WQ0042298_Final Permit_20210211

WGLA
Engineering
February 3, 2021
WGLA Engineering, PLLC
724 5th Avenue West l L FEB - 4 2021
Hendersonville, NC 28739
[phone] wgla.com
Mr. Tim Heim, P.E.
Water Quality Section
NCDEQ
2090 US Highway 70
Swannanoa, North Carolina 28778
RE: City of Hendersonville
Blue Ridge Community College — Patton Hall Expansion
Sewer Relocation
Dear Mr. Heim:
Water Quality Regional Operations
Asheville Regional UJflce
Please find the submittal package for the proposed sewer line relocation on the Blue Ridge
Community College Campus. This is a proposed extension of the City of Hendersonville system. Note
that we have not included a flow tracking form as this is estimated to be a zero flow project. The
existing sewer line is being relocated for the expansion of Patton Hall in conjunction with the
demolition of two existing buildings (General Studies Building and Arts & Sciences Building). The net
result is estimated to be no additional flow associated with the project.
In addition to the completed fast track application (original and one copy), the following items are
included with this letter:
-application fee of $480.00
-site maps
If you have any questions or need additional information, don't hesitate to contact our office.
Sincerely,
WGLA Engineering, PLLC
William R. Buie, P.E.
CIVIL ENGINEERS & LAND PLANNERS

DocuSign Envelope ID: 37EEEOF2-C2DA-4420-AOE1-13FC693B311C4
DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will he returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Hendersonville Water and Sewer Department (company, municipality, BOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑Privately-Owned Public Utility
❑ Federal ❑ State/County it Municipal ❑ Other
3. Signature authority's name: Lee Smith per l5A NCAC 02T .0106(b)
Title: Utilities Director
4. Applicant's mailing address; 305 Williams Street
City: Hendersonville State: NC Zip: 28792-
5. Applicant's contact information:
Phone number: [phone] Email Address: lsmithna,hvinc.gov
II. PROJECT INFORMATION:
1. Project name: Blue Ridge Community College - Patton Hall Interior Renovation and Addition
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Henderson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.18-26° Longitude: -82.35-32°
5. Parcel ID (if applicable): 9578-84-1661
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: William R. Buie License Number: 022989
Firm: WGLA Engerin ineg. PLLC
Mailing address: 724 51e Avenue West
City: Hendersonville State: NC Zip: 28739-
Phone number: [phone] Email Address: wbuie(awgla.com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Hendersonville WWTP Permit Number: NC0025534
Owner Name: City of Hendersonville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different han WWTF):
1. Permit Number(s): WO Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

DocuSign Envelope ID: 37EEE0F2-C2DA-4420-AOE1-BFC6938311C4
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 IINIA
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 El N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls)
❑ Residential Leased
® School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming PooLFilter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(201)
�Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
➢ If ves, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow ° °
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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 facifties 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: 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:
Z Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16
Page 2 of 5

DecoSign Envelope ID: 3]EEEOF2-C2DA-4420-AOE1-BFC6930311C4
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size Ouches)
Length (feet)
Material
8
454
PVC/SDR-35
8
92
DIP/CL-350
> Section II & III of the MDC for Permitting of Gravity Sewers contains information rela ed 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
L 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 I5A 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)(I)(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 timehnmes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

•
DocuSign Envelope ID: 3]EEE0F2-C2DA-4420-A0E1-BFC893B311C4
IX. SETBACKS & SEPARATIONS — (02B .0200 & 1SA NCAC 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
> 15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer vstems:
® Yes ❑ No
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
➢ I5A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(ft cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
> If noncompliance with 02T.0305(t) or (p) see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes D No
➢ 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
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes ® No
Z N/A
® N/A
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ®Yes No
Per 15A NCAC 02T.0105(e)(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 pennits (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

DocuSign Envelope ID: 37EEEOF2-C2DA-4420-AOE1-BFC693B311C4
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:
I William R. Buie, P.E. attest that this application for
(Professional Engineer's name from Application Item IIL1.)
Blue Ridge Community College - Patton Hall Interior Renovation and Addition
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:
3. Applicant's Certification per 15A NCAC 02T .0106(6):
I Lee Smith attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
Blue Ridge Community College - Patton Hall Interior Renovation and Addition
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 143-215.68 any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Lee Smigh
Signature: Lee Smith (Feb 2, 2021 12:45 EST)
Date
Feb 2, 2021
FORM: FTA 04-16 Page 5 of 5

