WQ0039534_Regional Office Historical File Pre 2018 (2)

Water Resources
Environmental Quality
October 12, 201.7
Larry Pressley, City Manager
City of Statesville
P.O. Box 1111
Statesville, NC 28687-1111
ROY COOPER
Governor
CHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Permit No. WQ0039534
City of Statesville
James Pointe Apt Homes
Wastewater Collection System Extension Permi
lredell County
Dear Mr. Pressley:
In accordance with your application received October 9, 2017 and additional information received
October 11, 2017, we are forwarding herewith Permit No. WQ0039534 dated October 12, 2017, to City of
Statesville (Permittee) for the construction and operation upon certification of the subject wastewater
collectionsystem 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 This permit shall be effective from the date of issuance until rescinded and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 permi
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, 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 150E 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.
State of North Carolina 1 Envi
Mooresville Regional Office
---Nothing Compares �r
ntal Quality Water Resources I Water Quality Regional Operations
0 East Center Avenue, Suite 3011 Mooresville, North Carolina,2Bt IS
704-663-1699

Ifyou need additional information concerning this matter, please contact Barry Love ot(7Y)4)23S'2143
or via e-mail at [e-mail],
bvVkCorey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division ofWater Reyources^NCDE(}
cc: DavidVV. Odom, P.E.
Regional Office Files
Water Resources Central Files
2

Environmental
Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolinaas
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to
City of Statesville
lredell County
for the construction and operation of approximately 386 linear feet(If) of 8-inch gravity sewer to serve as
part of the James Pointe Apt Homes project, and the discharge of 23520 gallons per day of collected
domestic wastewater into the City of Statesville existing sewerage system, pursuant to the application
received October 9, 2017 and additional information received October 11, 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 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.
•
byW. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Division of Water Resources, NCDEQ
Permit Number: WQ0039534
Permit Issued: October 12, 2017
3

SUPPLEMENT�� �����Kl� ��& �� ������
"�� "m~o���o"v "��°�u~on .�oov~u.0
City of Statesville i§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 Statesville Fourth Creek
Wastewater Treatment Plant inaccordance with Permit Number NCQ8]1836.
Permitting of this project does not constitute anacceptance of any part of the project that does not meet
15A NCAC 2T the Division's Gravity Sewer K86nknumn Design Criteria adopted February 12, 1996, as
applicable; and the Division's Minimum Design Criteria for the Fast-TrackPemnh±ingof9ompStaUnnsand
Force Mains adopted June 1, 2080, as applicable, unless specifically mentioned herein. Division apprnval
is based on acceptance of the certification provided by a North Caro lina-licensed Professional Engineer in
the application. |tshall bethe Permittee'sresponsibility toensure 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.
L SPECIAL CONDITIONS
1. No flow in excess of the quantity permitted herein, 23,520 GPD shall be made tributary to the subject
sewer system until anapplication for permit modification for nnincrease inflow has been submitted
to and approved by the Division. [15A NCAC 02T,0304(b)]
111. STANDARD CONDITIONS
1. This permit isnot transferable. |nthe event there (sadesire for the wastewater collection facilities
to change ownership, or there is a name change of the Pennitiee' a fdnnal permit rl�,Jtre«y shall be
submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials aymay beappropriate. The approval ofthis request shall beconsidered onits
merits and may ormay not beapproved. [1SANCACO2T.Q1U4;G�S143-215.1(d3)]
Z This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions ofthis permit; 15A NCA[ 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 02T.0110]
3. This permit shall beeffective only with respect to the nature and volume of wastes described in the
application and other supporting data, [l5ANCAC{2T.O1101
4. The wastewater collection facilities shall be properly maintained and operated at all thnes. The
Perm�tee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A N[AC 2T .0403. of an individual
permit is not required,the following performance criteria shall be met: (15A NCAC 02T.0108(bfl�

