WQ0040271_Regional Office Historical File Pre 2018

Water Resources
En'vIrunmentai i')ualTy
Mr. Adrian Miller, City Manager
City of Belmont
115 N. Main Street
Belmont, NC 2801.2
ROY COOPER
MICHAEL S. REGAN
Se,rewrk
LINDA CULPEPPER
!1?terdr>n b1recaw
September 19, 2018
Subject: Permit No. W00040271
City of Belmont
Belmont Crossing Townhomes
Wastewater Collection System Extension Perm'
Gaston County
Dear Mr, Miller:
In accordance with your application received September 7, 2018, we are forwarding herewith Permit No.
WQ0040271 dated September 19, 2018, to City of Belmont (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from the date of issuance until rescinded, and shall be subject to the conditions and limitations as specified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 vti+.ithin this permit:
Condition 11,1: This permit shall not be automatically 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 Permittee 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.
If any parts, requirements, car limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter'150B of North Carolina General
Statutes, and filed with the Office of Administrative Hearings,, 6714 Mail Service Center, Raleigh, NC
27699-6714, Unless such demands are made, this permit shall be final and binding.
dot kak a r Car, Etna E rvIraytimetrtai f;)
y100rsv;Ile Reuniiuil Olio:, 610 Fasl C:et er .AVe.00ue, Suite 301 Atom gv19r: " ,rh,

if you need additional information concerningth
or via e-mail at barry,iove@ncrienr. ay.
Sincerely,
by VV. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
cc: Matthew Lowder, 1 . E. (-copy)
Regional Office Files
Water Resources Central files
PERCS (e-copy)
please contact Bar
ve at
(704) 35-2143

Environs
Qua
yen ta!
tY
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
City of Belmont
Gaston County
for the construction and operation of approximately 1,339 linear feet of 8-inch gravity sewer to serve 34
three -bedroom townhomes as part of the Belmont Crossing Townhornes project, and the discharge of
12,240 gallons per day of collected domestic wastewater into the City of Belmont existing sewerage
system, pursuant to the application received September 7, 2018, 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 Environmental Quality 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.
DocuSigned by:
A14CC681 AF27425...
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources,, NCDEQ
Permit Number: WQ0040271
Permit Issued: September 19, 2018

SUPPLEMENT TO PERMIT COVER SHEET
City of Belmont is hereby authorized to:
Construct, and then operate �pqn cer-tification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the City ufBelmont Wastewater
Treatment Plant inaccordance with Permit Number NC0U2lI8l.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
I54 N[4C 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 1'2QO@ asapplicable, unless specifically mentioned herein. Division approval
isbased onacceptance ofthe certification provided by North [aroUna'||cem**dProfessional Engineer im
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,
i SPECIAL CONDITIONS
l. Noflow inexcess ofthequantity permitted herein, lIl48gallons per day, shaNbemadetributan/no
the subjectsewer system until an application for permit modification for an increase in flow has been
submitted toand approved b*the Division. [IS4N[A[OZT03O4(b)l
11. STANDARD CONDITIONS
I. 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 apprmpMate. The approval of this request shall be considered on its
merits and may ormay not beapproved. [I5ANC4CQ2T'U1U4; G,S I43-216�1(d3)]
l This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; I5A N[AC Z`[the Division's Gravity Sewer Minimum
Design Criteria adopted February 1Z' l996'asapplicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting nf Pump Stations and Force Mains adopted June 1,ZOO8'asapplicable; and
other supporting materials unless specifically mentioned herein, [15A NCAC 02T,01101
3. This permit shall beeffective only with respect tothe nature and volume ofwastes described inthe
application and other supporting data. [I5ANLACO2T�OlIO)
4

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 net: [15A NCAC 02T .0108(b)1:
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 are
documented,
f. 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 §9143-215.1C.
h. A Grease Control Program is in place as fo o
ws:
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,
Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. 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 the9ife of the system.

