WQ0039666_Regional Office Historical File Pre 2018

Water Resources
ENVIRONMENTAL QUAL iTY
June 4, 2018
Rick Howell, City Manager
City of Shelby
824 West Grover Street
Shelby,. NC 28150
SUBJECT: Final Engineering Certification Acknowledgement
Kennedy Gravity Sewer Extension
Permit No. WQ0039666
Permitee: City of Shelby
County: Clevekand
Dear vell:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary,
LINDA CULPEPPER
Interim Director
The Division of Water Resource's Mooresville Regional Office received the Final engineering
certification with record drawings for the subject sewer extension project on 6/4;2018, Enclosed
is a certification page for your records, A full review of the certification materials may or may not
be conducted. It is assumed that receipt of this certificationindicates compliance with all.
regulations, design criteria and the permit. However, if a full technical review is conducted, you
will be notified of any items of non-compliance.„
Please he reminded that the Pennittee is responsible for keeping a copy of the final record drawings
for the life of the project. If you have not received such copy from your consultant, please contact
them immediately to obtain a copy.
Lastly, you are receiving this letter because the Division has you listed as the responsible party. If
this permitted system is no longer owned by you or your company, please complete Form 'PNOCF
since the permit is not automatically transferable, Form PNOCF can be downloaded from
http;/!_portal.nedenr. r veb/wq/swolpsics/pnoc from the Collection Systems Applications page.
Should you have any questions, please do not hesitate to contact Ori Tuvia at [phone], or at
ori,tuviancdenr.gov.
Sincerely,
mola.Gzir
Ori Tuvia, Environmental Engineer
Mooresville Regional Office
Division of Water Resources, DI Q
cc: David Odom, PE (E-Copy)
Central Files, MRO (Laserfiche)
State of North Caroliw Eruarournerual Quality I 'Aiaer Resources
Cernef Au e Anne 301. kleveneMe. NC 2811:5
fehenee $134-563.1649 :eiernee WAVAIdelf .90V

AST TRACK SEWER ENGINEERING C
PERMITTEE: CITY OF SHELBY
PERMIT If: WQ0039666
PROJECT: KENNEDY GRAVITY SEWER EXTENSION
ISSUE DATE: DECEMBER 6, 2017
FICATION
This project shall not be considered complete nor allowed to operate in accordance with standard.
Condition 7 of this permit until the Division has received this Ceriificatia n and all required .supporting
documentation. It should be submitted in a manner that documents the Division's receipt. Send the
required documentation to the Regional Supervisor, Water Quality Regional Operations Section at the
address noted in the page footer.
Any wastewater Flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received by the Division. AFinal Certification shall be a complete set of
record drawings and design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Pernrittee,hereby state that this project has been constructed pursuant to
the applicable standards & requirements, the Professional Engineer below has provided applicable
designlctrnstruction information to the Permittee, and the Pcrmittee is prepared to operate & maintain the
wastewattelr collection system permitted herein
gofiVel
Printed Name,
State of North Carolina,
ng been auth xed toy observe perioadicaily, weekly, full flora) the construction of the
project naine and location as referenced above for the above Perntittee 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 Resources' (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 I, 2000, as applicable; and other supporting materials,
North Carolina Professional Engineer's Seal wlsignature & date:
Final © Partial (inciuu#e description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR - Water Quality Re to
Ntooresville Regional Office
ion 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone] FAX; (700633.6040

Water Resources
ENVIRONMENTAL QUALITY
December 6, 2017
Rick Howell, City Manager
City of Shelby
824 West Grover Street
Shelby, NC 28150
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No. WQ0039666
City of Shelby
Kennedy Gravity Sewer Extension
Wastewater Collection System. Extension Permit
Cleveland County
Dear Mr. Howell:
In accordance with your application received December 4, 2017, we are forwarding herewith Permit
No. WQ0039666 dated December 6, 2017, to the City of Shelby (Permittee) for the construction and
operation upon certification 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 shall be considered a part of this permit and is
therefore incorporated therein by reference.
Please pay particular attention to the following conditions contained within this pemiit:
Condition 11.1: This permit shall not be auto ally transferable; a request must be made and
approved.
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 the responsibility of the Pennittee 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 §143-215.6A 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.
State of North Carolina I Environmental Quality I Water Resources Water Quality Regional Operations
Mooresville Regional Office I 610 East Center Avenue, Suite 301 I Mooresville, North Carolina 28115
704 663 1699

�f any parts, requirements, or limitatio contained in this permit are u ceptable, you have the ri
request an adjudicatory hearing upon written request within 30 days following receipt of this
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 pennit shall be final and binding.
If you need additional information enncerr
or via e-mail at oriauvia nedenr.ov"
Sincerely,
gto sa
pie
e can t Ori Tuvia at (704) 23 2190
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
cc: David Odom PE -. py)
Mooresville Regional Office Files
Water Resources Central Files
PERCS (E-copy)
Page 2 of

