maximum Month I MGD I MGD
Maximum Day MGD MGD
Peak Hour MGD MGD
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 6

North Carding Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
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
GeneFal 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( ).:
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: N/A
Project Basis of Design
Design Influent Design Influent
Influent Concentration Load
Concentration - (Must be (Must be
Current Annual supported by supported by
Average (past Engineering Engineering Design Effluent
12 months) if Calculations Calculations Concentration and/or NPDES Permit Limits
Parameter Available [Section 3.H)) [Section 3.H]) Load (monthly average)
Ammonia Nitrogen mg/L Summer mg/L Summer
(NH3-N) mg/L mg/L Ib/day f
mg/L Winter mg/L Winter
Biochemical mg/L Summer mg/L Summer
Oxygen Demand mg/L mg/L Ib/day
(BODS) mg/L Winter mg/L Winter
Fecal Coliform per 100 mL per 100 mL
Nitrate + Nitrite
Nitrogen (NO3-N + mg/L N/A mg/L
NO2-N)
Total Kjeldahl mg/L
Nitrogen
mg/L mg/L
Total Nitrogen
Ib/year Ib/year
mg/L mg/L
Total Phosphorus mg/L mg/L Ib/day
Ib/year Ib/year
Total Suspended mg/L mg/L Ib/day mg/L mg/L
Solids (TSS)
3. Based on the "Project Basis of Design" parameters listed above, will the proposed design allow the treatment facility to
meet the NPDES Permit Limits listed above? ❑ Yes or ® No. If no, describe how and why the Permit Limits will not be
met: Not Applicable
4. Per 15A NCAC 02T .0505(1), by-pass and overflow lines are prohibited. Is this condition met by the design? ® Yes or ❑ No
If no, describe the treatment units bypassed, why this is necessary, and where the bypass discharges:
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 7

Nocn ca►orhaDivision of Water Resources State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
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.05056), 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 ® 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 the public shall be prohibited from access to the wastewater treatment facilities. Explain how
the design complies with this requirement: The existing plant site is surrounded by 6' high chain link fencing with barbed
wire and all gated entrances 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: Portions of the plant site is located in the 100 -year flood plain. The 100 -year flood
elevation is 341.4 feet (Firm Map 3710974100J) and the new improvements will be constructed above this 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):
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 8
Calculations!
Treatment Unit
No. of
TypeSize
per Unit
7—
Plan Sheet
Specification
Provided?
Units
Reference
Reference
�
M1
(Yes or No)
Manual Bar Screen
1
Bar Rack
7.5 MGD at peak hourly flow
N/A
No
Mechanical Bar
Bar Rack w/
M2, M3,
Yes
Screen
2
Rake
7.5 MGD at peak hourly flow
M4
11071
Grit Removal 2 Vortex
7.5 MGD at peak hourly flow
M2, M5,
11320
Yes, grit
M7
pump only
Ex. Eq. 1 & 2 - 600,000 gal. total
Flow Equalization 5 Total Aerated
New Eq. 3 & 4 — 596,000 gal. total
C7, C8, C13
11083, 11095
Yes
New EQ 5 —150,000 gal. total
ft diameter; ft side
Primary Clarifier Circular
water depth
square feet; ft side
Primary Clarifier Rectangular
water depth
Other
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 8

State of North Carolina
Norchcardina pjvjSjpn of Water Rso�ircDepartment of Environment and Natural Resources
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) N/A
3. TERTIARY TREATMENT N/A
No. of
No. of
Plan Sheet
Specification
Plan Sheet
Specification
Calculations
Treatment Unit
Units
Type
Size per Unit
Reference
Reference
Provided?
(Yes or No)
Tertiary Clarifier Circular
Reference
(Yes or No)
Aerobic Zones/
Tertiary Clarifier
Rectangular
square feet; ft side
Tanks
hourly flow; number of
gallons
water depth
Anoxic Zones/
Tertiary Filter
square feet
Tanks
Tertiary Membrane
gallons
square feet
Chlorination
Anaerobic
Filtration
gallons
tablet; liquid)
Zones/Tanks
Post -Treatment
--
gallons
(Gas;
Sequencing Batch
Flow Equalization
-"
gallons
tablet; liquid)
tank/unit
Reactor (SBR)
Post -Aeration
gallons
Other
Membrane
_
gallons
Bioreactor (MBR)
Secondary Clarifier
Circular
ft diameter; ft side
water depth
Secondary Clarifier
Rectangular
square feet; ft side
water depth
Other
3. TERTIARY TREATMENT N/A
No. of
Plan Sheet
Specification
Calculations
Treatment Unit Type
Units
Size per Unit
Reference
Reference
Provided?
Size per Unit
ft diameter; ft side
eification
Provided?
(Yes or No)
Tertiary Clarifier Circular
Reference
water depth
Tertiary Clarifier
Rectangular
square feet; ft side
(Parallel; in
hourly flow; number of
water depth
series)
Tertiary Filter
square feet
Tertiary Membrane
square feet
Chlorination
Filtration
tablet; liquid)
tank/unit
Post -Treatment
--
gallons
(Gas;
gallons of contact 1
Flow Equalization
tablet; liquid)
tank/unit
Post -Aeration
gallons
Other
4. DISINFECTION N/A
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 9
Calculations
Treatment Unit
No. of
Type
Size per Unit
Plan SheetFRecerence
eification
Provided?
Units
Reference
(Yes or No)
gal/day per bank at peak
Ultraviolet Light
(Parallel; in
hourly flow; number of
series)
banks; number of
lamps/bank
gallons of contact
Chlorination
(Gas;7
tablet; liquid)
tank/unit
Dechlorination
(Gas;
gallons of contact 1
tablet; liquid)
tank/unit
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 9

