WQ0042263_Application (FTSE)_20210125

DocuSign Envelope ID: CE5FD9F0-F449-4078-88BB-FCA5EBD69D7E
State of North Carolina
Department of Environmental Quality
nUIRDivision of Water Resources
Application Number:W � T (to be completed by DWR) RECEIVED/NCDEQ/D
WR
All items must be completed or the application will be returned JAN 2 5 2021
I. APPLICANT INFORMATION: WOROS
1. Applicant's name: WTH Times, LLC (company, municipality, HOA, utility, etc.
MOORESVILLE REGIONAL OFFICE
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: David Boyd per 15A NCAC 02T .0106(b)
Title: Registered Agent/Managing Member
4. Applicant's mailing address: P.O. Box 795
City: Lincolmon State: NC Zip: 28093-
5. Applicant's contact information:
Phone number: 704 201-3898 Email Address: [e-mail]
H. PROJECT INFORMATION:
1. Project name: Moores Chapel Road
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Pemut/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: WQ00
3. County where project is located: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.274° Longitude:-80.969'
5. Parcel ID (if applicable): 05549114
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Josh Butler License Number: 048418
Firm: Gateway Design Group, PLLC
Mailing address: 15126 Castlebridge Lane
City: Matthews State: NC Zip: 28104-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine Creek, Irwin Creek, Sugar Creek Permit Number: NC0024970 NC0024945 NCO024937
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than 'vVWTF):
1. Permit Number(s): WQunkno,,vn Downstream (Receiving) Sewer Size: 8" inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Charlotte Water
FORM: FTA 04-16 Page 1 of 5

DocuSign Envelope ID: CE5FD9F0-F449-4078-88BB-FCA5EBD69D7E
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 : % Domestic/Commercial 100 % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
1Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a 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 021,0114(1))
Daily Design Flow a,b
No. of Units
Flow
Convenience store
250 gal/plumbing fixture
9
2,250 GPD
Car wash
1,200 gal/car wash
1
1,200 GPD
Resturant
40 gal/seat
60
2,400 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
5,580 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: 5,580 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

DocuSign Envelope ID: CE5FD9F0-F449-4078-88BB-FCA5EBD69D7E
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"
352.2
PVC
8"
125.3
DIP
➢ Section II & III 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
VIII. 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: PS-1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.2740 Longitude:-80.969'
3. Design flow of the pump station:.007 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 14 gallons per minute at 12 feet total dynamic head (TDR
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
1.25
157
PVC
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)
[oil
❑ 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

DocuSign Envelope ID: CE5FD9F0-F449-4078-88BB-FCA5EBD69D7E
LY. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(D & (g) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided 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
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(fl 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
➢ Seethe 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 213.0202
4. Does the project require coverage/authorization under a 404 Natiomvide 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, seNver 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

DocuSign Envelope ID: CE5FD9F0-F449-4078-88BB-FCA5EBD69D7E
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?
® Yes ❑ No
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: DocuSigned by:
attest that this application for
(Professional Engine 3Cs nagbZgEylic t* Item I11.1.)
T644
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 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 p violation.
North Carolina Professional Engineer's seal, signature, and date ��.•"""CA
�N RO''',
SEAL
04841 IL
-"`,,,",/y' aA�SO o"
Applicant's Certification per 15A NCAC 02T .0106(b):
(Signature Authority's name & title
Application Item 1.3.)
for
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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: /I� Date:
FORM: FTA 04-16 Page 5 of 5

GATEWAY
i v it 2 6 kCasd bri l'oe 1-aid , Matthew "L' 28104
J g4 -266f DESIGN
joshjostifgate,vaydesigitgrotip.coiiiRECEIVED/NCDEQ/DWR R i E&I D/NCDEQ/C
JAN ` � 2021 JAN 1 021
January11, 2021
RO
NIOORESVILLE REGIONAL (OFFICE WQEGI
ROS
Mooresville Regional Office IVI®ORESVILLE REGIONAL
Water Quality Section
WR
610 E. Center Avenue, #301 RECEIVE®/NCDEQ/D
Mooresville, NC 28115
,1AN 2 5 2021
Project: Moores Chapel Road
Project Location: Mecklenburg County, North Carolina WOROS
MOORESVILLE REGIONAL OFFICE
Dear Sir or Madam,
On behalf of WTH Times, LLC, please find attached the following:
1. One original and one copy of the Sewer System Extension Applications (FTA-04-16)
2. Cover letter
3. Application fee of $48o payable to North Carolina Department of Environmental Quality
(NCDEQ) (under separate cover)
4. 8.5 x 11— USGS topographic map/Street level map
5. Flow Tracking Form (FTSE 10-18)
6. Proof of business entity
This project involves the construction of gravity sewer and low pressure force main for a
commercial site.
Please contact me with any questions/comments.
Sincerely,
Josh Butler, P.E.
President / Owner

