WQ0041048_Regional Office Historical File Pre 2018

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Num r:
(to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT 1„NEW.MATION
fk..100res'ou,,E.' R)/cautoi of/FtrE
1. Applicant's name: CROSSROADS RESCUE MISSION, (company, municipality, HON, utility, etc)
Applicant type: Ell individual
D Federal
Corporation [1] General Partnership E] Privately -Owned Public Utility
E] State/County El Municipal
3: Signature authority's name: ROCKY SHELTON per I 5.A Nt..A.0 02T ,0106(b)
Title: ,EXECUTIVE DIRECTOR.
4. Applicant's mailing address: P.O. BOX 2090
City: SIIELBY State: NC Zip: 281.51-
.5: Applicant's contact information:
Phone number [phone] Email Address: rshelton@crossroadsrescuemission,org
II. PROJECT INFORMATION:
1. Project name: CROSSROADS RESCUE MISSION
2. ApplicationProject status:
Other
Proposed (New Permit) .0 Existing Permit/Project
Ila modification, provide the existing permit number WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number WQ00
3. County where project is located: CLEVELAND
4: Approximate Coordinates (Decimal Degrees) Latitude: 35.2594.36Longitude: -81:559154'
5: Parcel ID (if applicable): 6.3871
(or Parcel ID to closest downstream sewer),
III. CONSULTANT INFORMATION:
1. Professional Engineer: LARISSA, OLEOS License Number: 029478
Firm: ODOM ENGINEERING, PLCC.
Mailing address: 169 OAK ST.
City: FOREST CITY State: NC Zip: 28043-
Phone number: [phone] Email Address: larisseiOdomengineering,com
IV. WASTEWATER TREATMENT FACILITY' (WWTF) I.NFORMATION:
I. Facility Natne: First Broad River Wastewater Treatment Plant Permit Number'NC0024538
Owner Name: City of Shelby
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8: inch
System Wide Collection System Permit -Number(s) (it -applicable): WQCSWQCS00037
Owner Name(s) : City of Shelby
FORM: FTA 04-16
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility,
DECENEVAir..Vzoq:'.,7",v".4,'
as a Certificate of Public Convenience and Necessity been attached?
E1 Yes ENo
2 he Applicant is a Developer of lots to be sold, has a Dev
E] Yes ENo
3, If the Applicant is a Home/Property Owners'," .ssocia
El Ye.
4. Origin of wastewater: (check all that apply):
Ej Residential Owned
ED Residential Leased
LI School / preschool / day care
LI Food and drink facilities
Lil Businesses / offices / factories
pont or)REsViLLEY:';E'Ciill Vthili84* FORM: ° A
NIA
has an Operational Agreement (,FORM : been attached?
EiNo N/A
Retail (stores, centers, malls)
Retail with food preparation/service
11 Medical/dental I veterinary facilities
El Church
Nursing Home
5. Nature of wastevvater 100 %.Domestic/C7omrn.ercial % Commercial
% Indu.strial (See ISA. .NCA( 02T ,0 103(20_1)
1-----3,1s there a Pretreatment Program in effect?
6. Has a flow reduction been approved under I5A NCAC 02°1.0114(1r
If ves., provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Yes I4 No
Establishment Type (see OTEN 14(p) Daily Design Flow "'h
RETAIL 100 gal/1.000 SF
RESTAURANT
WAREHOUSE
20 gal/SEAT
1.00 gal/LOADING BAY
gal/
gall
gal/
El Car Wash
El Hotel andlor Motels
Swimming Pool /Clubhouse
LI Swimming Pool ilter Backwash
n Other (Explain in Attachment)
' o
No. of Units
1,200 GPD
600 GPI)
200 GPD
GPD
GPD
Total 2,000 GPI)
a See SA NcAc (i2T 14 d liand (012) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling: proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in (i,S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table I 5A NCAC 02T.01 14j shall
be determined using available flow data, water using fixtures, occupancy' or operation patterns, and other measured data.
8, Wastewater generated by project: 2.,000 GPD (per 15 A NCAC 02 .01 14)
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
LJ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
EJ Flow has already been allocated in Permit Number:
Li Rehabilitation or replacement of existing sewer with no new flow expected
El Other (Explain):
FORM. FTA 04-16
Page 2 of 5

Vil. GRAVITY SEWER DESIGN CRITERIA Applicable) - 02T -0305
1. Summarize gravity sewer to be permitted,
Size (inches)
8'
Length (feet)
(Gravitv Se
Material
I ;002
SDR-2l PVC
▪ Section It& Ili of thc MDC for Permitting of Gravity Sewers contains information related to design criteria
Section Ill 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
VIAL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC(Ptimp Stations/EorceMain):
,
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1„ Pump station number or name: PS-1,
2, Approximate Coordinates (Decimal Degrees): Latitude: 35.2595'' Longitude: -81_5585'
3. Design flow of the pump station: _002 millions gallons per day (firrn capacity)
4. Operational point(s) of the purnp(s): 15_45 gallons per minute at 30 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size
inc
11/2
Length (feet)
340
Material
6. Power reliability' in accordance with 15A NCAC 021 .0305110W
El Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T „0305(h)(1)(13),:,
▪ 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 - 1.5A NCAC 02T
.0305(h)(I)(C)
Or
El Portable pumping unit with plugged emergency pump connection and telemetry - ISA NCAC 02T „0305(h)(1)(C):
Itshall be demonstrated to the Division that the portable source is owned or contracted by the applicant(draft agreement)
and is compatible with the station,
lie If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided in the case of a multiple station power outage,
FORM: ETA 04-16
Page 3 of 5

