WQ0039534_Regional Office Historical File Pre 2018

D
Division of
R
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
er Resources
FTA 04.16 & SUPPORTING DOCUMENTATION
fiV16.61
Application Nunibci ij (o. be vain placci by D R)
All items must be completed or the application will be relunied
I. APPLICANT INFORMATION:
1. Applicant's name: City of Statesville (con any, municipality, 110A, utility, etc)
(
rq...i.ECKYNIAL OPPW;E:
2. Applicant type: Individual 0 Corporation 0 General Partnership LJ Privately -Owned Public Utility
,Federal Li State/County ra Municipal Other
3. Signature authority's name:: Scott Harrell, PE , 1r j,,N,J2I.0jQ6b
Title: Public Works Director
4, Applicant's mailing address: ox 1111
City: Statesville State: NC Zip: 28687-1111
5. Applicant's contact information:
Phone number: (704) 87'8-358.3, Email Address:
II. PROJECT INFORMATION:
L Project. name: James Pointe Apt Homes
Application/Project status:
.0. Proposed (New Peri Existing Permit
If a modification, provide the existing permit number: WQ003953.4 and issued date: 10/12/17
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Iredell
4. Approximate Coordinates (Decimal Degrees): Latitude: 35..826388" Longitude: -80.87361.1'
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
I. Professional Engineer: Et Vi
V. ODOM, PE
'License Number, NC 21 —Q
Firm: ODOM ENGINEERING, MAX
Mailing address: 169 OAK ST.
City: FOREST CITY State: NC Zip: 280-$3-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) MEOWS IATION:
I „ Facility Name: Fourth Creek, ViAVIe Permit Number: 0031836
Owner Name: CITY OF STATESVILLE
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W\VTF):
1. Permit Number(s): WQ0039534 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): wQcspoo
Owiter Name(s): CITY OF STATESVILLE
FORM: FTA 04-16 Page 1 of 5

VL GENERAL REQUIREI4'IENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenienc
0 Yes DNo I'N/A
2. Ifthe Applicant is a Developer of lots to be sold, has a ev per's O ipnal Agreement (FORlvl': DEV) been attached?
Q Yes DNo
If the Applicant is a I-C9tne/Pp.er3;y^ fysvners':
4. Origin of wastewater; to lteck all that apply):
Residential Owned
0 Residential Leased
0 School / preschool / day care
0 Food and drink facilities
0 Businesses / offices / factories
Nature ofwast
oc
D Yes 0No N/A
A
0 Retail (stores, centers„ malls)
0 Retail with food preparation/service
0 Medical / dental / veterinary facilities
0 Church
0 Nursing Horne
10O % Domestic/Commercial % Commercial
% Industrial (See ,I5A NCAC 07,T .01
3
Is there a Pretreatment Program in effect? 0 Y
h. Has a flow reduction been approved under l 5A NCAC 02T ,0t 14(fl? 0 Yes 0 No
➢ If.ves. Provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
nd Necessity been attached?
t (FORM; HPA) been attached?
0 Car Wash
0 Hotel and/or Motels
0 Swimming Pool /Clubhouse
[] Swimming Pool/Filter Backwash
El Other (Explain in Attachment)
No
stablishment 'I
pe (see f;.tll_(4(
ly i`3eslgn Flow "Lb
No.
!io
l/
GPD
GPD
GPD
GPD
gal/
Total
GPD
GPD
0 GP1
ti See 15A NCAC 02T ,O1( fl 1, (rl), (elf I) Apo f e)(2) for caveats to wastewater design flow rates (Le., 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. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A, NCAC 02T,01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 9 GPD (per 915A NCAC 42T .0114)
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
0 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 of existing sewer with no new flow expected
Other (Explain): Future sewer per easement 0greement.between .l.C. Faw ticve[ap , No flow at this time,
FORM: FTA 04-16
Page 2 of 5