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEtNI EXTEtNSION\�VPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUlIENTATION
Application Number: {to be completed by DtWtt)
AIt items must be completed or the application evil) ate returned
I. APPLICANT INFORMATION:
1. Applicant's name: AN'TH Times. LLC (company, III till jet pal ity, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership
El Federal ❑ State/County ❑ kitmicipal
3. Signature authority's name: Dean Brown per 15A NCAC 02T .0106
Title: Vice President
4. Applicant's mailing address: P.O. Box 795
City: Lincolnton State: NC Zip: 28093-
5. Applicant's contact information:
Phone number: (70=1} 740-9848 Email Address: dean c timesoil.cont
I1. PROJECT INFORMATION:
MOORESVILLE
❑ Privately-MYR,4kC1R(WQfq/DWR
❑ Other JA>J`
MOORESVILLE REGIONA OFFICE
iRECENED/NCOEQ/OWR
j o 2 5 20
W®ROS
ILA®ORESVILLE REGIONAL OFFICE
I . Project name: Moores Chapel Road
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: NN'Q00 and issued date:
Ifrrew construction but part of master plan, provide the existirg permit number: N1'Q00__
3. County where project is located: NfecklenbUg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.274` Longitude:-80.969
5. Parcel ID (if applicable): 05549114
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Josh Butler License Number: 048418
Firm: Gateway Design Group• PLLC
Mailing address; 15126 Castlebridt­�e Lane
City: Matthews State: NC Zip: 28104
Phone number: ( 10) 840-2661• Email Address:jagj@gajg«atidesi�nwroui>.com
IV. WASTEWATER TREATMENT FACILITY (NNAVTF) INFORMATION:
1. Facility Name: McAlpine Creek•�reek. Straar Creeh Permit Number: NIC0024970. NC0024945. NC0024937
0\\-jiei- Name: Charlotte- Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than \N' WTF):
1. Permit Number(s): )YQuuknM Downstream (Receiving) Seaver Size: 3" inch
System amide Collectiott.Sysietat Permit Number s,fif app licable : AVQCS,--
Owrter Name(s): Charlotte Water
FORM: FTA 04-16 Page I of

N'I. GENERAL REQUIREMENTS
1. If the Applicant is aPrivately-Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ON/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORii4: DEVV been attached?
❑ Yes [:]No ®N/A
3. If the Applicant is a 1-lame/Prate Owners' Association, lias ail Operational Agreement {FORiyi: t-IOA} becn attacliecl?
❑ 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 ❑ Swinunin; Pool/Filter Backwash
Z Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% hldustrial See 15A NCAC 02T .0103(20 )
Is there a Pretreatment Program in effect? Cl Yes [] No
6. Has a flow reduction been approved under 15A NCAC 02T�.0I 1,41 ❑ Yes ® No
�> If �•es, r)rovide a conv of float• reduction a ) royal Metter
7. Sununarize wastewater generated by project:
Establishment Type (see 02T.0I I4 )
Convenience store
Daily Design Flog a,n
250 gal/plumbing fixture
No. of Units
9
Flow
2,250 GPD
Car wash
1,200 gal/car wash
1
1,200 GPD
Resturant
40 gal/seat
60
2,400 GPD
gal/
GPD
wal/
GPD
gal/
lotca/
GPD
5,580 GPD
a See 15, NCAC 02T .0114(b} {d} {e}{ 1 } and {e}{2} for caveats to tvaste�yater design floe 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 Water -way to be used as vacation rentals as defined
in G.S. 42A-4 .
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. \\'astewater generated by project: 5.580 GPD (per 15A NCAC 02T .01
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

