WQ0036362_Regional Office Historical File Pre 2018

FAST TRACK EN6INEERING CERTIFICATION
APR 0 5 .:10013
Permittee: Town of Taylorsville Permit No. WQ0036362
Project: Dollar General Sewer Extension Issue Date: 02/2012013
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension. Final record drawings should be clear on the plans or on digital media (CD or DVD
disk) in pdf format, Record drawings should indicate the design and the marked up changes during construction.
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump stations
permitted as part of this project
• Changes to the project should be dearly identified on the record drawings or in written summary form, Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria. Modifications should be submitted prior to certification.
This project shall not be considered complete nor allowed to operate until the Division has received this Engineer's
Certification and all required supporting documentation. Therefore, it is highly recommended that this certification
be sent in a manner that provides proof of receipt by the Division.
PERMITTEE'S CERTIFICATION
I, David Odom , the undersigned agent for the Permittee, hereby state that this project has
been constructed pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction information to the Permittee, and the Permittee is prepared to operate &
maintain the wastewater collection system permitted here r portions thereof,
David Odom, Town Manager 04402/17.004---'
Printed Name, Title
Si ature Date
ENGINEER'S CERTIFICATION
El Partial Final
I, Justin Church , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe periodically, 0 weekly, 0 full time) the construction of the subject project
for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the construction such that the construction was observed to be built within substantial compliance of this
permit, 15A NCAC 02T; the Division of Water Quality's (Division) Gravity Sewer Minimum Design Criteria adopted
February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 as applicable, and other supporting materials.
North Carolina Professional Engineer's
Seal, signatmtiqnd date:
SS
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
SURFACE WATER PROTECTION SUPERVISOR
MOORESVILLE REGIONAL OFFICE
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE, NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received, Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions,
LAVQ Use 0e1):
1low from this projccr kmibutary lo:

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Waklld, P, E.
Governor Director
February 20, 2013
David Odom, Town Manager
Town of Taylorsville
67 Main Avenue Drive
Taylorsville, NC 28681
Subject: Permit No. W003634-6 ,
Town of Taylorsville
Dollar General Sewer Extension
Wastewater Collection System Extension
Alexander County
Dear Mr. Odom:
John Skvarla, Ill
Secretary
In accordance with your application received February 4, 2013,.we are forwarding herewith Permit No.
WQ0036362, dated February 20, 2013, to the Town of Taylorsville for the construction and operation of
the subject wastewater collection system extension. This permit shall be effective from the date of
issuance until rescinded, and shall be subject to the conditions and limitations as specified therein. This
cover letter and supplement shall be considered a part of this permit and are therefore incorporated
therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.4:
Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 2T .0403 or any individual system -wide collection system
permit issued to the Permittee.
It shall be responsibility of the Town of Taylorsville to ensure that the as -constructed project meets the
appropriate design criteria and rules, Failure to comply may result in penalties in accordance with North
Carolina General Statute §143-21.5.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right
to request an adjudicatory hearing upon written request within 30 days following receipt of this permit.
This request must be in the form of a written petition, conforming to Chapter 150B of North Carolina
General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
1617 Mail Service Centers Raleigh, North Carolina 27699.1617
Location: 512 N. Salisbury Si- Raleigh, North Carolina 27604
Phone: [phone] FAX, 919-807-6492
Internet. www nrwalerquallty.oq
An Equal Opportunity t Affirmalbre Acllmn E inployer
One
NorthCarttna
mature!!

David Odom
February 20, ;201.
Page Two
if you need additional infer ion concerning this rraatter, please contact Michael P
2194 or via e-mail atMichael,Parker@ncrienrigov
Electronic coy:.lustin Church, P.E.
cc: MMlooresville Region
Water Quality Centra
PERCS (electronic copy)
for Charles Wakild, P.E.D
Division of Water
by Michael Parker
Mooresville Region Surface Water duality Supervisor
!fflc, Surface y
1 Files
ction Section