DocuSign Envelope ID:37EEEOF2-C2DA-4420-AOEi-BFC693B311C4
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
llvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completedbyDWR)
MI items must be completed or the application will be returned
I. APPLICANT INFORMATION:
Applicant's name: City of Hendersonville Water and Sewer Department (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Lee Smith per 15A NCAC 02T .0106(b)
Title: Utilities Director
4. Applicant's mailing address: 305 Williams Street
City: Hendersonville State: NC Zip: 28792-
5. Applicant's contact information:
Phone number: [phone] Email Address: Ismith(a.hvinc.gov
II. PROJECT INFORMATION:
Project name: Blue Ridge Community College - Patton Hall Interior Renovation and Addition
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Perna/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Henderson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.18-26° Longitude: -82.35-32°
5. Parcel ID (if applicable): 9578-84-1661
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: William R. Buie License Number: 022989
Firm: WGLA Engineering PLLC
Mailing address: 724 5111 Avenue West
City: Hendersonville State: NC Zip: 28739-
Phone number: [phone] Email Address: wbuie(4wgla.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: I-Iendersonville WWTP Permit Number: NC0025534
Owner Name: City of Hendersonville
RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
Permit Number(s): WQ Downstream (Receiving) Sewer Size:
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
nch
FORM: FTA 04-16 Page 1 of 5

,Docuslgn Envelope ID: 37EEEOF2-C2DA 4420-AOE1-BFC693B311C4
VI. GENERAL REQUIREMENTS
I. 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: DBV) 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
O Residential Leased
® School / preschool / day care
O Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
0 Nursing Home
5. Nature of wastewater : 100 % Domesti /Commercial % Commercial
0 Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
% Industrial (See 15A NCAC 02T .0103(201)
>Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes 0 No
D lives, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow a'b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(b) (d) (e)(1) and (e)(21 for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling proposed unknown non-residential development uses; public access facilties 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: GPD (per 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
0 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

DocuSl9n Envelope ID: 3]EEEOF2-C2DA-4420-AOEI-BFC0938311C4
VII. GRAVITY SEWER DESIGN CRITERIA(IfApplicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
454
PVC/SDR-35
8
92
DIP/CL-350
> 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 EACI3 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(h1(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 timefiames, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

ApcuSign Envelope ID: 37EEEOF2-C20A-4420-AOE1-BFC893B311C4
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in I5A NCAC 02T .0305(t) & (g)
> 15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer vstems.
® Yes ❑ No
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 DC.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
S. 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(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
> 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
® N/A
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per l5A NCAC 02T.0105(0(6) directly related environmental permits orcertification 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 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.
El Yes ®No El WA
> 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

.eacuSlen Envelope ID: 37EEEOF2-C2CA-4420-AOE1-BFC693B311C4
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:
I William R. Buie, P.E. attest that this application for
(Professional Engineer's name from Application Item 1II.1.)
Blue Ridge Community College - Patton Hall Interior Renovation and Addition
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 lmowledge. 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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I Lee Smith attest that this application for
(Signature Authority's name & title from Application Item I.3.)
Blue Ridge Community College - Patton Hall Interior Renovation and Addition
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 misdemeanr, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
LEE c%J%7h2
Signature: Lee Smith Feb(2, 202112:4s EST)
Date
Feb 2, 2021
FORM: FTA 04-16 Page 5 of 5

20201019_FTA_20140BRCC_
Final Audit Report
2021-02-02
Created: 2021-02-02
By: brendan shanahan ([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAVJQVFRdxjOWwQgiQOusNNV0a8EB2aE
"20201019_FTA_20140BRCC_" History
5 Document created by brendan shanahan ([e-mail])
2021-02-02 - 3:48:14 PM GMT- IP address: 64.147.217.130
a Document emailed to Lee Smith ([e-mail]) for signature
2021-02-02 - 3:48:56 PM GMT
S Email viewed by Lee Smith ([e-mail])
2021-02-02 - 5:44:03 PM GMT- IP address: 104.47.58.254
4. Document e-signed by Lee Smith ([e-mail])
Signature Date: 2021-02-02 - 5:45:15 PM GMT- Time Source: server- IP address: 64.147.217.130
® Agreement completed.
2021-02-02 - 5:45:15 PM GMT
Q Adobe Sign

/
0
;$(a)!
iii\ /(
:r!!!,2
)=
b-co cq..°26Ccc/l
2/ d
-){\/)}
GHil QS=
2,
/q
/)J
.— 2
February 3, 2021
THOROUGHFARE
IIIL
INTERSTATE
BOULEVARD

/
/
THOROUGHFARE
COLLECTOR
)
ra
ce