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 atleast 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 easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule fora 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,
following the occurrence or first knowledge of the occurrence of either of the following:

m. Any process unit failure, due to known or unknown reasons, that renders the fad I ityincapable
of adequate wastewater transport, ouchas mechanical or electrical failures of pumps, line
blockage orbreakage, etc.;nr
h. Any S8C)and/or spill over 1,00Ogallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages orfaxed information ispermissible, but this shall not be considered as the inhjm|
verbal report. Overflows and spills occurring outside normal business hours nnayalso bereported 10
the Division of Emergency Management at telephone muonber(8O0) 858'0368 or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part | of Form [S'S5Q (or the most current Division approved form) within five days following first
knowledge nfthe occurrence. This report must outline the actions taken orproposed tubetaken to
ensure that the problem does not recur. Part 1|ofForm C5'S5O(or the most current Division approved
form) can also becompleted toshow that the SS]was beyond control. [G.3. 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
tothe surface waters ofthe State. [15ANCACOZT.8108(b)]
7. Upon completion of construction and prior to operation of these permitted fod|hims, the completed
Engineering Certification form attached to this permit shall be submitted with the required supporting
documents tothe address provided nnthe form. Acomplete certification isone where the form is
fully executed and the supporting documents are provided asapplicable. 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 pcnn|t and shall subject the Permi|tec to
appropriate enforcement actions.
if the permit is issued twaprivate entity with an Operational Agreement, then mcopy wfthe Articles
qVIncorporation, 0eciaratonm/Cowenants/Re$tr|xtimny,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 hd|v executed and the supporting documents are
provided as applicable. 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 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 portable power
source or pump is dedicated 10 multiple stations, an evaluation mfall the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timefracnes,shall beprovided.
6

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 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 may be
required by the Division or any other Federal, State, of Local government agencies. [G.S. 143-
215.1(b)]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: City ofStatesville
PERMIT #: VVQ0039534
PROJECT: James Pointe Apt Homes
ISSUE DATE: October 1Z,2U17
This project shall not be considered complete nor allowed tooperate in accordance with 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
the Regional Supervisor, Water Quality Regional Operations Section at the address atthe bn"om.
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 Pennhtee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification 'haU be a complete set ofrecord drawings and
design calculations regardless ofvvhetherpartials have bm�nsubmitted.
PEnMu/I Lo'S CERTIFICATION
|,the undersigned agent for the Pennittee hereby state that this project has been constructed pursuant
to the applicable standards 8k requirements, the Professional Engineer below has provided applicable
design/construction information tothe Permktee, and the Pemmitteeisprepared tnoperate &main1ain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title Signature Date
ENGINEER'S CERTIFICATION
L , as m duly ^stered PUnthe State of North Carolina,
having been authorized to observe (| | Periodically, | ] weekly,�neer
full 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'cona 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; 154 N[AC0ZT; 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 w/signature &date:
-�Final --Partial description)
Certification Comments/Qualifiers (attach if necessary):
State of North Carolina I �wrontncntal Quality I Water ke�urces I Water Quality Regional Operadow
Mooresville o°pomuom=|moEastContxAvenue, suit*m1|xoo=~a"North caTvhu°zmm