5. The Pennittme shaU 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 o,ccurrence of e�her of the following:
a, Any process unit failure, due to known or unknown reasons, that renders the facility incapable
ufadequate wastewater transport, such as mechanical or e|ectrico�fai|ures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,UOOgallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages orfaxed information is permissible, but this shall not be considered as the initial
verbal report, Overflows and sp:ills occurring outside normal business hours may also be reported to
the Division ofEmergency Management attelephone number (WO) 858-0368pr (919)7]]-3300.
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Port | of Form [3'SSO (or the most current Division approved ha/rn) within five days following first
knowledge ufthe occurrence, This report must outline the actions taken orproposed tobetaken to
ensure that the problem does not recur. Part NnfForm [S-SS8(or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [GI 143-2I5.l[(al)]
6 Construction of the gravity sewers, pump stations' and force mains shall be scheduled so as not to
interrupt service 6ythe existing ut8itics nor result inanoverflow nrbypass discharge ufwastewater
to the surface waters of the State� [15A N[A[02T.D1OB(b)]
7, Upon completion o/ construction and prior to operation of these permitted facilities, the completed
Engineering Certification form attached to this permit shall be submitted with the required supporting
documents tothe address provided on the form. Acomplete certification 1sone where the form is
fully executed and the supporting documents are provided asapplicable. Any wastewater flow made
tributary to the wastewater co|Ye/tiun system extension prior to completion of this Engineer's
Certification shall be considered a violation of the permit and shall subject the Pernnittee 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 [ounty'sRegister of Deeds office shall 6esubmitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided asapplicable. Supporting documentation shall include the following:
a. 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 dear on
the plans oron digital media (CD orDVO 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.
h` One copy of the supporting applicable design calculations indudmg pope 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
6

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 stationsstorage
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 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.0105(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 Perrnittee 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 add it io n a 1 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 may be
7

DWR
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 Number: j j 1C71(lo be compieted by DWR)
Ail items must be completed or the application will be returned
L APPLICANT INFORMATION:
I Applicant's narne: CiiyofBeIrnont(conipanv, municipality, HOA, utility, etc..)
2, Applicant type: El Individual EI Corporation 0 General Partnership D Privately -Owned Public Utility
Federal Ej State/County Municipal El
3. Signature authority's name: Adrian Miller per 15A NCAC 02.T .0106(b) Oth171rECEIVI-AINO CENRIDWR
Title: City Manager
4 Applicant's mailing address: 115 N Main Street PO BOX 431
City: Belmont State: 1*IL Zip: 28012,-
Applicant's contact information:
Phone number: [phone] Email Address: amiller@cityofbelmont,org
II. PROJECT INFORMATION:
1, Project name: Belmont Crossing Townhornes
Application/Project status:
(Ill a
MOORqs REGoNAL prcE
Proposed (New Permit) LI Existing Permit/Project
If a 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: Gaston
4, Approximate Coordinates (Decinial Degrees): Latitude: 35,2346° Longitude: -81.0378')
5. Parcel ID (if applicable): 3594167693
(or Parcel ID to closest downstream sewer)
111 CONSULTANT INFORMATION;
1 Professional Engineer: Matthew Lowder,PE
Firm: gle Site Design, 1'LLC
Mailing address: 4004 Barrett Drive, Suite 101
City: Raleigh State: NC Zip: 27609-
Phone umber: [phone] Email Addre :
License Number; NC24434
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION;
1 Facility Name: City of Belmont WWTP Permit Number: NC002 I 181
Owner Name: City of Belmont
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Numbcr(s): WQ Downstream (Receiving) Sewcr Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Belmont
FO
'A 04-16 Page 1 of 5

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility., has a Certificate of Public Convenience and Necessity becn attached?
El Yes :No N/A
ApplicantApplicam isa Developer °Clots to be sold, has a Developer's Operational .Agreement (FORM: -DEV) been attached?
0 Yes 0No N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
0 Yes. LINo N/A
4, Origin of wastewater: (check all that apply):
Residential Owned
.0 Residential Leased
0 School / preschool / day care
El Food and drink facilities
Businesses / offices / factories
El Retail (stores, centers. malls)
Retail with food preparation/service
0 Medical / dental / veterinary .facilities
0 Church
0 Nursing Horne
LI Car Wash
0 Hotel and/or Motels
LI Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
0 Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
Is there a Pretreatment Program in effect? 0 Yes El No
6. Has a flow reduction been approved under I5A NCAC 02T .0114(f)? LI Yes
If yes, provide a copy of flow reduction approval letter
1% Summarize wastewater generated by project:
Establishment Type (see (12I.0I.14(f)
Daily Design Flow
No. of Units
Flo •
34 3 bedroom Townhome units
360 gal/tunt
34
12240 GPD
GPD
gal/unit
g
GPD
GPD
GPD
gal/
Total
GPD
12240 GPD
a See, 15A NCAC 02,T .01.14(b). (d), (e)(1) and (e)(2) for caveats. to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access 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 G.S. 42.A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified tin table 15A NCAC 02T. • '41 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8,, Wastewater generated by project.: .12240 ,GPD (per I5.A NCAC 02T .0114)
Do not include future flows or .previously permitted allocations
If permitted flow is zero, indicate why:
El Pump Station or Gravity Sewer where flow will be permitted in subsequentpermits that connect to .this line
LI Flow has already been allocated in Permit Number:
El Rehabilitation or replacement of existing sewer with no new flow expected.
0 Other (Explain):
FORM: FTA 04-16 Page 2 of 5

