WQ0041519_Regional Office Historical File Pre 2018

ISA NC
Application Number:
State of North Carolina.
Department of Environmental Quality
Division of Water Resources
FAST TRAC I SEWER S`rST`I M EXTENSION APPLICATION
I FA 04-16 & SUPPORTING DOCUMENTATION
FIECCIV IC000 t:rl.1:NRJL
he completed by MR)
All items must be completed or the application will be returned
9 ?i- )
ROS
APPLICANT INFORMATION:
1. Applicant's name: City of Shelby (company,=, municipality, HOA, utility°, etc_
.Applicant type: LI Individual 0 Corporation 0 General 'Partnership [j Privately -Ow ed Public Utility
Ei Federal 0 State/County Municipal Other
Signature authority's name: Rick Howell per
Title: City Manager
4. Applicant's mailing address: PC) Bax.27,
City: Shelby
State: N_C Zip: 281.50-
^applicant`s contact information:
Phone number: [phone] Email Address: rick howtiellsert ofshelby°.com
1I. PROJECT INFORMATION:
L Project name. ingles ti I
2. Application/Project status:
Proposed (New Penn it) Existing Permit/Project.
If a modification, provide the existing permit number: WOODand issued date:
If new construction but part of a master plan, provide the existing permit number WQ00
County where project is located: Cleveland
1. Approximate Coordinates (Decimal Degrees): Latitude': 35.27 5' Longitude: l 2
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
C` NSULTANT INFORMATION:
. Professional Engineer: Patrick Rivers License Number: 25645
Finn: Land Planning Associates of N
Mailing address: 1 10 West I" Avenue
City: ,Easley State: SC
Phone number: [phone] Email Address: pa.irick/c+Ipa-inc.ner.
Zip: '9640
R. 'WASTEWATER TREATMENT FAC(WWTF) INFORMATION:
1. Facility Name: First Broad River WWT[ Permit Number: NCUU_24538.
Owner Name: City of Shelby_
\ . RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF'):
1, Permit Numher(s)m WQCS00 7 Downstream (Receiving} Sewwer Siire.
WQCS
Owner Name(s): City ot'Shelby
FORM: FTA 04-16
Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate. of Public Convenience and Necessity been attached?
0 Yes
No N/A
If the Applicant is a Developer of lots to be sold, has a Lkvelc,vets's Qtwational Aufeertent (FORM: 1)E:\,11 been attached?
Yes E1No N/A
If the Applicant is a iforne/Proply Owners' ,,Nssooiatiort, has an (1./(perational ,stsareement room 10,A1, been attached?
0 Yes 0No N/A
4. Origin of wastewater: (c
El Residential Owned
0 Residential Leased
0 School / preschool / day care
0 Food and drink facilities
[E] Businesses / offices / factories
k all that apply):
0 Retail (stores, centers,. malls)
Z Retail with food preparation/service
0 Medical / dental/ veterinary facilities
0 Church
Ei Nursing Home
0 Car Wash
Li Hotel and/or Motels
Ej Swimming Pool ./Clubhouse
0 Swimming Pool/Filter Backwash
0 Other (Explain in Attachment)
Nature of wastewater : _ Domestic/Commercial 100 % Commercial
% Industrial (Sce I 5A N( .AC 0121 ,0 tO3L2,9))
there a Pretreatment Program in effect? 0 Yes
6. Has a flow reduction been approved under 13,A 'NC AC 02T .01 t 4(1)?
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021‘,9 4(q)
Commercial: Ingles Grocery Store
Commercial: Ingles Gas Express
Daily Design Flow 8'h
100.73 gali I 000 sq. fl.
105 gallgas station fixture
gal/
gal/
gal/
gal/
No
No
No. of Units
Flow
7520 GPD
210 GPD
GPD
GPD
GPD
GPD
Total 7,730 GPD
a See, I 5A. NC.AC 021 .01 is4(171.L(cilde1(.11s(as1f ot,q). 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
-:12A.-4).
b Per iSA NCAC 02T .01 14(c), designflowfor establishments not identified [in table 151,ANcz::),(1/Q10II:1] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7,730 GPD (per 1,5;\ NC/),C 02 0t 1,4)
'.111t-' 13o not include future flows or previously permitted allocations
If permiued flow is zero, indicate why:
0 Purnp Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
0 Flow has already been allocated in Permit Number:
El Rehabilitation or replacement of existing sewer with no new flow expected
0 Other (Explain):
FORM: ETA 04-16 Page .2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA Applicable) L0J5 & „ IDCA(;ravity
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet)
Material
150
DIP
6 10
DIP
• Section Il & 111 of the MDC for Permitting ol'Gravity Sewers contains information related to design criteria
▪ Section 111 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 .00.5 & Mar t nip .Statioas/Furce hth
COMPLETE FOR EACH PUMP sTivflON INCLUDED IN "MS PROJECT
Pump station .number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
Design flow of the .pump station: millions gallons per day (firm capacity.)
4, Operational poi:m.(s) of the pump(s) : gallons per minute at
5. Summ.arize the force main. to be permitted (for this Pump Station):
feet total dynamic head (TDH)
Length (feet) Material
6. Power reliability in accordance with I CA( tO?,, 1
O Standby' power source or pump with automatic activation and telemetry I5A NCAC 02T .0305(h)(1)(t3),
• Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
• 1V1ust be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day;
O Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(11)(1)(C)
or
O Portable pumping unit with plugged emergency pump connection and telemetry - 1.5A NCAC 02T .0305(1)( I.)(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 multiplepump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timefrarnes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04- 16 Page 3 of 5