fivision of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources,
1 A. NCAC 02T .031 1— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
r
ApplicationNumber:��,,.�_, .'� -mw �_..._ Robe completed by DWR)
All items mrtst. be completed or the application will be returned
APPLICA.NT INFORMATION:
1. Applicant's name: Citv of Statesville (ct'arnpany, municipality, HOA, utility, etc.)
2. Applicant type: © Individual © Corporation (i General Partnership Q Privately -Owned Public
Q Other
A NC AC, i11 ))ilCri
Federal El State/County
Signature authority's name: I..a ry Pressley
Title: City Manager
4. Applicant's mailing address: PO box 1111
City: Statesville State: NC Zip: 28687,-11 11
.Applicant's contact information:
Phone number: [phone] Email Address:
H. PROJECT INFORMATION:
1, Project name: James Pointe Apt Homes
2. Application/Project status: Proposed (New Permit)
If a modification, provide the existing permit number: WQ©O�
Munk
Existing .Perrnit/Proj
and issued date:
If new construction but part of a master plan, provide the existing permit number. WQPO
3. County where project is located: Iredell
Approximate Coordinates (Decimal. Degrees): Latitude: 35.826388° Longitude: m80 8736
Parcel I;D (if applicable):
(or Parcel ID to closest downstrearn sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: DAVID W. C?I`C1M, PE License Number: NC 21130
Firm: ODOM ENGINEERING, PLLC
Mailan.g address: 169 OAK ST.
City: FOREST CITY,
( )[e-mail],m
Phone
number: 8 '8 247-4495 Email Addre,ss. davidodom@odorne,ngine,erimt.com
NC Zip. 28043-
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Fourth Creek WWTP Permit. Number: NC003I836
Owner Name: City of Statesville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
):
1. Perms[ Number(s): WQ Downstream (Receiving) Sewer Size:
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner'Natne(s):
y
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
I. lithe Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes DNo ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Qoerational -Agreement (FORM DE V been attached?
❑ Yes ❑No ®N/A
3. Ifthe Applicant is a Hiime/Proaerty Owi s Ass jntion. h ..an Ojierational-Aereement (FORM: FIOAj been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater, (check all that apply):
❑ Residential Owned
® Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stares, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : I00 % Domestic/Commercial % Commercial
Industrial (See 1 A NCAC:02T .0 I03(20))
is there's Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T _01.14(ft? ❑ Yes 0 No
D. fives, provide a cony allow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 0lT Qt14(9)
Daily Design Flow''e
No. of Units
Flow
ONE BEDROOM APT
240 gal/DAY
8
240 GPD
TWO BEDROOM APT
240 gal/DAY
36
240 GPD
THREE BEDROOM APT
360 gal/DAY
36
360 GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
23520 GPD
a See 1`SA NC/IC Q?T .0114(bY. (d). (eY11 and left for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses: public access facili ies 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 ISA NCAC 02T,D1141 shall be
determined using available flow data, water using Cultures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project 23520 GPD (per 15A NCAC 02T .0114)
? Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-I6
Page 2.015

VII. GRAVITY SEWER DESIGN CRITERIA (li'"Applicable) -02T.0305 & MIDC :ruvittb Sewers'.
1. Summarize gravity sewer to be permitted
Size (torches)
Length (feet) Material
386 DIP
Section I & Ill of th+e MDC for Permitfing of Gravity Sewers contains information related to design critc
- Section Ill contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
V'III. PUMP STATION DESIGN CRITERIA Of Applicable) — 02T ,03O5 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
Approximate Coordinates (Decimal Degrees): Latitude:
Design flow of the pump station: millions gallons per day (firm capacity)
2.
3,
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):
6. Power reliability in accordance with 15A NCAC 02T ,0305th
© Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T ,0305(h)(1)(B)_
A Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Y 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 - I SA NCAC 02T
.0305(h)(1)(C)
Longitude: -
or
• Portable pumping unit with plugged emergency pump connection and telemetry - 1 5A NCAC 02T .030(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.
7 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
Pate 3 of 5

