NC0026000_Authorization to Construct_20180913

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ENVIRONMENTAL OUAI TY 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 02L 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: http://portal.ncdenr.org/web/wq/swp/ps/npdes.
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).
L
Applicant's name
Town of Tabor City
Signature authority's name per 15A NCAC 02T .0106(b)
Al J. Leonard
Signature authority's title
Town Manager
Complete mailing address
P.O. Box 655 Tabor City, NC 28463
Telephone number
910-653-3458
Email address
[e-mail]
Professional Engineer's name
Benjamin D. Clawson
Professional Engineer's title
Project Engineer
North Carolina Professional Engineer's License No.
033710
Firm name
Municipal Engineering Services Co. P.A.
Firm License number
C-0281
Complete mailing address
68 Shipwash Drive Garner, NC 27529
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 1

C.
r • •
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Telephone number
919-772-5393
Email address
[e-mail]
NPDES Permit number
NCO026000
Current Permitted flow (MGD) — include permit
flow phases if applicable
1.1
PROJECT
DESCRIPTIOiV
Provide a
brief description of the project: The proposed
project will consist of replacing
the existing composite samplers with
new models, Installing automated valve to divert excess influent flow to the surge basin
Replace existing influent pumps with 2
new 50 -Hp
pumps, Install DO probes, Rehabilitate
some piping between Aeration Basin
1 and Clarifier 1 Clean and Re -coat
Clarifier 1,
Rehabilitate RAS/WAS Pump Station by
repairing one pump and replacing second pump Replace Chlorine Contact
Chamber
Change Chlorine and Sulfer Dioxide gas
feeds to respective liquid systems. Replace
existing mixer in Digester with new
surface aerator.
® 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.
® 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.
❑ If the facility is subject to any Special Orders by Consent (SOC), submit the applicable SOC.
® Not Applicable.
❑ Submit a copy of the Finding of No Significant Impactor 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

ENViPONMENTAL GUALiTY APPLICATION FOR AUTHORIZATION TO CONSTRUCT PERMIT (FORM ATG12-
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):
® Civil ❑ Not Applicable
® Process Mechanical ❑ Not Applicable
® Structural ❑ Not Applicable
® Electrical ❑ Not Applicable
❑ Instrumentation/Controls ® Not Applicable
❑ Architectural ® Not Applicable
❑ Building Mechanical ® Not Applicable
❑ Building Plumbing ® Not Applicable
® Plan and profile views and associated details 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 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. ® 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.
Specifications shall include:
® Specifications for all applicable disciplines needed for bidding and construction of the proposed project (check as
appropriate):
® Civil
❑ Not Applicable
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 3

Ls
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ENVIR4kW.,G'3TAL_ OUALiTY
® Process Mechanical
® Structural
® Electrical
1111 11 111 I 1111111111
• f •
❑ Instrumentation/Controls
❑ Architectural
❑ Building Mechanical
❑ Building Plumbing
❑ Not Applicable
❑ Not Applicable
❑ Not Applicable
® Not Applicable
® Not Applicable
® Not Applicable
® 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: Sequence Plan is laid
out as part of the Engineering Plans,
Fi. 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.
❑ Supporting documentation that the specified auxiliary power source is capable of powering all essential treatment units.
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 4

cN IRONncEN AL GUAL.TY
M
D
• • •
® Provide the following information for each permit and/or certification required for this project:
Permit/Certification
Not
Applicable
Date
Submitted
Date
Approved
Permit/
Certification
Number
If Not Issued Provide
Status and Expected
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:
❑ 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 .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.
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 5

K, cn etResources
EN`.IPONMENTAE._ OUACiTY
1
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1. Provide the following flow information:
Plant Flows
Existing Plant Design
1.1 MGD
Current NPDES Permit Limit
1.1 MGD
Current Annual Average
(past 12 months)
0.450 MGD
For Past 12 Months:
For Past 24 Months:
Start Date: Feb 2018
Start Date: Feb 2018
End Date: Mar 2017
End Date: Mar 2016
Maximum Month
0.620 MGD
0.702 MGD Oct 2016
4.88 MGD Oct 8 2016
This flow occurrence was during
Maximum Day
2.52 MGD
Hurricane Matthew and is thought to
be skewed due to flooding in
receiving stream
Peak Hour
[Data not Available] MGD
[Data not Available] MGD
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 6