SETBACKS & SEPARATIONS (02B .0200 & 15A NCA( 02T .0305(f)):
I Does 'the project comply' with all separations found in 05A NCAr 02T .03050) &
5A NCAC 02T.0305(T1 contains minimum separations that shall be provided for sewer s ° • ems:
Sethack Parameter* Searation Required
Storm sewers and other utilities not listed below (vertical) 24 inches
-r mains (vertical -water over sewer ineludingin benched trenches)
LWater mains (horizontal)
I Reclaimed water lines (vertical - reclaimedover sewer)
Reclaimed water lines horizontal - reclaimed over sewer)
**Any private or public water supply source, including any wells. WS-1 waters of Class 1 or
Class 11 impounded reservoirs used as a source of drinking water
**Waters classified WS (except V S-1 or 41TS-V), B, SA, OR‘V„ HQW, or SB from normal
high water (or tide elevation) and wetlands (see item 1.X.2)
**.Any other stream, lake, impou.ndment, or ground water lowering and surface drainage
ditches
Arty building foundation
Any basement
Top slope of embankment or cuts of 2 feet or more vertical height
Drainane systems and interceptor drains
Any ming pools
Final earth grade_tverticall
18 inches
10 feet
18 inches
2 feet
100 feet
50 feet
10 feet
5 feet
1.0 feet
10 feet
5 feet
10 feet
36 inches
• 05A NCAC 0,2T00305.(ki contains alternatives. where separations in 1.:,21f1,0,105(1) cannot be achieved,
.;• **Stream classifications can be identified using the Divis.ion.'s NC Surf-1'1u Watcr lassi lictIttons wePpqge
• if noncompliance with 021'..0305(f0 or (0. see Section X of this application
2 Does the project comply with separation requirements for wetlands? (50 feet of separation) Yes
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 1.5A. NCAC 028. „0.1t00.t:t
• This would include Trout Buffered Streams per °I 5A NCA.0 2 B4O20.2
Does the project require eoveragelauthorization under a 404 Nationwide or Ei Yes El No
individual permits or 401 Water Quality Certifications?
• Information can be obtained from the 401 & 1:41tr Permitting Branch
Ej Yes LilNo
N/A
5. Does project comply with 15,A NC .AC 021J) Q5Aylt() (additional permits/certifications)? Yes LJ No
Per 0.5A N(17..AC (t2TA) I .0f.iGtVit, 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 ofdependent permits (erosion and
sedimentation control plans, storrnwater management plans, etc.),
6. Does this project includeany sewer collection lines that are deemed "high -priority?"
Per ;N!...,.,.'Nclfg11,kjj1:2, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sever
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer,
Lives No N/A
If yes, include an attachment vith details for each line, including type (aerial line, size, material, and location).
High priority lines. shall he 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: PTA 04-16 Page 4 of 5