SETBACKS & SEPARRATiONS -- (0213 .(12.00 , 15A NCAC 02T .030S(f))
1. Does the project comply with all separatiot found in 15A NCAC 02T .0305(f) & (']
I 5A NCAC 02T.0305(f) contains minimum separations that shall be provided for sew
Setback Parameter*
Storm sewers attd other utilities not listed below (vertical)
cal water over sewer includi
Water
Reclaimed wer lines (vertical - reclaimed over s
Reclaimed water lines (horizontal - rec
ed over sewer)
d
**Any private or public water supply source, including any wells, WS-1 waters of Class 1 or
Class II impounded drinking water reservoirs used as a source of dri
**Waters classified WS (except WS-1 or WS-V), 13, SA, ORW, 1HQW, 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
To slo of embankment
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
f J Yes [L]
ms:
.paration Required
24 inches
50 feet
10 feet
10 feet
36 inches
➢ I5A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface "Hater Classifications webpaee
➢ If noncompliance with Q2T.0305(ti rr (), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
5- 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 E No
3. Does the project comply with all setbacks found in the river basin rules per 15ANCAC 02B .0200 Yes [ j No
• This would include Trout Buffered Streams per 15A NCAC 2.13.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? Yes E No
➢ 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 4 Buffer Permitting Branch
Does project comply with I5A NCAC 02T_0105(c)(6) (additional permits/certifications)?
El 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 ISA 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 l' 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 NCAC 021'.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM; FTA 04-16
Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with ISA NCAC.02T, the Minimum Design Criteria,for the,Pern ininoo1PurrlSlations.
and Force Mains (latest version)„ and the Gravity Sewer Minimum Design Criteria (latest- version') as applicable?
Yes D No
If No, complete and submit the Variance/Alternative Design Request application (VADC 0-14) and supporting documents for
review. A, o es is 'or to submittal cif the Fast Track Application a,n,d su • • documents.
2. Professional Engineer's Certification:
(Professional Engneer's1name fromAppkcaiion Item III 1)
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable 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 143-215.68, 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, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
, -- (
(Signature Ant ity's namenarne & tit1e froni Apphcation Iter
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. I 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. 1 also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete,
NOTE — In accordance with General Statutes 143-215,6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which rnay
include a fine not to exceed $10,000 as welt as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: FTA 04-16
PAM', of 5

October 6, 2017
NCDEQ-DWQ
Attn: Mr. Barry Love
1634 Mail Service Center
Raleigh, North Carolina 27699-1634
PROJECT: Fast Track Gravity Sewer Application to serve James Pointe Apartment Homes
APPLICANT: City of Statesville
Attn: Larry Pressley,, City Manager
PO Box 1111
Statesville, NC 28687-1111
Dear Mr. Love:
The system expansion for the above referenced project shall be part of a proposed gravity sewer
extension to serve the James Pointe Apartment Homes.
The source of supply is an existing 8" gravity trunk line south of the proposed property being
developed. Installation of approximately 836 LF of 8" DIP gravity sewer, precast concrete manholes
(some with drops} and core of existing manhole for connection to the existing system.
The City of Statesville's'Water and Sewer Division is responsible for constructing, repairing, and
maintaining the City's water and sewer infrastructure. This Division currently maintains
approximately 274 miles of water lines and 278 miles of sanitary sewer lines, The lengths of these
lines will continue to grow overtime to meet the demands of new commercial and residential
construction projects as they are built within the City's limits.
The City's sewer lines work in reverse as compared to the City's water lines. The sewer lines carry
raw sewage from the homes and business to a processing plant where it is then treated, The majority
of these lines use gravity flow to drain the sewage due to costly maintenance and equipment to
force sewage up hill. Each of these sewer lines connect to larger lines which eventually connect to
Third Creek or Fourth Creek Waste Water Treatment Plants.
David W. Odom, P,E.

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STATESVILLLE EAST. Plc

Division of Wafer Resources
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 STATESVILLE
Project Name for which flow is being requested: JAMES POINTE APT HOMES
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 oldie proposed wasrewarel• f low.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: FOURTH CREEK WWTP
b. WWTP Facility Permit #: NC0031836
All flows are in MGD
c. WWTP facility's permitted flow 4.0
d. Estimated obligated flow not yet tributary to the WWTP 0.24595
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
2.40
0.02352
2.66947
66.73%
IL 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) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx.- Not Yet Total Current
Station Firm Flow“ Current Avg. Tributary Flow Plus
(Name or Capacity," (Firm / p0, Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MOD Flow Capacity**o'
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
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 a 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Scott Harrell, PE, Public Works Dir certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation
of the planned improvements identified in the planning assessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using
the best available data. This certification applies to those items listed above in Sections I and II
plus all attached planning assessment addendums for which I am the responsible party,
Signature of this form indicates acceptance of this wastewater flow.
1041 601,
Sigrtn Official Signature Date
Page2of6
FTSE 04-16