1 t.e R.aso tare s
eKNM.,WAENTAL OUAUri
State of
-,. • • •
Division Water R. �. Caroli
FOR TREATMENT PROCESS MODIFICATIONS
1. Have all of the requirements of 15 NCAC 02H. 01004 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 characteristics that are used as the basis for the project design, and the NPDES
permit limits for the following parameters:
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:
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 7

ENVI1TaPdMEN'T AIL QUALITY
1
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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:
5. Per 15A NCAC 02T .0505(k), multiple pumps shall be provided wherever pumps are used
design? ® Yes or ❑ No. If no, provide an explanation:
Is this condition met by the
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 ❑ No. If no, explain the alternative design criteria proposed for this project in accordance 15A NCAC
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: Existing fence around the perimeter of the facility with locked gate for entry
El
�'7
Is the treatment facility located within the 100 -year flood plain?
protected from the 100 -year flood:
Yes or ®No. If yes, describe how the facility is
1. PRELIMINARY AND PRIMARY TREATMENTphysical removal operations and flow equalization):
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 8
No. of
Plan Sheet
Specification
Calculations
Treatment Unit
Type
Size per Unit
Provided?
Units
Reference
Reference
(Yes or No)
Manual Bar Screen
N/A
Mechanical Bar
1
Multi -Rake
2.75 MGD at peak hourly
Major
Equipment
Y
Screen
flow
Item #1
Grit Removal
N/A
MGD at peak hourly
flow
New Automated
Major
Y
Flow Equalization
1
Valve
16" Plug Valve & Actuator
Equipment
Item #1
ft diameter; ft
Primary Clarifier
N/A
Circular
side water depth
Primary Clarifier
N/A
Rectangular
square feet; ft
side water depth
Other
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 8

ENVIRONMENTAL OVAL TY
14)
State of North Caroli
2. SECONDARY TREATMENT (BIOLOGICAL REACTORS AND CLARIFIERS) (i.e., biological and chemical processes to remove
organics and nutrients)
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 9
Calculations
No. of
Plan Sheet
Specification
Treatment Unit
Units
Type
Size per Unit
Reference
Reference
Provided?
Units
Reference
Reference
(Yes or No)
Aerobic Zones/
gal/day per bank at peak
(Yes or No)
N/A
gallons
Tanks
N/A
Circular
Anoxic Zones/
N/A
gallons
Tanks
N/A
Rectangular
square feet; ft side
Anaerobic
N/A
gallons
Zones/Tanks
N/A
square feet
Sequencing Batch
N/A
--
gallons
Reactor (SBR)
Membrane
N/A
--
gallons
Bioreactor (MBR)
Secondary Clarifier
N/A
Circular
ft diameter; ft side
Other
N/A
water depth
Secondary Clarifier
N/A
Rectangular
square feet; ft side
water depth
Other
N/A
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 9
Calculations
No. of
Plan Sheet
Specification
Treatment Unit
Units
Type
Size per Unit
Reference
Reference
Provided?
Units
Reference
Reference
(Yes or No)
gal/day per bank at peak
(Yes or No)
ft diameter; ft side
Tertiary Clarifier
N/A
Circular
water depth
Tertiary Clarifier
N/A
Rectangular
square feet; ft side
water depth
Tertiary Filter
N/A
square feet
Tertiary Membrane
N/A
square feet
Filtration
Post -Treatment
N/A
--
gallons
Flow Equalization
Post -Aeration
N/A
gallons
Other
N/A
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 9
Calculations
No. of
Plan Sheet
Specification
Treatment Unit
Units
Type
Size per Unit
Reference
Reference
Provided?
(Yes or No)
gal/day per bank at peak
hourly flow; number of
Ultraviolet Light
N/A
(Parallel; in
banks; number of
series)
lamps/bank
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 9