IX. SETBACKS & SEPARATIONS — (0213 .0200 & I5A NCAC 02T .0305(0):
1. Does the project comply with all separations found in NCACO2TM305fl
0305
• 1.5A NCAC 02T.0305(0 contains minimum separations that shall beprovided f 'stems,
Setback Parainete
Storm sewers and other utilities not listed below (vertical)
El Yes El No
Separation Required
24 inches
'a er rnains (vertical -water over sewer including in benched trenches)
/ater mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimedover sewer)
8 inches
10 feet
18 inches
e
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
Waters classified WS (except WS-1 or WS-V), 13, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
Any building foundation
Any basemen
Top slope
bankment or cuts of 2 feet or more verticali • h
Drainage systems and interceptor drains
Any swimming pools
100 feet
50 feet
10 feet
5 feet
10 feet
10 feet
10 feet
Final earth grade (vertical) 36 inches
15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(t) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
• If noncompliance with 021.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) Li Yes 111No 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 I5A NCAC 02B .0200?
• This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual per or 401. Water Quality Certifications?
• Information can be obtained from the 401 & Buffer Pcrrmttimz Branch
El Yes
No Xl NIA
5. Does project comply with 15A. NCAC 02T.0105(c)(6) (additional permits/certifications)? Yes LJ No
Per ISA 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 ofdependent 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 15.A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to strearnbanks that is subject to erosion that undermines or deteriorates the sewer.
II] Yes [1] 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: ETA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1, Does the submitted system comply with 15A_NcIL1 the ry141i,911.1111 teTia_fprttje k'ertnittiligof Nina) Stations
4114 Force ,..„Nlait1lates1. YetAi90, and the c,r4YitY04Ler MinitnUtO D,e411OtcriAlkilqg„Vg,lAi911,} as applicable?
Yes [j Net
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 Engin -'s Certification:
LARISSA COLES, PE
(Professional Engineer's name from Application Item ,)
CROSSROADS RESCUE MISSION
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 '4Iations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design CAleria 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 S25,000 per violation41
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
ROCKY SHELTON, EXECUTIVE DIRECTOR
attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
has been reviewed by the 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. 1 understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a
condition of this permit be violated. I also understand that if all required parts of this application package are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to
me as incomplete.
NOTE — In accordance with General Statutes 143-215,6A and 143:215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: FTA 04-16 Page 5 of 5

rtrt felts
Upload a PDF Filing Order a Document Online Add Entity to My Err ail oUfic ati n List View Film
on -Profit Corporation
Lgf Name
Crossroads Rescue
Information
ssion
Soslci: 0563137
Status: Current -Active
Annual, Report Status: Not Applicable
Citizenship: Dornestic
Date Formed:9/7/2000
Registered Agent: Not Listed
Addresses
Principal ffi e Reg ffi e Reg Mailingai it g
206 Mt. Sinai Road 206 Mt, Sinai Road P 0 Box 2090 P 0 Box 2090
Shelby, NC 1 Shelby, NC 28152 Shelby, NC 28 Shelby, NC 28151'
tC s 7=` )5.':` 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Tracking for Sewer Extension Applications
(FTSE 1.0-I8)
Entity Requesting Allocation: CROSSROADS RESCUE MISSION
Project Name ibr which flow is being requested: CROSSROADS RESCUE, i FISSION
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible fo
stations along the route of the proposed wastewater,, flow.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: CITY OF SIIELBY
b. WWTP Facility Permit #: NC0024538
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributar:
WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the fa
h. Percent of permitted flow used
Alt ows: are in .t ' D
6.0
the WWTP 0.431
y
3.87
0.0021
4.30
72%
Complete this section for each pump station you are responsibie for along the route of`this proposed
wastewater flow.
t_.ist pump stations located between the project connection point and the WWTP:
Pump
Station
(Name or
Number)
N/A
N/A
N/A.
(A) (B) (C) (D)=(B+C) ('E)=(A-D)
Design Obligated,
Pump Average Approx, Not Yet Total Current
Station Firm Daily Flow** Current Tributary Flow Plus
Permit Capacity, * (Firm / pt), Avg. Daily Daily Flow, Obligated Available
No, MGD MGD Flow,, MGD MGD Flow Capacity***
N/A
The Firm Capacity (design flow) of any purnp 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 facto
(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): SHELBY
Downstream Permit Number: WQ0007780
Page I of 6
FTSE 10-18

111. Certification Statement:
tt_ certify to the best of my knowledge that the addition of
the vokimc 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 1 and 11 plus all attached planning assessment
addendums for which I am the responsible party. Signature of this form certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
Page 2 of 6
FTSE 10-1 8

`D
July 23, 201.9
Odors
169 Oak Street • Forest City, NC 28043
IErigineeririg PlrC office 828. 247.449, fax [phone]
Mr. Wes Bell
Mooresville Regional Office
Water Quality Section
610 E. Center Avenue
Mooresville, NC 28115
Subject: Fast Track. Sewer System Extension Application
Crossroads Rescue Mission Project
Dear Mr, Bell,
We are submitting a Fast Track Sewer System Extension Application for Crossroads Rescue Mission
Project located at Seattle St., Cor. Dekalb St., Shelby, NC. This submittal includes the following items:
•
•
Signed Fast Track Sewer Application (FTA 04-16)
Check for application fee - $480.00
Signed Flow Tracking/Acceptance Form (FTSE 04-16)
USGS Topographic Map
Should you need more information or have any questions, please feel free to contact me at 828-
247-4495 or email me at larissaEodurnengineeri .coni,
Sincerely,
Larissa Coles, P.E.