CITY of `1��
e
NORTH CAROLINA
Larry Pressley, City Manager
P.O. Box 1111
Statesville, North Carolina 28687
[phone]
To Whom It May Concern:
By means of this Ietter, I, Larry Pressley, City Manager, City of Statesville, delegate the
authority herein described to the Public Works Director / City Engineer on the following terms
and conditions:
1. The Public Works Director / City Engineer may review and execute, on my behalf,
NCDEQ DWR Flow Tracking / Acceptance for Sewer Extension Applications, Fast
Track Sewer System Extension Applications, Fast Track Sewer Engineering
Certification, Application for Approval of Engineering Plans and Specifications for
Water Supply Systems, and Applicant Certification Forrns.
2. The effective date of this delegation is September 22, 2017 and shall run until revoked by
myself or successor.
3. The authority delegated is not subject to sub -delegation without my prior and express
written consent.
Acknowledged and agreed:
Larry Pr sley, City M ager
Date: 4 Z z�lr2
Scott Harrell, Public Works Director / City Engineer
Date: q1 .1

Central Files: APS _ SWP
10/12/2017
Permit Number WQ0039534 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
barry.love
Coastal SWRuIe
Permitted Flow
23.520 •
Facility
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name
James Point Apt. Homes
Location Address
Owner
MajorlMinor Region
Minor Mooresville
County
iredeil
Facility Contact Affiliation
Owner Name
City of Statesville
Dates/Events
Owner Type
Government- Municipal
Owner Affiliation
Larry P. Pressley
PE
City Of Statesville
Statesville
NC 28677
Orig Issue
10/12/2017
Scheduled
App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
10/9/2017 10/12/2017 10/12/2017
Regulated Activities Requested /Received Events
Wastewater collection
Outfall
• Additional information requested 10/10/17
Additional information received 10/11/17
Waterbody Name Streamlndex Number Current Class Subbasin

I

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 DOCUJ ENTATION
Application Number: (to Ix completed by DWR)
All items must be completed or the application will he returned
I. APPLICANT INFORMATION:
1. Applicant's name: Cjtvof Statesville (company, municipality, HOA, utility, etc.)
2. Applicant type: 0 Individual J Corporation 0 General Partnership 0 Privately -Owned Public Utility
El Federal 0 State/County Municipal 0 Other
3. Signature author4's name: Scott Harrell, PE, Public Work Dir- per 15A NC.AC 02T .0106D)
Title:
4. Applicant's mailing address: 1)0 Box 1111
City: Statesville State: NC Zip: 2,8687-jjjj
5. Applicant's contact information:
Phone number: (704) 878-35 51 Email Address: [e-mail]
II PROJECT INFORMATION:
I. Project name: 1unes Pointe At Homes
2. Application/Project status: Proposed (New Permit) 0 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: Iredell
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.826388Longitude: -80.87361r
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1, Professional Engineer: DAVID W. ODOM T., License Number: NC 21130
Firm: ODOM ENGINEERING, PLLC
Mailing address: 169 OAK ST.
City: FOREST CITY
Phone number: [phone] Email Address: [e-mail]
State: NC Zip: 28043-
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Fourth Creek WWTP Permit Number: 0031836
Owner Name: Fourth Creek WWTP
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if clifferen than WWTF):
1. Permit Number(s): WQ
Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Pave 1 of 5