~
STATE OFNORTH CARDUNA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OFENVIRONMENT AND NATURAL RESOURCES
WASTEWATER COLLECTION SYSTEM EXTENSION PERK4ff
in accordance with the provisions of Article 21 of Chapter 143' General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
Town ofTay|onvUe
,Alexander County
for the construction and operation of approximately 579 linear feet of 8-inch gravity sewer to serve the
Dollar General Sewer Extension, and the discharge of 1,390 gallons per day of collected domestic
wastewater into the Town of Taylorsvi|[e's existing sewerage system, pursuant to the application
received February 4, 2013, and in conformity with 15A NCA[ 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12^ 1996 a:s applicable; the Division's Minimum Design Criteria for the
Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000as applicable; and other
supporting data subsequently filed and approved by the Department of Environment and Natural
Resources and considered apart ofthis permit.
This permit shaU be effective from the date ofissuance until rescinded and shall be subject tothe
specified conditions and limitations contained therein,
Permit issued this the 20"' day of'February, 2013.
for Charles VVakib,P.E,Director
Division ufWater Quality
By Authority of The Environmental Management Commission
Permit NunmbmnVVQQU36362

SUPPLEMENT TO PERMIT COVER SHEET
Town of Taylorsville is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension,
The sewage and wastewater collected by this system shall be treated in the Town of Taylorsville's
Wastewater Treatment Facility prior to being discharged into the receiving stream.
Permitting of this project does not constitute an acceptance of any part of the project that does not
meet 15A NCAC 2T; the Division of Water Quality's (Division) Gravity Sewer Minimum Design Criteria
adopted February 12, 1996 as applicable and the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless specifically
mentioned herein. Division approval is based on acceptance of the certification provided by a North
Carolina -licensed Professional Engineer in the application. It shall be the Permittee's responsibility to
ensure that the as -constructed project meets the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
SPECIAL CONDITIONS
If, at any time, the additional wastewater flow volume made tributary to this sewer extension is believed to
exceed the value permitted herein, a modification shall be requested for this permit from the Division of
Water Quality to properly allocate the subject wastewater flow,
No flow in excess of the quantity permitted herein, 1,390 GPD, shall be made tributary to the subject sewer
system until an application for permit modification for an increase in flow has been submitted to and
approved by the Division of Environmental Management.
By copy of this per rrtit, the Alexander County Building Inspections Department is hereby notified that building
or occupancy permits shall only be issued for the (number of residences — only refer to # of bedrooms if an
approved flow reduction is used) as part of the PROJECT NAME project until a modified permit is issued by the
Division indicating additional connections,
4. By copy of this permit, the Alexander County Health Department and the Alexander County Building
Inspections Department are advised that, no certificates of occupancy are to be granted prior to the submittal
of a sealed engineer's certification,

IL STANDARD CONDITIONS
This permit shall not be transferable. In the event there is a desire for the wastewater collection facilities to
change ownership, or there is a name change of the Permittee, a formal permit request shall be submitted to
the Division accompanied by documentation from the parties involved, and other supporting materials as may
be appropriate. The approval of this request shall be considered on its merits and may or may not be
approved.
2. This permit shall become voidable unless the wastewater collection facilities are constructed in accordance
with the conditions of this permit; 15A NCAC 2T; the Division of Water Quality's (Division) Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other
supporting materials unless specifically mentioned herein.
This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
4. The wastewater collection facilities shall be properly maintained and operated at all times, The Permittee
shall maintain compliance with an individual system -wide collection system permit for the operation and
maintenance of these facilities as required by 15A NCAC 2T .0403, If an individual permit i not required, the
following performance criteria shall be met as provided in 15A NCAC 2T.0403:
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge to land or
surface waters, and to prevent any contravention of groundwater standards or surface water standards.
b. A map of the sewer system shall be developed and shall be actively rnairttained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (Le. 365 days
per year). Pump stations that are connected to a telemetry system shall be inspected at least once per
week.
High -priority sewer lines shall be inspected at least once per every six -months and inspections are
documented,
A general observation of the entire sewer system shall be conducted at least once per year.
Overflows and bypasses shall be reported to the appropriate Division regional office in accordance with
15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina General Statute
§143-215.1C.
h. A Grease Control Program is in place as follows:
For public owned collection systems, the Grease Control Program shall include at least biannual
distribution of educational materials for both commercial and residential users and the legal means to
require grease interceptors at existing establishments. The plan shall also include legal means for
inspections of the grease interceptors, enforcement for violators and the legal means to control
grease entering the system from other public and private satellite sewer systems.