VI 1. GRAVITI' SEiVER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC Gravity Severs):
1. Stinunarizegravity sewerto be permitted:
Size (incites)
8"
8"
Length (feet)
352.2
125.3
Material
PVC
DIP
Section It & III of the NIDC for Permitting of Gravity Sewers contains infomration related to design criteria
Section III contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet ntininttun slope requirement is not allowed and a violation of the i41DC
VI11. P U A I P STATION DESIGN CRITERIA (If Applicable)—.02T .0305 & DC � nt StatiastsfEaree �� €ins .
COMPLETE FOR EACH PUrNIP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: PS-1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.274' Longitude:-80.969`'
3. Design flow of the pump station:.007 millions gallons per (lay (firm capacity)
4. Operational point(s) of the pump(s): 14 gallons per minute at 12 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
1.25 157 PVC
6. Power reliability in accordance with 15A NCAC _02T .0305 hKlj.
❑ 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 clay
I IILlst be permanent to facility
Or if the pump station has an average (laity flog less than 15,000 gallons per day:
❑X Portable power source with manual activation,quick-connection receptacle and telemetry - I5A 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)
ZD
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 plump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

I1. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the projectcomply with all separations found in,15A NCAC 02T .0305 f)9, ® Yes ❑ No
I5A NCAC 02T.0305 f contains mininuun separations that shall be 7rovided for sewers stems:
Setback Parameter
Se aration Required
Storm sewers and other utilities not listed below (vertical)
24 inches
NVater mains (vertical -water over sewer including in benched trenches
18 inches
Water mains (horizontal)
10 feet
Reclaimed slater lines vertical - rec(aitned over sewer)
18 inclies
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or publie watersupply source, including any wells, tt'S-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except NVS-I or 4t'S-V), B, SA, OR\N', HQW, or S13 from normal
hi==h water (or tide elevation and wetlands (see item I�.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface tlrainage
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
Drainages stems and interce for drains
5 feet
Any swin milia pools
10 feet
Final earth Qrade (vertical)
36 inches
> 15A NCAC 02T.0305(��contains alternatives where separations in 02T.0305(fj cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Classifications webae
O If noncompliance witli 02T.0305(f} oMIA see Section Y of this application
2. Does the project comply with separation requirements for Netland s? (50 feet of separation) []Yes ❑ N'o ®N/A
);, See the Division's draft separation requirements for situations where separation cannot be meet
r 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 fbund in (lie river basin rules per 15A NCAC 0213.0200? ❑ N'es ❑ No ®N/A
This would include Trout Buffered Streanns per 15A NNC5_2B.0202
4. Does the project require coveraget'authorization under 404 Nationwide or ❑ Yes Z No
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 &Buffer Permittine Branch
5. Does project comply with 15A NCAC 02T.010- c 6' (additional permits/certifications)? ® Yes ❑ 1o
Per 15A NCAC 02T.0105 U a 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 I5A NCAC 02T.0402 "high -priority sextet" 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 [A N/A
> If yes, include an attachment with details fior each line, including type (aerial line, size, material, and location).
Iligh priority lines shall be inspected by the permittee or its representative nt least once every six-nnonths and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual Systenn-kVide Collection permit.
FORA: FTA 04-16 Page 4 of 5

S. CERTIFICATIONS:
1. Does the submitted system comply with ,ISA NCAC 02T. the Minimum Design Criteria fbr the Permittiut of Puma Stations
and Force Mains (latest version), and the Gfiavr v Sewer Minim Design _Criteria {latest version) as applicable?
m Yes ® No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-I4) and supportingdocuments for
review. �rova[ of the re nest is re aired prior to submittal of tl►e [ ast Track r4 tlication and sun Cortina documents.
2. Professional Engineer's Certification:
I, _ attest that this application for
(Professional Engineer's name from Application Item 11I.1.)
has been reviewed by me and is aceurate, 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 143-215.613, 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 S 10,000, as well as civil penalties up to $25,000 Per violation.
Milli Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0106(b):
(Signature Autlibrity's name c4 title Isom Application Item I.3.)
I
that this application for,
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 143-21.5.6A and 143-215.6B— any person who knowingly makes any false
statement, representation, or certification in any application package be guilty of Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to S25,000 per violation.
Signature:Dater �� — �-�
�—AIM14ak_ - - - - --- — — - - - -- � - _ F ----
FORM: FTA 0-1-16 Page 5 of 5