X. CERTIFICATMNS:
1, Does the submitted system comply with t ervliD imum C6teria
and 1 Niainsthltest versioni, and the Gravky Sewer Mihiniurn Design Criterirtfkates
Yes LilNo
If No, complete and submit the Variance/Alternative Design Request application (V ADC
review, Approval of the request is required prior to submittal of the East Track Ajj
for the Permih'Ing of rhn.1111.:5tA.q.,h,:msis
versiolu as applicable'?
10-14) and supporting documents for
ton and o docunients,
Professional Engineers Certification:
1, 4-rekk. attest that this application for
(Professional Engineer's name from Application hem. 111,1.)
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 Seer
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 or 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 I43-215.6A and 143-215.6E3, 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 I5A NCAC 02T .0106(b):
RIcic 14i/141.4.4, CITY
(Signature Authority's name &
n Application Item I.3.)
attest 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 vvastewater 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, andlor 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 (Wall 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 rile as
incomplete.
NOTE — In accordance with General Statutes I A and 143-2 Vi.69,, 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 $10.00.0 as well as civil penalties up to $25,000 per violation,
Signature:
Date:
FORM: 1TA 04-16 Page 5 of 5

Tuvia, Ori A
From: Litzenberger, Kristin S
Sent: Monday, April 06, 2020 4:30 PM
To: Tuvra, Ori A
Cc: Fertenbaugh, Christyn L
Subject: RE: #112 Ingles Store Flow Reduction Permit Language
Hi Ori,
Missed a couple of dates in the permit condition language.
On March 12, 2020,.the. Division of Water Resources (Division received a request for an adjusted daily sewage flow rate
(flow reduction) that would apply to the proposed Ingles #112 store, located in Shelby:, NC. Water usage data for three
:similar Ingles tores with gas station facilities located in. the same area of the State between .iiiiinuary 2019 and lariu-,1,'-y
2020 was provided and analyzed by central office staff, Based upon this data,. the Division hereby approves a reduction
in flow for this. proposed Ingles 4112. to 100,73 gal/1000 sq. ft. and 105 per gas station fixture,
Regardless of the adjusted design daily wastewater flow rate, at no time shall the wastewater flows exceed the effluent
limits defined in the permit for the treatment facility or exceed the capacity of the sewers downstream of any new
sewer extension or service connections).
Thanks,
Kristin
From: Litzenberger, Kristin 5
Sent: Monday, April 6, 2020 4:22 PM
To: Tuvia, Ori A <ori.tuvia@ncdenrigov>
Cc: Fertenbaugh, Christyn L <[e-mail]>
Subject: #112 Ingles Store Flow Reduction Permit Language
Hi Ori,
We have reviewed the proposed flow reduction for 4112 Ingles store in Shelby, NC, The approved flow reduction yields a
total permitted flow for this sewer extension of 7,730 gallons per day, Below is the proposed language for the permit.
Please let me know if you have any questions.,
Thanks,
Kristin
Proposed language:
Permitcover page:
Condition An adjusted daily sewage flow rate has been approved for the subject. sewer system extension, per 1„5A
NCAC 02T011.4(f). Please see Condition 1.1 for more details.
Special Condition page:
On March 12,.2020, the Division of Water Resources (Divis on) received a request for an adjusted daily sewage flow rate
(flow reduction) that wouldapply to the proposed Ingles 4112 store, located in Shelby, NC, Water usage data for three

similar gletores with gas station facilities ocated in the same area of the State between <insert monthslyears here>
was provided and analyzed by central office staff, Based upon this data, the Division hereby approves a reduction in flow
for this proposed ingies #112 to 100,73 gaff1000 sq, ft, and 105 per gas station fixture,
Regardless of the adjusted design daily wastewater flow rate, at CIO time shall the wastewater flows exceed the effluent
limits defined in the permit for the treatment facility or exceed the capacity of the sewers downstrearn of any new
sewer extension or service connection
Kristifl Litzenberger
Environmental Specialist
Division of Water Resources
Department of Environ ental Quality
919.-707-3699
2