2. For privately owned collection systems, the Grease Control Program shall include at least bi-annual
distribution of grease education materials to users of the collection system by the permittee or its
representative,
3. Grease education materials shall be distributed more often than required in Parts (1) and (2) of this
Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
Right-of-ways and easements shall be maintained in the full easement width for personnel and equipment
accessibility.
Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three years
with exception of the map, which shall be maintained for the life of the system,
5 Noncompiance Notification:
The Permittee shall report by telephone to a water quality staff member at the Mooresville Regional Office,
telephone number [phone], as soon as possible., but in no case more than 24 hours or on the next
working day, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable of
adequate wastewater transport, such as mechanical or electrical failures of pumps, line blockage or
breakage, etc; or
b. Any SSO and/or spill over ,1,.000 gallons; or
c. Any ,SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial verbal
report. Overflows and spills occurring outside normal business hours may also be reported to the Division of
Emergency Management at telephone number (800) 8,58-0368 or [phone]. Persons reporting any of
the above occurrences shall file a spill report by completing and submitting Part I of Form CS-SSO (or the most
current Division approved form) within five days following first knowledge of the occurrence. This report must
outline the actions taken or proposed to be taken to ensure that the problem does not recur, Part 11 of Form
CS-SSO (or the most current Division approved form) can also be completed to show that the SSO was beyond
control.,
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to interrupt
service by the existing utilities nor result in an overflow or bypass discharge of wastewater to the surface
waters of the State,
7, Per 15A NCAC 2T.0116, upon completion of construction and prior to operation of these permitted facilities,
the completed Engineering Certification form attached to this permit shall be submitted with the required
supporting documents to the address provided on the form, A complete certification is one where the form is
fully executed and the supporting documents are provided as applicable, Any wastewater flow made tributary
to the wastewater collection system extension prior to completion of this Engineer's Certification shall be
considered a violation of the permit and shall subject the Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles of
Incorporation. Declarations/Covenants/Restrictions, and Bylaws that have been appropriately filed with the
applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are provided as
applicable. Supporting documentation shall include the following:

a. One copy of the project construction record drawings (plan & profile views of sewer lines & force rnains)
of the wastewater collection system extension. Final record drawings should be clear on the plans or on
digital media (CD or DVD disk) and are defined as the design drawings that are marked up or annotated
with after construction information and show required buffers, separation distances, material changes,
etc.
b. One copy of the supporting pump station design calculations (selected pumps, system curve, operating
point, buoyancy calculations, available storage if portable generator(s) or storage greater than longest
past three year outage reliability option selected) for any pump stations permitted as part of this project.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the Minimum
Design Criteria should be clearly identified on the record drawings, on the certification in the space
provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting in non-
compliance with this permit (including pipe length increases of 10% or greater, increased flow, pump station
design capacity design increases of 5% or greater, and increases in the number/type of connections),
regulations, or the Minimum Design Criteria. Requested modifications or variances to the Minimum Design
Criteria will be reviewed on a case -by -case basis and each on its own merit: Please note that variances to the
Minimum Design Criteria should be requested and approved during the permitting process prior to
construction. After -construction requests are discouraged by the Division and may not be approved, thus
requiring replacement or repair prior to certification & activation.
8. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of the
wastewater collection facilities.
9. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the Division's Gravity
Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the
Fast -Track Permitting of Pump Station and Force Mains adopted June 1, 2000 as applicable; and other
supporting materials may subject the Permittee to an enforcement action by the Division, in accordance with
North Carolina General Statutes .§143-215,6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to the
licensing board.
10. In the event that the wastewater collection facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those as may be required
by this Division, such as the construction of additional or replacement facilities.
11. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes, rules,
regulations, or ordinances that may be imposed by other government agencies (local, state and federal) which
have jurisdiction, including but not limited to applicable river buffer rules in 15A NCAC 2B .0200, erosion and
sedimentation control requirements in 15A NCAC Ch. 4 and under the Division's General Permit NCG010000,
and any requirements pertaining to wetlands under 15A NCAC 2B ,0200 and 15A NCAC 2H ,0500.

FAST TRACK ENGINEERING CERTIFICATION
Permittee: Town of Taylorsville Permit No. WQ0036362
Project: Dollar General Sewer Extension Issue Date: 02/20/2013
Complete and submit this form to the permit issuing regional office with the following:
▪ One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension. Final record drawings should be clear on the plans or on digital media (CD or DVD
disk) in pdf format. Record drawings should indicate the design and the marked up changes during construction.
Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump stations
permitted as part of this project
▪ Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria. Modifications should be submitted prior to certification.
This project shall not be considered complete nor allowed to operate until the Division has received this Engineers
Certification and all required supporting documentation. Therefore, it is highly recommended that this certification
be sent in a manner thatprovides proof of receipt by the Division.
PERMITTEE'S CERTIFICATION
the undersigned agent for the Permittee, hereby state that this project has
been constructed pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction information to the Permittee, and the Permittee is prepared to operate &
maintain the wastewater collection system permitted herein or portions thereof.
Printed Name, Title Signature
ENGINEER'S CERTIFICATION
Date
El Partial 11 Final
, as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (El periodically, [1] weekly, full time) the construction of the subject project
for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the construction such that the construction was observed to be built within substantial compliance of this
permit: 15A NCAC 02T, the Division of Water Quality's (Division) Gravity Sewer Minimum Design Criteria adopted
February 12, 1996 as applicable: the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engi eer's
Seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
VVITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
SURFACE WATER PROTECTION SUPERVISOR
MOORESVILLE REGIONAL OFFICE
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE, NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received, Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions,
DWQ Use Only:
How frolIt this project is tributt :y to:

