WQ0041235_Permit (Issuance)_20191009

Engineering & Surveying, Inc-.
September 2019
NCDENR
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
336-776-9800
Re: Mebane Towne Center, Phase T1A
Fast -Track Sewer Application CPT # 1316-14
Dear Sir/Madam:
Env i( i ar;liiy
Winston-`.;�d<rn
Regional C iice
Please find enclosed the fast -track sewer application and $480.00 fee for your approval.
This multi -family development for Mebane Towne Center, Phase T1A consists of fifty-four (54)
townhomes and a clubhouse with a pool. This phase consists of 48 — 2 bedroom units and 6 — 3
bedroom units for a total of 54 units with a total number of bedrooms being 114. Sewer service
shall be provided by +/-1,542 l.f of 8" sanitary sewer lines (public) by gravity connecting to an
existing 8" gravity sewer line (public) located in a existing 20' sewer easement along the recently
approved Phase Al — Mebane Towne Center plans under construction at this time.
Please review the enclosed application and let me know if you need any additional information
Feel free to give me acall at [phone] ext. 305.
Sincerely,
i r1,/nC. I
Mike Venable
Civil / Survey Technician
CPT Engineering and Surveying, Inc.
4400 Tyning Street • High Point, NC
27265
Phone: [phone], ext 305 • Fax:
[phone]
[e-mail]

CPT Engineering and Surveying, Inc.
4400 Tyning Street • High Point, North Carolina 27265 • Phone [phone] • Fax [phone]
To: NCDEQ Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Rd., Suite 300
Winston-Salem, NC 27107 [phone]
We are sending you:
LETTER OF TRANSMITTAL
Date: 10-01-19
Job No: 1316-14
Attention:
Re: Mebane Towne Center Apts., Phase T1A
S. Fifth St., Mebane, NC
® Attached ❑ Under separate cover via: Fedex the following items:
❑ Plans ❑ Diskeue(s) ❑ For Approval ❑ For Review ❑ Specifications
❑ Other:
Quantity
Dw . No.
Description
Status
1
Fast -Track Sewer Application (FTA-04-16) Package
H
1
Copy of Fast -Track Sewer Application Package
H
1
Check payable to "NCDEQ" for $480.00
H
Status Code: A. Approved D. Rejected - See Remarks G Approved - As noted
B. Sign and Return E. For your information H. As Requested
C. Amend and Resubmit F. Refer to Remarks I. Review and Comment
Remarks: Please find attached the above -described items for Fast -Track Sewer Review. Feel free to call with any
questions or comments.
Envu-onnor'nial O'faliry
Reccit"eil
Win 'r.on-Sa!em
(?eoional Office
Mike Venable
CPT Engineering and Surveying, Inc.
Ext. 305
E-mail: [e-mail]

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
DIvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:'VV Q �D �_)l �;S )(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Mebane (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County Z Municipal ❑ Other
3. Signature authority's name: David Cheek per 15A NCAC 02T .0106(b)
Title: City Manager
CL
4. Applicant's mailing address: 106 East Washington Street wi i U dl [y
City: Mebane State: NC Zip: 27302-
5. Applicant's contact information: CT 0 2, 20i'_
Phone number: 219 563-5901 Email Address: dcheek(cbcitvofinebane.com Winston-Salem
Regional t ffice
II. PROJECT INFORMATION:
1. Project name: Mebane Towne Center Phase T1A
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0740 Longitude:-79.279°
5. Parcel ID (if applicable): 164358, 164338 (Pt.) & 164339
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Charles P. Tmby, Jr. License Number: NC 14984
Firm: CPT Engineering and Surveying. Inc.
Mailing address: 4400 Tyning Street
City: High Point State: NC Zip: 27265-
Phone number: [phone] Email Address: chuckt ,cptengineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mebane Wastewater Treatment Plant Permit Number: NCO021474
Owner Name: City of Mebane
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0040602 (Under Construction) Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS NCO021474
Owner Name(s): City of Mebane
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ® Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
Li,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ®Yes ❑ No
➢ If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)
Daily Design Flow a,b
No. of Units
Flow
Townhouse Unit (2 Bedroom)
160 gallunit
48
7,680 GPD
Townhouse Unit (3 Bedroom)
240 gal/unit
6
1,440 GPD
Clubhouse / Pool
10 gal/person
191
1,910 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Tota[
11,030 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 11 030 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,542 SDR-35
➢ Section II & HI of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VHL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be vrovided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
An swimmingpools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [-]Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ❑ No ® N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
r/�Mlm
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
o!
(Professional Engineer's nam4 from Application Item III.1.)
that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — 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, signature, and date:
SEAL °}
14984
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from, this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. 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.
NOTE — 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.
Signature: "' " Date:
FORM: FTA 04-16 Page 5 of 5