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Shelby
Project Name for which flow is being requested: Ingles 4112
%fore than one FTSE may he required for a single project lt the owner of the WWTP is not responsible far alipunip
stations along the route of the proposed wastewater flow.
Complete this section only if you are the owner of the wastewaterwastewatertreatment plant.
a. WWTP Facility Name: First Broad River WWTP
b. WWTP Facility Permit 4: NC00024538
c. WWTP facility's permitted flow
A!Iflows are in MGD
6.0
d. Estimated obligated flow not yet tributary to the WWTP .648
e. WWTP facility's actual avg. flow
f. Total flow for this specific request.
3.6
.00773
g. Total actual and obligated flows to the facility 4.26
h. Percent ofpermitted flow used
71°'
IL Complete this section for each pump station you are responsible for along the route of "s proposed
wastewater flow.
1....,ist p-ump stations located between the project connection point and the W P:
(A) OP (C) (0)--(11-1-C) (E),-(A-D)
Design Obligated,
Purnp Pump Average Approx, Not Yet Total Current
Station Station Firm Daily How** Current 'Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pl), Avg. Daily Daily Flow, Obligated Available
Number) No, MGD MGD How, MGD MGD Flow Capacity***
NIA
N/A
N/A
N/A.
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped .
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 < O.
Downstream Facility 'Name (Sewer): Shelby
Downstream Permit Number: WQ0007780
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Rick Howell
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 adequ e capacity to transport and treat the proposed new wastewater,.
Signing Qtlic al Signature 1)ate
Title Signing knit
Page 2 of 6

Division of Water Resources
Depart
State of North Carolina,
nt of Environmental Quality
Division of Water Resources
.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
ETA 04-16 & SUPPORTING DOCUMENTATION
Appllean nn Number:
ust becompleted or the application will be returned
APPLICANT INFORN
i. Applicant's name: City of Selbv (coinpany, municipality, FIOA
Applicant type: © Individual 0 Corporation
El Federal 0 State/County
Signature authorite<<"s narale: Rick .flow'e l
-Fide: City Man4, gg r
Applicant's mailing address: PO Box 207'
City: Shelby! State: NC
Applicant's coninformation:
Phone number: (704) =484-6840 Email
PROJECT INFORMATION:
I. Project name. 1ngjes it1 12: Shel
ikpplicatuon/Projeet status:
If a modification, provide the exiting permit number: WQ00 and issued date..
If new construction but part of a master plan, provide the exis-tinp permit number: A\CSC)
County where project is located: Cleveland
4. Approximate Coordinates (Decimal Dcrecs)' I atitude:
Parcel ID (if applicable):
(or Parcel ID to closest downstream. sew
0 General Partnership 0 Private" - Public Ut
Sit 'NCAC— 021 .(t 1
0-
._howeilla.�eut.
u
cipal
by.cu m.
El Proposed (New Permit)
III. CONSULTANT" INFORMATION:
1 Professional Engineer Patrick givers 1. kense Nurn.bet 25645
I'ursn: I_. and Planning Associates of NC, Inc.
Mailing address: 110 \Vest 1" Avenue
City; Easley State: 5C it: ?9640-
Phone number [phone]
cronnude: -8
Address: patrick:a 1pa-inc.net
STEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility. Name: First Broad River \V\\`TF Permit Number: NC0024538
Owner Name: City of Shelby
RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQCS0037 Downstream (Receiving) Sewer Size: .�-_.....
n 4 €c1 C €le trkrn S ,teen Permit N
er Name(): C°it a ("Shelby
hc1,`A.111 apllic.l
\\ QCCS. _._
Other
)jest
FORM: F"T.A 1)4-16
Page I of 5

GENER.A.L REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
11 Y es No
lithe Applicant is a Developer of lots to be sold, has a .Developerls Operational. Agreement (FOR :1 F\ been a.' ael ed.?
[11. Yes ENo NIA
3, If the Apphcant is a Home/Property Owners' Association, has an (:)perttlional ,Agrecinent (FOR)\l: 110A) been .attached?
YesLJo NA
4, Origin of Waste waten (c.heck all that apply):
Lill Residential Owned
'Residential Leased
El school preschool day care
Eli Food and drink facilities
El] Businesses offices / factories
LI Retail (stores, centers, malls)
E] Retail with food preparationtservice
Ej Medical. / dental / veterinary. facilities
ID Church
fl Nursing Horne
El Car Wash
rj Hotel andlor 'Motels
El Swimming Pool /Clubhouse
LJ Swimming Pool Filter Backwash
E] Other (1..°Aplain in Attachment)
5. Nature of wastewater 'A Domestic/Commercial 1.00 % Commercial
'Yo Industrial (See 1.5A NCAC 02lt.0103(20))
fo there a Pretreatment Program in. effect'? El Yes El No
6, Has a flow reduction been approved under 15A NCAC o 1 ,01140)? LI Yes No
Ifves..provide a copy. of flow reduction approval letter
Summarize %,vastewater generated by .project:
Establishment Type (see 14(1)
Daily Design .' o
Commercial: ingles Grocery Store
90 gallmin
o . of Units Flow
1 4000 GPD
"Tomrnercial: Ingles Gas Express
15 gallmin
gal
eal
250 GPD
GP.D
gal
GPD
gal
Total
(jPI)
GPD
4250 GPD
a See I5A NCAC 021 MI 14(bi,(d), .. Rilc..)(2) .for caveats to wastewater design flow rates (i,e„ minimum flow per
d %Nel)rog., proposed unknown non-residernial development uses.; public access facilities located near high public use areas:
and residentialproperty located south or east o-1 the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
h Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 021 ,01141 shall be
determined using available flow data, water using fixtures, occupancy o.r operation patterns, and other measured data,
8, Wastewater generated h' project, 4250 GPD (per I 5A NCAC 021 .0114)
Do not include 'future flows or previously permitted allocations
If permitted flow is zero, indicate 1vhy:
El Pump Station or Gravity Sewer where t10 ll be permitted in subsequent permits that connect to this line
Lill Flo s has already been allocated in Permit Number:
El 'Rehabilitation or replacement of existing se er ith no ncs fhoow expected
El Other (Explain):
FORM: HA 04-16 Page .2 of 5

, GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T At) critv Se
Summarize .gravity sewer to be permitted:
Size (inches) Len
s):
Section II & 111of the MDC for Permitting of Gravity Sewers rontain.s information related to design critcna
Section HI contains information related to minimum slopes for gravity sewerts)
Oversizing lines to meet minimum slope requirement is not Aimed and a violation of the MDC
PUMP STATION DESIGN CRITERIA (If Applicable)— 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROTECT
I, Pump station number or name: N/A
2, Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
.3, Design flow of he pump station: mdlions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TM)
5, Summarize the force main to be permitted (for this Pump Station):
Size(inches) Length (feet) Material
6, Power reliability in accordance with 1.5A NC.AC 021' :03050:10
Li Standby power source or pump with automatic activation and telemetry - 15A NCAC 021 .0305(1)( D(H):
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
.••• MUMbe permanent to facility
Or if the pump station has an average dai! t1ov less than '15,000 gallons per day:
El Portable power source with manual activation, quick -connection receptacle and telemetry - 1.5A. NC,AC 021
.0305(h)(1)(C)
Or
LI Portable pumping unit with pluggedemergency pump connection and .telemetry - 15A NCAC 022 ,0305(11)(1)(C
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
;itud is compatible with the station.
:0- lithe portable power source or pump is. dedicated to Ill Aipie pump statn.ms, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall he provided
in the case of a inultiple station power outage,
FORM: FTA 04- 6 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .020(1 & I5A NCAC 02T ,0305(0):
I, Does the project comply with all separations found in 15A NC.AC 02T,030,5(f)_&:Lb
15A NCAC 02-1.0305(1) contains minimum sepLarations that shal I be provided. for sewer systern
Setback Parameter*
sewers and other utilities not listed below (vertical)
[A Yes El No
Separation Required
24 inches
Voter mains (vertical -water over sewer including in benched. trenches) 18 inches
Voter mains (horizontal) 10 feet
Reclaimed water lines (vertical - reclaimed over sewer) l 8 inches
Reclaimed waterlines (horizontal - reclaimed over sewer) 2 feet
*Any private or public water supply s•ource, including any Welk. WS-I waters of Class 1 or
Class II imp2unded reservoirs used as source of drinking water -100 feet
**Waters classified WS (except WS-11 or WS-V), B, SA, OR W, HQW, or SB from normal
"g. water (or tide elevation) and wetlands (sec item IX.2) 50 feet.
"Any other stream., lake, im.poundm.ent, or ground water lowering and surface drainage
10 feet
Any building_foundation
Any basement
5 feet
10 .feet
Top slope of embankment or cuts of 2 feet or more vertical height
Drainage systems and interc(2tor drairo
' .An.y swimming pools
Final earth grade (vertical)
10 feet
5 feet
10 feet
36 inches
• 15.A NCAC 02 1.0305(0 contains alternatives where separations in 02 r.o3oan cannot be achieved.
• "Stream classifications can be identified using the Division's NC Surface_WaterPassi fietion5webpai,e
if noncompli MCC With 02 f.0305[11 or g), see Section X of this application
2., Does the project comply with separation requirements for Wetlands? (50 feet of separation) Yes. El No [1 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
Does the project comply with setbacks found in the river basin rules per 15A 028 .0200? Ye LJ No LJ N/A
• Trhis would include Trout Buffered Streams per 15A NCAC 2.B.0202
4. Does the project require coveragelauthorization under a 404 Nationwi
individual permits or 401 Water Quality. Certifications?
Information can be obtained from the 401 & Buffer Perini'
El Yes CEI No
5. Does project comply with I5A • -CAC 02T.0105(c)10 (additional permits/certifications)? Ye Li No
Per I5,ik NCAC 021„010.5(c, 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-priortty7
Per 15A NCAC 02'1,0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, sipho•n, or sewer
positioned parallel to treambanks that:is subject to erosion that undermines or deteriorates the .sewer.
Ayes Ne LJNA
ilf yes. include an attachmentdetailsdctii1 fur each inc.lincluding type (aerial e, size, rna erial, and locatii.
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(05) or the perrnitee's individual System -Wide Collection permit.
FORM: ETA. 04-.1.6 Page 4 of 5