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
), OwnerfPermittee:
la. Town of Taylorsville
Full Legal Name (company, municipality, HOA„ utility, etc.)
lb David Odom, Town Manager
Signing Official Name and Title (Please review
The legal entity who will o
❑ Individual ❑ Federal
ld. 67 Main Avenue Drive
• Mailing Address
Z
to
1c
lf. NC _..._
State
Application Number:
(to be completed by DWQ)
A NCAC 2T 0106 (b
or authorized signing officials
n this system is:
Municipality ❑ State/County 0 Private Partnership © Corporation D ©the
l h 828-632-2218 1 i. 828-632-7964
Telephone Facsimilery
2. Project (Facility) information:
2a, Dollar General Sewer Extension
Brief Project Name (permit will refer to this name)
Contact Person:
3a, Justin Church, PE — Project Engineer— Blue Ridge Environmental Consultants
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b, 336-844-4088
Phone Number
Project is El New ❑ Modifi
2. Owner is jj Public (skip to Item 8(3))
2a. If private, applicant will be:
0 Retaining Ownership (i.e, store, church, single office, etc.) or
❑ Leasing units (lots, townhomes, etc, - skip to Item B(3))
• Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Taylorsville
n existing permit)
❑ Private
3c. justin@a brec.b'iz
E-mail
Modification, Permit No.:
go to Item 2(a))
1 e, Taylorsville
City
1g, 2.8681
Zip Code
1j. townmanager
E-mail
2b. Alexander_
pepi
County Where Project is Located
2b. If sold, facilities owned by a (must choose one)
0 Public Utility (Instruction C)
❑ Homeowner Assoc./Developer (Instruction D)
Owner of Wastewater Treatment Facility (VVVVTF) Treating Wastewater From This Project
4a. Town of Taylorsville Wastewater Treatment Plant 4b. 0026271
Name of WWTF WWTF Permit No.
Town of Taylorsville `5b. 8" ® Gravity
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main
The origin of this wastewater is (check all that apply):
Residential Subdivision
❑ Apartments/Condominiums
• Mobile Home Park
❑ School
❑ Restaurant
❑ Office
Permit # of Downstrea
® Retail (Stores, shopping centers)
• Institution
❑ Hospital
❑ Church
• Nursing Home
❑ Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
Sewer (Instruction E)
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
0 gallons per day
O Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No..
❑ Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA12107

PF9PP'PPIPPF-, Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7), Values other than that in 15A NCAC 2T 0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
Retail w/o food service = 100 gpd/1000 sq ft = 100 x 9,1 = 910 gpd
Residential = 120 gpd/bedroom = 120 x 4 = 480 gpd
Total = 910 + 480 = 1390 gpd
10. Summary of Sewer Lines to be Permitted (attach additionat sheets if necessary)
Size (inches)
8
Length (feet)
New Gravity or Additional
Force Main
579 New Gravity
CI 1 1 Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
L1.11
Pump Station Location ID (self chosen - as shown on plans/map for reference)
i.". Design Flow
Operational Point Power Reliability Option
(MGD)
GPM ©TDH 1 -permanent generator wiATS; Force Main Size Force Main Length
2 - portable generator w/MTS
0
2
f."*. Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow Power Reliability Option
Operational Point ..
(MGD) permanent generator w/ATS; Force Main Size Force Main Length
GPM @TDH
2 - portable generator w/MTS
0
Pump Station Location ID
(self chosen - as shown on plans/map for reference)
Design Flow Power Reliability Option
Operational Point . -
(MGD) 1permanent generator wIATS; Force Main Size Force Main Length
GPM @TDH
2 - portable generator wfMTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
[I] Yes E No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
El Yes E] No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA12/07