State of o_
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: WTH Times, LLC
Project Name for which flow is being requested: Moores Chapel Road (Store)
More than one FTSE may be rerinired for it single project if the owner of the WWTP is not responsiblefor tall 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: McAlpine Creek, Irwin Creek, Sugar Creek
b. WWTP Facility Permit #: NC0024970, NC0024945, NCO024937
All flows are in MGD
c. WWTP facility's permitted flow 99.00
d. Estimated obligated flow not yet tributary to the WWTP 10.377
e. WWTP facility's actual avg. flow 73.817
f. Total flow for this specific request 0.00585
g. Total actual and obligated flows to the facility 84.194
h. Percent of permitted flow used 85.0%
IL 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)
(F)=(A-D)
Design
Obligated,
Pump Pump
Average
Approx.
Not Yet
Total Current
Station Station
Firm
Daily Flow**
Current
Tributary
Flow Plus
(Name or Permit
Capacity,
(Firm l p fl,
Avg. Daily
Daily Flow,
Obligated
Available
Number) No.
MGD
MGD
Flow, MGD
MGD
Flow
Capacity***
Paw Creek
11.4
4.56
6.612
0.867
7.479
-2.919
* 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): Rhyne Road
Downstream Permit Number: Unknown
Page I of 6
(,,l.SE i 0-- 18

III. Certification Statement:
I Keri Cantrell 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.
KA., 9/10/2020
Signing Official Signature
Chief Engineer
Title ofSigning Of
Date
Page 2 of 6
F I'S F 10-18

Submit a planning assessment addendum for each pump station listed in Section I1 where Available
Capacity is < 4.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
11.6 % and 0.867 MGD of the Available Capacity (E) in Pump Station
Paw Creek ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.867 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
Paw Creek Force Main Replacement is in design or under construction with
planned completion in Paw Creek Force Main - 2020 ; and/or
d. The following applies:
Charlotte Water's Community Investment Plan has allocated funds for
improvements to the Paw Creek force main and a five -million gallon EQ basin
at Long Creek Pump Station. Long Creek and Paw Creek pump stations operate as
a system using SCADA data to determine the rate of flow delivered from the
upstream pump station, Long Creek, to Paw Creek the downstream facility.
Long Creek pump station has the ability to transfer flows to flow
equalization tanks during peak flow events and then meter out flow to Paw
Creek as flow conditions allow. In addition, the basins for both stations
are large and result in a daily peaking factor of 2.06 at Paw Creek Pump
Station, which allows the stations to operate safely at flows greater than
40% of the firm pumping capacity.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification
to allow this flow to be permitted, without a significant likelihood of over -allocating capacity in
the system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S.
143-215.67(a) which prohibits the introduction of any waste in excess of the capacity of the
waste disposal system.
Signing Off cial Signature
Date
Page 3 of 6

-File an Annual Report/Amend an Annual Report - Upload a PDF Filing - Order a Document Online - Add
Entity to My Email Notification List 'View Filings - Print a Pre -Populated Annual Report form -Prim an
Amended a Annual Report form
Limited LiabiLity Company
Legal Rame
WTW Tittes, L
=1 Mc, =71
Sosid: 0675131
Status: Current -Active Q
Date Formed: 5/13/2003
Citizenship: Domestic
Annut*j,L R ort Due Date: Ayri 11 5th
Registered Agent: Boyd, David M,
Principal Office
1500 E Main St
Lincointon, NC 28092
Manager
David Boyd
Lincolnton NC 28092
Reg Off ice
1500 E. Main SI
mmins
MaiLing
PO Box 795
Lincointon, NC 28093
Manager
Sweet Treat Holdings, LLC
1500 East Main Street
Reg Mailing
PO Box 795
'Lincointon, NC 28093

For
1XIIIIIIIET M-141
January 5, 2021
Prepared for:
ill Faq ff I me =-
LincoInton, NC
A C .4
0 "o
SEAL
048
e
1 N F-
"N"42A B U1
4644 a A ab a a " �01
Gateway Design Group, PLLC
P-2147
Cell: (gio) 840-2661
Mailing Address:
15126 Castlebridge Lane
Matthews, NC 28104

Moores Chapel Road is a new commercial project. The project consists of a
restaurant, convenience store, and car wash. Sewage will leave the site via private
grinder pump station and foreemain emptying into private manhole.
Gateway Design Group, PLLC