X. CERTIFICATIONS:
1, Does the submitted system comply with J5A NCAC 02T, the Minimum Desi,m Criteria. for the Pernutt neof' Pump Stations
and Force Mains itatest version), and the Gravity Sewer ,Nlinitnin Design Cfiteria (latest r,onJ a applicable?
El Yes E] No
11No, complete and submit the Variance/Alternative Design Request application (VADC I 0-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and spjortint documents.
2.Protessiondl Engineer's Certification:
p81
(Professional Engineer's name from Application Item III. I,
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in. the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I Further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track. Permitting
of 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 143-21.5.6B, any person Who knowingly makes any false
statement, representation, or certificationin any application package shall be guilty of a Class 2 misdemeanor, which may.
include a fine not to exceed Si 0..000, as well as civil pe.nalties up to S25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3, Applicant's Certification per 1.5A 'NCAC 02T .0-1.06(b):
,
Rick Howell, City Manager attest that this application for
(Signature Authority's .11aMe & title from Application Item 1,3.)
has been reviewed by me and is accurate and completee to the best of my 'knowledge, 1 und.erstand that if all required parts of
this application are not completed and that if allrequired supporting docum.entation and attachments are not included., this
application package is subject to being returned as incomplete, 1 u.nderstand 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 relied', 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 inforrnaton and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 1' 5,6A and 143-215,6B, any person who knowingly makes any false
staterrumt, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a line not to exceed S10.000 as well as civil penalties up to S25,000 per violation.
Signature:
FORM: 11A 04-16 Page 5. of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Shelby
Project Name for which flow is being requested: Ingles .#11
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible
stations along the routeof the proposed wastewater flow,
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: First Broad River WWTP
b. WWTP Facility Pennit #: NC000245:,
Ail
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP :648
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
3.6
00425
g. "Fotal actual and obligated flows to the facility 4.25
h. Percent of permitted flow used
71 °Al)
11,, 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) (3) (C) (D)----(15+C) (E)=(A-D)
Design Obligated,
Pinup Pump Average Approx, Not Yet Total Current
Station Station Firin Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity,* (Firm / p), Avg. Daily Daily Flow, Obligated Available
Number) No, MOD ivIGD Flow, MOD WM Flow Capacity***
* 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):
Downstream Permit. Number:
Shelby
WQ00077
Page 1 of 6
FfSI„ 10-18

Certification Statement:
Rick Howell certify to the best of my knowledge that the addition of
the volume of�Gvastewater to beperm ited 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. d.ow-nstrearn 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 perlonned 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 adequa e capacity to transport and treat the proposed new wastewater.
kigna x r
City Manager
Title S'i xirxr
Page 2 of 6

LAND
PLANNING
ASSOCIATES, INC.
E
N:,ERIG
To: NCDEQ
NC
Date: February 13, 2020
From: Patrick Rivers, P.E. RE: Sewer Calculation Writeup
Sewer Calculations:
RECEIVED
FE3 19 2020
VH/NPDES
The sewer system as shown in the plans is a gravity sewer system. All lines meet minimum
slopes to meet scour velocities. There are no pump stations in the system.
864•242•6072
208•730•8214
Address:, 110 West 15t Avenue, Suite A • Easley, SC 29640