lave the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? 0 Yes 0 No N/A
Sedimentation and Erosion Control Plan? 1Z Yes 0 No 0 N/A
Stormwater? El Yes 0 No N/A
15, Does this project include any high priority lines, [see 15A NCAC 02T ,0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: [2] and provide details
1, Owner/Permittee*s Certification: (Signature of Signing Official and Project Name)
1, David Odom , attest that this application for Dollar General Sewer Extension has been
reviewed by me and is accurate and complete to the best of my knowledge, 1 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. Note: In accordance with North Carolina General
Statutes 143-215,6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application 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,
/— 2 043
Signi Signature
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMI I I AL OF THIS
APPLICATION, THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
in TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T 0305
0
Professional Engineer's Certification: {Signature of Design Engineer and Project Name)
1, Justin Church , attest that this application for Dollar General Sewer Extension has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although other professionals may have developed certain portions of this submittal package, inclusion of Mese 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 NC General Statutes 143-215,6A and 143-215.68, any person who knowingly
makes any false statement, representation, or certification in any application 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,
2a. Justin Church
Professional Engineer Name
2b, Blue RidatEnvironmental Consultants, PA
Engineering Firm
2c. 1305 S Collegiate Drive
Mailing Address
2d, Wilkesboro
2g
City
Telephone
2e, NC 2f 28697
Facsimile E-mail
C Clf‘
1/1)
NC RE S al gnature & Date
FTA12/07

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(F-rsE --10/07)
Project Applicant Name: Town of Tavlorsville
Project Name for which flow is being requested: Dollar General Sewer Extension
More than one FTSE-Ioso7 may be required for a single protect the owner of the WWTP is not responsible fOr all
pump stations along the route of the proposed wastewater flow,
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Tavlorsville Wastewater Treatment Plant
h. WWTP Facility Permit #: 0026271
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of pennitted flow used
All :flows are in MGD
0.83 MGD
0 MGD
0,3,7 MGD
0,00139 MGD
0.37139 MGD
44.7 ?""i)
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
Pump Station Name
Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily: Flow, MGD
Jav Drive Pump Station 0.72 MGD
0,06 MGD
HI. Certification Statement:
1, David Odom certify that, to the hest of my knowledge, 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. 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 1 and It for which in the responsible party. Signature of this form indicates
acceptance of this wastewater flow.
/ .2--",/3
Signing (?/ficiaI Signature
Date

FORM WSCAS-03/2012
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
licit t Name
Town of Taylorsville
Pr t fesslonal Engineer Name
Justin Church
ation
ID
Name of Waterbod
UT to Lower Little River
Project Name
Dollar General Sewer Extension
County
Alexander
t®ineerng Firrri
ue Ridge Environ
River
Basin
Catawba
ental Consultants, PA
aterbody Stream
Index No,
-59-10.5)
Waterbody
Classification
If unnamed, indicate "unnamed tributary to X", where Xis the named waterbody to which the unnamed tributary joins.
l certify that as a Registered Professional Engineer in the State of
North Carolina that i have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
PE Seal, Signature and Date
*** END OF FORM `S .7.AS-03/2012 ***
FORM: WSCAS-03/20
Page 1 of 1

rtNurnber
0036362
Central
Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type Fa
,t roc
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Extensions
Primary Reviewer
michael. parker
Coastal SW Rule
Permitted Flow
1390
Facility°
Facility Name
Dollar General Sewer Extension
Location Address
Owner
Owner Name
Town of Taylorsville
Date(Ev
Orig Issue
02/20/13
App Received Draft Initiated
©2/©4/13
Regulated Activities
Retail
Subdivision
Wastewater collection
Duffel!
Waterbody Name
Scheduled
Issuance
les. AP S SVVP_
02/20/13
Version Permit Classification
1.60 Individual
Permit Contact Affiliation
Major/Minor Region
Minor Mooresville
County
Alexander
Facilit t Contact Affiliation
Owner Type
Government - Municipal
Owner Affiliation
David Matthew Robinette
204 Main Ave Dr
Taylorsville
NC 28681
Public Notice Issue Effective
02/20/13 02/20/13
Requested!Received Events
Additional information requested
Additional information received
Expiration
Stream Index Number Current Class Subbasin

BLUE RIDGE ENVIRONMENTAL CONSULTANTS, PA
PH. 828-265-4425
467 CALLOWAY GAP RD
WEST JEFFERSON, NC 28694-9209
142.2 US Hwy 4211-M
P©, box 892 • PIT, 338-913-99�18
Wilkesboro, NC= 289.97 • o f •G
66-1284-531
ARS 11,