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
March 15, 2011
Robert L. Wilson
City Manager
City of Mebane
106 East Washington Street
Mebane, NC 27302
Subject: Mebane WWTP (NC0021474)
Flow Reduction Request
Alamance County
Dear Mr. Wilson:
Dee Freeman
Secretary
On February 14, 2011, the Pretreatment, Emergency Response and Collection System (PERCS) Unit of
the Division of Water Quality received a flow reduction request for connections to the City of Mebane WWTP.
The letter requests an allowable flow rate of 80 gallons per day (gpd) per bedroom based on the evaluated data.
As daily WWTP data is not representative of the project area, the DMR data from the City of Mebane
WWTP (NC0021474) from January 2009 through December 2009 was evaluated to determine the peak sewage
month. The highest flow month was December 2009. Daily wastewater flows were recorded downstream of
the Holly Ridge Subdivision during December 2010. This data was reviewed by PERCS and Regional Office
staff.
Based on the data, the Division hereby grants a reduction in flow to 80 gpd/bedroom (minimum of 160
gpd for I and 2 bedroom residences) for sewer extension permits issued tributary to the City of Mebane
WWTP.
Regardless of the adjusted design daily wastewater flow rate at no time shall the wastewater flows
exceed the effluent limits defined in the NPDES permit for the treatment facility or exceed the capacity of the
sewers downstream of any new sewer extension or service connection(s).
If you have any questions or comments regarding this matter, please contact Sarah Morrison at (919)
807-6310, or email [[e-mail]] or Deborah Gore, Unit Supervisor at [phone], or
email [[e-mail]].
Sincerely,
, V Coleen H. Sullins
cc: Darrell L. Russell, P.E., Alley, Williams, Carmen & King, Inc. (via email: drussell rGDawck.com)
Steve Maloney, Winston-Salem Regional Office (via email)
NPDES Unit, Permit File NCO021474
PERCS Flow Reduction File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
One
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone]\ FAX: 91"07-6492\ PERCS Unit FAX: [phone]\Customer Service: 1-877-623-6748
No. t.hCarolina
Internet: hftp�llpoftal.ncdenr.org/web/wq PERCS Unit: �:liZonal.ncoenrom/webtwq/swplps/pret
atur�ill�
An Equal Opportunity 1 Affirmative Action Employer

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PHASE T1A TOWNWOMES
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MEBANE. NC
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11 4400 TYNIN6 STREET SCALE: V • 600'
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.PHONE [phone] FAX, MW 812-0780
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DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Mebane
Project Name for which flow is being requested: Mebane Towne Center -Phase Tl
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Mebane
b. WWTP Facility Permit #: NC0021474
All flows are in MGD
c. WWTP facility's permitted flow 2.5
d. Estimated obligated flow not yet tributary to the WWTP 0.696
e. WWTP facility's actual avg. flow 1.45
f. Total flow for this specific request 0.01103
g. Total actual and obligated flows to the facility 2.106
h. Percent of permitted flow used
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design
Average Approx. Obligated,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pfl, Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
Farrar Ln WQ0012938 0.720 0.288 0.072 0.040 0.112 0.176
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Mebane Towne Center Phase Al
Downstream Permit Number: WQ0040602
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I David Cheek certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing OjTtc-ial Signature
M
Title of
Man
Official
30 69
Date
Page 2 of 6
FTSE 10-18

