WQ0029907_Regional Office Historical File Pre 2018

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
March 1, 2006
Mr. Robert Hites, City Manager
City of Statesville
301 South Center Street
Statesville, North Carolina 28687
Subject: Permit No. WQ0029907
Beverly Heights Subdivision
City of Statesville
Wastewater Collection System Extension
Iredell County, North Carolina
Dear Mr. Hites:
In accordance with your application received on February 7, 2006, we are forwarding herewith .
Permit No. WQ0029907, dated March 1, 2006, to the City of Statesville for the construction and
operation of the subject wastewater collection system extension. This permit shall be effective from the
date of issuance until rescinded, and shall be subject to the conditions and limitations as specified
therein. This cover letter shall be considered a part of this permit and is therefore incorporated therein
by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1) 15A NCAC 2H .0200; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable; 3) 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. 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
bdard.
Mooresville Regional Office 610 East Center Ave., Suite 301 Mooresville, NC 28115 Phone: [phone] Fax: [phone]
Internet: h2o.enr.state.nc,us Customer Service: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
No Carolina
Naturally

Mr. Hites
Page 2
March 1, 2006
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 Statesville for the construction and operation of approximately 1,728 linear feet of
8-inch gravity sewer, as part of the Beverly Heights Subdivision project, and the discharge of 11,160
gallons per day of collected domestic wastewater into the City of Statesville's existing sewerage
system, pursuant to the application received February 7, 2006, and in conformity with 15A NCAC 2H
.0200; 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 Erivironment and Natural Resources and considered a part of this
permit.
The sewage and wastewater collected by this system shall be treated in the City of Statesville -
Fourth Creek WWTP (NPDES No. NC0031836) prior to being discharged into the receiving stream.
If any•parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Dee Browder at (704)
663-1699.
Sincerely, /(1
for Alan W. Klimek, P.E.
cc: Iredell County Health Department
Mooresville Regional Office, Surface Water Protection (WWTP Permit No. NC0031836)
Dan Brewer, Chas. H. Sells, Inc.
Surface Water Protection Central Files
Marie Doklovic, PERCS

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
1. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2H .0200; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000, as applicable; and other supporting materials unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. 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 2H .0227. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2H
.0227:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (Le.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. 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 §143-215.1 C.
1

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. 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.
6. Per 15A NCAC 2H .0220, upon completion of construction and prior to operation of these
permitted facilities, the completed Engineering Certification form attached to this permit shall be
submitted with the required supporting documents to the address provided on the form. A complete
certification is one where the form is fully executed and the supporting documents are provided as
applicable.
7. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities.
8. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2H .0200; 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.
9. 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.
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.
11. Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
2

Voice mail messages or faxed information is permissible, but 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 Part I of Form CS-SSO (or the most current Division approved form), within five days
following first knowledge of the occurrence. This report shall outline the actions taken or
proposed 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.
Permit issued this the lst day of March, 2006.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. KlimeWP.E., Director .
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0029907
3

Fast Track Engineering Certification
Permit No. WQ0029907
March 1, 2006
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
❑ Partial El Final
1, , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of the Beverly Heights
Subdivision, a Iredell County project for the Permittee, hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance of this permit; 15A NCAC 2H .0200; the Division of Water Quality's (Division)
Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials.
North Carolina Professional Engineer's
seal, signature, and date:
SEND -THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions.

NORTH
UNTY OF
This AG_R
Commission, an.
L�
business in the Sta
WITNESSETIL
T:AROLINA
Permit No.
DFVEL OPER'SOPERAT )NAL,AGREEMEN7`
MENT made pursuant to G.S. 143-2,15.1 (d1) and entered into this day of
, by and between the North Carolina` tvirtanmental Management
1e Staate. of North Carolina, hereinafter known as t111e'C,OMMISSION; and
a corporation/general.,partncrship registercdllicensed to do
of North Carolina, hereinafter known as the DE ,E1 OPER..
The DEVELOPER is the owner of the certain lands ly
which it is erer:ting and will ere dwelling units and
as � °� ..?° G In
The DEVELOPER desires, to constn
works, and/or disposal facilities (here
the Development on said lands.
The DEVELOPER has applied to the
215.1 to construct, maintain, and op
The DEVELOPER has created c
and lands through filing of a D
47C or 47F of the .North Carolina
ate t
p
County, upon
mprovements, said development to be known
(hereinafter the Development).
n system with pumps, wastewater treatment
m) to provide sanitary sewage disposal to serve
'SSION for the issuance of a permit pursuant to G.S. 143-
posal System.
create uni
ion of Unit Ow
eral. Statutes.
;ership in said dwellings units, other improvements
rship (hereinafter Dcclaratioir), pursuant to Chapter
. The DEVELOPER has ca sed to be formed or will cause to *a formed at the time of filing of the
Declaration, the Enter Proposed Unit Owners' Association) (hereinafter
Association), a non-profit corporation. organized. and existing and `' and by the virtue of the laws of the
State of North Carolina, for the purpose, among others, of handling perty, affairs and business of
the Development; of operating, i n 'intaining, re -constructing and repairs .; the common elements of the
lands and improvements subject to unit ownership, including the Disposal System;„.and of collecting dues
and assessments to provide funds for such operation, maintenance, re -construction and repair.
6.. The COMMISSION desires to assure that the Disposal System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to protect the
quality of the waters of. the State and the public interest therein..
NOW, THEREFORE, in. consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and. DEVELOPER do hereby mutually agree as follows:
l . The DEVELOPER shall construct the Disposal System in accord.anc:c with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions and law.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal. System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Quality has inspected and approved of the facilities. In order to change the name; of
the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility
for the operation and maintenance of its Disposal System until. a permit has been reissued to the
DEVELOPER's successor.

DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance
expenses, the Declaration and Association Bylaws shall provide that a fund be created out of the common
expenses. Such fund shall be separate from the routine maintenance funds allocated for the facility and
shall be part of the yearly budget.
6. In the event the common expense allocation and separate fund are not adequate for the construction,
repair, and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for
special assessments to cover such necessary costs. There shall be no limit on the amount of such
assessments, and the Declaration and Bylaws shall provide that such special assessments can be made as
necessary at any time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit may require as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall
provide in the Association Bylaws that the Association shall not enter into voluntary dissolution without
first having transferred its said system and facilities to some person, corporation or other entity acceptable
to and approved by the COMMISSION by the issuance of a permit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration
is filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of
the Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL
MANAGEMENT COMMISSION
vettici
Name of 1 EVE
Alan W. Klimek, P.E., Director (Si
Division of Water Quality
(Date)
/,cL.y M. /suinis
Print Name and Title
���9/aG
(Da e)
LL G

Permit Number WQ0029907
Central Files: APS SWP
02/28/06
Permit Tracking Slip
Program Category Status Project Type
Non -discharge !n review New Project
Permit Type Version
Gravity Sewer Extension, Pump Stations, & Pressure Sewer A
Extensions
Primary Reviewer
dee.browder
Permitted Flow
11160
Facility
Permit Classification
Individual
Permit Contact Affiliation
Facility Name - Major/Minor Region
Beverly Heights Subdivision Minor Mooresville
Location Address
Owner
County
Iredeli
Facility Contact Affiliation
Owner Name Owner Type
City of Statesville Government - Municipal
Owner Affiliation
Robert Hites, Jr
POBox 1111
Statesville
Dates/Events
NC 286871111
Orlg Issue
App Received Draft Initiated
02/07/06
Scheduled
Issuance
Public Notice Issue
Effective Expiration
Regulated Activities Renuested/Received Events
Subdivision
Wastewater collection
Outfall NULL
Additional information requested
Additional information received
Waterbody Name Stream Index Number Current Class Subbasin

APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
•
USt I I1t !AU KIY IU MOVE I-KUIVI t-ItLU IU tit�.U! rr -- — — -- Iv
(to be. completed by DWQ) Y °n� N oD L` 0
'1. Owner:: f
... -..- ..
la. City of Statesville, NC
Full Legal Name (company, municipality, HOA, utility, etc.)
0 1 b. Robert W. Hites - City Manager
i, Signing Official Name and Title (Please review 15A NCAC 2H .0206(b)
'lc. The legal entity who will own this system is:
for authorized signing officials!)
Partnership ❑,Corporation ❑Other (specify):
Statesville
■ Individual ■ Federal ►/ Municipality ■ State/County ❑ Private
cc
0 ld. P.O. Box 1111 'le.
LL Mailing Address City
— 1f. NC 1g. 28687
Z State Zip Code
1 h. 704-878-3583 1 i. 1j. [e-mail]_
.nc.us
i-0
-�
Telephone Facsimile E-mail
Q 2. Project (Facility) Information:
-1 2a. Public Sewer to serve Beverly Heights Subdivision 2b. Iredell
a Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3_ Contact Person: - _ - - - -- _ ------ - ---- - -__ _.__ - __ _- _ _ ._. _
Q:3a. Dan E. Brewer, P.E.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 704-662-0100 3c. [e-mail]
Phone Number
E-mail
Permit No.:
1. Project is ►5 New ❑ Modification (of an existing permit) If Modification,
For modifications, attach a separate sheet clearly explaining the reason for the modification (Le. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2. Owner is ® Public (skip to Item B(3)) 0 Private (go to Item
2a. If private, applicant will be: 2b.
2(a))
If sold,...__..............ili._i.-------..__..._._...bya._.._._.._...s..___hooseone_...-...,.__..3
facilities owned b a (must choose one)
• Retaining Ownership (i.e. store, church, single office, etc.) or
■Public Utility (Instruction III)
Z • Leasing units (lots, townhomes, etc. - skip to Item B(3))
■ Homeowner Assoc./Developer (Instruction 1V)
0 IN Selling units (lots, townhomes, etc. - go to Item B(2b))
1-- 3. City of Statesville
Owner of Wastewater Treatment Facility (1NWTF) Treating Wastewater From This Project
re 4a. Fourth Creek Waste Water Treatment Plant 4b. NC0031836
0 Name of WWTF WWTF Permit No.
LL 5a. City of Statesville 15b. 8" IG Gravity
5c.
Z Owner of Downstream Sewer Receiving Sewer Size !■ Force Main
1 Permit Number of Downstream Sewer (if known)
I- 6. The origin of this wastewater is (check all that apply):
M ® Residential Subdivision 0 Car Wash
100 % Domestic/Commercial
Ce • Apartments/Condominiums ■ Institution
W . ■ Mobile Home Park 0 Hospital
% Industrialcd
a • School ■ Church
• Restaurant ■ Nursing Home
%
7. Volume of wastewater to be allocated for this particular project: 11.160 gallons per day
*Do not include previously permitted allocations
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted in subsequent permits that
❑ Flow has already been allocated in Permit No.
connect to this line
• Rehabilitation or replacement of existing sewer with no new flow expected
FTA 02/03 - Rev. 3 04/05

APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
•
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item 13(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be supported with actual water or wastewater use data in ,accordance with 15A
NCAC 2H .0219(I)(3).
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
W
Z
H
ENTER TOTAL LINE LENGTH IN MILES,
V11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Length (feet)
Gravity or Force Main
(use the pull down menu)
O Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point , (1- dual line feed; 2- permanent generator w1ATS; 3-
1— plans for cross-reference)-; (MGD) GPM DH _ portable generator wltelemetr 9 4-wet well storage)
@ TY
0
LL
H _
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
W ® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
CL variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
m
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes 0 No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No ® N/A
Stormwater? ❑ Yes ❑ No ® N/A
14. Does this project involve aerial fines or siphons? -Check if yes: ❑
These lines will be considered_hiah brioritv.and must be checked once.evety six.months._ __.. _ ......
15. Does this project have gravity sewer lines designed at minimum slopes? ❑
Be aware that the Division will not accept installed fines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification..
FTA 02/03 - Rev. 3 04/05

APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)' to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
Z regional office (see instructions for addresses) OR indicate the following:
❑ A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
Qwaterbody; AND, . _ __ - _ ._ _ . ._.-__
0 ❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
LL option for any pump station near a Class C down slope waterbody.
COCn Location ID on Map
(self chosen - as shown on Name of
map for cross-reference) _ Waterbody County
O UT to Gregory Creek Iredell
w
re
d
Waterbody Stream
River Basin Index
Yadkin 12-108-20-3-1 C
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
Waterbody
Classification
D. CERTIFICATIONS
1. Applicant's Certification:
1 a.
i, Robert W. Hites, attest that this application for Public Sewer to Serve Beveryly Heights Subdivision has been
reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. Note: in accordance with North Carolina General
Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000
as well as civil penalties up to $25, 000 per violation.
Signing Official Signature
2. Professional Engineer's Certification:
Date
I attest that this application for Public Sewer to serve Beverly Heights Subdivision has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation to the best of my knowledge. l further attest that to the best of my knowledge the proposed design has
been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although certain
portions of this submittal package may have been developed by other professionals, 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 NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a
fine not to exceed $10, 000 as well as civil penalties up to $25, 000 per violation.
2a. Dan E. Brewer, P.E.
Professional Engineer Name
2b. Chas. H. Sells, Inc.
Engineering Firm
2c. 128 Overhill Drive, Ste 105
Mailing Address
2d. Moores'iille
City
2e. NC 2f. 28078
State Zip
2g. 704-662-0100 2h. 704-662-0101 21. [e-mail]
Telephone Facsimile E-mail
- _ _..-\ill0111.11111.' 11 ,,,,,, , - -
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1/Z 110
Seal, Signature & Date
FTA 02/03 - Rev. 3 04/05

Fast Track Engineering Certification
Permit No. WQ0029907.
March 1, 2006
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modifications are required for anv changes resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
1, Da ti E. Ei-eWer
ENGINEER'S CERTIFICATION
Er Partial ❑ Final
, as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (0 periodically, ❑ weekly, ❑ full time) the construction of the Beverly Heights •
Subdivision, a Iredell County project for the Permittee, hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance of this permit; 15A NCAC 2H .0200; the Division of Water Quality's (Division)
Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials.
North Carolina Professional Engineer's
seal, signature, and date:
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SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions. ,

4
Coristritirig Engineers, Surveyors & Ptiotiagrarnmetrists
August 7, 2006
Ms. Dec Browder
NCDENR DWQ
610 Fast Center Ave, Suite 301
Mooresville, NC 28115
Reference: Fast Track Engineering Partial Certification
Permit No WQ0029907
Beverly Heights Subdivision
tredell County, North Carolina
[)ear • . s. Browder:
Please find attached one (1) copy of the Partial Fast Track Certification and one (I) copy of he As
Built drawings .for the above referenced project,
Thanks afor your assistance with this p•roject. If you have any questions or require additional
information., please contact us. jer htOff
. . . •
AND NM. URAL RESOURCES
00k1r'G,!:)NAL OFFICE
.Respectlidly submitted,
Chas. H. Sells, Inc.
Dan E. Brewer, P.E.
Senior Associate
AUG 1 f 2OO4;
ATER QUA TY SECT
Cc: Mr. Ten-y Keever, (it' of Statesville
128 Uverhin kriNo . Suitc,
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