NI, GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of PubliCorry
N/A
© Yes ❑No
If the Applicant is a Developer of lots to be sold, has a Ileva. lea er"s
LI Yes DNo ,NIA
lithe Applicant is a l rrre''`I t°opertv(� r� I M i ii Dias an t' perr :trna
Q Yes []No
4, Origin of wastewater: (checkall that apply):
© Residential Owned
E, Residential Leased
School / preschool / day care:
El Food and drink facilities
Q Businesses / offices / factories
5: Nature of wa
0 Retail (stores, centers, malls)
'© Retail with food preparation/service
0 Medical / dental / veterinary facilities
] Church
0 Nursing Home
er : 100 % Domestic/Commercial
% Industrial CSec I A NCAC 02°I`
Is there a Pretreatment Prograr
6. Has a flow reduction been
l f yes rrrovide a ecara'
of
Commercial
d.l In)
in effect?
pproved under 15A NCAC 02T .f➢ I l_4(t'? d Yes
of Bowv reduction approval letter
Summarize wastewater generated by project:
Establishment Type (see 02T.di l4'._
ONE BEDROOM APT
TWO BEDROOM APT
THREE BEDROOM APT
Daily Design Flow
240 gal/DAY
fence and Necessity been attached?
R, 1 Dt V) been attached?
nnentI°°(1R1w1 110been atttached'r
© Car Wash
Hotel and/or Motels
Swimming Pool /Clubhouse
Swimming Pool; Filter Backwash
© Other (Explain in Attachment)
D Yes ©No
[�No
240 gal/DAY
No. of Unit
Flow
240 GPD
360 gal/DAY 36
240 GPD
360 GPD
gal/
gal/
gall
GPD
GPD
GPD
©trrf 235 0 GPI)
a See l hC; A;C y)''7 () ➢ 14(§(I),(e)( li _:tnd (e (2J for caveats to wastewater design flow rate
dwelling; proposed unknown non-residential development uses, public access facilities located nea
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vac
in G .5„ 42, _4),
b Per 15A NCAC 02T :0114(c), design flow rates for establishments not identified in table 1 S/\_2'uCAC
determined using available flaw data, water using fixtures, occupancy or operation patterns, and other
Wastewater generated by project: 23520 GPD (per I A Nc AC 02T .0 14)
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
mum flow per
h public use areas,
n rentals as defined
© Flow has already been allocated in Permit Number:
© Rehabilitation or replacern
C Other (Explain):
nt of existing sewer with nea new flow expected
01 1 i] shall be
measured data.
FORM: FTA 04-16 Page 2 of 5

VII, GRAVITY SEWER DESIGN CRITERIA (If Applicable) 02T 1305 & .MDC)Gravity Sewers):
1. Summarize gravity sewer to be permitted:
• Section II & 1l1 of the MDC for Pemnitting of Gravity Sewers contains information related to design criteria
- Section III contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet mlrtfmum slope requirement is not allowed and a violation of the !VI DC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 021 03415 & MDC (Purfsgt StptiwmI1y
COMPLETE F©R EACH PUMP STATION INC.LUDED IN Tlil'S P'RCI'
I. Pum.p 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):
5. Summarize the force main to be permitted (for this Pump Station):
gallons per minute at.
feet total dynamic head (TDH)
ize (inches) Length (feet) Material
6. Power reliability in accordance with I'fiA NCAC 02 1 030,5('fiif` I).
Q Standby power source or pump with automatic activation and tel - 15A NCAC 02T ,0345(h)(I)(B):
i� Required for all pump stations with an average daily flow greater than err 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:
Q Portable power source with manual activation, quick -connection receptacle and telemetry - ISA NCAC 02T
.0305(h)(1)(C)
or
Q Portable pumping unit with plugged emergency pump connect:on and telemetry - 1 5A NCAC 02T .0
(C)
> 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 tirneframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16
Pa©e3ofi