IILYLsIUH Ul ♦v uLer acesoarees
Fast Track Application for Sewer Systems— Review Checklist
Project Name: 4? Application Number:
Application Completeness Review
Project is located in a County currently covered by the regional office 01fes ❑No
Application and supporting documentation submitted in duplicate? U"" ❑No
One Original and One Copy
Correct application fee submitted? See G.S. 143-215.3D 0 UNo ❑N/A
Ensure that a check for $480 is submitted and made out to NC DEQ.
All new projects and major modifications to existing projectXdianges
lication fee. A major modification
includes any changes to,pennitted flow volumes, changes in piin pipe length greater than 10of the originally permitted length, changes in operating points , etc. If unclear, contact the Central
Office.
Application package is complete?
Current application version (See. website)
Ls/ []No
fe
Brief project marrative(per Section BofF ctions)
�
its []No
Certification of Public Convenience and N is provided
Yes []No E /A
(if applicable)
Operational Agreements, signed and dated
No 2KIA
(if applicable)
Flow Tracking / Acceptance Fo signed and
Yes o ❑N/A
Flow Tracking/ Acceptance PI ant Adden
❑Yes []No EWA
(if applicable)
Site Map and Street ap (per S F o fructi
[]No
PE Certification s signed ed an N.C.
U�]No
Applicant Ce ' is si d date le s pro
es []No
If any portion of the ation is not c etc, or equired '
items have been omitted, and the
return of an application ' ent, the f g steps s be taken:
• cant d le pho email for very minor completeness deficiencies.
the ap and t) 48
• • e application a is to be income this completeness review, fill out a checklist that
' as the defici an the applicatio the applicant
with a copy to the consultant. If the
ap on fee has not epos etum it as well.
Any projects tha _ to be returned be re prior to accepting the application (i.e., before logging in the
application and de g the check er a "gject has been accepted,
any information that is found to be
incorrect and/or lac ' be reque- via an Additional Information Request in accordance with 15A NCAC
02T .0107

Permit Information
w Permit ❑Permit Modification
If the project is a modification to an existing permit, be sure to enter the application into'BIMS as a permit
modification (i.e. `renew/modify application and not "create now project"). BIMS will pull the previous signing
official and affiliations information. Modify all tabs.and enter updated information.
Does the project require apemrit for the activity? uv es []No
See Permitting by Regulation (15A NCAC 02T.0303) for projects deemed permitted
If No, return fee and application package
Is the project eligible for the Fast Track Program? (yes ONo
Projects not permitted through the fast track program:
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ . STEP or simplex grinder pumps connecting to pressurized systems (e.g, force mains);
➢ Vacuum sewer systems.
If No, return fee and.application package and advise applicant what to do
Information entered into BIMS? (Project details, affiliations, etc) // es ❑No
Applicant (Owner/Permittee) signature meets requirement of 15A NCAC .0106(b)? E]Yes ❑No
If No, request revised application with an appropriate official, or a letter from an
appropriate official that indicates the person in question is delegated to sign the
application on the applicant's behalf. If a new delegated signing official is listed,
add the person to BIMS
Is the applicant is a public entity (county, city, sanitary district, etc.)? es []No
If Yes, move to Wastewater Flow Information Section
Is the applicant is a private entity and intends to retain ownership (store, church, etc.)?
❑Yes
[]No
If Yes, move to Wastewater Flow Information Section
Is the applicant is a private entity (private utility)?
❑Yes
❑No
If Yes, Applicant has been designated as a public utility by the NC Utilities Commission
.❑Yes
[]No
Has submitted a Certificate of Public Convenience and Necessity (CPCN)
or Letter from the Public Staff of the NC Utilities Commission (contact Central Office)
The project name on the application and CPCN must match
❑Yes
ONO
Is the applicant is a private entity (Developer) that will be selling units?
❑Yes
❑No
If Yes, Applicant has submitted an executed Operational Agreement (DEV)
[]Yes
❑No
A developer may be responsible for the system for an interim period until the HOA is formed,
at which time a name change / change of ownership form is required to transfer the permit to the
HOA
The operational agreement should be attached to the permit and incorporated into the language of the permit.
Is the applicant is a Homeowner's or Property Owner's Association selling units?
❑Yes
[]No
If Yes, Applicant has submitted an executed Operational Agreement (HOA)
[]Yes
[]No
and. Copy of the Articles of Incorporation, Declarations and By-laws
[]Yes
❑No
The operational agreement should be attached to the permit and incorporated into the language of the permit.