Gateway Design Group, PLLC

Project Name: monmsCfhapo|
Project No. zno�ooz
Date: 1/6/202z
CelcEy: APYo
No. of Services
�
Daily Flow
sLs0gyd
Daily Flow, OddM
41gpm
OMthoAdditional Flow, QdC2
CLVgpm
Total Daily Flow, QdUf
41Opm
Peak Flow, Qp
102gpm
Qp=Qddfxx.5
Size ofForce Main, d
z. 2ginches
Velocity, v1(based onpeak flow)
2.7ft/soo
v1=0.409Qp/d^2
Trial Pump Flow, Qudj
112gpm
Velocity, v2(based onpump flow)
3.1 ft/soo
v2=0.409Oudj/d^2
D|a.nfWet Well, D
15 D
TRIAL CYCLE TIME
20min
2Omin. pump down volume, V
537ga|
V=VJddf(1-(Qddf/0mdj). t = 20
20 min. pump down volume, V
72 of
V=V°0.1837
uOmin. pump down height, k
OJh
h=4V4314DA g
Wet Well Elevations
Proposed
Top ofWet VVoUElew.
M
Ground Elev. +12^
8GInv. |n
748.8
ft
Gravity Line Invert = Top minus 44.3"
High Water Alarm
744.4
ft
Alarm =8''Above Pump On
Pump 1On
743.8
ft
Pump On4^Above Pump Off
Pump Off
743A
ft
Pump Off =18.84^from Bottom
u
Bottom
M
Required Depth ofWet Well
10.2ft
Top E|o,,BouomElev.

PUMP STATION DESIGN
SYSTEM CURVES
Moores Chapel
Job Name llvlor, " Ci nel
2020-002
Job No. 2020 002
1/6/2021
Date 1 /6/ 10
Starting Pump Elevation, Z1
74
Force Main Discharge Elevation, Z2
753
53 3 a'
High Point Elevation, Z2max
:; 5^
STATIC HEAD
9
9 9 9 9
Length of Force Main (Feet)
2
_. _ 2;
Diameter of Force Main (Ft), D
1.25" PVG
Hazen Williams C for Force Main, C
i20
�20
Discharge (GPM), Q
6
8 10 12
cn vvuuania � uauvn - nv woa
Hp= L ((10.44Q185)/((C185)(D4.e7)))
0
1
1
1
2
Hp = Total Piping System Head Loss
9
10
10
10
11
Minor Losses
K value
Minor Losses (ft)
11.25d Bends
___ 0.0
0.0
0.0
0.1
0.1
22.5d Bends
0.0
0.0
0.0
0.0
0.0
45d Bends
0.0
0.0
0.0
0.0
0.0
90d Bends
0.0
0.0
0.0
0.0
0.0
No. Check Valves
0.2
0.3
0.5
0.8
1.0
Entrance/Exit
3 0.1
0.1
0.2
0.3
0.4
No. Gate Valves
_.. 0.0
0.0
0.0
0.0
0.0
No. Tees / ARV
_.., 0.0
0.0
0.0
0.0
0.0
hl = Total Minor Losses (Feet)
0.3
0.5
0.8
1.1
1.5
TDH (feet) = H +hl(minor)
10
10
11
11
12
Pump Curve (TDH)
230
170
120
70
20
Check Pump Cycle 7 gal
(from Wet Well Sizing Calc)
Volume
Fill Time _2 min
t=V/Qddf
Pump Time min
t2=V/Qpump
Total 17.7 min
3 cycles per hour, OK
System pump Curve
0 2 4 6 8 10 12 14 16
240 j

Gateway Design Group, PLLC

EJONE
SPO PUMP PERFORMANCE
CURVE
GRINDER PUMP, lHP, 1725 RPM
10o
230
95
\
220
\
\
210
90
\
200
85
190
80
LOW PRESSURE SYSTEM DESIGN PRESSURE
180
75
170
CONSULT FJPSI
FOR INTERM
USE ABOVE70
OR 185 FE
160
65
150
60
140
130
w 55
120
cn 50
110
45
0
n
CD
100 Q
z
40
N
90
w
o 1-135
0
80 w
`C 30
w
70 `�
� Q
n- z
z
25
60 Q
Q
w
50 =
0 20
u
40 Q
15
>-
30 C'
10
20 1-
0
5
10
0
0
-5
-10
-20
- 10
-30
-15
-40
-20
-50
-25
-60
I I I I I I I I I
I
0 2 4 6 8 10 12 14 16
18
DISCHARGE (Q), GPM
ESD 08-0022 REV. 2, 6/08