V(24 r PC'G.1501 rces
CNViR3NMFNTAL OVAL:TY
L
5.
6.
r:. • r EMEMIEW
PUMP SYSTEMS (include influent, intermediate, effluent, major recycles, waste sludge, thickened waste sludge and plant
drain pumps)
Location
No. of
Pumps
Purpose
9400 gallons of contact
Capacity of
each pump
Plan Sheet
Reference
Y
Chlorination
i system
Liquid
tank/unit
C3 — C4
Specification
21000
Treatment Unit
Units
Type
gallons of contact
Reference
Reference
Provided?
Dechlorination
1System
Liquid
tank/unit
(Yes or No)
PUMP SYSTEMS (include influent, intermediate, effluent, major recycles, waste sludge, thickened waste sludge and plant
drain pumps)
Location
No. of
Pumps
Purpose
Type
Capacity of
each pump
Plan Sheet
Reference
Calculations
GPM
No. of
Influent Pump
Station
2
Plan Sheet
Specification
21000
Treatment Unit
Units
Type
Size per Unit
Reference
Reference
Provided?
700
30
Major
Equipment
Item #2
(Yes or No)
Gravity Thickening
N/A
square feet; ft side
Tank
water depth
Mechanical
Thickening/
N/A
dry Ib/hour
Dewatering
Replace
Y
Major
Aerobic Digestion
1
E
Existing mixer
25 HP
C-2 / C-3
Equipment
with new
Item # 6
aerator
Anaerobic
N/A
gallons
Digestion
Composting
N/A
dry Ib/hour
Drying
N/A
dry Ib/hour
Other
N/A
PUMP SYSTEMS (include influent, intermediate, effluent, major recycles, waste sludge, thickened waste sludge and plant
drain pumps)
Location
No. of
Pumps
Purpose
Type
Capacity of
each pump
Plan Sheet
Reference
Specification
Reference
GPM
TDH
Influent Pump
Station
2
Replacement for ExistingMajor
Pumps — Upsize to match
largest Pump in Station
Self -Priming
Pump
21000
54
Equipment
Item #2
RAS / WAS Pump
Station #1
1
In -Kind Replacement of
Existing Pump
Self -Priming
Pump
700
30
Major
Equipment
Item #2
7. MIXERS
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 10

15
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6NtsIPOFlh:ENTAL `UALIY
�''' •AL,•" •" • • •i ► �' . ••
Location
No. of
Mixers
Purpose
Type
Power of
each Mixer
(HP)
Plan Sheet
Reference
Specification
Reference
N/A
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 11

ENVRO NMFNTA . 03 rAIJTr
L
[J
�•a, • .MEMEEM
Location
No. of
Blowers
Purpose
Type
Capacity of
each Blower
(CFM)
plan Sheet
Reference
Specification
Reference
N/A
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
Location
No. of
Units
Purpose
Type
Plan Sheet
Reference
Specification
Reference
N/A
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
1. The minimum distance for each setback parameter to the wastewater treatment/storage units per 15A NCAC 02T .0506(b)
are as follows:
2. Have any setback waivers been obtained per 15A NCAC 02T .0506(d)? El 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? F1 Yes
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
or ❑ No. If
no, provide an explanation:
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 12

"QIVI Nffources
ENVIRONMENTAL QUALITY
LN
-
ITnTITIOXIMI IMMMITIrIm, Mrs 00
► • c • • •' • �; •,i i • • c
Professional Engineer°s Certification per 15A NCAC 02T .0105:
I, Benjamin D. Clawson ,attest that this application package for an Authorization to Construct
(Typed Name of Professional Engineer)
for the Town of Tabor City 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 143-215.6B, 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:
Application for Authorization to Construct Permit (FORM ATC -12-14) Page 13

ENVIRONM04TAL GUHL Y
E'- X
t, Al 3. Leonard, Town Manager, attest that this applicati©n package fo€an Authorizatiora to Construct
(Typed Name of Signature Authority and Title)
for th8 Town of Tabor City Wastewater Treatn7ent Plant —Tr�wn of Taber city WWTP Icn�raveaa�ents
(Facility and Project Name)
has been reviewed by me and is accurate and c©snplete to the best of rray knowledge. l 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.
1 understand that the Laivision caf Water Resources' issuance n
fthe Authorization to Construct Kermit 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 pians, 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.
1 understand that in accordance wi#h 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 Class 2 misdemeanor,
which may include a fine not tea e.�egd $10,000, as welj� civil penalties up to $25,000 perviolation.
Signature:
App€kation far Authorizatian to Ccrnsiruct Permit (FORM ATC 2 -IM Page 14