Wastewater Flow Information
Has submitted Flow Tracking/Acceptance Form (FTSE Form)
Ensure form is complete with all required information and that the owner
has accepted the entire volume of flow listed
Proper certification per 15A NCAC 02T .0106 (b)
Form is dated within one year of receipt of application package
Is FTSE Planning Assessment Addendum Required?
Required only for projects where available pump station capacity is < 0.
(Contact Central Office if needed)
Additional forms (FTSE 06-13) required?
Required only if the owner of downstream sewer different then owner of W WTF
Receiving W WTF and downstream sewers have adequate capacity
Ensure no compliance issues (SSOs or W WTF compliance issues)
MN-e�sONo ❑N/A
Yes . ❑No
e ❑No
es ❑N@ ❑N/A
❑Yes Ego,
es ❑No
❑N/A
Wastewater domestic in nature
If item B.6 indicates industrial wastewater, notify the regional pretreatment coordinator or
contact the Central Office to determine if a pretreatment permit is needed or if it is in place and compliant
Has the wastewater flow volume been calculated correctly (section 11.7 of PTA)? [Yes ❑No
Flow is calculated per 15A NCAC 02T.0114
or
If daily design flow is not based on regulations ensure that the applicant has an approved flow reduction of daily
design flow rate on file with the Division.
or
If other than 2T.0114, values must be supported with flow data per 15A NCAC 02T.0114
(Contact Central Office if this is the case)
Design Information
Adequate information related to sewer lines (Section VII of FTA) [Yd� ❑No . ❑N/A
Note that per the 2T and MDC, there is a minimum 8" for public gravity or
minimum 6" for private gravity
Adequate information related to pump stations (Section VIII of FTA) ® es []No ❑N/A
Ensure power reliability option is selected (see 15A NCAC 02T.030501))
Has Setbacks & Separations Section been completed? []Yes []No VN/
Required if any portion. of project is within 100 feet of any surface water or wetlands
Note, 15A NCAC 02T .0305 (f) contains minimum separations required for sewer
A variance is required if minimum separations cannot be attained (see below)
Is Project design is in accordance with (see section X of FTA) es ❑No
15A NCAC 02T
Gravity Sewer Minimum Design Criteria (latest version)
Minimum Design Criteria for Permitting of Pump Stations and Force Mains (latest version)
If no, a variance approval is required per the requirements of 15A NCAC 02T.0105(b)
• Applicant must submit TWO copies of the plans, specifications, and calculations
• Contact the Central Office to discuss the variance request to determine a course of action. The central
office will review the variance request, and if approvable, specific language regarding the variance will be
forwarded to the Regional Office reviewer to incorporate into the permit. A copy of the variance letter (or
email correspondence) should be kept with the application file.
Project contains high priority lines (15A NCAC 02T .0402(2)) []Yes n<01
If Yes, insure that the permit contains the necessary condition related to high priority lines
15A NCAC 02T.0403 (a)(5)

Application Certification
Has a N.C. PE stamped, signed, and dated the application? L�yx aONo
PE with active license in North Carolina? L'es []No
Check the NCBELS to ensure Engineer is currently registered to practice
NCBELS License Lookup
If the owner is a corporation, is the corporation registered in N.C.? Dyes dKo
N.C. Secretary of State (Comoration Searcy
Applicant should be registered to conduct business as a corporation in NC (Private Owners, Developers, HOAs, etc.)
If No, see return application guidance
Issuing a Permit
Most current version ofthe Fast -Track permit shell used? es E]No
Special conditions utilized within permit? E]Yes []No ON/A
High Priority Line's (Aerials)
Variance Language (Approved by the Central Office)
Regional Conditions (i.e. Stormwater Plans for Coastal Counties)
Construction Only Language ("Dry. Lines")
Other instances (contact the central office if required)
If permitmodification: E]Yes []No ❑N/A
Include Permit History
Void Previously Issued Permit in language
Permit signed only by those delegated to sign for the Director []Yes []No
Permit distributed as follows: []Yes . FlNo
• Original toPermittee
Copyto Consulting Engineer
• Copy to County Health Department (if applicable)
• Copy to Mecklenburg County Department of Environmental Protections
(Only for projects located in Mecklenburg County)
• Copy to the applicable Building Inspections Authority (if applicable)
e Copy(ies) to the owner of the W WTF and owner of the downstream sewers
(Only if different than the Peumittee)
• . Copy to Regional Office Files
• Copy to Water Quality Central Files (see Central Files Permit Package below)
• Electronic copy to PERCS unit
Electronic version shall preferably a signed, scanned copy of the permit in pdf format
If not, the electronic version can be a final version of the permit in word format. Regardless,
the permit should follow the marring convention of WQOOM= - YY.MM.DD.
Electronic copies should be forwarded to the PERCS unit contact on a frequent basis (once a month is fine).
• Signed Operational Agreements should be distributed with the permit (if applicable)
Finalizing BIlVIS �,,�
Permit issued in BIMS? MTe []No
All relevant Event Dates Entered? DV � []No
(add info request add info received, variance granted, variance denied, etc)
Central Files Permit Package
Complete package forwarded to Central Files []Yes []No
• Finalized Tracking Slip (BIMS Report)
• Copy of signed, issued permit (with operational agreements, if applicable)
• Copy of permit application package (application, supporting documentation, etc.)
• Review comments, calculations, notes, review checklist, etc.
• All other correspondence (email, phone logs, cover sheets, etc.)
All material in the permit package should be stapled together. Plans and specifications should not
be included in the permit package sent to central files.