Environmental
Quality
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
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
City of Shelby
Cleveland County
for the construction and operation of approximately 260 linear feet of 8-inch public gravity
sewer, to serve 5 homes as part of the Kennedy development project, and the discharge of 1,800
gallons per day of collected wastewater into the City of Shelby existing sewerage system,
pursuant to the application received December 4, 2017, and in conformity with 15A NCAC 2T;
the Division's 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 data
subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to
the specified conditions and limitations contained therein.
_41.by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority of the Environmental Management Commission
Permit Number: WQ0039666
Permit Issued: December 6, 2017
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
City of Shelby 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 City of Shelby First Broad River
Wastewater Treatment Plant in accordance with Permit Number NC002453 8.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T; the Division's 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
1) No flow in excess of the quantity permitted herein, 1,800 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. [15A NCAC 02T.0304 (b)].
11. STANDARD CONDITIONS
This permit is not 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. [15A NCAC 02T.0104; G.S 143-21 5.1(d3)]
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's 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. [15A NCAC
021-.01 10]
This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
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 is not required, the following performance criteria shall be met: [15A NCAC 02T .0108(b)]:
Page 4 of 8

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 maintained.
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 (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at least
once per week.
e. High -priority sewer lines shall be inspected at least once per every six months and inspections
documented.
A general observation of the entire sewer system shall be conducted at least once per year.
g. 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:
1 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.
i. Right-of-ways and easements shall be maintained in the full easenient 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. The Permittee shall report by telephone to a water resources staff member at the Mooresville Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours
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
Page 5 of 8

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 [phone] 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 II of Form CS-SSO (or the most current Division
approved form) can also be completed to show that the SSO was beyond control. [G.S. 143-
215.1C(a1)]
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. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form attached to this permit shall be submitted wi 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:
. One copy of the project construction record drawings (plan & profile views of sewer lines &
force mains) 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 applicable design calculations including pipe and pump sizing,
velocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection, detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timeframes, shall be provided.
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
Page 6 of 8

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. [15A NCAC 02T .0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis.. Resolution of such request shall be evident prior to completing and
submitting the construction certification. [ 15A NCAC 02T.01 t15(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities. [15A NCAC 02T .0116]
10. 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. [15A
NCAC 02T .0104; 15A NCAC 02T ,0108(b-c)]
11. 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.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. 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 the Division any other Federal, State, or
Local government agencies which have jurisdiction or obtaining other permits which maybe required
by the Division or any other Federal, State, of Local government agencies. [GSS. 143-215.1(b)]
Page 7 of 8

FAST TRACK SEWER, ENGINEERING CERTIFICATION
PERMITTEE: CITY OF SHELBY
PERMIT #: WQ0039666
PROJECT: KENNEDY GRAVITY SEWER EXTENSION
ISSUE DATE: DECEMBER 6, 2017
This project shall not be considered complete nor allowed to operate in accordance with standard
Condition 7 of this permit until the Division has received this Certification and all required supporting
documentation. It should be submitted in a manner that documents the Division's receipt. Send the
required documentation to the Regional Supervisor, Water Quality Regional Operations Section at the
address noted in the page footer.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received by the Division. A Final Certification shall be a complete set of
record drawings and design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
1, 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 infoiniation to the Permittee, and the Permittee is prepared to operate & maintain the
wastewater collection system permitted herein or portions thereof.
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
, as a duly registered Professional Erjgineer in the State of North Carolina,
having been authorized to observe (El periodically, El weekly, Di fun time) the construction of the
project name and location as referenced above for the above 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 Resources' (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 \No/signature & date:
[1] Final [11 Partial (include description)
Certification Co F ments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

II on 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 Number: �4 )((, (to be completed by DWR)
All items must be completed or the application will be returned
APPLICANT INFORMATION:
1, Applicant's name: CITY OF SHELBY (company, municipality, HOA, utility, etc.)
2. Applicant type: D Individual © Corporation ❑ General Partnership 0 Privately -Owned Public Utili
El Federal El State/County 1.i Municipal Cl Other
3. Signature authority's name: RICK DWELL per
Title: CITY MANAGER
4. Applicant's mailing address: 820 W. GROVER ST
City: SHELBY State: NC Zip: 28151-
5. Applicant's contact information:
Phone number: [phone] Email Address: david.hux@cityofshelby,com
11. PROJECT INFORMATION:
1. Project name: NNEI) G VITY E E TENSION
2. Application/Project status:
posed (New Permit) Existing PermiUProject
Ha modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: CLEVELAND
4, Approximate Coordinates (Decimal Degrees): Latitude: 35.264167° Longitude:-81.562778°
5. Parcel ID (if applicable): N/A
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:.
1, Professional Engineer: DAVID W. ODOM
Firm: ODOMENGINEERING, PLL
Mailing address: 169 OAK S.T
City: FOREST CITY State: NC Zip: 28043-____y
Phone number: [phone] Email Address: davidodom(codomengineerinttdcom
License Number: NC 21.130
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: CITY OF SHELBY Permit Number: NC0024538
Owner Name: CITY OF SHELBY
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):.
Permit Number(s): WQ
Owner Nam
Downstream (Receiving) Sewer1lSize: 8 inch
WQCS
FORM: FTA 04-16
Page 1 of 5

GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public U'tility,, has a Certificate of Public
Yes ONojN/A
2. If the Applicant is a Developer of lots to be sold, has a
0 Yes D No N/A
If the Applicant is a
4. Origin of wastewater: (check all that apply):
F�1 Residential Owned
Residential Leased
© School / preschool / day care
0 Food and drink facilities
0 Businesses / offices / factories
N/A
0 Retail (stores, centers, malls)
0 Retail with food preparation/service
0 Medical / dental / veterinary facilities
0 Church
Nursing home
venience and Necessity been attached?
been attached?
been attached?
[.] Car Wash
0 Hotel and/or Motels.
0 Swimming Pool /Clubhouse
0 Swimming PooVFilter Backwash
❑ Other (Explain in Attachment)
Nature of wastewater : 100 %© Domestic/Commercial % Commercial
% Industrial )
1.----9.1s there a Pretreatment Program in effect? 0 Yes
6. Has a flow reduction been approved under
9 If yes. provide a copy of flow reduction appr
7. Summarize wastewater generated by project:
Establishment Type (see E'
RESIDENTIAL HOMES
? Yes 0 No
0 No
Daily Design Flow "'e
360 gal/DAY
gal/
gal/
gal/
gab
gal/
No. of Units
Total
Flow
1800 GPD
GPD
GPD
GPD
GPD
GPD
1800 GPD
See for caveats to wastewater design flow rates (i,e minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located nearh'igh public use areas;
and residential property located south or east ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in
).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other treasured data.
Wastewater generated by project: 1800 GPD (per )
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
o, Pump 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:
0 Rehabilitation or replacement taf"existing sewer with no new flow expected
0 Other (Explain):
FORM: FTA 04-16
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & M DC (Gravity Sewers):
I . Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
elAPAR.IMAIMOXIM
8 260
> Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section 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
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. 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 IANCAC arr .o3o5010):
El Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(hX1)(B)i
> 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 l5,000 gallons per day:
El Portable power source with manual activation, quick -connection receptacle and telemetry - I 5A NCAC 02T
.0305(h)(1 XC)
or
D Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1 XC):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
• If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations° storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

SETBACK'S SEPARATIONS (On ,0200 t SA NCAC ,33050Th
1, Does ihel,:Troject cxprt ply wit.11 sepalltions f6und i u Yes ID No
I 5A NCAC'011,030an contains minimum separations that shall be proyi,ded, for er system
Setback Parameter* Separation Required
24 inches
Storm sewers and other utilities not listed below (yertical)
Water mains (vertical -water over sewer including in benched trenches)
er mains (horizontal)
d water lines (vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimed over sewer)
*Any private or public water supply source, including any wells, WS-I waters of Class 1 o
Classll impounded reservoirs used as a source of drinking water 100 feet
50 feet
18 inches
10 feet
18 inches
2 feet
Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from nonnal
high water (or tide elevation) and wetlands (see item IX.2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
di he
Any building foundation
Any basement
Top lops of embankment or uts of 2 feet or more vertical height
systems and interce tor drains
ontains alternatives where separations in
D "Stream classifications can be identified using the Division's
D. If noncompliance with see Section X of this application
10 feet
10 feet
10 feet
6 inches
cannot be achieved,
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) El Yes J No N/A
D. 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
D As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per
D This would include Trout Buffered Streams per
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
D Information can be obtained from the
El Yes D No N/A
Ej Yes No
5. Does project comply with (additional permits/certifications)? Yes Ej No
Per , directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per , "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.
D Yes 0 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 perrnitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

CERTIFICATIONS:
1. Does the submitted system comply with
and the
, the
as a
p
bie
Yes DNO
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 (1 ithe Fast Track ALkpli o d c ts.
2. Professional Engineer's Certification:
DAVID W. ODOM attest that this application for
(Professional Engineer's name from Application Item IRA.)
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 1 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, sign ture, and date: 'I
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, RICK HOWELL, CITY MANAGER attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 axe not included, this
application packLe 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 and , 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 exec $10,000 as oI1 as civil penalties up to $25,000 per violation.
Signature:
FORM: ETA 04-16 Page 5 of 5