‘11.: GRAVITY SEWER DESIGNCR1TERIA (ifApplkable) - 02T .0305 & MDC (Gravitv Sewer:
1, Summarize gravity sewer to be permitted.:
Size (inches)
Length (feet) Material
8
.1339 PVC
• Section 11 & III oldie MDC for Permitting of 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 .0305 & MDC (Pump StationsiForee Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - .
3. Design flow of the pump station: millions gallons per day (firm capacity)
4, Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5, Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet)
Material
6. Power reliability in accordance with 15A NCAC 02T .0305 h
El] Standby power source or pump with automatic activation and telemetry - I5A NCAC 02T .0305(10(1)(B);
▪ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
• Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
0 Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
,030500(1)(C)
or
0 Portable pumping unit with plugged emergency pump connection and telemetry - I5A NCAC 02T ,0305(h)(1)(C):
• 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 pwrip, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: F I A 04-16 Page 3 of 5

fight
inches
2 feet
100 feet
10 feet
10 feet
. LX. , SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T 00305(.08z. (g)
15A NCAC 02T.0305(f) cotitains minimumseparations.a shall be provided for sewer systems:
back Pa
Storm sewers and other utilities not listed below (v
Water mains (vertical -water over sewer including in benched trenches)
Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimed over sewer)
**Any private, or public water supply source, including any wells. WS-1 waters of Class 1 o
Cia.ss 11 impoundedreservoirs used as a source of drinkin water
Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item 1X.2)
*Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
Any building foundation
Any basement
Top siope of embankment or cuts of 2 feet or more v
Drathae systems and interce or drains
• 15A NCAC 02T 0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
• **Stream classifications can be identified using the Division's NC Surface Water Classifications Webpagg
fr If noncompliance with 02T.0305(1) or (g), see Section X of this application
Yes 0 No
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) P Yes Ej No 0 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
fr As built documents should reference the location of areas effected
3, Does, the project comply with setbacks found in the river basin rules per .15A NCAC 028 .0200? Ye,s El No 0 N/A
This would include Trout Buffered Streams per 15A NCAC 2B.0202
4„ Does the project require coverage/authorization •under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
fr Information can be obtained from the 401 & Buffer 'Permitting Branch
0 Yes [Z1 No
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? Yes Ej No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent 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 .1.5.A NCAC 02T.0402, "high -priority sewer" ntean.s an aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject 10 erosion that undermines or deteriorates the sewer,
0 Yes 121 No 0 N/A
fr if yes, include an a•ttaclunent with details for each line, including type (aerial line, site, 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 NCAC 02T, the Minimum De 'jgii Crjria for the Permitting of Pwnp into
and Force, Mainstlatest versiofl). and the Gravity Sewer Minimum Design Criteria (atesrversien) as applicable'?
Yes No
If No, complete and submit the VariancetAltemative Design Request application (VADC :10-14) and supporting documents for
review. A rovat of the rc(luest is recluircd �ior to submiftat of Ihe Fast Track Ajilieatkrn and sulwortintL documents.
2 Professional Engi
,.es Certification:
i ot-,616,17-
-,ssiona1 Engineer's name from .Application lieu
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications.
engineeting 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 nry 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 bc guilty of a Class 2 misdemeanor. which may
include a fine not to exceed $10,000, as well as civil penalties up to $25.000 per violation,
North Carolina Professional Engineer's seal, signature, and date:
3, Applicant's Certification per 15A NCAC 02T .0106(b):
/1,44
t-1 c.-•••
Signature Autlionty's nakie & title fr
Application Item
attest thatthis application for
has been reviewed by me and is accurate and complete to the best of my knowledge,. 1 understand that if all required parts of
this application are not completed and that if all required supporting documentation, and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater .froin 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. 1 also understand that if all :required parts of this application package are not completed and that if
all requiredsupporting information and attachments are not included, this application package will be returned to me as
incomplete,.
NOTE — In accordance with General Statutes .143-21.5.6.A and ,143-21.5..6B. any person who knowingly makes any false
statement, representation, or rti,fieation in any application package shall be guilt)., of a Class 2 misdemeanor, which may
include a fine not to exceed . ,000 as well as civil penalties up to $25,000 per violation.
Signature.
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
.Department of Environmental Quality'
Division of 'Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(itS!5 04-16)
Entity Requesting Allocation: City of Belmont
Project Name for which flow is being. requested: Belmont Crossing Townhomes
:lore than one FISE may he required for a single project if the owner of the trIVIT is not responsible fill- all puip
stations along the route of the prop() 5-ed wastewaterjlow.
1. Complete this section only if you are the
v
r of the wastewater treatment plant.
a. WWTP Facility Name: City of Belmont \V\VTP
b. WWTP Facility Permit 4: NCOO2
c. 'WAVTP facility's permitted flow
Atiliowsare in MGD
)00
d. Estimated obligated flow not yet tributary to the WWTP 13076
e. WWII' 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
1,7960 (20 7 Average)
0.0122
3.1158
6?%
IL Complete this section for each pump station you are responsible .for along the route c. t
proposed wastewater flow,
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) tn)—(134-C) (E)=tA-L))
Design Obligated,
Puny A vera,4e Daily /\pprox. Not 'Yet Total Current
Station. Firm Flow** Current Avg. Tributary Flow .Plus
(Name or Capacity, * (Firm i pi), Daily Flow, Daily Flow. Obligated A.vaitiable
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity of any pump station is defined as the maxim LI M pumped flow that
can he achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump st:
factor (p0 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:
divided by a peaking
Page 1 of 6
FIST (14-16

