WQ0040814_Application_20220110

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
RECEIVED/NCDEQ/DWR
Application Number:Wt iit (to becompleted by DWR)
JAN 1 0 2022
All items must be completed or the application will be returned VWOROS
MOORESVILLE REGIONAL OFFICE
I. APPLICANT INFORMATION:
1. Applicant's name: City of Albemarle (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Michael Ferris per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: 144 N Second Street, PO Box 190 Albemarle, NC 28166
City: Albemarle State: NC Zip: 28002-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Grandview Meadows
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0040814 and issued date: June 18, 2019,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Stanly
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.337134° Longitude: -80.163089°
5. Parcel ID (if applicable): 65570139170 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Patrick Murphy License Number: 036836
Firm: R. Joe Harris & Associates, Inc.
Mailing address: 1186 Stonecrest Boulevard
City: Tega Cay State: SC Zip: 29708-
Phone number: [phone] Email Address: pmumhy(a,rioeharris.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Long Creek Permit Number: NC0024244
Owner Name: City of Albemarle
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
El Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses / offices / factories ❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(0? ❑ Yes ® No
> If Yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow 0
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
® Flow has already been allocated in Permit Number: WQ0040814 Issuance Date: June 18, 2019
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

➢ 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 as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 4 of 5

CERTIFICATIONS:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Michael Ferris, City Manager , attest that this application for
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be
a significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Patrick Murphy, P.E. , attest that this application for Grandview Meadows
(Professional Engineer's name from Application Item MI) (Project Name from Application Item II.1)
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,
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 may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the
application information, including failure to disclose any design non-compliance with the applicable Rules and design
criteria, may subject the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
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Grandview Meadows
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.1)
attest that this application 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. I also understand that if all required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this
application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: FTA 06-21 Page 6 of 5

R. Joe Harris & Associates, Inc.
1186 Stonecrest Blvd., Tega Cay, S.C. 29708
[phone] RECEIVED/NCDEQ/DWR
JAN 1 0 2022
WORDS
MOORESVILLE REGIONAL OFFICE
January 5, 2022
Attn: Ori Tuvia
North Carolina DEQ
Mooresville (MRO)
Division of Water Quality
G10 E. Center Avenue
Mooresville, North Carolina 28115
Re: Grandview Meadows
Sewer Modification
RJH Project No.: 2754
NCDEQ Permit No.: WQ0040814 — Issued: June 18, 2019
Mr. Tuvia:
On behalf of City of Albemarle, we have enclosed the following items for NCDEQ's review and
approval for the above referenced project:
1. 1 original completed Fast Track Sewer Application — Modification
2. Copy of the original sewer permit — dated 6/18/2019
3. Check (#8060) for $480 made payable to NCDEQ
If you should have any questions or require any additional information, please feel free to contact
me at [phone] or via email at pmurphyf rjoeharris.com.
Sincerely,
R. JOE HARRIS & ASSOCIATES, INC
Patrick Murphy, P.E.
Engineering Director

Tuvia, Ori A
From: Patrick Murphy <[e-mail]>
Sent: Wednesday, January 12, 2022 11:16 AM
To: Tuvia, Ori A
Subject: Re: [External] Re: WQ0040814 Grandview final cert - additional info
CAUTION: External email. Do not click links or open attachments unless, you verify. Send all suspicious email as an attachment to
Report Spam.
That is correct.
From: Tuvia, Ori A <[e-mail]>
Sent: Wednesday, January 12, 2022 11:11 AM
To: Patrick Murphy <[e-mail]>
Subject: RE: [External] Re: WQ0040814 Grandview final cert - additional info
Patrick,
I wanted to confirm that the modified length of line would be 3,195 (removing 5,002 If from the original permit.
Sincerely,
Ori
From: Patrick Murphy <[e-mail]>
Sent: Wednesday, January 05, 2022 10:02 AM
To: Tuvia, Ori A <[e-mail]>
Subject: Re: [External] Re: WQ0040814 Grandview final cert - additional info
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Ok yes the form I emailed was just the copy. I have the original with me. III get this mailed out today.
Thanks
From: Tuvia, Ori A <[e-mail]>
Sent: Wednesday, January 5, 2022 10:00 AM
To: Patrick Murphy <[e-mail]>
Subject: RE: [External] Re: WQ0040814 Grandview final cert - additional info
Patrick,
We will need the application with original signatures and a check for 480$
Sincerely,
Ori
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