VII, GRAVITY SEWER DESIGN CRITE R
1. Summarize gravity sewer to be permitted:
02'
ity SON
A Section 11 & III of the MDC for Permitting ofGravity Sewers contains information related to design criteria
> Section 111 contains information related to minimum slopes for gravity sewer(s)
A 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 & lDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: .
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational points) of the pumps) gallons per minute at feet total dynamic head (TDH)
5, Summarize the force main to be permitted (for this Pump Station):
Longitude: -
Size (inches)
Length (feet)
Power reliability in accordance with
5.1
© Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(hX1)(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:
© Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(hx 1)(C)
Or
0 Portable pumping unit with plugged emergency pump connection and tei'emetry- 15A NCAC 02T .0305(h)(1)(C):
A 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 purnp, including travel timeframes, shall be provided
in the case of a multiple station power outage,
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(I)):
1. Dos the project comply with all separations found in 15A NCAC 02T .0305(0 & (g)
I SA NCAC 02T,0305(f) contains minimum separations that ,shall be provided for sewer syystetns
Sturm servers and other utili
e
k Parameter*
isted below
benched
Reclaimed water lines (horizontal - reclaimed over s e
ElYes ©No
Separation Required
24 inc
*Any private or public water supply source, including any wells, WS-I waters of Class I or
Alass II impounded reservoirs used as a source of drinkirr water
ified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
ide elevation) and wetlands see item IX.2
**Any other stream, lake, impoundment, or ground water lowering a
ditches
Any building foundation
Any base
Top slope of embankment or cuts of 2 feet or more verti
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
➢ 15A NCAC 02T,0305(g) contains alternatives where separations in 02T.0305
> **Stream classifications can be identified using the Division'
➢ If noncompliance with 02T.0305(f) or (e), see Section X of this application
100 feet
t be achieved.
sific
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
➢ See the Division's draft separation requirements for situations where separation cannot be meet
> No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
Yes D No
Does the project comply with all setbacks found in the river basin rules per 1.5A NCAC 02 .t 200? ED Yes D No
> This would include Trout Buffered Streams per .0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications?
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
® Yes D No
Does project comply with I 5A NcAc021%9105(c)(6) (additional permits/certifications)? Yes Q No
Per I5A NCAC 02T.0105(c1( ),, 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.).
Does this project include any sewer collection Tines that are deemed "high -priority?"
Per t,ri NCAC 02T.0402 "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.
Yes No
➢ 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 CAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
F©RMz FTA 04-16
Page 4 of 5

CERTIFICATIONS:
I. Does the submitted system comply with 15A. NCAC 02T, the iniinuiir esi«n Criteria fo c Peratt'tttngt Pump Station
anti Force, Win (latest version), and the Gravity_S v r i "ii es' t iter` ((ntest vets on as applicable
Yes 0 No
If No, complete and submit the Variance/Alternativc Design Request application (VADC 1(i-14) and supporting documents for
review. Approval of the request is required pricer to submittal of the Fast Track Annlieatinn and supporting documents.
Professional Engineer's Certification:
➢,
Prole:
n ineer's nariie from Application Item I➢LI.)
his application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge, I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that i have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143.215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which,lnay
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:
Applicant's Certification per 15A NCAC 02T .0106(b):.
r9w-ptrZ,dr4Aut
(Signature Authority's ame & title from Application It m
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. 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. ➢ 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 Ste
statement, representation, or certification i
include a fine not to exceed $ 10,000 as wel
es 143-215,6A and I43-215,613, any person who knowingly makes any false
my application package shall be guilty of a Class 2 misdemeanor, which may
s civil penalties up to $25,000 per violation,
Date: 1441-zo tT
FORM: PTA 04-16
Page 5 of5

Historical Topo Map
This report includes information from the
following map sheet(s),
TP, Statesville East, 2013, 7.5-minute
W, Statesville West, 2013, 7.5-minute
2013
0 Miles 0.25 0.5
SITE NAME: James Pointe Apartments
ADDRESS; Turnersburg Highway
Statesville, NC 28625
CLIENT- Ge©Technologies, Inc.
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6) THE'REVERSESIDE OF THIS DOCUMENT INCLUDES MICROPRINTED ENDORSEMENT LINES AND ARTIFICIAL WATERMARK sHOLD AT`AN ANGLE TO VIEW
•
Caliber Builders LLC
P.O.,Bok.19691-
. Raleigh, NC 27619
919-755-0558:
SunTrust Bank 427
Raleigh, North Carolina 27609
66-46/531
11 /30/2018
NGDEQ , $ **480.00
- Four Hundredr.Eightyand 00L100****** **********«,.#*********************************,*, **, *****************************
NCDEQ•
„ Di�isiiirs of Mitigation Services
1652Mail Service;Center ,
Raleigh; NC' 27699-1652-
MMO' G`-
James Pointe .1,4r,' 06315,3,t-1aci
i'❑ 2 20 280 1:D 5 3 110046 5D: 4 2 i L 24491=10
ED SIGNATURE
22028
DOLLARS
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