)n St
edge that the addition of
-r along the route to the
project is not anticipated to
en any downstream pump station-
t plant under normal circunrstancr;s given the intpl rn ntatio t of
nned intpro events identified in the planning assessment where applicable. le. Ibis analysis
has been performed in accordance with local established policies any procedures using the hest
available data. This certitreat ° n applies to those items, listed above inSections 1 and 11 plus all
ied plannient addenduna:srlat h 1 area the rsponsihlc part, :Signature of this
dic=ates ace t this ‘\rrstekNater
Adrian Tf
volume of ‘vas
gt ast cw,at
apaci
lca the rece
t
e perm
nt facility. a
s° r
s proj
rt' the
2of6
04®1t

*
.
FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE:
PERN8|T#�
PROJECT:
ISSUE DATE;
City ofBelmont
VVQO040271
Belmont Crossing Townhomes
September l9,2QlB
This project shall not be considered complete nor allowed tooperate in accordance with Condition 7cf
this permit until the Division has received this Certification and all required supporting documentation. It
should besubmitted inamanner that documents the Division's receipt, Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom.
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 Permhtee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set ofrecord drawings and
design calculations regardless of whether partials have been submitted,
pEmMnmEE'sCEqnF|C4TuOm
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 information to the Permittee, d the Permittee is prepared to operate & maintain
the wastewater collection system permitted rtiomthe�o�
���� ~~ �
`
Printed Name,Title
Signature
ENGINEER'S CERTIFICAT16N
1, Zot-jde,�', as a duly registered Professional En
having been authorized to observe ([�Keriodically, — weekly,
project name and location as referenced above for the above Perm
�
ate
ineer in the State of North Carolina,
uU time) the construction of the
eehereby state that, oothe 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 NCA[OIT; the
Division of Water Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12,
1996,asapplicable; the Division's Minimum Design Criteria forthe Fast -Track Permitting of Pump Stations
and Force Mains adopted June I' 2800' as applicable; and other supporting materials,
North Carolina Professional Engineer's SeaI w/signature & date:
Final | nai / /PamdmlUndudedeochpdon
Certification Comments/Qualifiers (attach if necessary):
om="nNor hCarolina |c=r°nme°tWV"aJay/Wat�o=°ur=^/Water o�i»eql°na/mp=ab"w%