' IX, SETBACKS & SEPARATIONS -- (02B .0200 & I 5A NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A. NCAC.: 02 r
5A NCAC 02T,0305(0 contains minimum sep_arations that shall be_provided for sewer systems:
Setback Parameter* Se aratiori Re uired
Yes 0 No
sewers and other utilities not listed below (vertical)
:er mainslyerfical-wa: •' o e • sewer 'ticludinr&in benched trenches)
er 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-1waters of Class 1 or
Cass 11 irn.ounded reservoirs used as a source ofdrinking water
ers classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
ater (or tide elevation) and wetlands (see item IX2)
*Any other stream, lake, impoundment, or ground water lowering and surface drainage
itches
undation
TeRslope of embankment or cuts of 2 feet or more verti a jght
Drainage systems and interceptor drains
An v'mn al'
24 inches
• indie
10 feet
18 inches
2 feet
100 feet
50 feet
10 feet
5 feet
10 feet
10 feet
5 feet
10 feet
36 inches
15A NCAC 021'4)305W contains alternatives where separations in 0,21 ,Q30510 cannot be achieved,
**Stream classifications can be identified using the Division's N(5uj WztjesC144ssifiqtions :wojvatte
If noncompliance with 021 ,0305(j),qj LO, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
A See the Division's draft separation requirements for situations where separation cannot be meet
A 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 DNo
1. Does the project comply with all setbacks found in the river basin rules per 3A NCAC 028 .0200? Yes 0 No
A This would include Trout Buffered Streams per 15A,..KAC, 2,13,0202,
4. Does the project comply with an individual 404 Permit or any 401 Certifications? El Yes D No
A Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
) Information can be obtained from the 40 4 eiButTcy Permojtin Roach
5. Does project comply with 15A N CAC 02 1:,Q I OL016) (additional permits/certitications)? Yes No
Per 15A NCAC 02-1,0105(06), 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 15A NCAC 02T,0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to strearnbanks that is subject to erosion that undermines or deteriorates the sewer.
Ei Yes No
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 l5A NCAC 02T.0403(a)(5) or the permitce's individual Systern-Wide Collection permit.
FORM: FTA 04-16 Paee 4 of 5

CERTIFICATIONS:
1, Does the submitted system comply with
and Force ,Mains (latest, and the a aft Sewer l °tini m' I e
Yes No
If No, complete and submit the Variance/A
piicab
native Design Request application (VA DC 10-14) and supporting documents for
review, Approval of the reque o submittal of the Fast: Track Application and supporting documents.
2. Professional Engineer's Certification:
n1i .
(Professional Engineer's name fm Applicat
attest that this applicaticatt 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, 1 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 143-21.5.6A and I43-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 rnisenteanor, with may
include a fine not to exceed '$10,1100, 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 .a 106(b):
Scott Harrell. PE , Public Works Director
c Authority's name & titl
orn Application Item 1,3.)
hat this 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. 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
ofthis permit be violated. 1 also understand that if all required parts ofthis applicat'ion 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 I-13- 6A and 1 4_3r2 1;., any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: F TA a4-16
Nye, 5 of

WE).
Division of Water Resources
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 STATESVILLE
Project Name for which flow is being requested: JAMES POINTE APT HOMES
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.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: FOURTH CREEK WWTP
b. WWTP Facility Permit #: NC0031836
All flows are in MGD
c. WWTP facility's permitted flow 4.0
d. Estimated obligated flow not yet tributary to the WWTP 0.24595
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
2.40
0.02352
2.66947
66.73%
II. 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) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pt), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily FIow 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 04-16

IH. Ce
ificationStatement:'
Scott Harrel, PE, Public Works air certify to the hest ofknowledge that the edit
the volume oi
receiving wasj
cause any capaci
en route to the r
of the planned irrrprovetvre
analysis has been performed
the hest available data. TI
plus all attached plannin
Signature of this form indicate
0 be permitted in this project has keen evaluated along the route
Sigt
lity and that the flow frrinr this project is not ant
sewer overflows or overburden any downstream peat
ntent plant under normal eiretr stances, given the irnpler to
s identified in the planning ssessrtvent 'a here applicable
n of
o the
Rated to
iation
ion
This
n accordance with local established policies and procedures using
'cation applies to those items listed above in Sections I and TT
nt addendurns for which T am
ceeptance of this wastewater flow.
Pape2 of
ponsihle party.