Divi'sion of '4N, ate t" Re-sott
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation; City of Shelby
Project Name for which flow is being requested: James Love School Rd - Kennedy
More than one FTSE may be required fOr a single project if 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: First Broad WWTP
b. WWTP Facility Permit #: NC0024538
Allflows are in MGJi
c. WWTP facility's permitted flow 6.000
d. Estimated obligated flow not yet tributary to the WWTP 0.590
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 permitted flow used
3.09
0.0018
3.682
61.36%
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) (B) ((2) (D)=(B+C) (E)----(A-D)
Design Obligated,
Pwnp Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firru I pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MOD MOD MOD Flow Capacity***
* The Firm Capacity of any pump station is defined as the maximumpumped 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.
*** 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):
Downstream Permit Number:
Page 1 of 6
FTSE 0416

Certification Statiment
I Rick I I avr ll certify to the hest of my knowledge e that the addition of
the volume oaf v e\v ter to betapermitted in this project has been evaluated along the route to the
receiving wastewater tr ent facility and that the flay from this project is not anticipated to
cause my capacity related y sewer overflows or overburden any downstream pump station
en vacate to the receiving treatment plain under normal irc ce , ,liven the implementation of
the planned improvements identified in the pl = 'fig assessment where applicable. Tins analysis
has been performed in accordance w`th local established policies and procedures using the best
available data. This certification applies to those items listed Mauve in Sections I and II plus all
attached planning assessment addendums for which I the responsible party. Signa of this
form iodic' accepttan .e of this e ster flora,
Page 2 of

UNITED t,TATCS
,AR'TMENT OF ME ,NE"E'REOR
GEi3C.GCN AL SURVEY
ai I E NORTIhM CAROLINA
nAfi1,1,NENT ar NATUWAY, RESo4lkkcAs
scan CONMUNrrt onVELOPt,O T
£Ski€LBY C?tlMBRANaLE
NeRTM COMA.,,,C.A6NRAND 4A7

KENNEDY SEWER

November Q„ 2017
des Bell
Mooresville Regional Office
Water Quality Section
610 E i Center Avenue
Mooresville, NC 28115
Subject Fast Track Sewer System Extension Application
Cleveland County — Kennedy Gravity Sewer Extension
Dear Mr. Bell
We are submitting a Fast Track Sewer System Extension Application for the Kennedy Gravity Sewer
Extension project located in Cleveland County. This submittal will include one original and one copy of
the following items:
Fast Track Sewer Application
Check for application fee
Flow Tracin/.cceptance'Forrr
USGS Topographic Map
Aerial Map
if you have any questions or need additionaorrra tion, please con
Sincerely,
David Odom, P E..
ct rrae
828-47-5 or

Nov tuber ail, 2017
Wes Bell
Mooresville Regional Office
Water Quality Section
610 E. Center Avenue
Mooresville, NC 28115
Subject: Fast Track Sewer System Extension Application
Dear Mr, Be
Oak trE t F rifst r its: rid, 2 0,
f 828,' .Jt fax
Cleveland County — Kennedy Gravity Sewer Extension
We are submitting a Fast Track Sewer System Extension Application for the Kennedy Gravity Sewer
Extension project located in Cleveland County. This submittal will include one original and one copy of
the following items:
• Fast Track Sewer Application
Check for application fee
■ Flow Tracking/Acceptance Form
USGS Topographic Map
• AerialMap
if you have any questions or need additional inforrnatioru, please contact me a 28-247-4495 or
Sincer
David Odor, P.E

Cen Files. APS
t Nu
Permit Type
r Extension, Puna
003
Primary Reuaewer
ori.tuvia
Coastal S
Permitted Flow
1.;
Fad
rty
Kennedy ra
a
Location Address
Owner
Ion
Pressur
n
Extensions
Permit Tracking Shp
Status
Versio n
A
Permit Ce
a
SWP
1275/2 17
Prot t Type
New Project
Permit Ci:assifacatdn
Individual
Affiliation
Facility Contact Affiliation
ty
Cleveland
Owner Name
City of Shelby
Oaf Events
Type
prat - Muniolpel
r Afflliat
Rick Howell
Ci Manager
PO Box 207
Shelby
281:a1020,
rlg issue Apo Received
12161 171 /4/2017
Regulated Activ`rtaes
Apartment complex
Subdivision
Wastewater coilecii
0utfall
4n
hedull
Mated issuance
Public Notice
12/6/2017
Requested received Events
Additional information ruet
Additional information received
Effective
121612017
Expiration
terbody Name
She
ndex Number Current Class
Subastn