Nonh cacw Division of Water R -25C]lll-c es
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
5. RESIDUALS TREATMENT N/A
Treatment Unit No. of
Units
Gravity Thickening
Tank
Mechanical
Thickening/
Dewatering
Aerobic Digestion
Anaerobic
Digestion
Composting
Drying
Type
Size per Unit
square feet; ft
side water depth
dry Ib/hour
gallons
dry lb/hour
dry Ib/hour
Plan Sheet Specification Calculations
Reference Reference Provided?
(Yes or No)
6. PUMP SYSTEMS (include influent, intermediate, effluent, major recycles, waste sludge, thickened waste sludge and plant
drain pumps)
Capacity of
Location No. of Purpose Type each pump Plan Sheet 'Specification
Pumps GPM TDH Reference Reference
_
Transfer Pump Pump raw wastewater to 1,040 in
Station 3 Sanford Big Buffalo Creek Suction -Lift parallel 25 M8, M10 11309
WWTP
Equalization Pumps 2 Pump Eq. flow to Suction -Lift 1700 60 M8, M11 11310
Equalization Basins
Grit Lift Pump No. 1 1 Pump grit to Suction -Lift 250 60 M3, M7 11322
cyclone/classifier No. 1
Grit Lift Pump No. 2 1 Pump grit to Suction -Lift 250 63 M3, M7 11322
cyclone/classifier No. 2
Pump eq. flow from Eq.
Drain Pump Station 2 Basins 3&4 to the Transfer Submersible 600 25 C14 11307
Pump Station
7. MIXERS
Location No. of Purpose
Mixers
Power of
Type each Mixer Plan Sheet Specification
(HP) Reference Reference
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 10

Nath Carding Division of Water Resources
No. of
Units
State of North Carolina
Type
Plan Sheet
Reference
Department of Environment and Natural Resources
® Yes
❑ No
Odor control for
Division of Water Resources
E] No
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
8. BLOWERS
Any well with exception of monitoring wells 100 ft
Headworks
1
Any property line 50 ft
Air Scrubber
Capacity of
Location
No. of purpose
Type
each Blower � plan Sheet Specification
no, provide an explanation:
Blowers
Reference Reference
(CFM)
EQ Tank 3 — Blower 1
Positive
Transfer Pump
(existing)
1 EQ Aeration
Displacement
400 C7, C9, C12 N/A
EQ Tank 3 — Blower 2
1
Positive
Liquid Feed
(existing, new motor)
1 EQ Aeration
Displacement
350 to 800 C7, C9, C12 11083
EQ Tank 4 — Blower 1
Positive
(existing)
1
EQ Aeration
Displacement
400
C8, C9, C12 N/A
EQ Tank 4 — Blower 2
Positive
(existing, new motor)
1
EQ Aeration
Displacement
350 to 800
C8, C9, C12
11083
9. ODOR CONTROL N/A
Location
No. of
Units
Purpose
Type
Plan Sheet
Reference
Specification
Reference
® Yes
❑ No
Odor control for
® Yes
E] No
waterbodies, and wetlands)
influent headworks
Any well with exception of monitoring wells 100 ft
Headworks
1
Any property line 50 ft
Air Scrubber
❑ No
2. Have any setback waivers been obtained per 15A NCAC 02T .0506(d)? ❑ Yes or ® No.
If yes, have these waivers been
and transfer pump
Yes or ❑ No. If
no, provide an explanation:
station wet well
Mitigation of
Transfer Pump
Hydrogen Sulfide
1
Liquid Feed
Station
generation in force
main to Sanford
D. SETBACKS —COMPLETE FOR NEW WASTEWATER TREATMENT STRUCTURES
1. The minimum distance for each setback parameter to the wastewater treatment/storage units per 15A NCAC 02T .0506(b)
are as follows:
Setback Parameter
Is Minimum Distance
Minimum Distance Requirement met by the
Required from Nearest Design? If "No", identify
Treatment/Storage
Unit Setback Waivers in Item D.2
Below
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 11
Any habitable residence or place of assembly under separate
ownership or not to be maintained as part of the project site
100 ft
® Yes
❑ No
Any private or public water supply source 100 ft
® Yes
❑ No
Surface waters (streams — intermittent and perennial, perennial
50 ft
® Yes
E] 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:
Application for Authorization to Construct Permit (FORM ATC -12-14)
Page 11

North carorna Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
SECTION 5: APPLICATION CERTIFICATION BY PROFESSIONAL ENGINEER
Professional Engineer's Certification per 15A NCAC 02T.0105:
I, Charles W. Davis, P.E. , attest that this application package for an Authorization to Construct
(Typed Name of Professional Engineer)
for the Town of Pittsboro WW Transmission System 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 4.6.1 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 143-215.68, 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:
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Application for Authorization to Construct Permit (FORM ATC -12-14) Page 12

State of North Carolina
worth c�d� pivisiort of Water Resources
Department of Environment and Natural Resources
Division of Water Resources
APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATC -12-14)
SECTION 6: APPLICATION CERTIFICATION BY APPLICANT
Applicant's Certification per 15A NCAC 02T .0106(bl:
I, John Poteat, Utilities Director, attest that this application package for an Authorization to Construct
(Typed Name of Signature Authority and Title)
for the Town of Pittsboro Wastewater Transmission Svstem Imorovements
(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 143-215.66 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 exceed 1-9,000, as well as civil penalties up to $25,000 per violation.
Signature: Date. q1Z1/Y
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 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 -12-14)
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